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1
Mitry, Danny. "Primary rhegmatogenous retinal detachment : clinical epidemiology and genetic aetiology." Thesis, University of Edinburgh, 2013. http://hdl.handle.net/1842/8923.
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Primary rhegmatogenous retinal detachment (RRD) is one of the most common ophthalmic emergencies. RRD is caused by a full thickness break in the retina which initiates separation of the neurosensory retina from the underlying retinal pigment epithelium. The subsequent accumulation of fluid within this potential space extends the area of detachment and causes visual loss. Previous assessments of RRD incidence have demonstrated large differences in case definition and methodology, with incidence estimates varying 3-fold geographically and in different time periods. To date there have been no systematic or prospective incidence estimates of primary RRD in the U.K. In this thesis I present the findings of a 2-year epidemiology study that prospectively aimed to recruit all incident cases of primary RRD diagnosed in Scotland. Case recruitment from consenting participants comprised a detailed questionnaire and a blood sample. In this thesis, I present the findings of the Scottish retinal detachment study that examined the incidence, demographic features, temporal incidence trends, as well as clinical and socio-economic associations of primary RRD in Scotland. From the clinical and genetic resource I assembled, I calculated the first population based estimate of the sibling recurrence risk ratio for RRD and designed and assisted in the analysis of the first case-control genome wide association study of this condition. Results from this study have estimated the annual incidence of primary RRD in Scotland to be 12.05 per 100,000 population. Based on this estimate, there are approximately 7,300 new cases annually in the United Kingdom. RRD incidence increases with age, is more common in men and right eyes, and is strongly associated with socio-economic affluence. In addition, using hospital episode data, the overall age-standardised incidence of RRD in Scotland was shown to be steadily increasing since 1987 with an average annual increase of 1.9%. Analysis of the clinical findings highlighted that the majority of RRD cases are caused by more than one retinal break; an important consideration for appropriate surgical management. Ocular trauma, previous cataract surgery, family history, and retinal degeneration are important predisposing features. In addition, over a 2 year period approximately 7% of individuals will suffer a RRD in the fellow eye representing an important risk of bilateral visual loss. Furthermore, I demonstrate that the risk of having an affected sibling with RRD is increased 2-fold given that one sibling has had the condition, substantiating a genetic component to the pathogenesis of this condition. In the final aspect of this thesis I will present the design and analysis of a two stage case-control genome-wide association study examining the role of common genetic variants and selected candidate genes in predisposing to RRD development.
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Almutairi, Wafa A. H. J. "The association between clinical and radiographic findings in carious primary molar teeth." Thesis, University of Leeds, 2017. http://etheses.whiterose.ac.uk/18577/.
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AIM This project undertook two cross-sectional studies involving the primary dentition. The aim was: Study A: to characterise the relationship between the radiographic appearance of early approximal carious lesions and cavitation threshold in primary molar teeth. Study B: to correlate the radiographic and histological measurements of the Remaining Dentine Thickness (RDT) beneath deep caries lesions in primary molar teeth. MATERIALS AND METHODS Patients requiring extraction under general anaesthesia at the Leeds Dental Institute were asked to participate in the study. For Study A, teeth were examined visually (both in-vivo and in-vitro) for presence/absence of cavitation and radiographically according to two radiographic criteria (i) ICDAS radiographic scoring system and (ii) the extent of the lesion as < or > 0.5mm from the enamel-dentine junction (EDJ) into dentine. For Study B, RDT was measured radiographically and histologically (in mm). RESULTS For Study A, 72 primary molars with approximal carious lesions extending radiographically into enamel, outer and inner dentine were included. Teeth showed a mixture of first and second primary molars (30 and 42 respectively), maxillary and mandibular teeth (36 teeth each), and mesial and distal lesions (34 and 38 respectively). Regarding radiographic ICDAS, no cavitation was associated with score 0 and 1. For score 2, 3 and 4, cavitation was reported in 11%, 45% and 86% of the cases respectively. According to the radiographic extension from EDJ, there was a statistically significant increase (p<0.05, chi-square) in the probability of cavitation (92%) with the radiographic lesions extended >0.5mm beyond the EDJ compared to the lesions extended < 0.5mm (29%). For study B, 50 primary molars were collected. Teeth showed a mixture of 21 first and 29 second primary molars of which 23 were maxillary and 27 were mandibular teeth with approximal and occlusal lesions (28 and 22 respectively). Radiographic RDT overestimated the histologic RDT by approximately 0.4 (0.2) mm. The overestimation was consistent across all primary molars and both proximal and occlusal lesions. CONCLUSION This study has given an additional insight into the radiographic interpretation in the primary dentition. It identified noticeable increase in the probability of cavitation when carious lesions extend >0.5mm beyond EDJ. In addition, it showed that digital bitewing radiographs overestimate the remaining dentine thickness in carious primary molars. These are significant findings when considering different treatment options for both early and deep carious lesions in primary molars.
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Martin, Keith J. "Association between Unscheduled Pediatric Primary Care Visits and Risk of Developmental Delay." University of Cincinnati / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1613745845662717.
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Lichtenstein, Morgan R. L. "The Association Between Patient Complexity and Primary Care Visit Length and Composition." Thesis, Harvard University, 2016. http://nrs.harvard.edu/urn-3:HUL.InstRepos:27007752.
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Importance: Our research examines the duration and content of primary care visits with a focus on whether visit length or composition differs for highly complex patients as compared to non-complex patients. This comparison elucidates the potential for primary care practices to provide more appropriately tailored outpatient care to meet the needs of complicated patients.
Objective: We hypothesized that physician-defined complex patients would spend more time with their primary care physicians in each visit based on their increased medical, psychosocial, and mental health issues. With similar reasoning, we predicted that a physician-defined complex patient appointment would have different composition than a non-complex appointment.
Design, Setting and Participants: This study was a prospective cohort study conducted at a large hospital-based primary care practice at Massachusetts General Hospital. Seven volunteer primary care physicians were recruited and data was collected from a total of 635 visits.
Results: The study results regarding total visit length revealed that physician-defined complex patients and non-complex patients spend the same amount of time in any given primary care appointment. We also found that visit composition differs significantly between physician-defined complex and non-complex groups.
Conclusion and Relevance: The study results regarding visit length showed that physician-defined complex patients and their non-complex counterparts spend the same amount of time in a single medical appointment. Within this standard visit length, we found that visit composition differs significantly between the patient groups. In complex visits, more time is spent discussing medications, specialty care coordination, and mental health. These patients receive less time on education, care planning, screening guidelines, logistics, and social discourse. These differences raise questions about whether standard visit length provides adequate time for patients with increased medical needs. Given that physician-defined complex patients struggle with relatively compromised health outcomes, these patients likely need more, not less, emphasis on the elements currently lacking in their care. Though complex patients have a greater number of appointments over time, less focus on the same subset of topics in each visit may ultimately compromise care in those areas. Thus complex patients may benefit from standardized supplemental care tailored to meet their advanced needs.
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Nahhas, Mahmoud A. "Investigating the association between obesity and asthma among primary schoolchildren in Madinah, Saudi Arabia." Thesis, University of Edinburgh, 2014. http://hdl.handle.net/1842/17916.
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Background: Over the latter half of the last century, a dramatic increase in the prevalence of asthma has been observed. Over this same period there has been a substantial increase in the prevalence of obesity, this giving credence to the hypothesis that obesity and asthma may be causally associated. Aim: The main aims of this thesis were to: i) estimate the prevalence of asthma, allergic rhinitis, and atopic eczema in primary schoolchildren in Madinah, Saudi Arabia; ii) investigate the association between childhood obesity and prevalence of asthma; and iii) investigate possible mechanisms that might explain any associations observed. Methods: I undertook a pilot study aimed at testing the feasibility of conducting a large-scale descriptive epidemiological study of asthma and associated allergic disorders. This was followed by a two-stage cross-sectional survey, which was conducted to investigate the prevalence of asthma, allergic rhinitis, and atopic eczema in a sample of 5,188 schoolchildren, aged 6-8 years using an Arabic, validated version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Finally, I undertook an analytical study investigating the relationship between obesity and asthma. The cross-sectional study allowed for the identification of cases (i.e. those with a history of symptoms suggestive of asthma) and controls (i.e. those without a history suggestive of asthma). A sample of 632 cases and controls were recruited into a matched case-control study. Conditional logistic regression analysis, with appropriate adjustment for a range of potential confounders, was undertaken to explore the association between measures of obesity (in particular, body mass index (BMI)) and asthma. The possible aetiological roles of atopy and airway obstruction were studied by investigating the impact of sensitisation to common aeroallergens and measurements of lung function on the association between body mass index (BMI) and asthma. Results: In the pilot study, I found that the asthma, allergic rhinitis, and atopic eczema were very prevalent in children in Madinah and that further epidemiological studies were therefore likely to be feasible. The overall prevalence of children with a history of symptoms suggestive of asthma was 23.6% (95% CI: 21.3, 26.0); the prevalence among boys was estimated at 24.4% (95% CI: 22.0, 26.9) and among girls at 21.9% (95% CI: 17.4, 27.1), respectively. After adjustment for a number of possible confounders, BMI was found to be a significant predictor of the odds of asthma in both boys (OR=1.11; 95% CI: 1.03, 1.19) and girls (OR=1.38; 95% CI: 1.23, 1.56). When sensitisation to allergens was included in the analyses, the effect of BMI on the risk of asthma was no longer evident in boys (OR=1.09, 95% CI: 0.99-1.19) or girls (OR=1.25; 95% CI: 0.96-1.60). When the effect of lung function measures were factored into the model, the association however persisted: boys: OR=1.10 (95% CI: 1.02, 1.18) and girls OR=1.37 (95% CI: 1.22, 1.54). Conclusions: Asthma and related allergic disorders are very common in primary schoolchildren in Saudi Arabia. BMI is associated with symptoms suggestive of asthma in primary schoolchildren. This effect does not appear to be mediated through respiratory obstruction, but may, at least in part, be mediated through increasing the risk of allergic sensitisation. Prospective and more detailed gender-specific mechanistic studies are now needed to further investigate this association.
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Tomson, Derek. "Evaluating the association between adult primary brain tumours and a family history of cancer." Thesis, University of Ottawa (Canada), 2006. http://hdl.handle.net/10393/27301.
