Dissertations / Theses on the topic 'Disease;Definition of disease;Explication of Disease'

Disease is ubiquitous. Disease afflicts humans. It afflicts animals. It afflicts plants. People refer to disease in their everyday conversation. Newspapers comment upon it. Parliaments enact legislation regarding it. Novelists write about it. Artists depict it. Physicians, veterinary surgeons and agriculturalists seek to combat it. Insurance companies offer reimbursement against it. Anthropologists study it. Philosophers debate its nature, and dictionaries define it. Disease looms large in human consciousness. One might presume that, since disease is so important in daily life, human beings would know exactly what they mean by it. Most people seem to believe instinctively that they understand the nature of disease, and that their ideas about it coincide with other people's ideas. The definition of disease therefore arouses little controversy in everyday conversation. People use the word disease as readily as they use the words spade, or table or nose. They suggest, when they joke that somebody calls a spade a spade, that the nature of the implement used to dig the garden is so obvious that it requires no further definition. Similarly with a table or a nose. They might debate how many legs a table must have, but-regardless of the answer-rarely deny that it is a table; whilst every human must surely know what a nose is. This high level of agreement about so many commonly used terms perhaps creates an assumption that the meaning of disease is equally obvious and requires no further analysis. Is this, however, really the case? Disease is a somewhat less concrete phenomenon than is a spade or a table or a nose. Its existence, most would agree, is incontrovertible, but its nature is less clear. It is something that seems to befall people and animals and plants. It rarely serves any useful purpose. It often carries dire implications. It is something that most of us would prefer not to have, but rarely succeed in avoiding. It commonly comes unannounced and at inconvenient times. It usually causes distress, but not always. It can have a fatal outcome. Some people appear more prone to it that others. It sometimes sweeps through whole populations producing social devastation, but its manifestations vary. Some diseases affect a person's whole body, others merely a part of the body; some affect some parts of the body, others other parts. Some diseases only affect humans, whereas others affect both humans and animals. Some spread from animals to humans, others from humans to humans, and others still do not appear to spread at all. Some diseases affect plants, and few that affect plants seem to affect humans, but some humans can acquire diseases when they come into contact with plants that appear to have no diseases. Any reasonable analysis of the nature of disease must account for all these aspects and many others also. The nature of disease is a topic that has attracted the attention of physicians, scientists and philosophers over millennia. The close association that existed between medicine and philosophy in the classical Egyptian, Palestinian and Greek eras ensured that scholars who flourished in those societies examined the nature of disease. Comparable developments occurred in classical Indian and Chinese civilizations. The natural philosophers of Renaissance and post-Renaissance Europe divided into competing schools of thought over the nature of disease. More recent years have witnessed an enormous flourishing of physicians, pathologists, and agriculturalists who study aspects of disease that relate to their individual disciplines. Most of these researchers have, however, examined ever-narrower aspects of specific diseases-such as manifestations, mechanisms and causes-rather than the generic nature of the phenomenon. Some contemporary philosophers, on the other hand, have become interested in general aspects of the topic. They have proposed a number of novel ideas and reached some stimulating conclusions, although they can hardly yet claim to have reached a consensus. This lack of unanimity presumably implies that the issues involved require closer analysis if a formulation is to emerge that most of them can accept. The object of the present thesis is to undertake such an analysis. It will start by outlining in this introduction the general background to the topic. It will then detail the more noteworthy of previously proposed theories about the nature of this phenomenon, classifying them according to their most prominent components, and assessing their several strengths and weaknesses. It will next discuss the specific philosophical issues of definition, causation, and explication in the biomedical context, before suggesting a comprehensive, but succinct, definition that acknowledges many older views about disease, encompasses current usage, and provides a theoretical base from which to work into the future. It will finally test the strengths and weaknesses of that definition to account for observed phenomena and to accommodate some former definitions.

