Dissertations / Theses on the topic 'Acquired'
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Baxter-Versi, Doreen Mary. "Acquired spelling disorders." Thesis, University College London (University of London), 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.262683.
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Qin, Xiaohui. "Papaya systemic acquired resistance." Thesis, University of Hawaii at Manoa, 2003. http://hdl.handle.net/10125/6872.
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Challenge by a pathogen induces systemic acquired resistance (SAR) in plants, a state marked by the elevated expression of pathogenesis related (PR) genes and enhanced resistance to a broad spectrum of pathogens. SAR requires the endogenous accumulation of salicylic acid (SA), and can be induced by exogenous application of SA or related molecules such as benzo(1,2,3) thiadiazole-7-carbothioic acid S-methyl ester (BTH). All tested plants have a SAR response, but some important aspects of SAR differ between species. In this work, four (partial) PR-1 cDNAs were cloned from papaya. One of these, PR-1d, was shown to be induced by BTH. This data, together with previous data showing the induction of SAR related enzymes and enhanced tolerance to a pathogen in response to BTH, demonstrates that papaya has a SAR response and it is induced by BTH. With this knowledge, global profiling of papaya genes induced by BTH was carried out by suppression subtractive hybridization. 25 unique expressed sequence tags (ESTs) induced by BTH were identified, including homologs of numerous genes known to be defense related, and some genes previously unknown to have defense functions. A papaya homolog of NPRl, shown to be required for SAR signal transduction in Arabidopsis, was isolated and found to contain all three structural domains required for activity in Arabidopsis. This data, together with the profile of BTH induced genes, and induction kinetics for some of these genes, shows that papaya SAR is similar in many important aspects to SAR in the model system Arabidopsis. Additionally, tobacco plants over-expressing Arabidopsis NPRI were produced and found to produce elevated (compared to wild-type) levels of PR-la mRNA in response to SA treatment. This demonstrates that even in a heterologous system, over-expression of NPRl may confer an enhanced SAR response.xvi, 116 leaves
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Potgieter, Peter Daniel. "Severe community-acquired pneumonia." Doctoral thesis, University of Cape Town, 1996. http://hdl.handle.net/11427/27658.
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In this thesis I will review the current knowledge of community-acquired pneumonia, including its classification, pathogenesis, pathology, aetiology, diagnosis, and antibiotic therapy and report my experience with severe community-acquired pneumonia in patients requiring admission to our respiratory intensive care unit. The original research in this thesis comprises a prospective, descriptive analysis of 196 cases of severe community-acquired pneumonia requiring admission to the Respiratory Intensive Unit at Groote Schuur Hospital from January 1987 until December 1992, with emphasis on the influence of aetiology on the severity of pneumonia, the· aetiological diagnosis of pneumonia in severely ill patients, measures of severity of pneumonia, and an audit of ICU therapy and outcome. In addition, different aspects of novel therapies and specific aetiological varieties of pneumonia which have been investigated over the past ten years will be presented.
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Caddick, James M. "Molecular typing of hospital-acquired, community-acquired and multidrug-resistant methicillin-resistant staphylococcus aureus." Thesis, Aston University, 2005. http://publications.aston.ac.uk/11028/.
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Cipolotti, Lisa. "Acquired disorders of numerical processing." Thesis, University College London (University of London), 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.242400.
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Bradley, Veronica A. "Varieties of acquired phonological dyslexia." Thesis, Aston University, 1985. http://publications.aston.ac.uk/12145/.
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The existence of different varieties of the acquired reading disorder termed "phonological dyslexia" is demonstrated in this thesis. The data are interpreted in terms of an information-processing model of normal reading which postulates autonomous routes for pronouncing lexical and non-lexical items and identifies a number of separable sub-processes within both lexical and non-lexical routes. A case study approach is used and case reports on ten patients who have particular difficulty in processing non-lexical stimuli following cerebral insult are presented, Chapters 1 and 2 describe the theoretical background to the investigation. Cognitive models of reading are examined in Chapter 1 and the theoretical status of the current taxonomy of the acquired dyslexias discussed in relation to the models. In Chapter 2 the symptoms associated with phonological dyslexia are discussed both in terms of the theoretical models and in terms of the cosistency with which they are reported to occur in clinical studies. Published cases of phonological dyslexia are reviewed. Chapter 3 describes the tests administered and the analysis of error responses. The majority of tests require reading aloud of single lexical or non-lexical items and investigate the effect of different variables on reading performance. Chapter 4 contains the case reports. The final chapter summarises the different patterns of reading behaviour observed. The theoretical model predicts the selective impairment of subsystems within the phonological route. The data provide evidence of such selective impairment. It is concluded that there are different varieties of phonological dyslexia corresponding to the different loci of impairment within the phonological route. It is also concluded that the data support the hypothesis that there are two lexical routes. A further subdivision of phonological dyslexia is made on the basis of selective impairment of the direct or lexical-semantic routes.
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Wootton, Daniel. "Recovery from community acquired pneumonia." Thesis, University of Liverpool, 2015. http://livrepository.liverpool.ac.uk/2028510/.
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Aims: To measure symptomatic recovery over a year among an adult cohort recruited from hospital with community acquired pneumonia (CAP). To measure the host recovery mechanism efferocytosis and the diversity of the bacterial microbiota in sputum and relate these to individual characteristics of subjects in the cohort. Methods: Patients with CAP were recruited from two hospitals in Liverpool, (UK) and were followed-up for one year. The CAP-sym questionnaire was completed at multiple time-points in order to create a statistical model of symptomatic recovery. DNA was extracted from acute sputum samples and 16S rRNA sequencing revealed the diversity of bacteria in sputum. At one month into recovery subjects volunteered for bronchoalveolar lavage and rates of efferocytosis were measured by co-culturing ex-vivo alveolar macrophages with apoptotic autologous neutrophils. Results: The 169 subjects recruited with CAP were found to have high levels of socio-economic deprivation, smoking and COPD and the median age was 64 years. A non-linear, longitudinal, statistical model of symptoms found that smoking impaired recovery but people tended to describe better recovery as they got older. Efferocytosis was impaired by smoking but improved by statins and these effects were modified by body mass index. Those with prior pulmonary disease had lower bacterial diversity in their sputum and in this cohort a species from the genus Haemophilus was dominant. Conclusion: This work proves the principal that modelling CAP-sym scores can be used to investigate factors associated with differential recovery from CAP. It highlights the detrimental effects of smoking on both recovery and efferocytosis. This is the first study to show that the bacterial diversity of CAP sputum is influenced by prior lung disease. The translational outcomes are the potential for trials of statins as pro-recovery agents and to study modified empirical antibiotics for those with CAP and prior-lung disease.
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Vasilescu, Camelia. "Earnings management in acquired companies." Thesis, University of Leeds, 2014. http://etheses.whiterose.ac.uk/8388/.
