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1
Karndumri, Parinya. "On Holographic RG Flows." Doctoral thesis, SISSA, 2011. http://hdl.handle.net/20.500.11767/4632.
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A study of holographic renormalization group (RG) flows is discussed in the framework of supergravity and string theories. Some RG flow solutions are found in N = 4 Chern-Simons gauged supergravity in three dimensions. The resulting solutions describe vev flows, driven by a vacuum expectation value (vev) of a relevant operator or a vev of a marginal operator, in a dual two dimensional eld theory. In the minimal six dimensional supergravity, RG
flow solutions, describing two dimensional vev flows driven by a vev of a marginal operator, in the presence of Yang-Mills instantons are found...
2
Tiedt, Caio Luiz. "RG flows e sistemas dinâmicos." Universidade de São Paulo, 2019. http://www.teses.usp.br/teses/disponiveis/43/43134/tde-18032019-151627/.
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No contexto de Renormalização Wilsoniana, os fluxos do grupo de renormalização (RG flows) são um conjunto de equações diferenciais que define como as constantes de acoplamento de uma teoria dependem de uma escala de energia. o conteúdo destes é semelhante a como sistemas termodinâmicos estão relacionados com a temperatura. Neste sentindo, é natural olhar para estruturas nos fluxos que demonstram um comportamento termodinâmico. A teoria matemática para estudar estas equações é chamada de sistemas dinâmicos e aplicações desta têm sido usadas no estudo de RG flows. Como exemplo o teorema-C de Zamolodchikov e os equivalentes teoremas em dimensões maiores mostram que existe uma função monotonicamente decrescente ao longo do fluxo e é uma propriedade que se assemelha à segunda lei da termodinâmica, estão relacionadas com a função de Lyapunov no contexto de sistemas dinâmicos e podem ser usadas para excluir a possibilidade de comportamentos assintóticos exóticos, como fluxos periódicos ou ciclos limites. Estudamos a teoria de bifurcação e a teoria de índice, que foram propostas como sendo úteis no estudo de RG flows: a primeira pode ser usada para explicar constantes cruzando pela marginalidade e a segunda para extrair informação global do espaço em que os fluxos vivem. Nesta dissertação, também olhamos para aplicações em RG flows holográficos e tentamos buscar relações entre as estruturas em teorias holográficas e as suas duais teorias de campos.In the context of Wilsonian Renormalization, renormalization group (RG) flows are a set of differential equations that defines how the coupling constants of a theory depend on an energy scale. These equations closely resemble thermodynamical equations and how thermodynamical systems are related to temperature. In this sense, it is natural to look for structures in the flows that show a thermodynamics-like behaviour. The mathematical theory to study these equations is called Dynamical Systems, and applications of that have been used to study RG flows. For example, the classical Zamolodchikov\'s C-Theorem and its higher-dimensional counterparts, that show that there is a monotonically decreasing function along the flow and it is a property that resembles the second-law of thermodynamics, is related to the Lyapunov function in the context of Dynamical Systems. It can be used to rule out exotic asymptotic behaviours like periodic flows (also known as limit cycles). We also study bifurcation theory and index theories, which have been proposed to be useful in the study of RG flows, the former can be used to explain couplings crossing through marginality and the latter to extract global information about the space the flows lives in. In this dissertation, we also look for applications in holographic RG flows and we try to see if the structural behaviours in holographic theories are the same as the ones in the dual field theory side.
3
Zanusso, Omar. "Selected applications of functional RG." Doctoral thesis, SISSA, 2010. http://hdl.handle.net/20.500.11767/4148.
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In this thesis we will address the study of quantum field theories using the exact renormalization group technique. In particular, we will calculate the flow of a Yukawa system coupled to gravity and that of a higher derivative nonlinear sigma model. The study of the Yukawa system in presence of gravity, as well as the study of any matter theory coupled to gravity, is important for two reason. First, it is interesting to see what gravitational dressing one should expect to the beta functions of any matter theory. Second, it is important to test the possibility that gravity is an asymptotically safe theory [1, 2] against the addition of matter degrees of freedom. We also calculate the 1-loop flow of a general higher derivative nonlinear sigma model, using exact renormalization group techniques. We think that the nonlinear sigma model is an important arena to test the exact renormalization. The reason is that the nonlinear sigma model shares many of the features of gravity, like perturbative nonrenormalizability, but does not have the additional complication of a local gauge invariance. Furthermore, it is an interesting question whether a nonlinear sigma model admits a ultraviolet limit or it has to be regarded as an effective field theory only.
The plan of the work is as follows. In Chapter 1 we give a very brief introduction to the technique of functional exact renormalization group. In Chapter 2 we introduce the notion of “Asymptotic Safety” [1] and discuss some of the approximation schemes generally involved in calculations. In Chapter 3 we use a simple Yukawa model as a toy model for many of the techniques we will need later. We also discuss the background field method in the context of a theory with local gauge invariance, which will turn out to be useful in Chapter 4. In Chapter 4 we couple the simple Yukawa model with gravity and calculate its renormalization group flow. In Chapter 5 we study numerically the flow calculated in Chapter 4 and point out the possibility that the model admits a nontrivial ultraviolet limit. Chapter 6 is the final chapter and contains the study of the flow of the higher derivative nonlinear sigma model; it is a self contained chapter. In fact, Chapter 5 and 6 contain separate discussions for the results of the Yukawa and sigma model, respectively. We dedicate the appendices to arguments that would have implied very long digressions in the main text.
4
Kocaoglu, Argun H. "Rg wave dispersion tomography in northern Alabama." Thesis, Georgia Institute of Technology, 1990. http://hdl.handle.net/1853/25765.
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Ugolotti, Alessandro. "Alternative derivative expansion in Functional RG and application." Master's thesis, Alma Mater Studiorum - Università di Bologna, 2016. http://amslaurea.unibo.it/10434/.
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We give a brief review of the Functional Renormalization method in quantum field theory, which is intrinsically non perturbative, in terms of both the Polchinski equation for the Wilsonian action and the Wetterich equation for the generator of the proper verteces.
For the latter case we show a simple application for a theory with one real scalar field within the LPA and LPA' approximations.
For the first case, instead, we give a covariant "Hamiltonian" version of the Polchinski equation which consists in doing a Legendre transform of the flow for the corresponding effective Lagrangian replacing arbitrary high order derivative of fields with momenta fields. This approach is suitable for studying new truncations in the derivative expansion.
We apply this formulation for a theory with one real scalar field and, as a novel result, derive the flow equations for a theory with N real scalar fields with the O(N) internal symmetry. Within this new approach we analyze numerically the scaling solutions for N=1 in d=3 (critical Ising model), at the leading order in the derivative expansion with an infinite number of couplings, encoded in two functions V(phi) and Z(phi), obtaining an estimate for the quantum anomalous dimension with a 10% accuracy (confronting with Monte Carlo results).
6
Pangon, Vincent. "An RG study of models with spontaneous symmetry breaking." Strasbourg, 2009. http://www.theses.fr/2009STRA6116.
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Rachwal, Leslaw. "Models for RG running for Gravitational couplings and applications." Doctoral thesis, SISSA, 2013. http://hdl.handle.net/20.500.11767/4799.
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The plan for this thesis is as follows. In the first part we discuss the relation between two different RG flows: functional and holographic one. The bigger emphasis is put on the novel holographic RG flow and we devote full third chapter for studying holographic RG flow geometries. We are not only interested in flows for gravitational couplings, we also consider standard RG flows from field theories with matter. The second part of this work is divided into two chapters. In the fourth chapter we study classicalization for nonlinear sigma model understood as a toy example before attacking more diffcult problems of full quantum gravity. We also point there possible relations between classicalization and asymptotic safety as between two similar in some conditions mechanisms for UV completion. In the fofth chapter we consider universal 1-loop effective action in system of gravitating scalar field. We use new methods to derive its IR limit and we compute few low-energetic observables in such effective field theory of gravitational interactions. Finally in the sixth chapter we shortly collect main obtained results and conclude. The material presented in this work is partially based on two scientific articles [42] and [63], I published during my
PhD studies.
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Andrade, Rita Morais de. "Boué Soeurs RG 7091: a biografia cultural de um vestido." Pontifícia Universidade Católica de São Paulo, 2008. https://tede2.pucsp.br/handle/handle/13076.
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Previous issue date: 2008-06-20Universidade Anhembi Morumbi
This theses investigates the social and cultural circulation of a frock from its manufacture in a couture House atelier back in the 1920s Paris to its storage at Museu Paulista da Universidade de São Paulo in 1993, where it was catalogued as Boué Soeurs RG 7091. Searching trhough some of this object paths its manufacturing, the people who wore it, the cities where it circulated this paper proposes the interpretation of objetcs as a method to elaborate a dress cultural biography. The material analyses of RG 7091, approached here as a historical document, allowed to question the idea of a totalitarian fashion hegemony over all forms of dress. Through the interpretation of certain material aspects, elements and articulation of the dress, I discuss some timely and spacially perceptions as well as youthness and modesty. The material evidences of people s interference but also of time, climate, storage and circulation conditions over textiled clothes indicate sensitive meanings in the ways to dress the body
Esta tese investiga a circulação social e cultural de um vestido desde sua confecção num atelier de alta-costura em Paris na década de 1920 até seu armazenamento na reserva técnica do Museu Paulista da Universidade de São Paulo em 1993, quando ele foi catalogado como Boué Soeurs RG 7091. Percorrendo algumas trajetórias deste objeto sua confecção, os corpos que vestiu, as cidades por onde passou , esta pesquisa propõe um método interpretativo de objetos como método para a elaboração de uma biografia cultural do vestido. A análise material do RG 7091, tratado aqui como um documento histórico, permitiu colocar em xeque a idéia de hegemonia da moda sobre todas as formas de vestir. Através da interpretação de determinadas marcas, elementos e articulações do vestido, discutem-se aqui percepções de temporalidades e espacialidades, juventude e pudor. As evidências materiais das interferências dos sujeitos e outros atores (tempo, clima, condições de armazenagem) sobre as roupas feitas de tecido indicam formas sensíveis de vestir os corpos
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Rosenthal, Axel. "Probleme im zivilprozessualen Revisionszulassungsrecht nach Inkrafttreten des ZPO-RG vom 01.01.2002 /." Berlin : Logos-Verl, 2007. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=015593003&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Spaniol, Ednardo Paulo. "Um paralelo entre o eletromagnetismo e o equivalente teleparalelo da RG." reponame:Repositório Institucional da UnB, 2007. http://repositorio.unb.br/handle/10482/8520.
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A suposicão de que cargas e correntes de matéria poderiam gerar campos chamados, em analogia ao eletromagnetismo clássico, gravito-elétrico e gravito-magnético origina-se nos primórdios da Relatividade Geral (RG). Por outro lado, o Equivalente Teleparalelo da RG (ETRG), como teoria de gauge, parece-nos o cenário ideal para a definição destes campos que corresponderiam, exatamente como o eletromagnetismo, às componentes do tensor intensidade do campo de gauge. Esta é a proposta deste trabalho: investigar a natureza dos campos gravitacionais elétrico e magnético no contexto do ETRG, analisar as equações que conduzem suas dinâmicas e estudar o comportamento destes campos sob algumas aplicações específicas, tais como a geometria de Schwarzschild e a casca massiva girante. _________________________________________________________________________________ ABSTRACT
The assumption that matter charges and currents could generate fields, called by analogy to eletromagnetism, gravito-eletric and gravito-magnetic, comes from the origin of General Relativity (RG). Besides, the Equivalente Teleparallel of GR (ETGR), as a gauge theory, seems to be the ideal scenario to define these fields, based on the gauge field strength components. This is the purpose of this work: to investigate the nature of the gravitational electric and magnetic fields in the context of ETGR, to analyze the equations that lead its dynamics and to study the behavior of these fields under some specific applications, such as the Schwarzschild geometry and the rotating mass shell.
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Haenel, Claude. "Neutropenie cyclique et traitement par rg-csf : a propos d'une observation." Université Louis Pasteur (Strasbourg) (1971-2008), 1991. http://www.theses.fr/1991STR1M217.
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Ozdilek, Bagdeser A., Valery F. Thompson, Nasiha S. Ahmed, Connor I. White, Robert T. Batey, and Jacob C. Schwartz. "Intrinsically disordered RGG/RG domains mediate degenerate specificity in RNA binding." OXFORD UNIV PRESS, 2017. http://hdl.handle.net/10150/625471.
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RGG/RG domains are the second most common RNA binding domain in the human genome, yet their RNA-binding properties remain poorly understood. Here, we report a detailed analysis of the RNA binding characteristics of intrinsically disordered RGG/RG domains from Fused in Sarcoma (FUS), FMRP and hnRNPU. For FUS, previous studies defined RNA binding as mediated by its well-folded domains; however, we show that RGG/RG domains are the primary mediators of binding. RGG/RG domains coupled to adjacent folded domains can achieve affinities approaching that of full-length FUS. Analysis of RGG/RG domains from FUS, FMRP and hnRNPU against a spectrum of contrasting RNAs reveals that each display degenerate binding specificity, while still displaying different degrees of preference for RNA.