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There are very few established causes of primary brain tumours in adults. Associated with short survival times, increasing effort is being put forth in an attempt to better understand the risk factors of these neoplasms, including investigating the possible relationship with a family history of cancer and germline genetic polymorphisms. This thesis was conducted to evaluate both of these potential associations.
Using an international population-based case-control study, the self-reported family histories of cancer were compared between 1089 glioma cases and 1922 matched controls and between 307 meningioma cases and 1095 controls. Significantly lowered odds of glioma were associated with the reporting of any type of cancer in a first degree relative (OR = 0.8, 95% CI = 0.7-0.99) and with any type of cancer excluding brain tumours (OR = 0.8, 95% CI = 0.7-0.9). No significant associations were found amongst the meningioma cases and controls, though elevated point estimates were found for those reporting parental lung and genitourinary cancers, while the presence of breast, lip, oral, pharyngeal and unspecified cancers all produced great reductions in meningioma odds, suggesting that further study is required.
In order to evaluate the association between adult brain tumours and genetic polymorphisms, a systematic review of the literature was completed. A total of 41 case-control studies were included, covering 46 separate genes and more than 100 different single nucleotide polymorphisms. When possible, quantitative data synthesis was performed to establish a more refined point estimate and confidence intervals. Heterogeneity across the studies and variability in the subject matter often prevented any possible data synthesis so establishing associations that were statistically significant was difficult. All told, there were 41 significant associations found amongst the included studies and each varied by the particular polymorphism or histology studied. None of the estimates produced in the quantitative data syntheses suggested a statistically significant association.
The results of this thesis suggest that a family history of cancer is not a risk factor for primary brain tumours in adults and that further work is necessary to better establish the possible association between various genetic polymorphisms and adult brain tumours.
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Sharafieh, Roshanak. "Molecular genetic screening and association studies of adult-onset primary open angle and congenital glaucomas." Thesis, St George's, University of London, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.559280.
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Glaucoma is a group of disorders with a broad range of clinical and histopathological manifestations. This condition presents itself in many different ways and with distinct shared characteristics that include optic neuropathy due to optic nerve head damage (cupping) and visual field dysfunction with or without presence of increased intraocular pressure (lOP). Glaucoma is the leading cause of irreversible blindness, which afflicts nearly 67 million people worldwide. It is considered the second most frequent cause of bilateral blindness, affecting 6.7 million people worldwide. By 2020, glaucoma is anticipated to affect 79.6 million people, increasing the number of bilaterally blind individuals due to glaucoma to 11.1 million. This thesis aimed to provide new insights into the molecular genetics of adult-onset Primary Open Angle Glaucoma (POAG) and a paediatric form of Primary Congenital Glaucoma (PCG). In the first portion of this work, the GLC1B locus on chromosome 2pl1.2-qI2.2 was investigated using extensive linkage and saturation mapping in order to reduce the region and to select potential candidate genes for screening 9 previously linked families. Genomic Convergence and Proteomic Streamlining methods were used to select and prioritise the most likely candidate genes. The prioritisation was based on tissue expression, bioinformatics, microarray data, as well as assessment of their protein- encoded functions. This investigation leads to the hypothesis that there may actually be two areas of interest for the GLCl B locus, one on the p arm and the other on the q arm of chromosome 2. Since at least three other independent studies shared a common overlapping area on the q arm of chromosome 2, single nucleotide polymorphisms (SNPs) from each of the genes within this common region were selected for a regional gene-specific association study. After genotyping our linked-GLC1B POAG families, sporadic cases and other matched control subjects, the genes that showed strong association were selected and screened for mutations. After direct sequencing of these genes, 62 DNA alterations (known and novel intronic and exonic variants) were observed and their disease-causing nature was carefully investigated. In conclusion, the GLC1B locus has been significantly reduced to a region of approximately 6.66-Mb. A total of 10 candidate genes were selected, individually sequenced and ultimately excluded as being involved in the aetiology of a group of GLC1B-linked POAG families. Further work is necessary to identify the defective gene(s) at the GLC1B locus. In the second portion of this thesis, the GLC3C locus on chromosome 14q24.3- q31.1, the study aimed to prioritise genes using similar methods to the strategies previously used to identify candidate genes within the GLC1B locus. These included Genomic Convergence, Proteomic Streamlining and the information from other linked families within the region. A total of 7 regional candidate genes were selected, sequenced and excluded as being involved in the aetiology of our GLC3C-linked family. Altogether, 80 DNA alterations (known and novel intronic and exonic variants) were observed in the sequenced genes and their disease-causing nature was carefully investigated. In addition, to the screening of the above-mentioned GLC3C candidate genes, a newly described PCG-causing gene, LTBP2, was fully sequenced and excluded in our GLC3C-linked family. Additionally, a total of 94 familial and sporadic PCG and 96 matched-control subjects were fully sequenced for the entire 36-coding exons of the LTBP2 gene. Only two heterozygous DNA alterations were identified in 2 PCG individuals, which were absent in 96 normal control subjects. Since no homozygous mutations were observed, further investigation is required to determine the disease- causing nature of these two DNA alterations. Therefore, this study was unable to replicate previously described mutations in the PCG subjects from Pakistan and Iran. Likewise, at least one other study of American PCG cases did not find any gene mutations in the LTBP2 gene, thus further confirming the observation of this study. As this gene is implicated in diseases with multiple clinical presentations, further investigation is necessary to determine the overall role that LTBP2 plays in the isolated PCG phenotype as well as in identifying the causative gene(s) within the GLC3C locus.
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Fletcher, Stephen. "Analysis of a failed primary commodity cartel : the Grenada Cooperative Nutmeg Association (GCNA) and the Association of Indonesian Nutmeg Exporters (ASPIN) Joint Marketing Agreement." Thesis, Aston University, 2017. http://publications.aston.ac.uk/37547/.
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This thesis is a study of a failed attempt at the formation of a primary commodity cartel. In 1986, the Grenada Cooperative Nutmeg Association (GCNA) entered into a Joint Marketing Agreement with the Association of Indonesian Nutmeg Exporters (ASPIN) to create a cartel by agreeing to control the supply of nutmeg and mace onto the international market to increase and stabilise the prices of the commodities. At the time of the Agreement , Indonesia was the world‘s largest supplier of nutmegs and mace (75 - 80 per cent of supply), and Grenada the second the second largest (10 - 15 per cent of supply). Catz International B V, a Dutch spice trader played a key role in the formation of the Agreement and was also instrumental in the formation of ASPIN, as an Indonesian association of nutmeg exporters and secured sole buyer status for nutmeg and mace exported by ASPIN. The Agreement appeared to be briefly effective raising prices but cracks appeared in the Agreement within two years and it formally ended in mid-1990. This thesis investigates: (a) the motivations and decision making of Grenadian stakeholders in forming the Agreement; (b) the role of external stakeholders in the formation, performance and demise of the Agreement, and (c) the ongoing efforts of the GCNA to continue the Agreement when it was failing. GCNA‘s archival records, statistical data, and discussions with key Grenadian stakeholders and some international traders were the sources of data. Stakeholder analysis and the literature on cartels provided the theoretical grounding and context. The qualitative case-study approach using triangulation to establish what happened and Langley‘s sense-making strategies have been used to construct the narrative. The key results of this study are: (a) the fundamental economic conditions necessary for the formation and sustenance of the Agreement as a cartel were absent; (b) the organisational arrangements for the sustenance of the Agreement on the Indonesian side were deficient, and (c) GCNA was active in forming the Agreement and persisted in attempts to revive the Agreement because of deficiencies in its information and knowledge about the Indonesian and market situation arising out of over-reliance on a single source. The study contributes to knowledge on decision making in commodity cooperatives in small economies and has wider lessons for management decision making in developing countries.
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Takada, Shiho. "Association Between Subjective Sleep Quality and Future Risk of Falls in Older People: Results From LOHAS." Kyoto University, 2018. http://hdl.handle.net/2433/232464.
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Jamensky, Glen Alexander. "Investigation of the association between posterior interproximal contact points and approximal caries in the primary dentition." Thesis, McGill University, 2001. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=33006.
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Caries in the primary dentition remains a public health problem despite a general decline in caries prevalence over the past 25 years. The present cross-sectional study investigates a hypothesized association between closed contact points in the primary dentition and approximal caries formation. It was carried out using a convenience sample of 286 children receiving dental care at the Montreal Children's Hospital. Bivariate analysis was performed using odd ratios, to determine which independent variables collected by the survey had a significant association with the dependent variable (approximal caries). Significant independent variables were then controlled for in multiple logistic regression analysis. These analyses revealed a strong association between the presence of approximal caries and closed contact points, warranting further investigation by longitudinal studies. If these results can be replicated, flossing the primary teeth and incorporating tooth position into prediction models could become important preventative weapons in fighting this disease.
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Liong, Chi-ki Jackie. "The association of primary dysmenorrhea with the perception of pain, work stress and lifestyles of nurses /." View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36396321.
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Liong, Chi-ki Jackie, and 梁姿琪. "The association of primary dysmenorrhea with the perception of pain, work stress and lifestyles of nurses." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B45011825.
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Brucker, Penny Sue. "Examining the association between collaboration, therapeutic alliance, and psychotherapy outcome in a primary care medical setting /." The Ohio State University, 2001. http://rave.ohiolink.edu/etdc/view?acc_num=osu1486394475981279.
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Rahman, Nuzhat. "Association between circulating concentrations of micronutrients and risk of being diagnosed with primary lung cancer among smokers." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2009. https://www.mhsl.uab.edu/dt/2009m/rahman.pdf.
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Williams, Hilary J. "An analysis of the immune response to primary Epstein-Barr Virus infection and the association with clinical events." Thesis, University of Edinburgh, 2005. http://hdl.handle.net/1842/27681.
