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Memon, Ameer Afzal. "Helicobacter pylori virulence tests : interpretation and clinical significance". Thesis, University of Nottingham, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.580532.
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Unless treated, Helicobacter pylori persists as a chronic lifelong infection in the gastric mucosa of almost half the human population. Peptic ulcer disease or gastric cancer result in a small proportion of cases, thus it is important to develop effective methods to identify those patients at high risk of developing disease. The studies in this thesis aimed firstly to develop more accurate serological tests for non-invasive diagnosis of a H. pylori infection; secondly, to develop tests to identify virulence markers of disease-associated H. pylori strains; and thirdly, to determine implications of these tests for disease pathogenesis. Methods: Gastric biopsies and blood samples were collected from patients undergoing a routine upper gastrointestinal endoscopy at the Nottingham University Hospital NHS Trust- Queen's Medical Centre Campus, Nottingham. In addition, a panel of H. pylori isolates from Belgian population, including patients with duodenal ulcer, gastric cancer and, an age and gender matched gastric cancer control group with non-ulcer dyspepsia, was also characterised. ELISA assays were developed using serial dilution methods to accurately and quantitatively measure anti-H. pylori and anti-CagA IgG titres. PCR genotyping was carried out on H. pylori isolates for vacA region polymorphisms, cagA status and determination of the number of cagA EPIY A-C motifs. cagA mRNA levels in gastric biopsy tissues and cultured H. pylori strains were assessed using real- time RT-PCR. Naturally occurring polymorphic differences in the cagA promoter regions were identified by sequence analysis. Results and conclusions: The ELISA assays developed in this study allowed reliable detection of H. pylori infection and its virulence factor CagA. These assays performed well to overcome previously reported limitations of serological methods. Antibody titres closely associated with the severity of inflammation in the gastric mucosa but not with gastric atrophy. The relationship between anti-CagA IgG responses and numbers of EPIY A-C motifs was investigated and surprisingly patients infected with less virulent cagA types were found to have significantly higher titres. These strains were also found to express significantly higher cagA transcript levels both in vivo and in vitro. Sequence analysis of the cagA promoter region identified few potential naturally occurring polymorphisms. Polymorphic differences at position -54 within the inverted repeat of the cagA promoter region were found to be important in determining cagA transcription and site directed mutagenesis confirmed this. Genotyping analysis of the Belgian samples showed that vacA s l and il-type H pylori strains were closely associated with DU and ,GC and there was also a good concordance with cagA status. However, these strains were not significantly associated with mononuclear cell infiltration and neutrophil infiltration. In conclusion, serological detection of H pylori and its virulence factor CagA is a useful diagnostic tool and the intensity of the immune response in patients infected with these virulent strains is a good indicator of inflammatory process in the gastric mucosa. It was observed that a complex interaction between H pylori virulence and host exists, and that the cagA+ strains are likely to modulate their virulence potential possibly by regulating their gene expression. This has important implications and could explain why only some CagA strains cause disease. Although, vacA sl- and il-type strains are good markers of disease, determination of an independent virulence marker of H pylori- associated disease is difficult.
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Zayed, Richard S. "Interpretation in psychotherapy: An empirical phenomenological-hermeneutic study". Thesis, University of Ottawa (Canada), 2006. http://hdl.handle.net/10393/29326.
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As a psychotherapeutic intervention, interpretation has an extensive history dating back to the beginnings of psychotherapy itself. It has been theoretically expounded as the essence of psychotherapy by some theorists, and rejected as unnecessary by others. However, as the major theoretical orientations have begun to converge, interpretation has entered into their contemporary discourses in one form or another. Empirically, interpretation has been addressed extensively, particularly in the psychodynamic and process psychotherapy literatures. However, few qualitative studies have been conducted on the phenomenon as it presents itself in actual therapy sessions, and these qualitative studies have presented with significant limitations.
The present dissertation conducted a phenomenological study of interpretation in psychotherapy by examining the manner in which it presents itself through three sessions of self-identified psychodynamic, humanistic-existential, and cognitive behavioural therapists. These sessions were followed by separate interviews with the therapists and the patients regarding their experiences of the interpretations within the sessions. The three sessions and six interviews were analyzed by using the phenomenological method. The resulting general meaning structure indicated that interpretation was a core therapeutic intervention in all three sessions, and presented as a highly complex phenomenon. Its deeply interrelated main features indicated that interpretation is a highly dialogical phenomenon immersed in therapist and patient contexts and intentions, as well as pre-interpretive and post-interpretive contexts. Both the therapists and patients contributed to the evolution of interpretations in the interpretive dialogue, and in fact patients were found to initiate some of the interpretations. The dialogical nature of interpretation also implied that, through their interrelationship, the therapist and patient dialogued with the interpreted material as a presence beyond their relationship, giving rise to the actual interpretations.
Interpretive threads interweaved throughout the sessions as the interpretations formed layers of thematic development and increased in complexity. These interpretations involved greater or lesser degrees of intuition or reflection. Intuition and reflection counterbalanced each other; the former reflecting the interpretation's grounding in understanding the patient's experiencing, and the latter reflecting the interpretation's abstraction, complexity, and/or explanatory focus. Through its temporal dimension, interpretation unfolded in the present of the therapeutic dialogue, but reached back into the past and thrust forward into the future, even beyond the session itself. Finally, the present dissertation addressed specific and general patient responses to interpretation, and suggested a novel typology of interpretation.
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Dodd, Dorian R. "Attaining Imperfection: An Interpretation Bias Intervention Targeting Clinical Perfectionism". Miami University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=miami159545061793484.
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Macdonald, Morag M. "Craft knowledge in medicine : an interpretation of teaching and learning in apprenticeship". N.p, 1997. http://ethos.bl.uk/.
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Puccini, Cecilia. "Interpretation of Nonverbal Communication by Individuals Exhibiting Schizotypal Traits". W&M ScholarWorks, 1991. https://scholarworks.wm.edu/etd/1539625699.
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Zhao, Bo. "Towards semantic interpretation of clinical narratives with ontology-based text mining". Thesis, Cardiff University, 2016. http://orca.cf.ac.uk/93447/.
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In the realm of knee pathology, magnetic resonance imaging (MRI) has the advantage of visualising all structures within the knee joint, which makes it a valuable tool for increasing diagnostic accuracy and planning surgical treatments. Therefore, clinical narratives found in MRI reports convey valuable diagnostic information. A range of studies have proven the feasibility of natural language processing for information extraction from clinical narratives. However, no study focused specifically on MRI reports in relation to knee pathology, possibly due to the complexity of knee anatomy and a wide range of conditions that may be associated with different anatomical entities. In this thesis, we describe KneeTex, an information extraction system that operates in this domain. As an ontology-driven information extraction system, KneeTex makes active use of an ontology to strongly guide and constrain text analysis. We used automatic term recognition to facilitate the development of a domain-specific ontology with sufficient detail and coverage for text mining applications. In combination with the ontology, high regularity of the sublanguage used in knee MRI reports allowed us to model its processing by a set of sophisticated lexico-semantic rules with minimal syntactic analysis. The main processing steps involve named entity recognition combined with coordination, enumeration, ambiguity and co-reference resolution, followed by text segmentation. Ontology-based semantic typing is then used to drive the template filling process. We adopted an existing ontology, TRAK (Taxonomy for RehAbilitation of Knee conditions), for use within KneeTex. The original TRAK ontology expanded from 1,292 concepts, 1,720 synonyms and 518 relationship instances to 1,621 concepts, 2,550 synonyms and 560 relationship instances. This provided KneeTex with a very fine-grained lexicosemantic knowledge base, which is highly attuned to the given sublanguage. Information extraction results were evaluated on a test set of 100 MRI reports. A gold standard consisted of 1,259 filled template records with the following slots: finding, finding qualifier, negation, certainty, anatomy and anatomy qualifier. KneeTex extracted information with precision of 98.00%, recall of 97.63% and F-measure of 97.81%, the values of which are in line with human-like performance. To demonstrate the utility of formally structuring clinical narratives and possible applications in epidemiology, we describe an implementation of KneeBase, a web-based information retrieval system that supports complex searches over the results obtained via KneeTex. It is the structured nature of extracted information that allows queries that encode not only search terms, but also relationships between them (e.g. between clinical findings and anatomical locations). This is of particular value for large-scale epidemiology studies based on qualitative evidence, whose main bottleneck involves manual inspection of many text documents. The two systems presented in this dissertation, KneeTex and KneeBase, operate in a specific domain, but illustrate generic principles for rapid development of clinical text mining systems. The key enabler of such systems is the existence of an appropriate ontology. To tackle this issue, we proposed a strategy for ontology expansion, which proved effective in fast–tracking the development of our information extraction and retrieval systems.
