Dissertations / Theses on the topic 'Clinical pathology'
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1
Scott, Alexander. "Tendon overuse pathology : clinical and laboratory studies." Thesis, University of British Columbia, 2008. http://hdl.handle.net/2429/5621.
Full textAbstract:
Background: Painful tendon overuse pathology (tendinosis) is poorly understood. The
objectives were to identify major cell populations within clinical tendinosis lesions, and
to examine factors involved in the regulation of tendon cell death, survival, or
proliferation. The overarching hypothesis was that both cell death and cell proliferation
play roles in the development of tendinosis.
Methods:
1: Chronic patellar tendinosis tissue was compared with normal, pain-free patellar tendon
using Western blot, immunohistochemistry and in situ hybridization. A variety of cell
types were examined in relation to relevant features of soft tissue injury and repair
including cellular proliferation and versican expression.
2: In adult male rats, early tendinosis was induced in the supraspinatus tendon by 4-16
weeks of mechanical loading (eccentric exercise). Tendons were analyzed
morphologically using polarized light and transmission electron microscopy, and by
immunolabeling for molecular markers of proliferation and survival.
3: The influence of IGF-I on tenocyte survival was tested in response to chronic hypoxia
in a cell-culture setting.
Results
1: Tendinosis was characterized by proliferation of tenocytes, endothelial cells, and
smooth muscle cells within a versican-enriched extracellular matrix. Mast cells were also
more numerous in patient biopsies, whereas macrophages and lymphocytes were virtually
absent. VEGF expression was increased in endothelial cells from tendinosis tendons and
was more marked in patients with shorter symptom duration.
2: Mechanical loading of the rat supraspinatus tendon by downhill running caused focal
tendon lesions characterized by tenocyte proliferation, collagen disarray and
glycosaminoglycan accumulation. Tenocytes in these areas of injury demonstrated a
proliferative response which correlated with IGF-I expression and phosphorylation of
ERK-l/2and IRS-1.
3: Prolonged hypoxia of primary tenocyte cell cultures resulted in tenocyte apoptosis and
caspase activation. Apoptosis could be prevented dose-dependently by IGF-I, which
activated the PKB survival pathway
Conclusions
The current studies outlined predominant cell populations present in tendinosis lesions
and identified factors which may be involved in regulating their death, survival and
activity. These experiments have opened up new avenues of research into the
pathophysiology of tendinosis.
2
Patel, Soyab Ahmed. "Chemical imaging for clinical pathology and bioanalysis." Thesis, University of Manchester, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.488821.
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McNicol, A. M. "Pathology of pituitary corticotrophs : Clinical and experimental studies." Thesis, University of Glasgow, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.372421.
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MUZIO, DIANE. "Clinical Supervision of Externs in Speech-Language Pathology." OpenSIUC, 2017. https://opensiuc.lib.siu.edu/dissertations/1467.
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The focus of this qualitative study was to investigate clinical supervisors’ perceptions about the externship experience in speech-language pathology. This study was designed to investigate the range of supervisors’ preparedness to mentor the extern student, self-perceptions of the role of the externship supervisor, and opinions regarding a possible professional credential. Data was collected from a focus group and individual interviews. All participants were SLPs who supervised a minimum of two graduate student externs from the same large Midwestern university. The results indicated that externship supervisors felt unprepared for their early supervision experiences, vary in their practices of developing and systematizing pre-professional externship experiences, and that a professional credential in supervision would likely contribute to the standardization of graduate students’ training in speech-language pathology.
5
Akin, Faith W. "Best Practice: Clinical Vestibular Assessment." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/2441.
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6
Baguley, David M., and Marc A. Fagelson. "Tinnitus: Clinical and Research Perspectives." Digital Commons @ East Tennessee State University, 2015. https://www.amzn.com/1597567213.
Full textAbstract:
Book Summary: Tinnitus: Clinical and Research Perspectives summarizes contemporary findings from basic and clinical research regarding tinnitus mechanisms, effects, and interventions. The text features a collection of international authors, active researchers, and clinicians who provide an expansive scope of material that ensures relevance for patients and professionals. Reviews and reports of contemporary research findings underscore the text s value for classroom use in audiology and otolaryngology programs. Patients and students of audiology will benefit from the text s coverage of tinnitus mechanisms, emerging practice considerations, and expectations for outcomes--for example, recent successes of cognitive behavioral therapy, neuromodulation, and hearing aid use. These and other topics, such as the effects of noise and drugs on tinnitus, are reported in a way that enhances clinicians ability to weave such strategies into their own work. The influence of tinnitus on all aspects of life is explored, from art to medicine and communication to isolation, thereby providing clinicians and patients a deeper understanding of and greater facility managing a tinnitus experience. Finally, this text includes case studies that provide a practical view of tinnitus effects and management approaches. The editors hope that the consideration of mechanisms, interventions, and outcomes resonates with patients, clinicians, and students of audiology.https://dc.etsu.edu/etsu_books/1179/thumbnail.jpg
7
Thornhill, Jaime. "Emotional intelligence : aetiological role in sub-clinical eating pathology /." [St. Lucia, Qld.], 2005. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18667.pdf.
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Maddison, John. "Digital image processing for prognostic and diagnostic clinical pathology." Thesis, University of Huddersfield, 2005. http://eprints.hud.ac.uk/id/eprint/22322/.
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When digital imaging and image processing methods are applied to clinical diagnostic and prognostic needs, the methods can be seen to increase human understanding and provide objective measurements. Most current clinical applications are limited to providing subjective information to healthcare professionals rather than providing objective measures. This Thesis provides detail of methods and systems that have been developed both for objective and subjective microscopy applications. A system framework is presented that provides a base for the development of microscopy imaging systems. This practical framework is based on currently available hardware and developed with standard software development tools. Image processing methods are applied to counter optical limitations of the bright field microscope, automating the system and allowing for unsupervised image capture and analysis. Current literature provides evidence that 3D visualisation has provided increased insight and application in many clinical areas. There have been recent advancements in the use of 3D visualisation for the study of soft tissue structures, but its clinical application within histology remains limited. Methods and applications have been researched and further developed which allow for the 3D reconstruction and visualisation of soft tissue structures using microtomed serial histological sections specimens. A system has been developed suitable for this need is presented giving considerations to image capture, data registration and 3D visualisation, requirements. The developed system has been used to explore and increase 3D insight on clinical samples. The area of automated objective image quantification of microscope slides presents the allure of providing objective methods replacing existing objective and subjective methods, increasing accuracy and rsducinq manual burden. One such existing objective test is DNA Image Ploidy which seeks to characterise cancer by the measurement of DNA content within individual cell nuclei, an accepted but manually burdensome method. The main novelty of the work completed lies in the development of an automated system for DNA Image Ploidy measurement, combining methods for automatic specimen focus, segmentation, parametric extraction and the implementation of an automated cell type classification system. A consideration for any clinical image processing system is the correct sampling of the tissue under study. VVhile the image capture requirements for both objective systems and subjective systems are similar there is also an important link between the 3D structures of the tissue. 3D understanding can aid in decisions regarding the sampling criteria of objective tests for as although many tests are completed in the 2D realm the clinical samples are 3D objects. Cancers such as Prostate and Breast cancer are known to be multi-focal, with areas of seeming physically, independent areas of disease within a single site. It is not possible to understand the true 3D nature of the samples using 2D micro-tomed sections in isolation from each other. The 3D systems described in this report provide a platform of the exploration of the true multi focal nature of disease soft tissue structures allowing for the sampling criteria of objective tests such as DNA Image Ploidy to be correctly set. For the Automated DNA Image Ploidy and the 3D reconstruction and visualisation systems, clinical review has been completed to test the increased insights provided. Datasets which have been reconstructed from microtomed serial sections and visualised with the developed 3D system area presented. For the automated DNA Image Ploidy system, the developed system is compared with the existing manual method to qualify the quality of data capture, operational speed and correctness of nuclei classification. Conclusions are presented for the work that has been completed and discussion given as to future areas of research that could be undertaken, extending the areas of study, increasing both clinical insight and practical application.