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Özakin, Arkadas I. Wise Mark B. "RG-flows, AdS/CFT correspondence and stability of non-dilatonic branes /." Diss., Pasadena, Calif. : California Institute of Technology, 2004. http://resolver.caltech.edu/CaltechETD:etd-04272005-130936.
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Schouten, Shane Michael. "Complete CFD analysis of a Velocity XL-5 RG with flight-test verification." Texas A&M University, 2008. http://hdl.handle.net/1969.1/85894.
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The Texas A&M Flight Research Laboratory (FRL) recently received delivery of its
newest aircraft, the Velocity XL-5 RG. The Velocity can fly faster than the other aircraft
owned by the FRL and does not have a propeller in the front of the aircraft to disrupt the
air flow. These are definite advantages that make the Velocity an attractive addition to
the FRL inventory to be used in boundary-layer stability and transition control. Possible
mounting locations built into the aircraft for future projects include hard points in the
wings and roof of the fuselage. One of the drawbacks of the aircraft is that it has a
canard ahead of the main wing that could disrupt the incoming flow for a wing glove or
research requiring test pieces mounted to the hard point in the wing. Therefore, it is
necessary to understand the influence the canard and the impact of its wake on the wing
of the aircraft before any in-depth aerodynamic research could be completed on the
aircraft.
A combination of in-flight measurements of the canard wake and Computational
Fluid Dynamics (CFD) were used to provide a clear picture of the flowfield around the
aircraft. The first step of the project consisted of making a 3-D CAD model of the
aircraft. This model was then used for the CFD simulations in Fluent. 2-D, 3-D, inviscid,
and viscous simulations were preformed on the aircraft. A pressure rake was designed to
house a 5-hole probe and 18 Pitot probes that extended forward of the main wing to
measure the location and strength of the canard wake at various flight conditions. There
were five primary test points that were recorded at multiple times over the course of three flights. Once all of the data were collected from the flights, the freestream
conditions became the inputs into the final, 3-D CFD simulations on the aircraft.
The good agreement between the CFD results and the in-flight measurements
provided the necessary verification of the CFD model of the aircraft. These results can
be used in the future planning and execution of experiments involving the Velocity XL-5
RG.
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Freire, Izaura Luzia Silverio. "Fatores associados ? efetividade da doa??o de ?rg?os e tecidos para transplantes." Universidade Federal do Rio Grande do Norte, 2013. http://repositorio.ufrn.br:8080/jspui/handle/123456789/14763.
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Previous issue date: 2013-09-09The transplantation of organs and tissues presents itself as an important therapeutic option, both from a medical standpoint, the social or economic. Thus, the identification of variables that can interfere in the effectiveness of organs and tissues donation for transplantation needs to be investigated adequately, because it stands before increasing index of chronic and degenerative diseases in the population, what makes the waiting list for transplantation grow disproportionately and patients come to death without the opportunity of realization the treatment due to a lack of donors. In this context, has defined as objective of this study evaluate the factors associated with the effectiveness of organs and tissues donation for transplantation. It is a evaluative research, quantitative, prospective, with longitudinal design, developed at Central of Catchment, Notification and organ donation for transplant, Organ Procurement Organization and in six accredited hospitals to collect and transplantation of organs and tissues, in Natal/RN, between august 2010 and february 2011, after the approval of the Research Ethics Committee, under No. 414/10 and CAAE 007.0.294.000-10. The probabilistic sample without replacement was composed of 65 potential donors. It was used as an instrument of data collection a structured script non-participant observation of checklist type. Data were analyzed using descriptive statistics and presented in tables, charts, graphs and figures. For this, was used Microsoft Excel 2007 and statistical program SPSS version 20.0. To check the level of significance was chosen by applying the chi-square test (χ2) and Mann Whitney and caselas for less than five, it is considered the Fisher exact test. It was adopted as the significance level p-value <0.05. Among the surveyed it was observed that most of the individuals were male (50,8%), in the age group 45 years (53,8%), mean age of 42,3 years, minimum 5 and maximum 73 years (? 17,32 years). Single / widowers / divorced (56,9%), with up to completed elementary school (60,0%) in the exercise of professional activity (86,2%), catholic (83,1%) and residents in metropolitan region of Natal (52,3%). Was obtained donation effectiveness of 27,7%. There was no statistical significance between structure and effectiveness of the donation, but were observed inadequacies in physical resources (36,9%), materials (30,8%), organizational structure (29,2%) and human resources (18,5%). In the process, the maintenance phase (p= 0.004), diagnosis of brain death (p= 0.032), family interview (p≤ 0.001) and documentation (p= 0.001) presented statistical significance with effectiveness. Thus, it is accepts the alternative hypothesis of the study, in which is evidenced that the adequacy of the factors related to structure and process is associated to effectiveness of organs and tissues donation for transplantation. In this way, the effectiveness of organ and tissue donation ends in an essential way the rapidity and accuracy with which the donation process is conducted, requiring appropriate structure, with appropriate physical and material resources and skilled human resources to optimize the reduction of time and the suffering of those waiting for an organ or tissue transplant queued in Brazil
O transplante de ?rg?os e tecidos apresenta-se como importante op??o terap?utica, tanto do ponto de vista m?dico, quanto social ou econ?mico. Assim, a identifica??o das vari?veis que podem interferir na efetividade da doa??o de ?rg?os e tecidos para transplante precisa ser investigada de maneira adequada, pois se est? diante de crescente ?ndice de doen?as cr?nicas e degenerativas na popula??o, que faz com que a lista de espera para transplante aumente desproporcionalmente e os pacientes chegam ao ?bito sem a oportunidade de realiza??o do tratamento devido ao d?ficit de doadores. Nesse contexto, definiu-se como objetivo deste estudo avaliar os fatores associados ? efetividade da doa??o de ?rg?os e tecidos para transplantes. Trata-se de pesquisa avaliativa, quantitativa, prospectiva, com delineamento longitudinal, desenvolvida na Central de Capta??o, Notifica??o e Doa??o de ?rg?os para transplantes, Organiza??o de Procura de ?rg?os e em seis unidades hospitalares credenciadas para capta??o e transplante de ?rg?os e tecidos, em Natal/RN, entre agosto de 2010 e fevereiro de 2011, ap?s a aprova??o do projeto de pesquisa pelo Comit? de ?tica em Pesquisa, CAAE 007.0.294.000-10. A amostra probabil?stica sem reposi??o foi composta de 65 potenciais doadores. Utilizou-se como instrumento de coleta de dados um roteiro estruturado de observa??o n?o participante do tipo checklist. Os dados foram analisados por meio da estat?stica descritiva e apresentados em forma de tabelas, quadros, gr?ficos e figuras. Para tanto, utilizou-se o Microsoft Excel 2007 e o Programa Estat?stico SPSS vers?o 20.0. Para verificar o n?vel de signific?ncia optou-se pela aplica??o dos testes Qui-quadrado (χ2) e Mann Whitney e, para as caselas inferiores a cinco, considerou-se o teste exato de Fisher. Adotou-se como n?vel de signific?ncia p-valor <0,05. Entre os pesquisados observou-se que a maior parte dos indiv?duos era do sexo masculino (50,8%), na faixa et?ria at? 45 anos (53,8%), com m?dia de idade de 42,3 anos, m?nimo de cinco e m?ximo de 73 anos (? 17,32 anos). Solteiros/vi?vos/divorciados (56,9%), com at? o ensino fundamental completo (60,0%), em exerc?cio de atividade profissional (86,2%), cat?licos (83,1%) e residentes na regi?o metropolitana de Natal (52,3%). Obteve-se efetividade de doa??o de 27,7%. N?o ocorreu signific?ncia estat?stica entre a estrutura e a efetividade da doa??o, por?m observaram-se inadequa??es nos recursos f?sicos (36,9%), materiais (30,8%), estrutura organizacional (29,2%) e recursos humanos (18,5%). No processo, as fases de manuten??o (p=0,004), diagn?stico de morte encef?lica (p=0,032), entrevista familiar (p≤ 0,001) e documenta??o (p= 0,001) apresentaram signific?ncia estat?stica com a efetividade. Assim, se aceita a hip?tese alternativa do estudo, na qual se evidencia que a adequa??o dos fatores relacionados ? estrutura e processo est? associada ? efetividade da doa??o de ?rg?os e tecidos para transplantes. Desse modo, a efetividade da doa??o de ?rg?os e tecidos encerra de forma imprescind?vel a rapidez e a precis?o com que o processo de doa??o se conduz, requerendo estrutura adequada, com recursos f?sicos e materiais apropriados e recursos humanos capacitados, para otimizar a diminui??o do tempo e do sofrimento daqueles que aguardam um ?rg?o ou tecido na fila do transplante no Brasil
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?vila, Gustavo Noronha de. "Da esperan?a aos dilemas : doa??o e com?rcio de ?rg?os humanos." Pontif?cia Universidade Cat?lica do Rio Grande do Sul, 2007. http://tede2.pucrs.br/tede2/handle/tede/4994.
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Previous issue date: 2007-12-11A disserta??o visou abordar os procedimentos de transplanta??o humana, especificamente a tutela penal relativa ao com?rcio de ?rg?os humanos que tem sido dispensada n?o s? pelo legislador p?trio (Lei 9.434/97), como tamb?m em rela??o ao direito comparado a esta revolucion?ria t?cnica. Tal objetivo foi desenvolvido atrav?s de an?lise eminentemente interdisciplinar, com a abordagem de elementos da hist?ria das id?ias, psiquiatria, filosofia, etnografia, bio?tica e direito. Primeiramente buscou-se investigar a transi??o das vis?es de corpo na modernidade e contemporaneidade: indo desde uma id?ia de sacralidade at? a de profana??o. Ap?s, buscou-se, al?m da realiza??o de an?lise hist?rico-comparativa dos principais avan?os cient?ficos na ?rea com a evolu??o legislativa, principalmente em nosso pa?s, a defini??o de conceitos relacionados ? tem?tica, como o de transplante, suas modalidades e a pol?mica relativa a morte encef?lica. A quest?o de escassez demonstrou-se essencial ? discuss?o, j? que ensejadora de um dos mais debatidos e controversos temas relativos aos transplantes de ?rg?o na atualidade: o com?rcio de ?rg?os humanos. Ap?s discuss?o de casos documentados sobre a pr?tica, foi realizada a confronta??o entre os argumentos favor?veis e contr?rios, chegando-se ? conclus?o de que uma an?lise ? luz da dignidade humana e da ?tica da alteridade ? suficiente para recha?ar a disposi??o remunerada de ?rg?os humanos. Sob a ?tica dos bens jur?dicos envolvidos e do consentimento do ofendido, a conclus?o n?o ? outra. Por ?ltimo atrav?s de pesquisa de campo em que foram entrevistadas 450 pessoas, evidenciou-se a avers?o majorit?ria ao com?rcio de ?rg?os, fundada em um crit?rio moral, em tr?s grupos diferentes (profissionais e acad?micos de Medicina e outras ci?ncias da sa?de; profissionais e acad?micos do Direito e comunidade em geral). O desejo de salvar vidas precisa estar em conson?ncia com o necess?rio respeito ? dignidade humana.
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Pereira, Francisco Edeneziano Dantas. "Modelagem empresarial : abordagem de integração de empresas : aplicação da metodologia CimOsa/rg a plataforma PIPEFA." [s.n.], 2001. http://repositorio.unicamp.br/jspui/handle/REPOSIP/265333.
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Orientador : João Mauricio RosarioDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecanica
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Resumo: Este trabalho apresenta a integração de empresa e focaliza a modelagem empresarial como uma abordagem dessa integração, tendo como contexto a realidade das empresas de manufatura atuais e como referencial teórico, as arquiteturas de referência CIMOS A (Open System Architecture for CIM), GRAI-GIM (GRAI Integrated Methodology), a arquitetura PERA (Purdue Enterprise Reference Architecture) e a metodologia CimOsa/rg. Descreve o ambiente experimental PIPEF A (Plataforma Industrial para Pesquisa, Ensino e Formação em Automação), redefine seus elementos principais e procede a sua modelagem empresarial, desenvolvendo um modelo conceitual segundo a sistemática da metodologia CimOsa/rg e a arquitetura CIMOS A, contando com o auxílio da ferramenta computacional Cimtool. O modelo descreve a plataforma de maneira semi-formal e não-ambígüa, segundo dois domínios: Planejamento e Controle da Produção e Chão de Fábrica, a partir dos quais explicita seus requisitos funcionais, em termos de Processos de Negócio e Atividades de Empresa; determina as necessidades de informação em termos de Vistas de Objetos e Objetos de Empresa e esses em Segmentos de um Modelo Semântico de Informação. Exprime também os conhecimentos utilizados em um subconjunto dessas atividades e os recursos necessários
Abstract: This work describes enterprise integration focusing enterprise modeling as an integration approach. It considers manufacturing enterprise reality as the current context and CIMOS A (Open System Architecture for CIM), GRAI-GIM (GRAI Integrated Methodology), PERA (Purdue Enterprise Reference Architecture) and CimOsalrg methodology as its theoretical reference. It presents PIPEFA (Industrial Platform for Research, Teaching, and Training in Automation) experimental environment, redefines its main elements and develops a conceptual model according to CimOsalrg methodology and CIMOS A architecture. The development process is supported by Cimtool, a toei CASE (Computed-aided Software Engineering). The developed model expresses the plataform on a semi-formal and unambiguous manner, in terms of two domains: Production Control and Shop FIoor; the model defines PIFEFA's functional requirements in terms of Business Processes and Enterprise Activities, and also shows its information requirements in terms of enterprise Object View and Enterprise Objects; these latter are organized into three Segments of a Semantic Information Mode!
