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1
Lee, Chung-won. "Non-Clinical Risk Factors of Hysterectomy." DigitalCommons@USU, 2001. https://digitalcommons.usu.edu/etd/4336.
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In the United States, hysterectomy is one of the most commonly performed operations for women that is not related with pregnancy. However, not enough attention has been paid to how women's exposure to the surgery differs according to their social characteristics as well attitudinal/behavioral factors. Using cohort data from the National Longitudinal Surveys of Mature Women, this study investigated two aspects: (1) the association between socioeconomic status and hysterectomy and (2) the impact of women's attitudinal/behavioral characteristics on hysterectomy. With Cox proportional hazards analyses, this study found that women's exposure to hysterectomy significantly differs according to their social and attitudinal standings. Social characteristics that were found to be statistically significant risk factors of hysterectomy include women's eduction, employment status, and marital status. Among additional and behavioral factors, women's locus of control and number of children were identified as statistically significant risk factors. These findings may be used to enhance consumer awareness of hysterectomy and aid in policy reconstruction.
2
Chronopoulos, Aristeidis. "Clinical presentation and risk factors of osteoradionecrosis." Diss., Ludwig-Maximilians-Universität München, 2015. http://nbn-resolving.de/urn:nbn:de:bvb:19-180892.
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Introduction: Osteoradionecrosis (ORN) of the jaws is defined as exposed irradiated bone that fails to heal over a period of 3 months without the evidence of a persisting or recurrent tumor. In the previous decades, numerous factors were associated with the risk of ORN development and severity.
Aims: The purposes of this study were to present the data of the patients that were treated for ORN in the Department of Oral and Maxillofacial Surgery in Munich (LMU), to detect factors that contributed to the onset of ORN, to identify risk factors associated with the severity of ORN and finally, to delineate and correlate these factors with the personal, health and treatment characteristics of the patients.
Material and Methods: A retrospective study was conducted during the period from January 2003 until December 2012 that included all ORN cases having been treated in the Department of Oral and Maxillofacial Surgery in Munich (LMU). The total sample was categorized in three groups according to stage and several variables were evaluated in an attempt to identify possible correlations between them and the necrosis severity.
Results: One hundred and fifty three cases of ORN were documented. Among them, 23 (15.1%) cases were stage I, 31 (20.2%) were stage II and 99 (64.7%) were stage III and all localised in the mandible. There was a predominance of the disease in the posterior region when compared to the anterior region. The majority of cases was addicted to alcohol and tobacco abuse and was suffering from Diabetes Mellitus (DM). All cases were treated with RT and 80.4% of them with concomitant chemotherapy. The initial tumor was predominantly located in the floor of the mouth, the tongue and the pharynx. Αpproximately two thirds of the cases occured either after dental treatment or due to a local pathological condition. Logistic regression analysis identified Diabetes Mellitus (OR: 4.955, 95% Cl: 1.965-12.495), active smoking (OR: 13.542, 95% Cl: 2.085-87.947), excessive alcohol consumption (OR: 5.428, 95% Cl: 1.622-18.171) and dental treatment/ local pathological condition (OR: 0.237, 95% Cl: 0.086-0.655) as significant predictors for stage III necrosis. Tumor size (T) (p<0.001), stage of the tumor (UICC) (p=0.001), concomitant chemotherapy (p<0.001), dental examination and treatment prior to RT (p<0.001) and the different causes of ORN (p=0.03) were statistically significantly associated with the severity of ORN.
Conclusion: The aforementioned factors are predictive of ORN severity and can guide its prophylaxis and management. Based on these findings, prospective studies should be conducted in order to better understand risk factors associated with the development, severity and pathophysiology of ORN and improve treatment strategies for this complication of RT.
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Newrick, P. G. "Clinical and vascular factors in diabetic neuropathy." Thesis, University of Bristol, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.381409.
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Penkal, Jessica Lynn. "Factors Associated with Stalking Victimization." University of Dayton / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=dayton1375232327.
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Gunnard, Katarina. "Risk factors and clinical correlates in eating disorders." Doctoral thesis, Universitat de Barcelona, 2012. http://hdl.handle.net/10803/81472.
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The central scientific objective of the current dissertation was to take a multidisciplinary approach to make use of the full potential information, both scientific and clinical to aid prevention and treatment of EDs. In our studies we assessed a.) social and individual risk factors in EDs (Study 1), b.) empirical ED subtypes based on drive for thinness (DT) and depression (Study 2) and c.) the classification based on these four different empirical ED subtypes without cluster analysis and based on the use of clinical cutoff scores of DT and depression. Finally, we assessed the predictive validity for this subtyping scheme with regard to dropout from CBT in an unselected BN-P population seeking treatment.
Our first line of investigation (Study 1) assessed social and self-standards in EDs. The results of the study suggest that compared to healthy controls, standards for physical appearance, family standards and self-achievements were higher in individuals with EDs, that ED patients show higher self-discrepancy between their personal and social values and confidence to attain them and that the conflict with their significant others over these issues was higher. Furthermore, high social and self-standards was associated with developing an ED, which emphasize the importance of assessing risk factors in ED. Finally we also observed differences in the ED subtypes; physical appearance a greater risk factor in BN and EDNOS while social-other standards were more associated with AN.
The second research area (Study 2 and 3) explored new empirical ED subtypes along DT and depression. In our initial study (Study 2) we found four new ED subtypes through cluster analysis; “DT”, “DT-Depressive”, “mild DT” and “depressive-moderate DT”. This result indicates that dieting and depression are useful for analyzing and identifying ED subtypes.
Study 3 further assessed these empirical subtypes and found that the same subtypes emerged when basing them on scores from clinical well-validated questionnaires and moreover that attrition rates differed between subtypes and that the dropout rate was highest for the “DT-Depressive” subtype. Our findings agree with the growing body of research indicating the importance of dieting and comorbid depression as contributing factors in ED diagnoses. Finally, these findings will hopefully aid in resolving the current controversy surrounding current DSM-ED classifications.El objetivo central de esta tesis ha sido, desde una perspectiva multidisciplinar, integrar los conocimientos clínicos y científicos para contribuir en el avance de la prevención y tratamiento de los Trastornos de la Conducta Alimentaria (TCA). En estos estudios, se han explorado una serie de aspectos como a) factores de riesgo sociales e individuales en los TCA (estudio 1), b) identificación de subtipos empíricos de los TCA, basados en el impulso a la delgadez y la realización de dietas y la depresión (estudio 2), y c) asociación entre los cuatro subtipos de TCA, basados en los factores descritos, y respuesta a un abordaje cognitivo-conductual, en una población con diagnóstico de bulimia nerviosa purgativa (BN-P), que solicitaron tratamiento por su trastorno (estudio 3). Nuestra primera línea de investigación (estudio 1) analizó la implicación de las expectativas sociales e individuales en los TCA. Los resultados de este trabajo sugirieron que las expectativas familiares, individuales y las relacionadas con la apariencia física, eran superiores en pacientes con TCA que en sujetos control. Asimismo, los pacientes con diagnóstico de TCA mostraban mayor discrepancia entre sus valores personales y sociales, menor confianza en poder alcanzarlos y mayor conflicto con sus familiares por estas cuestiones. Por otra parte, la presencia de elevadas expectativas sociales y personales se asociaba al desarrollo de un TCA, lo que enfatizaba la importancia de evaluar estos factores de riesgo. Finalmente, se observaron diferencias significativas entre los subtipos de TCA, siendo la apariencia física un factor de riesgo más presente en BN y en trastornos de la conducta alimentaria no especificados (TCANE), mientras que otras expectativas sociales se asociaban más a la anorexia nerviosa (AN). La segunda línea de investigación (estudios 2 y 3) exploraba nuevos subtipos empíricos de TCA, teniendo en cuenta las variables de impulso a la delgadez y realización de dietas (ID) y la depresión (D). En el primer trabajo (estudio 2), se obtuvieron cuatro nuevos subtipos a través de un análisis de cluster. Los subgrupos fueron “ID”, “IDDepresivo”, “ID moderado” y “D-ID moderado”. Estos resultados mostraban que la realización de dietas y la depresión eran útiles en el análisis e identificación de subtipos en los TCA. En el estudio 3 se exploraban estos subtipos con mayor profundidad, observando que se obtenían los mismos subgrupos, cuando nos basábamos en las puntuaciones de diversos cuestionarios clínicos validados. Asimismo, la respuesta al tratamiento era distinta en función de los subtipos de TCA, presentando tasas de abandonos más elevadas el subtipo “ID-Depresivo”. De este modo, los resultados estaban en concordancia con las evidencias empíricas, cada vez mayores, que indican la importancia de la realización de dietas y la depresión comórbida como factores que contribuyen a explicar características diagnósticas en los TCA. Finalmente, estos hallazgos podrían tener una relevancia destacada en la controversia actual sobre las clasificaciones diagnósticas en el próximo DSM.
