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1
Sirbu, Dan. "Occulter-based high-contrast exoplanet imaging| Design, scaling, and performance verification." Thesis, Princeton University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3665346.
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Over the last two decades, a large number of exoplanets have been confirmed with the rate of discovery increasing in recent years primarily as new instruments with improved sensitivities have become available. Direct imaging of an Earth-like planet is now an important goal of the science community. This is a challenging problem for two primary reasons. First, the intensity ratio between the bright star and its dim Earth-like companion is expected to be approximately ten orders of magnitude and, second, the angular separation to the star is very small.
An external occulter is a specially-shaped spacecraft that is flown in formation with a telescope in order to block most of the starlight before it reaches the entrance pupil thereby allowing planetary light outside of the occulter's inner working angle to become visible. Designing a shape for the occulter spacecraft to enable suppression over a wavelength band of interest requires modeling through scalar diffraction theory. Typical designs feature occulters that are tens of meters across at a separation of tens of thousands of kilometers from the space telescope.
In this dissertation, we focus on occulter design and scaling to enable experimental optical verification of occulters in the laboratory. We provide experimental results that establish a 10-5 suppression level in the pupil and 10-10 contrast in the focal plane, which are both approximately two orders of magnitude below the ideal performance of the testbed. We use numerical simulation to study the sensitivity of the occulter design in the laboratory and determine that performance is feature-size limited. We provide the design of a longer and flight-like occulter experiment, and study its sensitivity to determine the expected performance.
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Venet, Melanie. "Coronographes spatiaux : Solar Orbiter / Metis, Smese / Lyot, Proba-3 / Aspiics." Thesis, Aix-Marseille 1, 2011. http://www.theses.fr/2011AIX10011.
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La couronne solaire est la partie de l'atmosphère du Soleil qui s'étend de la photosphère (surface solaire d'où sont émis les photons) jusque dans le milieu interplanétaire. Sa compréhension relève d'un enjeu majeur car elle est à l'origine de phénomènes qui peuvent perturber les télécommunications, les êtres vivants et même le climat. L'instrument privilégié pour l'observer est le coronographe, système optique occultant le disque solaire au profit de la couronne, un million de fois moins intense. Ma thèse porte sur son étude, en particulier à travers les projets spatiaux :- SOLAR ORBITER, qui doit s'approcher du Soleil à 0.2 unité astronomique (distance Terre-Soleil), permettant ainsi une très haute résolution spatiale ;- SMESE, en coopération avec la Chine, qui étudiera la couronne dans l'infrarouge lointain ;- et ASPIICS, dont l'occulteur externe sera placé à 150 m de l'instrument imageur, permettant d'observer la couronne dans des conditions proches d'une éclipse solaire naturelle.Le premier aspect abordé est la réjection de la lumière parasite instrumentale, dont l'optimisation est une des problématiques majeures en coronographie. Le second concerne les modes d'observation par imagerie en lumière blanche, imagerie monochromatique, et interférométrie, en particulier le Fabry Perot. Le développement et l'amélioration de ces techniques permettra des avancées considérables en terme de résolution et l'accès à la couronne toujours plus proche de la surface du Soleil, lieu encore mal connu où l'activité solaire prend naissanceThe solar corona is the part of the Sun's atmosphere that extends from the photosphere (solar surface where the photons are emitted) into the interplanetary medium. Its understanding is a major issue because it is the source of phenomena that can disrupt telecommunications, living beings and even climate. The most appropriate tool to observe it is the coronagraph, an optical system obscuring the solar disk in favor of the corona, a million times fainter. My thesis deals with its review, particularly through the spaceprojects :- Solar Orbiter, which will approach the Sun at 0.2 astronomical unit (distance between Earth and Sun), allowing a very high spatial resolution ;- SMESE, in cooperation with China, which should study the corona in the Lymanalpha (and far infrared) ;- and ASPIICS, which will observe the corona in conditions close to a natural solar eclipse, with its occulting disk located at 150 m from the imaging instrument.The first point tackled is the rejection of instrumental stray light, whose optimization is one of the major problems in coronagraphy. The second concerns the methods of observation and imaging in white light, monochromatic imaging, and interferometry, in particular the Fabry Perot. The development and improvement of these techniques will allow considerable progress in terms of resolution and access to the corona ever closer to the Sun's surface, the location yet little known where the solar activity originates
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Swartz, Laura A. "Occulture : W.B. Yeats' prose fiction and the late ninteenth- and early twentieth-century occult revival." CardinalScholar 1.0, 2010. http://liblink.bsu.edu/uhtbin/catkey/1560843.
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In addition to being a respected poet, dramatist, essayist, and statesman, William Butler Yeats was a dedicated student of the occult and practicing magician for most of his adult life. In spite of his dedication, Yeats’ commitment to occultism has often been ridiculed as “bughouse” (as Ezra Pound put it), shunted to the margins of academic discourse, or ignored altogether. Yeats’ occult-focused prose fiction—the occult trilogy of stories “Rosa Alchemica,” “The Tables of the Law,” and “The Adoration of the Magi” and the unfinished novel The Speckled Bird—has often received similarly dismissive treatment. Some critics have accused Yeats of being an escapist or of being out of touch with the intellectual currents of his time.
However, Yeats was in touch with the intellectual currents of his time, one of which was the late nineteenth- and early twentieth-century occult revival. This was not a fringe movement; it was one which intersected with some of the most pressing social and cultural issues of the time. These include the dissatisfaction with mainstream religions, the renegotiation of women’s roles, the
backlash against science, and nationalism and the colonial enterprise. This intersection is what I have termed occulture.
The central purpose of this dissertation is twofold. First, I demonstrate the cultural and academic relevance of the occult revival by analyzing its connections to these critical issues. Second, I situate the occult trilogy and The Speckled Bird as artifacts of the occult revival and its associated facets. Through its main characters, the occult trilogy illustrates a fragmented self associated with literary modernism and with scientific challenges to individual identity from Darwin, Freud, and others. In addition, these three stories exemplify a sacralization of the domestic sphere which conflicts with the officially-sanctioned sacred spaces of mainstream religions. The Speckled Bird also reconfigures the sacred space as Michael Hearne contemplates a magical order with Irish nationalist implications. In examining these works within this historical context, I present them as texts which engage with the social and cultural landscape of the time.Occulture : occultism and the occult revival -- The occult trilogy : self and space in an occult context -- The speckled bird : sacralizing Ireland.