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Mergers and acquisitions (M&A) are very important corporate events for both acquirers and targets, and the quality of public accounting information has a significant role in mergers and acquisitions decisions. Acting on the shareholders’ behalf or pursuing their self-interests, targets’ managers have strong incentives to manipulate reported earnings prior to a deal in order to boost the stock price and generate higher gains for shareholders and themselves. Consistent with this view, researchers have dedicated much effort to examining whether acquirers and targets undertake earnings manipulation around takeovers. The objective of this thesis is to examine whether UK publicly listed targets engage in accruals and real-activity earnings management prior to M&A, and the consequences this has on targets’ shareholder wealth, in particular deal premium and stock return. Earnings management can occur through two main channels: accruals earnings management and real-activity earnings management. These two main earnings management tactics differ in their opacity, cost and the effect they cause to stock price performance prior to M&A (Roychowdhury et al., 2012). Most of the previous studies on this subject have focused exclusively on accruals earnings management, however, the evidence shows that opportunistic accruals earnings management is not a common practice among targets in M&A. More recent research on earnings management provides evidence that firms use multiple earnings manipulation strategies based on accruals and real-activities (e.g., Graham et al., 2005; Roychowdhury, 2006; Cohen and Zarowin, 2010; Zang, 2011), and managers prefer real-activities manipulation over accruals earnings manipulation as a way to increase reported earnings (Graham et al., 2005). The first empirical study of this thesis examines whether UK publicly listed targets attempt to manipulate earnings via accruals prior to a deal, and further, investigates the relationship between the deal premium and the targets’ earnings management behaviour. The results of the accruals tests under the cross-sectional modified-Jones model and performance-matched model, and using either the balance-sheet approach or the cash-flow approach, indicate that, on average, targets do not manage earnings upward prior to mergers and acquisitions. Furthermore, the analysis of the relationship between earnings management and deal premium provides evidence that the deal premium and the targets’ abnormal accruals are negatively related, which is consistent with the view that acquirers take into consideration the quality of targets’ earnings in making takeover decisions (e.g., Anilowski et al., 2009; Raman et al., 2013). The evidence in this study also suggests that the deal premium constrains targets’ accruals earnings management and acts as a strong disincentive to manipulate earnings. Consequently, the cost of detection explanation for the lack of earnings management by UK targets appears capable of explaining this relationship between the deal premium and the abnormal accruals of targets. The second empirical study builds on the results of the previous research, which finds no evidence of accruals manipulation by UK targets in M&A, and explores a potential explanation of this phenomenon. Specifically, this study examines whether firm diversification has an impact on earnings management by targets in M&A. An explicit distinction between industrial and geographical diversification is made in this study. Prior research provides evidence that the mode of diversification, such as industrial vs. geographical, can explain the difference in the correlation between discretionary accruals and diversification due to whether or not they are in different industry segments and/or whether business units are located in different countries (Kim and Kim, 2001). Using a panel data framework for a sample of publicly listed targets, the results of this empirical study suggest that industrial diversification mitigates earnings management prior to mergers and acquisitions. In addition, the results also show that a combination of industrial and geographical diversification alleviates earnings management. However, there is no clear empirical evidence that geographical diversification facilitates or mitigates earnings management. These results are consistent with those reported in Jiraporn et al. (2008) and El Mehdi and Seboui (2011), who find that industrial diversification decreases earnings management by US firms. Finally, the third empirical study investigates the earnings management behaviour of UK targets in M&A, in particular combined and simple strategies based on accruals and real-activities, and the impact of earnings management on targets’ stock overvaluation at the time of a deal. Prior literature provides evidence that at times of heightened scrutiny, such as M&A, earnings management via accruals is unlikely to be a dominant source of overvaluation (e.g., Cohen and Zarowin, 2010; Roychowdhury et al., 2012). Consistent with this view, the results of this study, which were derived from a panel data regression analysis, show that if targets engage in income-increasing earnings management, they are more likely to use combined strategies of earnings management via both accruals and real-activities simultaneously rather than simple strategies based solely on either accruals or real-activities. Furthermore, managers’ propensity to engage in combined strategies of earnings management prior to M&A is significantly higher than the propensity for accruals earnings management, despite the high and long-term costs of this earnings management method. Furthermore, the stock return tests performed in this study provide evidence that firms which exhibit evidence of combined earnings management strategies tend to be the most overvalued targets prior to M&A which is consistent with those results reported by Roychowdhury et al. (2012). To sum up, UK publicly listed targets are more likely to utilise combined earnings management strategies based on accruals and real-activities prior to a takeover, and these targets’ shareholders appear to gain the most if they sell their shares before the deal announcement. However, accruals earnings management as a sole method of earnings manipulation is not a widespread practice in UK mergers and acquisitions, and the deal premium constrains the targets’ accruals earnings management behaviour. If earnings manipulation by targets is detected, acquirers might adapt their takeover strategies by adjusting the deal price downward. Finally, industrial diversification mitigates earnings management by UK targets prior to mergers and acquisitions. Given the significant negative wealth consequences of both accruals and real-activity earnings manipulation, the findings of this thesis emphasise the fact that targets’ shareholders, board of directors and auditors, as well as financial advisors need to be alert to managers attempting to engage in earnings management via accruals, but also carefully monitor real-activities. Furthermore, investors, acquirers and financial analysts should be fully aware of the existence and severity of targets’ stock overvaluation when they make or facilitate important investment decisions.
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Jones, Druscilla Willis. "Hospital-Acquired Pressure Ulcer Prevention." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7670.
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Hospital-acquired pressure ulcers (HAPUs) represent a significant challenge in the care provided for hospitalized patients. HAPUs impact morbidity, mortality, and quality of life. At the local practice site, the incidence of HAPUs increased in the perioperative setting. The practice-focused question for this project asked if an education program for staff nurses working in a perioperative care setting with high HAPU incidence can advance nurse knowledge regarding prevention, early assessment, symptoms, and treatment of HAPUs. The purpose of this educational project was to develop a pretest and posttest designed education program on HAPU prevention and care for perioperative nurses. The Iowa model was used to guide content development with application of the content to nursing practice, and Watson’s theory of caring was used to align with the organizational core values. Information on the prevention and treatment of HAPUs was obtained from national and international guidelines. A presentation was developed to address the practice guidelines for assessment, prevention, and treatment of HAPUs. A standardized pretest from NetCE was given to 15 nurses and 5 medical assistants prior to the education program and again after the education program. NetCE score results indicated improvement in nursing staff members’ knowledge from 65 on the pretest to 100 on the posttest; medical assistants’ scores increased from 35 to 65. For patients who undergo surgical procedures, the results of this project may improve assessment, prevention, and treatment of HAPUs and thereby promote positive social change because patients have a reduced risk of HAPUs and HAPU-associated complications.
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Jones, Kevin Dominic. "Psychological adjustment to acquired brain injury." Thesis, University of Oxford, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.556195.
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Acquired brain injury (ABI) has a significant impact upon wide areas of a person's life including cognition, physical health, mood and social functioning, thus posing significant challenges to psychological adjustment. However, the literature is unclear in defining the theoretical concept of adjustment, and is lackinq in synthesis, In addition, there is a growing body of research indicating that a wide range of psychological outcomes are experienced after ABI ranging from psychological distress to more positive outcomes such as posttraumatic growth, although traditionally a focus has been maintained on distress. The first paper considers psychological adjustment from a theoretical and empirical perspective in relation to traumatic brain injury (TBI). The second paper addressed a gap in the literature regarding positive outcomes after ABI by conducting a qualitative exploration of nine individuals' experiences of positive psychological changes after sustaining an ABI. Interpretative phenomenological analysis was used to investigate these experiences. Three overarching themes were identified: (1) positive psychological changes; (2) Drivers of positive changes; and (3) I'm the same as before, but I know things are different. The findings of this study make a contribution to the growing evidence that individuals' with ABI do experience positive outcomes, and highlights the complexity of these experiences. Both papers discuss future research and clinical implications.
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Pearson, Corinne. "Substance use and acquired brain injury." Thesis, University of Southampton, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.419003.
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NÄSMAN, MARKUS. "Detecting Hospital Acquired Infections usingMachine Learning." Thesis, KTH, Skolan för datavetenskap och kommunikation (CSC), 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-142355.
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Every year a large number of patients contract infections due to their hospital stay. These infections are a major hazard to patient safety causing increased mortality and morbidity in affected patients. Manual detection and reporting of these infections add to the workload of the medical staff which makes it infeasible to do on a continuous basis. The goal is to automate detection using machine learning methods. This will be done using supervised learning and data available in electronic patient records. As most of the data available is in unstructured free-text the emphasis of this thesis is on how to turn this text into features that are able to capture the patterns associated with hospital acquired infections. Three different data representations are explored: bag of words, complex symbolic sequences and simple parameters by information extraction. The classifiers used are support vector machines and gradient tree boosting. The data-set used consists of 300 hospitalizations from Karolinska University Hospital, Sweden from 2011 and 2012. These hospitalizations have been marked has having a hospital acquired infection or not by medical experts and the class distribution is: 53% contain a hospital acquired infection and 47% do not. Support vector machines and gradient tree boosting perform similarly for the task but the focus is on gradient tree boosting due to its visualization capabilities. The best results, evaluated using 5-fold cross-validation, are obtained by gradient tree boosting giving a F1-score in the range of 0.82-0.83, recall in the range 0.88-0.89 and a precision of 0.78, for all three data representations. Future research will have to focus on how to incorporate more parameters into the information extraction based representations, how to capture patterns common only in minority subclasses and how well the three data representations workload with larger datasetsVarje år ådrar sig en stor andel sjukhuspatienter infektioner på grund av sin sjukhusvistelse. Dessa infektioner är ett stort patientsäkerhetsproblem som leder till ökad mortalitet och morbiditet för de drabbade patienterna. Manuell detektion och inrapportering av dessa infektioner leder till merarbete för sjukvårdspersonalen vilket försvårar att detta sker kontinuerligt. Målet är att automatisera detektionen med hjälp av maskininlärning. Detta kommer att göras genom att använda övervakad inlärning och data tillgänglig i elektroniska patientjournaler. Då det mesta av den tillgängliga information endast är tillgänglig som fritext så ligger fokuset för denna uppsats på hur man kan förvandla texten till särdrag som kan fånga de mönster som är karakteristiska för vårdrelaterade infektioner. Tre olika datarepresentationer utforskas: termfrekvenser, komplexa symboliska sekvenser och “enkla parametrar” baserade på informationsextraktion. De klassificerare som används är stödvektormaskiner (support vector machines) och “gradient tree boosting”. Datamängden som används består av 300 vårdtillfällen från Karolinska Universitetssjukhuset från 2011 och 2012. Vårdtillfällena har markerats som innehållandes en vårdrelaterad infektion eller ej av sjukvårdspersonal. Av dessa vårdtillfällen har 53% markerats som innehållandes en vårdrelaterad infektion och 47% har markerats som ej innehållande en vårdrelaterad infektion. Stödvektormaskiner och “gradient tree boosting” presterar snarlikt för uppgiften men fokus ligger på sistnämnda metod då resultatet delvis kan visualiseras. Bäst resultat uppnås med “gradient tree boosting”m utvärderat med 5-delad korsvalidering. Detta ger ett F1-värde i intervallet 0,82 - 0,83, täckning i intervallet 0,88 - 0,89 och 0,78 i precision oavsett vilken av datarepresentationerna som används. Framtida arbete bör fokusera på hur man kan inlemma fler parametrar i de informationsextraktionsbaserade representationerna, hur man kan hitta mönster som är vanliga i en specifik subklass men inte i huvudklassen, samt hur väl de olika datarepresentationerna fungerar för större datamängder.