9
Sheepway, Lyndal. "Influences on Competency Development in Speech Pathology Students." Thesis, The University of Sydney, 2014. http://hdl.handle.net/2123/11449.
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Due to shortages of clinical education experiences for allied health students, there is a risk that curriculum decisions are made based on availability of experiences rather than evidence regarding competency development. This research was situated in the speech pathology profession in Australia. The aims were to establish current clinical education practices internationally and the drivers behind these practices, explore growth of competency in a cohort of students, and compare impacts of features of clinical placements on students’ competency growth. This was achieved through three related studies. University personnel from speech pathology programs in seven countries were surveyed regarding the clinical placement and supervisory models used and drivers for choice of these models. The COMPASS® competency assessment tool was used to compare competency development of third year speech pathology students in placements which differed by caseload, intensity and setting. Competency development across the final two years of an undergraduate program was also investigated. Traditional placement and supervisory models are most commonly used, with some correlations between frequency of use and opinions of effectiveness. Drivers for choice of models included availability of placements, clinical educator factors such as training and availability and standards of professional associations. Results indicate that competency follows a developmental continuum suggesting that learning and competency transfer between placements. Students in placements with a paediatric caseload had greater growth of competency than those with adult caseloads. There were no differences in competency growth between groups of students who completed different intensities of placements or settings. The sequences of placements experienced did not have a significant effect on competency over a longer term.
10
Flygt, Johanna. "Oligodendrocyte pathology following Traumatic Brain Injury : Experimental and clinical studies." Doctoral thesis, Uppsala universitet, Institutionen för neurovetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-316401.
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Traumatic brain injury (TBI) caused by traffic and fall accidents, sports-related injuries and violence commonly results in life-changing disabilities. Cognitive impairments following TBI may be due to disruption of axons, stretched by the acceleration/deceleration forces of the initial impact, and their surrounding myelin in neuronal networks. The primary injury, which also results in death to neuronal and glial cells, is followed by a cascade of secondary injury mechanisms including a complex inflammatory response that will exacerbate the white matter injury. Axons are supported and protected by the ensheathing myelin, ensuring fast conduction velocity. Myelin is produced by oligodendrocytes (OLs), a cell type vulnerable to many of the molecular processes, including several inflammatory mediators, elicited by TBI. Since one OL extends processes to several axons, the protection of OLs is an important therapeutic target post-TBI. During development, OLs mature from oligodendrocyte progenitor cells (OPCs), also present in the adult brain. The aim of this thesis was to investigate white matter pathology, with a specific focus on the OL population, in experimental and clinical TBI. Since the inflammatory response may contribute to OL cell death and OPC proliferation, neutralization of interleukin-1β (IL-1β) was investigated. The lateral and central fluid percussion injury models were used in mice and rats where memory, learning and complex behaviors were investigated by two functional tests. Brain tissue, surgically resected due to life-threatening brain swelling or hemorrhage, from TBI patients was also investigated. Axonal injury, myelin damage, microglia alterations and OPCs and OL cell death were investigated by immunohistochemical techniques. In focal and diffuse experimental TBI, OL cell death was observed in important white matter tracts. OL cell death was accompanied by myelin damage, axonal injury and presence of microglia as well as an increased number of OPCs in both the experimental and human setting. OPCs were found to proliferate in diffuse TBI in mice where both complex behavioral changes and impaired memory were observed. Neutralization of IL-1β normalized and improved these behavioral alterations and also lead to a preserved number of mature OLs although without influencing OPC proliferation. The results provided in this thesis indicate that white matter pathology is a key component of the pathophysiology of TBI. The OPC proliferation may influence regeneration post-injury and might be an important future therapeutic targets for TBI. The present studies also suggest that treatment strategies targeting neuroinflammation may positively influence behavioral outcome and OL cell death in TBI.(Faculty of Medicine)
11
Bosman, Michelle. "Assessment of the effectiveness of electronic gatekeeping as a utilization management tool at Groote Schuur Hospital." Master's thesis, Faculty of Health Sciences, 2018. http://hdl.handle.net/11427/30151.
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BACKGROUND: Utilization management ensures the appropriateness of laboratory testing by reducing the performance of tests which can be reasonably avoided with no adverse effects for the patient. Electronic gatekeeping, a utilization management tool, was introduced at Groote Schuur in 2010. Criteria were based on the minimum retesting interval, healthcare location, level of experience and discipline of the requesting clinician and specific ICD-10 codes.
METHODS: A retrospective observational study assessing the effectiveness of electronic gatekeeping at Groote Schuur Hospital (Cape Town, South Africa), by comparing the test request volumes by using absolute test numbers and pre-defined ratios in the year prior to gatekeeping, to the two years following implementation. A secondary aim is to apply selected ratios to the other national academic hospitals to determine the potential for cost saving. RESULTS: At the medical wards of Groote Schuur Hospital there was an overall decrease in number and cost of tests of 24% per inpatient day for 2011. The most dramatic difference in cost is seen for chloride (91%) followed by HbA1c (90%), FT3 (89%) and CRP (82%). The application of ratios to Groote Schuur Hospital show a decrease in 2011 in all ratios apart from PCT: FBC+WCC (0.003 vs 0.002) and Mg: Ca (0.86 vs 0.84). AST: ALT remained the same at 0.55. This suggests overall effectiveness of the eGK rules although there is ongoing panel requesting. If the GSH eGK rules were to be applied at all other national academic hospitals, it could translate into a potential cost saving of $13 411 873.96 (R103 196 838.80) per annum.
CONCLUSIONS: Electronic gatekeeping is an effective utilization management tool at Groote Schuur Hospital. It is relatively easy to implement and manage, and when combined with additional tools has the potential to result in larger reductions of unnecessary tests, cost savings and improved patient outcome.
12
Swanepoel, Hendré. "Utility of chloride and adenosine deaminase measurement in cerebrosphinal fluid for the early presumptive diagnosis of tuberculous meningitis." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25438.
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Background: Chloride and adenosine deaminase measurements in cerebrospinal fluid are still sporadically requested as part of tuberculous meningitis work-up. In the literature, evidence is contradictory and opinion is divided on their utility in clinical practice. The accuracy of both for the early presumptive diagnosis of tuberculous meningitis was investigated in patients in a region with high prevalence of tuberculosis and HIV infection in order to inform a decision on whether to continue offering these tests to clinicians. Methods: A retrospective descriptive study of diagnostic accuracy was conducted at the National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa. Data were collected on all cerebrospinal fluid specimens submitted for tuberculosis culture between 1 January 2012 and 31 December 2014. Chloride and adenosine deaminase concentrations were compared with automated liquid culture for Mycobacterium tuberculosis as the reference standard. Findings: There were 2531 cerebrospinal fluid specimens submitted for tuberculosis culture during the study period; exclusion of duplicates yielded 2081 specimens. Chloride was requested on 711 (34·2%) specimens; 44 (6·2%) were tuberculosis culture-positive. Adenosine deaminase was requested on 152 (7·3%) specimens; 20 (13·2%) were culture-positive. Chloride sensitivity (<120 mmol/L) for the detection of tuberculous meningitis was 93·2% (95% confidence interval 81·3-98·6), with specificity 62·4% (58·6-66·1), positive predictive value 14% (10·3-18·6), negative predictive value 99·3% (97·9-99·9), positive likelihood ratio 2·48 (2·18-2·81), and negative likelihood ratio 0·109 (0·037-0·326). Adenosine deaminase sensitivity (>6 U/L) was 70% (45·7-88·1), specificity 89·4% (82·8-94·1), positive predictive value 50% (30·6-69·4), negative predictive value 95·2% (89·8-98·2), positive likelihood ratio 6·6 (3·72-11·7), and negative likelihood ratio 0·336 (0·171-0·657). Interpretation: In this patient population chloride and adenosine deaminase showed at best only modest performance as markers of tuberculous meningitis. However, very good negative predictive values could serve to identify patients highly unlikely to have the disease.
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Haumann, Carel Eduard. "Investigation of an atypical protoporphyric family in South Africa." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/11184.