Department of English
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Deboskre, Sylvie. "Le féminin occulte dans l'oeuvre de Maupassant." Villeneuve d'Ascq : Presses universitaires du Septentrion, 2000. http://catalog.hathitrust.org/api/volumes/oclc/45385012.html.
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DEBOSKZE, SYLVIE. "Le feminin occulte dans l'oeuvre de maupassant." Lille 3, 1997. http://www.theses.fr/1997LIL30016.
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Notre these est consacree a la question du feminin dans l'oeuvre de maupassant, le terme " feminin " signifiant tout ce qui renvoie a la femme et a la feminite ( reelle ou symbo♭ lique ) dans la creation de cet ecrivain. La presence du femi♭ nin est occulte, discrete mais cependant influente, indefinis♭ sable ou dissimulee par de multiples procedes d'ecriture. L'objet de notre these est en substance l'analyse du dialogue qui se noue dans toute l'oeuvre entre ce feminin si absent et si present et l'homme ( l'auteur et ses heros ).
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Key, Charles Stevan. "Among strangers : protocols of an occulted social type /." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC campuses, 1997. http://wwwlib.umi.com/cr/ucsd/fullcit?p9804530.
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Valensky, Chantal. "Le soldat occulté : les Malgaches de l'armée française, 1884-1920 /." Paris : Ed. l'Harmattan, 1995. http://catalogue.bnf.fr/ark:/12148/cb35803245p.
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Antoniades, Irene. "Modern writing and the occult." Thesis, University of London, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.264702.
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Harvey, M. J. "Pollution transfer by occult deposition." Thesis, University of Nottingham, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.378479.
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Chessa, Luciano. "Luigi Russolo and the occult /." For electronic version search Digital dissertations database. Restricted to UC campuses. Access is free to UC campus dissertations, 2004. http://uclibs.org/PID/11984.
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Cleroux, Carolyne. "Biodegradable nanoparticles for sustained occular drug delivery." Thesis, University of Ottawa (Canada), 2010. http://hdl.handle.net/10393/28485.
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Apoptosis (programmed cell-death) is a common final pathway through which cells die in retinal degenerative diseases. The purpose of this project was to develop biodegradable nanoparticles that quickly deliver XIAP, an inhibitor of apoptosis, to retinal cells following acute insults. In vitro protein release profiles from different formulations were established, and two cell types were incubated with nanoparticles to assess cellular uptake. Subretinal injections were carried out in rats to assess in vivo localization and possible toxicity. In vitro studies showed an initial burst of protein followed by sustained release, with overall low levels of protein release. Cell culture experiments suggest that particles are mostly membrane-bound, and some may be internalized. In vivo experiments revealed no signs of toxicity, and protein localized within the photoreceptor layer. In conclusion, nanoparticles may provide a good delivery system for XIAP; however higher levels of protein release are needed for neuroprotection, warranting further investigation.
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Mrani, Saad. "Caractérisation moléculaire des infections à VHB occultes au cours des hépatites C chroniques." Lyon 1, 2007. http://www.theses.fr/2007LYO10064.
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L’infection par le virus de l’hépatite B occulte, définie par la présence de l’ADN du VHB en l’absence d’AgHBs dans le sérum, a été retrouvée de manière fréquente dans les hépatites C chroniques. Afin de mieux cerner les mécanismes d’échappement du VHB occulte aux tests diagnostiques classiques et de déterminer les conséquences de cette co-infection sur l’évolution de l’hépatite C chronique, nous avons analysé, par des techniques moléculaires très sensibles développées au laboratoire, les sérums de 203 patients atteints d’hépatite C chroniques avant qu’ils ne soient traités. Les résultats de cette première étude ont montré que la prévalence des infections occultes chez les patients porteurs chroniques du VHC pourrait atteindre 20% en France et que la présence de l’infection à VHB occulte est associée à une mauvaise réponse au traitement ainsi qu’à l’aggravation des lésions hépatiques et à l’accélération de l’évolution vers l’hépatocarcinome. Afin de permettre la caractérisation moléculaire du VHB occulte, le génome entier a été amplifié, puis cloné et séquencé dans le cas particulier d’un patient VHC transplanté. L’analyse des différents clones n’a pas montré les mutations connues susceptibles d’expliquer l’absence de détection de l’AgHBs. Ces résultats suggèrent d’une part, l’implication d’autres facteurs dans la suppression de la réplication et l’altération de l’expression du VHB, d’autre part, l’importance des sites extrahépatiques dans l’infection à VHB occulte. Ces travaux soulignent la nécessité de développer de nouvelles approches diagnostiques et thérapeutiques dans la prise en charge du VHB occulte et particulièrement dans les co-infections avec le VHCOccult Hepatitis B infection (HBV), defined by HBV DNA positivity in absence of HBsAg in the serum was found in 30% of hepatitis of unknown aetiology and frequently among HCV chronic carriers. In order to better understand how HBV escape to diagnosis tests and determine the consequences of this co-infection on HCV chronic infection, we analyzed by ultra sensitive molecular tests developed in the lab, serum samples from 203 HCV chronic carriers before any antiviral treatment. The results from this first study showed that occult HBV infection frequency could reach 20% in France and that occult HBV infection may worsen the course of HCV infection being associated to a bad response to antiviral therapy and aggravation of liver disease. In order to perform the molecular characterization of hepatitis B viruses in cases of occult HBV infections, the whole HBV genome was amplified by a new technique developed in the lab, named Rolling Cycle Amplification (RCA), cloned and sequenced in a HCV transplanted case. The analysis of the cloned sequences did not show the presence of any of the known mutations in the viral genome that may explain HBsAg negativity. Our results suggest, on one hand, the implication of other factors in the suppression of the HBV replication and altered expression of HBV, on the other hand, the importance of extra hepatic sites of HBV replication during occult HBV infections, since it was able to persist after liver transplantation. Our work emphasise the need to develop new diagnostic and therapeutic tools in the case of occult HBV infections especially during co-infection with HCV
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Sieg, George J. "Occult war : the legacy of Iranian dualism and its continuing influence upon the modern occult revival." Thesis, University of Exeter, 2009. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.548618.
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Sangha, Amandeep K. "William Lethaby, symbolism and the occult." Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/44643/.