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Butterfill, Stephen Andrew. "Beliefs and how they are acquired." Thesis, University of Oxford, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.288914.
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Sargeant, Malcolm. "Implementation of the Acquired Rights Directive." Thesis, Middlesex University, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337841.
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Gray, Colin. "The enterprise culture : an acquired taste?" Thesis, London Metropolitan University, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.283087.
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Ward-Robinson, Jasper. "An associative account of acquired equivalence." Thesis, University of York, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.319455.
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Williams, Geraint P. "Immunoregulation of acquired ocular immunobullous disease." Thesis, University of Birmingham, 2012. http://etheses.bham.ac.uk//id/eprint/3235/.
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Ocular Mucous Membrane Pemphigoid (OcMMP) is a blinding immunobullous disease, characterised by auto-antibody driven conjunctival inflammation and scarring. My hypothesis was that progressive fibrosis in OcMMP, occurring in the apparent absence of clinical inflammation, was driven by underlying inflammatory processes. I observed that in OcMMP, progressive scarring did occur in the apparent absence of clinically identifiable inflammation and I was able to improve clinical documentation by developing and validating an objective Fornix Depth Measurer (FDM) for assessment of scarring. I optimised non-invasive Ocular Surface Impression Cytology (OSIC) combined with flow cytometry to characterise conjunctival leukocytes. I found that CD8αβ+ effector memory, cytotoxic, mucosal-homing T cells were the dominant population in health. This population was unaltered with age but CD4+ T cells, capable of producing IFN-γ, increased. In OcMMP, the conjunctiva was characterised by decreased CD8+ lymphocytes and an elevation in CD45INTCD11b+CD16+CD14- neutrophils. Although neutrophils correlated with clinical inflammation, they were even present in the absence of identifiable conjunctivitis. This elevation was associated with progression of scarring assessed by FDM, even in the clinically Non-inflamed eye. These findings confirmed my hypothesis and provide a platform for quantifying neutrophils as a biomarker of sub-clinical inflammation and their role in the scarring process.
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Whitelaw, D. A., and D. A. Whitelaw. "Community acquired bacteraemia in the elderly." Master's thesis, University of Cape Town, 1990. http://hdl.handle.net/11427/24974.
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Age affects the human frame at all levels - from the skin which is ravaged by exposure to ultraviolet light and toxic irritants to the immune system which becomes progressively less responsive to antigenic stimuli. Bacteraemia follows a focal infection and thus any change which results in increased infection will result in an increased chance of bacteraemia. Therefore any factors bearing on focal infection will, of necessity influence not only the possibility but also the severity of a bacteraemia.
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Bonilla, Ingrid Marie. "Acquired Electrophysiological Remodeling and Cardiac Arrhythmias." The Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1396024058.
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Salas, Christian E. "Emotion regulation after acquired brain injury." Thesis, Bangor University, 2013. https://research.bangor.ac.uk/portal/en/theses/emotion-regulation-after-acquired-brain-injury(6bcd1d9b-8e25-43b6-ae26-d350cfd2c750).html.
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Emotion dysregulation is a common phenomenon after brain injury, often compromising socioemotional adjustment and participation. Nevertheless, there has been little research exploring the mechanisms by which brain damage impacts emotion regulation [ER]. In contrast, outside the field of neuropsychology, the study of ER has matured during the last decade, generating a robust body of evidence on the strategies that people use to modulate their feelings. The main goal of this thesis is to bring together, for the first time, these two fields of knowledge. Chapter two presents three articles touching key conceptual issues, such as the description of self-regulation and self-other regulation problems after brain injury, the relationship between neuropsychological profiles of impairment and ER strategies deficits, and the impact of concrete behaviour on emotional experience. Chapter three explore the problem of emotion elicitation and emotional reactivity. In two articles, the efficacy of internal and external forms of elicitation is explored on a student sample [n = 40], as well as compared between people with right hemisphere [RH] damage and matched healthy controls [RH: n = 10, HC: n = 15]. The main finding of both studies is that internal elicitation procedures generate higher levels of subjective reported emotion across populations of different age. In addition, patients with RH damage present similar levels of emotional reactivity compared to controls. Chapter four explores how specific ER strategies are compromised by focal brain injury. In the first study, people with RH frontal lesions [n = 10] were compared to healthy control [n = 15] on a response modulation task. It was found that RH patients were impaired voluntarily manipulating emotional facial expressions, and that a subgroup of RH patients was unable to inhibit emotional displays. The second study explored the impact of unilateral lesions in the capacity to reappraise [RH: n = 8, LH: n = 8, HC: n = 14]. Individuals with RH and LH lesions were equally slow, compared to controls, generating reappraisals. However, when time was not considered, both groups were equally productive. Finally, Chapter five uses a single case study methodology to explore the mechanism by which ER, and particularly reappraisal, is disrupted after left prefrontal lesions. Here, two articles offer important insight into how concreteness and executive impairment are associated to emotion dysregulation, and the mechanisms by which such dysregulation can be externally compensated.
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Jonsson, Gustav, and Ehsan Ullah. "Acculturation: The view of the acquired." Thesis, Uppsala universitet, Företagsekonomiska institutionen, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-388947.
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Acquisitions are growing in popularity as a way for organizations to grow. Yet the proportion of acquisitions that fail to meet their performance goals are high. The reason behind this failure rate can be many, but one often cited cause is differences in organizational culture and acculturative stress. This thesis aims to gain a fuller understanding of how acculturation and acculturative stress are perceived by the members of staff of an acquired firm. This thesis took a qualitative approach with semi-structured interviews as the method of data collection. The sample consisted of four members of staff of a firm who had been acquired part of an international acquisition. The results showed that they perceived the acquirers preferred mode of acculturation to be more intrusive than the one preferred by the members of staff of the acquired firm. Furthermore, the participants expressed that the organization suffered from common symptoms of acculturative stress, such as increased turnover among management.
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Littleson, Steven G. "Strategies to Reduce Hospital-Acquired Conditions." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6605.
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Hospital-acquired conditions cause harm to patients and increase mortality. In addition to lowering the quality of patient care, hospital-acquired conditions also negatively affect financial performance, which makes them a business problem for hospital administrators. The purpose of this single case study, which was grounded in the theory of high reliability, was to explore strategies used to reduce the number of hospital-acquired conditions. The sample consisted of 13 senior leaders of a large academic medical center in the southeastern United States, who shared successful strategies used to reduce hospital-acquired conditions. Data collection took place through semistructured interviews and a review of plans and reports that showed rates of hospital-acquired conditions from 2014 to 2017. Data analysis involved using Yin's 5-step process as well as coding interview text and data from documents and then grouping related words to develop themes. Themes that emerged from this study included leadership style, communication practices, and trust. A key finding was the importance of positive and trusting leadership behaviors by senior leaders planning to reduce hospital-acquired conditions. Another key finding was the confirmation that hospital administrators can and should prioritize quality and financial improvement simultaneously. The implications of this study for positive social change include the potential to reduce health care costs and save patients' lives by reducing the number of hospital-acquired conditions.