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Infectious Mononucleosis (IM) is one of the most common serious illnesses in young adults, and is caused by delayed primary infection with Epstein-Barr Virus (EBV). The characteristic clinical features are thought to be due to extensive T cell activation, and cytokine production, but the molecular mechanisms underlying this are unclear. SAP (Surface Lymphocyte Activation Marker (SLAM) associated protein), is mutated in X-linked lymphoproliferative disease (XLP), in which fatal IM occurs, and is a key regulator of lymphocyte activation via signals from cell surface 2B4 (CD244) and SLAM. Our aim was to monitor T cell activation via this SAP/SLAM/CD244 pathway, and analyse whether the scale of activation was related to the severity of clinical features in a cohort of 26 cases of IM. In addition, 10 males with fulminant IM were screened for XLP gene mutations but none were identified. At diagnosis of IM, SAP, CD244 and SLAM were significantly upregulated, compared to controls, on both CD4 and CD8 T cells in peripheral blood (p < 0.01). The expression fell over the course of IM, but CD244 and SLAM remained elevated on CD8 cells at one month post diagnosis. The numbers of lymphocytes expressing CD8, and CD244/CD8 were significantly higher in cases with severe compared to mild sore throat (p < 0.05). Both expression of CD8, and expression of CD244 on CD8 cells correlated positively with increased viral load (p < 0.05). Time is required for this antigen specific immune response to develop. In contrast innate immune responses, such as Natural Killer (NK) cells are thought to be vital early in the infection process. We show that NK cell numbers are significantly elevated at diagnosis of IM compared to controls (p < 0.01) and in the first month following diagnosis. In healthy adults, 2 distinct populations of NK cells have been identified by the density of cell surface expression of CD56; these subsets of CD56bright and CD56dim cells differ in their ability to produce cytokines and lyse target cells. We have identified significant changes in NK cell phenotype and function during IM, with an increase in the proportion of CD56bllght cells, and cells showing an enhanced ability to kill an EBV infected cell line. We suggest that activated T cells expressing CD244 modulate the clinical features of IM, but control of activation is maintained by concurrent increased expression of SAP. However, before this occurs NK cells have a critical role in both eliminating infected B cells and augmenting this antigen specific T cell response via release of immunomodulatory cytokines. The magnitude of the NK cell response may ultimately determine whether primary EBV infection has a subclinical or clinical outcome.
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Karnosky, Julia [Verfasser], and Christian [Akademischer Betreuer] Schulz. "Association between human papillomavirus and primary lung cancer – a systematic review and pilot study / Julia Karnosky ; Betreuer: Christian Schulz." Regensburg : Universitätsbibliothek Regensburg, 2020. http://d-nb.info/1216703590/34.
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Nkambule, Ntombizodwa Rosemary. "Association between diet dental caries and body mass index amongst grade six learners at selected primary schools in Tshwane." Diss., University of Pretoria, 2017. http://hdl.handle.net/2263/65843.
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Introduction: Childhood obesity and dental caries (DC) have increased worldwide and are continuing to pose challenges to public health. The increasing risk of obesity for children is of particular concern because research has suggested that childhood obesity predicts adult obesity. Children experiencing DC early in their lives have a much greater probability of subsequent caries in their permanent dentitions and adulthood. Studies have reported a strong association between the nutritional intake and DC and reported a direct link between DC, sugar consumption and obesity. Objectives: to assess the association between dental caries (DC), the Body Mass Index (BMI) and diet among grade six learners at selected primary schools in Tshwane West District. Methods: A cross-sectional analytical study of grade six learners was carried out in Tshwane. The data collection consisted of a questionnaire, clinical oral examination and anthropometric measurements. All clinical data was collected by a single calibrated examiner. A validated questionnaire was used to collect the demographic data and the type of diet consumed. The SPSS version 23 software was used for analysis. Descriptive statistics, Chi-Square test to test for significance for categorical data and logistic regression analysis were used to determine statistical significance. Results: The response rate was 83% (440) and of these 53% were male. The mean age of the participants was 11.8yrs. The majority of the participant’s fathers (71%) and 50% of mothers were employed. The DC prevalence was 43% with a mean DMFT score of 1.19 (SD= ±1.79). The PUFA score was zero. Less than half (47%) of the participants reported to brush their teeth twice daily. The majority (71%) claimed to drink between one and one and a half glasses of sugar-sweetened beverages (SSBs) with 67% eating between one and three sweets per day. While most of the participants reported having a balanced meal at supper, a third reported eating junk food. The majority (71%) of participants had a BMI score that was within the normal range with 19% being overweight. There were no significant associations between the mean DMFT, BMI scores and the SES of the participants. Conclusion: The DMFT was low, but the decayed component was relatively high. The PUFA score was zero. Most participants were classified as having a “normal” BMI with almost a quarter being classified “overweight”. There were no significant associations between the DMFT and the mean BMI scores and SES of the learners. More than half of the participants were from a medium SES and had a slightly high DMFT score than their counterparts. Less than half reported to brush their teeth daily, most of them had a balanced diet at supper.Dissertation (MChD)--University of Pretoria, 2017.
Community Dentistry
MChD
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Oosthuizen, Henriëtte. "The association between prematurity, motor fuction and health related quality of life among learners in the foundation primary phase." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/28261.
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Introduction and Aims: Children born prematurely (≤ 36 weeks gestation) are at risk of poor developmental outcomes and are more likely than their full-term (FT) peers to have behavioural, physical and/or cognitive limitations. In order to deliver effective interventions, therapists need to have a sound understanding of the problems experienced by children who were born prematurely. Presently, very little is known about the functional problems of young school aged children, living in the Free State province of South Africa, who were born prematurely. Methodology: This study was conducted in 15 randomly selected schools located within in a 100 km radius of Bloemfontein. Two groups of children in grades R, 1 and 2 (age range: 5-8 years) were recruited, the first group (PREM group) consisted of children having a history of premature birth (≤ 36 weeks). The second group consisted of full term children (FT group) who were matched for age and gender to the first group. The PREM group was categorised into three subgroups according to prematurity status: late premature (34-36 weeks, LP), moderate (MP) to very premature (29-33 weeks, VP) and extremely premature (≤ 28 weeks, EP). A self-designed questionnaire was used to record demographic and medical information obtained from parents. The questions were related to antenatal factors, birth and medical history of the child. The Movement Assessment Battery for Children second edition (MABC-2) and MABC-2 Checklist were used to evaluate functional motor problems in children. The European Quality of Life Dimension Scale- Youth version (EQ-5D-Y) was used to determine the Health Related Quality of Life of the children and the Strengths and Difficulties Questionnaire (SDQ) was used to describe the behavioural and emotional status of each child according to their parents and teachers. Ethical approval was obtained from the University of Cape Town Research Ethics Committee (HREC REF: 694/2014) and permission to conduct the study within schools was granted by the Free State Education Department. Informed consent and assent was obtained. Parents were interviewed by a research assistant using the self-designed questionnaire. A different researcher then tested all children using the MABC-2 and assisted each child to complete the EQ-5D-Y. The parents and teachers each completed the SDQ and teachers completed the MABC-2 checklist. Statistical analysis was conducted using SAS® Version 9.4 and STATISTICA 10. The data were summarized using descriptive statistics (i.e. number of available data (n), mean, and standard deviation, minimum, median and maximum). The Mann Whitney U test was used to compare groups (PREM vs FT groups) and the Chi-square test was used to determine any association between groups and 5 descriptive variables. Comparisons between prematurity subgroups were conducted using the Kruskal- Wallis ANOVA. Results: 122 children participated in this study: 61 FT children and 61 PREM children. The PREM group consisted of 23 children who were classified as late premature, 27 who were moderate to very premature and 11 children who were extremely premature There were no differences between groups in terms of age (U = 1760, z = -0.51, p = 0.610), gender (Chi = 0.03, df = 2, p = 0.86), grade level (Chi = 0.386, df = 3, p = 0.98) and socioeconomic status [as defined by mothers level of education (Chi = 3.79, df = 2, p = 0.15) and school quintile (Chi = 5.22, df =2, p = 0.07)]. Differences were found in terms of maternal age at delivery (PREM = 31.9 years [SD=5.2] vs. FT = 29.02 years [SD = 3.5] df = 120, t = -3.61, p < 0.001). As expected, the PREM group had a significantly lower birthweight compared to the FT group (PREM = 2201g [SD = 748] vs. FT = 3132g [SD = 406], df = 120, t = 8.54, p < 0.001). 96.7% of those in the PREM group were born via C/section (p < 0.0001). Apart from one case of respiratory distress, the FT group reported no neonatal complications. As expected, more candidates in the PREM group were more frequently hospitalised (Chi = 34.605, df = 2), and cases of CP were reported. The APGAR scores were significantly different between FT and PREM groups at 1min (p<0.0001) and 5min (p<0.0001) Regarding motor performance, there was a significant difference in MABC-2 Total Standard Scores (MABC TSS) (U = 1425.0, z = 2.23, p = 0.026) and the MABC-Checklist Total Motor Scores (U = 1016.5, z = -4.32, p < 0.0001) with FT group performing better and reporting less functional motor problems than the PREM group. Regarding HRQoL, we found that groups were also significantly different in terms of the Mobility domain of the EQ-5D-Y with the Prem group reporting more problems than the FT group (Chi = 6.31, df =1, p = 0.012). No differences were found between groups with regard to the Looking After Myself (Chi = 2.03, df =1, p = 0.153), Usual Activities (Chi = 0.00, df = 1, p = 1.0), Worried/Sad/Unhappy (Chi = 1.22, df =1, p = 0.541), and Pain/Discomfort (Chi = 3.59, df = 1, p = 0.165) domains. In terms of emotional-behavioural status, we found no differences between the two groups in terms of Parent Total Difficulties scores (U = 1791.50, z = -0.351, p = 0.725) as well as Teachers Total Difficulties Scores (U = 1518.0, z = -1.751, p = 0.08). However, the FT group scored lower than the PREM group on the emotional domain (U = 1404.0, z = -2.33, p = 0.02) indicating less problems and higher on the prosocial domain (U = 1335.0, z = 2.68, p = 0.007) indicating more positive factors in this group. On examination of the PREM sub groups, we found no differences in Parent Total Difficulties Score between groups (p = 0.377). When we compared parent versus teacher SDQ scores, 45 (73.8 %) cases where the parent and teacher were in agreement with the "normal" assigned score. In addition, there were 2 (3.3 %) cases were the parent and teacher respectively assigned a score of "abnormal" and "borderline". Regarding the Impact scores, parents/caregivers reported that the difficulties (emotional, conduct, hyperactivity, peer and prosocial problems) did not have an impact on a child's friendship (p = 0.2889), classroom learning (p = 0.2325), leisure activities (p = 0.3585) or their home life (p = 0.1248). In contrast, teachers' responses indicated that the difficulties had an influence on classroom learning (p = 0.0030) but not friendships (p = 0.2374). Discussion: The late premature group made up a bigger proportion of the premature group. This correlates with the PPIP report, where the same trend was noted for the South African premature population (Pattinson, Saving Babies [PPIP], 2012-2013; Kalimba & Ballot, 2013). Findings from this study correlated with literature on PREM children being more at risk of decreased motor function when compared to FT peers (Hack et al., 2002; Chyi et al., 2008; Stephans & Vohr, 2009; Van Baar et al., 2009; Hornby & Woodward, 2009; Van Baar et al, 2013). Fine motor skills is essential in a child's daily activities and very important to function at school. This study indicated a deficiency within fine motor and balance domains within the PREM group. Maternal age surfaced as predictor of motor performance as younger mothers (< 19 years) have an increased risk of low birth weight and premature infants (very and extremely premature) (Schempf, Branum, Lukacs & Schoendorf, 2007; Gibbs, Wendt, Peters & Hogue, 2012; Kalimba & Ballot, 2013; Fall, Sachdev, Osmond, Restrepo-Mendez, Victora, Martorell, Stein, Sinha, et al., 2015; Benli, Benli, Usta, Atakul, Koroglu, 2015). Literature on older mothers (≥ age 35) also showed an increased risk towards premature birth (moderate and very premature) with more medical conditions (such as hypertension and diabetes)-this was not the case in this research (Schempf et al., 2007; Gibbs et al., 2012; Kalimba & Ballot, 2013; Fall et al., 2015; Benli et al., 2015), however it is reported that PREM infants from older mothers show somewhat better outcomes of infants later in life (Schempf et al., 2007; Gibbs et al., 2012; Kalimba & Ballot, 2013; Fall et al., 2015; Benli et al., 2015). Other findings from this research indicated that, from the teachers' perspectives, PREM children showed a greater tendency towards emotional and prosocial behaviour impairments, than the FT population. This align with literature where premature infants are mentioned to be more susceptible to behaviour performance problems at school-age (Kerstjens et al., 2012; Bos et al., 2013; Moreira et al., 7 2014). In this research, the extremely premature group had more behavioural problems which had an impact on theses children's leisure activities, peer, and classroom learning. Conclusion: Our findings suggest that PREM children have more motor problems than FT children and that the very preterm group showed the highest risk for motor problems. Maternal age also indicated to be an influencing factor where mothers younger than 19, as well as mother over 35, both indicated a risk for premature birth, resulting in low birth weight. Other risk factors influencing function in the PREM, apart from low birth weight, indicated by the results were factors like respiratory distress, apnoea, haemorrhaging and the exposure to post-natal steroids. According to teacher's perceptions, the children in the PREM group, tended to show more behavioural and emotional problems that those of the FT sample.