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Includes bibliographical references (leaves 171-184).Affected members of the family investigated in this dissertation presented with photosensitivity and raised red cell protoporphyrin concentrations, indicative of protoporphyria. Further examination of this family revealed features that were atypical of erythropoietic protoporphyria. These included a highly penetrant disease, disease severity as expressed by more prevalent hepatic complications, a preponderance of protoporphyrin in its zinc chelated form, a therapeutic response to iron supplementation, and an absence of mutations in the ferrochelatase gene or haplotype markers associated with erythropoietic protoporphyria. We have reviewed clinical data from this family, established a ferrochelatase enzyme assay in our laboratory, and shown normal ferrochelatase enzyme activity in affected subjects.
14
Williams, A. Lynn. "Phonology in Clinical Settings: It’s about Time." Digital Commons @ East Tennessee State University, 2004. https://dc.etsu.edu/etsu-works/2023.
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Elmedhem, Abdurrezagh Mansur. "Acute tubulo-interstitial nephritis : clinical profile and pathogenic mechanisms." Thesis, University of Birmingham, 2010. http://etheses.bham.ac.uk//id/eprint/570/.
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Acute tubulointerstitial nephritis (ATIN) is an important cause of renal morbidity. This study showed that it represents up to 8% of acute renal failure where biopsy material was available and accounted for 1% of all renal biopsy material. This study, which is believed to be the largest single retrospective study carried out to date, consists of 78 cases over nineteen years (1984-2002). Forty one cases were males and 37 were females. Acute tubulointerstitial nephritis (ATIN) was divided into three groups according to the cause: drug-induced ATIN, idiopathic ATIN and TINU syndrome. Drug-induced ATIN has come to dominate this area of medicine and in this study it represented 85% of all the cases of ATIN. Comparing the creatinine level at different time points among the the diagnosis groups shows that the creatinine level at presentation was high in patients with drug-induced ATIN compared to patients with TINU syndrome or idiopathic ATIN and the P value was 0.020. Comparison of clinical features investigations with the reversibility of renal function (cr level < 150μmol/l) shows that patients with fever, normal or high haemoglobin level, normal or low potassium level, and normal or low level of phosphate tended to have reversible renal function with P values of 0.021, 0.018, 0.002 and 0.03 respectively. Comparing the result of investigations between the different diagnosis groups showed that the lymphocyte count tended to be lower in drug induced ATIN and TINU syndrome than in idiopathic acute tubulointerstitial nephritis and this difference was statistically significant (P value = 0.026). By one year follow-up, 75% of patients had an improvement in renal function(creatinine level < 150 μmol/l). Comparing the outcome for renal function among the different diagnostic groups showed a significant statistical difference (P values 0.017-30.020). ATIN due to non steroidal anti-inflammatory drugs carried a bad prognosis in comparison to other groups. Histologically, sections of ATIN tissue biopsies showed a strong staining for CD3+ cells, CD4+ cells, CD8+ cells, CD68+ cells, eotaxin, CCR3, VCAM-1, IL-4 and eosinophil proteins. These results suggest that there is a Th 2 type of inflammatory and immune response in acute tubulointerstitial nephritis. Comparison between the infiltrating cells showed no significant difference (P values were between 0.549 and 1.00). Comparison between the infiltrating cells and the renal function outcome shows no relationship. On the other hand, there was a correlation between the CD68 positive cells and the creatinine level at presentation which indicated that there was a tendency for a greater CD68 positive cell infiltration to be associated with a higher creatinine level at presentation, and the P value was 0.003 (r =0.651). Comparison between the index of chronic damage and the reversibility of renal function shows a significant relationship at three months and one year time and the P values were 0.002 and 0.001 respectively (low index of chronic damage associated with low creatinine level). This study also showed no relationship between idiopathic acute tubulointerstitial nephritis and Epstein-Barr virus. This study confirms that ATIN remains an important cause of acute renal failure, that is predominantly drug-related, and that renal biopsy has diagnostic and prognostic significance. Immunological mechanisms are important in pathogenesis with macrophagedependent processes correlating with renal function at presentation. Prognosis is good providing diagnosis and therapeutic intervention occurs before irreversible chronic damage has developed.
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Ali, Asif. "Biomarkers for pancreatic cancer : identification, validation and clinical application." Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/6272/.
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Pancreatic cancer is common and aggressive: the main type is pancreatic ductal adenocarcinoma (PDAC). It is the fifth most common cause of cancer death in the UK with an overall five year survival of only 2-3%. Establishing the diagnosis of PDAC is important for optimal patient management but can be difficult and relies on imaging and cytology/pathology. Although imaging may be highly suggestive of PDAC, a pathological diagnosis is preferred prior to definitive treatment; therefore tissue samples are required. Cytology samples are obtained at endoscopy. Cytological analysis requires the identification of different cell types and in particular the distinction of malignant pancreatic epithelial cells from reactive pancreatic cells and other gastrointestinal contaminants. This requires experience and expertise and can be difficult. A tissue diagnosis is not achieved in a significant proportion of PDAC cases. Hence, an unmet clinical need exists for the diagnosis of PDAC from cytological samples. One potential way of improving the cytological diagnosis is to use immunohistochemistry (IHC) biomarkers as an adjunct to cytology in difficult to diagnose cases. Diagnostic IHC biomarkers have been investigated, but to date none has entered into routine clinical practice. The aim of this study was to improve the diagnosis of PDAC from cytology samples. It is hoped that the identification and validation of IHC biomarkers in PDAC will help their clinical translation. For biomarker identification a meta-analysis of potential IHC diagnostic biomarkers investigated in PDAC was performed. Sixteen biomarkers were quantified in meta-analysis and the highest ranked biomarkers were KOC, maspin, S100P, mesothelin and MUC1. These biomarkers have not entered into clinical practice partly because they were investigated in separate studies with relatively small sample sizes and without a uniform and clinically appropriate cut-off. Biomarkers identified in the meta-analysis were validated in a resection cohort from patients with pancreatico-biliary adenocarcinoma. The aim was to identify better biomarkers and cut-offs that could potentially be investigated in cytology samples. KOC, S100P, mesothelin and MUC1 were investigated in one set of tissue microarrays, while maspin was investigated in another set. Five cut-offs were carefully chosen for sensitivity/specificity analysis using receiver operating characteristics curve analysis. Using 20% positive cells as a cut-off achieved higher sensitivity/specificity values: KOC 84%/100%; S100P 83%/100%; mesothelin 88%/92%; MUC1 89%/63%; and Maspin 96%/99%. Analysis of a panel of KOC, S100P and mesothelin achieved almost 100% sensitivity and specificity if at least two biomarkers were positive for both 10% and 20% cut-offs. Clinical translation of biomarker requires a reliable and reproducible cut-off for interpretation of IHC. We identified three cut-offs for investigation to establish a consensus based cut-off(s) that could potentially be used by pathologists for PDAC and other cancers. A series of IHC images of microarray cores were used to investigate observer agreements for 10%, 20% and +2/+3 cut-offs. Seven pathologists participated in this study. The inter- and intra-observer agreements using the three cut-offs were reasonably good. For all three cut-offs a positive correlation was observed with perceived ease of interpretations (p<0.01 for all cut-offs). Finally, cytoplasmic only staining achieved higher agreement than cytoplasmic/nuclear and cytoplasmic/membranous staining. All three cut-offs investigated achieve reasonable strength of agreement modestly decreasing inter and intra-observer variability in IHC interpretation but 10% is slightly better than 20% and +2/+3 cut-offs. Finally, KOC, maspin, mesothelin and S100P were investigated in archival cytology samples with the aim to generate a diagnostic panel which could potentially help as an adjunct to cytology. Using 10% cut-off achieved higher sensitivity/specificity values: KOC 92%/100%; maspin 54%/100% and mesothelin 72%/100%. But no staining was observed for S100P. In addition, analysis of a panel of KOC, maspin and mesothelin achieved 82% sensitivity and 100% specificity for 10% cut-off if at least two biomarkers in the panel were positive. The inter-observer agreement for 10% positive cells as IHC cut-off in cytology samples was very good for all three biomarkers. In conclusion, a panel of KOC, maspin and mesothelin is a suitable diagnostic panel and 10% cut-off is a reasonable cut-off achieving high observer agreement. Their diagnostic accuracies approach those of optimal conventional cytology. These markers may be appropriate for further clinical validation and potentially routine use in difficult cases.