L’objectiu central d’aquesta tesi ha estat, des d’una perspectiva multidisciplinar, integrar els coneixements clínics i científics per a contribuir a l’avenç de la prevenció i tractament dels trastorns de la conducta alimentària (TCA). En aquests estudis, s’han explorat una sèrie d’aspectes com a) factors de risc socials i individuals en els TCA (estudi 1), b) identificació de subtipus empírics dels TCA, i c) associació entre els quatre subtipus de TCA, basats en els factors descrits, i resposta a un abordatge cognitivoconductual, en una població amb diagnòstic de bulímia nerviosa purgativa (BN-P), que varen sol•licitar tractament pel seu trastorn (estudi 3). La nostra primera línia de recerca (estudi 1) va analitzar la implicació de les expectatives socials i individuals en els TCA. Els resultats d’aquest treball varen suggerir que les expectatives familiars, individuals i les relacionades amb l’aparença física, eren superiors en pacients amb TCA que en subjectes control. Alhora, els pacients amb diagnòstic de TCA mostraven major discrepància entre els seus valors personals i socials, menor confiança en poder aconseguir-los i major conflicte amb els seus familiars per aquestes qüestions. Per altra banda, la presència d’elevades expectatives socials i personals s’associava al desenvolupament d’un TCA, fet que emfatitzava la importància d’avaluar aquests factors de risc. Finalment, es varen observar diferències significatives entre els subtipus de TCA, sent l’aparença física un factor de risc més present en BN i en trastorns de la conducta alimentària no especificats (TCANE), mentre que altres expectatives socials s’associaven més a l’anorèxia nerviosa (AN). La segona línia de recerca (estudis 2 i 3) explorava nous subtipus empírics de TCA, tenint en compte les variables d’impuls a estar prim i realització de dietes (ID) i la depressió (D). En el primer treball (estudi 2), es varen obtenir quatre nous subtipus a través d’una anàlisi de cluster. Els subgrups foren “ID”, “ID-Depressiu”,“ID moderat” i “D-ID moderat”. Aquests resultants mostraven que la realització de dietes i la depressió eren útils en l’anàlisi i identificació de subtipus en els TCA. En l’estudi 3 s’exploraven aquests subtipus amb major profunditat, observant que s’obtenien els mateixos subgrups, quan ens basàvem en les puntuacions de diversos qüestionaris clínics validats. Alhora, la resposta al tractament era diferent en funció dels subtipus de TCA, presentant taxes d’abandonament més elevades el subtipus “IDDepressiu”. D’aquesta manera, els resultats estaven en concordança amb les evidències empíriques, cada vegada més grans, que indiquen la importància de la realització de dietes i la depressió comòrbida, com a factors que contribueixen a explicar les característiques diagnòstiques en els TCA. Finalment, aquestes troballes podrien tenir una rellevància destacada en la controvèrsia actual sobre les classificacions diagnòstiques en el proper DSM.
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Diederen, Roselie Maria Helena. "Biochemical and clinical factors in rhegmatogenous retinal detachment." [Maastricht : Maastricht : Universiteit Maastricht] ; University Library, Universiteit Maastricht [host], 2007. http://arno.unimaas.nl/show.cgi?fid=8304.
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Asch, Rachel E. "Factors influencing participation in screening and clinical trials." Thesis, Cranfield University, 1988. http://dspace.lib.cranfield.ac.uk/handle/1826/4790.
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The reported research was an investigation of attitudes and beliefs
associated with participation in screening programmes and clinical
trials, carried out by general practitioners. Particular focus was given
to cardiovascular risk-reduction.
The work comprised two main studies. The preliminary study was entirely
exploratory, designed to guage public attitudes towards GP involvement
with preventive screening programmes and clinical research; and to
identify the range of variables associated with participation in such
projects. The subsequent study utilised a more formal approach in which
the Behavioural Intention Model was utilised to evaluate the power of
influencing factors.
Both studies employed self-completion questionnaires, developed from
preliminary in-depth interview data. For the first study instrument
distribution was effected by personal approach, for the second study
postal distribution was employed.
In all, 1,037 respondents contributed to the surveys - 442 to the
preliminary exploration and 695 to the follow-on study. These
represented response rates of approximately 65% and 36% respectively.
The main findings were that attitudes towards screening were generally
favourable, though there was less conformity in attitudes expressed
towards clinical trials. These findings were reflected in reported
participatory intentions.
No evidence was found of any factors which might pose widespread
barr i ers to screen ing part ic i pa t ion, though some potent ia 1 deterren ts
were identified for older women. It was also noted that other potential
deterrents may have been masked by the 'middle class' bias of the
sample.
Major deterrents to trial entry were identified as worries about: sideeffects,
acquired resistance, discontinuation of current effective
medications and lack of adequate information. These all interacted with
the 'guinea pig' factor.
Response rates and responses associated with medical and non-medical
sampling sources were also discussed; and consideration was made of the
general utility of the Behavioural Intention Model for research of this
kind.
8
Hussey, David Llewellyn. "Factors affecting clinical performance of resin bonded bridgework." Thesis, Queen's University Belfast, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.322950.
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Robinson, C. J. E. "Factors associated with self-compassion in clinical psychologists." Thesis, University of Essex, 2015. http://repository.essex.ac.uk/15221/.