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Collins, Blanche C. "The association between 2002 office Chlamydia screening rates, physician perception, and physician behavior." Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2006. https://www.mhsl.uab.edu/dt/2007r/collins.pdf.
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Keulen, Silvia van Verfasser], and Nikos K. [Akademischer Betreuer] [Logothetis. "Catecholaminergic Modulation of Sensory Processing in functionally distinct Primary Sensory and Association Cortex / Silvia van Keulen ; Betreuer: Nikos K. Logothetis." Tübingen : Universitätsbibliothek Tübingen, 2017. http://d-nb.info/1199545740/34.
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Keulen, Silvia van [Verfasser], and Nikos K. [Akademischer Betreuer] Logothetis. "Catecholaminergic Modulation of Sensory Processing in functionally distinct Primary Sensory and Association Cortex / Silvia van Keulen ; Betreuer: Nikos K. Logothetis." Tübingen : Universitätsbibliothek Tübingen, 2017. http://d-nb.info/1199545740/34.
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Artus, Majid. "The association between non-specific factors and response to primary care treatments for low back pain : a synthesis of evidence." Thesis, Keele University, 2011. http://eprints.keele.ac.uk/3828/.
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Findings from randomised controlled trials (RCTs) on primary care treatments for non-specific low back pain (NSLBP) often show modest or non-significant differences in responses to treatments. The overall response to treatment within arms, however, is often large. This raises the question of the non-specific effects associated with using the treatments and whether the size of these non-specific effects is much larger than the size of effects associated with the specific components of treatments. Non-specific effects in clinical trials, defined in this thesis as the effects on the overall improvement of symptoms (i.e. response to treatment) that is not attributed to the treatment itself, contribute to the clinical course of symptoms and can be related to the patient, the symptoms, the healthcare practitioner, the communication between the patient and practitioner, the nature of treatment provided and the setting and environment of the clinical encounter. The objectives of this study were examining: 1) the pattern of within-arm overall responses to treatments in RCTs on non-specific low back pain; 2) sources of variation in responses to treatments by investigating the association of non-specific factors with overall responses to treatments; 3) the influence of patient characteristics on responses to treatments using individual patient data from RCTs; and 4) whether merely participating in RCTs adds to the size of response to treatments (the ‘trial effect’). The findings suggest that responses to treatments for NSLBP follow a pattern of an early large improvement in symptoms within 13-27 weeks of starting treatment followed by a smaller further improvement. This pattern was common to arms of RCTs regardless of the type of treatment. There was evidence that participants who had back pain episodes of less than 13 weeks showed larger responses to treatments than those with longer duration. There was weak inconclusive evidence for the association with age, gender, history of back pain, overall trial quality, adequacy of patient blinding and adequate compliance. There was no evidence that participating in RCTs led to larger improvement in back pain symptoms compared with participating in cohort studies. In conclusion, there is some evidence for the association of factors that are not related to the treatments with responses to treatments for NSLBP. Insufficient data hindered the assessment of other non-specific factors that were considered to be important, such as practitioner-patient communication.
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Geisler, Matthias [Verfasser]. "About the association of tracks to primary vertices in the context of a Pileup subtraction at the CMS experiment / Matthias Geisler." Aachen : Hochschulbibliothek der Rheinisch-Westfälischen Technischen Hochschule Aachen, 2014. http://d-nb.info/106681290X/34.
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Havyarimana, Enock. "Blood pressure variation and its association with outdoor temperature among adults with hypertension in a primary care setting in South Africa." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29246.
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Rationale – There is limited evidence about the effect of climate on blood pressure management of people living with and cared for hypertension in Sub-Sahara Africa. We investigate the relationship between outdoor temperature and blood pressure in a primary care setting with limited control of indoor climate in Cape Town, South Africa.
Method – The study uses blood pressure data from 2494 participants screened and enrolled for entry in the SMS-text Adherence (StAR) trial study. Participants’ data were matched with outdoor temperature and air quality data using the nearest hour of enrolment. Individuals were included in this study if they were recruited during the study’s screening period (June 2012 to November 2014) and the clinic’s operating hours (7h00 and 17h00).
Result - 72% of participants enrolled for the trial were female and had a BMI of 31 kg/m2 . There was an inter-subject variation of blood pressure between participants enrolled in winter and spring. Those enrolled in winter (June – July) and in the morning (07h00-10h00) when temperatures were generally low, had a higher mean blood pressure compared to those enrolled during spring (September - November) and in the afternoons (≥13h00). Mean outdoor temperature during the trial period was 16.7°C (min: 3.7°C –max: 30.7°C) with lowest temperatures recorded in June. Both outdoor temperature and blood pressure were found to be associated with nitrogen dioxide (NO2) and sulphur dioxide and (SO2) and therefore may be confounded by them. In a multivariate analysis controlling for air pollution, humidity and several leading cardiovascular risk factors, it was observed that a 10°C increase in outdoor temperature was associated with 7.5mmHg (95% CI: 3, 82 - 11, 18) change in systolic blood pressure. This association is modified by age, BMI and the time of the day. Those 65 years and older, with a low BMI and those enrolled in the morning (7h00 – 10h00) had the greatest change in blood pressure due to outdoor temperature
Conclusion –The study shows an inverse association between outdoor temperature and clinic-based blood pressure in a primary care setting in South Africa. Given the fact that clinic-based blood pressure measures are used to direct the management of hypertension, greater attention needs to be given to environmental factors which may affect it. This may become of greater clinical relevance with changes in the climate and extreme weather patterns, including extensive smog
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Kang, Cuiping. "The role of paired-associate learning skill and rapid naming in learning to read Chinese." Click to view the E-thesis via HKUTO, 2010. http://sunzi.lib.hku.hk/hkuto/record/B44141038.
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Teague, Barbara A. (Barbara Ann). "An Assessment of Arkansas Middle school/Junior High School Art Programs Using National Art Education Association Standards." Thesis, North Texas State University, 1986. https://digital.library.unt.edu/ark:/67531/metadc331828/.
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The purpose of the study was to make an assessment of Arkansas middle school/junior high art programs using National Art Education Association standards. Data were collected from questionnaires, curriculum guides, and school visitations. Participating in the study were 127 schools enrolling 53,502 students of which 14,755 (28%) were taking art classes. For comparisons, the state was divided into five regions.
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Wohlwend, Martin. "Investigation of an Exercise-Induced State of Hypofrontality : And its Potential Association with Central Fatigue." Thesis, Norges teknisk-naturvitenskapelige universitet, Institutt for nevromedisin, 2012. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-16840.