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Piper, K. "Interpretation of clinical imaging examinations by radiographers : a programme of research". Thesis, Canterbury Christ Church University, 2014. http://create.canterbury.ac.uk/13316/.
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Background Studies which have investigated the interpretation of plain skeletal examinations by radiographers have demonstrated encouraging findings, however, the studies have not extended beyond this area of practice and radiographers' diagnostic performance for other more complex investigations has not been established. Comparisons of performance between groups of healthcare practitioners to date, has also been limited. Aim This research programme aimed to investigate the interpretation of clinical imaging examinations by radiographers, and other healthcare practitioners, in the provision of initial interpretations and/or definitive reports of plain imaging ( skeletal and chest) and crosssectional ( magnetic resonance imaging [MRI] – lumbar/thoracic spine, knees and internal auditory meati [IAM]) investigations. Methods The eight studies utilised a variety of methodological approaches and included quasiexperimental and observational studies. One quasi-experimental study compared the performance of radiographers, nurses and junior doctors in initial image interpretation and another similar study included a training intervention; both utilised alternate free-response receiver operating characteristic curve (AFROC) methodology. Three of the observational studies investigated the ability of radiographers to provide definitive reports on a wide range of clinical examinations, including chest and MRI investigations, in a controlled environment. One large multi-centre observational study investigated the performance of radiographers, in clinical practice (A/E: skeletal examinations) during the implementation of a radiographic reporting service. The agreement between consultant radiologists' MRI reports of lumbar/thoracic spine, knee and IAM examinations was investigated in another observational study. The final study compared the reports of trained radiographers and consultant radiologists, with those of an index radiologist, when reporting on MRI examinations of the knee and lumbar spine, as part of a prospective pre-implementation agreement study. Results The first AFROC study demonstrated statistically significant improvements after training, for radiographers (A1=0.55 - 0.72) and nurses (A1=0.65 - 0.63), although the radiographers maintained a better overall performance post training (p=0.004) in providing an initial image interpretation of trauma radiographs of the appendicular skeleton. Radiographers also achieved statistically higher (p<0.01) AUC values (A1=0.75) than nurses (A1=0.58) and junior doctors (A1=0.54) in the second AFROC study. Three studies, which examined 11155 reports, were conducted under controlled conditions in an academic setting and provided evidence of radiographers’ high levels of accuracy in reporting of skeletal A/E (93.9%); skeletal non A/E (92.5%); chest (89.0%); MRI lumbar/thoracic spine (87.2%), knees (86.3%) and IAM (98.4%) examinations. In the multi-centre clinical study, the mean accuracy, sensitivity and specificity rates of the radiographers reports (n=7179) of plain examinations of the skeletal system in the trauma setting was found to be 99%, 98% and 99%, respectively. The considerable range of values for agreement, between consultant radiologists reports of MRI examinations of the thoracic/lumbar spine (k=0 – 0.8), knee (k=0.3 – 0.8) and IAM (k=1.0) was similar to other studies and resulted in a reasonable estimation of the performance, in the UK, of an average non specialist consultant radiologist in MRI reporting. In the final study, radiographers reported in clinical practice conditions, on a prospective random sample of knee and lumbar spine MRI examinations, to a level of agreement comparable with non-musculoskeletal consultant radiologists (Mean difference in observer agreement <1%, p=0.86). Less than 10% of observers' reports (radiographers and consultant radiologists) were found to be sufficiently discordant to be clinically important. Conclusion The outcomes of this research programme demonstrate that radiographers can provide initial interpretations of radiographic examinations of the appendicular skeleton, in the trauma setting, to a higher level of accuracy than A/E practitioners. The findings also provide evidence that selected radiographers with appropriate education and training can provide definitive reports on plain clinical examinations (A/E and non A/E referral sources) of the skeletal system and the chest; and MRI examinations of the knee, lumbar/thoracic spine and IAM to a level of performance comparable to the average non specialist consultant radiologist. Wider implementation of radiographer reporting is therefore indicated and future multi-centre research, including economic evaluations, to further inform practice at a national level, is recommended.
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Schön, Joan. "Elements of dream interpretation: laying the foundation of a basic model for clinical practice". Thesis, Rhodes University, 2001. http://hdl.handle.net/10962/d1002559.
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The study addresses certain paradoxes evident in the theory and practice of dream interpretation. These relate to the considerable value afforded to dreams in psychoanalytic thinking, compared with (1) the surprising dearth of literature, research, and training on dream interpretation in clinical practice, (2) the difficulties voiced by clinicians regarding dream interpretation, and (3) the diversity of keys employed by different schools to unlock the ‘truth’ of dreams. The intention of the study is to examine these paradoxes in order to develop a model fordream interpretation which falls within the ambit of psychodynamic psychotherapy. It is argued that there have been few insights over the century to match the seminal work of Freud (1900/1976), except perhaps the work of Carl Jung. As a result of the 1914 rift between these two, Jung’s insights have been largely ignored in mainstream psychoanalytic thinking and the focus on dreams has given way to other areas of development, such as, unconscious thinking, symbol formation, and interpretation in a general sense. These, it is argued, have contributed to a more comprehensive understanding of dreams and their interpretation. Thus a model would need to consider both Freud and Jung’s work, and later salient developments. It would also need to be informed by local, contemporary practice. The method used in this thesis is one of breaking down the process of dream interpretation into component parts, in order to examine useful contributions from different sources and to compare work with dreams to work with other material. The literature review examines the major theoretical contributions in relation to four elements of dreams interpretation: the nature and function of dreams, methods of dream interpretation, the meaning of dreams, and the goals of dream interpretation. A model which accommodates diverse theories without resorting to eclecticism is then proposed. Dream interpretation is further examined in the light of a multiphase clinical study, designed to provide different perspectives on the topic. The study yielded findingscompatible with the literature reviewed, as well as certain problems in relation to the proposed model. These included shortcomings of the elements used in the literature review, particularly the sequence of these elements, and caveats about affording dreams a special focus in the consulting room. Thus a second configuration was posited, namely the idea of viewing dream-work as a triangular situation, comprising the dream, the dreamer, and the dream interpreter. The final model which is the outcome of the study provides two interrelated methods of addressing dream interpretation which accommodate the theory/practice dichotomy. In the first, the elements of dreams and their interpretation are considered sequentially. This method provides a framework for considering theoretical contributions on dreams, as well as issues of technique, without recourse to the introduction of theory in the consulting room. In the second, dream interpretation is regarded as a triangular situation, comprising the interchange between therapist and patient in relation to the patient’s dream-life. This structure accommodates the alliance which is discernible in practice and draws on Segal’s (1957/1986) notion that the process of symbol formation is a triangular situation. The value of regarding ‘dream-work’ in the consulting room as a triangular situation is threefold: (1) it is akin to symbol formation in terms of the meaning reached; (2) dreams cannot be accurately interpreted in isolation from the contributions of both therapist and patient; and (3) it provides ‘dream-work’ in practice with its own structure, highlighting a perspective that dreams are an element of clinical practice, rather than a focus, a subtext within the broader framework of psychodynamic psychotherapy.
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Nikolaenko, E. M., Вікторія Едуардівна Проняєва, Виктория Эдуардовна Проняева i Viktoriia Eduardivna Proniaieva. "New joint initiative to explore clinical interpretation of molecular tests for cancer". Thesis, Sumy State University, 2016. http://essuir.sumdu.edu.ua/handle/123456789/45978.
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New life requirements enforce doctors navigate one of the most important scientific questions faced by the cancer community could help improve survival rates for patients. A joint initiative of UNICANCER, ESMO and Cancer Research UK, the meeting on Molecular Analysis for Personalised therapy (MAP) will explore clinical interpretation of molecular tests for cancers that have spread.
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Macdonald, Morag M. "Craft knowledge in medicine : an interpretation of teaching and learning in apprenticeship". Thesis, Open University, 1998. http://oro.open.ac.uk/56460/.