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At present, two dominant conceptualisations of self-compassion exist. However, a unifying consensus includes self-compassion as a basic kindness and an understanding, non-judgemental attitude towards ones inadequacies and failures (Neff, 2003a), coupled with the wish and effort to relieve ones suffering (Gilbert, 2010a). A review of the literature reveals elevated stress levels within clinical psychologists (CP’s) and a disproportionate amount of research exploring effective self-care strategies. Given the well-evidenced benefits of self-compassion for good psychological wellbeing, it seemed valuable to understand what the levels of self-compassion were within CP’s and establish what factors may relate to them. The factors explored in the present research were: 1) current levels of stress, 2) current level of psychological distress, 3) age of clinician, 4) years of clinical experience, 5) level of social connectedness, 6) fear of giving compassion to others, 7) fear of receiving compassion from others and 8) fear of self-compassion. Furthermore, no research had demonstrated UK community normative data for the Self-Compassion Scale (Neff, 2003b). Therefore this research adopted a quantitative, cross sectional design, using both online and paper methods to access a community sample and an online survey to access trainee and qualified CP’s. Analyses revealed that qualified CP’s reported significantly higher self-compassion than trainees, themselves significantly higher than a community sample. A multiple regression analyses revealed that fear of self-compassion, perceived stress and social connectedness, significantly related to self-compassion scores in trainee CP’s. Within the qualified CP, fear of self-compassion and perceived stress again were found to significantly relate to self-compassion. Results also demonstrated that in the UK, 1/3rd of trainee CP’s and 1/5th of qualified CP’s reported psychological distress significant enough to meet the clinical criteria for an anxiety or depressive disorder. These findings are therefore discussed and clinical implications are presented.
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Hancock, Eleanor. "Tuberous sclerosis : clinical factors in long term outcome." Thesis, University of Bath, 2003. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269678.
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Tuberous sclerosis (TSC) is a dominantly inherited disorder with a high spontaneous mutation rate and a birth incidence of 1 in 10,000. It is a systemic disorder characterised by the growth of hamartomas, which in turn give rise to the clinical manifestations, for example, epilepsy and learning difficulties. Although some patients with TSC are only mildly affected and lead a normal life with typical life expectancy, there is an immense amount of morbidity associated with this disease. In addition, for the majority of patients there is reduced life expectancy. The purpose of this thesis is to look at the clinical factors that contribute to the morbidity and mortality seen in TSC and examine means of reducing the impact of these factors on long-term outcome. It reports a longitudinal population study of a small but defined group of patients looking at the epidemiology and natural history (the morbidity and mortality) suffered by in this population. It investigates the current treatment regimes for the types of epilepsy (infantile spasms and nonconvulsive status epilepticus) known to be associated with the highest risk of learning difficulties in order to determine the most efficacious treatment for the seizures potentially reducing long-term psychomotor delay. A cochrane review of the treatment of infantile spasms was performed. This thesis also examines the effect of exogenous melatonin on sleep disorders (one of the major causes of morbidity) in tuberous sclerosis and the natural circadian rhythms in patients with sleep disorder in TSC and compares them with the normal population. Two important causes of premature mortality in TSC patients are respiratory and renal failure. This thesis examines the prevalence and underlying causes of end stage renal failure in adults with TSC and reviews the literature of LAM (in patients both with and without TSC) investigating further the natural history and treatment of LAM in TSC.
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Doran, Jacqueline. "Psychosocial factors in eating disordered attitudes and risk among clinical and non-clinical samples." Thesis, University of Ulster, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.503054.
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West, Darwin R. "Clinical theory development : a Delphi study of influential factors." Diss., Manhattan, Kan. : Kansas State University, 2007. http://hdl.handle.net/2097/272.
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Parsons, Martin. "Factors affecting the research activity of UK clinical psychologists." Thesis, Canterbury Christ Church University, 2011. http://create.canterbury.ac.uk/10323/.
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Part A provides an overview of the literature pertaining to influences on the research activity of clinical psychologists. The need for ongoing research within the profession is outlined and the evidence for the role of different factors associated with research activity is described and evaluated. Further investigation is recommended in the areas of the research training environment and the practice context. Part B reports an empirical study looking at how components of the theory of planned behaviour may mediate the impact of factors within the research training environment (RTE) on research intention in a sample of UK clinical psychologists. Low levels of clinical psychologist research activity are repeatedly highlighted within the literature. Several potential influences have been identified with the majority of investigation directed towards the RTE and mediators of this factor. A model has been proposed using the theory of planned behaviour to explain research activity and preliminary support has been found for this. The current study took a more in-depth look at the active ingredients of the RTE, as well as aspects beyond training in the workplace. Factor analysis revealed two second order factors within the RTE that differed from an earlier two-factor solution in the literature. These were labelled stimulation and expectations. The relationship between stimulation and intention to do research was shown to be mediated by theory of planned behaviour components, whilst expectation maintained a direct relationship with intention. Thematic analysis of comments from clinical psychologists relating to influences on their research activity supported some of these findings, but also identified new barriers and facilitators of research activity relating to the work environment. Further research exploring both training and practice contexts is called for and implications for training and practice are made. Part C is a critical appraisal of the project, which considers learning points and skills gained from the process of undertaking the study. Future directions for developing research skills are discussed and personal reflections on how the implications of the project may be incorporated into future roles are provided.
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Bhardwa, Jeetesh Maganlal. "Clinical and molecular prognostic factors in superficial bladder cancer." Thesis, Queen Mary, University of London, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.497943.
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Aim: To identify molecular clinical and molecular prognostic indicators markers for superficial bladder cancer. Univariate statistical analysis of the clinical database revealed grade (p<0.001, Log rank test) and positive urine cytology at presentation (p= 0.002 Log rank test) are highly significant for recurrence and progression.
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Holden, R. "Risk factors for suicidality in clinical populations of adolescents." Thesis, Canterbury Christ Church University, 2018. http://create.canterbury.ac.uk/17647/.
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This study investigated the impact of bullying on suicidality in a clinical population of adolescents with autism spectrum conditions (ASCs). Evidence suggests that adolescents that experience bullying are at increased risk of developing suicidality. Adolescents with ASCs are at increased risk of developing suicidality and are at increased risk of being bullied. However, the relationship between bullying and suicidality in adolescents with ASCs has not been investigated. Electronic health records (EHRs) of adolescents (13-17 yrs) with a diagnosis of ASC using the services of a South London mental health trust were analysed. Natural language processing (NLP) was employed to identify mentions of suicidality and bullying in the free text fields of adolescents’ clinical records. Cox regression analysis was employed to investigate the longitudinal relationship between bullying and suicidality. Bullying at baseline was associated with suicidality over the follow-up period. In addition, female gender, psychosis or affective disorder diagnosis and absence of intellectual disorder diagnosis were associated with suicidality at follow-up. After controlling for functional assessment score bullying did not predict suicidality. Bullying seems to predict future suicidality in adolescents with ASCs. That bullying did not predict suicidality after controlling for functional assessment score may have been due to the impact of lost power or overfitting. The results of this study suggest that mental health clinicians and educators should take reports of bullying seriously.
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Stenberg, Maud. "Severe traumatic brain injury : clinical course and prognostic factors." Doctoral thesis, Umeå universitet, Rehabiliteringsmedicin, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-119826.