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The reticular-activating hypofrontality model of acute exercise (RAH) predicts exercise-induced hypoactivity in frontal cortex which mediates executive function. Connors Continuous Performance Test (CCPT) was used to investigate changes in executive function during- and post treadmill running in healthy volunteers (n=30, 15 male). In a randomized order, subjects performed the CCPT at rest, during low- (LI; 63% maximal heart rate; MHR) and moderate intensity (MI; 75% MHR). Separately, subjects then performed isocalorifically matched exercise bouts of LI, MI and high intensity interval training (HIT) consisting of 4x4 min with 90% MHR and 3 min recovery at 60-70% MHR. Repeated measures ANOVAs revealed main effects of exercise intensity for reaction time RT during- (p≤0.001) and post exercise (p≤0.0001). Subsequent analyses showed an overall increase of RT during exercise compared to rest (p≤0.005). RT decreased significantly from rest to post exercise levels in an exercise intensity dependent, linear fashion (p≤0.0001). Commission errors showed a non significant linear trend to increase both during (p=0.057), and post exercise (p=0.052) as a function of intensity. In a follow up study, we sought to relate observed exercise effects to frontal cortex activity through the use of transcranial direct current stimulation (tDCS) (n=4) and transcranial magnetic stimulation (TMS) over the dorsolateral prefrontal cortex (DLPFC). Prior to TMS stimulation cortical excitability was estimated post running through motor-evoked potentials (MEP) elicited from the primary motor cortex (M1) induced by single burst TMS and measured in the first dorsal interosseous (FDI) muscle using electromyography. At rest, inhibitory cathodal tDCS with left DLPFC cathode and right supraorbital anode led to improved reaction time and increased amount of commission errors, whereas anodal stimulatory tDCS in the immediate post exercise period was unable to recover the post exercise effect. Continuous theta burst stimulation over the left DLPFC post running further impaired inhibitory control and facilitated reaction time. Different findings during- and after- exercise suggests that potential contributing mechanisms such as computational and metabolic factors may be differentially active during these respective conditions. Furthermore, the fact that an inhibitory TMS protocol pronounced the post running effects even more and that we were able to mimic the reported RAH effects at rest with inhibitory frontal tDCS, but observed different patterns during exercise, suggests that the latter state cannot be fully explained by reducing activity in the left frontal cortex alone. Failure to modify the after exercise effect with stimulatory tDCS also supports an interplay of different factors and might emphasize the strong, robust effects of exercise that cannot simply be attenuated by current application. Increases in MEP post running for 35min paired with the observed performance decrements imply an excited state of M1 and might serve as an explanatory cross-link to central fatigue suggesting that a hypofrontal state might enhance the motor cortical drive to activate muscles.
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Makino, Seiko. "Investigation of expression quantitative trait loci and regulatory genetic variants in primary human immune cells." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:67d0c1e8-c6f1-4ca7-a311-52f20b79128b.
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The post human genome sequence era has begun to explore various aspects of the functional genome in relation to disease including gene expression, genetic variation and epigenetics. The genetic determinants of common and complex phenotypes are difficult to resolve even though their heritability is recognised. Recent genome-wide association studies (GWAS) for common diseases has identified many new disease susceptibility associated loci. These loci often lie in non-coding regions of the genome and disease associated genetic variants are proposed to act by modulating gene expression. This thesis investigated genetic variation as determinants of gene expression in the context of the immune system especially focused on the innate immune and inflammatory responses. Different primary human immune cell types were collected from healthy volunteers of European ancestry to achieve this. In order to identify genetic variants associating with gene expression, expression quantitative trait loci (eQTL) mapping was conducted in a cell type specific manner. The primary dataset (n=288) consists of CD19+ B-cells from the adaptive immune system and CD14+ monocytes from the innate immune system. 78% of the total cis eQTL were found to be cell type specific and include genes relating to their roles in the immune response. Trans eQTL showed greater cell type specificity and include master regulatory eQTL on the LYZ locus at chromosome 12q15 in monocytes and the KLF4 (9p31) in B-cells. The identified eQTL are implicated in association with autoimmune disease susceptibility including inflammatory bowel disease, diabetes and rheumatoid arthritis. The second analysed dataset (n=64) consists of CD14+ monocytes and macrophages differentiated ex vivo. Macrophages are involved in many inflammatory diseases as well as in the innate immune response. The differential gene expression and eQTL mapping analyses were conducted to investigate macrophages specific gene expression signatures and associations to genetic variants. Macrophage eQTL are involved in signal transduction for the inflammatory response (IL1RN and STAT4) and lipid metabolism (PPARG) with implication for metabolic disease association. The eQTL analyses using primary immune cell types provide insights into genetic variation in association to gene expression which is involved in autoimmunity and disease susceptibility.
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Vaideanu-Collins, Daniela. "An association study of PITX2 polymorphism in a cohort of patients with primary open angle glaucoma and considerations on the genetics of glaucoma." Thesis, University of Newcastle Upon Tyne, 2010. http://hdl.handle.net/10443/1061.
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Background: Glaucoma is a major cause of blindness world-wide. There is a need for methods to identify individuals at risk of developing glaucoma, so that early treatment can prevent visual loss. Genetic screening tests offer the prospect of pre-symptomatic diagnosis of at risk individuals. There is now strong evidence that a number of different genes are associated with glaucoma susceptibility. Mutations in the PITX2 homeobox transcription factor gene disrupt normal development of the anterior segment and cause overt structural abnormalities. It is possible that, as yet undetected mutations/polymorphisms in PITX2 may produce subtle and undetected abnormalities in anterior segment structure and function that could predispose to glaucoma. Purpose: The aim of this thesis is two fold: 1. Screening for the presence of single nucleotide polymorphisms in PITX2 gene in a cohort of 100 unrelated primary open angle glaucoma/ ocular hypertension patients, 10 Posterior embryotoxon subjects and 100 age and ethnically matched controls to establish the mutation spectrum. 2. Identification, phenotyping and recruitment for genetic studies of primary open angle glaucoma patients with strong family history of glaucoma. Materials and methods: 1. 100 primary open angle glaucoma patients and 60 age and ethnically matched controls were enrolled in the study. Patients and controls were phenotyped and a blood sample for DNA extraction collected. PITX2 exon-specific primers were used to PCR amplify patient and control DNA. Direct sequencing was used to screen for sequence alterations in the entire coding sequence of PITX2 gene. Concurrently, polymorphic sites reported in the PITX2 gene were identified from the NCBI and Ensemble databases and the frequency of polymorphic sites was investigated. The SHEsis and UNPHASED software packages were used for statistical analysis. 2. Patients diagnosed with glaucoma and strong family history were identified from Glaucoma Unit at Sunderland Eye Infirmary, phenotyped and enrolled in the study. The pedigrees were constructed and interested relatives enrolled in the study and phenotyped. A sample of blood for DNA extraction was collected from all people enrolled in the study. Results: 1. Direct sequencing did not identify any sequence variation in the coding region. 26 PITX2 polymorphic sites were identified from the internet databases, including five in the coding sequence. Sixteen non coding SNPs were confirmed within our study group and SNP frequencies were examined. None of the coding sequence SNPs was identified in our cohort, demonstrating a high degree of sequence conservation. Also, none of the SNPs confirmed in this study group showed an increased frequency in the primary open angle glaucoma group compared with the control group. 2. Thirty-three pedigrees were identified with strong family of glaucoma during the time allowed for patient recruitment. Of these, twenty-two agreed to take part in the study. Thirteen pedigrees are presented in this study, mostly demonstrating autosomal dominant inheritance. Conclusion: There is ample evidence to suggest that genetics play an important role in unravelling the pathogenesis of glaucoma. Identification and recruitment of patients for genetic studies is an essential step and the role of the clinician in this process is paramount. Also, developmental glaucoma genes are an important group of genes to be screened in primary open angle glaucoma/ocular hypertension patients, as they may play a role in the pathogenesis of this preventable blinding disease.
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Stokes, Michele A. "The Association of Adult Day Health Services Use and Burden, Self-Rated Health, and Additional Characteristics of Primary, Informal Caregivers of Older Adults." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1313610157.
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Liao, Hsin-Chung. "The Association of Spatial Accessibility to Health Care Services with Health Utilization and Health Status Among People with Disabilities." Cleveland State University / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=csu1295035743.
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Kang, Cuiping, and 康翠萍. "The role of paired-associate learning skill and rapid naming in learning to read Chinese." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44141038.
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Nakafero, Georgina. "The association between benzodiazepines and asthma exacerbation, influenza-like illness related pneumonia and mortality : population-based studies using the United Kingdom Primary care data." Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/31839/.
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Background: Influenza-like illness (ILI) and asthma are common diagnoses in the general practice and exert considerable morbidity and mortality worldwide. One potentially important strategy to reduce this is to determine whether commonly prescribed drugs modify the occurrence and outcomes of respiratory diseases including mortality. The benzodiazepines, a class of psychoactive drugs generally used in the treatment of anxiety and sleep disorders, have recently been suggested as having detrimental effects on immune response to infection, predisposing its users to increased risk of infection and mortality. These drugs have also been implicated in the pathogenesis of asthma. This thesis therefore aimed to investigate whether benzodiazepines modify the occurrence of asthma exacerbation and subsequent mortality in patients with asthma as well as ILI-related pneumonia and ILI-related mortality in patients with ILI. Methods: The Clinical Practice Research Datalink (CPRD) was used as the data source. CPRD contains the medical records of over 13 million patients prospectively collected from over 600 general practices across the United Kingdom and has linkages to the Hospital Episode Statistics database [HES] and national death registry data (the Office of National Statistics [ONS]) which were utilised in this study. CPRD-HES linked data was used to validate diagnoses of asthma exacerbation whereas ONS mortality data validated deaths identified from CPRD. Case-control and cohort study designs were used to investigate associations between benzodiazepines and the occurrence of asthma exacerbation, ILI-related pneumonia and mortality. Results: After adjusting for a wide range of potential confounders including physical and psychiatric comorbidities, and concurrent use of other drugs, exposure to benzodiazepines was associated with statistically significant increased occurrence of asthma exacerbation, ILI-related pneumonia and mortality. These associations were observed with both short term and chronic benzodiazepines use. However, the effect of individual benzodiazepines varied across the outcomes of interest with some of the associations lacking statistical significance. For instance, current use of diazepam and temazepam but not lorazepam showed statistically significant associations with increased occurrence of asthma exacerbation. Conclusion: Overall, findings of this research signal an adverse benzodiazepine effect and hence suggest that a precautionary approach should be exercised when prescribing benzodiazepines in the interim before conclusive evidence is yielded by further research, especially in patients who may already be at increased risk of asthma exacerbation or pneumonia and mortality.
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Winter, Stephen John. "Tutor supervision, tutoring behaviours and outcomes in peer tutored paired reading." Thesis, Hong Kong : University of Hong Kong, 1994. http://sunzi.lib.hku.hk/hkuto/record.jsp?B14473239.
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Moodie, Crawford. "An investigation into the gambling behaviour of those in primary through to tertiary education in Scotland, and an examination of the association between gambling and depression and erroneous cognitions." Thesis, Glasgow Caledonian University, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.443245.