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The diagnosis and management of patients requires professional know-how or medical craft knowledge. To explain how this knowledge is acquired, this research asked 'How do medical experts pass on their craft?' Other questions arose through successive data collections and progressive focusing on what medical experts did well in their work and teaching. The programme comprised: pilot interviews with three expert physicians; a case study in a hospital medical unit; and paired consultant/SHO interviews. Participant observation, interviews, and expert-novice comparisons explored clinical work, teaching, and learning in apprenticeship. Data analysis of participants' responses and ward round discussions allowed identified categories to cluster within three inter-related constructs instrumental to the acquisition of medical knowledge: gaining experience in the experiential process of clinical practice (1); and the products of experience which manifest as experts' clinical expertise (2) and teaching/learning expertise (3). These constructs can be located within a model of apprenticeship based on Spady's (1973) analysis of authority in effective teaching containing two frames of reference: the social, 'traditional-legal'; and the individual, 'expert-charismatic'. The medical apprenticeship is associated with similar perspectives: the 'traditional-experiential' represents the professional process of learning through patient care with its infrastructure of clinical methods in presentation, discourse, and commentary; and the 'expert-charismatic' represents clinical and teaching expertise coupled with vocational enthusiasm. Experienced experts synthesised two repertoires of knowledge and skills derived from the craft knowledge of medicine and pedagogy, respectively. Both crafts are required for effective clinical education. While apprenticeship accommodates a range of teaching/learning experiences, in postgraduate education experts pass on knowledge through the deliberate engagement of junior doctors in diagnosis and management. The skills involved in this process were largely unrecognised by most senior and junior doctors and were not perceived as 'clinical teaching' although learning was structured through service-based work.
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Bell, Emily K. "Interpretation of Nonverbal Expression of Emotion in Relation to Schizotypal Characteristics". W&M ScholarWorks, 2006. https://scholarworks.wm.edu/etd/1539626526.
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MacDougall, Alicia A. "The Relational Interpretation of Dreams: A Book Proposal". Antioch University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1588347245889786.
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Blatchford, Patrick Judson. "Monitoring bivariate endpoints in group sequential clinical trials /". Connect to full text via ProQuest. Limited to UCD Anschutz Medical Campus, 2007.
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Thesis (Ph.D. in Biostatistics) -- University of Colorado Denver, 2007.Typescript. Includes bibliographical references (leaves 104-106). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;
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Cadesky, Nadine Elizabeth. "Music Therapists' Perspectives on the Assessment and Clinical Interpretation of Clients' Vocal Parameters". Diss., Temple University Libraries, 2013. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/216567.
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Music TherapyPh.D.
The purpose of this study was to investigate North American professional music therapists' perceptions and use of singing voice assessment. The focus was on a general population of music therapists who may or may not specialize in the use of singing as a clinical instrument. The researcher designed an online survey to gather music therapists' perceptions about the frequency with which they use singing voice assessment with clients, the singing voice parameters they assess and the clinical interpretations they make. Participants' demographic information was gathered and analyzed according to their responses. It was expected that these therapists would vary in their training and education, singing background and clinical context. Three hundred and thirty-five North American music therapists with a music therapist-accredited (MTA) or music therapist-board-certified (MT-BC) designation participated in the study, for an overall response rate of 13.9%. Results were analyzed using frequencies, proportions indicating association with Wilson Confidence Limits, Logistic Regression Models, Firth's Estimation, Tukey-Kramer adjusted-p levels and 95% confidence limits. Results indicated that a majority of participants assessed client singing at the beginning of therapy and periodically or regularly afterwards, paying attention to singing voice parameters of breathing and breath-support, freedom versus tension, vocal range, vocal tone quality, and/or pitch control. Results also indicated that a majority of participants used one or more of these parameters as a basis for interpretations about affect, personality characteristics, internal psychological processes, developmental stage, and/or psychopathological states. There were statistically-significant associations between therapists' primary clinical population and frequency of singing voice assessment performed; therapists' primary clinical population and singing voice parameters assessed; and therapists' primary theoretical orientation and singing voice parameters assessed. Results of this study suggest that music therapists in this sample were assessing and interpreting client singing even if some of these therapists had no specialized advanced training in the clinical assessment and interpretation of singing. Furthermore, it appears that music therapists in this study were paying attention to the same kinds of vocal parameters and made the same kinds of clinical interpretations as those featured in the clinical literature. Finally, it appears that voice assessment is not associated with a particular population. Future research should explore the impact of a client and therapist's background with singing on the clinical singing voice assessment. Future research should also explore the role singing voice assessment may play in different clinical contexts and the differential meanings that may be gleaned in these different contexts. There is also evidence within to support future development and validation of a vocal assessment tool.
Temple University--Theses
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Cowden, Hindash Alexandra H. "An Experimental Examination of Automatic Interpretation Biases in Major Depression". Scholar Commons, 2018. https://scholarcommons.usf.edu/etd/7681.
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Cognitive theories of depression have long posited automatic interpretation biases (AIB) as a central contributor to depressed mood. The current study was first to examine AIB in a clinically defined depressed sample. While assessing AIB using a semantic association paradigm, pupillary reactivity was simultaneously recorded to build insight into the AIB process. A total of 53 individuals (25 depressed and 28 healthy control) completed the Word Sentence Association Paradigm for Depression (WSAP-D) while pupillary reactivity was recorded. Results revealed the depressed group was significantly more likely to endorse negative AIB and less likely to endorse benign AIB compared to healthy controls. The depressed group demonstrated a modest effect size difference indicating they were faster to endorse negative AIB compared to the healthy controls, but did not differ in endorsing benign AIB or in rejecting either valence. Pupillary reactivity was found to differentiate behaviorally defined AIB type from a natural processing condition when counter to theorized, group relevant AIB. The depressed group demonstrated greater initial pupillary constriction during initial presentation of ambiguous information and comparatively less pupillary dilation during and after endorsing a benign AIB. Taken together, the results suggest that theorized negative AIB and lack of benign AIB are characteristic of depression, that greater cognitive effort is required to reject interpretations consistent with theorized biases consistent with reinterpretation processes, and that depressed individuals are less engaged with benign AIB compared to healthy controls, possibly associated with hedonic deficits. Theoretical implications and future directions are discussed.
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Bluhm, Amy Colwell. "Turning toward individuation| Carol Sawyer Baumann's interpretation of Jung, 1927-1932". Thesis, Saybrook Graduate School and Research Center, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3564246.
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Given an additional 10 volumes that could still be added to his Collected Works and 35,000 unpublished letters, the historical record on Swiss psychiatrist, Carl Gustav Jung, remains incomplete. An example is the unpublished letters between Jung and Carol Sawyer Baumann (1897-1958), an analysand and member of Jung's circle in Zurich for 30 years. The focus of this dissertation is the period of transition between 1927 and 1932, when, after a near-death experience, Baumann shifted her attention from her husband and two children in Cleveland to a search for individuation, first as an analysand under various Jungians, including Cary and H. G. Baynes, then under Jung himself.
Jung's place in psychology is first assessed, noting that he is either generally ignored or else cast as a mere acolyte of Freud. Alternatively, the dissertation is situated in the New Jung Scholarship, which positions Jung as the 20th century exponent of the symbolic hypothesis, but in the tradition of the late 19th century psychologies of transcendence.
Jung's emerging conceptions are chronicled using his documents on individuation from 1916 until 1931. The documents show the emergence of the concepts of the persona, the personal and collective unconscious, the anima and animus, attitudinal and functional types, the balancing mechanism of the psyche, the transcendent function, and the self. These conceptions are compared to an abundance of archival evidence available on Baumann, including papers held by her heirs and primary source material from repositories in various libraries.
The interaction of Jung's theory and Carol Sawyer Baumann's interpretation of individuation reveals to what degree and in what way each influenced the other. The process of collecting, reviewing, and presenting documentary evidence, as an alternative to a hypothesis-driven approach, raises further questions from the material. The extent to which she was successful in her quest can be gauged by Carol Sawyer Baumann's superior intellectual grasp of the principles of analytical psychology, her extensive researches into non-Western cultures, and her ability to communicate her findings on the process of individuation through her lectures and published writings.
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Bournazos, Adam Michael. "Optimising RNA diagnostics for implementation into clinical practice". Thesis, The University of Sydney, 2022. https://hdl.handle.net/2123/29198.
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Background: Genetic variants that elicit aberrant splicing of pre-messenger RNA (pre-mRNA) are recognised as causative variants in ~30-50% of genetic disorders. However, it is still not possible to predict reliably if and how a variant will impact splicing, limiting the application of in silico splice prediction tools in variant interpretation. Most splicing variants fall outside the essential splice site and, in the absence of RNA testing, remain classed variants of uncertain significance (VUS) according to ACMG-AMP (American College of Medical Genetics and Genomics and Association for Molecular Pathology) guidelines. Sequence analysis of spliced messenger RNA (mRNA) is the only definitive means to determine the precise nature of variant associated mis-splicing. Tissues with limited accessibility, for instance vital organs, present a challenge for RNA testing of genes with tissue specific expression. Fortunately, clinically accessible tissues such as blood and fibroblasts can be used to infer variant associated mis-splicing outcomes in the manifesting tissue. A further challenge arises from the lack of guidance on how functional evidence (PS3/BS3 criteria) from RNA studies should be applied to variant interpretation within the current ACMG-AMP framework. There is an urgent need to establish ACMG-AMP aligned quality standards and guidelines for complex RNA assay data for accurate and consistent variant interpretation between clinical laboratories.