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Traumatic brain injury (TBI) constitutes a major health problem and is a leading cause of long-term disability and death. Patients with severe traumatic brain injury, S-TBI, comprise a heterogeneous group with varying complexity and prognosis. The primary aim of this thesis was to increase knowledge about clinical course and outcome with regard to prognostic factors. Papers I, II and III were based on data from a prospective multicentre observational study from six neurotrauma centers (NCs) in Sweden and Iceland of patients (n=103-114), 18-65 years with S-TBI requiring neurosurgical intensive care or collaborative care with a neurosurgeon (the “PROBRAIN” study). Paper IV and V were performed on a regional subset (n=37). In Paper I, patients with posttraumatic disorders of consciousness (DOC) were assessed as regards relationship between conscious state at 3 weeks and outcomes at 1 year. The number of patients who emerged from minimally conscious state (EMCS) 1 year after injury according to status at 3 weeks were: coma (0/6), unresponsive wakeful syndrome (UWS) (9/17), minimally conscious state (MCS) (13/13), anaesthetized (9/11). Outcome at 1 year was good (Glasgow Outcome Scale Extended (GOSE>4) in half of the patients in MCS (or anaesthetized) at 3 weeks, but not for any of the patients in coma or UWS. In Paper II, the relationships between clinical care descriptors and outcome at 1 year were assessed. A longer length of stay in intensive care, and longer time between discharge from intensive care and admission to inpatient rehabilitation, were both associated with a worse outcome on the GOSE. The number of intervening care units between intensive care and rehabilitation, was not significantly associated with outcome at 1 year. In Paper III, the clinical course of cognitive and emotional impairments as reflected in the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and the Hospital Anxiety and Depression Scale (HADS) were assessed from 3 weeks to 1 year together with associations with outcomes GOSE and Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) at 1 year. Cognition improved over time and appeared to be stable from 3 months to 1 year. In Paper IV, clinical parameters, the clinical pathways from injury to 3 months after discharge from the NC in relation to outcomes 3 months post-injury. Ratings on the RLAS-R improved significantly over time. Eight patients had both “superior cognitive functioning” on the RLAS-R and “favourable outcome” on the GOSE. Acute transfers to the one regional NC was direct and swift, transfers for postacute rehabilitation scattered patients to many hospitals/hospital departments, not seldom by several transitional stages. In Paper V, an initial computerized tomography of the brain (CTi) and a further posttraumatic brain CT after 24 hours (CT24) were evaluated according to protocols for standardized assessment, the Marshall and Rotterdam classifications. The CT scores only correlated with clinical outcome measures (GOSE and RLAS-R) at 3 months, but failed to yield prognostic information regarding outcome at 1 year. A prognostic model was also implemented, based on acute data (CRASH model). This model predicted unfavourable outcomes for 81% of patients with bad outcome and for 85% of patients with favourable outcome according to GOSE at 1 year. When assessing outcomes per se, both GOSE and RLAS-R improved significantly from 3 months to 1 year. The papers in this study point both to the generally favourable outcomes that result from active and aggressive management of S-TBI, while also underscore our current lack of reliable instruments for outcome prediction. In the absence of an ability to select patients based on prognostication, the overall favourable prognosis lends support for providing active rehabilitation to all patients with S-TBI. The results of these studies should be considered in conjunction with the prognosis of long-term outcomes and the planning of rehabilitation and care pathways. The results demonstrate the importance of a combination of active, acute neurotrauma care and intensive specialized neurorehabilitation with follow-up for these severely injured patients.
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Baxter, Derek. "Clinical and epigenetic factors underlying treatment refractory Rheumatoid Arthritis." Thesis, University of Glasgow, 2014. http://theses.gla.ac.uk/5608/.
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Rheumatoid Arthritis (RA) is a chronic, progressive, multisystem inflammatory disorder for which there is, at present, no cure. It affects up to 1% of the population resulting in chronic pain, disability and, through loss of function, may lead to loss of employment. It is associated with major co-morbidities that account for premature mortality. There is now extensive published research that suggests early treatment with disease modifying drugs can retard joint damage and improve outcome. In a proportion, drug- free remission is possible. However, there remain both individuals with persistently active disease despite standard drug treatments and those with longstanding disease not exposed to effective early treatment that remain relatively unresponsive to therapy. There is a growing literature that epigenetic modifications may underpin, or at least accelerate the development of many autoimmune disorders. These include alterations in DNA methylation patterns, histone tail modifications, post-translational mRNA regulation by microRNA and combinations therein. Having established the human genome project and underlying human DNA sequence, the recognition of dynamic epigenetic regulation of the genome has added further complexity. Few data however are currently available in ‘real-world’ cohorts of patients. In order to explore the hypothesis that specific epigenetic changes may underpin differences in response to therapy, I first examined the characteristics of a cohort of fifty RA patients with longstanding and active disease (DAS28 >3.2) despite receipt of standard therapies (disease modifying drugs (DMARD) and biologic therapies. This included a detailed examination of clinical characteristics, immune profile, inflammatory markers and burden of co-morbid complications such as vascular disease and depression. Outcomes such as disability, quality of life assessments and fatigue were evaluated by means of previously validated questionnaires. These groups were assessed at baseline, three months and six months. I then measured one of the many epigenetic marks, namely microRNA, of this cohort. We analyzed the accessible profile of peripheral RA CD14+ cell microRNAs in treatment resistant RA patients, in healthy controls, DMARD inadequate responders and DMARD good responders in order to determine the presence of a microRNA profile indicative of biologic resistance. An analysis of the serum cytokine profile of the biologic resistant and DMARD resistant groups was also performed. Finally, to extend the analysis beyond conventional clinical and novel molecular biomarkers the influence of additional patient factors such as coping and illness perception were evaluated by questionnaire to determine subjective disease severity in discrete patient groups. Active inflammatory disease was present as judged by the DAS28 score and there was some improvements seen over the six-month assessment period reflecting treatment changes in all groups. Substantial disability and impaired quality of life was found particularly in the therapeutic resistant group but also in those with inadequate response to DMARD, and remained relatively unresponsive to treatment escalation. Clinical variables, deprivation, quality of life and fatigue were strongly correlated with mood suggesting close interactions and resultant increase in disease activity as measured by the DAS28. Multiple cardiovascular risk factors were determined and, having applied cardiovascular risk scoring systems, unmet treatment of modifiable risk was demonstrated. Exploratory analysis of candidate microRNA -34a, -27b and -125a showed no correlation with clinical or biochemical variables other than swollen joint counts but differential expression between study groups. Exploratory microarray profiling between the four study groups demonstrated a number of differentially regulated microRNA. Of these, a unique microRNA profile of the biologic resistant group was found. MicroRNA-423 and -1275 showed higher expression in the biologic resistant group and fell in parallel with the DAS28 reduction between study visits raising their potential utility as biomarkers. MicroRNA-3178 showed higher relative expression in the biologic resistant group. Cytokine profiles demonstrated significant differences vs healthy controls but biologic resistant, DMARD resistant and DMARD good responder groups were less distinct and individual cytokines failed to discriminate in these study groups. Cytokine profiling did not correlate with observed clinical variables, inflammatory markers nor central processes such as mood or fatigue. Finally, those coping strategies favoured were adaptive and problem based. These were unaffected by the high prevalence of mood disturbance. Conversely, illness perception was influenced by mood and both affected subjective disease assessments. The strong influence of mood and fatigue raise the hypothesis that blunted treatment response may be partially driven by these variables. Ultimately we seek to explain, identify and target those patients with aggressive disease as early intervention may prevent established disease and it's accompanying co-morbid conditions. Undoubtedly, a personalised assessment of disease variables and co-morbid conditions is necessary where treatment response is being evaluated. In such a way, significant cardiovascular morbidity and mortality may be prevented. The question of true biologic resistance remains open. Undoubtedly residual inflammation exists in longstanding RA but significant ‘disease activity’ may be explained at least in part by those subjective clinical variables influenced by both external and internal factors. The identification of a ‘biologic resistant’ microRNA profile could act both as a biomarker of treatment response in longstanding disease, superior to the DAS28 scoring system and, through target identification, better understanding of the regulation of the molecular pathways of inflammation operating in such patients. In this way novel pathways of treatment resistance may be exposed and novel treatment targets revealed. However, mood and thus illness perception also contribute to resistance to therapy and should be sought, characterized, and directly addressed to add to the global improvements in outcome that we seek in a holistic model of care in the rheumatic diseases.