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Miller, Lakisha Chitique. "Medical Resident Turnover and Its Association with Inpatient Mortality in Patient Discharges with a Primary Diagnosis in the Heart Disease, Cancer, or Stroke Diagnostic Groups at U.S. Teaching Hospitals, 2002." Case Western Reserve University School of Graduate Studies / OhioLINK, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1239044238.
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Shiomi, Hiroki. "Association of onset to balloon and door to balloon time with long term clinical outcome in patients with ST elevation acute myocardial infarction having primary percutaneous coronary intervention: observational study." Kyoto University, 2013. http://hdl.handle.net/2433/174776.
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Sinquin, Anne. "Alginates associatifs : synthèse et étude physico-chimique en milieu aqueux." Vandoeuvre-les-Nancy, INPL, 1995. http://www.theses.fr/1995INPL035N.
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La synthèse de polymères hydrosolubles présentant un caractère associatif a été effectuée, par réaction de diverses alkylamines à chaine longue (Cn-NH2, 8≤n≤16) sur l'alginate de propylène glycol (PGA), un dérivé partiellement estérifié d'un polysaccharide extrait des algues. Les propriétés physico-chimiques des dérivés hydrophobisés résultants ont été étudiées, comparativement à celles des polymères parents, en rhéologie, en spectrophotométrie de fluorescence et par des mesures de tension superficielle, dans l'eau pure ou en présence de sels. De façon générale, on observe que le caractère associatif des dérivés synthétisés augmente avec le taux et la longueur des segments hydrophobes immobilisés sur le PGA. Ainsi, si les effets d'interactions hydrophobes ne sont pas mis en évidence pour le dérivé en C8, les dérivés hydrophobisés par des chaines alkyles longues (C12 et C14) présentent, quant à eux, d'importantes variations de comportement par rapport aux polymères parents. Celles-ci résultent de la mise en place d'interactions hydrophobes entre les chaines alkyles immobilisées sur le squelette polysaccharidique. Ces interactions sont essentiellement de nature intramoléculaire en solution diluée tandis que les associations intermoléculaires deviennent prépondérantes en régime semi-dilué. Des entités de volume hydrodynamique élevé apparaissent alors et conduisent à une augmentation spectaculaire de la viscosité, pouvant aller jusqu'à la formation d'un réseau tridimensionnel ayant une structure de gel physique
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Silva, Alessandra Carvalho dos Santos da. "Capacitação ativa para o atendimento de parada cardiorrespiratória: uma adaptação da metodologia OSCE." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/7/7144/tde-01112018-144132/.
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Esta pesquisa apresenta um modelo de capacitação para o atendimento de parada cardiorrespiratória a partir de uma abordagem qualitativa com foco na prática pedagógica envolvida nesse processo. Os objetivos específicos foram: aplicar o método Objective Structured Clinical Examination (OSCE)adaptado para o atendimento de parada cardiorrespiratória, elaborar uma metodologia para a capacitação dos profissionais para o atendimento de parada cardiorrespiratória e analisar os mediadores pedagógicos aplicados no processo capacitação. A pesquisa foi realizada em uma Assistência Médica Ambulatorial Integrada, localizada na Região Leste do Município de São Paulo. Estimou-se que a capacitação ocorreria no centro de treinamento e no espaço dos participantes, o que demandou o reconhecimento antecipado do campo e articulações junto à Supervisão Técnica de Saúde. A organização dos materiais didáticos envolveu a parceria com um instrutor credenciado pela American Heart Association, além da elaboração e aplicação da metodologia OSCE adaptada para o processo de aprendizagem. Os sujeitos da pesquisa foram oito participantes voluntários, do turno da manhã e da tarde, integrantes da equipe de enfermagem da unidade. Procedeu-se uma capacitação em três etapas: a primeira constitui-se uma aula teórico-prática em atendimento à parada cardiorrespiratória no centro de treinamento. A segunda foi uma simulação de um caso clínico de parada cardiorrespiratória na sala de classificação de risco, envolvendo uma atriz e os sujeitos da pesquisa, seguido de um atendimento na sala de emergência utilizando um manequim e aplicando todos os procedimentos recomendados. Na terceira etapa foi realizada uma entrevista semiestruturada norteado por perguntas disparadoras. As cenas foram captadas por meio de gravação de imagens e de áudio na segunda etapas, a fim de promover um feedback aos participantes. Ao término dessa construção, procedeu-se à entrevista com roteiro semiestruturado individualmente, de forma a conhecer as dificuldades e facilidades vivenciadas pelos participantes e, simultaneamente, analisar a aplicabilidade da metodologia proposta. Quanto aos dados da entrevista, realizou-se a escuta, transcrição e sistematização em categorias por meio da técnica de análise de conteúdo. Os fundamentos teóricos e pedagógicos propostos por Robert Harden (1975), Paulo Freire (2014) e Edgar Morin (2003), nortearam a discussão dos resultados em duas categorias analíticas: mediação pedagógica no processo de capacitação e aprendizado no ambiente de trabalho como forma de produção. O resultado foi uma associação de três fases operacionais. A primeira fase de fundamento teórico-prático foi caracterizada pela interação proativa. A segunda fase de simulação com uma paciente-atriz, os participantes foram ativos no atendimento, entretanto os sinais de agravo clínico provocaram comportamento de apreensão, rapidamente superado. Houve uma pequena disfunção no acesso aos materiais, porém a equipe demonstrou equilíbrio, fito às manobras de ressuscitação realizando os procedimentos com sucesso. A terceira etapa foi a entrevista semiestruturada, resultando em uma súmula de pertinência pedagógica e metodológica para a transformação da prática. Cabe ressaltar que o conjunto da metodologia favoreceu a co-construção do sentido da aprendizagem e da reflexão crítica como base da transformação. Em síntese, foi possível concretizar a elaboração de um modelo de capacitação e comprovar sua aplicabilidade na prática do atendimento à parada cardiorrespiratória.This research presents a training model for cardiorespiratory arrest care based on a qualitative approach focused on the pedagogical practice involved in this process. The specific goals were: to apply the Objective Structured Clinical Examination (OSCE) method - adapted for cardiorespiratory arrest attendance, to create a professionals\' qualification methodology for cardiorespiratory arrest attendance and to analyze the pedagogical mediators applied in the training process. The research was carried out in an Integrated Ambulatory Medical Assistance, located in Sao Paulo\'s eastern area. It was stipulated that the training would take place at the training center and the participants environment, which required field early recognition and articulation with the Technical Health Supervision. The teaching supplies organization involved the partnership with an American Heart Association accredited instructor, besides the use of OSCE - adapted methodology for the learning process. The research subjects were eight volunteers, from morning and afternoon shifts, members of the unit\'s nursing team. A training was carried out in three stages: the first one constituted of a theoretical / practical class in cardiorespiratory arrest attendance at the training center. The second stage was a simulation of a clinical case of cardiorespiratory arrest at the risk classification room, people involved were an actress and the subjects of the research, followed by emergency room care using a mannequin and following all recommended procedures. In the third stage a semi-structured interview was conducted guided by triggering questions. The scenes were captured through recording of images and audio in the second stage, in order to provide feedback to participants. At the end of the training an individual semi-structured interview was conducted, in order to understand the difficulties and facilities experienced by the participants and simultaneously analyze the applicability of the proposed methodology. Regarding to interview data, listening and transcription and systematization were performed in categories through the technique of content analysis. The theoretical and pedagogical foundations proposed by Robert Harden (1975), Paulo Freire (2014) and Edgar Morin (2003) guided the results discussion in two analytical categories: training process pedagogical mediation and learning at work environment as a way of production. The result was an association of three operational phases. The first phase of theoreticalpractical foundation was characterized by proactive interaction. The second fase de simulation with a patient-actress, the participants were active in the attendance however the signs of clinical injury caused apprehension behavior, quickly overcome. There was a small dysfunction in the access to the materials, however the team demonstrated balance, aiming at resuscitation maneuvers performing the procedures successfully. The third step was the semistructured interview, resulting in a summary of pedagogical and methodological relevance for the transformation of the practice. It should be emphasized that the whole methodology favored the co-construction of the meaning of learning and critical reflection as the basis of transformation. In summary, it was possible to accomplish the elaboration of a training model and to prove its applicability in the practice of cardiorespiratory arrest attendance.
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Welch, Shane Matthew. "Multiscale habitat associations of three primary burrowing crayfish." Connect to this title online, 2006. http://etd.lib.clemson.edu/documents/1175184962/.
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Day, A. C. "Primary angle closure : epidemiology and ocular biometric associations in European populations." Thesis, University College London (University of London), 2013. http://discovery.ucl.ac.uk/1407372/.
Full textAbstract:
Aims: To describe the epidemiology, biometric characteristics and risk factors for primary angle closure disease (PAC & PACG) in European people. Methods: 1.Systematic reviews of PACG prevalence and acute angle closure (AAC) incidence studies; with prevalence modelling, and incidence trend analysis. 2.Analyses of EAGLE study data to investigate for differences in presenting characteristics by diagnosis , ethnicity and PACG severity. 3.Quantification of risk factors associated with PAC/ PACG by case-control analysis using EAGLE, EPIC-Norfolk and Liwan Eye Study data. 4.Genotype-phenotype correlation study of SNPs recently associated with PACG, and ocular biometry in participants of the EPIC-Norfolk Eye Study. 5.Investigation into the epidemiology and characteristics of EPIC-Norfolk participants with nanophthalmos: the “angle closure phenotype.” Results: 1.PAGC prevalence was estimated as 0.4% in those ≥40 years old. AAC incidence appears to be reducing, equivalent to halving over the past decade. 2.EAGLE participants with PACG were older, had longer axial length (AL) and thinner CCT than those with PAC. Chinese ethnicity was associated with a shallower anterior chamber depth (ACD), less hyperopia and thinner CCT. PACG severity was associated with IOP, ACD and Chinese ethnicity. 3.The odds of PAC/ PACG were 33 times and 15 times higher per 1mm shallower ACD for non-Chinese andChinese people respectively. For each 1mm less AL, the odds of PAC/ PACG were 2.7and 1.8 times higher for non-Chinese and Chinese respectively . 4.PACG risk locus, rs1015213, may exert at least part of its effect through an association with ACD in European populations. 5.There is no standardized definition for nanophthalmos. Small eyes were more common than expected and associated with visual impairment. Conclusions: PACG appears to have been historically under-recognised in populations of European descent. This series of work provides a basis for future angle closure disease risk models.