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The thesis will reconsider the thought and design work of the architect William Richard Lethaby (1857–1931). The research will focus upon Lethaby’s affiliation with the occult, with particular reference to alchemy. The relationship between nineteenth- and twentieth-century architects and occultism has been overlooked, and in many cases intentionally neglected, by scholars and historians. Current scholarship in the field has placed a greater emphasis on twentieth-century proponents of the occult. This detailed study on Lethaby and the occult therefore forms an original contribution to existing scholarship, highlighting the parallels between the nineteenth-century architect’s work and the ideology and imagery of the occult. The thesis will demonstrate Lethaby’s familiarity with occult concepts and the extent to which these were employed by him in his work. The study will then go on to examine how Lethaby’s fascination with occult themes and magic had a consequent influence on his contemporaries and question how far this interest in the occult impacted the future generation of designers and subsequent movements. The research will recognise Lethaby’s work within the context of its time and suggest it to be a product of its era. Alongside the well-documented Industrial Revolution of the nineteenth-century there also existed a spiritual revolution. This encouraged countless individuals, particularly members of the avant-garde, to reject the traditional religious pathways and to seek answers through more experimental and mystical alternatives. The majority of Lethaby’s working life was spent in London, where there was a revival of interest in the occult that included the foundation of such societies as the Theosophical Society and the Hermetic Order of the Golden Dawn. The thesis will illustrate how Lethaby was profoundly influenced by the Zeitgeist, which was saturated with references to spiritualism, mysticism and the occult. Lethaby’s attraction towards mysticism and magic, as see in first published book, Architecture, Mysticism and Myth (1891), which was later revised and retitled Architecture, Nature and Magic (1928), was not confined to his theoretical work but also pervaded both his design and his completed work. A considerable portion of the thesis will therefore, for the first time, extensively scrutinise several of Lethaby’s drawings and architectural work to suggest how they embody his interest in the occult. The study will conclude by unearthing parallels between Lethaby’s completed works and those executed by prominent modern architects with recognised occult affiliations, such as Lauweriks, Frank Lloyd Wright and Le Corbusier, to suggest a comparable use of occult symbolism, with similar intent. The thesis will create a renewed interest in Lethaby and address the impact of occultism on the architect, his contemporaries and the wider Arts and Crafts Movement. Finally, it will put forward that subsequent twentieth-century schools or movements in architecture with spiritualist tendencies, such as the Bauhaus and the Modern Movement, were not so much revolutionary as evolutionary, advancing from a previous Arts and Crafts ideology.
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Ribstein, Florence. "La tradition mystique et occulte dans la formation et l'oeuvre de William Butler Yeats." Paris 3, 1985. http://www.theses.fr/1985PA03A014.
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PETIT, FABRICE. "Les moyens de detection du sang occulte : applications au depistage des cancers colo-rectaux." Strasbourg 1, 1989. http://www.theses.fr/1989STR15037.
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Shotsha, Katshunga. "La sous-traitance occulte dans les marchés publics et privés des travaux de construction." Paris 12, 1991. http://www.theses.fr/1991PA122002.
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Anderson, David Frederick. "The role of the mast cell in seasonal allergic conjunctivitis." Thesis, University of Southampton, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.250012.
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Legras, Isabelle. "L'anemie des coureurs de fond : a propos de 3 observations comportant des hemorragies digestives occultes." Lyon 1, 1991. http://www.theses.fr/1991LYO1M197.
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BERTOUT, PHILIPPE. "Les malformations vasculaires cerebrales angiographiquement occultes : revue de la litterature a propos de 17 observations." Nantes, 1990. http://www.theses.fr/1990NANT105M.
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McIntire, Janet E. "H. Rider Haggard and the Victorian occult." Full text available online (restricted access), 2000. http://images.lib.monash.edu.au/ts/theses/McIntire.pdf.
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Ryan, Kathleen T. M. D. "Occult Hepatitis B in HIV Positive Batswana." University of Cincinnati / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1468335589.
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Granieri, Camilla <1981>. "Infezione occulta da Virus B: aspetti virologici e immunologici." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2011. http://amsdottorato.unibo.it/3498/.
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Davies, Owen. "The decline in the popular belief in witchcraft & magic." Thesis, Lancaster University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.282362.
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Roosa, Naomi Monique. "Participation in faecal occult blood colorectal cancer screening /." Title page, table of contents and abstract only, 2001. http://web4.library.adelaide.edu.au/theses/09ARPS/09arpsr7813.pdf.
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Greenwood, Susan Elizabeth Jane. "The British occult subculture : identity, gender and morality." Thesis, Goldsmiths College (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.300028.
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Wiener, Martin. "Lymphatic mapping and occult nodal metastasis in melanoma." Thesis, University of Sheffield, 2016. http://etheses.whiterose.ac.uk/13621/.
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Around 20% of patients, diagnosed with a clinically localized primary cutaneous melanoma, have occult lymph node metastases. Lymphatic mapping and sentinel node biopsy, using pre-operative lymphoscintigraphy, intra-operative blue dye injection and gamma probe localization, in most cases identifies the node or nodes most likely to contain occult metastases, if present. The presence or absence of such metastases is the most powerful prognostic indicator in this group of patients. However, a number of other factors related to the patient and the primary melanoma can be used to determine prognosis. It is therefore important that the quality of lymphatic mapping is maximized and information gained from sentinel node biopsy is used to best effect, so that advice and treatment can be tailored to the individual patient. The studies contained within this thesis represent an attempt to improve the quality and individualization of care. The technique of lymphatic mapping using lymphoscintigraphy has been critically analysed to identify sources of inaccuracy. The frequency and causes of failure to identify sentinel nodes using lymphoscintigraphy have been determined in a large series of patients. The lymphatic drainage patterns from the head and neck have been investigated, using the forehead and its subdivisions, in order to produce new recommendations for selective neck dissection. The relative importance of clinical and pathological factors in sentinel node positive patients and the significance of nodal metastasis beyond sentinel nodes have been determined. A new prognostic classification or survival tree has been developed for patients with occult nodal metastases and then validated in a separate population. This allows four distinct prognostic groups with 5-year survival ranging from over 90% to around 20% to be identified. The prognostic groups differentiate patients who are at high and low risk of having occult distant metastases and so could be used to select patients for entry into clinical trials of adjuvant therapies as well as to determine who should receive existing adjuvant therapies. The survival tree has been compared with currently available prognostic tools with favourable results.
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LEGNANI, SIMONE. "I patti parasociali occulti tra opa obbligatoria e tutela dell'investimento." Doctoral thesis, Università Cattolica del Sacro Cuore, 2013. http://hdl.handle.net/10280/2053.