Disease is ubiquitous. Disease afflicts humans. It afflicts animals. It afflicts plants. People refer to disease in their everyday conversation. Newspapers comment upon it. Parliaments enact legislation regarding it. Novelists write about it. Artists depict it. Physicians, veterinary surgeons and agriculturalists seek to combat it. Insurance companies offer reimbursement against it. Anthropologists study it. Philosophers debate its nature, and dictionaries define it. Disease looms large in human consciousness. One might presume that, since disease is so important in daily life, human beings would know exactly what they mean by it. Most people seem to believe instinctively that they understand the nature of disease, and that their ideas about it coincide with other people�s ideas. The definition of disease therefore arouses little controversy in everyday conversation. People use the word disease as readily as they use the words spade, or table or nose. They suggest, when they joke that somebody calls a spade a spade, that the nature of the implement used to dig the garden is so obvious that it requires no further definition. Similarly with a table or a nose. They might debate how many legs a table must have, but�regardless of the answer�rarely deny that it is a table; whilst every human must surely know what a nose is. This high level of agreement about so many commonly used terms perhaps creates an assumption that the meaning of disease is equally obvious and requires no further analysis. Is this, however, really the case? Disease is a somewhat less concrete phenomenon than is a spade or a table or a nose. Its existence, most would agree, is incontrovertible, but its nature is less clear. It is something that seems to befall people and animals and plants. It rarely serves any useful purpose. It often carries dire implications. It is something that most of us would prefer not to have, but rarely succeed in avoiding. It commonly comes unannounced and at inconvenient times. It usually causes distress, but not always. It can have a fatal outcome. Some people appear more prone to it that others. It sometimes sweeps through whole populations producing social devastation, but its manifestations vary. Some diseases affect a person�s whole body, others merely a part of the body; some affect some parts of the body, others other parts. Some diseases only affect humans, whereas others affect both humans and animals. Some spread from animals to humans, others from humans to humans, and others still do not appear to spread at all. Some diseases affect plants, and few that affect plants seem to affect humans, but some humans can acquire diseases when they come into contact with plants that appear to have no diseases. Any reasonable analysis of the nature of disease must account for all these aspects and many others also. The nature of disease is a topic that has attracted the attention of physicians, scientists and philosophers over millennia. The close association that existed between medicine and philosophy in the classical Egyptian, Palestinian and Greek eras ensured that scholars who flourished in those societies examined the nature of disease. Comparable developments occurred in classical Indian and Chinese civilizations. The natural philosophers of Renaissance and post-Renaissance Europe divided into competing schools of thought over the nature of disease. More recent years have witnessed an enormous flourishing of physicians, pathologists, and agriculturalists who study aspects of disease that relate to their individual disciplines. Most of these researchers have, however, examined ever-narrower aspects of specific diseases�such as manifestations, mechanisms and causes�rather than the generic nature of the phenomenon. Some contemporary philosophers, on the other hand, have become interested in general aspects of the topic. They have proposed a number of novel ideas and reached some stimulating conclusions, although they can hardly yet claim to have reached a consensus. This lack of unanimity presumably implies that the issues involved require closer analysis if a formulation is to emerge that most of them can accept. The object of the present thesis is to undertake such an analysis. It will start by outlining in this introduction the general background to the topic. It will then detail the more noteworthy of previously proposed theories about the nature of this phenomenon, classifying them according to their most prominent components, and assessing their several strengths and weaknesses. It will next discuss the specific philosophical issues of definition, causation, and explication in the biomedical context, before suggesting a comprehensive, but succinct, definition that acknowledges many older views about disease, encompasses current usage, and provides a theoretical base from which to work into the future. It will finally test the strengths and weaknesses of that definition to account for observed phenomena and to accommodate some former definitions.