Methods: Families were recruited from local area health districts across Australia and New Zealand using inclusion criteria to ascertain putative splicing variants with high clinical suspicion of causality. More than 120 families with diverse monogenic conditions were triaged into PCR-based RNA testing, with comparative RNA-sequencing for 38 cases. Consensus ascertainment criteria, standard practices for PCR-based RNA testing, and RNA assay interpretation rubric were devised through consultation with the clinical and molecular genetics community via surveys, live polls and SpliceACORD consortium (Australasian Consortium for RNA Diagnostics) meetings.
Results: Informative RNA assay data was obtained for 96% cases, enabling variant re-classification for 75% of variants. RNA testing reports were used to guide clinical care and genetic counselling, and 75% of diagnosis were clinician-reported to have a positive impact for the family. PCR-based RNA diagnostics has the capacity to analyse 81.3% of clinically significant genes and to allow phasing of RNA splicing events. Variant associated mis-splicing was highly reproducible between affected individuals and heterozygotes, and between different biospecimens.
Discussion: We provide a standardised protocol for PCR-based RNA testing and ACMG-AMP aligned recommendations for the interpretation of RNA assay data. Our study demonstrates the significant diagnostic and health benefits of RNA analysis as adjunct testing to extend diagnostic yield from genomic testing.
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Breen, Cathal J. "An investigation of novel ECG interpretation techniques to enhance the pedagogy of this clinical skill". Thesis, Ulster University, 2017. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.733557.
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This thesis presents the Author’s work of novel 12 lead ECG interpretation pedagogies, which includes an overview of methods and principles that have been identified in the acquisition and maintenance of expert performance within ECG interpretation and the development and testing of a clinical decision support system for the acquisition and maintenance of ECG interpretation competence. The work described in this thesis was conducted between 2009 to 2017. The first chapter introduces the background, scope and structure of the thesis. Chapter 2 provides an appraisal of teaching, learning and assessment methods utilised for ECG interpretation instruction. Chapter 3 evaluates the impact incorrect positioning of ECG electrodes, erroneous connection of ECG leads and variable patient postures during ECG acquisition affects the ECG recording. This chapter highlights the constant need for quality control in electrocardiography acquisition and the need for focused training and continuing education of professionals involved in the recording of routine and research ECGs. Chapter 4 establishes expert 12 lead ECG interpretation performance, specifically through patterns of expert behaviour and cognitive psychology. The concepts presented in chapters 2, 3 and 4 describes the rationale, design and development of a novel format to assist with ECG interpretation competency presented within Chapter 5. Chapter 6 summarises the significance of this work, followed by potential future research directions and concluding remarks. This thesis represents multidisciplinary research across the domains of medicine, psychology, clinical & healthcare science, computer science and engineering, that contribute to the quality assurance of 12 lead ECG interpretation competency testing.
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Cartledge, Jonathan David. "Unresponsive HIV-related oral candidosis : clinical interpretation of susceptibility testing; risk assessment and treatment strategies". Thesis, University of Bristol, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.395154.
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Waite, Polly. "Understanding anxiety disorders in adolescence : an examination of clinical characteristics, parental behaviours and interpretation biases". Thesis, University of Reading, 2015. http://centaur.reading.ac.uk/45042/.
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Anxiety disorders in children and adolescents are a common psychiatric problem. Although research and treatment has developed greatly, adolescents have been largely overlooked. Studies of normative development suggest that adolescence is a distinct phase of development. These developmental differences may account for the (albeit mixed) evidence that adolescents with anxiety disorders have significantly poorer treatment outcomes, compared to anxious children. The aim of the papers in this thesis was to develop understanding of characteristics of anxious adolescents that could be addressed through psychological treatment, relating to clinical presentation, cognitive biases and parenting behaviours. Adolescents with anxiety disorders, compared to children with anxiety disorders, were found to have more severe anxiety symptoms, more frequent primary diagnoses of social anxiety disorder, diagnoses/symptoms of mood disorders, and irregular school attendance. Parents of adolescents showed significantly lower levels of expressed anxiety, intrusiveness and warmth/engagement than parents of children. Furthermore, offspring age moderated the association between anxiety disorder status and parenting behaviours, in that parents of adolescents with anxiety disorders showed significantly higher intrusiveness and lower warmth/engagement than parents of non-anxious adolescents, but no significant differences were found between anxious and non-anxious children. The findings for adolescents were consistent with the existing literature, although with stronger effects for parental lack of warmth than other, mainly community-based, studies have found. Finally, children and adolescents with anxiety disorders showed significantly higher levels of threat interpretation and avoidant strategies than non-anxious children and adolescents. However, age significantly moderated the effect of anxiety disorder status; adolescents with anxiety disorders showed significantly higher levels of threat interpretation than non-anxious adolescents, but, again, there were no significant differences between anxious and non-anxious children. Taken together, these results underline the importance of taking age into account in order to improve understanding of the critical components of adolescent-specific treatments for anxiety disorders.
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Hernández, Adrian V., Vinay Pasupuleti, Abhishek Deshpande, Priyaleela Thota, Jaime A. Collins i Jose E. Vidal. "Deficient Reporting and Interpretation of Non-Inferiority Randomized Clinical Trials in HIV Patients: A Systematic Review". Public Library of Science (PLoS), 2014. http://hdl.handle.net/10757/316304.
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Objectives: Non-inferiority (NI) randomized clinical trials (RCTs) commonly evaluate efficacy of new antiretroviral (ARV)
drugs in human immunodeficiency virus (HIV) patients. Their reporting and interpretation have not been systematically
evaluated. We evaluated the reporting of NI RCTs in HIV patients according to the CONSORT statement and assessed the
degree of misinterpretation of RCTs when NI was inconclusive or not established.
Design: Systematic review.
Methods: PubMed, Web of Science, and Scopus were reviewed until December 2011. Selection and extraction was
performed independently by three reviewers.
Results: Of the 42 RCTs (n = 21,919; range 41–3,316) selected, 23 were in ARV-naı¨ve and 19 in ARV-experienced patients.
Twenty-seven (64%) RCTs provided information about prior RCTs of the active comparator, and 37 (88%) used 2-sided CIs.
Two thirds of trials used a NI margin between 10 and 12%, although only 12 explained the method to determine it. Blinding
was used in 9 studies only. The main conclusion was based on both intention-to-treat (ITT) and per protocol (PP) analyses in
5 trials, on PP analysis only in 4 studies, and on ITT only in 31 studies. Eleven of 16 studies with NI inconclusive or not
established highlighted NI or equivalence, and distracted readers with positive secondary results.
Conclusions: There is poor reporting and interpretation of NI RCTs performed in HIV patients. Maximizing the reporting of
the method of NI margin determination, use of blinding and both ITT and PP analyses, and interpreting negative NI
according to actual primary findings will improve the understanding of results and their translation into clinical practice.
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Menke, Chelsea A. "Non-Genetics Pediatric Providers' Understanding and Interpretation of a VUS Result". University of Cincinnati / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1552398848715174.
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Gibson, Margaret Agnes Ruth. "A study of the clinical interpretation of dyspepsia in general practice and the use of cimetidine in treatment". Thesis, Queen's University Belfast, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.336207.
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Neves, Teresa Santos. "The interplay between symbolic expression and interpretation in the therapeutic context : a clinical case of a child's psychotherapy". Thesis, University of Kent, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.410580.
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Yakami, Masahiro. "Using a high-speed movie camera to evaluate slice dropping in clinical image interpretation with stack-mode viewers". Kyoto University, 2013. http://hdl.handle.net/2433/174780.
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Gomez, Alex A. "Feelings of Enlightenment: A Hermeneutic Interpretation of Latent Enlightenment Assumptions in Greenberg's Emotion-Focused Therapy". Antioch University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1534515730529141.
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Curtis, Amie. "Modifying interpretation bias in adolescents with clinical levels of social phobia : an explorative case design series using Cognitive Bias Modification". Thesis, University of East Anglia, 2013. https://ueaeprints.uea.ac.uk/47927/.