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Ho, Tip-yin. "Community-acquired pneumonia in elderly requiring hospitalization." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31971787.
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Sebastián, Romagosa Marc. "Brain computer interfaces for brain acquired damage." Doctoral thesis, Universitat Autònoma de Barcelona, 2020. http://hdl.handle.net/10803/670835.
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El terme Interfície Cervell-Ordinador (ICC), va sorgir als anys 70 pel Dr. Jacques J. Vidal, que mitjançant l’ús de l’electroencefalografia (EEG) fou el primer a intentar proporcionar una sortida alternativa als senyals cerebrals per controlar un dispositiu extern. L’objectiu principal d’aquesta fita era ajudar als pacients amb problemes de moviment i comunicació a relacionar-se amb el seu entorn.
Des de llavors, molts neurocientífics han emprat aquesta idea i han intentat posar-la en pràctica utilitzant diferents mètodes d’adquisició i processament del senyal, nous dispositius d’interacció, noves metes i objectius. Tot això ha facilitat l’aplicació d’aquesta tecnologia en moltes àrees, i actualment les ICC s’utilitzen per jugar a videojocs, moure cadires de rodes, facilitar l’escriptura en persones sense mobilitat, definir criteris i preferències en el món del comerç i el consum, o inclús poden servir com a detector de mentides.
Tot i així, el sector que presenta un major avenç en el desenvolupament de les ICC, és el sector biomèdic. A grans trets, podem utilitzar les ICC amb dues finalitats diferents dins de la neurorehabilitació; substituint una funció perduda o induint canvis en la plasticitat neuronal amb l’objectiu de restaurar o compensar la funció perduda.
Existeixen diferents principis per al registre dels senyals del cervell; de manera invasiva, col·locant els elèctrodes de registre dintre de la cavitat cranial, o de manera no invasiva, col·locant els elèctrodes de registre fora de la cavitat cranial. El mètode més conegut i difós és l’EEG. El seu ús és molt adequat en entorns clínics, té una resolució temporal molt precisa i és possible obtenir una retroalimentació en temps real que pot induir la plasticitat cortical i el restabliment de la funció motora normal.
En aquesta tesi presentem tres objectius diferents: (1) avaluar els afectes clínics de la rehabilitació mitjançant les ICC en pacients amb ictus, ja sigui realitzant un meta-anàlisi dels estudis publicats o avaluant els canvis funcionals dels pacients amb ictus després de la teràpia d’ICC; (2) explorar paràmetres alternatius per quantificar els efectes de les ICC en pacients amb ictus, avaluant diferents biomarcadors de l’EEG en pacients amb aquesta patologia i correlacionant aquests marcadors amb els resultats de les escales funcionals; (3) optimitzar el sistema ICC mitjançant la gamificació d’un avatar.El término Interfaz Cerebro-Computadora (ICC) surgió en los años 70 por el Dr. Jacques J. Vidal, que mediante el uso de la electroencefalografía (EEG) trató de dar una salida alternativa a las señales del cerebro para controlar un dispositivo externo. El objetivo principal de esta hazaña era ayudar a los pacientes con problemas de movimiento o comunicación a relacionarse con el entorno. Desde entonces, muchos neurocientíficos han utilizado esta idea y han tratado de ponerla en práctica utilizando diferentes métodos de adquisición y procesamiento de señales, nuevos dispositivos de interacción y nuevas metas y objetivos. Todo ello ha facilitado la aplicación de esta tecnología en muchas áreas y actualmente las ICC se utilizan para jugar a videojuegos, mover sillas de ruedas, facilitar la escritura en personas sin movilidad, establecer criterios y preferencias de compra en el mundo del comercio y el consumo, o incluso pueden servir como detector de mentiras. Sin embargo, el sector que presenta un mayor avance y desarrollo de las ICC es el sector biomédico. A grandes rasgos podemos utilizar las ICC con dos finalidades distintas dentro de la neurorehabilitación; sustituir una función perdida o inducir cambios en la plasticidad neuronal con el objetivo de restaurar o compensar dicha función perdida. Hay diferentes principios para el registro de las señales del cerebro; de forma invasiva, colocando los electrodos de registro dentro de la cavidad craneal, o no invasiva, colocando los electrodos de registro fuera de la cavidad craneal. El método más conocido y difundido es la EEG. Su uso es adecuado para entornos clínicos, tiene una resolución temporal muy precisa y su retroalimentación en tiempo real puede inducir la plasticidad cortical y el restablecimiento de la función motora normal. En esta tesis presentamos tres objetivos diferentes: (1) evaluar los efectos clínicos de la rehabilitación mediante las ICC en pacientes con ictus, ya sea realizando un meta-análisis de los estudios publicados o evaluando los cambios funcionales en los pacientes con ictus después de la terapia de ICC; (2) explorar parámetros alternativos para cuantificar los efectos de las ICC en pacientes con ictus, evaluando diferentes biomarcadores de electroencefalografía en pacientes con esta patología y correlacionando los posibles cambios en estos parámetros con los resultados en las escalas funcionales; (3) optimizar el sistema ICC utilizando mediante la gamificación de un avatar.
The term Brain Computer Interface (BCI) emerged in the 70's by Dr. Jacques J Vidal, who by using electroencephalography (EEG) tried to give an alternative output to the brain signals in order to control an external device. The main objective of this feat was to help patients with impaired movement or communication to relate themselves to the environment. Since then many neuroscientists have used this idea and have tried to implement it using different methods of signal acquisition and processing, new interaction devices, new goals and objectives. All this has facilitated the implementation of this technology in many areas and currently BCI is used to play video games, move wheelchairs, facilitate writing in people without mobility, establish criteria and purchase preferences in the world of marketing and consumption, or even serve as a lie detector. However, the sector that presents the most marked progress and development of BCI is the biomedical sector. In rough outlines we can use BCI with two different purposes within the neurorehabilitation; to substitute a lost function or to induce neural plasticity changes with the aim to restore or compensate the lost function. To restore a lost function by inducing neuroplastic changes in the brain is undoubtedly a challenging strategy but a feasible goal through BCI technology. This type of intervention requires that the patient invests time and effort in a therapy based on the practice of motor image and feedback mechanisms in real time. There are different principles to record the brain signals; invasively, placing the recording electrodes inside the cranial cavity, or non-invasive, placing the recording electrodes outside of the cranial cavity. The best known and most widespread one is EEG, since they are suitable for clinical environments, have a highly accurate temporal resolution and their real-time feedback can induce cortical plasticity and the restoration of normal motor function. On this thesis we present three different objectives: (1) to evaluate the clinical effects of rehabilitation based on BCI system in stroke patients, either by performing a meta-analysis of published studies or by evaluating functional changes in stroke patients after BCI training; (2) to explore alternative parameters to quantify effects of BCI in stroke patients, by evaluating different electroencephalography biomarkers in stroke patients and correlating potential changes in these parameters with functional scales; (3) to optimize the BCI system by using a new gamified avatar.
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Powell, Trevor J. "Working with people with acquired brain injury." Thesis, University of Surrey, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.298039.
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Pancaroglu, Raika. "Eye region processing : insights from acquired prosopagnosia." Thesis, University of British Columbia, 2014. http://hdl.handle.net/2429/49942.
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Face processing models propose a holistic representation of faces in the human brain.