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Hotaling, Mary. "Effect of clinical laboratory practitioner licensing on wages." ScholarWorks, 2011. https://scholarworks.waldenu.edu/dissertations/860.
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Professional licensing directly affects about 29% of U.S. workers and is considered a primary means to establish and maintain health care practitioner competence. Clinical laboratory practitioner licensing was largely ignored in the literature with only 2 studies 30 years apart that provided conflicting conclusions regarding wage effects. This research provided the first study of clinical laboratory practitioner licensing effects on wages after controlling for human capital and individual characteristics wage determinants. This nonexperimental correlational study extended the literature on licensing effects on wages, including women's wages and professions not uniformly licensed across 50 states. The theoretical foundation relied on the human capital wage model that wages vary according to human capital investment, namely education and experience. Census 2000 5% Public Use Microdata Sample provided wages and control variable data, including educational attainment, experience, gender, marital status, and children. Using hierarchical regression analysis, this study found clinical laboratory practitioner wages were significantly higher (5.8%) in licensing states compared to nonlicensing states after controlling for these human capital and individual characteristics, R 2change (p < .001). Female clinical laboratory practitioners working in licensing states earned significantly higher wages (5.0%) compared to those in nonlicensing states, R 2change (p < .01). This study has potential for positive social change in clinical laboratory practitioner licensing policy development, implementation, and analysis by providing urgently needed empirical wage data for legislators to make informed decisions on costs to adopting such legislation.
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Mirabile, I. "Prion pathology in the brainstem : clinical target areas in prion disease." Thesis, University College London (University of London), 2012. http://discovery.ucl.ac.uk/1346475/.
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Prion diseases are fatal transmissible neurodegenerative disorders characterized by spongiform changes, neuronal loss, reactive astrocytosis, and deposition of disease associated prion protein (PrP). Our aim was to investigate "clinical target areas" for prion disease, responsible for disease onset, progression, and the clinical phenotype, using PrP overexpressing MloxP and PrP depleted NFH-Cre/MloxP transgenic mouse lines. Upon infection with different prion strains NFH-Cre/MloxP mice have significantly longer survival than MloxP mice (first set of experiments: Me7, ~29 weeks vs. ~17 weeks; Mouse-adapted BSE , ~33 weeks vs. ~20 weeks; second set of experiments: RML, ~35 weeks vs.12 weeks; Me7 ~29 weeks, vs. ~17 weeks; MRC2 ~31 weeks vs. ~22 week). As we found that the first pathological changes in the brains of Me7 and Mouse–adapted BSE infected mice are localized in the brainstem, and clinical signs of prion disease point to brainstem failure, we quantitatively scored spongiosis, abnormal PrP accumulation and astrogliosis at early and late stage of disease in specific brainstem nuclei of RML and Me7 infected MloxP and NFH-Cre/MloxP mice. The first target areas showing abnormal PrP accumulation and gliosis in both prion infections are the locus coeruleus (LC), the nucleus of the solitary tract (NTS) and the pre-Bötzinger complex (PBC). We then studied the pathology progression, scoring prion pathology in these and other brainstem nuclei of infected MloxP and NFH-Cre/MloxP mice in the course of the disease. We show that neural degeneration in the LC, NTS, and PBC correlate with clinical signs characteristic of terminally ill mice. We therefore propose that these areas are potential clinical target areas of prion disease. We also studied the spatial and temporal characteristics of Cre-mediated recombination. With immunohistochemistry in reporter mice, we estimated that in the LC, NTS, and PBC, Cre-mediated recombination is 60% or lower, and this can explain why mice proceed to terminal stage of the disease. In NFH-Cre/MloxP mice we found that recombination is a progressive event and in the hippocampus it is complete by 5 weeks post-natally, differently from previous data. Finally, we produced anti PrP RNAi –encoding lentivirus which could be used as focal therapy in the clinical target areas we propose.
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GUALA, ANDREA. "Mathematical modelling of cardiovascular fluid mechanics: physiology, pathology and clinical practice." Doctoral thesis, Politecnico di Torino, 2015. http://hdl.handle.net/11583/2615064.
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The cardiovascular apparatus is a complex dynamical system that
carries oxygen and nutrients to cells, removes carbon dioxide and
wastes and performs several other tasks essential for life. The
physically-based modelling of the cardiovascular system has a long
history, which begins with the simple lumped Windkessel model by
O. Frank in 1899. Since then, the development has been impressive
and a great variety of mathematical models have been proposed.
The purpose of this Thesis is to analyse and develop two different mathematical models of the cardiovascular system able to
(i) shed new light into cardiovascular ageing and atrial fibrillation
and to (ii) be used in clinical practice. To this aim, in-house codes
have been implemented to describe a lumped model of the complete
circulation and a multi-scale (1D/0D) model of the left ventricle
and the arterial system. We then validate each model. The former is validated against literature data, while the latter against
both literature data and numerous in-vivo non-invasive pressure
measurements on a population of six healthy young subjects.
Afterwards, the confirmed effectiveness of the models has been
exploited. The lumped model has been used to analyse the effect
of atrial fibrillation. The multi-scale one has been used to analyse the effect of ageing and to test the feasibility of clinical use
by means of central-pressure blind validation of a parameter setting unambiguously defined with only non-invasive measurements
on a population of 52 healthy young men. All the applications
have been successful, confirming the effectiveness of this approach.
Pathophysiology studies could include mathematical model in their
setting, and clinical use of multi-scale mathematical model is feasible.
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Smurzynski, Jacek. "New Clinical Applications of Otoacoustic Emissions." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/2158.
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Wenham, Philip R. "Multiple forms of γ-glutamyltransferase." Thesis, University of Edinburgh, 1985. http://hdl.handle.net/1842/19404.
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Williams, A. Lynn. "Making Phonology Functional: Assessment and Intervention in Clinical Settings." Digital Commons @ East Tennessee State University, 2003. https://dc.etsu.edu/etsu-works/2024.
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Williams, A. Lynn. "Making Phonology Functional: Assessment and Intervention in Clinical Settings." Digital Commons @ East Tennessee State University, 2000. https://dc.etsu.edu/etsu-works/2025.
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Innes, David Findlay. "The value of the autopsy in clinical medicine." Master's thesis, University of Cape Town, 1993. http://hdl.handle.net/11427/26604.
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The main purpose of this study was to assess the value of the autopsy in clinical medicine today. This has been achieved by analysing several variables. Clinical diagnostic accuracy was determined by assessing the concordance/discrepancy of clinical and autopsy diagnoses. In addition, several variables were assessed, namely whether or not the size of the hospital, type of ward, autopsy rate, age of the patient, and degree of confidence with which the clinical diagnosis was made had any bearing on the accuracy of the diagnosis. The impact of the newer diagnostic tests on clinical diagnosis was also assessed to confirm or refute the widely held opinion amongst clinicians that diagnostic advances have indeed reduced the need for autopsies. The attitudes of pathology registrars and consultants towards the autopsy were analysed, using a questionnaire proposed by Stubbs et al.
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Akin, Faith W., and Owen D. Murnane. "ASHA Perspectives: Clinical Assessment of Otolith Function." Digital Commons @ East Tennessee State University, 2009. https://dc.etsu.edu/etsu-works/1794.
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The two otolith organs (the saccule and utricle) are positioned perpendicular to each other and sense linear acceleration, head tilt, and gravity, with the primary role of providing input to the vestibulospinal reflex for postural stability. The vestibulospinal reflex serves to modulate posture via two descending pathways that aid in tonic contractions of the antigravity muscles in the arms and legs (lateral vestibulospinal tract) and activate neck motoneurons for the coordination of neck and eye movements (medial vestibulospinal tract). The lateral vestibulospinal tract receives the majority of its input from the otoliths and the cerebellum, whereas the medial vestibulospinal tract receives the majority of its input from the semicircular canals.