Mestrado
Mecanica dos Solidos
Mestre em Engenharia Mecânica
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Heinzen, Evelyn. "An??lise dos ??rg??os ofertados ?? Central Nacional de Transplantes (CNT) provenientes de doadores idosos." Universidade Cat??lica de Bras??lia, 2015. https://bdtd.ucb.br:8443/jspui/handle/tede/2075.
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Organ transplantation is one of the greatest twentieth century advances in medicine, with success rates above 80%. Recent changes on donors profile, due to worldwide population aging, has led to modified organs acceptance criteria by the transplantation centers. This study aimed to describe the epidemiological, serological and clinical data of elderly organ donors, aged 60 years old or above, distributed by the National Transplant Center - NTC, Brazil, from 2011 to 2014, with special regard to organ donations progression and donation processes outcome related to the elderly organs donors. A descriptive, exploratory, retrospective, temporal and documentary series study was conducted with secondary data concerning Brazilian Federal Unit origin (UF), donation processes data and solid organs (heart, lung, liver and kidney) distribution, conducted by NTC, from 2011 to 2014, of older donors with 60 years or above. A total of 1,173 donation processes were analyzed, 38.6% of elderly donors were 60-64 years range and 31.5% were 65-69 years range. 57.9% were men and stroke (haemorrhagic) was the leading cause of death. Santa Catarina (20.2%), Cear?? (13%) and Rio de Janeiro (11.3%) were the most tendered states for national elderly organs distribution. Kidney was the most offered organ, followed by liver, heart and lung, in that order. Potential donor hospital stay was identified as an average of 5 - 6 days. Considering the use of vasoactive drugs and antibiotics, there was not a significant difference between donors with transplanted organs and donors with discarded organs. As for serologic tests, the presence or absence of a positive serologic test did not influence the acceptance of organs; however creatinine, urea and total bilirubin levels influenced this acceptance. Our results suggests that further researches are needed to better understand the old organ donor profile, consequently stimulating the use of organs from these donors by the transplantation centers and state transplant centers.
O transplante de ??rg??os foi um dos maiores avan??os obtidos pela medicina no s??culo XX, com ??ndice de sucesso acima de 80%. A mudan??a no perfil do doador, devido ao envelhecimento populacional em todo o mundo, tem ocasionado modifica????es nos crit??rios de aceita????o dos ??rg??os pelas equipes transplantadoras. O presente trabalho buscou descrever o perfil epidemiol??gico, cl??nico e sorol??gico dos doadores de ??rg??os idosos com 60 anos ou mais, provenientes da Central Nacional de Transplante ??? CNT, Brasil: 2011 a 2014, a evolu????o do n??mero de doa????es de ??rg??os e o desfecho do processo de doa????o quanto ao aproveitamento dos ??rg??os de doadores idosos. Para tal, foi realizado um estudo descritivo, explorat??rio, retrospectivo, de s??rie temporal e documental, com dados secund??rios, abrangendo as Unidades da Federa????o (UF) do Brasil, para os anos de 2011 a 2014, provenientes dos processos de doa????o / distribui????o de ??rg??os s??lidos (cora????o, pulm??o, f??gado, rim e p??ncreas), realizados pelo CNT por doadores com 60 anos ou mais. Foram analisados 1.173 processos de doa????o nos quais, 38,6% dos doadores tinham entre 60 e 64 anos, e 31,5%, entre 65 e 69 anos. Quanto ao sexo, 57,9% dos doadores eram homens e o AVC ??? H foi a principal causa de morte. Em rela????o ??s disponibiliza????es de ??rg??os pelas Unidades Federativas para distribui????o nacional, Santa Catarina (20,2%), Cear?? (13%) e Rio de Janeiro (11,3%) foram as que mais ofertaram. Os principais ??rg??os ofertados foram: rim, f??gado, cora????o e pulm??o, nesta ordem. Quanto ao tempo de interna????o do potencial doador, a m??dia de interna????o foi de 5 a 6 dias. E quanto ao uso de droga vasoativa e antibi??tico n??o foi significativa a diferen??a entre doadores com ??rg??os transplantados e doadores com ??rg??os descartados. No que tange ?? sorologia, a presen??a ou n??o das sorologias estudadas positivas n??o influenciou na aceita????o do ??rg??o, no entanto, as vari??veis creatinina, ureia e bilirrubina quando alteradas, representaram maior possibilidade de descarte desses ??rg??os. A partir desses resultados, sugere-se a realiza????o de mais pesquisas com o objetivo de conhecer o perfil do doador idoso de ??rg??os e, mediante isso, estimular o aproveitamento dos ??rg??os provenientes desses doadores pelas equipes transplantadoras e Centrais Estaduais de Transplantes.
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Stelmach, Aleksandra. "Field-making and sense-making : foetal programming, risk and human reproduction." Thesis, University of Nottingham, 2018. http://eprints.nottingham.ac.uk/52697/.
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Sembi, Sukhdev. "Mums4Mums : structured telephone peer-support for women experiencing postnatal depression : a pilot RCT to test its clinical effectiveness." Thesis, University of Warwick, 2018. http://wrap.warwick.ac.uk/114368/.
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Background: Postnatal Depression (PND) is experienced by around 13% of women, who suffer a range of disabling symptoms that can have a negative effect on the mother and infant relationship, with significant consequences in terms of the child's later mental health. Research has shown that providing support to mothers experiencing PND can help reduce their depressive symptoms and improve their coping strategies. This study aimed to evaluate the impact of telephone peer-support for women experiencing PND. Methods/Design: A pilot RCT was conducted in which women who screened positive for postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS > =10) were randomised to receive telephone-based support from peers who had recovered from PND, or standard care. Primary outcome measures included depressive symptomatology measured post-intervention and at six-months using the EPDS, and parent-infant interaction using the CARE-Index. Secondary outcome measures included anxiety and depression, dyadic adjustment, parenting stress, and self-efficacy. Maternal perceptions of the telephone peer-support were being assessed using semi-structured interviews. Quantitative and qualitative data was also collected from the peer-supporters to assess the impact on them of delivering the intervention. Results: Participants: twenty-eight participants were recruited to the study, and there was a fifty-percent dropout rate (intervention group n=6, control group n=8). While there were no differences in EPDS scores between the two groups at post-intervention, the intervention group continued to improve at six-month follow-up, whereas the control group showed signs of relapse. The intervention had no impact on mother-infant interaction. In-depth interview data show that women valued the support that was provided. Peer-Supporters: nineteen peer-supporters were recruited, of whom five left before supporting a participant, and eight left after supporting only one participant. The quantitative results showed a significant non-clinical increase in anxiety at post intervention. The qualitative results indicated that the peer-supporters found the majority of calls challenging, and that delivering the intervention had had a deleterious impact on some peer-supporters. Conclusion: While these findings suggest a positive impact of telephone-based peer-support, further research into ways of improving mother-infant interaction are urgently required. Research is also required into providing effective support for the peer supporters.
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Eapen, Abey. "Recombinant human granulocyte colony stimulating factor for unexplained recurrent miscarriage : a randomised placebo controlled multi-centre study." Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8297/.
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Immune mediated mechanisms are thought to contribute to recurrent pregnancy losses. A number of treatment options with limited evidence are being used in clinical practice to treat women with recurrent miscarriages. The objectives of this thesis was a. To summarise the available evidence for granulocyte colony stimulating factor (G-CSF) in reproductive medicine. b. To perform a randomised controlled study (RCT) to evaluate the efficacy and safety of recombinant human granulocyte colony stimulating factor (rhG-CSF) in women with unexplained recurrent miscarriages. The main conclusions from this thesis are: a. The systematic narrative review found that available evidence is of poor quality, but suggestive of benefit with granulocyte colony stimulating factor in women with recurrent miscarriages. b. The RCT concluded that administration of rhG-CSF does not improve pregnancy outcomes among women with a history of unexplained recurrent miscarriages. RhG-CSF appears to be safe for both mothers and their offspring/s.
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Shehmar, Manjeet. "An evaluation of recovery after hysterectomy." Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8259/.
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Differences in recovery from types of hysterectomy may be due to different advice, rather than different incisions alone. Aims: What are the beliefs and experiences of women who have a hysterectomy and the practices and beliefs of health care professionals? Explore the evidence for psychological preparation for surgery. Methods: .Retrospective structured questionnaires .Semi-structured interviews and validated quality of life questionnaires .Systematic review Results: No significant difference in return to work for type of employment and incapacity pay. Variation between the advice given for recovery by UK gynaecologists and nurses. Regardless of route of surgery, the expectations and fears of women are similar and rely on health care advice, with conflicting advice and varied recovery experiences. Women who had a vaginal hysterectomy had concerns around sitting, laparoscopic route had a lower length of stay and abdominal hysterectomy had higher anxiety scores (P 0.003). Mean quality of life scores by EQ5 were not different based on route of surgery (pre-surgery P 0.4446, 1 week P 0.447, 4 weeks P 0.876,12 weeks P 0.850). There was a reduced length of stay [P 0.03, 5.65 (-10 82 to -0.48)] and reduced trait anxiety intervention [P < 0.00001, mean difference 7.78 (7.19, 10.61)] for psychological interventions.
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Walker, S. "Competence and expertise in physiological breech birth." Thesis, City, University of London, 2017. http://openaccess.city.ac.uk/20269/.
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This doctoral thesis by prospective publication aims to provide pragmatic, evidence-based guidance for the development and evaluation of physiological breech skills and services within the context of contemporary maternity care. The research uses multiple methods to explore development of professional competence and expertise. While skill and experience are acknowledged in multiple national guidelines as important safety factors in vaginal breech birth, prior to this research no guidance existed about how skill and experience should be defined, developed and evaluated. The thesis begins with an integrative review of the efficacy of current breech training methods, highlighting a lack of evidence associating any training methods with improved outcomes for breech births. Following this are two papers reporting the results of a Delphi consensus technique study involving a panel of breech experienced obstetricians, midwives and service user representatives. The first outlines standards of competence, training components and volume of experience recommended to achieve competence and maintain proficiency in upright breech birth. The second outlines principles of practice for physiological breech birth, rooted in relationship and response, and divergent from medicalised practices based on prediction and control. Following this is a grounded theory paper exploring the deliberate acquisition of breech competence among midwives and obstetricians with moderate upright breech experience. The paper reports a theoretical model that can inform development of breech teams and training programmes. The final paper reports a mixed methods analysis of data from the Delphi and grounded theory studies concerning breech expertise. The results present a model of generative expertise, underpinned by affinity, flexibility and relationship, which may function to increase the availability and safety of vaginal breech birth. Each paper is followed by critical analysis and reflection. The thesis ends with a discussion of the implications for practice and research in light of the overall body of work.
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Brown, Catriona Elizabeth. "Assessment of cardiovascular risk in women with a history of pre-eclampsia." Thesis, University of Glasgow, 2018. http://theses.gla.ac.uk/9129/.