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La tesi ha per oggetto lo studio del fenomeno dei patti parasociali occulti nell’ambito di s.p.a. aperte al mercato del capitale di rischio e quotate. La prima parte del lavoro si concentra sulle norme dell’ordinamento italiano che prevedono obblighi di trasparenza degli accordi tra azionisti, senza trascurare gli altri principali sistemi europei e quello statunitense. Il secondo capitolo sviluppa l’analisi dei diversi profili in relazione ai quali il fenomeno del patto parasociale occulto reagisce ed influisce sull’interpretazione e sull’applicazione della disciplina dell’opa obbligatoria da concerto. Inoltre, si fornisce un’illustrazione delle modalità attraverso le quali dovrebbe essere possibile pervenire alla prova dell’esistenza di siffatti accordi. Nell’ultimo capitolo si prende in esame la responsabilità degli azionisti per la violazione del dovere di disclosure e, soprattutto, per la mancata promozione dell’opa obbligatoria da patto occulto. Si argomenta nel senso che tale condotta possa integrare altresì un’ipotesi di insider trading (o, eventualmente, di manipolazione del mercato) e si procede ad una ricostruzione del danno risarcibile e del relativo nesso causale, traendo spunto, in particolare, dai risultati emersi nell’esperienza statunitense.The thesis concerns the shareholders’ agreements - within a corporation - that are kept secret, breaching a legally imposed duty of disclosure. The first part of the analysis focuses on the rules that contain such a duty of disclosure, mainly as regards the Italian regulation but also through a consideration of other legal systems. The second chapter develops the study by showing how the not-disclosed shareholders’ agreements could vary the way in which the regulation of the mandatory bid should be interpreted and applied. Moreover, an illustration about the possible ways to get the evidence of the existence of these agreements is provided. In the final chapter, the liability of the shareholders - mainly based on the breach of the duty to promote a mandatory bid - is taken into consideration, especially through a comparison with the American legal system as for the damages caused by an insider trading conduct and the causal connection: it is argued, in fact, that the violation of the rules regarding both the disclosure of the agreements and the mandatory bid should be also identified as a case of insider trading (or market manipulation).
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McDonald, Tracesandra Jade. "Witchcraft and occult crime within a contemporary Canadian context." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0002/MQ45239.pdf.
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Greene, Elizabeth. "The Kabbalah in the British Occult Revival, 1860-1940." Thesis, University of Bristol, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.520223.
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Cheung, Ka-yee Cindy, and 張家怡. "Occult hepatitis B virus reinfection in liver transplant recipient." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B41290562.
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Cheung, Ka-yee Cindy. "Occult hepatitis B virus reinfection in liver transplant recipient." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B41290562.
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Darie, Camelia Dana. "Victor Brauner and the surrealist interest in the occult." Thesis, University of Manchester, 2012. https://www.research.manchester.ac.uk/portal/en/theses/victor-brauner-and-the-surrealist-interest-in-the-occult(15306875-b880-456e-929a-ce86265a9a1a).html.
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My research on Victor Brauner’s work in the first two decades of his affiliation with the Surrealist group in Paris re-establishes the role played by the Romanian Jewish artist in the definition of automatic Surrealist procedures of painting and mixed-technique objects that relied upon a new and unconventional understanding of the occult. In the three chapters of this study of Victor Brauner’s work in the 1930s and early 1940s, I analyse key notions, such as the fantastic, animal magnetism, and the occult practices of art making in a Surrealist context. The fantastic is discussed in the first chapter of the thesis from a literary perspective with political connotations in Surrealism, which resulted from a debate engaged in nineteenth-century French literature on the issue of the marvellous versus the fantastic. Due to the Surrealists’ interest in the fantastic a new category emerged, the fantastic art, which is examined in this first chapter in connection with Brauner’s artworks in the 1930s. The incursion into the fantastic, with focus on the premonition of the painter’s left eye loss in his artworks of the 1930s is completed with an approach to spiritualism that had a revival at the time. The second chapter of the thesis investigates the doctrine of animal magnetism and the state of magnetic somnambulism in eighteenth-century scholarship and shows how this experimentation had influenced the development of a new branch of the science, metapsychics or psychical research at the end of the nineteenth century and the beginning of the twentieth one. I take into account and demonstrate that these outdated and modern domains of enquiry into the unknown and beyond reality were appealing to Surrealists, in particular to Brauner, due to their research into unconscious processes of the mind. I argue that through the attainment of a condition similar to the one of the somnambulist in sessions of magnetic sleep, the Surrealists aimed to generate automatic procedures of painting and object making. In the third chapter of the thesis I discuss Victor Brauner’s technique of drawing with a candle, or le cirage, as an automatic procedure of art developed in connection with the occult. This final part of the thesis makes also manifest the association of Brauner’s artworks in the early 1940s with practices of the occult in the near and centuries before past.
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Zurutuza, Amaia. "Novel microgels for biomedical applications." Thesis, University of Strathclyde, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.248836.
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Arteau, Joanie. "Le recours à l'aide médicale à mourir au Québec : l'expérience occultée des proches." Master's thesis, Université Laval, 2019. http://hdl.handle.net/20.500.11794/34970.