The goal of the work presented herein was to further our understanding of Bovine Leukocyte Antigen (BoLA) class I diversity of Holstein cattle and develop tools to measure class I restricted T cell responses to intracellular pathogens such as foot and mouth disease virus (FMDV) following vaccination. BoLA is a highly polymorphic gene region that allows the bovine immune system to differentiate pathogen-infected cells from healthy cells. Immune surveillance by CD8+ T cells plays an important role in clearing viral infections. These CD8+ T cells recognize BoLA class I molecules bearing epitopes (antigenic peptides) of intracellular origin in their peptide binding groove. Polymorphisms in the peptide binding region of class I molecules determine affinity of peptide binding and stability during antigen presentation. Different antigen peptide motifs are associated with specific genetic sequences of class I molecules. In order to better understand the adaptive immune response mediated by BoLA molecules, technologies from human medicine such as high-throughput sequencing, biochemical affinity and stability assays, tetramers and IFN-γ ELIspot assays could be applied. Therefore, it was hypothesized that we can translate these technologies from the study of human T cell responses to the study of cattle immunity. The first objective was to establish a comprehensive method for genotyping BoLA of Holstein cattle by using Illumina MiSeq, Sanger sequencing and polymerase chain reaction sequence-specific primers (PCR-SSP) (See Chapter 2). This is an important first step in order to study the BoLA restricted immune responses following FMDV vaccination. The second objective was to define the FMDV capsid protein peptide repertoire bound by BoLA class I molecules using bioinformatics and biochemical affinity and stability assays to facilitate the identification of T cell epitopes (See Chapter 3). The third objective was to demonstrate clonal T cell expansion for specific epitope polypeptides using ex-vivo multi-color flow cytometric MHC-epitope complexes (tetramers), followed by IFN-γ production measured by an ELIspot assay to quantify and define the antigen specific response of Holstein cattle to FMDV vaccination (see Chapter 4). In this, my dissertation studies aimed to improve our understanding of the BoLA class I restricted T-cell responses to candidate FMDV vaccines in Holstein cattle. In this manner, my research will improve animal health through the production of assays for characterizing the bovine immune response to intracellular pathogens and enhance vaccine design leading to improved biologicals to protect cattle from devastating infectious diseases.

In this work we introduce the Wishart Distributed Matrices Multiple Order Classification (WISDoM) method. The WISDoM Classification method consists of a pipeline for single feature analysis, supervised learning,cross validation and classification for any problems whose elements can be tied to a symmetric positive-definite matrix representation. The general idea is for informations about properties of a certain system contained in a symmetric positive-definite matrix representation (i.e covariance and correlation matrices) to be extracted by modelling an estimated distribution for the expected classes of a given problem. The application to fMRI data classification and clustering processing follows naturally: the WISDoM classification method has been tested on the ADNI2 (Alzheimer's Disease Neuroimaging Initiative) database. The goal was to achieve good classification performances between Alzheimer's Disease diagnosed patients (AD) and Normal Control (NC) subjects, while retaining informations on which features were the most informative decision-wise. In our work, the informations about topological properties contained in ADNI2 functional correlation matrices are extracted by modelling an estimated Wishart distribution for the expected diagnostical groups AD and NC, and allowed a complete separation between the two groups.