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Cognitive Bias Modification for interpretation bias (CBM-I) is a procedure which has been found to successfully modify interpretation bias and anxiety symptoms. To date, very few studies have investigated the efficacy of CBM-I with adolescents. This research investigated the application of a multi-session CBM-I programme in a clinical adolescent population. Eight adolescents (14 to 17 years old) with clinical levels of social phobia symptoms completed a seven session CBM-I programme at home via the internet. The programme trained adolescents to interpret ambiguous situations in a positive manner. Imagery of oneself in the scenarios was also encouraged in an attempt to enhance the potential effects. Participants completed a battery of self-report measures to identify changes in interpretation biases and symptomology. Four participants made improvements on social phobia symptoms after the CBM-I training, which were maintained at follow-up. Six participants experienced reduced negative interpretation biases post-CBM-I, with three participants moving from a negative interpretation bias pre-CBM-I, to a positive interpretation bias post-CBM-I. Participants and their parents completed questionnaires to investigate their opinions of the CBM-I procedure. Interestingly, participants who reported enjoying the task were more likely to have a reduction in symptomology. The participants also reported that the scenarios would benefit from being tailored to their specific interests and presentations. Parents noted that the procedure was practical and easy to use, but felt that the training did not significantly impact upon their child’s presentation. Overall, the results indicate the potential value of CBM-I in modifying negative interpretative biases and symptomology in adolescents with social phobia. However, the findings were not absolute, with variability amongst participants making it difficult to draw strong conclusions. Further research is therefore needed to confirm and add weight to the current findings.
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Li, Qing. "Interim monitoring efficacy, safety and futility in phase III clinical trials". Thesis, Birmingham, Ala. : University of Alabama at Birmingham, 2008. https://www.mhsl.uab.edu/dt/2008p/li.pdf.
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McNally, Liam. "A cognitive bias modification for interpretation (CBM-I) task with individuals experiencing clinical levels of generalised anxiety : a single case series". Thesis, University of East Anglia, 2014. https://ueaeprints.uea.ac.uk/50726/.
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Objectives The study investigated the efficacy of an online multi-session cognitive bias modification for interpretation (CBM-I) package for reducing worry and negative interpretive bias in individuals presenting with clinical levels of generalised anxiety. Design Single case-series using a non-concurrent multiple-baseline across participant design with follow-up. Method Seven patients referred from Psychological Wellbeing Services completed a seven day CBM-I programme at home via the internet. The CBM-I task trained the participants to imagine ambiguous scenarios and to interpret them in a benign or positive manner. To assess change in worry, anxiety and interpretive bias, participants completed a battery of self report measures. Results Two participants demonstrated a positive response in their level of worry upon starting the CBM-I training and for both, gains were maintained one week after its completion. For the sample as a whole, negative interpretation bias reduced at post CBM-I and at one week follow-up. Conclusions The results indicate the potential value of CBM-I as a clinical tool for modifying interpretation bias in patients experiencing clinical levels of generalised anxiety. The ability of CBM-I to attenuate generalised anxiety disorder (GAD) associated symptomatology appears equivocal. In light of methodological constraints, the findings are tentative warranting further investigation.
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Arimoto, Maya. "Intra- and inter-observer agreement in the visual interpretation of interim 18F-FDG PET/CT in malignant lymphoma: influence of clinical information". Kyoto University, 2018. http://hdl.handle.net/2433/233833.
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Howell, Ashley N. "The Roles of Concept Learning and Discrimination in Interpretation Biases and Fear Generalization: Transdiagnostic and Neuropsychological Perspectives for Anxiety Disorders". Ohio University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1465830078.
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Iyappan, Anandhi [Verfasser]. "Conceptualization of computational modeling approaches and interpretation of the role of neuroimaging indices in pathomechanisms for pre-clinical detection of Alzheimer Disease / Anandhi Iyappan". Bonn : Universitäts- und Landesbibliothek Bonn, 2018. http://d-nb.info/1173789685/34.
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Ragnehed, Mattias. "Functional Magnetic Resonance Imaging for Clinical Diagnosis : Exploring and Improving the Examination Chain". Doctoral thesis, Linköping : Department of Medical and Health Sciences, Linköping University, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-18095.
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Hennings, Joakim. "Clinical studies on adrenocortical tumours using [11C]-metomidate positron emission tomography". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl.[distributör], 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-108797.
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Lodge, Joanna. "An experimental investigation using Cognitive Bias Modification for paranoid attributions in a non-clinical sample : effects upon interpretation bias, emotions, and paranoia following a stressful paranoia induction". Thesis, University of East Anglia, 2013. https://ueaeprints.uea.ac.uk/48112/.
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Background: Bentall, Corcoran, Howard, Blackwood, and Kinderman (2001) suggested that paranoid individuals display an ‘external-personal bias’ of blaming negative events on other people rather than situational circumstances or themselves, however, the literature remains equivocal. This study tested whether Cognitive Bias Modification for Interpretations (CBM-I) could train a positive attribution bias and affect subsequent reactions to a stressor designed to induce paranoia. Method: Non-clinical participants were randomly assigned to positive CBM-I training (n = 18), or a neutral control CBM-I (n = 17). Participants were then subject to a stressful paranoia induction: seeing a live video of themselves whilst accessing negative self-beliefs and being given negative feedback when attempting an impossible task. The subsequent effects upon interpretation bias and state paranoia and emotions were assessed. Results: After the paranoia induction, participants in the positive CBM-I group demonstrated a more positive interpretation bias than those in the neutral control group: they endorsed less paranoid interpretations, although there was no difference in ratings of positive interpretations. However, both groups reported a similar increase in state paranoia and suspiciousness after the stressful paranoia induction, and there was no relationship between the trained interpretation bias and the changes in state paranoia. Unexpectedly, pre-existing trait paranoia was correlated with state paranoia and interpretation bias after the stressor. xiv Conclusions: This study demonstrated that CBM-I can train non-clinical participants to endorse less paranoid interpretations. Pre-existing trait paranoia had a stronger relationship to interpretative bias and state paranoia under stress than the CBM-I. The lack of a subsequent effect on emotional reactions suggests that further research is necessary to refine the materials and procedure, and test for possible small or varied effects in a larger sample. Unfortunately, significant methodological problems limit the conclusions that can be drawn about the theory that an externalpersonal attribution bias causes paranoia.
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Hampson, James. "A single-case series investigation of the efficacy of an internet delivered multi-session cognitive bias modification-interpretation task in a population with clinical levels of panic symptomatology". Thesis, University of East Anglia, 2014. https://ueaeprints.uea.ac.uk/50715/.
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Cognitive bias modification for interpretation bias (CBM-I) has been shown to successfully modify interpretative biases across psychological presentations including social anxiety, generalised anxiety and depression. Despite the role catastrophic misinterpretations of bodily sensations are thought to maintain with panic disorder, to date no study has sought to explore the efficacy of CBM-I with individuals with clinical levels of panic symptomatology. Six individuals (19 to 53 years old) with clinical levels of panic symptomatology, as measured by the panic disorder severity scale, completed an internet administered seven session CBM-I training programme at home. A single-case series design was adopted in order to investigate the efficacy of the CBM-I training programme. Participants were randomised to a seven, nine or eleven day baseline control phase. Daily measures and outcome measures were completed. Visual analysis revealed that four of the six participants responded to the CBM-I training programme. Three participants made clinically significant and reliable change on a measure of panic, whilst four participants made significantly reliable change on a measure of anxiety sensitivity. Interpretation bias was assessed using the ranking and believability tasks of the Brief Body Sensations Interpretation Questionnaire. Four of the six participants showed a significant change in interpretation bias on the ranking task, whilst only two participants showed a change in interpretation bias in the expected direction on the believability task. The results indicate the potential clinical utility of CBM-I in reducing levels of panic symptomatology. These results need to be interpreted with caution due to the small sample size. Future areas for research are considered, with the potential for CBM-I to serve a preventative, as well as a therapeutic, function discussed.
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Montalvo, Zulueta Nigreisy. "Development of federated learning models for improved genetic variant assessment in a multi-site clinical setting". Electronic Thesis or Diss., Université Paris Cité, 2024. http://www.theses.fr/2024UNIP5289.