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Le but de cette recherche qualitative exploratoire est de documenter le point de vue des proches quant à leur expérience globale durant le processus d’aide médicale à mourir (AMM), plus particulièrement en lien avec l’environnement social. Elle vise à : 1) décrire l’accompagnement offert aux proches durant le processus d’AMM provenant de l’équipe médicale ; 2) explorer les relations et interactions des proches entre eux durant le processus d’AMM; 3) décrire les perceptions des proches concernant le processus d’AMM et 4) explorer le processus de deuil des proches spécifique à l’AMM. Les données recueillies proviennent d’entrevues individuelles, en partie libres et en partie semi-dirigées, réalisées auprès de sept proches ayant accompagné une personne dans le processus d’une demande d’AMM. La méthode d’analyse de données phénoménologiques de Giorgi (1997) a été utilisée afin de codifier et d’interpréter les propos des proches. Les résultats ont été éclairés par la perspective théorique choisie, soit la théorie bioécologique de Bronfenbrenner (2005). Les résultats de cette étude suggèrent que l’accompagnement des proches est surtout pris en charge par le corps médical, soit les médecins et les infirmières, et que la place de la travailleuse sociale et de son accompagnement psychosocial ou de ses interventions ne sont pas clairement établis au sein de ce processus. Les proches ont globalement été satisfaits de leur expérience durant le processus d’AMM, mais souhaitent que des modifications viennent améliorer la prestation de ce soin de fin de vie, surtout en ce qui concerne l’encadrement psychosocial des familles. Finalement, leur deuil ne semble pas différent de celui qui suit un décès plus conventionnel, si ce n’est que leur processus semble pour certains accéléré ou facilité. Mots-clés : aide médicale à mourir, mort médicalement assistée, euthanasie, proches, proches aidants, famille, soins palliatifs, soins de fin de vie, accompagnement psychosocial.The aim of this exploratory qualitative research is to document the overall experience of relatives of the patient during the process of medical assistance in dying (MAID), focussing particularly on the social environment. It aims to 1) describe the accompaniment provided by medical team to relatives during MAID’s process; 2) explore the relatives’ relationships and interactions between them during MAID’s process; 3) describe the relatives’ perceptions about MAID’s process and 4) explore the relatives specific MAID’s mourning process. Data was collected from semi-structured and free style individual interviews with seven relatives who accompanied a person in a MAID demand process. Giorgi’s (1997) phenomenological data analysis method was used to codify and interpret qualitatively relatives’ sayings. The results were highlighted according to the chosen theoretical perspective, the Bronfenbrenner’s (2005) bioecological model. The results of this study suggest that relatives’ accompaniment is mainly supported by the medical team, such as doctors and nurses, and that the position of social workers and their potential psychosocial support or interventions is not clearly established in this process. Relatives were generally satisfied with their global experience during the MAID process, but they specify that this end-of-life care need to be improved, especially regarding the psychosocial support of families. Finally, relatives’ grief does not seem different from grief of a conventional death, except that their process seems for some of them to be accelerated or facilitated. Keywords: medical aid in dying, medical assistance in dying, euthanasia, relatives, caregivers, family, palliative care, end-of-life care, psychosocial support
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Strandsbjerg, Camilla. "Les sens du pouvoir : des forces "occultes" à la grâce divine : religion et transformations politiques dans le Bénin contemporain." Paris, EHESS, 2008. http://www.theses.fr/2008EHES0572.
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La thèse aborde les transformations politiques au Bénin essentiellement à partir de l’étude de leur champ narratif et montre la manière dont les références et idées religieuses participent à la construction de nouvelles catégories politiques et au façonnement idéologique du pouvoir. En analysant d'un côté le changement du discours politique de l'ex-président Mathieu Kérékou de la période régime militaro-marxiste (1972-1989) jusqu'aux deux mandats démocratiques (1996-2006) et, de l'autre, les interprétations populaires auxquelles il a donné lieu, la thèse reprend également le fil de l'anthropologie politique classique pour étudier à nouveau les échanges symboliques et sémantiques entre le politique et le religieux afin de contribuer à une réflexion sur le pouvoir et l'État en Afrique contemporaineThe thesis focuses on political transformation in Benin on a discursive level and illustrates how religious ideas and practices participate in the construction of new political categories and the ideological frame of power. The analysis focuses both on the changes in the political discourse of former president Mathieu Kérékou from the authoritarian period (1972-1989) to the democratic period (1996-2006), and on the popular interpretations of his discourse. Thereby, the thesis also takes up classical themes from political anthropology proposing a new analysis of the semantic and symbolic exchange between the religious and the political spheres; an analysis intended to contribute to the reflection on political power and the State in contemporary Africa
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De, carli Manuel. "Le tarentisme et les qualités occultes en Hollande aux XVIIe et XVIIIe siècles : l’œuvre de Wolferd Senguerd (1646-1724)." Thesis, Tours, 2019. http://www.theses.fr/2019TOUR2023.
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Le présent travail de thèse est consacré à la reconstruction de la réflexion de Wolferd Senguerd (Utrecht, 1646- Leyde, 1724) sur la tarentule, sur les effets merveilleux de son poison et sur les extraordinaires propriétés curatives de certaines musiques, par rapport à la question des qualités occultes. Professeur de “Philosophie péripatéticienne” à l’Université de Leyde, Senguerd est une figure peu connue dans le cadre des études sur le tarantisme. Toutefois, il est l’auteur de bien trois textes sur la question. En effet, Wolferd passe son doctorat en philosophie, en écrivant une "Disputatio philosophica inauguralis de tarantula" (Leyde, 1667). Ce texte est considéré comme un des premiers écrits entièrement consacrés à l’étude de la problématique. En outre, Senguerd rédige un "Tractatus physicus de tarantula" (Leyde, 1668) et une "Disquisitio de tarantula" (Rotterdam, 1715). L’attention de Wolferd pour les effets des tarentules des Pouilles et pour la thérapie musicale s’inscrit dans le plus grand intérêt – très répandu dans la physique du XVII siècle – pour les qualités occultes. Le présent travail de thèse est structuré en trois parties. La première est consacrée à retracer l’origine de l’intérêt de Wolferd Senguerd pour les qualités occultes. Wolferd est initié à l’étude de la question par son père Arnold Senguerd (1610-1667), philosophe néo-aristotélicien et professeur de Wolferd dans les années de sa formation académique à l’Athenaeum Illustre d’Amsterdam. Dans cette perspective, la réflexion sur les qualités occultes développée par Arnold a été reconstruite. En plus, on a analysé les disputationes discutées par Wolferd sous la présidence de son père et consacrées à l’étude des qualités occultes. Il a donc été possible de constater la grande influence que la leçon d’Arnold exerce sur les réflexions suivantes de Wolferd en matière des qualités occultes et du tarantisme. La deuxième partie est consacrée à l’étude de la réflexion de Wolferd sur le tarantisme, par l’analyse des œuvres de jeunesse : la "Disputatio philosophica inauguralis de tarantula" et le "Tractatus physicus de tarantula" qui constitue une version plus élargie du premier écrit. Dans les deux œuvres, le tarantisme est présenté par l’auteur comme un phénomène composé de plusieurs éléments que la tradition a expliqués en recourant aux qualités occultes. On a donc procédé à une reconstruction des sources de Wolferd. En outre, on a vu que son objectif est de démontrer que ces éléments sont explicables au moyen de solutions alternatives aux qualités occultes. La clarification est menée en utilisant les outils de l’histoire naturelle, ainsi