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Pre-eclampsia is an important and serious condition affecting 2-8% of pregnancies worldwide and carries with it significant associated risk of morbidity and mortality for both mother and child. It is characterised by new onset hypertension after the 20th week of gestation with accompanying proteinuria. Resolution of symptoms should occur following delivery. Several pathophysiological mechanisms are common to both pre-eclampsia and cardiovascular disease, and the link between pre-eclampsia and cardiovascular disease later in life has been established. While the underlying pathophysiological mechanisms of pre-eclampsia are complex, endothelial dysfunction is a key component. Increased arterial stiffness and hypertension have also been documented. Endothelial dysfunction has been shown to extend beyond childbirth, into the postpartum period. Studies evaluating endothelial dysfunction at even longer time-points following an affected pregnancy have produced conflicting results. Results from biomarker studies have supported the concept of endothelial dysfunction throughout pregnancy and the postpartum period, but as more time elapses between index pregnancy and biomarker sampling, these results also vary. Cardiac imaging and electrocardiographic studies have also contributed to knowledge about the normal physiology of pregnancy and changes which are associated with hypertensive disorders of pregnancy during pregnancy, the postpartum period and beyond. The main focus of this thesis was to investigate the possible mechanisms behind the link between pre-eclampsia and future cardiovascular disease. The aim was to investigate women who were free from cardiovascular disease for any evidence of subclinical vascular damage long-term following a pre-eclamptic pregnancy. Overall women recruited to this study would be older than women who participated in the majority of previously published studies on this theme. Before embarking on the investigation of subclinical vascular damage in women with a history of pre-eclampsia, a link was confirmed between a history of pre-eclampsia and cardiovascular disease up to 30 years from time of index pregnancy. This was accomplished using record-linkage in a large Scottish cohort; the Generation Scotland Family Health Study (GS:SFHS). Following on from this, ECGs available in women with and without a remote history of pre-eclampsia in the GS:SFHS cohort were assessed for any obvious differences. There was a more leftward shift in the QRS-axis in these women and a trend towards a longer corrected QT interval (QTc) which approached statistical significance, but after adjusting for other co-variates, pre-eclampsia did not independently predict QTc. Investigations for subclinical vascular damage were carried out by means of non-invasive vascular function studies in women recruited from three different cohorts (blood pressure clinics, GS:SFHS and the previous Proteomics in Pre-eclampsia (PIP) study of women during pregnancy). Time since index pregnancy varied between 1-30 years. Flow-mediated dilatation (FMD) was performed to assess for endothelial dysfunction, pulse wave analysis (PWA) and pulse wave velocity (PWV) assessed arterial stiffness, and carotid ultrasound was performed to establish whether there was any evidence of atherosclerosis. After adjusting for other co-variates, I was able to demonstrate the presence of endothelial dysfunction many years after pregnancy in women with a history of pre-eclampsia in comparison with those who experienced a normotensive pregnancy. There was also a significantly higher presence of carotid plaque in women with a history of pre-eclampsia. To investigate whether the findings from the vascular study translated to findings in biomarker studies of women with a history of pre-eclampsia in comparison with controls, samples from the vascular studies cohort and from the wider GS:SFHS cohort were used. Markers of inflammation, angiogenesis, cardiac damage and collagen turnover were studied. A significantly higher vascular endothelial growth factor (VEGF) was detected in women with a history of pre-eclampsia. Pre-eclampsia is associated with an increased risk of cardiovascular disease, and endothelial dysfunction is evident later on in life. Larger studies are required to further investigate the vascular and biomarker results, and studies including more thorough cardiac assessment (such as echocardiography) in this population should also be considered. The studies described found no evidence of one single component to explain the relationship between pre-eclampsia and cardiovascular disease later in life. This is not unexpected as pre-eclampsia is a complex condition with multiple contributing factors and it is likely that the increased cardiovascular risk later in life is likewise multifactorial in origin.
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Rocha, Carlos Frederico Duarte da. "Estrategia e ciclo reprodutivo de Liolaemus luizae (Sauria iguanidae) na restinga de Barra de Marica, RG." [s.n.], 1989. http://repositorio.unicamp.br/jspui/handle/REPOSIP/315795.
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Orientador : Augusto S. AbeDissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia
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Resumo: A estratégia, o ciclo reprodutivo e o crescimento do lagarto das dunas de restinga, Liolaemus Jutzae, foi estudado ao longo de dois anos na restinfa de Barra de Marica, Rio de Janeiro. Os resultados mostraram que estes lagarto possui uma reprodução sazonal bem acentuada, que esteve relacionada com a pluviosidade na área. As fêmeas reservam gorduras nos corpos gordurosos durante a estação seca, investindo essa reserva na produção da primeira ninhada, no início da estação reprodutiva (setembro-março). Em geral o recrutamento iniciou-se na segunda quinzena de dezembro, em ambos os anos estudados, terminando em maio-junho. Ambos os sexos maturaram na primeira estação reprodutiva após o nascimento, com uma idade de aproximadamente 8 meses. O menor comprimento rostro-anal na maturidade foi de 51,5mm para as fêmeas e de 61,1 mm para os machos. O tamanho da ninhada variou de 1 a 4 ovos, embora os extremos tenham sido raros. O tamanho corporal explica pequena parte da variação no tamanho da ninhada, que apareceu ser relativamente fixa (2 ovos) nesta espécie. Observações sobre fêmeas, marcadas no campo sugerem que pelo menos três ninhadas sucessivas são possíveis para fêmeas de segundo ano (potencial reprodutivo de 6 a 8 ovos), mas apenas suas para fêmeas de primeiro ano (potencial reprodutivo de 4 a 5 ovos) ...Observação: O resumo, na íntegra, poderá ser visualizado no texto completo da tese digital
Abstract: The reproductive strategy, cycle and growth of the sand dunes lizard Liolaemus lutzae was studied during two years at restinga de Barra de Maricá, Rio de Janeiro, Brazil. The lizard showed a marked sazonality in reproduction related to rainfall. Femalles reserved fat in fat bodies during drought periods, investing it in the production of the first clutch in the beginning of the reproductive season. Recruitment began in the middle of December and terminated in may-june of the following year. Individuals of both sexes matured in the first reproductive season after birth, attaining sexual maturity at an age of approximately B months. The minimun snout-vent length at maturity for females (51,5 mm) differed from that of males (61,1 mm). Clutch size varied from 1 to 4 eggs but most had 2. Female body size explained small part of the variation in clutch size. Observation on marked females suggested that at least three clutches are possible for second year females but two for first year females per reproductive season. Juvenile males had a significantly higher average growth rate ('delta¿ = 0,145 mm/day) than juvenile females ('delta¿=0,121mm/day). Additionaly, females showed a marked reduction in growth rate at maturity while males of equivalent size continued to increase in size at higher growth rate ...Note: The complete abstract is available with the full electronic digital thesis or dissertations
Mestrado
Ecologia
Mestre em Ciências Biológicas
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SOARES, Henrique Melo. "Acuracidade na execu????o or??ament??ria dos ??rg??os ligados ??s justi??as estaduais no Brasil." FECAP, 2018. http://tede.fecap.br:8080/jspui/handle/jspui/776.
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This research analyzes the degree of fulfillment of public budget execution, based on the values proposed and approved in the Annual Budget Law of the organs of the state legal system, composed by: Public Defender, Public Prosecutor and Court of Justice, all at state level. Considering the period from 2007 to 2015, the period after the publication of the Fiscal Responsibility Law. The research also seeks to identify the significance of variables that may influence the degree of budget assertiveness. The study had a quantitative approach, using econometric analyzes such as mean test, POLS regressions and panels with fixed and variable effects. In this study, it was possible to observe that about 60% of the analyzed organs present budgetary variations above 5%. It was evidenced that the variables size, type and GDP are statistically significant, since the simple existence of the area of internal control and the composition of the revenue has no significant relation with the accuracy in the budget.
Esta pesquisa analisa o grau de cumprimento da execu????o or??ament??ria p??blica, tendo como base os valores propostos e aprovados na Lei Or??ament??ria Anual (LOA), dos ??rg??os ligados ao sistema judici??rio estadual, quais sejam: Defensoria P??blica Estadual, Minist??rio P??blico Estadual e Tribunal de Justi??a. O recorte cronol??gico abrange o per??odo de 2007 a 2015, per??odo este posterior a publica????o da Lei de Responsabilidade Fiscal. A pesquisa tamb??m procura identificar a signific??ncia de vari??veis que possam influenciar o grau de assertividade or??ament??ria. O estudo teve abordagem de natureza quantitativa, utilizando-se analises econom??tricas tais como teste de m??dia, regress??es POLS e pain??is com efeitos fixos e vari??veis. Neste estudo p??de-se constatar que cerca de 60% dos ??rg??os analisados apresentam varia????es or??ament??rias acima de 5%. Ficou evidenciado que as vari??veis tamanho, tipo de ??rg??o e PIB s??o estatisticamente significantes, j?? a simples exist??ncia da ??rea de controle interno e a composi????o da receita n??o tem rela????o significativa com a acuracidade no or??amento.
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N?brega, Marcella Pereira da. "Minist?rio P?blico: atua??o como ?rg?o agente na defesa de direitos individuais indispon?veis." PROGRAMA DE P?S-GRADUA??O EM DIREITO, 2016. https://repositorio.ufrn.br/jspui/handle/123456789/21902.
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O Minist?rio P?blico recebeu um delineamento constitucional muito peculiar pela Constitui??o Federal de 1988 como institui??o de controle e agente de transforma??es sociais, de maneira que as suas amplas miss?es devem se harmonizar com esse perfil constitucional. Uma inquieta??o causada pela atua??o tradicional e pouco refletida do Minist?rio P?blico como ?rg?o agente na defesa de direitos individuais indispon?veis foi a v?lvula propulsora para este trabalho. A pesquisa desenvolvida tem por objetivo analisar a atua??o do Minist?rio P?blico como ?rg?o agente na defesa de direitos individuais indispon?veis em busca de uma interpreta??o que compatibilize essa miss?o com o seu perfil constitucional na Constitui??o Federal de 1988. Para tanto adota como metodologia a pesquisa bibliogr?fica, incluindo, legisla??o, doutrina e decis?es judiciais. O estudo apresenta o percurso hist?rico transposto pelo Minist?rio P?blico at? os dias atuais e os influxos do modelo estatal adotado na defini??o do seu perfil e da sua voca??o na atual ordem constitucional. Destaca o Minist?rio P?blico como garantia institucional e institui??o integrante do sistema de justi?a, ressaltando a relev?ncia da sua atua??o como ?rg?o de controle e como ?rg?o agente de transforma??es sociais. Resgata a sua tradicional atua??o como ?rg?o agente na defesa de direitos individuais indispon?veis na primeira Lei Org?nica Nacional do Minist?rio P?blico Estadual de 1981. Enfatiza a institucionaliza??o da Defensoria P?blica apenas em 1988 e destaca o seu genu?no perfil constitucional e voca??o ? defesa do indiv?duo. Num cotejo entre as duas institui??es e os respectivos perfis constitucionais, discute sobreposi??o de atua??es entre elas na defesa de direitos individuais indispon?veis, para concluir que a atua??o do Minist?rio P?blico como ?rg?o agente na defesa de direitos individuais indispon?veis ? residual e que somente se compatibiliza com o seu perfil constitucional de agente de controle e de transforma??es sociais quando inexistir ou for ineficaz a Defensoria P?blica ou a advocacia privada.
The Public Prosecution Service received a peculiar and solid design by the Federal Constitution of 1988 as a control institution and social change agent, in a way that the constitutional tasks harmonize with this constitutional profile. A concern caused by the traditional and little reflected operation of the Public Prosecution Service as the entity agent in defense unalienable individual rights was the driving valve for this work. Thus, the developed research aims to analyze the performance of the Public Prosecution Service as the agent entity in defense of unalienable individual rights in search for an interpretation that achieves compatibility with this mission and its constitutional profile in the Federal Constitution of 1988. For this purpose it adopts as methodology bibliographic research, including legislation, doctrine and judicial decisions. The study, then, presents a historic route transposed by the Public Prosecution Service until the present day and the outlines of the state model adopted in their profile defining and their calling in the current constitutional order. It highlights the Public Prosecution Service as a guarantee institution and institution integrant of the justice system, giving emphasis to the importance of its performance as a control agency and as a social change agent. It recovers its traditional performance as agent in defense of unalienable individual rights in the first National Organic Law of the State Prosecutor of 1981. It emphasizes the institutionalization of the Public Defender occurred only in 1988 and highlights their genuine constitutional profile and vocation to the defense of the individual. In a comparison between the two institutions and their respective constitutional profiles, it discusses overlapping of their performances in defense of unalienable individual rights, to conclude that the actions of the Public Prosecution Service as agent in defense of unalienable individual rights is residual and that only harmonizes with its constitutional profile of control and social change agent when the Public Defender or private law do not exist or be ineffective.
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Bailey, Elizabeth Helen. "An investigation into the combination of nifedipine with potassium channel openers as potential tocolytic therapy for preterm labour, and a novel potassium channel blocker as potential therapy for post-partum haemorrhage." Thesis, University of Warwick, 2015. http://wrap.warwick.ac.uk/78668/.
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Background Preterm labour and post-partum haemorrhage are leading causes of pregnancy morbidity and mortality. Previous work identified potassium channels expressed in myometrium and hypothesized modulation of channels with greater expression in MSMC than VSMC will influence contractility and avoid cardiovascular effects. By combining calcium channel blockers with potassium channel openers an enhanced tocolytic effect is anticipated. VU590 inhibits Kir 7.1 and it was hypothesised would elicit a contractile effect with therapeutic potential for post-partum haemorrhage. Aim To determine the effect of select potassium channel openers and a specific potassium channel blocker in myometrial contractility. Methods Human and murine myometrial strips were used in contractility organ bath experiments. Select combined doses were tested in myometrial small arteries using wire myography. Western blotting was carried out to determine the gestational and labour-state expression of potassium channels in human myometrium and myometrial small arteries. Results Pinacidil demonstrated a relaxatory effect on both myometrial and vascular smooth muscle. Riluzole reduced contractility alone and greater inhibition in combination with nifedipine than nifedipine alone. Riluzole appeared to have a mild effect on myometrial arteries. Kir 7.1 showed a trend of diminished expression by gestation and was downregulated in term and preterm labour states. VU590 elicited a significant increase contractility characterised by a prolonged contraction phase of up to 6.7±1.9 hrs (VU590 10 µM). A gestational-dependent effect was seen on murine myometrium. Conclusion The combination of nifedipine with potassium channel openers has a more potent effect on reducing contractility than either compound alone. Riluzole combined with nifedipine warrants further investigation for potential tocolytic therapy. VU590 augments spontaneous contractions profoundly in human myometrium in vitro and could have potential therapeutic benefits in the treatment of postpartum haemorrhage.
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Tyers, Theresa Lorraine. "The rebirth of fertility : the Trotula and her travelling companions c. 1200-1450." Thesis, University of Nottingham, 2012. http://eprints.nottingham.ac.uk/14017/.