Additionally, behavioral studies in healthy individuals indicate a bias towards the eye region of faces, namely a Feature Salience Hierarchy. The exact mechanisms of this feature salience hierarchy are not known. Using behavioral face perception and neuroimaging experiments, we investigated the perceptual mechanisms and the neural correlates of the feature salience hierarchy, and the correlations of the human perceptual performance with the neural signal. Prosopagnosia studies also indicate an asymmetrical loss of the ability to deduce information from the eye region of faces. In a cohort of ten acquired prosopagnosia patients, we investigated and characterized the relationship between the structural brain damage and the behavioral face processing impairments. This dissertation examines the perceptual and neuroanatomical bases of the bias towards the eye region of a face in healthy individuals and the deviation from this bias in relation to the brain lesion locations in acquired prosopagnosia patients. Our findings confirm the dominance of the eyes in feature salience hierarchy in an adaptation aftereffects experiment. Investigation of the neuroanatomical correlates of the feature salience hierarchy shows that the activation pattern in Fusiform Face Area (FFA) correlates with the human perceptual performance, suggesting FFA’s involvement in the feature salience hierarchy demonstrated for the eye region of faces behaviorally. Examination of the eye region processing in prosopagnosia patients shows that both apperceptive and associative variants of prosopagnosia can cause eye region processing deficits, yet apperceptive prosopagnosia patients with inferior occipitotemporal cortex lesions have significantly more severe deficits in eye region processing. Face scanning patterns in a learning and memory task with unlimited viewing times demonstrate that both healthy and prosopagnosic individuals spend more time looking at the upper halves of faces while learning the faces, yet prosopagnosia patients spend significantly longer durations studying the faces. Our investigation of memory for half faces indicate that when presented in isolation, the upper and lower face halves do not have different contributions to face memory in healthy subjects. Prosopagnosia patients are similarly impaired in memory for upper and lower face halves.Medicine, Faculty of
Graduate
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May, Michelle. "Socio-emotional behaviour following acquired brain injury." Thesis, University of Edinburgh, 2014. http://hdl.handle.net/1842/16445.
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Introduction: Socio-emotional behaviour difficulties following acquired brain injury (ABI) have been shown to have a persisting negative effect on quality of life. A systematic review was carried out to look at the efficacy and clinical effectiveness of available psychological treatments for socio-emotional behaviour difficulties following ABI. Research was carried out to further understand socio-emotional behaviour by exploring the possible underlying cognitive aspects (specifically social cognition) in a traumatic brain injury (TBI) population. The study investigated the relationship between social cognition and socio-emotional behaviour post-TBI. Method: A systematic search of articles published between January 2008 and November 2013 was carried out following the Cochrane (2008) guidelines. Papers were quality assessed to identify strengths and weaknesses. In the research study, forty TBI participants were asked to complete tasks of emotion recognition, theory of mind, cognitive flexibility, processing speed, attention and working memory. Selfrated and proxy-rated behaviour questionnaires were also administered. Results: The systematic review revealed seven studies for inclusion; three papers looked at a Comprehensive Holistic Approach, two papers on Cognitive Behavioural Therapy, and two on Cognitive Rehabilitation Therapy. The findings suggested that CHA showed the best efficacy and generalization. However, there were also positive results within the CBT studies. The research paper found that the TBI group performed significantly poorer than the control group on measures of emotion recognition and three out of the four ToM tasks. The TBI group also performed significantly poorer on measures of processing speed and working memory (executive function). There was no association found between performance on any of the cognitive tests and socio-emotional behaviour. Conclusions: This is an area of limited research, likely due to the challenges of carrying out research in an ABI population. The systematic review highlighted the limited research available which has implications in clinical practice due to a lack of evidence base for potentially effective interventions. The research study results suggest that there is still a lack of understanding of socio-emotional behaviour and its underlying cognitive functioning. Further research would improve understanding and could also focus appropriate post-ABI interventions for socio-emotional behaviour problems.
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Ho, Tip-yin, and 何蝶燕. "Community-acquired pneumonia in elderly requiring hospitalization." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31971787.
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Scott, Eileen Margaret. "Hospital acquired pressure sores in surgical patients." Thesis, Teesside University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.417233.
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Coote, Peter John. "Mechanisms of acquired thermotolerance in Saccharomyces cerevisiae." Thesis, University of Nottingham, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335420.
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Chagger, Pabhinder Singh. "Stigma, nurses and acquired immune deficiency syndrome." Thesis, University of Southampton, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.242496.
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Brennan, Andrew. "Coping and adjustment following acquired brain injury." Thesis, University of Birmingham, 2002. http://etheses.bham.ac.uk//id/eprint/637/.
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Volume I of this thesis addresses the adjustment of individuals who have sustained acquired brain injuries. To date there has been a only a thin evidence base for the aetiological factors involved in people's emotional reactivity following what is a profound and potentially devastating life changing event. The first paper critically reviews the concept of 'coping' following an acquired brain injury. This draws on two main bodies of literature. First, Kurt Goldstein's 'organismic theory' and, in particular, the catastrophic reaction model is examined from its phenomenological and existential perspective on adjustment to acquired brain injury. Contemporary developments of the catastrophic reaction model have also been considered. Second, applications of Lazarus and Folkman's stress-appraisal and coping theory to adjustment following injury is reviewed for its more empirically based propositions. A comparison and contrast between the two theories is made. The second paper is a full length research report exploring the subjective nature and frequencies of threat appraisals, and related avoidance coping, reported by people with traumatic brain injury. This goes on to explore the relation of these threat-appraisals, and avoidance coping, to adjustment factors of anxiety, depression and quality of life.
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Lefevre, Thierry. "Segmentation of irises acquired in degraded conditions." Thesis, Evry, Institut national des télécommunications, 2013. http://www.theses.fr/2013TELE0005/document.
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Les performances des systèmes de reconnaissances basés sur l'iris sont très négativement affectées par les relâchements des contraintes lors de l'acquisition des images (sujet mobile ou faiblement coopératif, image acquise loin du capteur…). L’objectif de cette thèse est de proposer une amélioration des algorithmes de segmentation traditionnels afin de pouvoir travailler dans de telles conditions. Nous avons identifié et traité quarte modules qui permettent de limiter l'impact des dégradations des images sur les performances du système de reconnaissance global : • Une localisation précise et robuste de la pupille dans l'image l'œil. Pour cela, nous avons développé une méthode qui supprime les cils et les sourcils de l'image pour faciliter la détection de la pupille. • Une segmentation précise de la texture de l'iris dans l'image. Nous avons étudié plusieurs méthodes de la littérature des Contours Actifs et comparé l'impact de ces méthodes sur les performances de reconnaissances du système complet. • Une estimation précise et robuste des contours anatomique de l'iris indépendamment des occlusions dans l'image. Pour cela, nous avons dérivé les équations des Contours Actifs explicitement pour des cercles et des ellipses. Nous avons par ailleurs proposé une méthodologie efficace pour rendre la détection moins sensible aux minimas locaux. • Une méthode de détection des erreurs de segmentation. Il est en effet important de pouvoir avertir le système de reconnaissance global qu'une erreur s’est produite. Pour cela nous avons développé plusieurs critères d'évaluation de la qualité de segmentation. Nous avons ensuite fusionnés ces mesures en utilisant un algorithme de type <> (SVR) pour former une mesure de qualité globale évaluant la qualité de la segmentationThis thesis is focused on the development of robust segmentation algorithms for iris recognition systems working in degraded acquisition conditions. In controlled acquisition scenarios, iris segmentation is well handled by simple segmentation schemes, which modeled the iris borders by circles and assumed that the iris can only be occluded by eyelids. However, such simple models tend to fail when the iris is strongly occluded or off-angle, or when the iris borders are not sharp enough. In this thesis, we propose a complete segmentation system working efficiently despite the above-mentioned degradations of the input data. After a study of the recent state of the art in iris recognition, we identified four key issues that an iris segmentation system should handle when being confronted to images of poor quality, leading this way to four key modules for the complete system: • The system should be able locate the pupil in the image in order to initialize more complex algorithms. To address this problem, we propose an original and effective way to first segment dark elements in the image that can lead to mistakes of the pupil localization process. This rough segmentation detects high frequency areas of the image and then the system uses the pupil homogeneity as a criterion to identify the pupil area among other dark regions of the image. • Accurate segmentation of the iris texture in the eye image is a core task of iris segmentation systems. We propose to segment the iris texture by Active Contours because they meet both the requirement in robustness and accuracy required to perform segmentation on large databases of degraded images. We studied several Active Contours that varies in speed, robustness, accuracy and in the features they use to model the iris region. We make a comparative evaluation of the algorithms’ influence on the system performance. • A complete segmentation system must also accurately estimate the iris shape in occluded regions, in order to format the iris texture for recognition. We propose a robust and accurate scheme based on a variational formulation to fit an elliptic model on the iris borders. We explicitly derive evolution equations for ellipses using the Active Contours formalism. We also propose an effective way to limit the sensitivity of this process to initial conditions. This part of our work is currently under review for final acceptance in the international journal Computer Vision and Image Understanding (CVIU). • Finally, we address the main issue of automatic detection of segmentation failures of the system. Few works in the literature address measuring the quality of a segmentation algorithm, critical task for an operational system. We propose in this thesis a set of novel quality measures for segmentation and show a correlation between each of them with the intrinsic recognition performance of the segmented images. We perform fusion of the individual quality measures via a Support Vector Regression (SVR) algorithm, in order to propose a more robust global segmentation quality score
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McFaline-Figueroa, José L. "Mechanism of acquired temozolomide resistance in glioblastoma." Thesis, Massachusetts Institute of Technology, 2014. http://hdl.handle.net/1721.1/89944.