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Gauvreau, Claudie. "La TMS pairée associative du cortex moteur primaire et du lobule pariétal inférieur : une évaluation avec l’IRM fonctionnelle." Mémoire, Université de Sherbrooke, 2017. http://hdl.handle.net/11143/10648.
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Les méthodes non-invasives de neuro-imagerie et de neurostimulation peuvent être
combinées pour mieux comprendre les connexions dans le cerveau. Pour la première fois,
une étude combine de façon séquentielle l’IRM fonctionnelle (fMRI) et un protocole de TMS
associative pairée cortico-corticale (TMS-PAScc) sur le cortex moteur primaire (M1) et sur
le lobule pariétal inférieur (LPI) dans l’hémisphère gauche. La TMS module-t-elle le couplage
neurovasculaire et permet-elle de renforcer une connexion fonctionnelle qui soit
détectable à la fMRI à l’état de repos (RS-fMRI)? 10 sujets droitiers et en santé font une
session de TMS-PAScc LPI-M1 de courte durée (180 paires d’impulsions, fréquence de
stimulation à 0.02 Hz). Les mêmes sujets font 2 sessions de la RS-fMRI, avant et après le
protocole PAScc. Les résultats montrent que la corrélation du signal BOLD entre les régions
LPI-M1 avant et après la PAScc ne change pas de façon significative (avant-PAS=0.10±0.07
et après-PAS=0.09±0.07, p=0.64), tout comme l’amplitude des potentiels évoqués moteurs
(PEM) des impulsions pairées LPI-M1 ne change pas de façon significative du début de la
PAScc à 25 minutes après la PAScc (PASdébut=0.71±0.46mV, PASpost25min=0.72±0.89mV,
p=0.338). Toutefois, les PEM des impulsions pairées LPI-M1 sont réduites par rapport aux
PEM des impulsions simples M1, avant la PAScc et après la PAScc (PEM simples_pré et
PASdébut, réduction de 0.32mV, p=0.05; PEM simples_post et PASpost25min, réduction de
0.39mV p=0.008), illustrant la présence d’un lien fonctionnel de nature inhibitrice entre LPI
et M1. Toutefois, l’amplitude de cette inhibition n’est pas modulée de façon significative
par la TMS-PAScc (ratio mesures pairées/mesures simples préPAS=0.9 et ratio postPAS=0.6,
p=0.257). Dans l’ensemble, la TMS-PAScc ne montre pas d’effet soutenu sur la connectivité
cérébrale telle que mesurée par la RS-fMRI et la TMS et ce, bien que le LPI montre un lien
inhibiteur sur M1 de façon aigue. Plusieurs hypothèses peuvent expliquer cette absence
d’effet soutenu, notamment, il est possible que l’altération de la connectivité ne soit visible
que lorsque le réseau LPI-M1 est activement sollicité, comme durant l’exécution d’une
tâche motrice. Il est aussi possible que le nombre de pairages soit insuffisant pour induire
des changements mesurables, mais que la connectivité fonctionnelle suite à des sessions
répétées de protocole PAScc pourrait modifier le couplage neurovasculaire et la plasticité
cérébrale.Abstract : Noninvasive neuroimagery and neurostimulation methods can be combined to further the understanding of the human brain connections. For the first time, resting state functional MRI (RS-fMRI) and paired associative cortico-cortical TMS (TMS-PAScc) of the motor cortex (M1) and the cortex of the inferior parietal lobule (LPI) of the left hemisphere are combined in a serial manner. Is TMS able to modify the neurovascular coupling as to facilitate LPI-M1 functional connectivity and change the fMRI BOLD signal? 10 right-handed and healthy subjects did a LPI-M1 TMS-PAScc session of short duration (180 paired pulses at 0.02 Hz, 15 min total). The same subjects underwent 2 fMRI sessions, before and after TMS-PAScc LPI-M1. Results show that the BOLD signal correlation between LPI-M1 does not change significantly before and after PAS (prePAS=0.10±0.07 et postPAS=0.09±0.07, p=0.64). TMS measures of motor evoked potentials (PEM) were taken before and after PAS LPI-M1. The paired pulse PEM measures did not change significantly from the start of PAScc to 25 minutes postPAS (PASstart=0.71 ± 0.46 mV, PASpost25min=0.72±0.89 mV, p=0.338). Paired PEM measures are statistically reduced from PAS PEM single measures, before and afterPAS (sPEM_pre et PASstart, significant 0.32mV reduction, p=0.05; PEMs_post et PASpost25min, 0.39mV reduction, p=0.008). PAScc did not show any significant neuroplasticity effect after 20 minutes because paired pulses did not change before and after PAScc. The PEM reduction of paired pulses is most likely related to the inhibiting effect of the conditioning stimulus of LPI on the test stimulus of M1 at 8ms. This inhibition is an effect limited to the measure itself and does not increase significantly with time (pairedpulse/singlepulsemeasures prePASratio=0.9 and postPASratio=0.6, p=0.257). TMSPAScc did not show a sustained effect on cerebral connectivity as measured by RS-fMRI although stimulation of LPI showed an acute inhibiting effect on M1 during paired measures. LPI-M1 TMS-PAScc did not show sustained connectivity and it could be because no task was involved in our study to actively solicit both cerebral regions during PAS. It is also possible that the number of paired stimulation was not enough to bring a change of connectivity and that PAS needs to be repeated on different days to eventually have a sustainable effect.
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Dirmaier, Jörg, Birgit Watzke, Uwe Koch, Holger Schulz, Hendrik Lehnert, Lars Pieper, and Hans-Ulrich Wittchen. "Diabetes in Primary Care: Prospective Associations between Depression, Nonadherence and Glycemic Control." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2012. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-100111.
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Background: Findings are inconsistent regarding the degree to which depression may exert a negative impact on glycemic control in patients with type 2 diabetes. We therefore aimed to examine the longitudinal relationship between depression, behavioral factors, and glycemic control.
Methods: In a prospective component of a nationally representative sample, 866 patients with type 2 diabetes aged ≧18 years completed a standardized assessment including a laboratory screening, questionnaires, and diagnostic measures. Subsequent to baseline (t0), patients were tracked over a period of 12 months (t1). Depression was assessed according to DSM-IV and ICD-10 criteria. Glycemic control was determined by levels of glycosylated hemoglobin (HbA1c); a level of ≧7% was judged as unsatisfactory. Regression analyses were performed to analyze the prospective relationship between depression, medication adherence, diabetes-related health behavior, and HbA1c.
Results: Patients with depression at t0 revealed increased rates of medication nonadherence (adjusted OR: 2.67; CI: 1.38–5.15) at t1. Depression (adjusted regression coefficient: β = 0.96; p = 0.001) and subthreshold depression (β = 1.01; p < 0.001) at t0 also predicted increased problems with diabetes-related health behavior at t1. Adjusted ORs for poor glycemic control (HbA1c ≧7%) at t1 were also increased for patients with baseline depression (2.01; CI: 1.10–3.69). However, problems with medication adherence as well as problems with diabetes-related health behavior at t0 did not predict poor glycemic control at t1.
Conclusions: In a prospective representative study of patients with type 2 diabetes, baseline depression predicted problems with medication adherence, problems with health-related behaviors, and unsatisfactory glycemic control at follow-up.
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Dirmaier, Jörg, Birgit Watzke, Uwe Koch, Holger Schulz, Hendrik Lehnert, Lars Pieper, and Hans-Ulrich Wittchen. "Diabetes in Primary Care: Prospective Associations between Depression, Nonadherence and Glycemic Control." Karger, 2010. https://tud.qucosa.de/id/qucosa%3A26285.
Full textAbstract:
Background: Findings are inconsistent regarding the degree to which depression may exert a negative impact on glycemic control in patients with type 2 diabetes. We therefore aimed to examine the longitudinal relationship between depression, behavioral factors, and glycemic control.
Methods: In a prospective component of a nationally representative sample, 866 patients with type 2 diabetes aged ≧18 years completed a standardized assessment including a laboratory screening, questionnaires, and diagnostic measures. Subsequent to baseline (t0), patients were tracked over a period of 12 months (t1). Depression was assessed according to DSM-IV and ICD-10 criteria. Glycemic control was determined by levels of glycosylated hemoglobin (HbA1c); a level of ≧7% was judged as unsatisfactory. Regression analyses were performed to analyze the prospective relationship between depression, medication adherence, diabetes-related health behavior, and HbA1c.
Results: Patients with depression at t0 revealed increased rates of medication nonadherence (adjusted OR: 2.67; CI: 1.38–5.15) at t1. Depression (adjusted regression coefficient: β = 0.96; p = 0.001) and subthreshold depression (β = 1.01; p < 0.001) at t0 also predicted increased problems with diabetes-related health behavior at t1. Adjusted ORs for poor glycemic control (HbA1c ≧7%) at t1 were also increased for patients with baseline depression (2.01; CI: 1.10–3.69). However, problems with medication adherence as well as problems with diabetes-related health behavior at t0 did not predict poor glycemic control at t1.
Conclusions: In a prospective representative study of patients with type 2 diabetes, baseline depression predicted problems with medication adherence, problems with health-related behaviors, and unsatisfactory glycemic control at follow-up.
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Meyer, Stefanie Marie. "Associations between Physical Activity and Quality of Life: Implications for Primary Care." Diss., North Dakota State University, 2018. https://hdl.handle.net/10365/28757.