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This thesis examines to what extent women were involved in their own healthcare and that of others, in the late medieval period. It starts from the observation that modem text editing practices often exclude from discussion other widely disseminated texts that formed the 'travelling companions' of a manuscript - in this case particularly the ensemble known as the Trotula. By focusing on one specific text within the manuscript compilations, the diverse and widespread dissemination of women's knowledge of healthcare and the use of vernacular texts have been marginalised. The thesis argues that the consideration of these 'travelling companions' can offer an alternative view of women's involvement in healthcare, despite the seeming female exclusion from the culture of book-learning and the development of professional licensing in the later Middle Ages. The corpus of manuscripts examined is taken from a range of vernacular compilations produced in England, Flanders and Italy, with some discussion of ownership and transmission of these into the Early Modem period. A number of transcriptions and close readings of the contents are used to identify the discrete characteristics of each copy and to track changes that took place during the transmission process. Detailed comparisons demonstrate that conscious, active choices were made in both the adaptation and interpretation of the material being copied. Analysis of these manipulations reveals that the production of vernacular texts enabled easier consultation and use. The manuscripts point to women's continuing engagement with both the texts and the practice of self-care and that, despite the increase in the number of professional male practitioners over the period, women continued to offer advice to others well into the sixteenth century.
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Crittenden, Mark E. "Real-time intrapartum fetal electrocardiogram analysis." Thesis, University of Nottingham, 1997. http://eprints.nottingham.ac.uk/27969/.
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The research within this thesis concerns the monitoring of the fetus during labour, using the fetal electrocardiogram (FECG). A versatile FECG analysis system was developed for the Microsoft Windows environment, to allow various FECG parameters to be extracted. Algorithms, currently used in other FECG analysis systems, were implemented using Object Oriented Programming, thus allowing new algorithms to be easily added at a later stage. Although these current algorithms have been demonstrated by several authors, it was felt that they had been used with only partial investigation of their limitations, and with failure to fully determine their accuracy in controlled conditions. These factors are fully addressed within this thesis. By developing a FECG simulator, in which heart-rate, morphology, and noise levels could be varied, the ability of the analysis algorithms to extract the parameters, and the accuracy of these parameters under different noise conditions, were thoroughly checked. Both ability and accuracy were shown to be very good in ideal noiseless conditions; but, with the addition of noise, there exists a compromise between parameter accuracy when the morphology is static, and parameter accuracy when the morphology is changing. The accuracies of the most common indices in this field (the Conduction Index, and the T/QRS ratio) were determined for different levels of simulated noise, and their values demonstrated for data previously recorded from the fetal scalp. Errors as large as 0.3 in the CI and 0.05 in the T/QRS suggested that in the clinical environment, an indication of the accuracy of each index ought to be displayed, and this may be estimated from the measured level of noise. Furthermore, this analysis system allows the direct comparison of both indices. Finally, in order to design a more effective front-end filter, it is important to be aware of the frequency content of the underlying FECG. The Integral Pulse Frequency Modulation (IPFM) model, combined with Pulse Amplitude Modulation (PAM), was used to estimate realistic frequency components within the FECG signal. The effects of filtering could then easily be modelled to show the distortion of both the FECG and any parameters taken from it. For a FECG frontend filter, distortion was found to be insignificant provided that, above 1 Hz, both the gain remained constant and there was no phase-distortion.
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Vadiveloo, Thenmalar. "Sequential testing strategies in prenatal screening for down's syndrome." Thesis, University of Glasgow, 2010. http://theses.gla.ac.uk/1889/.
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It is important therefore that maternal smoking is accurately recorded on screening request forms and in this study, the accuracy of self reported smoking status was assessed by analysis of cotinine in serum. Results showed that the percentage of self-reported smokers (24.1%) at booking was significantly lower than the cotinine-validated estimate of 30.1%. Also, smoking was associated with low birth weight, delivery prior to 39 weeks, increased AFP level (3.1%) and reduced hCG level (28.7%) in the second trimester. An increasing AFP level (but not hCG level) was associated with lower birth weight and delivery prior to 39 weeks in both smokers and non smokers but the effect was most marked in smokers. The difference in birth weight between the highest and the lowest AFP category for non-smokers was 448.3g and for smokers was 619.2g, suggesting that smoking exacerbates the effect of an elevated AFP on birth weight. Overall the difference in birth weight between the lowest AFP category in non smokers and the highest AFP category in smokers was 931.6g. Summary In summary, this study has shown that a cross-trimester contingent screening protocol with repeat measures has the potential to meet the UK NSC aspirational standard of 90% detection of Down’s syndrome pregnancies with a screen positive rate of less than 2%. Around 90% of women would complete screening in the first trimester without the need for a second stage sequential test. Correcting for factors such as maternal smoking habits, ethnicity and ART would further improve screening performance. Also it has been shown that where ultrasound resources are scarce, within-trimester and across-trimester protocols can reduce the need for NT measurement in all women and still deliver excellent screening performance although this falls short of the higher performance standard. The potential of these new screening protocols now need to be tested in prospective multicentre trials to confirm their performance in prospective practice.
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Huda, Shahzya Shahnaz. "Metabolic pathways in normal and pre-eclamptic pregnancies." Thesis, University of Glasgow, 2011. http://theses.gla.ac.uk/2537/.
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Maternal metabolism undergoes dramatic changes in pregnancy in order to sustain and nourish the developing fetus. During healthy pregnancy the mother goes from an anabolic state in early pregnancy to a state of catabolism in late pregnancy with increased lipolysis together with a significant reduction in insulin sensitivity. Pre-eclampsia (PE) characterised by hypertension and proteinuria is a major cause of maternal and perinatal morbidity. There is acute ‘atherosis’ in PE placenta, and lipid accumulation within glomerular cells and liver. PE women have an early, excessive triglyceride and free fatty acid (FFA) rise and greater cardiovascular disease (CVD) risk in later life. The cause of these lipid abnormalities in PE is unknown but disordered adipocyte function including exaggerated lipolysis and aberrant release of adipokines (such as IL-6 and TNF alpha) is a major candidate pathway. Elevations in FFAs, and pro-inflammatory adipokines could underpin the oxidative stress, endothelial dysfunction, inflammation, and insulin resistance - characteristic features of PE. The aims of this thesis were to acquire a better understanding of lipid metabolism and function in normal pregnancy, to determine if adipocyte function was altered in PE and, if so, to establish mechanisms. In addition I planned to corroborate epidemiological evidence of increased future CVD risk and to establish which risk factors accounted for this increased risk. I collected subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) biopsies in non-labouring pregnant healthy (n=31) and PE (n=14) women who underwent caesarean section. Maternal blood was collected prior to delivery and phenotyping of the mother was performed including plasma assay for cholesterol, triglyceride, HDL-cholesterol, IL-6, TNF-α, leptin, adiponectin, high sensitivity CRP, glucose and insulin concentrations. Maternal BMI at booking, standardised blood pressure measurements and birth weight centile were also recorded. I determined ex vivo lipolytic activity (basal, isoprotenerol stimulated and insulin suppression of lipolysis) and adipokine production in response to lipopolysaccharide (LPS) stimulation from these biopsies. The gene expression of relevant target genes and macrophage densities in each adipose depot by immunocytochemistry (ICC) was also performed. In addition I performed carotid ultrasound assessment of women with a previous history of PE (n=31) and matched controls (n=29). Ethical approval was obtained from Glasgow Royal Infirmary LREC and all patients gave their informed consent. I found that in normal pregnancy, adipocyte lipolytic function is independent of maternal BMI. Adipocyte lipolytic function of SAT and VAT are also independent of each other. Adipose tissue is very metabolically flexible and the rate of whole body lipolysis is still insulin sensitive in late gestation. VAT is more closely related to markers of maternal insulin resistance (IR) and is more sensitive to catecholamine stimulation and less sensitive to insulin suppression of lipolysis than SAT, the basis of the “portal paradigm”. Increasing BMI is associated with an increase in VAT cell size, with increased lipolysis and an increase in pro-inflammatory adipokines, a potential mechanism through which increasing obesity could predispose to metabolic complications of pregnancy. In contrast SAT cell size is not closely related to BMI and this may reflect the adaptation of this depot to increasing fat mass through both hypertrophy and hyperplasia, a metabolically advantageous response. TNF alpha is an important correlate of basal lipolysis in SAT. In PE there is decreased insulin sensitivity of both SAT and VAT compared to controls as calculated by the fat cell insulin sensitivity index (or responsiveness to insulin once the tissue is stimulated by isoproterenol). This would potentially make a significant impact on total circulating FFA as almost 60% of circulating FFA are from these adipose depots. The rise in FFA in PE occurs early in pregnancy and contributes significantly to IR. Therefore the IR of adipose tissue could lead to a vicious cycle of increased lipolysis, increased FFA and further exacerbation of IR. In contrast to controls, SAT cell size is intimately related to BMI suggesting that adaptation to increasing fat mass is mainly through adipocyte hypertrophy which could lead to increased endoplasmic reticulum stress, increased IR and increased release of inflammatory adipokines. I have shown that SAT cell size does relate to adipokine release in PE, with increased release of leptin, CRP and PAI-1 and paradoxical increase in the anti-inflammatory IL-10. I had hypothesised that in addition to an inherent defect in adipocyte function there was an additional factor present in maternal serum of women with PE released from the placenta which excessively stimulated lipolysis. I failed to demonstrate any effect of maternal serum on adipocyte lipolysis in either controls or PE. I also found that after stimulation with LPS, there was increased release of TNF alpha and IL-6 in VAT in PE but not in controls, with higher gene expression of these adipokines. TNF alpha release also correlated negatively with the fat cell insulin sensitivity index (FCISI) of VAT implicating a paracrine effect in this tissue. I also demonstrated an increase in gene expression of cfms (activated macrophages) relative to control gene, and increased density of cfms+ macrophages/adipocytes in the VAT of PE women implicating activated adipose tissue macrophages as a potential source of the increased release of inflammatory adipokines. Lastly I attempted to corroborate epidemiological evidence for the increase future risk of CVD women with a history of PE by assessing two surrogate markers for atherosclerosis - carotid IMT and carotid plaque scores. Both were found to be increased, with plaque scores significantly so. Classic risk factors such as age, lipids, BP and smoking did not attenuate this effect and BMI only marginally attenuated it, therefore only partially explaining this increased risk. In summary the data presented in this thesis provides further evidence that PE is a “metabolic syndrome of pregnancy” with disordered adipocyte function and metabolism, with an increased future risk of CVD in later life. Further studies on adipose accumulation, function and composition in normal and complicated human pregnancy are warranted.
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Carty, David Martin. "Pre-eclampsia : early prediction and long-term consequences." Thesis, University of Glasgow, 2012. http://theses.gla.ac.uk/3124/.
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Approximately one in ten pregnant women will have their blood pressure recorded above normal at some point during their pregnancy. Pre-eclampsia, the most common hypertensive disorder of pregnancy, affects around 5% of all first time mothers, and is an important cause of foetal and maternal morbidity and mortality worldwide. Efforts to diagnose the condition have been hampered by inability to predict which women are likely to be affected. Multiple pathways are known to be involved in its pathogenesis, and several screening tests have been suggested for its early prediction. None, however, have been sensitive or specific enough to have come into routine medical practice. The work contained in this thesis describes a study which was designed to detect biochemical and clinical markers that could improve ability to predict pre-eclampsia. Over 3900 women were recruited in early pregnancy at four maternity clinics across the West of Scotland; baseline characteristics and information on past medical and obstetric history were obtained. Women were followed up throughout their pregnancy, and information on deliveries obtained from hospital databases. One-hundred and eighty of these women, who had multiple risk factors for pre-eclampsia, attended for further sampling and vascular assessment at gestational weeks 16 and 28. The primary aim of the overall study was to examine whether a proteomic strategy could be used to identify patterns of peptides in urine that detect pre-eclampsia in the first and second trimesters. Using samples from healthy pregnant and non-pregnant women I was able to describe the normal human urinary proteome in pregnancy. By comparing these pregnancy-associated peptides between women who went on to develop pre-eclampsia and matched controls, I was able to identify a pattern of peptides, characterised by collagen fragments, fibrinogen and uromodulin that accurately predicted pre-eclampsia at week 28. No such markers were identified in the first trimester samples. A further aim of the overall study was to identify early pregnancy plasma markers that could help to identify women destined to develop pre-eclampsia. By examining samples from early pregnancy I was able to demonstrate that the angiogenic markers soluble endoglin and placental growth factor are already altered at week 12-16 in women who go on to develop pre-eclampsia. Using a multi-marker approach, I also showed that E-Selectin, an adhesion molecule expressed on endothelial cells which controls interaction between circulating leukocytes and the endothelium, is higher at week 12-16 in women who go on to develop pre-eclampsia. Experiments using samples from later pregnancy, alternative analysis techniques and samples from an independent study population all helped to confirm these novel findings. Endothelial dysfunction is known to play a key role in the development of pre-eclampsia, contributing to the hypertension, proteinuria and oedema seen in affected women. In the risk factor cohort I used vascular function studies to examine whether they supplied additional information to aid in risk stratification. Peripheral arterial tonometry, a novel non-invasive tool for the assessment of microcirculatory endothelial function, was examined in 180 women at gestational weeks 16 and 28. Reactive hyperaemia index (RHI), a measure of endothelial dysfunction calculated from vascular response to arm blood-flow occlusion, did not correlate with maternal factors such as age, BMI and blood pressure. Further, RHI did not help to identify which women would go on to develop pre-eclampsia, when examined at either week 16 or 28. I found that PAT score was negatively correlated with baseline digital pulse amplitude, suggesting that in later pregnancy, when women are more vasodilated, PAT and other techniques which rely on flow-mediated dilatation are less likely to be reliable. I used pulse wave analysis, a well-established method for measuring arterial stiffness and central pressures, to determine whether it supplied additional information about pre-eclampsia risk. This technique has been previously reported to predict pre-eclampsia in early pregnancy. In this cohort of high risk women, no difference was seen at either week 16 or 28 between those who would go on to develop pre-eclampsia and those who would have normotensive pregnancies. Although blood pressure and proteinuria return to normal after pre-eclampsia, evidence has emerged the condition has long-lasting implications; women with a history of pre-eclampsia have an increased risk of cardiovascular disease later in life, suffering stroke or myocardial infarction more frequently than women who had a healthy pregnancy. Conventional risk factors are thought to contribute, but do not fully explain this increased risk. I carried out further vascular function studies in women after pre-eclamptic pregnancy, to examine whether they had ongoing detectable endothelial dysfunction and arterial stiffness. At 6-9 months post-natally, affected women had lower baseline digital pulse amplitude but no other evidence of persistent vascular dysfunction. Taken together, these data provide information about a number of markers that may improve understanding of the pathophysiological mechanisms underlying pre-eclampsia. As well as potentially improving the early prediction of disease, this work represents a highly topical area for further studies. While vascular function analysis does not appear to provide additional information on top of risk factors, these studies also provide useful information on vascular physiology in high-risk pregnancies.