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Nugent, Lynn Louise Bartlett. "Factors influencing implementation of innovations in clinical nursing education." Diss., The University of Arizona, 1992. http://hdl.handle.net/10150/185822.
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The purposes of this study were to determine whether associate degree nursing (ADN) programs were implementing innovations in their clinical curricula, to identify recent clinical innovations in these nursing programs, and to identify attributes of innovations that influence innovation adoption. Data were obtained from two questionnaires to all directors of ADN programs in six southwestern states. The first questionnaire asked respondents to identify clinical innovations they had considered recently. The second questionnaire used a Likert Scale to seek respondents' perception of six attributes of innovations--Relative Advantage, Compatibility, Complexity, Observability, Trialability, and Cost--that come from diffusion theory. Analysis of data indicated that 77% of the respondents had implemented changes in their clinical curriculum during the past six years. The most frequently implemented innovations were computer assisted instruction, preceptorship experiences, clinical competency exams, initiating or increasing use of skills labs, and workstudy/externship experiences. Likert Scale values for perceptions of the six attributes, along with a variable created to represent the influence of the Environment, were analyzed by principal component analysis and logistic regression analysis. These analyses led to the conclusion that no one or two variables can be used to predict adoption of an innovation. Instead, a model with each of the attributes should be used in predicting adoption. These findings generally supported the model provided by diffusion theory. However, the influence of Trialability was negligible. Additionally, the Environment variable was found to be an important influence in a favorable adoption decision. Nursing program directors who seek to implement innovations could enhance successful implementation by emphasizing the positive aspects of all attributes of a proposed innovation.
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Wilson, Katherine Ann. "Does safety culture predict clinical outcomes?" Doctoral diss., University of Central Florida, 2007. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/2919.
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Patient safety in healthcare has become a national objective. Healthcare organizations are striving to improve patient safety and have turned to high reliability organizations as those in which to model. One initiative taken on by healthcare is improving patient safety culture--shifting from one of a 'no harm, no foul' to a culture of learning that encourages the reporting of errors, even those in which patient harm does not occur. Lacking from the literature, however, is an understanding of how safety culture impacts outcomes. While there has been some research done in this area, and safety culture is argued to have an impact, the findings are not very diagnostic. In other words, safety culture has been studied such that an overall safety culture rating is provided and it is shown that a positive safety culture improves outcomes. However, this method does little to tell an organization what aspects of safety culture impact outcomes. Therefore, this dissertation sought to answer that question but analyzing safety culture from multiple dimensions. The results found as a part of this effort support previous work in other domains suggesting that hospital management and supervisor support does lead to improved perceptions of safety. The link between this support and outcomes, such as incidents and incident reporting, is more difficult to determine. The data suggests that employees are willing to report errors when they occur, but the low occurrence of such reportable events in healthcare precludes them from doing so. When a closer look was taken at the type of incidents that were reported, a positive relationship was found between support for patient safety and medication incidents. These results initially seem counterintuitive. To suggest a positive relationship between safety culture and medication incidents on the surface detracts from the research in other domains suggesting the opposite. It could be the case that an increase in incidents leads an organization to implement additional patient safety efforts, and therefore employees perceive a more positive safety culture. Clearly more research is needed in this area. Suggestions for future research and practical implications of this study are provided.Ph.D.
Department of Psychology
Sciences
Psychology PhD
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Wiltsey, Michael T. Heilbrun Kirk. "Risk factors for intimate partner homicide /." Philadelphia, Pa. : Drexel University, 2008. http://hdl.handle.net/1860/2713.
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Nygren, Ingela. "ALS - a clinical thesis /." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4804.
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De, Sancho Maria. "Risk factors for clinical manifestations in carriers of Factor V Leiden and prothrombin gene mutations /." Access full-text from WCMC, 2008. http://proquest.umi.com/pqdweb?did=1695109691&sid=1&Fmt=2&clientId=8424&RQT=309&VName=PQD.
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Mancini, Kathryn J. "Mother-Adolescent Dyadic Affective Flexibility across Interactions: Measurement and Predictive Factors." Miami University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=miami1529685938908801.
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Wilson, Frances Carol. "Self-Concept Uncertainty and Self-Esteem Liability: Vulnerability Factors for Depression?" W&M ScholarWorks, 1997. https://scholarworks.wm.edu/etd/1539626139.
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Jones, Chris I. "Haematological and clinical factors influencing thrombus formation, structure and fibrinolysis." Thesis, University of Leicester, 2007. http://hdl.handle.net/2381/29893.
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This work investigates how changes in the thrombus over time, and in the action of platelets, brought about by physiological or therapeutic factors, influence the susceptibility of thrombi to fibrinolysis. Resistance to fibrinolysis increased with thrombus age, and was associated with expression and/or release of FXIII, TAFI, PAI-1, and FXI, by cells within the thrombus, the recruitment of which was largely platelet dependant. Platelets increase resistance to fibrinolysis through release of FXIII and TAFI, and act pro-fibrinolytically through the recruitment of monocytes, and, by a yet undetermined mechanism, when hyper-activated. Overall, the action of platelets is anti-fibrinolytic, as evidenced by the increase in fibrinolysis associated with reduced platelet number or activity. The plasma expander dextran had no discemable direct effect on platelets, although it did significantly increase the generation of plasmin and the rate of fibrinolysis. This, indirectly, led to a reduction in vWF activity and platelet response to thrombin, but not to TRAP, collagen, or ADP, indicating the these effects result non-specific proteolytic cleavage by plasmin. The contrast media lodixanol or lohexol increased both thrombus formation and resistance to fibrinolysis, whilst Ioxaglate inhibited thrombus formation. These change may in part be due to increased degranulation but is more likely to result from their effect on fibrin fibre formation. These data have implications for clinical resolution of occlusive arterial thrombotic events. Thrombolytic therapy may be more successful if targeted to individuals with lower platelet counts or on long term anti-platelet therapy, and if administered rapidly after thrombus formation. Furthermore low dose Dextran therapy maybe a useful adjuvant to pre-hospital thrombolytic therapy.
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Barr, Helen Louise. "Clinical factors contributing to morbidity and mortality in cystic fibrosis." Thesis, University of Nottingham, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.606574.