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L'apprentissage fédéré (FL) est une technique d'apprentissage automatique qui permet à plusieurs détenteurs de données d'entraîner un modèle de manière collaborative, sans partager les données brutes. Cette approche est particulièrement pertinente dans le domaine de la génétique, où les données sont souvent réparties entre plusieurs institutions, et où des contraintes réglementaires, telles que le Règlement Général sur la Protection des Données, limitent la centralisation des données. En plus d'améliorer la confidentialité et la sécurité des données, FL permet l'entraînement de modèles plus robustes en accédant à des ensembles de données plus vastes et plus diversifiés. FL a été proposé pour la première fois en 2016 comme approche pour entraîner des modèles d'apprentissage automatique sur une fédération d'appareils mobiles, coordonnée par un serveur central. Dans leur mise en œuvre, le serveur définissait un modèle global, et transmettait ses paramètres à un sous-ensemble de clients. Les clients optimisaient ensuite le modèle reçu, en effectuant une descente de gradient stochastique sur leurs données locales, puis renvoyaient les mises à jour locales au serveur. Le serveur créait un nouveau modèle global en agrégeant les mises à jour locales par moyenne pondérée. Ce processus était répété soit pendant un nombre prédéfini de tours, soit jusqu'à la convergence du modèle. FL a également été adapté aux environnements cross-silo, où les clients (généralement entre 2 et 50) sont des organisations telles que des hôpitaux et des instituts de recherche. L'objectif de cette thèse est d'étudier l'efficacité de FL cross-silo pour l'évaluation clinique des variantes génétiques humains. À cet effet, nous avons utilisé la base de données publique ClinVar pour simuler des collaborations multi-institutionnelles réalistes dans l'évaluation des variantes nucléotidiques simples, codantes et non codantes, ainsi que des variations du nombre de copies. Concrètement, nous avons évalué la performance de plusieurs modèles d'apprentissage automatique supervisé, entraînés de manière fédérée entre plusieurs institutions, pour classifier les variantes génétiques comme pathogènes ou non pathogènes. Nous avons ensuite comparé ces performances à celles de modèles centralisés et celles de modèles locaux propres à chaque institution. Pour ce qui est de la comparaison avec les performances de modèles centralisés, les performances de FL étaient équivalentes ou supérieures. Pour ce qui est de la comparaison avec les performances de modèles locaux, les performances de FL étaient dans la grande majorité des cas supérieures. Ces résultats démontrent les avantages à utiliser l'apprentissage fédéré dans la collaboration entre les institutions. Dans nos expériences, nous avons évalué plusieurs stratégies d'agrégation de FL, notamment FedProx, FedAdagrad, FedAdam et FedYogi, qui font référence aux méthodes utilisées par le serveur pour combiner les mises à jour locales en un nouveau modèle global. Nos résultats ont montré que FedProx offrait généralement les meilleures performances. De plus, nous avons analysé la dégradation des performances du modèle de FL et de son modèle centralisé équivalent lorsqu'une institution décidait de ne pas participer à l'entraînement collaboratif. Nous avons constaté que, dans la plupart des cas, le modèle de FL se montrait plus résilient que les approches centralisées, démontrant sa capacité à se généraliser de manière adéquate à des ensembles de données non vus, même avec des ensembles d'entraînement plus réduits. À notre connaissance, cette thèse présente la première étude simulée de FL pour la classification de la pathogénicité des variantes génétiques. Avec nos conclusions, nous espérons encourager l'adoption de FL pour établir des collaborations multi-institutionnelles sécurisées dans l'interprétation des variantes humainsFederated learning (FL) is a machine learning (ML) technique that enables multiple data holders to collaboratively train a model, without raw data sharing. This approach is particularly relevant in the field of genomics, where data is often distributed across institutions, and regulatory constraints, such as General Data Protection Regulation (GDPR) and Health Insurance Portability and Accountability Act (HIPAA), restrict data centralization. In addition to improving privacy and data security, FL allows the training of more robust ML models, by leveraging access to a larger and more diverse dataset. FL was first proposed by Google researchers in 2017 as an approach for training ML models on a federation of mobile devices coordinated by a central server. In this setup, the mobile devices contained data that was either sensitive or large in size with respect to the ML model. In their implementation, the server defined a global ML model and communicated the parameters to a subset of clients. The clients then optimized the received model by performing Stochastic Gradient Descent on local data, and sent back the local updates to the server. The server derived a new global model by aggregating the local updates through weighted averaging. This process was repeated for a predefined number of rounds or until the model converged. FL has also been adapted to cross-silo settings, where clients (typically 2-50) are organizations, such as hospitals and research institutions. The objective of this thesis is to study the effectiveness of cross-silo FL for the clinical assessment of human genetic variants. To that extent, we leveraged the public-available database ClinVar for simulating realistic multi-institutional collaborations in the assessment of coding Single Nucleotide Variants (SNVs), non-coding SNVs, and copy number variants (CNVs). Concretely, we evaluated the performance of a diverse set of supervised ML models, trained in a FL manner across multiple institutions, in classifying genetic variants into pathogenic or non-pathogenic, and compared it to the centralized and individual- institution (local) model counterparts. Our results showed that FL generally achieved competitive or superior performance than the centralized model, and systematically outperformed the local models, highlighting the advantages of collaboration. In the experiments we benchmarked several FL aggregation strategies, including FedProx, FedAdagrad, FedAdam, and FedYogi, which refer to the methods used by the server to combine local updates into a new global model. Our results showed that FedProx generally provided the best performance. Furthermore, we analyzed the performance degradation of both FL and its centralized model counterpart when one institution decided not to participate in the collaborative training. We found that FL was more resilient than centralized approaches in most cases, demonstrating that FL can generalize adequately to unseen datasets with smaller training sets. To the best of our knowledge, this thesis presents the first simulated FL study for the pathogenicity classification of genetic variants. With our findings, we expect to incentive the adoption of FL for establishing secure multi-institutional collaborations in human variant interpretation
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Jaros, Mark J. "A joint model for longitudinal data and competing risks /". Connect to full text via ProQuest. Limited to UCD Anschutz Medical Campus, 2008.
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Thesis (Ph.D. in Biostatistics) -- University of Colorado Denver, 2008.Typescript. Includes bibliographical references (leaves 117-119). Free to UCD Anschutz Medical Campus. Online version available via ProQuest Digital Dissertations;
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Clarke, Timothy. "An exploratory investigation into the efficacy and feasibility of a multi-session cognitive bias modification for interpretation (CBM-I) task in a clinical population experiencing social phobia : a single-case series". Thesis, University of East Anglia, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.588769.
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Social phobia is characterised by a tendency to interpret ambiguous social information in a negative of threatening manner. It is predicted that such biases play 'a causal role in the development and maintenance of social phobia. Research suggests that interpretive biases can be modified using a text-based paradigm called Cognitive Bias Modification for Interpretation (CB M-I), and that anxiety can reduce as a result. The efficacy and feasibility of this task as a clinical intervention has not been investigated using a social phobia clinical sample. The present study aimed to satisfy this. Nine participants, presenting to mental health services with social phobia were recruited from waiting lists. A non-concurrent multiple-baseline, single-case design was used to assess efficacy and feedback collected to assess feasibility of self-administered, one-week, daily sessions of CBM-I delivered at home. Measures of social phobia were completed daily during the baseline and intervention phases and change assessed. Secondary outcome measures were assessed for reliable and clinical change prior to CBM-I, post-CBM-I and at one-week follow-up. The results indicated that interpretive biases were reliably modified in eight of the participants and visual inspection of the daily scores showed that five of these participants responded to CBM-I in relation to reduced social phobia scores. Reliable and clinical change for secondary outcome measures of social phobia was mixed. For example, six participants demonstrated reliable improvements in Social Phobia Scale (SPS) scores post-CBM-I and five of these were considered to be clinically significant. Group effect sizes on the primary social phobia outcome measure were high. Results and feedback from participants suggest that CBM-I is a feasible clinical tool. The preliminary nature of these findings is discussed in relation to the literature and suggestions for clinical implications and future research are made.
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Finocan, Gillian M. "Understanding Ourselves Through Dreamwork: Women Finding Significance in the Stories and Images of Dreams". Connect to this document online, 2005. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=miami1122927116.
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Thesis (M.A.)--Miami University, Dept. of Psychology, 2005.Title from first page of PDF document. Document formatted into pages; contains [1], iv, 53 p. Includes bibliographical references (p. 45-56).
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Barreto, Carmem Lúcia Brito Tavares. "A psicologia clínica e o mal-estar contemporâneo: impasses e re-significações". Universidade Católica de Pernambuco, 2001. http://www.unicap.br/tede//tde_busca/arquivo.php?codArquivo=82.