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Akin, Faith W. "Clinical Perspectives in Audiology: Cervical Vestibular Evoked Myogenic Potentials." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etsu-works/2442.
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This session was developed by Special Interest Division #6: Hearing & Hearing Disorders. Cervical vestibular evoked myogenic potentials (cVEMP) supplement the current vestibular test battery by providing diagnostic information about saccular and/ or inferior vestibular nerve function. The session will provide background, recording method, and clinical application of the cVEMP
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Joseph, Shari. "The neuropsychological risk factors associated with borderline pathology in children." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0006/MQ44192.pdf.
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Dronik, T. A. "Clinical markers of gastrointestinal disorders in newborns who have undergone perinatal pathology." Thesis, БДМУ, 2022. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/19797.
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Giori, L. "IDENTIFICATION OF NEW BIOMARKERS AND INNOVATIVE ANALYTICAL METHODS IN VETERINARY CLINICAL PATHOLOGY." Doctoral thesis, Università degli Studi di Milano, 2012. http://hdl.handle.net/2434/168079.
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Since laboratory tests are becoming more and more important in the diagnostic process even in the veterinary clinical practice, a specialist, able to manage the quality of the amount of work inside the laboratory itself, becomes a must.
The main challenge for the clinical pathologist, when introducing instruments or new methods in the laboratory, is the “validation phase” to ensure that all the results show the real clinical condition of the patient rather than the variable analytical nature of the test itself.
Diagnostic test or instrument validation is composed of four steps, including both the evaluation of analytical performances and the actual applicability and utility of the test/instrument in clinical practice.
The general purpose of this thesis has been to investigate some methods and instruments, through analytical validation studies regarding one or more of the 4 steps of validation process, for which information about the applicability on animal samples does not exist or is very rare. We have also looked for new molecules/techniques that could improve the performances of the traditional ones, especially considering the potential elements that would improve them. In particular, research activities have been focused to three main objectives, respectively directed to the three more studied macro areas of the clinical pathology: hematology, biochemistry and urinalysis. Specifically, the more extensive analytical and biological validation was focused on paroxonase (PON1) a new and promising acute phase reactant that would act as a fast negative acute phase proteins.
Moreover, through two sequential studies, we addressed the first step of the validation process (analytical validation) for quantitative and qualitative evaluation of proteinuria.
Other studies were focused on biological validation, in selected clinical conditions, of new hematological parameters provided by laser-based instruments or of biochemical markers. Specifically we validate an instrumental approach that might be a useful preliminary screen for detecting leukemia in dogs; we validate the possible role of high fluorescent fractions of platelets in Norfolk terriers with macrothrombocytopenia; we validate a new “GE” gate to be used in breeds with “grey eosinophils” that are underestimated by traditional instrumental hematological approaches.
As regards hematological parameters, the analytes that were already validated by others for which we investigate the biological role in veterinary laboratories were: SAA in foals after strong exercise; AGP in atypical forms of FIP and CK isoenzymes in horses.
This thesis demonstrates the importance to maintain and establish rigorous processes of validation both for analytes/methods newly introduced in clinical practice and for analytes/methods that are currently used. Only through this process of analytical and biological validation it is possible to discover novel diagnostic applications of traditional approaches (as for hematological analyzers in our case) but also to define both the advantages and the limitations of traditional diagnostic approaches that could provide unreliable results when applied to selected clinical conditions.
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Murnane, Owen D. "Clinical Assessment of Otolith Organ Function." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/1930.
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Arnold, Amanda, Lisa Phillips, Lindsay Pickler, Whitney White, Amanda McCamey, and Christopher McCrea. "Voice Onset Time as a Clinical Indicator of Hypofunctional Voice Disorders." Digital Commons @ East Tennessee State University, 2008. https://dc.etsu.edu/etsu-works/1960.
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The purpose of this study was to measure and compare the voice onset times (VOTs) of healthy individuals using a normal and breathy voice in an effort to determine if VOT can be used as a noninvasive clinical indicator of laryngeal function. Recordings were made of 20 adults between the ages of 20-48 with normal laryngeal function, each using a normal (Group 1) and breathy voice (Group 2). The participants’ productions were designed and collected in such a manner to control for speaking rate, vowel context, pitch, and loudness; all of which have been shown to influence VOT. A mixed analyses of variance showed that hypofunctional productions demonstrated longer VOTs across all stop consonants when compared to normal productions. Within the stops, a significant difference between the voiced and voiceless stops was noted, although no gender differences were found. It was concluded that VOT can be used as an indirect clinical indicator of laryngeal function.
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Williams, A. Lynn, and T. Boggs. "Efficacy in Clinical Education: Comparison of Supervisory Models." Digital Commons @ East Tennessee State University, 2000. https://dc.etsu.edu/etsu-works/2100.
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Basich, Dinko. "The role of IL-4Rá in Nippostrongylus brasiliensis-induced chronic lung pathology." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/13437.
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Includes bibliographical references (leaves 108-126).Infection by the parasitic nematode Nippostrongylus brasiliensis involves migration through the lungs, causing significant damage and generating chronic lung pathology. The resolution of N. brasiliensis infection and also the induction of pulmonary pathology, including goblet cell hyperplasia and acute airway inflammation, depend on IL-4Rá signalling. A key feature of IL-4Rá signalling is the induction of a strong TH2 response which induces the development of alternatively activated macrophages (AAMs). AAMs are associated with tissue remodelling and the control of exacerbated inflammation. In order to investigate potential roles for IL-4Rá in N. brasiliensis' induced lung pathology, we infected mice deficient for IL-4Rá on macrophages and neutrophils (LysMCreIL-4Rá-/lox), IL-4Rá -/- and control mice (IL-4Rá-/lox) with N. brasiliensis and examined lung pathology at days 5, 42 and 180 post infection (p.i.).All three mice strains showed similar emphysemic-like pathology (alveolar dilatation) and airway hyperresponsiveness (AHR) which was well developed by day 42 p.i. and remained chronic. However, LysMCreIL-4Rá-/lox mice consistently demonstrated earlier and increased pulmonary inflammation when compared to IL-4Rá-/lox control mice and IL-4Rá-/- mice. Immunological studies at day 5 p.i. revealed that there were increased CD4+ and CD8+ T-cell numbers and increased CD4+ IL-4 and IL-13 production in the lungs of LysMCreIL-4Rá-/lox mice when compared to control and IL- 4Rá-/- mice. LysMCreIL-4Rá-/lox mice also showed decreased pulmonary arginase activity, indicative of a reduction of AAMs. RNA transcript analysis of isolated alveolar macrophages showed a strong association with promoting inflammation in LysMCreIL-4Rá-/lox mice. Together these data demonstrate that IL-4Rá-responsive macrophages control pulmonary inflammation and play an important protective role in the lung following N. brasiliensis infection.
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Reece, Benjamin K. "Facilitating collaborative supervision in a university speech-language pathology clinic." Scholarly Commons, 2020. https://scholarlycommons.pacific.edu/uop_etds/3667.
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Clinical education is a key element of graduate school training in the field of speech-language pathology. Graduate students are required to obtain 375 supervised clinical practice hours in order to earn their provisional license and begin their career. Supervision of clinical hours is most often provided by experienced speech-language pathologists with minimal, if any, training in effective supervision practices.
Within the field of speech-language pathology, Anderson’s Continuum of Supervision (Anderson, 1988) is the most widely accepted model and provides a structure and sequence for supervisors to follow in order to facilitate the clinical development of their student clinician. Anderson’s model suggests that the collaborative supervision style should be used to transition student clinicians from directive supervision (where they are reliant on the supervisor for direction) to self-supervision, which represents independence. Despite this, and because of a lack of evidenced-based methods and a lack of training opportunities, many supervisors have difficulty implementing the collaborative supervision style. This study examines the effectiveness of an external tool, the Clinician’s Hierarchy for Advancing Treatment (CHAT) (Duthie, 2008), in helping supervisors to implement the collaborative supervision style.