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Cystic fibrosis (CF) is the commonest autosomal recessively inherited condition leading to reduced survival in the Caucasian population. It is caused by defective chloride regulation, resulting in premature death, predominantly from respiratory failure secondary to chronic infection and inflammation. Over the past 70 years, there have been vast improvements in survival in CF due to advances in early diagnosis, antibiotics, airway clearance, nutritional support and infection control. Accordingly, researchers and clinicians have endeavoured to identify prognostic indicators and outcome measures that can accurately assess response to treatment. Over 20 years ago, females and individuals of lower socioeconomic status were found to have a poorer prognosis than males or those of higher socioeconomic status. The first part of this thesis describes an epidemiological study that showed that these socioeconomic and gender disparities are still present today. The natural history of CF is a slow decline in lung function punctuated by episodes of increased respiratory symptoms, termed pulmonary exacerbations. These exacerbations are associated with reduced lung function, lower quality of life and increased mortality. The second part of this thesis describes the investigation of clinical and sputum factors that may influence the time between pulmonary exacerbations. The study showed that female gender, increased bacterial load in a patient's sputum and shorter duration of infection with the bacterium Pseudomonas aeruginosa are independent predictors for a shorter time to next the exacerbation. The third part of this thesis focuses on respiratory infection with P. aeruginosa, a key pathogen in CF. These bacteria thrive in the warm, moist environment of the CF airways where they form antibiotic resistant biofilms. As a community, the bacteria co-operative with each other to sense and respond to changes in environmental stimuli using a cell-to-cell communication system, known as quorum sensing (QS). QS 'signal' molecules have been detected in the sputum and plasma of patients with CF but little is understood about their clinical significance in the human host. This thesis describes a prospective observational clinical study showing that: (1) QS signal 2 molecules can be detected in the sputum, plasma and urine of patients with CF; (2) QS signal concentrations in the sputum, plasma and urine are correlated with quantitative measures of P. aeruginosa in the lung and (3) QS signal molecules have significant potential as biological markers for lung infection with P. aeruginosa. Overall, this thesis highlights several clinical factors associated with increased morbidity and mortality in CF patients and the potential use of biological markers of infection to measure and improve respiratory outcomes in future. It concludes by reflecting on the clinical significance of these observations and considering future areas of research that may increase our understanding of the biological processes involved. 3
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Davis, Cheryl Jane. "Psychological factors that influence patient participation in cancer clinical trials." Thesis, University of Hull, 2001. http://hydra.hull.ac.uk/resources/hull:5794.
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The accrual of patients to cancer clinical trials has been noted by a number of authors as a significant problem. Research to date has examined a range of patient and physician related factors that may account for the low accrual rate. Patient refusal as a reason for non-participation has been found by previous research to account for a significant proportion of patients who are not entered onto a trial. This project aimed to explore the differences in attitudes and psychological variables between patients who refused a clinical trial and those who consented. A cross sectional, single point, postal questionnaire design was employed. Patients who were medically eligible for current phase I, II or III cancer chemotherapy clinical trials received a series of self-report questionnaires. These assessed personality, mood status, emotional expression and health locus of control, and patients' attitudes to research and hypothetical clinical trials. Follow up semi-structured interviews were held with a subsample of participants. During the data collection period, 48 patients were identified as eligible for clinical trials. Of these, 95.9% consented to a trial. The results query previous fmdings that patient refusal is a significant problem in accrual to trials. Thirty-one patients (63%) returned the questionnaires and of these, none refused entry to a clinical trial. Statistical analyses showed that patients' attitudes to research were related to their willingness to enter hypothetical clinical trials. An effect of personality and health locus of control on patients' perception of choice when offered a trial was found. Qualitative analysis revealed that the decision to enter a clinical trial was not difficult for patients, as had been previously proposed. Recruitment and methodological difficulties are discussed.
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McMullin, Mary Frances. "Disordered erythropoiesis in various clinical states : control by serum factors." Thesis, Queen's University Belfast, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.317033.
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Hiscoke, Ulrika Landblom. "Risk management the role of clinical factors in violent behaviour /." Stockholm, 2010. http://diss.kib.ki.se/2010/978-91-7409-323-0/.
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Upadhyay, Parth. "Pharmacokinetic, Pharmacodynamic and Pharmacogenetic Factors Associated with Busulfan Clinical Pharmacology." Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/20490.
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Busulfan is a bifunctional alkylating agent used in combination with other chemotherapeutics for the ablation of dysfunctional bone marrow prior to haematopoietic stem cell transplantation. Busulfan use is complicated by a large inter-individual and inter-occasion pharmacokinetic variability. Furthermore, the exposure of busulfan (estimated as a cumulative area under the curve) has been associated with dose-limiting toxicities such as sinusoidal obstruction syndrome, which can lead to multi-organ failure and death if left untreated. The research presented in this thesis retrospectively explores SOS incidence in 337 HSCT patients over an eleven-year study period (2006 – 2017) across seven institutions in Australia. Out of 344 busulfan-based conditioning occasions, there were 64 cases of SOS reported. A population pharmacokinetic analysis was developed to explore the pharmacokinetic variability present. Association studies were conducted post hoc and non-parametric and Cox proportional hazards models were developed to better understand the development of SOS post-busulfan use. Lastly, an exploration of the influence of patient genotypes on clinical outcome was conducted. A total of 3241 observations informed the selection of a one-compartment pharmacokinetic model. Inter-occasion and inter-individual variability were characterized for both clearance and volume. Adjusted-ideal bodyweight (kg) and a sigmoidal Emax, maturation function were incorporated as covariates. A post hoc analysis into concomitant medications found a significant decrease in busulfan CL for patients co-administered metronidazole (difference in median CLNORM = 0.05 L/h/kg, n = 17, P < 0.0001), and a marginal increase with dexamethasone (difference in median CLNORM = 0.01 L/h/kg, n = 49, P < 0.01). Overall, cAUC was not significantly associated with SOS, although median Cmax observed on Day 1 of busulfan therapy was higher in patients with SOS (2 μg/mL vs. 2.61 μg/mL, P < 3.7 x 10-5). A multivariate Cox proportional hazard model characterized the hazard of developing SOS as a combination of risk factors: low AIBW, low pre-transplant albumin, younger age and high Cmax. A linear regression analysis on an ADME panel of 67 SNPs in a sub-cohort (223 patients) found found no significant effect of SNPs on busulfan clearance. A logistic regression analysis of the same number of patients over the panel of enzyme-related SNPs failed to report any significant genetic associations with SOS. A separate analysis of 189 patients for polymorphisms of GSTA1 (an enzyme previously associated with busulfan metabolism) showed a 14% – 18% lower clearance (difference in mean CLNORM = 0.03 L/h/kg, P = 0.004 and 0.04 L/h/kg, P = 0.0003) in patients heterozygous and homozygous for the *B allele, respectively. A further categorisation of GSTA1 polymorphisms into activity-based groups was of no additional benefit. In conclusion, the high degree of inter-occasion and inter-individual variability in busulfan pharmacokinetics was reconfirmed through this thesis. Patient specific factors such as GSTA1 polymorphisms affected pharmacokinetic variability, but cAUC was not associated with risk of SOS.
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Giddings, Jeffrey Michael. "Influential Factors in the Sustainability of Clinical Legal Education Programs." Thesis, Griffith University, 2011. http://hdl.handle.net/10072/367752.
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This thesis considers how to best recognise and realise the contributions that clinical methodologies can make to legal education. The use of experiential learning methods and the combining of community service with student learning distinguish clinical teaching from other forms of legal education. The thesis focuses on making the most of this distinctiveness by deepening the understanding of the factors that influence the establishment and sustainability of clinical programs. It will be argued that sustainability can be promoted through the constructive integration of clinical methods and insights across the various activities of a law school.
Clinical legal education programs often face a tenuous existence unless they are recognised as an integral part of the legal education project. A series of factors need to work together in order for a program to be established and then sustained. While no single factor can be taken to ensure the establishment and sustainability of a clinic program, the commitment and understanding of key staff to the clinic (both clinic supervisors and, beyond the clinic, law school leaders) is central to both establishment and sustainability. It appears that establishment is influenced more by contextual factors beyond the law school, whereas sustainability and continuing development are closely linked to factors more specific to each individual law school.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
Griffith Law School
Arts, Education and Law
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Suiter, S. R. "Factors influencing Western Australian clinical registered nurses in discharge planning." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1995. https://ro.ecu.edu.au/theses/1166.