Full textAbstract:
It is increasingly well-known that chronic diseases are placing a burden on the United States, including the healthcare system. Considering chronic disease risk and quality of life (QOL) measures, improving lifestyle behaviors such as physical activity (PA) should be further explored. In particular, using a place-based approach such as the healthcare system to improve lifestyle behaviors is a strategy to explore. Lifestyle Medicine (LM) is an approach that uses behavior as therapy to treat conditions and is suggested as an approach for primary care. The purpose of study 1 was to explore potential differences in QOL of patients who were referred to LM and are categorized into one of three groups 1) did not engaged in LM 2) engaged in up to two sessions of LM 3) engaged in three or more sessions of LM. The purpose of study 2 was to explore the relationship among provider QOL, PA level, and referral practices to LM. Participants completed demographic and lifestyle referral practices questionnaire, RAND-36 item health questionnaire, and Physical Activity Vital Sign questions. Results from study 1 include no significant differences between LM groups, QOL, and PA. Additionally, a significant difference was found for patient general health QOL score for those who met PA guidelines (M = 68.16, SD = 23.346) versus those who did not meet PA guidelines (M = 54.67, SD = 16.23); t (48) = 2.41, p = .02. Results for study 2 include no significant differences between provider PA minutes and LM referral as well as provider general health QOL and LM referral. A significant difference was found for provider general health QOL score for those who met PA guidelines (M = 85.833, SD = 10.68) versus those who did not meet PA guidelines (M = 67, SD = 9.08); t (9) = 3.109, p = .013. This dissertation will further inform the healthcare community (health system and health professionals) about the importance of PA to overall QOL for patients and providers. Moving from sick care to preventive care using LM approaches must be further explored and studied for both improved health outcomes and financial sustainability.North Dakota State University. College of Human Development and Education. Department of Health, Nutrition and Exercise Sciences
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Russak, Samantha. "PRIMATE SUPER-GROUPS? POLYSPECIFIC ASSOCIATIONS OF CAPTIVE MONKEYS." Miami University Honors Theses / OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc_num=muhonors1146073571.
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Rubio, Bernadette. "Réponse d’Arabidopsis thaliana au Turnip mosaic virus (TuMV) en conditions extérieures et en conditions contrôlées : phénotypage fin de traits de maladie et métaboliques et architecture génétique associée." Thesis, Bordeaux, 2017. http://www.theses.fr/2017BORD0758/document.
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Les plantes sont des organismes immobiles qui doivent répondre et s’adapter à des contraintes abiotiques et biotiques. Parmi les stress biotiques, les maladies virales, établies ou émergentes, peuvent être responsables de pertes de rendement majeures aux conséquences économiques importantes. Face aux phytovirus la lutte génétique constitue le moyen de lutte le plus efficace, le plus respectueux de l’environnement et du consommateur. Comprendre l’interaction entre les plantes et les virus reste indispensable pour rechercher de nouvelles sources de résistances. Ce travail de thèse s’intéresse à l’étude du pathosystème naturel Arabidopis thaliana/Turnip mosaic virus (TuMV). Les essais ont été menés majoritairement en conditions extérieures permettant une analyse de l’interaction dans un environnement multistress. La réponse d’A. thaliana a été explorée par l’étude de traits liés à la maladie et par la variation en métabolites primaires et secondaires. Ce travail a permis i) de caractériser de façon fine la réponse d’A. thaliana au TuMV en conditionsmultistress en exploitant la diversité naturelle d’une population mondiale et française ii) de déterminer l’architecture génétique de cette interaction par des approches de génétique d’association et de QTL mapping. Plusieurs nouveaux loci potentiellement impliqués dans la réponse ont été identifiés iii) de montrer l’intérêt du phénotypage métabolique pour discriminer les accessions en fonction de leur sensibilité au TuMV. La multidisciplinarité des approches constitue la richesse de ce travail de thèse qui contribue à une meilleure caractérisation et compréhension de la réponse des plantes lors d’une infection viralePlants are immobile organisms which have to adapt to abiotic and biotic constraints. Among bioticstress, established or emerging viral diseases, may be responsible for major yield losses withsignificant consequences. Genetic control is the most effective, environmentally and consumerfriendlyway to control viral infections. Understanding plant/virus interactions remains essential tosearch for new sources of resistance. This work, focuses on the study of the natural pathosystemArabidopsis thaliana/Turnip mosaic virus (TuMV). Most of the trials were conducted in commongarden conditions allowing the analysis of the interaction in a multistress environment. A. thaliana’sresponse was explored through the study of disease-related traits and the variations in primary andsecondary metabolites. This work allows i) the fine characterization of A. thaliana’s response toTuMV in multistress conditions through the exploration of the natural diversity of a world and Frenchpopulation ii) to determine the genetic architecture of this interaction by genome wide associationsand QTL mapping. Several new loci potentially involved in the response have been identified iii) tohighlight the interest of metabolic phenotyping to discriminate accessions according to theirsusceptibility to TuMV. The multidisciplinary approaches contribute to a better characterization andunderstanding of plant-virus interaction
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Cohen, Romain. "Caractérisation phénotypique et clinique des cancers colorectaux métastatiques avec instabilité des microsatellites Clinical and molecular characterization of hereditary and sporadic metastatic colorectal cancer harbouring microsatellite instability/DNA mismatch repair deficiency Association of primary resistance to immune checkpoint inhibitors in metastatic colorectal cancer with misdiagnosis of microsatellite instability or mismatch repair deficiency status." Thesis, Sorbonne université, 2018. http://www.theses.fr/2018SORUS313.
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L’instabilité des microsatellites (MSI) est un phénotype tumoral dû à une déficience héréditaire ou acquise du système de réparation des mésappariements de l’ADN (MMR : mismatch repair). Le phénotype MSI est retrouvé dans 5% des cancers colorectaux métastatiques (CCRm) et est un facteur prédictif positif majeur de l’efficacité des inhibiteurs de checkpoints immunitaires (ICKi). L’objectif de mon travail a été de caractériser sur le plan clinique et moléculaire les CCRm MSI, d’en évaluer les modalités diagnostiques et d’évaluer la réponse aux ICKi. Dans un 1er travail, je montre que l’histoire naturelle clinique des CCRm MSI diffère selon le mécanisme sporadique ou héréditaire de la déficience MMR (Cohen et al., Eur J Cancer 2017). Dans un 2e travail, je montre que près de 10% des CCRm détectés comme MSI/MMR-déficients en vie réelle correspondent à des faux positifs des analyses immunohistochimiques et/ou de PCR, et que ces faux positifs sont responsables de la majorité des cas de résistance primaire aux ICKi observés dans les essais cliniques (Cohen*, Hain* et al., JAMA Oncol. 2018). Après une revue de la littérature concernant le phénotype MSI, son impact dans le cadre du CCR et des ICKi, je présente les résultats des travaux développés durant ce doctorat, avant de proposer différentes perspectives à l’ère de l’immunothérapie des cancers MSIMicrosatellite instability (MSI) is a tumor phenotype linked to somatic or germline inactivating alterations of DNA mismatch repair (MMR) genes. MSI is observed in approximately 5% of metastatic colorectal cancers (mCRC) and has recently emerged as a major positive predictive biomarker for the efficacy of immune checkpoint inhibitors (ICKi) amongst mCRC patients. The objectives of my work was to clinically and molecularly characterize MSI mCRC, to evaluate the accuracy of MSI screening methods and the response to immunotherapy in the context of ICKi clinical trials. Fist, I show that sporadic and inherited MSI mCRC display distinct natural history (Cohen et al., Eur J Cancer 2017). In a second work, I show that MSI testing in routine practice is associated with almost 10% of false positives due to misinterpration of IHC and PCR assays. Moreover, these false-positives are the main cause of mCRC primary resistance to ICKi observed in clinical trials (Cohen*, Hain* et al., JAMA Oncol. 2018). After summarizing the literature concerning MSI, its consequences on CRC and immunotherapy, I present the results of the nosologic and diagnostic works developed during this doctoral thesis. Then I will go on perspectives in the context of MSI cancer
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Beattie, Allison. "Associations between cost and quality in the delivery of primary level care : evidence from South Africa." Thesis, University of London, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.244687.
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Kira, Geoffrey Dean Juranovich. "Associations of patterns of daily life, physical fitness and body composition of primary school age children." AUT University, 2009. http://hdl.handle.net/10292/930.
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The daily patterns of life, for example, food, physical activity and inactivity and sleep as well as physical fitness are associated with the accumulation of excess body fat in children. A positive energy balance between food (energy intake) and metabolism, particularly physical activity (energy output) is the accepted explanation. The reality of daily life for children is excessive calorie consumption, imbalances in macronutrient intake and missed opportunities for activity are being driven by the physical and social environment. Excess body fat tracks into adulthood and is associated with decreased insulin sensitivity, which may lead to increased risk of insulin resistance and chronic disease. Resting metabolic rate and substrate utilisation (measured by respiratory exchange ratio) are implicated in the prediction of weight gain in adults, but these relationships have been rarely explored in children. Both insulin and respiratory exchange provide insights into the pathways of accumulation of body fat. The purpose of this body of work presented here was to explore and explain how lifestyle patterns, substrate metabolism, physical fitness attributes and insulin resistance are related to excess body fat accumulation in children. “Project Energize” is a Waikato District Health Board-initiated through-school nutrition and physical activity intervention, operated in a growing number of primary schools throughout the Waikato. Data was collected from Project Energize control and programme schools between 2004 and 2006. The children that participated in this body of work were aged between 5 and 12 years of age (20% Māori). Fat mass (FM) change in Hamilton and Waikato primary school age children over a two year period is reported in study one (n=618). Study two (n=69) and three (n=169) are cross-sectional sub-studies of low decile schools (<3) that employ two methods of metabolic assessment; indirect calorimetry and glucose homeostasis; to investigate the relationships between food, activity, fitness with body composition and metabolic risk. More than 70% of the increase in body mass index (BMI) and percentage body fat (PBF) could be explained by the same measures two years earlier and more than 10% of the reported food, activity and sleep behaviours were able to be predicted from the responses two years earlier. There were no clear associations found with resting respiratory exchange ratio (RER), but resting metabolic rate (RMR) was best explained (45%) by fat free mass with a further 3% explained by cardiorespiratory fitness. Children with longer legs (as represented by height) travelled further, but FM attenuated final speed. Children with more fat had higher insulin resistance. Physical fitness was not associated with insulin resistance. Overall, a pattern of increased FM was linked to: 1. FM two years previously 2. a lesser speed attained in the 20m Shuttle Run Test and 3. higher insulin resistance. A focus on weight gain rather than change in FM and FFM, fitness and metabolic markers as the outcome of interventions is unlikely to show short or medium term changes. Therefore it is recommended that when instigating school-based nutrition and physical activity programmes, there must also be a focus on the daily patterns of life alongside community, family and culture-based partnerships to support sustainable behavioural change.