This is an exploratory quantitative, quasi-experimental non-equivalent groups study. Students and supervisors were surveyed about their perceptions of the supervisory process following their participation in a semester-long clinical practicum in a university speech-language pathology clinic. Prior to working with a second cohort of students, the supervisor group was trained on the CHAT. This method features a chart which objectively defines levels of client performance and corresponding levels of clinical supports needed for the client to advance in treatment. Supervisors were trained to use this tool to guide student clinicians in the clinical decision-making processes. Implementation of the CHAT occurred across the following semester in the same university clinic with a new group of student clinicians. Supervisors and students were again surveyed at the end of the semester on their experience of the supervisory process to determine if the perception of collaborative supervision had increased with the implementation of the CHAT.
The Supervisory Relationship Measure (Pearce et al., 2013) and the Supervisory Relationship Questionnaire (Palomo et al., 2010) were used to survey the student clinicians and supervisors, respectively. Independent-samples, one-tailed t-tests were conducted to determine if there was a significant increase in the perception of collaborative supervision. These analyses were conducted using the Safe Base Subscale score from the surveys, of which items focus on the interactions and relationship between the supervisor and the student clinician as they relate to collaboration. Analysis resulted in insufficient evidence to suggest an increase in the perception of collaborative supervision from the first semester (without CHAT) to the second semester when CHAT was implemented. Additional analyses were also conducted on items that were considered particularly salient to collaborative supervision. Results of item-level analyses were marginally significant for two items from the supervisor surveys, both of which queried the supervisor’s perception of the student’s level of openness and honesty in supervisory conferences.
These findings suggest that using an external tool such as the CHAT, may result in student clinicians being more open and honest about their experience of the clinical process in the supervisory conference. It is argued that the objectivity of the external tool prompts more objective conversation between the supervisor and student clinician. The increase in objective conversation, in turn, decreases the judgment and evaluation that students often associate with supervision, thereby creating a safer environment in which to voice their honest reflections.
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Fagelson, Marc, and David M. Baguley. "Hyperacusis and Disorders of Sound Intolerance: Clinical and Research Perspectives." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu_books/190.
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Hyperacusis and Disorders of Sound Intolerance: Clinical and Research Perspectives is a professional resource for audiology practitioners involved in the clinical management of patients who suffer from sound tolerance concerns. The text covers emerging assessment and intervention strategies associated with hyperacusis, disorders of pitch perception, and other unusual processing deficits of the auditory system. In order to illustrate the patients perspectives and experiences with disorders of auditory processing, cases are included throughout.
This collection of diagnostic strategies and tools, evidence-based clinical research, and case reports provides practitioners with avenues for supporting patient management and coping. It combines new developments in the understanding of auditory mechanisms with the clinical tools developed to manage the effects such disorders exert in daily life. Topics addressed include unusual clinical findings and features that influence a patient s auditory processing such as their perceptual accuracy, recognition abilities, and satisfaction with the perception of sound. Hyperacusis is covered with respect to its effects, its relation to psychological disorders, and its management. Hyperacusis is often linked to trauma or closed head injury and the text also considers the management of patients with traumatic brain injury as an opportunity to illustrate the effectiveness of interprofessional care in such cases.
Interventions such as cognitive behavioral therapy, self-efficacy training, and hearing aid use are reported in a way that enhances clinicians' ability to weave such strategies into their own work, or into their referral system. Hyperacusis and Disorders of Sound Intolerance illuminates increasingly observed auditory-related disorders that challenge students, clinicians, physicians, and patients. The text elucidates and reinforces audiologists contributions to polytrauma and interprofessional care teams and provides clear definitions, delineation of mechanisms, and intervention options for auditory disorders.https://dc.etsu.edu/etsu_books/1210/thumbnail.jpg
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Cunningham, M., Faith W. Akin, Owen D. Murnane, C. Clinard, and J. Tampas. "The Clinical Evaluation Of Bilateral Vestibular Loss." Digital Commons @ East Tennessee State University, 2006. https://dc.etsu.edu/etsu-works/1896.
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Akin, Faith W., Owen D. Murnane, and T. Medley. "Clinical Application of Vestibular Evoked Myogenic Potentials." Digital Commons @ East Tennessee State University, 2002. https://dc.etsu.edu/etsu-works/1910.
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Mohammed, Mohammed Zubair Khuder. "Pre-clinical development of human apurinic/apyrimidinic endonuclease (APE1) inhibitors for cancer therapy." Thesis, University of Nottingham, 2011. http://eprints.nottingham.ac.uk/13980/.
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Modulation of DNA base excision repair (BER) has the potential to enhance response to chemotherapy and improve outcomes in tumours such as melanoma, glioma and pancreatic cancer. APE1, a critical protein in BER that processes potentially cytotoxic abasic sites (AP sites), is a promising new target in cancer. In the current study, my aim was to develop small molecule inhibitors of APE1 for cancer therapy. An industry-standard high throughput virtual screening strategy was adopted. The SYBYL8.0 (Tripos, St Louis, MO, USA) molecular modelling software suite was used to build inhibitor templates. Similarity searching strategies were then applied using ROCS 2.3 (Open Eye Scientific, Santa Fe, NM, USA) to extract pharmacophorically related subsets of compounds from a chemically diverse database of 2.6 million compounds. The compounds in these subsets were subjected to docking against the active site of the APE1 model, using the genetic algorithm-based programme GOLD2.7 (CCDC, Cambridge, UK). Predicted ligand poses were ranked on the basis of several scoring functions. The top virtual hits with promising pharmaceutical properties underwent detailed in vitro analyses using fluorescence-based APE1 AP-site cleavage assays and counter screened using endonuclease IV AP-site cleavage assays, fluorescence quenching assays and Whole cell extract AP-site cleavage assays. Biochemical APE1 inhibitors were then subjected to detailed cytotoxicity analyses. Several specific APE1 inhibitors were isolated by this approach. The IC50 for APE1 inhibition ranged between 50 nM and 25 µM. I also demonstrated that APE1 inhibitors lead to accumulation of AP sites in genomic DNA and potentiated the cytotoxicity of alkylating agents in melanoma, glioma and pancreatic cancer cell lines. I have also shown that APE1 inhibitors induce delay in cell cycle progression and caused delay in cancer cell growth. I also demonstrated that APE1 knockdown by shRNA results in decrease cancer cell growth and enhanced cell killing by alkylating agent in Glioma cell line. This PhD project provides evidence that APE1 is an emerging drug target and could have therapeutic application in patients with melanoma, glioma and pancreatic cancer.
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Cardozo, Karin. "Speech-Language Pathology Interns’ Perceptions of What Supervisors Value Most During Clinical Practicum." FIU Digital Commons, 2015. http://digitalcommons.fiu.edu/etd/2276.
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The purpose of this investigation was to analyze interns’ perceptions of what supervisors considered important supervisory behaviors and to compare those perceptions with what the supervisors considered important. Participants consisted of 33 interns and 23 supervisors. Results of two surveys collected in previous studies were compared and analyzed. Tihen’s (1983) “Tihen’s Student Expectations of their Clinical Supervisor(s) Scale” was used for the intern group. A modified version of the same scale was used for the supervisor group. The scale rated five domains: passive, evaluative, active, cooperative, and affective.
Results revealed that interns ranked perceptions of what supervisors considered important supervisory behaviors as less important than what supervisors rated them. Supervisors rated all domains significantly higher than interns. Both groups considered the active domain to be the most important category and the passive domain to be the least important. Groups differed in their rankings for the affective, evaluative, and cooperative domains.
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Namati, Eman, and eman@namati com. "Pre-Clinical Multi-Modal Imaging for Assessment of Pulmonary Structure, Function and Pathology." Flinders University. Computer Science, Engineering and Mathematics, 2008. http://catalogue.flinders.edu.au./local/adt/public/adt-SFU20081013.044657.
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In this thesis, we describe several imaging techniques specifically designed and developed for the assessment of pulmonary structure, function and pathology. We then describe the application of this technology within appropriate biological systems, including the identification, tracking and assessment of lung tumors in a mouse model of lung cancer.