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A descriptive quantitative study was conducted to determine what factors nurses considered when discharge planning, and how these factors compared with factors identified in the literature as being effective in planning for discharge. This study was undertaken because with the intended Prospective Payment System (PPS) of funding to hospitals, it is essential that Western Australian Clinical Registered Nurses are able to prepare patients for discharge effectively to prevent the financial burden of cost outliers and re-admissions. Anderson and Steinberg ( 1984) in their studies of factors that influence the cost of hospital care for the elderly, found that the results of inappropriate and premature discharges resulted in a 22% readmission rate within 60 days of discharge for all Medicare hospitalisation. Their (1988) study of readmission rates of Medicare beneficiaries between 1974 and 1977 showed that the added costs associated readmissions cost the U.S. government more than US$2.5 billion per annum. It would seem probable that such a system introduced into the Australian health:care system will have the potential to produce similar effects for Western Australian patients, nurses and nursing.
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Whittle, Rosemary Anne. "Decisions, decisions: factors that influence student selection of final year clinical placements." Thesis, University of Canterbury. Education, 2007. http://hdl.handle.net/10092/1057.
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Clinical practice is an essential and integral component of nursing education. The decision-making process involved in student selection of clinical placements is influenced by a range of factors which are internal or external to students. As there was little research that explored these factors and the influence they have on student decisions, I wanted to investigate this further. A mixed-method approach was used, using a questionnaire and focus group interview, to give breadth and depth to the research. This study found that students are particularly influenced by previous positive experiences, or an interest in a particular area of practice. Their personality will also influence their placement decisions. Nurse preceptors and clinical lecturers also provide a key support role to students in the clinical environment.
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Eales, Martin James. "Social factors in the occurrence of depression and allied disorders." Thesis, Royal Holloway, University of London, 1986. http://repository.royalholloway.ac.uk/items/321002e0-d7e5-4155-8660-ffe1eae9063f/1/.
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A retrospective study was conducted in a sample of 80 unemployed men selected from an unemployment benefit office in London. Psychiatric state was assessed using reliable, clinically-oriented, criteria for the diagnosis of affective disorders (depressive and anxiety states), and the date of onset of any disorder ascertained. Feelings of shame over unemployment were rated using explicit criteria, and information on life events, and difficulties, and a variety of other social factors ,collected using established procedures. Among men who were well at the time of job loss, one in seven subsequently developed a relatively severe ('case') affective disorder, and one in three a severe or a mild ('borderline case'?) disorder. Most of these were depressive states and had arisen in close proximity to the event of job loss. Factors found to increase the risk of onset of a disorder following job loss were (1) the lack of an intimate relationship with a wife or girlfriend (for the more severe disorders only) ; (2) economic difficulties antedating the present spell of unemployment (pre-existing money difficulties or a past history of insecure employment) and (3) the personality trait of shyness (each for the more severe and the milder disorders). Feelings of shame were reported by one in four men, and these were also associated with previous economic difficulties and with trait shyness. Shame was strongly associated with the onset of an affective disorder following job loss, and analysis indicated that the most likely explanation for this was that shame and affective disorder were both related to a common mediating factor, which it was suggested may have been chronically low or acutely damaged self-esteem.
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Bourgon, Guy André. "Factors influencing the effects of instructed human imagining behaviour on subsequent performance." Thesis, University of Ottawa (Canada), 1994. http://hdl.handle.net/10393/6786.
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Numerous anecdotal reports from athletes and coaches suggest that performance of a physical skill can be improved by imaginal practising of that skill. Practising a skill in one's imagination has been called symbolic rehearsal, mental practice, mental rehearsal, conceptualizing practice, imaginal practice, covert rehearsal, and instructed human imagining behaviour (IHIB). For at least 50 years, researchers have attempted to empirically demonstrate the effects of instructed human imagining behaviour on subsequent performance. A review of the IHIB and related literature suggests (a) that although IHIB can influence skill performance, it may not always do so; (b) that the conceptual schemes involved in IHIB need careful development; and (c) that before IHIB can be used to effectively and systematically improve performance, we need to identify critical variables involved in IHIB. An alternative explanation of IHIB and its effects on subsequent performance based on radical behaviourism is described and examined. This conceptual scheme proposes that IHIB is similar to the overt behaviour and thus, shares similar controlling variables. Three experiments, investigated the effects of presenting task-specific auditory stimuli during IHIB procedures. The results suggest that task-specific auditory stimuli increase the similarity between IHIB and the target behaviour, and that it is this similarity that mediates the effects of IHIB on subsequent performance.
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Léonard, Stéphanie. "Specificity of relationships among vulnerability factors and symptom dimensions in Bulimia Nervosa." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0015/MQ50816.pdf.
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Kometsi, Kgamadi Thamsanqa Joseph. "Factors affecting a decision on cadaveric organ donation in Black African families." Master's thesis, University of Cape Town, 1998. http://hdl.handle.net/11427/13481.
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Bibliography: leaves 45-49.Black Africans continue to be the group with low consent for cadaveric organ donation However, the number of African Black patients with organ malfunctioning or failure continues to rise. Feelings associated with death and the novelty of the concept of organ donation to Blacks hinder the process of organ donation. Previous research indicate that although organ removal is not new in the Black African culture, its use for medical purposes is a recent development . This study explores factors that have affected the decision of Black African families regarding cadaveric organ donation . It focuses on families which have been requested to donate by the Groote Schuur Hospital (GSH) transplant co-ordinators from 1994 to 1996 Further, it examines whether the attitudes held at the time of the request have changed. An understanding of the factors and recommendations are offered at the end.
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Allen, Latasha Lavette. "Juvenile Offender Risk Factors Associated With Participation in Diversion Programs and Recidivism." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6711.
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Although reducing recidivism among juvenile offenders is an important goal of the criminal justice system and diversion programs are known to reduce recidivism, little is known about the risk factors associated with participation in diversion programs or recidivism. The purpose of this quantitative study was to identify the juvenile offender risk factors associated with participation in diversion programs and recidivism. Social learning theory was the theoretical framework. The key research questions focused on how juvenile offenders' demographic characteristics, risk factors, and participation in different types of diversion programs were associated with recidivism. Archival data from a large juvenile justice agency were analyzed using chi-square tests and binary logistic regression to examine the associations between the characteristics of N = 4,656 juvenile offenders (age at the referral date, gender, race, size of family, guardian involvement, and offense type); participation in a 90-day program (DP90) or a 180-day program (P180); and recidivism (referral within 1 year). The overall rate of recidivism was 15.3% per year, but recidivism varied significantly between groups of offenders. The strongest predictor of recidivism was dropping out of the DP180 program. Offenders who did not drop out of the DP90 program were the least likely to recommit a crime. The findings of this study suggest that likely steps for positive social change be implemented through policy changes to expand the role of guardians in diversion participation process. Further research to explain how and why the level of parental/primary guardian involvement and the type of diversion program may moderate the behavior of juvenile offenders in diversion programs is recommended. The use of family-based support strategies may improve the completion rate of diversion programs and may ultimately help to reduce the rate of recidivism for juvenile offenders.
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Levi, Judith. "Therapeutic factors : a process study of small group psychotherapy." Thesis, University of Hull, 2006. http://hydra.hull.ac.uk/resources/hull:11516.