Background: Inflammation is the natural reaction of the body to an antigen. In some conditions, this reaction continues even after the elimination of the antigen, entering a chronic stage; it targets normal cells of the body and causes extensive damage. Rheumatoid arthritis (RA) is such a condition. It associates with significant metabolic alterations that lead to changes in body composition and especially body fat (BF) increases. In the general population, increased body fat (i.e. obesity) associates with a number of health disorders such as systemic low grade inflammation and a significantly increased risk for cardiovascular disease (CVD). Both effects of obesity could have detrimental effects in RA. Increased inflammation could worsen disease activity while obesity could further increase the already high CVD risk in RA. However, obesity in RA has attracted minimal scientific attention. Aims: The present project aimed to: 1) assess whether the existing measures of adiposity are able to identify the changes in body composition of RA patients, 2) if necessary develop RA-specific measures of adiposity, 3) investigate the association of obesity with disease characteristics and CVD profile of the patients, 4) and identify factors that might affect body weight and composition in these patients. Methods: A total of 1167 volunteers were assessed. Of them 43 suffered from osteoarthritis and 82 were healthy controls. These, together with 516 RA patients were used in the first study. Their body mass index (BMI), BF, and disease characteristics were assessed. In the second, third, fourth and fifth studies a separate set of 400 RA patients was assessed. In addition to the above assessments, their cardiovascular profile and more detailed disease characteristics were obtained. For the final study, 126 RA patients were assessed for all the above and also data on their physical activity levels and their diet were collected. Results: Assessments of adiposity for the general population are not valid for RA patients. Thus, we proposed RA-specific measures of adiposity. These are able to better identify RA patients with increased BF. We were also able to find associations between obesity and disease activity. Both underweight and obese RA patients had more active disease compared to normal-weight patients. Obese patients had significantly worse CVD profile compared to normal-weight. The newly devised measures of adiposity were able to identify those at increased risk. However, not all obese individuals were unhealthy and not all normal-weight healthy. Among our patients we were able to identify subtypes of obesity with distinct phenotypic characteristics that warrant special attention. Finally, we were able to identify factors that influence body weight and composition. Cigarette smoking protected against obesity while its cessation associated with increased adiposity. Physical activity was also found to be protective against obesity while diet or inflammation of the disease failed to produce any significant results. Conclusions: Obesity is a significant threat to the health of RA patients. The measures of adiposity developed herein should be used to identify obese RA patients. Physical activity seems like the sole mode for effective weight management in this population. Health and exercise professionals should actively encourage their patients to exercise as much as they can. This study has created more questions than it answered; further research in the association of obesity and inflammation, as well as in ways to treat it, is essential.

This study analyzes the travel conventions manifest in the engravings of the thirty-volume Description de l’Egypte produced as a result of the Napoleonic campaign to Egypt in 1798 and published between 1809 and 1828. The first chapter examines the discourse established on Egypt in travelogues throughout the eighteenth century prior to the invasion of the country. I argue that the perceptions developed around the country did not stem from actual experience, but from political and economic motivations that cast Egypt in a light favorable for occupation. I examine how this perception was challenged during the collapse of distance between the French and Egyptians in the process of colonial encounter. Drawing upon medical records and proclamations of the French medical team in Egypt, I examine a specific epidemic known as ophthalmia that led to swollen, irritated eyes and eventual blindness throughout the French army in Egypt. While it is actually caused by Chlamydia, in every appearance it makes in French medical records throughout the occupation, the disease was blamed on the climate, sunlight, and air specific to the land of Egypt. As a result, I argue that the Description’s hyper-real contrasts of light and dark and amplified decay in its representations of the monuments residing in Egypt’s ravaging climate are determined by the manner vision itself was altered by the epidemic of ophthalmia. I then contend that there exists a metaphorical parallel between the decaying pharaonic monuments in the Description and the perceived decay of modern Egyptian society that are linked by misconceptions of Egypt’s climate. I conclude that the effect of Egypt’s climate believed to destroy both physical monuments and physiological disposition was used as evidence to support the larger agenda of French imperialism that justified colonization of Egypt. Lastly, this study examines how Egyptians counteracted the negative discourse of their race by appropriating symbols of their country used in European representations and altering them to develop a national identity. Tracing the time period from French occupation through British colonization, Egyptians were able to galvanize resistance while still working within the confines of colonial control.