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Anderson, Laurie. "The myometrial effects of progesterone." Thesis, University of Glasgow, 2010. http://theses.gla.ac.uk/2203/.
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Introduction: Preterm birth is the leading cause of perinatal morbidity and mortality and rates are rising. The UK now has the highest rate of premature birth in Europe with 5.3% of overall births in Scotland occurring spontaneously before 37 weeks gestation (1, 2) .Preterm babies have higher rates of perinatal mortality and morbidity and those that survive are at risk of multiple conditions including respiratory distress syndrome, central nervous system abnormalities, necrotising enterocolitis and sepsis. The mechanisms of preterm birth are poorly understood. Preterm birth can be spontaneous or induced and spontaneous preterm labour has multiple aetiologies. Current evidence suggests that prolonged treatment with progesterone and 17 α-hydroxyprogesterone caproate (17OHPC) may reduce the incidence of premature delivery in high risk patients with a history of spontaneous preterm birth (3) or with a short cervix. However, progesterone is not uniformly effective in preventing preterm labour and at present its principal mode of action on myometrium is unknown. I aimed to determine some of the specific mechanisms of action of progesterone. Aims: I hypothesised that progesterone has a direct inhibitory effect on spontaneous myometrial contractility, induces increased sensitivity to tocolytic agents and decreases sensitivity to contractile agonists such as oxytocin. I also hypothesised that progesterone has inhibitory effects on endogenous uterine stimulants, stimulatory effects on endogenous uterine relaxants, induces upregulation of endogenous receptors that inhibit uterine contractions and inhibits contraction associated proteins both in vitro and in vivo. Methods: I recruited women already enrolled in the STOPPIT (a double blind randomised placebo controlled study of progesterone for the prevention of preterm birth in twins) who were given vaginal progesterone, or placebo and who were scheduled for caesarean section. I also recruited women with healthy twin or singleton pregnancies undergoing elective caesarean section. Myometrial biopsies were obtained from the upper border of the lower uterine segment incision during caesarean section. Samples were divided and used for contractility measurements, or subsequent mRNA, protein and immunohistochemical analysis. Myometrial strips were cut and suspended under resting tension within organ baths. Concentration-response curves were carried out in response to oxytocin, levcromakalim, nifedipine and ritodrine to ascertain any reduction in effect by progesterone on oxytocics or enhancement of tocolytic effects. I also carried out concentration-response curves to progesterone alone and in the presence of potassium channel blocking agents. I then assessed ex vivo, the inherent contractility of the placebo versus progesterone groups from myometrium sampled from the STOPPIT cohort of patients. I carried out cell culture experiments on myometrium from healthy singleton women who were not in labour at the time of sampling. Myometrial explants were placed in cell culture medium, cultured for 1, 4 and 24 hours, and the supernatants were then analysed using Bio-Plex array technology to ascertain cytokine release. I selected time points and concentrations conditions to incubate myometrial tissue using progesterone and 17OHPC and was able to assess cytokine release. The myometrial explants were used for subsequent molecular studies. I performed real time-polymerase chain reaction (RT-PCR) (Abi,Taqman) to quantitate endogenous inhibitors of uterine contractility (cGRPR, EP2,NOS), cytokines (interleukins- IL6, IL8, IL1β), uterine stimulants COX-2 and gap junction components ( connexin 26 and connexin 43) expressed relative to housekeeping gene 18s. Lastly, I analysed the STOPPIT cohort of myometrial samples for to determine the in vivo effect of progesterone. We carried out RT-PCR (Abi,Taqman) to quantitate endogenous inhibitors of uterine contractility (cGRPR, EP2,NOS, PGDH), cytokines (IL6, IL8, IL1β) and gap junction components (connexin 26 and 43).I performed immunohistochemistry, staining for localisation of pro-inflammatory cytokines. I then carried out protein expression analysis using Western blot for contraction associate protein, connexin 43. The project was approved by North Glasgow University Hospitals Research Ethics Committee ref no. 05/S0705/18. All patients gave written informed consent to participate. Results: I found that progesterone, exerted consistent, rapid and sustained inhibition of the amplitude of spontaneous myometrial contractions in vitro at high concentrations however, this affect was not achieved through the principal potassium channels. Levcromakalim, a KATP channel opener, produced a concentration-dependent inhibition of the amplitude and frequency of spontaneous contractions. These effects were antagonised by the KATP channel blocker, glibenclamide. In contrast, glibenclamide had no effect on the progesterone-induced inhibition of myometrial contractility. Charybdotoxin 10 nM (which blocks IKCa, BKCa and Kv channels), iberiotoxin 100 nM (which blocks BKCa channels) and apamin 100 nM (which blocks SKCa channels) failed to affect the ability of progesterone to inhibit myometrial contractility. In contrast, 17OHPC did not exert any inhibitory effect on myometrial activity in vitro. Results indicated, at the selected pharmacological doses used in vitro that progesterone did not increase sensitivity to tocolytic agents tested. There was no decrease in sensitivity to the uterotonin oxytocin. Lastly, from our STOPPIT patient cohort I demonstrated no difference between the progesterone and placebo groups in either spontaneous contractility, response to tocolytics as above or response to oxytocin. One main conclusion of this arm of the study is that in vivo progesterone therapy to prevent pre-term labour does not appear to modify contractility ex vivo. I demonstrated that administration of progesterone but not 17OHPC for up to 24 hours in vitro does not appear to modify mRNA expression of uterine stimulants such as cytokines, COX-2 or endogenous uterine relaxants such as NOS and PGDH. Progesterone but not 17OHPC inhibited production of gap junction component connexin 43. This modification of contraction associated protein is in agreement with other literature presented on human myometrial data in vitro (4) . I used STOPPIT patients as a potential example of the myometrial effects of progesterone in vivo with a placebo treated control group. Prolonged maternal administration of progesterone appeared to inhibit expression of gap junction components connexin 26 and 43 in myometrium. Connexin 43 importantly, was also modified in vitro within the progesterone treated arm. However, ex-vivo assessment of the functional impact on human myometrium does not demonstrate a long-term inhibitory impact on myometrial function with down regulation of endogenous contractile inhibitors such as eNOS and EP2. The connexins play an essential role in regulating synchronous myometrial contractions. If progesterone has been of benefit in those at risk of preterm labour with a history of spontaneous preterm birth, it is possible therefore that this is by reducing connexin expression, which prevents the development of these synchronous contractions whilst on progesterone therapy. In summary, I have demonstrated putative mechanisms by which progesterone (and its analogue 17OHPC) might prevent preterm birth. Further studies characterising these pathways might inform the design of other agents which could provide additional efficacy in preventing preterm delivery.
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Rayment, Juliet. "Midwives’ emotion and body work in two hospital settings : personal strategies and professional projects." Thesis, University of Warwick, 2011. http://wrap.warwick.ac.uk/36856/.
Full textAbstract:
Much has been written in recent years of a ‘crisis’ in the recruitment and retention of midwives in the NHS. The crisis has been attributed variously to burnout, a lack of professional autonomy, a bullying culture, and an ideological conflict between the way in which midwives wish to practise and the way they are required to practise within large bureaucratic institutions, such as NHS Trusts. Negotiating these experiences requires a significant amount of emotional labour by midwives, which they may find intolerable. This thesis explores the strategies NHS midwives deploy in order to continue working in NHS maternity services when many of their colleagues are leaving. It examines the extent to which working in a midwife-led service rather than a consultant-led service helps or hinders midwives’ capacity to manage the emotional and ideological demands of their practice. Ethnographic fieldwork was carried out in a consultant unit and an Alongside Midwife-led Unit (AMU) in two NHS Trusts in England. The findings from negotiated interactive observation and in-depth unstructured interviews with eighteen midwives were analysed using inductive ethnographic principles. In order to ameliorate the emotional distress they experienced, the midwives used coping strategies to organise the people and spaces around them. These strategies of organisation and control were part of a personal and professional project which they found almost impossible to articulate because it ran contrary to the ideals of the midwifery discourse. Midwives explained these coping strategies as firstly, necessary in order to deal with institutional constraints and regulations; secondly, out of their control and thirdly, destructive and bad for midwifery. In practice it appeared that the midwives played a role in sustaining these strategies because they formed part of a wider professional project to promote their personal and professional autonomy. These coping strategies were very similar in the Consultant Unit and the Midwifery Unit. A midwife-led service provided the midwives with a space within which to nurture their philosophy of practice. This provided some significant benefits for their emotional wellbeing, but it also polarised them against the neighbouring Delivery Suite. The resulting poor relationships profoundly affected their capacity to provide a service congruent with their professional ideals. This suggests that whilst Alongside Midwife-led Units may attempt to promote a midwifery model of care and a good working environment for midwives, their proximity to consultant-led services compounds the ideological conflict the midwives experience. The strength of their philosophy may have the unintended consequence of silencing open discussion about the negative influence on women of the strategies the midwives use to compensate for ideological conflict and a lack of institutional and professional support.
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Stewart, Frances Maria. "The impact of maternal obesity on vascular and metabolic function throughout pregnancy." Thesis, University of Glasgow, 2008. http://theses.gla.ac.uk/426/.
Full textAbstract:
Maternal obesity increases the risk of numerous maternal and fetal complications of pregnancy. Women were recruited at booking for antenatal care. Each subject was examined in the first, Second and third trimester of pregnancy as well as twelve weeks post partum. Using non invasive techniques microvasular function was measured at each visit. Fasting bloods were taken. This assessment allowed us to observe microvascular function, inflammatory response, dislipidaemia and changes in fatty acid composition with advancing gestation and the degree of recovery in the post partum. By recruitment of women with varying body mass index (BMI) values we were able to examine the influence of maternal BMI on these responses to pregnancy.
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Moss-Luffrum, Beverley Jane. "Paradigmatic resonance and dysjunction in the development of the human sciences : accountability and expertism in the history of parturial practices." Thesis, University of Warwick, 1993. http://wrap.warwick.ac.uk/36195/.
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This thesis examines the function of discursive paradigms in the process of subjectivisation and the formulation of objects in the development of the human sciences. The history of childbirth practices exemplifies the operations of paradox and paradigm, and of epistemic changes and continuities, in relation to medical, ethical, and pedagogic discourses. The recent past has brought rapid change in the practices and outcomes of parturition with regard to technologisation, and the improvement in mortality rates. The achievement of technological childbirth has a complex and paradoxical history, and should be understood other than as an inevitable and progressive phenomenon of scientific endeavour, or as a conspiracy of patriarchy which victimises and subjugates women as a matter of intentionality. The histories of the parturient and of the midwife are only partially linked. An examination of childbirth history reveals some of the implications of phallogocentricity for the history of women and for the constitution of gender and gender relations. Midwifery has its own unique but unmistakeable place in the historical discourse of pathologisation and professionalisation - and cannot be regarded simply as an arena of masculine appropriation. The mechanisms for change in parturial practices have been developing to facilitate the modifications of recent history since around 1800, but there are discursive resonances which are linked also to changes in pedagogic organisation which began in the Middle Ages. Further, in order to analyse and evaluate the history of parturition over the past two hundred years, it is necessary to examine the paradigmatic structures based upon dialectical reasoning which have dominated the development of the human sciences since antiquity. Childbirth provides examples of many historical exigencies which informed a panoply of disparate effects, but it is also in many respects unique and anomalous. An exploration of the operations of power, knowledge and influence in this sphere, reveals as much in terms of its resistances as its susceptibilities, to medical appropriation. The history of childbirth is unusual insofar as the technologies and innovations that developed in relation to it, were in fact, slow to be implemented. Evidence of such paradigmatic dysjunction is provided by the examples of the use of forceps, asepsis and anaesthesia in the nineteenth century. This thesis addresses aspects and effects of professionalisation, and the increasingly disciplinary implications of expert discourses for the pregnant and parturient woman in the twentieth century.