The design and development of a Large Image Microscope Array (LIMA), an integrated whole organ serial sectioning and imaging system, is described with emphasis on whole lung tissue. This system provides a means for acquiring 3D pathology of fixed whole lung specimens with no infiltrative embedment medium using a purpose-built vibratome and imaging system. This system enables spatial correspondence between histology and non-invasive imaging modalities such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET), providing precise correlation of the underlying 'ground truth' pathology back to the in vivo imaging data. The LIMA system is evaluated using fixed lung specimens from sheep and mice, resulting in large, high-quality pathology datasets that are accurately registered to their respective CT and H&E histology.
The implementation of an in vivo micro-CT imaging system in the context of pulmonary imaging is described. Several techniques are initially developed to reduce artifacts commonly associated with commercial micro-CT systems, including geometric gantry calibration, ring artifact reduction and beam hardening correction. A computer controlled Intermittent Iso-pressure Breath Hold (IIBH) ventilation system is then developed for reduction of respiratory motion artifacts in live, breathing mice. A study validating the repeatability of extracting valuable pulmonary metrics using this technique against standard respiratory gating techniques is then presented.
The development of an ex vivo laser scanning confocal microscopy (LSCM) and an in vivo catheter based confocal microscopy (CBCM) pulmonary imaging technique is described. Direct high-resolution imaging of sub-pleural alveoli is presented and an alveolar mechanic study is undertaken. Through direct quantitative assessment of alveoli during inflation and deflation, recruitment and de-recruitment of alveoli is quantitatively measured. Based on the empirical data obtained in this study, a new theory on alveolar mechanics is proposed.
Finally, a longitudinal mouse lung cancer study utilizing the imaging techniques described and developed throughout this thesis is presented. Lung tumors are identified, tracked and analyzed over a 6-month period using a combination of micro-CT, micro-PET, micro-MRI, LSCM, CBCM, LIMA and H&E histology imaging. The growth rate of individual tumors is measured using the micro-CT data and traced back to the histology using the LIMA system. A significant difference in tumor growth rates within mice is observed, including slow growing, regressive, disappearing and aggressive tumors, while no difference between the phenotype of tumors was found from the H&E histology. Micro-PET and micro-MRI imaging was conducted at the 6-month time point and revealed the limitation of these systems for detection of small lesions ( < 2mm) in this mouse model of lung cancer. The CBCM imaging provided the first high-resolution live pathology of this mouse model of lung cancer and revealed distinct differences between normal, suspicious and tumor regions. In addition, a difference was found between control A/J mice parenchyma and Urethane A/J mice normal parenchyma, suggesting a 'field effect' as a result of the Urethane administration and/or tumor burden. In conclusion, a comprehensive murine lung cancer imaging study was undertaken, and new information regarding the progression of tumors over time has been revealed.
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Barnett, Sue. "The clinical effectiveness of orthoses prescribed to control and reduce diabetic foot pathology." Thesis, University of the West of England, Bristol, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.249150.
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Anokhina, A. "Implicit attitudes towards food and the self in sub-clinical eating disorder pathology." Thesis, University College London (University of London), 2015. http://discovery.ucl.ac.uk/1464573/.
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This thesis focuses on the assessment of implicit cognition in disordered eating behaviour, and specifically on the role of implicit attitudes towards the self and food in sub-clinical levels of eating disorder (ED) pathology. Chapter I reviews key theoretical approaches to implicit cognition and an assessment of the properties of implicit attitudes. Chapter II discusses methodological approaches to implicit attitude assessment, with a focus on the Implicit Attitude Test (IAT) which was used in the empirical studies. Chapter III (Study 1) outlines research in implicit cognition in ED pathology and assesses differences in implicit self-esteem (i.e., implicit attitude towards the self) between high-pathology and low-pathology participants. While the results of the study supported the presence of a self-esteem discrepancy in the high-pathology group, the findings were insufficient to pursue further research in this area. The next three studies were focused on the role implicit food attitudes. Chapter IV (Study 2) introduces the hypothesis that implicit food attitudes and ego depletion may play a role in elevated ED pathology. However, the ego depletion procedure used was not successful and the results were therefore insufficient to either support or reject the hypothesis. Chapter V (Study 3) assessed similar questions to Study 2, but from the angle of automatic approach and avoidance towards food stimuli and dietary restraint failure. Contrary to expectations, the results suggested that it is unlikely that either ego depletion or a positive implicit attitude towards high-fat foods contributes to dietary restraint failure. Chapter VI (Study 4) was designed to clarify the findings of Study 3 and found that implicit food attitudes may change following novel goal activation or changes in behaviour. Chapter VII is a general discussion which summarises the findings, discusses the outcomes within the broader context of implicit cognition theories, and proposes directions for further study.
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Start, Roger David. "Attitudes towards autopsy." Thesis, University of Sheffield, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.285544.
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McAllister, Sue Margery. "Competency based assessment of speech pathology students' performance in the workplace." University of Sydney, 2005. http://hdl.handle.net/2123/1130.
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Doctor of Philosophy (PhD)Ensuring that speech pathology students are sufficiently competent to practise their profession is of critical importance to the speech pathology profession, students, their future employers, and clients/patients. This thesis describes the development and validation of a competency based assessment of speech pathology students’ performance in the workplace and their readiness to enter the profession. Development involved an extensive literature review regarding the nature of competency and its relationship to professional practice, the purpose and nature of assessment, and the validation of performance assessments. An online and hard copy assessment tool (paper) was designed through integrating multiple sources of information regarding speech pathology and assessment of workplace performance. Sources included research, theory, expert opinion, current practice, and focus group consultations with clinical educators and speech pathology students. The resulting assessment tool and resource material included four generic components of competency (clinical reasoning, professional communication, lifelong learning, and professional role) and seven occupational competencies previously developed by the speech pathology profession. The tool comprised an assessment format, either in a booklet or online, for clinical educators to rate students’ performances on the competencies at mid and end placement using a visual analogue scale. Behavioural descriptors and an assessment resource booklet informed and supported clinical educators’ judgement. The validity of the assessment tool was evaluated through a national field trial and using Messick’s six interrelated validity criteria which address content, substantive, structural, generalisability, external, and consequential aspects of validity (Messick, 1996). The validity of the assessment tool and its use with speech pathology students was evaluated through Rasch analysis, parametric statistical evaluation of relationships existing between information yielded by the Rasch analysis and other factors, and student and clinical educator feedback. The assessment tool was found to have strong validity characteristics across all validity components. Item Fit statistics generated through Rasch analysis ranged from .81 to 1.17 strongly upholding that the assessment items sampled a unidimensional construct of workplace competency for speech pathology students and confirming that generic and occupational competencies are both necessary for competent practice of speech pathology. High Item and Person Reliabilities (analogous to Cronbach’s alpha) were found (.98 and .97 respectively) and a wide range of person measures (-14.2 to 13.1) were generated. This indicated that a large spread of ability and a clear hierarchy of development on the construct was identified and that the assessment tool was highly reliable. This was further confirmed by high Intra Class Correlation coefficients for a small group of paired clinical educators rating the same student in the same workplace (.87) or in different workplaces concurrently (.82). Rasch analysis of the visual analogue scale used to rate student performance on 11 items of competence identified that clinical educators were able to reliably discriminate 7 categories or levels of student performance. This, in combination with careful calibration procedures, has resulted in an assessment tool that Australian Speech Pathology pre-professional preparation programs can use with confidence to place their students’ level of workplace competence into 7 zones of competency, with the seventh representing sufficient competence to enter the profession. The assessment tool also showed strong potential for identifying marginal students and for future use in promoting quality teaching and learning of professional competence. Limitations to the research and the tool validity were discussed, and recommendations made regarding future research. First, the clinical educator, who has dual and possibly conflicting roles as facilitator and assessor of student learning, made the assessment. Second, situating the assessment in the real workplace limits the students’ opportunities to demonstrate competence to those that naturally arise in the workplace. Paradoxically, both these factors also contributed to the validity of the assessment tool. It was recommended that the assessment tool be revised on the basis of the information gathered from the field trial, that further data be collected to ensure a broader proportional representation of speech pathology programs, to investigate possible threats to validity as well as those areas for which the tool showed promise. This research developed the first prototype of a validated assessment of entry level speech pathology competence that is grounded in a unified theoretical conception of entry level competence to the profession of speech pathology and the developmental progression required to reach this competence. This research will assist the profession of speech pathology by ensuring that speech pathologists enter the workplace well equipped to provide quality care to their future clients, the ultimate goal of any professional preparation program. Messick, S. (1996). Validity of performance assessments. In G. W. Phillips (Ed.), Technical Issues in Large-Scale Performance Assessment (pp. 1-18). Washington: National Centre for Education Statistics.