In this essay, I go through the different parts that compile my degree project. I have explored the power of graphic design for educational purposes. During my process, I have found a new area of graphic design, respectful design. Something that can be briefly described as design created with the greatest reverence for conveying a difficult subject without diminishing the affected person behind. An approach where one works closely with the involved and frequently checks in, so that nothing is portrayed incorrectly. This along with the constant search for information makes up the basics of respectful design. The disease ME has finally begun to be talked about in society. But the way the disease is portrayed can be argued as incorrect in relation to the bigger picture. As a graphic designer I have analyzed the problem and worked out a possible solution. My conclusion is that strong colors mixed with melancholy and straightforward information can make the subject less heavy and easier to handle. This can open the senses to problem solving and understanding instead of stopping at pity. The aim of the project has been to get away from these dark quilts that the media has placed on us. The goal was to create something that does not hide the awfulness of the disease but informs in a more fun and more inviting way. I strongly believe that graphic design can reduce the social stigma around a topic if done properly. When life is the toughest it has helped me and (after the response of the exhibition) others to learn more about our disease. Above all, if more people know more about the disease, ME- patients will get help. Hopefully society will open it’s arms so that no more people are forced to choose suicide.
I denna uppsats går jag igenom de olika delarna som sammanställer mitt examensprojekt. Jag har i grunden utforskat kraften av grafisk design i utbildningssyfte. Under min process har jag kommit fram till ett nytt område inom grafisk design, respektfull design. Detta går kort att beskriva som design utformat med största vördnad inför att förmedla ett svårt ämne utan att förminska den drabbade människan bakom. Respektfull design innebär att man jobbar nära med inblandade, kollar av hela tiden så att inget porträtteras felaktigt och läser på om ämnet så långt det går. Sjukdomen ME har äntligen börjat talas om i samhället. Men sättet sjukdomen porträtteras kan argumenteras som svartvitt och felaktigt gentemot helhetsbilden. Som grafisk designer har jag analyserat problemet och jobbat fram en möjlig lösning. Min slutsats är att starka färger blandat med melankolisk och rak information kan göra ämnet mindre tungt och mer lätthanterligt. Detta kan öppna sinnena för problemlösning och förståelse istället för att stanna vid medlidande. Syftet med projektet har varit att komma ifrån detta mörk täcke som media lagt över oss. Målet var att skapa något som inte döljer det hemska med sjukdomen men informerar på ett roligare och mer inbjudande sätt. Jag tror stark på att grafisk design kan minska det sociala stigmat runt ett ämne om det görs på rätt sätt. När livet är som tuffast har det hjälpt mig och (efter respons av utställningen) också andra med att utbilda och läsa på. Framför allt om fler vet mer om sjukdomen kommer det att gå att få bättre hjälp. Förhoppningvis öppnar samhället sina armar så att inte fler tvingas till att välja självmord.

Although the female menopause has been extensively characterized as a well-defined symptomatic state of oestrogen deficiency, which responds relatively well to oestrogen replacement therapy, the symptomatic state of androgen deficiency in men is poorly defined and uncertainty exists whether it responds to testosterone replacement. It has been proposed that hypothalamic-pituitary-testicular (HPT)-axis function (responsible for the production of androgens) and regulation could be viewed as a ‘barometer’ of health status in older men and that potential alterations in HPT-axis function and regulation reflect subclinical and clinical deficits in function and health, which may result in an aged phenotype of human health and disease in older men. The HPT-axis constitutes a well-defined, tractable, clinically-relevant, biological system, which may permit insight into the mechanisms underlying the expression of ageing-related phenotypes of human health and disease. By using a different lens – such as the genetic background; the compensatory responses within the HPT-axis; the syndromes of androgen deficiency; the ethnic background of an individual or the life course trajectory of function and health from conception into older age – to magnify potential dysregulation in the HPT-axis will it be possible to visualize and understand the phenotypic expression of human male ageing as a gradient of functional and health outcomes. This will allow for a better understanding of the physiological mechanics underlying symptomatic expression of dysregulation in the HPT-axis.