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Purkis, Judith Christine. "Beyond qualification : learning to be midwives." Thesis, University of Warwick, 2006. http://wrap.warwick.ac.uk/4079/.
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"I know that every day I am gaining experience ... learning more" (Int. 6(a)) This thesis examines the social practices and associated learning that shape the meaning of midwifery for new members of the profession. In doing so it explores the extent to which the implications of practice either liberate or circumscribe midwives' identity formation. The thesis further suggests how this identity formation may impact upon commitment to a long term career in midwifery. The theoretical framework for this thesis acknowledges that continuing professional development and evidence of recognised learning activity is, for all midwives, a professional requirement. However, less attention has historically been paid to the unstructured, unintended and relatively informal learning that occurs within and throughout midwives' involvement in everyday practice. It is through these forms of learning, and drawing upon data elicited through surveys, interviews and diaries, that this thesis seeks to make a contribution. Using a social model of learning, particularly through Wenger's (1998) work on communities of practice, the development of identity is presented as a negotiated process mediated to a greater or lesser degree by workplace relationships. Whilst relationships with pregnant women form an important element of this process, the thesis argues that collegial relationships generally assume greater importance and impact on the development of identity and meaning for newly qualified midwives. By situating the everyday experiences of newly qualified midwives within a broader theoretical debate about social learning, identity and the making of meaning, this thesis suggests that the contemporary 'doing' of hospital based midwifery remains within what are fairly narrowly prescribed, contested, yet firm boundaries. The development, existence and negotiation of these boundaries is central to the space which pregnant women, midwifery and midwives can occupy. These boundaries are simultaneously hierarchical, intra professional and personal. Furthermore, in practice, these boundaries are frequently unclear and rapidly changing. Whilst this contributes to a potentially dynamic opportunity for identity formation, the thesis demonstrates how this also transpires to contribute to an unstable, frustrating and frequently challenging context particularly for newly qualified members of the profession. Overall, this thesis contributes to an understanding of the development, or lack of development, of midwifery practice at theoretical, conceptual and practical levels. Viewing practice as social learning offers a new perspective on the opportunities and challenges inherent in the current model of care. Simultaneously it suggests a new perspective on the recruitment crisis faced by the profession and accordingly the opportunity for new potential solutions.
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Bailham, Dawn Bernadette Ruth. "Psychological trauma following childbirth." Thesis, University of Warwick, 2001. http://wrap.warwick.ac.uk/4506/.
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The aim of this study was to assess risk factors to PTSD following childbirth incorporating a longitudinal design. Since the introduction of DSM-IV (APA, 1994) there has been an awareness in the literature that women can develop PTSD following childbirth. The first study in this thesis provides a comprehensive review of the literature in this area and the clinical implications of the disorder. The aim of the second study was to investigate the factor structure of a questionnaire measure (PLDQ) that has been used in past studies to assess women's perceptions of labour and delivery. The findings from this study indicate that the PLDQ consists of three internally reliable factors that can assess a woman's perception of pain, staff support/care and fear during labour and delivery. The scale can differentiate among women on these factors according to type of delivery. The aim of the third paper was to assess risk. factors to PTSD across time in the antenatal period, appraisal factors during delivery with the PLDQ, and maintenance factors in the postnatal period. There is an absence of studies in the literature that assess risk factors to PTSD over time. The results of this study indicate that postnatal depression (PND) and a negative appraisal of staff support and care during labour and delivery can predispose women to PTSD at 5-8 weeks following delivery. At 10 -14 weeks the relationship between PTSD and PND was still consistent. The clinical implications of the research are discussed for screening women at risk of PTSD following childbirth, assessment of a woman's appraisal of a difficult labour and delivery and the provision of support in the postnatal period.
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Briscoe, Lesley. "Vulnerability within maternity care." Thesis, Edge Hill University, 2018. http://repository.edgehill.ac.uk/10083/.
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Background: Vulnerability is universally present but experienced biopsychosocially on an individual level. Stigma develops when populations are labelled vulnerable. Individual vulnerability can be lessened by resources accessed to assist in developing resilience. A deeper analysis of vulnerability and resilience is required to inform policy, ethics, law and social life. Design: Qualitative, quantitative and mixed method approaches were used. Sample: Five papers represented the perspectives of 102 women, 21 clinicians and 13 student midwives. A further paper presented a concept analysis which included the perspectives of 10,067 women and 325 clinicians (total sample size women n=10,169; clinicians n=346; student midwives n=13). Methods: Gadamer’s ontological perspective of time, place and culture and was seen through Engel’s biopsychosocial lens. Epistemologically, truth originated from multiple realities. Methodologically, women’s experiences were captured via mixed methods. 7 Analysis: Thematic analysis and descriptive statistics were synthesised via framework analysis. Findings: A coherent theme of vulnerability in maternity care was apparent. Women’s concerns were trivialised. The professional’s style of communication determined the women’s experience of maternity care. Clinician control of care provision undermined women’s ability to choose. Women developed resilience in adverse circumstances via: accessing other supportive members of society, identifying their need for information, talking to others and developing accommodative coping strategies. Conclusion: The new conceptual model, in this thesis, should be evaluated via mixed methods. A biopsychosocial approach should underpin informed choice. Clinicians need raised awareness about how interaction can lower women’s self-esteem and build resilience in others. Higher education needs to challenge preconceived biases in safe environments via reflective processes. Research should explore women’s influential circle in decision making during maternity care. Women should be involved in the design of research to inform how best to capture their complex lived experience. Funders of research and ethics committees should request information about how implementation of evidence may be influenced by the current clinical environment. Impact should be measured post implementation. Social policy should be informed by a deeper, conceptual analysis of vulnerability and resilience.
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Lacey, Lauren. "Prediction of inappropriate myometrial function." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/91479/.
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Preterm birth is a major clinical problem, worldwide 15000000 babies are born prematurely each year. Inappropriate myometrial function is a major cause of preterm labour. Preterm labour is the result of multiple pathological processes involving several underlying mechanisms. In all cases, a quiescent uterus in pregnancy changes to one that can produce coordinated, forceful contractions, following an increase in uterine conductivity and contractility, and cervical remodelling to facilitate cervical dilatation. Currently there are several biochemical and clinical tests available to assist in the prediction of preterm birth. Many of these have a very high negative predictive value but their positive predictive value remains low. One in five women in the UK requires induction of labour. The outcomes of this process are again difficult to predict. Both of these areas of obstetrics would benefit from improvements in prediction of clinical outcomes. Previously, phospholipase C like 1 (PLCL1) was identified as a novel intracellular protein found to be significantly downregulated in both the myometrium with the onset of spontaneous labour using sequencing techniques (Chan et al., 2014). It acts as an IP3 chelator, uncoupling phospholipase C from myometrial contractions, maintaining myometrial quiescence and therefore regulating a common pathway to inflammatory, oxytocin or prostaglandin mediated labour. We aimed to develop a clinical test utilising PLCL1 as a quiescence or susceptibility marker to other stimuli to premature labour and to determine if this marker could determine sensitivity to prostaglandins and syntocinon during the induction of labour process. During a prospective observational cohort study, patients were recruited from a preterm prevention clinic throughout mid-pregnancy, and from the antenatal ward when attending for induction of labour at term. Cervical cytobrush samples were taken to obtain cervical epithelial cells. A novel assay was developed to quantify PLCL1 from these samples. There have been various challenges in the process, including the small and varying number of cells obtained, problems with interference from cervical mucus with protein quantification and difficulty adequately lysing our cells to release the protein. We have demonstrated the presence of PLCL1 in cervical cytobrush samples using immunocytochemistry, SDS-PAGE, and western blotting and ELISAs. We have developed a method to isolate our cervical cells from the cervical mucus, lyse these cells and quantify PLCL1 using an ELISA. Our findings demonstrate that PLCL1 is a promising novel protein which could be utilised in the prediction of preterm birth and outcomes of induction of labour. As a susceptibility marker, PLCL1 could be used in conjunction with other markers.
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Doherty, Nicola. "Disclosure of genetic origins : parental experiences and attitudes in the UK and Brazil." Thesis, University of Warwick, 2018. http://wrap.warwick.ac.uk/100889/.
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Embryo donation (ED) and double donation (DD) are fertility treatments whereby resulting children are raised by parents to whom they are genetically unrelated. The main similarity between ED/DD and adoption is the lack of genetic parent-child relationships, and the main difference is the presence of the gestational link in ED/DD families, which provides an option of concealing genetic origins. This thesis consists of one large study followed by three subsidiary studies, with the overall aim of exploring the disclosure of genetic origins in the UK and Brazil, and the support available to assist parents with this process. In Study I, 36 ED/DD parents, and 27 adoptive parents were interviewed to determine if and how they disclosed to their children, and identify the support that they received to manage this process. In Study II, 30 UK-based infertility counsellors completed an online survey to ascertain how they engage in disclosure-related issues with patients seeking embryo donation/double donation treatment. In Study III, 19 Brazilian parents, who conceived a child using donated sperm or eggs, completed an online survey to explore if and how they disclosed to their children, and whether they felt supported with this process. In Study IV, 24 Brazilian fertility professionals completed an online survey to determine how they engage with parents seeking treatment with donated gametes. Overall, adopters were more confident in the process of adoption revelation, and received more support in order to achieve this, compared to ED/DD parents. Findings highlight the complex nature of disclosing donor conception, and identified that Brazilian parents experience similar challenges compared to those in the UK. Disparities were found in the disclosure-related support provided both across and within these two country contexts. From these results, recommendations for how parents could be better supported with disclosure-related issues are given.
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Al-Musharaf, Sara. "Prevalence of vitamin D deficiency in pregnant women and its association with gestational diabetes mellitus." Thesis, University of Warwick, 2017. http://wrap.warwick.ac.uk/94005/.
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Several reports have linked vitamin D deficiency with an increased risk of gestational diabetes mellitus (GDM). Both of these conditions are alarmingly common in Saudi Arabia, and pose additional risk of developing future metabolic disease. This study, therefore, investigates the vitamin D status amongst pregnant Saudi women, and the potential influence of vitamin D deficiency on metabolic dysfunction, such as GDM. A total of 578 pregnant women (28.8 ± 5.4 years) were recruited for this study during their first trimester of pregnancy (8-12 weeks) and followed up in their second trimester (24-28 weeks), where data were collected from 297 [51.3% (297/578); 28.9 ± 5.3 years] women. The study collected socio-economic, anthropometric and biochemical data, along with dietary intake, physical activity and sun indices. The findings of this study indicate that during the first trimester 81% of women being vitamin D deficient, dropping to 77% in the second trimester. It was also noted that being younger in age, multiparous, having a lower level of education, being a housewife, and living in West Riyadh were all associated with vitamin D deficiency during the first trimester (p < 0.05), and this further corresponded to reduced sun exposure (p < 0.001). In contrast, physically active pregnant women, women adequately exposed to sunlight at noon (p < 0.001), and residents of North Riyadh all had significantly higher circulating vitamin D levels (p < 0.05). Furthermore, low levels of high-density lipoprotein cholesterol (HDL-cholesterol) during early pregnancy were also associated with an increased risk of vitamin D deficiency (p < 0.05). Ultimately, compared with the first trimester, circulating vitamin D levels were significantly higher in the second trimester, after adjustment (p < 0.001). Among the pregnant women studied here, it was subsequently found that 33% developed GDM in the second trimester. Vitamin D deficiency in early pregnancy was associated with significantly higher risk of GDM, and this risk persisted after adjusting for confounding risk factors with regard to both vitamin D deficiency and GDM [odds ratio (OR) 3.97, confidence interval (CI) 1.12-14.15, p = 0.033]. In addition, significantly higher random blood glucose levels, higher glycated haemoglobin (HbA1c), and low HDL-cholesterol in early pregnancy were observed in the GDM subjects, compared to those without GDM (p < 0.05). Furthermore, vitamin D deficiency in mid-pregnancy increased the risk of metabolic syndrome and low HDL-cholesterol, thus pointing to the role of vitamin D in the probability of developing cardiometabolic disease. In summary, a high prevalence of vitamin D deficiency was observed amongst the subjects in this study, namely pregnant Saudi women. Moreover, hypovitaminosis D in early pregnancy was identified as a significant risk factor for the development of GDM. The present study, therefore, suggests that maintaining optimal levels of vitamin D during pregnancy may be a useful intervention in preventing the development of GDM and metabolic syndrome. Along with vitamin D supplementation, lifestyle modification also appears to be critical for maintaining optimal vitamin D levels during pregnancy, thus avoiding pregnancy-related complications.