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Thesis: Ph. D., Massachusetts Institute of Technology, Department of Biology, 2014.Cataloged from PDF version of thesis.
Includes bibliographical references.
Glioblastoma (GBM) is the most common and malignant form of brain cancer. After aggressive treatment, therapy resistant tumors inevitably recur. However, the molecular mechanisms underlying such resistance remain unclear. We isolated GBM cells resistant to temozolomide (TMZ), the frontline chemotherapy agent for GBM, and observed modest decreases in the mismatch repair (MMR) components MSH2 and MSH6. The modest decrease in MSH2, and relatively modest decrease in MSH6, did not seem sufficient to account for the very large increase in TMZ resistance. However, shRNA-mediated modulation of MSH2 and MSH6 levels in vitro confirmed that such decreases in MSH2 and MSH6 provide a potent mechanism for TMZ resistance. We demonstrate in an in vivo GBM mouse model that minor changes in MSH2 suppress TMZ-induced tumor regression, and moreover, show that even minor decreases in MSH2 transcript levels correlate with decreased survival in TMZ treated GBM patients. These modest changes in MMR are unlikely to alter classical markers of MMR deficiency, namely microsatellite instability and a mutator phenotype. Our results suggest that the involvement of MMR deregulation in mediating TMZ resistance is likely to be much more prevalent than previously appreciated. Additionally, we have employed phosphoproteomic network analysis to identify changes at the signaling network level that accompany the acquisition of TMZ resistance. Through mathematical and computational approaches, we identified changes that suggest increased PDGFR and integrin/FAK1 signaling in response to repeated TMZ exposure. Additionally, kinase motif analysis identified widespread alterations in phosphorylation of peptides containing motifs associated with the CDK/MAPK kinase family. Currently, we are applying molecular biology techniques to investigate the effects of these altered cellular signals on MMR activity and the sensitivity of GBM cells to TMZ.
by José L. McFaline-Figueroa.
Ph. D.
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Hellal, Paula Joanne. "Acquired childhood aphasia : historical and theoretical perspectives." Thesis, Birkbeck (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.413628.
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The traditional concept of Acquired Childhood Aphasia (AeA) has been derived from a limited number of late 19th century cases. The concept can be summarised as: a) Language comprehension is preserved relative to expression. b) Recovery is swift and complete. c) ACA is found after right as well as left cerebral lesions. This traditional concept has been contested by late 20th century reports of sensory aphasia, auditory comprehension deficits and poor prognosis in childhood. It now seems less certain that the clinical description of ACA is as homogeneous as first thought. Reconsideration of the early modern period of neuroscientific research typically considers work carried out on the Continent. This study critically examines clinical research carried out in England to determine whether the traditional concept of ACA is accurately reflected in 19th century British medical opinion. The study reviews cases of AeA drawn from the archives of Great Ormond Street Hospital (GOSH) covering the period 1860-1900. These cases illustrate the characterisation of language difficulties in various modalities and reflect assumptions regarding development and organisation of mental faculties. They also reveal information about which variables were considered significant. The etiology and prognosis of these ACA cases together with possible variables such as the child's age and gender are discussed in the light of contemporaneous medical opinion. Comparison of archived casenotes with cases published in English medical journals reveals biases in the evidence selected to serve as the basis for the standard view of presentation, recovery and pathology of ACA. The study concludes that, from the English language literature, there is little evidence to support the traditional concept of AeA. Cases of aphasic children presenting with adult-like long term language impairment (including comprehension deficits) appear both in the archived and published papers from this period, while few cases of ACA following right cerebral lesions are to be found.
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Murphy, Maggie M. "Impaired self-awareness following acquired brain injury." Thesis, Oxford Brookes University, 2005. https://radar.brookes.ac.uk/radar/items/113cb7c4-9ee0-4481-a0a2-65afa5ccafd6/1/.
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Impaired self-awareness of everyday task ability following acquired brain injury (ABI) presents a serious obstacle to progress in rehabilitation. However, there is a lack of consensus about the optimal method of determining awareness level, how best to increase awareness, and even with regard to the very nature of impaired awareness. Awareness level is usually ascertained by comparing self/third party ratings of task performance. A behavioural measure of task performance would circumvent some of the concerns regarding the validity of methods relying solely on verbal report. Three main research questions were identified: 1. Is it possible to measure self-awareness of activity limitation and impairment? 2. Is it possible to increase self-awareness of activity limitation and impairment? 3. What is the nature of impaired awareness of activity limitation and impairment? To address these questions, the research programme had four phases: In phase 1, a cross-sectional design was used, incorporating behavioural observation and quantitative questionnaires, to develop a task battery that could be used as a behavioural measure of self-awareness. The resultant task battery consisted of six everyday tasks. In phase 2, a group comparison design was used to establish the sensitivity of the task battery to impaired self-awareness. Questionnaires were administered to obtain a quantitative measure of awareness - including social skills - in the acquired brain injury (ABI) participants. Eighteen ABI participants, identified as having impaired self-awareness, were compared with three comparison groups. The task battery was found to be sensitive to impaired awareness of everyday task ability. In phase 3, a single-case, experimental design methodology was attempted in two ABI participants to determine the effectiveness of interventions designed to increase awareness. Four ABI participants were followed up longitudinally, as natural history case studies, to ascertain changes in awareness over time, and critical incidents contributing to change. The intervention programmes were not found to be effective. Phase 4 included two qualitative studies to explore the nature of impaired awareness. In study 1, interview scripts from thirty-six clinicians were analysed thematically. In study 2, interview data from phase 3 were re-examined to explore 'objects' of awareness and factors contributing to fluctuations in awareness. Both phase 4 studies indicated that manifestations of impaired self-awareness were very varied in terms of 'objects' of awareness, severity of the awareness impairment, and the number of factors contributing. Impaired self-awareness is complex in nature, necessitating repeated measures, of verbal report and behaviour within variolls functional domains, to determine awareness level. Detailed examination of further single cases could help identify profiles of impaired self-awareness for which specific interventions and explanatory models could be developed. It is argued that intervention to address impaired selfawareness within the social skills domain should be prioritised.
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Hocking, Sian Elin. "Parental adjustment in paediatric acquired brain injury." Thesis, University of Exeter, 2015. http://hdl.handle.net/10871/18329.
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Paediatric acquired brain injury (pABI) can lead to an array of long term physical, cognitive, emotional, and behavioural difficulties. Due to the long-term sequelae of more severe pABI, it presents a significant challenge to the child’s family. Studies have suggested that social support can positively impact psychological adjustment following a stressful life event, and can aid personal resilience. There remains limited qualitative investigation of subjective family and parental adjustment experiences following pABI. Researchers have argued for future research that include the experiences of parents who have children younger than 16 years old, and are able to shed light on the individual experiential journey of parents. The current study used interpretative phenomenological analysis (IPA) to explore to the experiences of adjustment and social support of parents of children with pABI. Purposive sampling was used to recruit 10 participants who were individually interviewed. Five superordinate themes emerging from the data were identified: 1) Lives changed forever, 2) Sense of self, 3) Interaction with services, 4) The psychological experience, 5) Coping and adjustment. Relevant literature and implications for future research and clinical practice are discussed.
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Tyerman, Emma. "Family experience after paediatric acquired brain injury." Thesis, Lancaster University, 2015. http://eprints.lancs.ac.uk/76531/.
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This thesis explores family experiences after paediatric Acquired Brain Injury (ABI). ABI can result in physical, cognitive and psychological difficulties (Royal College of Physicians& British Society of Rehabilitation Medicine, 2003). Given its wide-ranging impact, ABI is likely to have an effect on the family. However, there is limited qualitative research exploring the lived experiences of siblings of children with ABI, and none that focuses specifically on sibling relationships. There is more research exploring parents’ experience of this same phenomenon but a lack of synthesis of this knowledge. My thesis seeks to address this gap by conducting a systematic review of parents’ experiences and qualitative research on sibling experience. In the literature review, I systematically searched three databases and identified fourteen qualitative papers that met the inclusion criteria. These were synthesised in line with Noblit and Hare’s (1988) guidelines. Three themes emerged, representing the challenges that parents experience with a child with ABI: (1) Disconnection: Cut off from internal emotions and isolated from society; (2) Seeking understanding and support to manage in an insecure world; (3) New parent to a different child. In the research project, I used semi-structured interviews with five siblings (aged between 9-12) and Interpretative Phenomenological Analysis to understand their experience of the sibling relationship after ABI. This resulted in four themes: (1)Coping with “a nightmare that you live”; (2)Disconnection from family relationships; (3)My sibling is different but “still the same underneath all this thing”; and (4)Changing togetherness. These themes showed high levels of distress alongside attempts to adjust to a changed sibling and sibling relationship. In the third section of this thesis, I critically appraise the above papers and consider strengths and weakness, challenges and recommendations for future research. I hope that this paper will inform future researchers interviewing children, particularly within ABI.