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Este estudo tem como objetivo compreender o mal-estar contemporâneo partindo da experiência clínica. Traduz um verdadeiro testemunho da autora enquanto pesquisadora, psicoterapeuta e supervisora. Parte de inquietações desalojadoras experienciadas na clínica e utiliza como objeto de reflexão teórica a Abordagem Centrada na Pessoa, mais especificamente, a Terapia Centrada no Cliente. Realiza uma leitura crítica da teoria da Terapia Centrada no Cliente, analisando a concepção de ciência e a trajetória conceitual empreendida por Carl Rogers. Partindo dessa analise, aponta para a insuficiência dos conceitos de Tendência Atualizante e Angústia para acolher e dar passagem ao mal-estar contemporâneo, indicando a necessidade de uma outra via de acesso que apreenda a condição fundamental e originária do homem. Por fim, apresenta o conceito de angústia de Heidegger enquanto possível contribuição para fecundar e re-significar a prática clínica. Como resultado do percurso empreendido, a autora revela o momento de trânsito em que se encontra, encaminhando-se para uma clínica psicológica enquanto cuidar (Sorge), vinculada a uma teoria do existir humano que pode ser lida como uma ética de aceitação da finitude, da transitoriedade, e dos conflitos. Tal teoria enseja uma prática clínica, que envolva um ato de criação, como abertura de acolhimento para algo que não se conhece, com disponibilidade para se lançar nas complexidades do ser-aí. Aponta que, apesar de ter encontrado algumas respostas para as inquietações desalojadoras que motivaram o presente estudo, a temática abordada, pela sua complexidade e dinâmica própria, esteve e estará sempre aberta a novos olhares e leiturasDeparting from clinical experience, this study aims to comprehend the contemporary uneasiness. It shows the author's true testimony not only as a researcher, but also as a psychotherapist and supervisor. This research is based on disruptive clinical experiences by taking into account, as object for theoretical reflection, within the Person-Centered Approach, the Client-Centered Therapy. It makes a critical overview of the Client-Centered Therapy theory by analyzing Carl Rogers' concept of science as well as his conceptual path. Such analysis points to an insufficiency of the Actualizing Tendency and Anguish concepts toward sheltering and, at the same time, to promote a passage for the contemporary uneasiness. Thus, it indicates the need of another way to access and comprehend the fundamental and original human condition. Finally, this study presents Heidegger's anguish concept as a possible contribution to fertilize and re-signify the clinical praxis. As a result of such path, the author reveals her transitional moment of theoretical reflection, directing herself toward a psychological conception of clinic as "care" (Sorge), linked to a human existence theory conceived as an ethics of finitude acceptance, of transivity and conflicts. Such a theory demands a clinical praxis by conceiving a creation act as an opening to shelter something unknown, plenty of availability to carry forward onweself towards the "being-there complexity. The author manifests that, in spite to have found some possible answers to her dislodged inquietude experience that motivated this actual work, its approached thematic, by its own complexity and dynamic involved, implies in an always present openness that instigate new sights and reflections, thus deserving further re-readings
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Keenberg, Dylan A. "Clinical Psychologists' Lived Experiences of Uncertainty| An Interpretative Phenomenological Analysis". Thesis, The Chicago School of Professional Psychology, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10108633.
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Despite past discussion of uncertainty as a part of therapeutic theory and practice, few researchers have studied how uncertainty is understood by currently practicing clinical psychologists. Through semistructured interviews, 4 clinical psychologists provided their lived experiences of how they define, become aware of, experience, and make sense of uncertainty in their work. Their accounts were analyzed using interpretative phenomenological analysis, resulting in 16 superordinate themes. These included: (a) defining uncertainty as beyond knowledge, inevitable, future-bound, and from complex sources; (b) becoming aware of uncertainty in interrelating with others and in fulfilling professional roles; (c) experiencing uncertainty as distressing and/or threatening; and (d) reacting through reducing/controlling/rejecting, distancing, questioning themselves, seeking out other perspectives, embracing uncertainty, applying uncertainty, using hope and faith, and experiencing uncertainty as professionally taboo. Findings are discussed individually and integrated according to several dissonances/paradoxes emerging from the analysis. Recommendations are provided for clinicians, researchers, training programs, and students regarding experiencing uncertainty and new opportunities for incorporating the impact of uncertainty into clinical research, practice, and education.
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Kirk, Jennifer Anne. "Psychiatric, traditional and other interpretations of Ukuthwetyulwa : a witchcraft phenomenon in the Western Cape". Master's thesis, University of Cape Town, 1996. http://hdl.handle.net/11427/13480.
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Bibliography: leaves 66-74.This paper attempts to address the way in which a phenomenon that has been constructed within a traditional African framework, is confronted by and reinterpreted within a western psychiatric framework. This in turn may shed light on the way in which psychiatric and traditional discourses may be used in the process of the formation of a collectively accepted understanding of ukuthwetyulwa. The study provides the opportunity to explore the relationship between psychiatric and traditional discourses surrounding ukuthwetyulwa, at a moment in history when the issue of traditional healing practice and its relationship to psychiatry is increasingly on the agenda of mental health policy makers in South Africa.
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Grubb, Michael Louis. "Concurrent Psychotherapy and Twelve-Step Recovery for Compulsive Overeating| An Interpretative Phenomenological Analysis". Thesis, Pacifica Graduate Institute, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10132139.
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This qualitative study examines the situation when an individual is in psychotherapy and twelve-step recovery for compulsive overeating at the same time. Although both are common approaches, controversy exists concerning the relationship between compulsive overeating and addiction, the optimal treatment approaches for compulsive overeating, and the widespread use of twelve-step recovery by consumers and clinicians. This work describes issues related to the integration of psychotherapy and twelve-step programs in the treatment of compulsive overeating and establishes recommendations for psychotherapists who are treating compulsive overeaters who are making or may make use of twelve-step programs. This study utilizes interpretative phenomenological analysis, informed by conceptualizations from Jungian psychology, to analyze the interviews of eight participants in order to generate phenomenological description of the nature and elements of change when these two approaches are concurrent, and the ways in which the two approaches interact, making use of the participants’ understandings of their own experiences to inform clinical practice.
Keywords: psychotherapy, twelve step, compulsive overeating, addiction, phenomenology, Jungian, Overeaters Anonymous.
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Barreto, Carmem Lúcia Brito Tavares. "A psicologia clínica e o mal-estar contemporâneo: impasses e re-significações". Universidade Católica de Pernambuco, 2002. http://tede2.unicap.br:8080/handle/tede/891.
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Departing from clinical experience, this study aims to comprehend the contemporary uneasiness. It shows the author's true testimony not only as a researcher, but also as a psychotherapist and supervisor. This research is based on disruptive clinical experiences by taking into account, as object for theoretical reflection, within the Person-Centered Approach, the Client-Centered Therapy. It makes a critical overview of the Client-Centered Therapy theory by analyzing Carl Rogers' concept of science as well as his conceptual path. Such analysis points to an insufficiency of the Actualizing Tendency and Anguish concepts toward sheltering and, at the same time, to promote a passage for the contemporary uneasiness. Thus, it indicates the need of another way to access and comprehend the fundamental and original human condition. Finally, this study presents Heidegger's anguish concept as a possible contribution to fertilize and re-signify the clinical praxis. As a result of such path, the author reveals her transitional moment of theoretical reflection, directing herself toward a psychological conception of clinic as "care" (Sorge), linked to a human existence theory conceived as an ethics of finitude acceptance, of transivity and conflicts. Such a theory demands a clinical praxis by conceiving a creation act as an opening to shelter something unknown, plenty of availability to carry forward onweself towards the "being-there” complexity. The author manifests that, in spite to have found some possible answers to her dislodged inquietude experience that motivated this actual work, its approached thematic, by its own complexity and dynamic involved, implies in an always present openness that instigate new sights and reflections, thus deserving further re-readings.
Este estudo tem como objetivo compreender o mal-estar contemporâneo partindo da experiência clínica. Traduz um verdadeiro testemunho da autora enquanto pesquisadora, psicoterapeuta e supervisora. Parte de inquietações desalojadoras experienciadas na clínica e utiliza como objeto de reflexão teórica a Abordagem Centrada na Pessoa, mais especificamente, a Terapia Centrada no Cliente. Realiza uma leitura crítica da teoria da Terapia Centrada no Cliente, analisando a concepção de ciência e a trajetória conceitual empreendida por Carl Rogers. Partindo dessa analise, aponta para a insuficiência dos conceitos de Tendência Atualizante e Angústia para acolher e dar passagem ao mal-estar contemporâneo, indicando a necessidade de uma outra via de acesso que apreenda a condição fundamental e originária do homem. Por fim, apresenta o conceito de angústia de Heidegger enquanto possível contribuição para fecundar e re-significar a prática clínica. Como resultado do percurso empreendido, a autora revela o momento de trânsito em que se encontra, encaminhando-se para uma clínica psicológica enquanto cuidar (Sorge), vinculada a uma teoria do existir humano que pode ser lida como uma ética de aceitação da finitude, da transitoriedade, e dos conflitos. Tal teoria enseja uma prática clínica, que envolva um ato de criação, como abertura de acolhimento para algo que não se conhece, com disponibilidade para se lançar nas complexidades do ser-aí. Aponta que, apesar de ter encontrado algumas respostas para as inquietações desalojadoras que motivaram o presente estudo, a temática abordada, pela sua complexidade e dinâmica própria, esteve e estará sempre aberta a novos olhares e leituras.