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Weli, Homayemem Kinikanwo. "Changes in advanced glycation content, structural and mechanical properties of vaginal tissue during pregnancy and in prolapse." Thesis, Keele University, 2018. http://eprints.keele.ac.uk/5104/.
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Introduction: Pelvic organ prolapse is present in up to 50% of women. It is commoner in older women, often above 50 years of age and associated with hormonal e.g. oestrogen decline, and stiffer vaginal tissue. Pregnancy, on the contrary is a physiologic condition with higher oestrogen level and exhibits reversible structural and mechanical changes in pelvic tissues. Advanced glycation products, the ageing markers, stiffen connective tissues. There has been no previous systematic study on the relationship and action mechanisms of oestrogen, glycation level and mechanical property of vaginal tissues. Aim: The aim of this project was to study the ultrastructural and mechanical properties of vaginal tissues, and understand the relationship and possible mechanisms of accumulation of glycation (pentosidine), vaginal wall mechanics and oestrogen receptor (ER-a) expression in the vaginal tissues in both pregnancy and prolapse. It was hypothesised that prolapse is a disease of accelerated ageing and that mechanical and ultrastructural changes in prolapsed tissues and oestrogen decline are related to the elevation of glycation content in the tissues. Methods: Following ethical approval, vaginal tissues from 49 women with prolapse and 16 controls were obtained and proformas containing information on known and suspected prolapse associations were completed for each participant. Female Sprague Dawley rats‘ vaginal tissues were used for the pregnancy study. Nano-scale, micro-scale and tissue level mechanical characterizations of the tissues were performed using ball indentation technique, scanning electron microscopy, peakforce nanomechanical property mapping atomic force microscopy, and optical coherence elastography, which was applied for the first time to the study of vaginal tissues. The glycation contents of vaginal tissues in pregnancy and prolapse were quantified by high performance liquid chromatography and values obtained were analysed in comparison to medical comorbidities. Tissues were qualified by histological and immunological staining for structure (haematoxylin &eosin, trichrome and picrosirus red stainings), glyoxalase I, ER-a, elastin and neural stain. A sulphated glycosaminoglycan (sGAG)-collagen model was used to study the role of sGAG in collagen fibrillogenesis. Results: Rat vaginal tissues in pregnancy contained significantly lower amounts of pentosidine, higher oestrogen receptor-a and glyoxalase I (antioxidant enzyme) expression with larger creep, lower elastic modulus, larger fibril diameter and higher sGAG content than their non-pregnant counterparts. Observed morphological changes of the collagen fibrils in pregnancy were attributed to sGAG, which was noted to influence collagen fibril aggregation and bundling. Skin pentosidine content was reflective of vaginal tissue pentosidine in the same subjects. Pentosidine was significantly higher in prolapsed tissues and increased with age; with more age-dependent increase observed in the prolapse population and also significantly different between the 6th and 7th decades. Glyoxalase I and ER-a were poorly expressed in the prolapsed tissues in comparison to controls. Prolapsed tissues had notably disorganized ultrastructure and higher collagen fibril modulus. At all levels of tissue organization, prolapsed tissues were stiffer than controls, with increased stiffening at the more superficial layers of the tissue. Hypertension and smoking were associated with higher glycation and prolapse. In both pregnancy and prolapse, higher expression of glyoxalase I and ER-a were associated with lower glycation content of the vaginal tissues and lower modulus. These observations have led to the suggestions that oestrogen plays an important role in increase or reduction of glycation through an oestrogen-gluthathione-glyoxalase (antioxdant) pathway, which directly affects vaginal tissues‘ mechanics. Future implications: These findings have implications to the current understanding of how prolapse may occur and can inspire future translational research on improved treatment of women with prolapse. Oestrogen may significantly influence the temporary and permanent mechanics of pelvic tissues such as the vaginal wall through its modulation of glycation accumulation within the tissues. Oestrogen thus shows promise of a potential future medical treatment for early stages of prolapse. The knowledge of new prolapse comorbidities can aid the early detection and possible prevention of prolapse through a high index of suspicion.
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Badger, Frances Jane. "Delivering maternity care : midwives and midwifery in Birmingham and its environs, 1794-1881." Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/5318/.
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This thesis examines the working milieu of midwives in the urban west midlands, primarily Birmingham and Coventry, between 1794 and 1881. Adopting a microhistorical approach, and by integrating sources including a midwife’s register, lying-in charity and poor law records, the thesis argues that developments in midwifery provision over the period mainly arose from local factors and circumstances, however some metropolitan influences can also be discerned. Reasons for the relatively late introduction of midwifery training in the locality, and the minimal interest by local midwives are considered, alongside evidence of midwives’ awareness of the varying reputation of their occupation. This research indicates that midwives worked for a range of clients including charities, the poor law and private clients, and midwifery could be combined with other strands of caring work, or even work unrelated to caring. The analysis illustrates the existence of full-time, sustained midwifery careers and of midwives who achieved a middle-class lifestyle, and a degree of status within their localities. Combined with the evidence of entrepreneurial approaches to midwifery, the thesis argues that these provincial midwives should be integrated into the historiography of businesswomen.
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Gehrig, Jochen. "Function of core promoters in differential gene regulation during embryogenesis." Thesis, University of Birmingham, 2010. http://etheses.bham.ac.uk//id/eprint/971/.
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The core promoter is the ultimate target of all transcriptional regulatory processes. The recently discovered diversity of core promoters and basal transcription factors suggests a regulatory role in differential gene expression. However, the direct contribution of the core promoter remains poorly understood. I investigated core promoters and their putative role in differential gene regulation using the zebrafish embryo as an in vivo model system. To analyse the functional requirement for the general transcription factor TATA-box binding protein (TBP), a diverse set of promoters was tested for their TBP dependence. This analysis revealed a differential requirement of TBP for promoter activity. To further explore the roles of core promoters the ability of various core promoters to interact with tissue-specific enhancers was investigated. A high-throughput pipeline combining automated imaging with custom-designed software for registration of spatial reporter gene activity in thousands of zebrafish embryos was developed. The technology was applied in a large-scale screen analysing the tissue specific activities of 202 enhancer - core promoter combinations. A variety of interaction specificities observed suggests an important role of the core promoter in combinatorial gene regulation. Overall, these findings indicate that the core promoter significantly contributes to differential transcriptional regulation in the vertebrate embryo.
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Bakour, Shagaf Haj. "Evaluation of ambulatory diagnosis of abnormal uterine bleeding." Thesis, University of Birmingham, 2003. http://etheses.bham.ac.uk//id/eprint/42/.
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In the ambulatory assessment of women with abnormal uterine bleeding, the main aim is to reach a diagnosis and thereby allow appropriate treatment. Excluding endometrial pathology, particularly carcinoma and hyperplasia, is of paramount importance. However there is no consensus as to which set of investigations should be used (hysteroscopy, ultrasonography and endometrial sampling). There is a lack of good quality research evidence on the accuracy of the various diagnostic tests in predicting endometrial lesions. This dearth of relevant evidence prompted the research presented in this thesis to address and answer the following research questions: • What is the accuracy of outpatient miniature hysteroscopy / ultrasonography in the identification of premalignant and malignant endometrial lesions? • What is the relative significance of hysteroscopic and ultrasonographic evidence of endometrial atrophy in relation to an insufficient sample on outpatient endometrial biopsy? • What is the risk of premalignant and malignant pathology among endometrial polyps? What is the significance of various risk factors associated with endometrial polyps? • What is the feasibility of multivariable analysis to evaluate combinations of diagnostic tests in the diagnosis of endometrial disease? Findings and Conclusions Positive hhysteroscopy is accurate in ruling in endometrial cancer and hyperplasia (the LR was 51.1 (95% CI 7.9-326.9). Using endometrial thickness >4mm at ultrasound scan, ultrasound is accurate in ruling out endometrial cancer and hyperplasia (the LR was 0.14 (95%CI 0.02-0.64). Insufficient sample on endometrial biopsy was more common among cases with hysteroscopic finding of endometrial atrophy (adjusted OR= 4.79, 95% CI 1.05-21.91, p=0.04) and less common among cases with sonographic endometrial thickness above 5mm (adjusted OR=0.19, 95% CI 0.07-0.53, p=0.001). Therefore insufficient sample may be considered a substitute to absence of pathology provided the hysteroscopic and sonographic endometrial assessment is consistent with endometrial atrophy. Hyperplasia was more frequent in endometrial specimens with polyps than in those without (9.7% vs 4.8%, OR=2.1, 95% CI 0.85-5.2), but the rate of carcinoma in the two groups was not statistically different (4.8% vs 3.2%, OR=1.5, 95% CI 0.46-5.0). Tamoxifen treatment was associated with endometrial polyps (adjusted OR= 8.16, 95% CI 2.01-33.2, p=0.003) but hormone replacement therapy was not (adjusted OR=1.35, 95% CI 0.65 – 2.81, p=0.42). The true clinical value of a test lies in the added information over and above what was already known from the history and examination. It is feasible to develop a stepwise multivariable analytic approach to explore the added value of tests (hysteroscopy or ultrasonography) over and above history when predicting endometrial hyperplasia or cancer. This analytic strategy needs to be applied in larger datasets to draw clinical conclusions.
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Connolly, Thomas James. "Calcium signalling during human sperm interaction with cells of the female reproductive tract." Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3411/.
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The female reproductive tract acts not only as a complex mediator of sperm function and selection but animal data suggests that it alters protein expression after exposure to sperm, implying two-way communication. We have used single-cell fluorescence imaging to observe [Ca2+]i signalling in human female reproductive tract cells upon initial contact with sperm and in sperm during binding and release events. Parallel experiments were also performed on a model human oviductal cell line, OE E6/E7 and a control, human foreskin fibroblasts. Upon exposure to sperm, tract cells generated [Ca2+]i signals through mobilisation of thapsigargin-sensitive intracellular Ca2+ stores. The percentage of significant [Ca2+]i responses varied in different anatomical regions of the female tract. Furthermore, [Ca2+]i signalling was observed upon exposure to sperm-conditioned media suggesting signalling factors may be shed or secreted by sperm. Human foreskin fibroblasts were unresponsive to sperm. Co-culture of sperm with tract explants induced post-translational modification of sperm proteins through NO-dependant S-nitrosylation. We have also provided initial evidence for [Ca2+]i alterations in sperm during binding to and detachment from oviductal explants. We conclude that sperm can elicit [Ca2+]i signals in female tract cells upon initial contact though mobilisation of intracellular Ca2+ stores. This may reflect events upstream of reported gene and protein expression changes. In addition, human sperm interaction with oviductal epithelium is likely to be important in modulating sperm function during migration and associated events through the female reproductive tract.
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To, Wilson King Lim. "A role of ATP in modulating vasomotion during hypoxia in umbilical cord blood vessels." Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3313/.
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Previous studies have associated intracellular calcium ([Ca2+]i) oscillations in vascular smooth muscle cells (SMC) with vasomotion in multiple species. In normal and pre-eclamptic pregnancies, there is strong evidence to suggest that the intrauterine environment is hypoxic. The aim of this study was to investigate whether ATP and [Ca2+]i oscillations play a role in modulating vasomotion during hypoxia in human umbilical blood vessels. The results obtained from in vitro studies using firefly luciferase assay and quinacrine staining indicated that human umbilical artery and vein endothelial cell (HUAEC, HUVEC respectively) constitutively released ATP and, in HUVEC at least, the release was accentuated by hypoxia (7.6 mmHg O2, 30 min). This release is dependent on the PI3K/ROCK pathway, and on normal vesicular transport. Further, application of ATP to human umbilical artery SMC induced dose-dependent [Ca2+]i oscillations, which was mediated by P2Y4 receptor. Moreover, ex vivo data from freshly isolated umbilical artery rings showed that acute hypoxia increased the frequency of vasomotion. It is therefore proposed that the findings of the present study is important in the understanding of the behaviour of human umbilical vessels in normal pregnancy, but may also have implications in the pathophysiology of complicated pregnancy such as pre-eclampsia.
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Smith, Paul Philip. "The practice of office hysteroscopy." Thesis, University of Birmingham, 2015. http://etheses.bham.ac.uk//id/eprint/6061/.
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Advances in technology have led to the miniaturisation of hysteroscopes without compromising optical performance. This development has facilitated the routine use of diagnostic hysteroscopy in an outpatient setting without the need for general anaesthesia. Further developments have expanded hysteroscopy from a simply diagnostic intervention to an operative one with a plethora of hysteroscopic surgical procedures. The work in this thesis has adopted a mixed methodological approach to rigorously evaluate patient selection, feasibility and efficacy of office hysteroscopy. Based on the results of this thesis we recommend: 1) Women with recurrent PMB should be investigated with either hysteroscopy or saline infusion sonography. 2) Vaginoscopy should probably be used in preference to other techniques to introduce the hysteroscope into the uterine cavity. 3) Women who have a uterine cavity >9cm or dysmenorrhoea should be warned they are more likely to require further intervention after endometrial ablation. 4) There appears to be no difference between the effectiveness of bipolar radiofrequency ablation and thermal balloon ablation at five years of follow up. 5) Women who present with abnormal uterine bleeding and an endometrial polyp should have it removed. 6) The hysteroscopic morcellator should be used in preference to bipolar resection for endometrial polyp removal.