qu’en invoquant les actions mécaniques et le processus de fermentation ; au contraire, les aspects considérés comme fabulosi sont niés dans leur existence empirique. La troisième partie est consacrée à la - réflexion de Wolferd sur le tarantisme. La réévaluation de la question des qualités occultes et l’adhésion aux principes de la philosophie expérimentale postérieure à 1675 se reflètent sur l’élaboration de la "Disquisitio de tarantula". Bien que l’intention de l’auteur reste d’expliquer les effets exceptionnels du tarantisme, il y a certaines variations significatives dans les modèles explicatifs qu’il adopte. On a mis en évidence l’incidence de ses recherches pneumatiques sur l’élasticité dans l’explication de la thérapie des sons et des danses. En outre, on a identifié l’influence exercée par la source implicite du "De anatome, morsu et effectibus tarantulae" (1696) de Giorgio Baglivi (1668-1707). Cette source aussi est inscrite par Wolferd dans le nouveau cadre expérimental qui caractérise la "Disquisitio de tarantula". Grâce à cette source, il peut mettre au jour sa propre réflexion sur le tarantisme, surtout à propos des aspects de l’histoire naturelle et de la médecine iatromécaniqueThis thesis is dedicated to reconstruct the reflection of Wolferd Senguerd (Utrecht, 1646- Leiden, 1724) about the tarantula, the wonderful effects of its poison, the prodigious and curative properties of some peculiar music, concerning occult qualities. Professor of “Peripatetic Philosophy” at the University of Leiden, Wolferd is a little known figure in the field of studies about tarantism. However, he is the author of three texts about this topic. In fact, Wolferd takes his doctorate in philosophy, by composing a "Disputatio philosophica inauguralis de tarantula" (Leiden, 1667), among the first independent writings completely devoted to the study of the problematic. Furthermore, he wrote "Tractatus physicus de tarantula" (Leiden, 1668) and "Disquisitio de tarantula" (Rotterdam, 1715). The attention of Wolferd to the wonderful effects of Apulian tarantulas and to the extraordinary musitherapy is part of the wider interest – widespread in the 16th century – in occult qualities. This work consists of three parts. The first part deals with the origin of Wolferd’s interest in occult qualities. It was found that Wolferd had been initiated to the study of the problematic by his father Arnold Senguerd (1610-1667), neo-Aristotelian philosopher and professor of Wolferd during the years of his academic training at the Athenaeum Illustre of Amsterdam. In this perspective, the reflection on occult qualities developed by Arnold was reconstructed. The disputationes, discussed by Wolferd under the supervision of his father and devoted to the study of occult qualities, have also been analysed. Therefore, the considerable influence that the lesson of Arnold exerts on the subsequent reflections of Wolferd about occult qualities and tarantism is recognizable. The second part focuses on the study of Wolferd’s reflection about tarantism due to the analysis of early works: "Disputatio philosophica inauguralis de tarantula" and a wider version of the previously mentioned writing, "Tractatus physicus de tarantula". In both works, tarantism is presented as a phenomenon consisting of many aspects explained by the tradition through the occult qualities. Therefore, the sources of Wolferd have been reconstructed. Furthermore, it has been noted that his aim is to show that these aspects are explicable by alternative solutions to occult qualities. The clarification of these aspects is accomplished making use of the tools of natural history and invoking mechanical actions and fermentation processes, while the aspects considered fabulosi are denied in their own empirical existence. The third part is devoted to the mature reflection of Wolferd about tarantism. It has been shown that a reconsideration of the problem concerning occult qualities and the adherence to the principles of experimental philosophy after 1675 are reflected in the writing of the "Disquisitio de tarantula". Although the author’s intent is to explain the extraordinary effects of tarantism, there are some significant changes in the explanatory patterns that he adopts. The incidence of his pneumatic studies corcerning the elasticity in explaining the therapy of sounds and dances has been highlighted. In addition, the influence exercised by the implicit source of the "De anatome, morsu et effectibus tarantulae" (1696) of Giorgio Baglivi (1668-1707) has been identified. This source is inserted by Wolferd in the new experimental frame that distinguishes the "Disquisitio de tarantula". Due to this source, he can revise his reflection about tarantism, in relation to aspects of the natural history and iatromechanical medicine
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Bellino, Vincenzo <1981>. "Ex occulto carpere agmen: la guerriglia antiromana in Britannia e in Giudea." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2012. http://amsdottorato.unibo.it/5045/.
Full textAbstract:
Scopo di questo lavoro è quello di analizzare le componenti tattiche, strategiche e sociali della guerriglia antiromana in Britannia e in Giudea, in un periodo che va dal I secolo a. C. al III secolo d. C., con l'obiettivo di mettere in luce la differente efficacia delle tattiche non ortodosse rispetto a quelle convenzionali; e di analizzare le risposte teoriche ed empiriche concepite dai Romani per affrontare questa forma di lotta.
La tesi è stata articolata nel modo seguente: una prima parte analizza gli aspetti tattici, strategici e sociali della guerriglia e della controguerriglia, anche attraverso il metodo comparativo, mettendo cioè a confronto alcuni dei principali testi sulla guerra non convenzionale redatti in epoche e contesti diversi, dai quali si è cercato di delle costanti potenzialmente applicabili a qualsiasi periodo storico e a qualsiasi area geografica.
Nella seconda parte si cerca di applicare tali costanti alla realtà storico – sociale dell'impero romano. Particolare attenzione è stata riservata al rapporto tra la mentalità romana, basata sul concetto di bellum iustum, e le tattiche non ortodosse.
La terza e la quarta parte analizzano la resistenza antiromana in Britannia e in Giudea, mettendone in luce tutti gli aspetti, in particolare quelli legati alla guerriglia rurale, a quella urbana, al terrorismo, all'evoluzione della guerriglia da guerra per bande a guerra convenzionale e alla controguerriglia.
La scelta di queste due province non è casuale. In province così lontane e diverse tra loro, Roma inviò spesso gli stessi generali esperti di controguerriglia. Questo particolare permette di notare la presenza, a Roma, di una grand strategy che, consapevole del fenomeno della guerriglia, ne affidò la repressione agli stessi generali, specialisti della controguerriglia, non esitando a spostarli, in caso di necessità, da un capo all'altro dell'impero.Aim of this work is the analysis of the strategical, tactical and social aspects of the anti – roman guerrilla warfare in Britannia and Judaea, from the first century B.C. to the III A. D. The target is to underline the differences between conventional and irregular warfare and to analyze the theoretical and practical Roman answers to this particular method of fighting. The first part of the thesis analyzes the characteristics of guerrilla warfare with the use of comparative method, that is comparing some of the most important works about guerrilla written in different periods and historical contexts, trying to obtain some constant rules, potentially applicable in every historical period and geographical area. In the second part there is an attempt to apply these rules to the Roman empire, with particular attention on the relations between the Roman concept of bellum iustum and the irregular strategy. In the third and fourth part there is an analysis of the anti – Roman resistance in Britannia and in Judaea, with particular attention on rural guerrilla, urban guerrilla, terrorism, about the evolution from war of gangs to conventional warfare and about Roman counter - guerrilla. The choice of these two provinces in not casual, because in both, in spite of distance and geographical differences, Rome sent the same generals, expert in counter – guerrilla. This aspect underline the presence, in Rome, of a grand strategy that, conscious of the importance of guerrilla warfare, entrusted the same generals of her repression, without any hesitation in moving them from one end to another of the empire.