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Algahtani, Mohammad. "Development of platelet function analysis for use in haematological and clinical investigations." Thesis, University of Nottingham, 2016. http://eprints.nottingham.ac.uk/33393/.
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Platelets are highly specialised cells that play a pivotal role in the regulation of haemostasis and thrombosis. Accurate measurement of platelet function is important in identifying patients with platelet abnormalities: for example, platelet hyperfunction, which may result in hyperthrombotic risk, or platelet hypofunction, which may lead to enhanced bleeding. Also, accurate measurement is becoming crucial for assessing the adequacy of treatment with antiplatelet therapy. Platelet function testing to assess the efficacy of antiplatelet drugs is becoming widely used and a range of assays has been developed. However, assays such as Light Transmittance Aggregometry (LTA), VerifyNow and Multiplate Electrode Aggregometry (MEA) are cumbersome for regular clinical use and have many limitations. Only a limited number of assays offer the advantage of assessing multiple platelet activation pathways simultaneously. In this thesis, I describe the development of a 96-well plate-based assay carried out in whole blood, where flow cytometry is used concomitantly to assess platelet aggregation (measured as the decrease in number of single platelets in the blood) together with platelet leucocyte conjugate (PLCs) formation, using lysing and non-lysing conditions (fluorescence triggering) – both measurements performed on the same fixed sample of whole blood. First, this thesis evaluates the effect of blood volume and different fixation approaches, double fixation flow cytometry (DFF) and single fixation Ultra-Flo 100 (SFU), on measuring platelet aggregation in whole blood. The smallest blood volume that was appropriate to study platelet aggregation was 125µl. Both fixation methods were shown to be highly comparable. The preliminary results revealed the suitability of using the 96-well plate format to evaluate the platelet response to a range of different platelet agonists. The second part of this thesis explores the suitability of the 96-well plate format to study platelet aggregation, and to assess inhibition, using aspirin and the P2Y12 antagonist, cangrelor. The 96-well plate format has successfully demonstrated dose-dependent inhibition of adenosine diphosphate (ADP)-induced platelet aggregation with cangrelor and of arachidonic acid (AA)-induced platelet aggregation with aspirin, except when using high concentrations of AA. The apparent failure of aspirin to inhibit AA-induced platelet aggregation at a high concentration could have been due to the fact that endogenous ADP, which may have leaked from red blood cells (RBCs), may have overcome the inhibition. Dual antiplatelet therapy, using aspirin in conjunction with cangrelor, has confirmed this explanation and also demonstrated that more inhibition is obtained when antiplatelet agents are used in pairs. When the glycoprotein (GP) IIb/IIIa antagonist MK-0852 was used to block the final aggregation pathway, it failed to achieve a complete inhibition of platelet aggregation, when measured using the single platelet counting technique. This could be due to the binding of platelets to leucocytes, as demonstrated previously by our group. To investigate whether it was PLCs formation that was responsible for the decrease in the number of single platelets in the presence of MK-852, platelet leucocyte interaction was studied using lysing and non-lysing approaches, based on a 96-well plate format. The findings demonstrated that PLCs formation in the presence of MK-0852 tends to increase, especially platelet-monocyte conjugate formation. As expected, there was inhibition of PLCs formation with KPL-1, an agent that blocks P-selectin glycoprotein ligand-1 (PSGL-1) on leucocytes, to which P-selectin binds. In this regard, thrombocytopenia, which sometimes occurs after administration of a GPIIb/IIIa antagonist, and the accompanied increase in mortality, could be thereby explained and also implies a potential limitation to the use of GPIIb/IIIa antagonists. The final part of this thesis focused on the possibility of studying more than one platelet function and the effect of antiplatelet therapy. PLC formation can be measured using fluorescence triggering to capture the leucocyte population, instead of lysing RBCs, to avoid manipulation of the cells. The results have indicated that the use of more than one antiplatelet agent can achieve more inhibition by blocking more activation pathways than a single antiplatelet agent. In conclusion, 96-well plate methods have shown the advantage of assessing multiple platelet activation pathways using a small volume of whole blood. This method has the advantage of using only one sample of fixed whole blood to assess both aggregation and PLCs formation. Moreover, development of this assay can also be useful to testing the effects of new compounds on platelet function.
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Williams, A. Lynn, Jan Edwards, Benjamin Munson, Amy Glaspey, and Shelley Velleman. "Assessment of Speech Sound Disorders: Clinical Decision Making." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/2055.
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This session is developed by, and presenters invited by Speech Sound Disorders in Children. A case-based approach will be used to assess the complexity of SSD through assessment and analysis measures that guide clinical decisions regarding differential diagnosis, intervention planning, and progress monitoring.
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Johnson, Robyn Bethany. "We all hate the ‘F’ word, but some speech pathology students do fail clinic: can this difficulty developing clinical competence be predicted?" Thesis, The University of Sydney, 2021. https://hdl.handle.net/2123/25468.
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All speech pathology (SP) students in Australia must achieve entry-level clinical competence at the end of their degrees to graduate and enter the profession. Little is known about predictors of competence development.
This thesis describes three reviews and four studies investigating predictors of the difficulty developing competence some students experience, with Astin’s Input-Environment-Output (I-E-O) model as a conceptual framework. A mixed methods approach was used to answer the questions informed by the narrative review: What input and environment factors contribute to students’ difficulty developing competence at different program stages (Output)? Is there value in screening the communication skills of first year students to identify any who may have difficulty developing competence?
A systematic review on predictors of successful entry to health professions identified predictors across professions and degree types: students’ discipline knowledge, academic skills, and test-taking ability. A scoping review in SP students found similar but inconsistent predictors.
A two part quantitative study investigated this and other input and environment predictors of difficulty developing competence, for third (Study 1) and final year (Study 2) students. Both input and environment predictors were identified, different for at risk and failing students at both levels. The screener identified most of the input predictors.
Key input factors can be identified by a first year communication screener. A two part qualitative study investigated the views of staff (Study 3) and students (Study 4) on the value of such a screnner. Both staff and final year students valued such a screener.
Predictors of students likely to have difficulties developing competence can be identified early in an undergraduate program. As it is possible to identify students who may have difficulty developing competence before placements begin, future research should investigate effective ways to support them.
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Black, Deborah Naomi. "Familial leukoencephalopathy in Chisasibi, Nouveau Québec : clinical epidemiological, and genetic aspects." Thesis, McGill University, 1986. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=61267.
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Two distinct patterns of neurological disease have been identified among Cree Indian children in Chisasibi, Nouveau Quebec and among Native Indian infants in Northern Manitoba. Both affect the cerebral white matter. The fifteen patients in the first group may suffer from an autosomal recessive defect causing defective development of cerebral myelin. The eleven patients in the second group have systemic immune dysfunction and meningoencephalitis. Together, these diseases are responsible for over half the deaths of infants and young children in Chisasibi. Inbreeding, and the familial occurrence of cases, suggest a genetic cause in both groups, in whom no gestational or perinatal causes can be identified. The first disease pattern may be due to hypomyelination of the central nervous system. The etiology of the second group may be a genetic susceptibility to viral infection.
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Smurzynski, Jacek. "Otoacoustic Emissions: Recent Advances in Research and in Clinical Applications." Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/2164.
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Williams, A. Lynn, R. Epperly, J. R. Rodgers, and L. Feltes. "Treatment Efficacy in Phonological Intervention: Clinical Case Studies." Digital Commons @ East Tennessee State University, 1999. https://dc.etsu.edu/etsu-works/2102.
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