L’imagerie scintigraphique des cancers thyroïdiens différenciés (CTD) présente la particularité d’utiliser deux radiopharmaceutiques, l’iode 131 (131I) et le 18-Fluorodésoxyglucose (18FDG). La fixation de ces traceurs dépend habituellement du degré de différenciation et de l’agressivité de la tumeur. L’objectif de ce travail était d’étudier l’apport de différents aspects techniques et d’instrumentation, à savoir l’imagerie hybride par TEMP/TDM et TEP/TDM, la point-spread function (PSF), la taille des voxels et la technologie TEP digitale, et d’explorer si d’autres traceurs TEP pouvaient présenter un intérêt. Le but de la première partie était d’étudier les performances de la TEP/TDM au 18FDG à l’étage cervical pour la détection de la maladie ganglionnaire. Une acquisition TEP/TDM dédiée a amélioré la détection de la maladie tumorale par rapport à l’acquisition classique. L’utilisation de la PSF a permis de détecter des tailles de lésions plus petites et la durée optimale de cette acquisition a été évaluée. Des reconstructions avec des tailles de voxels ultra-fines ont été réalisées sur TEP digitale pour étudier l’impact de la PSF et des voxels ultra-fins sur les données quantitatives. La seconde partie a porté sur l’imagerie 131I-TEMP/TDM et 18FDG-TEP/TDM, afin de quantifier le volume de la maladie persistante. Il a ainsi été montré que la masse tumorale était corrélée au risque post-opératoire et avait un impact sur la réponse au traitement. L’objectif de la troisième partie était d’étudier un autre traceur TEP, la 18-Fluorocholine (FCH), ainsi qu’un marqueur de la néovascularisation, l’antigène membranaire spécifique de la prostate (PSMA). Nos données suggèrent qu’un examen TEP à la FCH négatif au sein d’un nodule thyroïdien à cytologie indéterminée permettrait d’éliminer la malignité, et pourrait éviter des chirurgies inutiles. Par ailleurs, le marquage au PSMA évalué par immunohistochimie dans les néo-vaisseaux est associé à des facteurs de mauvais pronostic. D’autres études sont nécessaires pour confirmer l’intérêt éventuel des examens TEP à la FCH et au 68Ga-PSMA en oncologie thyroïdienne
Radioiodine (131I) and 18-Fluorodeoxyglucose (18FDG) are two radiopharmaceuticals used for scintigraphic imaging in differentiated thyroid cancers (DTC). Tumour uptake of each tracer depends on tumour differentiation and aggressiveness. Our goal was to further assess various technical aspects in DTC imaging workup, such as SPECT/CT and PET/CT, point-spread function (PSF), voxel size, digital PET, and to explore further other PET tracers. The aim of the first part was to assess the performance of 18FDG PET/CT for the detection of neck lymph node involvement. A dedicated PET/CT acquisition improved tumour detection compared to the whole-body acquisition. PSF reconstruction allowed detection of smaller cancer deposits and the optimal acquisition duration time was assessed. Using digital PET acquisitions, ultra-thin voxels reconstructions were performed. The impact of ultra-thin voxels and PSF on quantitative values was evaluated. The second part focused on 131I-SPECT/CT and 18FDG-PET/CT imaging, in an attempt to assess tumour burden of persistent disease. Tumor burden was correlated with the postoperative risk and affected the response to therapy. In the third part, another PET tracer, i.e. 18-Fluorocholine (FCH), and a marker of neovasculature, i.e. prostate-specific membrane antigen (PSMA), were studied. FCH PET/CT offered high negative predictive value to reliably exclude cancer in PET-negative nodules with indeterminate cytology and might prevent unnecessary surgeries. Also, PSMA expression assessed with immunohistochemistry was associated with poor prognosis factors. Further studies are needed to confirm new insights of FCH PET and 68Ga-PSMA PET in DTC

碩士
國立陽明大學
生物醫學資訊研究所
103
Background Quality of medical care has been gaining more and more attention in the past years. Application of Clinical practice guidelines are a useful way to improve the quality of care. To make it more effective, we need clinical practice guidelines incorporate medical procedures, enabling us to offer a diagnosis of the patient. However, it is not easy to read the paper guidelines, because it is full of obstacles in a clinical setting. Therefore, it would be more useful for integrating medical informatics systems by using the computer-based clinical guidelines. Previous studies have shown that computer-based guidelines can improve clinical outcomes significantly. To make effective use of clinical practice guidelines, principles of computer-based research becomes even more important nowadays. Aim For long, the medical informatics domain has lacked a clinical standard for adequately integrating EHR with the computer-based clinical guideline. openEHR is an open standard specification in health informatics established by the University College London and Ocean Informatics Pty Ltd from UK and Australia corporately. They developed the archetype to represent clinical knowledge and used Guideline Definition Language (GDL) to express clinical guideline. In this way they enhance the interoperability of semantic. Our aim is to build clinical practice guideline using openEHR technology including archetypes and GDL. Method There were three stages in this study. The first stage focused on organizing the clinical guideline as well as identifying the clinical concepts and rules within it. We used Chronic Kidney Disease (CKD) guideline as material. The second stage was to search for the existing archetype and develop the new archetype. The last stage was to model guideline and validation. A focus group discussion was conducted for better understand the feasibility of GDL. Result Ten CKD anemia guidelines were represented by GDL. These computer-based guidelines were based on 11 public archetypes and 12 newly created archetypes. We carried out a focus group study with 16 physicians and 22 IT staffs. After discussion we sorted out two topics. One is about separates the opinion of knowledge from information; another is about feasibility of GDL into information system. Conclusion This study utilized openEHR guideline definition language to build the clinical practice guideline of chronic kidney disease. Using archetype and GDL to represent the guidelines as well as clinical knowledge within it. The result of this study can be a foundation for the integration of EHR and the computer-based clinical guideline.