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Niemeyer, Marcus. "NKT cells between innate and acquired immunity." Doctoral thesis, Humboldt-Universität zu Berlin, Mathematisch-Naturwissenschaftliche Fakultät I, 2005. http://dx.doi.org/10.18452/15330.
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Die Funktion und Spezifität von Natürlichen-Killer-T-Zellen (NKT) in angeborener und erworbener Immunität ist nicht vollständig geklärt. Die Mehrheit der NKT-Zellen erkennt alpha-galactosylceramid (alphaGalCer), ein Lipid eines marinen Schwamms mit ungeklärter Relevanz. Verschiedene mykobakterielle Lipide wurden isoliert und auf ihre CD1d-Bindung und NKT-Zell-Aktivierung untersucht. Phospatidylinositol-mannosid (PIM) von Mycobacterium bovis BCG konnte als erstes bakterielles NKT-Zell-Antigen identifiziert werden. PIM aktiviert CD1d-abhängig murine und humane NKT-Zellen zur IFN-gamma aber nicht zur IL-4 Produktion. Mehrere andere Lipid-Fraktionen aktivierten ebenfalls NKT-Zellen. Diese Stimulation war entweder eine direkte, T-Zell-Rezeptor (TZR)-vermittelte und/oder indirekte, Toll-like-receptor 2 (TLR2) vermittelte Aktivierung. Iso-globotrihexosylceramide (iGb3) wurde als das endogene NKT-Zell-Antigen beschrieben. IGb3 ist ubiquitär in Lysosomen vorhanden. Dies wirft die Frage nach der Regulation der Antigen-Verfügkarkeit und der Kontrolle der NKT-Zell-Aktivierung auf. Es konnte gezeigt werden dass die Regulation der Antigen-Verfügbarkeit essentiell für die Regulation der NKT-Zell-Aktivität ist. Unkontrolliertes Auftreten und erhöhte Konzentration von iGb3 führte zu einer substantiellen Reduktion der NKT-Zell-Zahl, vermutlich durch Aktivierungs-induziertem-Zelltod. Mit Hilfe von DNS-Microarray Analysen wurden die Gen-Expressionsprofile von naïven NKT-Zellen und klassischen CD4 T-Zellen, regulatorischen T-Zellen, NK-Zellen und aktivierten NKT-Zellen verglichen. Es konnte sowohl ein NKT-Zell-spezifisches Expressionsmuster etabliert als auch eine gemeinsame Expression von Genen in allen verglichenen Zelltypen identifiziert werden. Naive und aktivierte NKT-Zellen zeigen eine erhöhte Expression von Apoptose-regulierenden Genen welches auf eine starke Selbst-Kontrolle zur präzisen Regulation der eigenen Aktivität hinweist.The function and specificity of Natural Killer T (NKT) cells in innate and acquired immunity still remains elusive. The vast majority of CD1d restricted NKT cells recognise alpha-galactosylceramid (alphaGalCer), derived from a marine sponge, a lipid of unclear physiological significance. Different mycobycterial glycolipids were isolated and examined for binding to CD1d as well as for their capacity of NKT cell stimulation. Phospatidylinositol-mannoside (PIM) derived from Mycobacterium bovis BCG was identified as the first bacterial lipid antigen presented by CD1d. PIM activated both murine and human NKT cells to secrete IFN-gamma but not IL-4 in a CD1d dependent manner. Additionally, several other lipid fractions with NKT cell activation capacities were identified. This activation was either a direct, T-cell-receptor (TCR) mediated and/or an indirect, toll-like-receptor 2 (TLR2) mediated activation. Iso-globotrihexosylceramide (iGb3) was described as the endogenous NKT cell antigen. iGb3 is a ubiquitously present lysosomal glycolipid which raises the question of regulation of antigen availability and NKT cell activation control. It could be shown that regulation of antigen availability plays a crucial role in regulation of NKT cell activation. Moreover, uncontrolled appearance and increased concentrations of the endogenous antigen iGb3 led to substantial decrease in NKT cell number, presumably by activation induced cell death. Using DNA Microarray analysis, the gene expression profiles of naïve NKT cells and classical CD4 T cells, regulatory T cells, NK cells as well as to activated NKT cells were compared. The profiles revealed a NKT cell specific gene expression pattern as well as expression of genes which NKT cells share with NK cells, conventional CD4+ T cells and Treg cells. Both, naïve and activated NKT cells display elevated expression of apoptosis regulating genes providing NKT cells with high degree of self-control to precisely regulate their own activity.
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Lynch, Janet. "THE FINANCIAL PERFORMANCE OF SYSTEM ACQUIRED HOSPITALS." VCU Scholars Compass, 1988. https://scholarscompass.vcu.edu/etd/5224.
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This study investigated the financial performance of not-for-profit hospitals in 10 Southern states acquired by either the for-profit or not-for-profit multihospital systems between the years 1978 through 1982. The impact of system affiliation on acquired hospitals was investigated by looking at average financial performance from the two years before acquisition to 1984/1985. Differences between the performance of hospitals acquired by for-profit and not-for-profit multihospital systems were examined as well. with regard to the latter, major findings revealed both for-profit and not-for-profit multihospital systems increased debt in acquired hospitals and made improvements to plant and equipment. For-profit multihospital systems additionally increased profitability and appeared to operate their acquisitions in a more business-like fashion than the not-for-profit multihospital systems did. Comparing acquired hospitals with matched independents revealed that both for-profit and not-for-profit multihospital facilities used more debt and had newer plant and equipment than the not-for-profit independents did. Multihospital systems decreased liquidity in acquisitions as compared with independent not-for-profit hospitals. Only for-profit multihospital system facilities showed increased profitability, and this was largely due to higher prices. Little or no improvement in efficiency was observed in either for-profit or not-for-profit multi hospital system hospitals; however, the financial indicators used to measure efficiency proved to be problematic.
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Lamorgese, Michael. "Early Recognition and Treatment of Acquired Pneumonia." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5741.
Full textAbstract:
Sepsis is a life-threatening organ dysfunction disease process that costs the healthcare system millions of dollars each year. By using existing assets, the number of patients admitted to the hospital suffering from sepsis secondary to community-acquired pneumonia can be reduced. The purpose of this project was to improve and expand the scope of practice of the registered nurse working in a private medical office to initiate treatment for suspected CAP using evidence-based practice. Data from the last quarter of 2017 and the first quarter of 2018 were compared. The purpose of comparing these data sets was to examine outcomes of patients who received empirical treatment for CAP using both the complaint-specific protocol (CSP) and algorithm to see if these patients had lower rates of hospitalization than those who received the standard treatment. None of the patients who were treated using the CSP and algorithm were admitted to the hospital. Two patients were diagnosed with CAP before the implementation of the CSP and algorithm in the last quarter of 2017. The implications for social change resulting from the project are expansion of the scope of practice of the RN to work collaboratively with the physician in empirically treating CAP in the patients at the clinic to prevent hospitalization for pneumonia.
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Birmingham, Robert B. "Intellectual property rights in software acquired by DoD." Thesis, Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 1995. http://handle.dtic.mil/100.2/ADA305992.
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Ruhe, Jakob, and Johan Nordin. "Classification of Points Acquired by Airborne Laser Systems." Thesis, Linköping University, Department of Electrical Engineering, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-10485.
Full textAbstract:
During several years research has been performed at the Department of Laser Systems, the Swedish Defense Research Agency (FOI), to develop methods to produce high resolution 3D environment models based on data acquired with airborne laser systems. The 3D models are used for several purposes, both military and civilian applications, for example mission planning, crisis management analysis and planning of infrastructure.
We have implemented a new format to store laser point data. Instead of storing rasterized images of the data this new format stores the original location of each point. We have also implemented a new method to detect outliers, methods to estimate the ground surface and also to divide the remaining data into two classes: buildings and vegetation.