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Buyson, Darwin. "Bilingual clinical psychologists' experiences of conceptualising emotional distress : an interpretative phenomenological analysis". Thesis, University of Hertfordshire, 2010. http://hdl.handle.net/2299/5089.
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Aim: The study aims to explore, in-depth, South Asian bilingual clinical psychologists personal and clinical experiences of conceptualising emotional distress in first and second language. It is hoped that a clearer understanding of these experiences will help emphasise the role of language in the experience of emotional distress, which may be beneficial for working with clients that make sense of emotional distress in multiple languages. An understanding of these processes may also encourage further exploration and critique of the ways in which western psychological models are used to make sense of emotional distress, given many, if not all have been constructed using English language. Method: A qualitative approach was used for this study. Semi-structured interviews were conducted with six South Asian, bilingual clinical psychologists working in NHS services. The resulting data was analysed using interpretative phenomenological analysis (IPA). Results: The analysis highlighted four main themes emerging from participant accounts of conceptualising emotional distress in multiple languages. These were: “Worlds apart in culture and language”, “Oscillating self in language”, Ubiquity of English language and values” and “Challenging and managing difference”. Implications: Whilst much has been written about race and cultural issues in the context of clinical psychology, relatively little attention has been given to the experience and impact of multiple languages on the conceptualisation and experience of emotional distress. A major implication is first language conceptualizations are rarely considered in the development of psychological models of emotional distress, nor are they explicitly considered in the way clinical psychologists are trained and in the majority of current clinical practice guidelines. Participant accounts are dicussed in the wider historical context of psychology, anthropology and sociolinguistics informing further discussions on bilingualism and current psychological practice and theorising.
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Carmichael, Kirsty. "Exploring clinical psychologists' understandings and experiences of how they use reflective practice in their clinical work : an interpretative phenomenological analysis". Thesis, University of East Anglia, 2018. https://ueaeprints.uea.ac.uk/69042/.
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Background: Reflective practice is regarded as a key competency in managing the complexity and uniqueness of clinical work (Schön, 1983). However, the dearth of research combined with the methodological limitations of how this concept has been explored has limited our understanding of how reflective practice is being used in clinical practice, particularly outside of a training context. Design: This project is presented as a thesis portfolio, which includes a systematic review of qualitative literature on the uses of reflective practice among qualified therapists’, an empirical study exploring clinical psychologists’ experiences of how they use reflective practice in their clinical work, an extended methodology chapter, and a discussion and critical evaluation chapter. Results: The systematic review produced eight studies, and within these seven interrelated themes emerged, which were encapsulated by two overarching themes: the value of reflective practice and conceptualising reflective practice. Despite difficulties with understanding and integrating reflective practice, therapists reported many benefits to reflection including: increasing self-awareness, enhancing connection with clients, enhancing clinical practice and facilitating self-care. The empirical study used an interpretative phenomenological analysis (IPA), which produced three superordinate themes to capture participants’ experiences of reflective practice: 1) discovery through exploratory questioning, 2) containment in practice through making sense of their thoughts and feelings and 3) human survival. Conclusion: The findings from the systematic review suggest the criticisms of the literature have yet to be addressed, with the majority of studies reporting therapists’ retrospective opinions of reflective practice. The findings from the empirical study suggest reflective practice may enhance perspective-taking abilities, interpersonal skills, and personal resilience. The study has begun to address criticisms of the literature by combining reflective diaries and interviews to capture lived experience, therefore linking the benefits of reflective practice to real world examples.
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Merriman, Olivia. "Clinical implications of counselling psychologists' responses to client trauma : an interpretative phenomenological analysis". Thesis, University of Roehampton, 2012. https://pure.roehampton.ac.uk/portal/en/studentthesis/clinical-implications-of-counselling-psychologists’-responses-to-client-trauma(15c5281c-b0f5-4032-96d7-f63264a7c48e).html.
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Background and aims: The past two decades have seen a surge of interest in the impact of working with trauma on psychological therapists’ well-being. However, the implications of therapists’ responses to trauma for the process of therapy are unknown. The existing literature carries the assumption that therapists’ strong subjective responses to traumatic material have a negative impact on the therapeutic process, but this has not been directly researched. Therefore, this thesis investigates the experiences of therapists working with clients who describe traumatic events, and how therapists consider their responses to the disclosure of traumatic material to have impacted upon the therapeutic process. Method: Semi-structured interviews were carried out with nine qualified chartered counselling psychologists with experience of working with trauma. Interview transcripts were analysed using Interpretative Phenomenological Analysis (IPA). Results: The analysis produced four superordinate themes. These were: (1) Demands and challenges in the use of self in response to trauma; (2) Dimensions of complexity in working with trauma: Conceptual, contextual, ethical, political; (3) Developing the therapeutic self in response to trauma; and (4) Valuing the therapeutic self in work with trauma. Conclusion: The research indicated that significant challenges were experienced in terms of the complex interpersonal dynamics, troubling somatic processes and ethical dilemmas in therapy with trauma. Furthermore, existing theoretical models were not sufficient to illuminate practice in these areas. Thus, this research indicates that specific 8 training and development in these areas is warranted, and a possible theoretical framework to help facilitate this is proposed. In addition, the current research supports the development of more explicitly socially contextualised approaches to trauma. Future research could usefully build on the current study by further investigating embodied processes and interpersonal dynamics, as well as the impact of therapists’ disclosure of their subjective responses in therapy with trauma.
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Malins, Samuel. "Clinical psychologists' experiences of addressing spiritual issues in supervision : an interpretative phenomenological analysis". Thesis, University of Nottingham, 2011. http://eprints.nottingham.ac.uk/12215/.
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Background: Psychological therapists have found spirituality a complex and confusing subject to work with in therapy and research (e.g. Jackson & Coyle, 2009). However, little is known about the role supervision may play in maintaining or resolving this situation (Miller, Korinek & Ivey, 2006). Aim: To explore how clinical psychologists address spiritual issues in supervision, using the qualitative methodology of Interpretative Phenomenological Analysis (IPA, Smith, 1996). Method: Semi-structured interviews were conducted with a purposive sample of seven clinical psychologists who had addressed or attempted to address spiritual issues in supervision. Results: Three superordinate themes emerged from data analysis: The Ineffable Nature of Spirituality: How and why spirituality is difficult to put into words; Struggles with Spirituality: Consequent interpersonal and intrapersonal tensions; Negotiating Struggles: How participants managed the difficulties faced. Conclusions Whereas previous literature has implied that spirituality itself can be the “elephant in the room”, this study suggests the “elephant” is the inherent struggle involved when addressing spirituality in therapy and supervision. Engaging with spirituality in supervision requires ongoing management of tensions related to spirituality. Making implicit processes in supervision explicit may facilitate this process.
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Hunter, Ruth. "Leadership, motherhood and the NHS : an interpretative phenomenological analysis of clinical psychologists' experience". Thesis, University of Leeds, 2015. http://etheses.whiterose.ac.uk/10429/.
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Introduction: This project was developed from a recognition that there is a lack of attention to gender in the leadership literature and, in particular, a gap in the research exploring the experiences of female leaders who are also mothers and managing multiple roles and identities. The research focused on individual leaders embedded in their personal and organisational context (NHS), and considered the experiences of leadership in clinical psychology and motherhood. The experiences of being both a leader and a mother were explored in the context of a largely female profession – clinical psychology – and in doing so provide an addition to the greater body of research that has been conducted in male-dominated environments. Method: Using a combination of purposeful sampling and snowballing, a relatively homogeneous sample of seven female clinical psychologists with a leadership aspect to their role, who were also mothers, were recruited. They participated in semi-structured interviews which were transcribed and then analysed using Interpretative Phenomenological Analysis. Firstly, individual transcripts were analysed and themes and subthemes were generated for each participant. These individual themes were then used to develop the group themes. Results: Three master themes and eight superordinate themes were developed from the group analysis. The master themes are: Feeling congruent, Working out whether I’m a leader and Coming to terms with too many demands. Discussion: The key findings from the study are linked to the literature as well as psychological theory. The study adds to existing literature on women and leadership, and specifically leaders who are mothers and the negotiation of these roles within the public sector. The strengths and limitations of the study are presented. Implications for stakeholders are discussed as well as important areas for future research.