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Webb, Jessica. "What lies beneath : orthodoxy and the occult in Victorian literature." Thesis, Cardiff University, 2010. http://orca.cf.ac.uk/55460/.
Full textAbstract:
This thesis explores the relationship between orthodox Christianity, quasi-religious movements, pseudo-science and the supernatural in both a pre- and post-Darwinian world, tracing it through fiction and non-fiction, and in novels, novellas and short stories by canonical authors Charles Dickens, George Eliot and Thomas Hardy, by the lesser known writers Catherine Crowe, and Arthur Machen, and in the non-Sherlock Holmes stories by Arthur Conan Doyle. Across this variety of literary forms, these very different authors all engage with the supernatural, with quasi religious creeds and with pseudo-science. Chapter One focuses on the presence of the supernatural and the spirit world in Edward Bulwer Lytton's Zanoni (1846), and The Haunted and the Haunters; or the House and the Brain (1859), Catherine Crowe's The Night-Side of Nature (1848), and Charles Dickens' Christmas stories. Chapter two explores George Eliot's use of superstition and medieval and Jewish mysticism in The Mill on the Floss (1860), and Daniel Deronda (1876), before considering Thomas Hardy's Anglo-centric approach to similar issues in The Return of the Native (1878), and "The Withered Arm" (1888). Chapter three discusses the late nineteenth century interest in spiritualism, Egyptology, and ancient religion as represented in Arthur Machen's The Great God Pan (1894) and Arthur Conan Doyle's "The King of Thoth" (1890) and "Lot No. 249" (1894). Overall, the thesis is concerned with the way "rational" Victorian society is constantly undermined by its engagement with the supernatural: the nineteenth century desire for empirical evidence of life after death proves, paradoxically, Victorian irrationality.
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McWilliams, S. J. "Magic and Possibility : Medievalism and the idea of the Occult." Thesis, Queen's University Belfast, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.527868.
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White, Rachel. "Occult poetics and the production of English verse, 1558-1603." Thesis, Lancaster University, 2016. http://eprints.lancs.ac.uk/86197/.
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This thesis examines how the occult tradition is an inherent part of the production of vernacular literature during the Elizabethan period. I argue that occult discourses about language are drawn upon by writers of the period who seek to establish an English literature to rival that of the classical tradition. The quotidian nature of occult philosophies which vacillate between the scientific and the magical in the early modern period has been recognised in recent criticism. Taking into consideration the etymological root of the word occult as secret or hidden, this thesis departs from the traditional demarcations of occult studies. By removing the occult from the realm of the magus and dramatic sensationalism, this thesis begins with the premise that occult discourses are present within Elizabethan culture and are absorbed into textual practice. It adopts the term occult poetics to describe the processes of writing that rely upon occult discourses to imbue efficacious qualities and communicate esoteric knowledge within Elizabethan vernacular poetry. I examine John Dee, traditionally viewed as a magus-figure, and resituate him within discourses about language. I show that Dee believed the divine origins of language lay in geometry and number, and that his semiotics informs his hopes for Elizabethan imperialism. Contemporaneous to Dee’s depiction of Elizabeth as imperial queen is Edmund Spenser’s cry to establish English as a kingdom of language, which leads to experimentation with English verse that is based on the occult qualities of number and quantity. I consider how occult and emergent scientific discourses are engaged with in the new poetry in terms of cosmology with Fulke Greville and Giordano Bruno, and optics in George Chapman’s poetry. Finally, I approach the figure of Elizabeth as an occult body analogous to the lodestone who sits at the centre of language production through analysing Spenser’s The Faerie Queene.
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Elsen, Juliëtte van den. "Monsters, demonen en occulte krachten : de journalistieke perceptie van magische en wonderbaarlijke verschijnselen in de vroege Verlichting 1684-1727 /." [S.l. : s. n.], 2003. http://catalogue.bnf.fr/ark:/12148/cb39251197q.
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Lee, Ming-tong Tony, and 李銘棠. "Detection of occult influenza infection in patients with sudden cardiac death." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40738218.
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Lee, Ming-tong Tony. "Detection of occult influenza infection in patients with sudden cardiac death." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40738218.
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S, Hanekom Gideon. "The detection of occult metastatic disease in patients with cutaneous melanoma." Doctoral thesis, University of Cape Town, 1999. http://hdl.handle.net/11427/26789.