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There is a need for structured research into the psychodynamic psychotherapies to strengthen evidence-based practice knowledge and communicate this knowledge to practitioners and funders. We know that group psychotherapy is effective, but many outcome assessment instruments fail to reflect process and individual experience. The current study used the Therapeutic Factors Questionnaire in an attempt to add to research knowledge of process. In this exploratory study, twenty-two participants in small group psychotherapy at a day attendance therapeutic community rated eleven factors for perceived helpfulness in a modified version of Yalom's Therapeutic Factors Questionnaire, at five time points in the year. Therapists completed an identical version for each member, conveying what they thought each member had found most helpful in that period. Members who had been in the group for a year participated in a semi-structured interview, which was analysed using Interpretative Phenomenological Analysis. TFQ data was collated into three six-month phases dependent on length of time in the group. Admission data on individual clinical problems was coded by the researcher into nine categories. Lower than expected numbers made the drawing of conclusions from the quantitative data impossible, though statistical analysis showed certain trends. However, interviews provided a particularly rich source of information, which also suggested that the TFQ trends were probably authentic. Two complete cases were explored in terms of the relationship between TFQ and interview results.
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Mowder, Melissa Hogue. "Resiliency factors among juvenile offenders." [Bloomington, Ind.] : Indiana University, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3331406.
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Thesis (Ph.D.)--Indiana University, Dept. of Counseling and Educational Psychology, 2008.Title from PDF t.p. (viewed on Jul 28, 2009). Source: Dissertation Abstracts International, Volume: 69-11, Section: B, page: 7127. Adviser: Jack A. Cummings.
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Pukall, Monica G. "Postnatal risk factors in the etiology of schizophrenia : association with good premorbid adjustment." Thesis, McGill University, 1999. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=30728.
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Research shows distinct premorbid subtypes in schizophrenia. While family history of schizophrenia and obstetric complications are associated with poor premorbid adjustment, risk factors associated with good premorbid adjustment, characterizing most patients, remain unidentified. Both childhood trauma and premorbid substance use appear to increase vulnerability to schizophrenia. The goals of this study were to determine the association among family history, obstetric complications, childhood trauma, and premorbid substance use; and secondly, to assess whether trauma and premorbid substance use are associated with good premorbid schizophrenia. Trauma and substance use were assessed in 26 schizophrenia patients whose mothers were asked about family history of schizophrenia and obstetric complications. Results suggest that childhood trauma may co-occur with a family history of schizophrenia; high premorbid cannabis consumption was significantly associated with an absence of family history. Childhood trauma and premorbid substance use, however, did not consistently predict a good premorbid adjustment profile.
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Jager-Hyman, Shari Gail. "Nonsuicidal Self-Injury in a College Sample: Risk Factors, Pathways, and Diagnostic Correlates." Diss., Temple University Libraries, 2012. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/201201.
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PsychologyPh.D.
As research on nonsuicidal self-injury (NSSI) is in its beginning stages, relatively little is known about the variables that confer risk for this class of behaviors. Although recent work has implicated the role of childhood maltreatment in the development of NSSI, this body of literature is hampered by several important limitations. These limitations include either grouping together all forms of maltreatment (i.e., emotional, physical, and sexual abuse) or focusing on only one form of maltreatment. In addition, there is a paucity of research exploring the mechanisms by which maltreatment experiences relate to NSSI. Furthermore, although a great deal of attention has focused on the relation between self-harm (both suicidal and nonsuicidal) and specific psychological diagnoses, particularly borderline personality disorder (BPD), the vast majority of this research has been conducted with severe clinical samples. As a result, there is a dearth of knowledge about the risk factors, pathways, and diagnostic correlates of NSSI in non-clinical samples. Given that recent research has suggested that NSSI is increasingly common in college samples, the current study aimed to address these limitations in a diverse sample of 1,819 college students. Participants completed assessments of childhood maltreatment experiences, NSSI, as well as two potential mediators, emotion dysregulation and cognitive vulnerability, and one potential moderator, impulsivity. In addition, a subset of participants (n = 140) were administered diagnostic interviews for BPD and depression. Results provided support for the role of childhood maltreatment in the development in NSSI. Controlling for other forms of maltreatment, emotional maltreatment was most predictive of NSSI. Both emotion dysregulation and negative cognitive style partially mediated the relationship between childhood maltreatment and NSSI. In contrast, impulsivity did not significantly moderate the childhood maltreatment - NSSI relation. As expected, borderline personality features significantly predicted NSSI. However, contrary to expectations, impulsivity and affective instability were not the strongest borderline criteria in the prediction of NSSI. Treatment implications of these results, strengths and limitations, as well as areas of future research are discussed.
Temple University--Theses
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Byllesby, Brianna M. "The Relationship Between the Latent Factors of Posttraumatic Stress Disorder and Distress Tolerance." University of Toledo / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1434798195.
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Devon, Angela. "An exploration of factors which predict client satisfaction." Thesis, University of Surrey, 1996. http://epubs.surrey.ac.uk/983/.
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Mugerwa, Pumla Princess. "The relationship between clinical learning environmental factors and clinical competence of newly qualified registered nurses in public hospitals." Thesis, Nelson Mandela Metropolitan University, 2017. http://hdl.handle.net/10948/19266.
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There is increasing concern that newly qualified registered nurses (RNs) find it difficult to make a smooth transition from completing their four-year nursing training to taking up their posts as first time RNs. In a constantly changing healthcare system, these newly qualified RNs are expected to work independently and be competent in applying the decision making and problem-solving skills gained during their training. While certain aspects of clinical incompetence may be ascribed to individual factors, the importance of the clinical learning environment and its influence on the development of clinical competence cannot be ignored. Nurses need support and guidance to effect a successful transition from being novice to competent nurse and the environment is regarded as important in developing technical competencies. The research study followed a positivistic, quantitative paradigm, where the hypothesized relationship between clinical learning environmental factors and clinical competence of newly qualified RNs were explored. Data was collected from the experienced RNs in the hospitals by means of a structured pre-existing questionnaire, namely the Competency Inventory for Registered Nurses (CIRN). Descriptive statistics and inferential statistics were used to analyse data. The analysed data was used to describe the findings. Recommendations were made based on the findings. Results suggested that the development of clinical competence is dependent on both the individual and context. Positive relations were reported between clinical learning environmental factors and clinical competencies.
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Simmonds, D. W. "The construing of trainee clinical psychologists in relation to personality, theoretical orientation and factors that influence clinical practice." Thesis, University College London (University of London), 2008. http://discovery.ucl.ac.uk/1445849/.
Full textAbstract:
Literature pertaining to the development of professional identity in clinical psychologists and other health professionals is reviewed. Particular attention is given to studies of professional identity using repertory grid methodology. Other factors of personality, preference for theoretical orientation and factors that influence clinical practice that were found to be relevant to a clinical psychologist's professional identity are also examined. Findings are summarised and discussed in terms of external and internal factors influencing professional identity.
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Kilpatrick, Nicola M. "Glass ionomer cements : factors influencing their durability." Thesis, University of Newcastle Upon Tyne, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.318230.
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Berglin, Lennart. "Choroidal neovascularization (CNV) : clinical and experimental aspects /." Stockholm, 2002. http://diss.kib.ki.se/2002/91-7349-284-1/.
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Voors, Adriaan Alexander. "Risk factors, endothelial function, and clinical outcome after coronary bypass surgery." [S.l. : [Groningen] : s.n.] ; [University Library Groningen] [Host], 1997. http://irs.ub.rug.nl/ppn/157840069.
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Harron, Joanne Camille. "Investigation of vasoactive factors in clinical and experimental diabetic renal disease." Thesis, Queen's University Belfast, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.266710.
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