It is also shown that it is possible to get more accurate results by analyzing the points directly instead of only using rasterized images and image processing algorithms. We show that these methods can be implemented without increasing the computational complexity.
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Hagberg-van't, Hooft Ingrid. "Cognitive rehabilitation in children with acquired brain injuries /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-380-9/.
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Smith, Michelle Adrienne. "The transaction financing decision, overinvestment, and acquired goodwill /." Title page, contents and abstract only, 1996. http://web4.library.adelaide.edu.au/theses/09C/09cs655.pdf.
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Jassem, Agatha Natalie. "Aminoglycoside susceptibility and acquired resistance in Burkholderia vietnamiensis." Thesis, University of British Columbia, 2012. http://hdl.handle.net/2429/42154.
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Pernhorst, Katharina [Verfasser]. "Molecular genetic analyses in acquired epilepsies / Katharina Pernhorst." Bonn : Universitäts- und Landesbibliothek Bonn, 2014. http://d-nb.info/1047622750/34.
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Carapeti, Melina. "Identification of acquired genetic changes in acute leukaemia." Thesis, Imperial College London, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287882.
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Bewick, Thomas. "Improving outcomes in patients with community-acquired pneumonia." Thesis, University of Nottingham, 2012. http://eprints.nottingham.ac.uk/12432/.
Full textAbstract:
Community-acquired pneumonia (CAP) is a leading cause of adult morbidity and mortality worldwide despite decades of effective antibiotics and vaccination initiatives. There have been no recent significant improvements in outcomes, including 30-day mortality. The bacterium Streptococcus pneumoniae is the most prevalent causative pathogen in CAP, being found in up to half of cases. In September 2006 a childhood pneumococcal vaccine (PCV-7) was introduced, leading to reductions in vaccine-type (VT) pneumococcal disease in infants, with possible additional benefits reported in adults. However, the effect that infant PCV-7 vaccination has on adult disease has to date been inadequately described in a small fraction of patients with invasive CAP, almost exclusively in populations in the US. These issues are explored fully in the literature review, encompassing chapters 1, 2 and 3. New strategies for CAP are therefore required. The outcome of CAP can be improved by a) preventing the disease by vaccination and herd immunity, and b) ameliorating the course of the disease after it has been acquired. This thesis presents a collection of studies that aim to acquire observational data to investigate these two issues. The majority of the included studies are drawn from a two year prospective cohort study of consecutive adults with CAP admitted to a large UK teaching hospital trust between September 2008 and September 2010. After obtaining informed consent, the presence of pneumococcal disease in each participant was established by testing urine samples for pneumococcal capsular polysaccharide, a test which has a high sensitivity and specificity. The urine samples were subsequently tested for pneumococcal serotype. A full record of care processes, investigations, and clinical outcomes was made, and child contact in the month preceding admission was assessed. These methods are described more fully in chapter 4. Chapter 5 presents the data on the pneumococcal serotypes found in the cohort over a two year period, and links them to epidemiological characteristics in the study population. The most prevalent serotypes were 14, 1, 8, 3 and 19A, with VT serotypes less frequent in the second year of the study. Chapter 6 examines the association that infecting serotype has with disease manifestation and patient characteristics. Infection with a serotype not contained within PCV-7 (NVT) was associated with younger and fitter patients, a higher rate of complications such as para-pneumonic effusion, and hypotension at admission. The effect of child contact on pneumococcal disease is reported in chapter 7. Prior contact with a child aged ≤8 years was particularly associated with pneumococcal aetiology, and contact with a PCV-7 vaccinated child independently associated with NVT CAP. The findings from these three chapters are unique in that they relate individual pneumococcal serotype to specific clinical disease patterns, epidemiology and transmission in both invasive and non-invasive pneumococcal CAP for the first time. They show a change in serotype distribution in adults following the introduction of PCV-7 in infants, which is important to inform future vaccine development for both adults and children. Furthermore, different serotypes are associated with different clinical disease patterns, which may have a significant impact on the disease that clinicians see at the “front door” given that the serotype distribution of pneumococcal CAP may be changing. Finally, the link between child vaccination and adult disease provides more direct evidence for the transmission of pneumococci from children to adults as a mechanism for the development of CAP in adults. The second part of this thesis looks at current care processes, and how these might be improved. Chapters 8, 9 and 10 relate to efforts to better predict prognosis, and chapters 11 and 12 with how patents with CAP may be better managed at the “front door”. Symptoms are clearly important to patients, but the role of symptoms in management and outcome is unclear. Chapter 8 presents a study validating a symptom score that has not yet entered routine use, but which is shown to correlate with clinical outcomes, and may be useful in assessing outcome in low severity CAP. The influence that oxygenation status at admission has on outcome is poorly understood. Chapter 9 describes a study showing that whilst hypoxaemia does positively predict adverse outcome, it is not as predictive as existing severity scores. The presence of hypoxaemia may however identify a subset of patients who are classified as low severity by existing severity scoring, but are nevertheless at increased risk of adverse outcome. Severity scoring is the cornerstone of management in adult CAP, and is explored in chapter 10. Current severity scores adequately predict mortality in CAP, but often generate a group of “moderate severity” where appropriate management is often unclear. This study looked at the effect of pre-admission functional status on outcome in conjunction with existing severity scores in this difficult group, and validated a novel severity score for predicting need for escalation of care, SMART-COP. Incorporation of functional status does marginally improve the performance of existing severity scores, but may be of more use as a post-severity score test to identify sub-groups of patients with moderate severity CAP who are at increased risk of death. Chapter 11 looks at the influence that making a prompt diagnosis (rather than prompt treatment with antibiotics, as has previously been studied) has on outcome, using the time between admission and first chest radiograph as a surrogate measure. Whilst an early chest radiograph was not associated with an improvement in mortality, it was associated with a shorter length of hospital stay, and may therefore be regarded as a marker of good quality care. There is current debate as to the role of the speciality physician in the front-door early assessment of patients, and whether early review of patients with CAP may improve outcome compared with management by a non-specialty physician. Chapter 12 looks at the effect that early specialist senior respiratory review has on outcome for adults with CAP, showing a clear benefit on length of hospital stay to early consultant review. In conclusion, this thesis provides an up-to-date picture of the circulating pneumococcal serotypes in non-invasive adult CAP, and correlates infecting serotype to clinical and epidemiological parameters. It also identifies five areas of clinical care where management processes could be improved. By addressing of these aspects the outcome of CAP may be improved in the future.
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Sato, Hitomi. "Acquired dyslexia in Japanese : implications for reading theory." Thesis, University College London (University of London), 2007. http://discovery.ucl.ac.uk/1334689/.
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Acquired dyslexia research has been conducted mainly on English neurological patients. A limited number of dyslexia studies on non-alphabetic orthographies are available. Classical case studies for acquired dyslexia in Japanese, which has two distinctive scripts (morphographic Kanji and phonographic Kana), reported 'script-dependent' dyslexia patterns. Although recent case studies showed 'script-independent' dyslexia patterns for surface and phonological dyslexia, a 'script-independent' deep dyslexia pattern in Japanese has not yet been reported. This study examined four Japanese aphasic patients, using psycholinguistically well-manipulated reading stimuli for both Kanji and Kana strings. YT, with phonological impairment, demonstrated the same effects of psycholinguistic variables as observed in English deep dyslexia, but semantic errors rarely occurred in Kana word reading. YT's concomitant deep dyslexia for Kanji, and phonological dyslexia for Kana fit the phonological impairment hypothesis, and this can be treated as a unique characteristic of Japanese deep dyslexia. HW, with semantic impairment, demonstrated a 'script-independent' surface dyslexia pattern. SO, with severe semantic impairment, demonstrated a surface dyslexia pattern in Kanji word reading, but showed substantial difficulty with Kanji nonword reading. ME, with phonological impairment and a visuo-spatial deficit, showed both lexicality and length effects on reading aloud Kana strings, thus suggesting phonological dyslexia for Kana. That is, the double dissociation between Kanji and Kana nonword reading was observed in SO and ME. These results suggest that Japanese acquired dyslexia patterns are not dependent on script-type, but are also not totally independent of script-type. These outcomes of this study are discussed in terms of universality and orthographic-specificity in acquired dyslexia. Moreover, possible workings of the Japanese version of the DRC model (Coltheart et al., 2001) and the triangle model Plaut, et al., 1996; Harm & Seidenberg, 2004) are presented in order to explain acquired dyslexia patterns in Japanese.