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The ability to identify melanoma patients with progressive disease is central to efficient management. The challenge therefore, is to develop prognostic markers and techniques which will allow the identification of those patients whom, at the time of primary tumor diagnosis, already have micrometastases (occult or clinically undetectable metastases). The use of the reverse transcription-PCR (RT-PCR) technique for the detection of circulating melanoma cells (CMCs) is potentially a powerful tool for identifying those patients at risk for developing metastases. The first aim of this study was to develop a more sensitive, reproducible, cost effective and clinically applicable assay and to eliminate the problem of false positives. A combined RT-PCR assay for tyrosinase mRNA, a marker specific for melanoma cells, was developed and tested. It was shown that the assay can reproducibly detect a single, viable melanoma cell in 10-15 ml of peripheral blood. Furthermore, a simple but effective procedure was developed to prevent carryover contamination. It was found that the chance of obtaining normal melanocyte contamination with the needle prick during blood sampling was only 2% and that illegitimate transcription does not contribute to sporadic false positives. The second aim of this study was to determine whether the early detection of CMCs is of any clinical value to monitor melanoma progression. Peripheral blood samples from 143 patients with primary melanoma (PM) were analysed by RT-PCR for the presence of tyrosinase mRNA. Seven percent (10/143) of the patients with PM had detectable CMCs. The percentage of PCR-positive patients was higher for stage II patients (9.0%) compared to stage I (5.3%) but the difference was not significant. A significantly higher percentage (P < 0.05) PCR-positive patients were found to have tumors greater than 1.5 mm thick and with ulceration present. Although this finding supports the notion that tumor thickness and ulceration are the two most significant prognostic factors, it was not possible at this stage, to link this directly to a poor prognosis since the majority of the PCR-positive patients have not yet (within four years) developed metastatic disease. However, the data does indicate that cells from tumors greater than 1.5 mm thick and with ulceration have a greater propensity to enter the circulation but that these cells do not necessarily have the ability to establish metastases. The results suggest that the detection rate of 9% for patients with stage II disease is much lower than would be expected, since 23.9% (16/67) of the stage II patients subsequently developed metastases. Of these 16 patients, only one was PCR-positive, one week before the metastases became clinically evident. Thus, the current technique fails to predict the likelihood of developing metastatic disease (P = 0.3485). The other nine PCR-positive patients had not yet developed metastases after a median follow-up period of four years. It is concluded that the current technique for the detection of CMCs is of limited clinical value to predict the likelihood of metastasis in patients with PM. It is suggested that other anatomic compartments, such as sentinel lymph nodes, should be explored for the identification of patients at risk for developing metastases. The third aim of this study was to determine whether high or low plasma levels and/or activity of plasminogen activator inhibitor type 1 (PAI1) correlate with the presence of metastatic disease in patients with melanoma. PAI1 is considered to be the main regulator of fibrinolytic activity in blood and has been identified as a key enzyme in the metastasis and vascularization of solid tumors. A unique enzyme-linked immunosorbant assay was developed to measure both the total amount of PAI1 in plasma as well as the active fraction of the inhibitor. This novel assay was then used to analyse and compare the plasmatic PAI1 levels and activity of a group of patients with advanced melanoma (AM) with a group of patients with primary disease and a control population. There was no statistical difference in the total plasmatic PAI1 levels between the controls and patients with PM and AM (P = 0.6199). In contrast, there was a significant difference in the active fraction of PAI1 between the controls and patients with PM or AM (P = 0.0076). A value of less than 44% active PAI1 was shown to be clinically meaningful by linear discriminant analysis. This means that a melanoma patient with a plasmatic PAI1 activity value less than 44% will have a 50% chance of harbouring metastases. Of the patients with PM, 19% had PAI1 activity values less than 44%, which strongly supports further investigations to determine whether plasmatic PAI1 activity levels might be predictive of metastatic disease. The false positive rate was 2.6%. It is speculated that this reduction in the active fraction of PAI1 for patients with AM might be attributed to tumor-derived tissue plasminogen activator and/or other melanoma-derived proteases or factors. The last section of this study describes several monoclonal antibodies (Mabs) that were developed against PAI1 in order to obtain useful reagents to study the regulatory functions of PAI1 in the metastasis and vascularization of solid tumors. The baculovirus expression system was used to express human PAI1 in insect cells and the crude infected cell population was used as the immunogen in mice. This approach was followed since the Escherichia coli-derived recombinant molecule elicited a poor immune response. A unique panel of anti-PAI1 Mabs was developed that were characterized with regard to their use for immunoblotting, immunofluorescence and immunocytochemistry. One of these antibodies blocked the binding of PAI1 to vitronectin and inhibited the activity of the inhibitor. Finally, two of these Mabs turned out to be extremely valuable and were used to develop a novel microtiter plate assay for measuring the active fraction of PAI1 in biological fluids by making use of Mabs against different epitopes of PAI1.
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Martin, Quigley Christina M. "Characterization of Occult Hepatitis B Virus Infection in HIV-Positive Individuals." University of Cincinnati / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1307441402.
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Powell, Eleanor A. "Viral Factors Associated with Occult HBV in HIV-positive South Africans." University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1439561912.
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Mattos, David. "PROPHYLACTIC MASTECTOMIES: OCCULT HISTOLOGY AND FISCAL IMPACTS OF SURVEILLANCE VS. SURGERY." Thesis, Harvard University, 2014. http://etds.lib.harvard.edu/hms/admin/view/51.
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Introduction:
During the last decade, our institution saw a 260% increase in bilateral breast reconstruction cases, consistent with national trends. We reported a drop in average age of prophylactic mastectomy from 57 to 51 years. There is limited data on the likelihood of histological abnormalities in this population. This study measures the prevalence of occult histological findings in prophylactic mastectomy patients. Given the current healthcare reform climate, we estimate the lifetime cost implications of prophylactic mastectomy with immediate reconstruction vs. surveillance.
Methods:
A retrospective database of breast reconstructions at the Massachusetts General Hospital was searched from 2004 to 2011 for prophylactic mastectomy patients. Breasts with prior biopsy-proven LCIS, DCIS, or cancer were excluded. Patient demographics, risk factors, and pathology reports were collected. Lifetime treatment reimbursements were estimated with 2013 rates from the Center for Medicare and Medicaid Services using Medicare billing codes. Reimbursements were estimated for 45-year-old patients undergoing contralateral prophylactic mastectomy and 40-year-old patients undergoing bilateral prophylactic mastectomies, and then were compared to women opting for surveillance. Conversion rates to cancer in these patients were used to estimate the percentage patients in the surveillance groups that would need therapeutic mastectomy. Sensitivity analyses were done to test the robustness of the models.
Results:
495 prophylactic mastectomy specimens were identified, of which 2.0% had invasive cancer, 4.4% had ductal carcinoma in situ (DCIS), and 10.9% had lobular carcinoma in situ (LCIS) as the highest-risk lesion. Only age group was predictive of finding DCIS or cancer (P=0.02). The likelihood of finding LCIS, DCIS, or cancer increased with age group (P<0.001) and decreased with prior bilateral salpingo-oophorectomy (BSO)(P=0.02). In almost all scenarios, lifetime reimbursements were lower for pursuing either contralateral or bilateral prophylactic mastectomy, with immediate single-stage implant, expander, or abdominal perforator free flap (DIEP) reconstruction, as compared to surveillance.
Conclusions:
Prophylactic mastectomy patients have a significant rate of occult histological findings, increasing with age group and decreasing with prior BSO. Lifetime cost estimates suggest a cost-saving role in bilateral and contralateral prophylactic mastectomies. Ultimately, such a critical decision needs to be made individually, but should not be hindered by cost concerns. This study addresses a gap in knowledge with broad interest, contributing evidence of oncologic risk and cost to help guide decision-making in prophylactic mastectomy.
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Rouhier, Marie-Laurence. "Dépistage des tumeurs colorectales : étude des tests de recherche de sang occulte dans les selles : à partir de données bibliographiques." Bordeaux 2, 1993. http://www.theses.fr/1993BOR23116.
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Depetiteville, Marie-Pierre. "Cytologie dirigée en stéréotaxie d'anomalies mammographiques infracliniques." Bordeaux 2, 1991. http://www.theses.fr/1991BOR23078.
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