Thomas Watkins studied a specialised type of white blood cell called a T cell, which are primarily responsible for the defence against foreign microbes. During his PhD, he characterized and defined numerous different T cell populations throughout the human body in both healthy and disease models.

In partial fulfilment of the requirements for the degree Masters of Arts in Clinical Psychology, 2006.
The purpose of this research was to describe the experience of working with patients with HIV/AIDS, in particular performing caesarean sections, from a medical practitioner's perspective. A phenomenological study method was employed in which each participant used in the research was interviewed in a single session. The original sample consisted of 9 participants. They were selected by means of criterion sampling from the gynaecology and obstetrics department of different public hospitals in Johannesburg, Pretoria and Cape Town. Six protocols were selected for phenomenological explication based on the interviews with the 9 original participants. The sample consisted of 3 females and 3 males, from different cultural backgrounds, who regularly perform surgical gynaecological procedures on patients with HIV/AIDS. The results were presented in the form of an integrative text, which accounted for all of the individual variations of the experience of working with patients with HIV/AIDS. Out of this text the researcher explicated natural meaning units, specific to each participant, which were used in formulating a specific description of experiencing the performance of a caesarean section on a patient with HIV/AIDS. This study concluded with a discussion of the results, as well as a formulation of a general description of experiencing the performance of caesarean sections on patients with HIV/AIDS for all 6 participants. Overall, this research explicated unique descriptions of individual experiences, and contributes to a general understanding of the experience of performing a caesarean section on a patient with HIV/AIDS. Operational definitions • Phenomenology - A department of the inductive sciences concerned with the facts that form the basis of its system. • Caesarean section - A mode of childbirth in which a surgical incision is made through a pregnant woman's abdomen and uterus to deliver a baby. • Human Immunodeficiency Vinis- A retrovirus that attacks and severely damages the body's immune system and for which there is presently no cure. • Life-wortd- The space occupied by any one person in the external, physical world, as well as the internal lived-in world, consisting of emotions and cognitions.

碩士
國立中興大學
獸醫學系暨研究所
105
Degenerative myxomatous mitral valve disease (MMVD) is the most common canine heart disease. The prevalence is higher in small-breed dogs. MMVD is characterized by chronic myxomatous mitral valve degeneration resulting in thickening and incomplete apposition of the valve leaflets during systole with secondary mitral regurgitation (MR) and congestive heart failure (CHF) eventually. Mechanical alternans is a phenomenon of alternating strong and weak beats with a constant beat-to-beat interval. The phenomenon has been recognized in patients with CHF. The purpose of the study is to investigate the prevalence and the interaction with CHF of mechanical alternans in small-breed dogs with MMVD using High-Definition Oscillometry (HDO) device (HDO®). In the present study, 22 small-breed dogs diagnosed with MMVD were included which examinations by using HDO device, by which blood pressures and pulse waveforms (via software) can be recorded, were performed at the same visit. The degree of CHF were classified according to the American College of Veterinary Internal Medicine (ACVIM) recommendations for dogs with MMVD. Twelve patients (54.6%) showed mechanical alternans, and there is an increasing trend in the prevalence of mechanical alternans with increasing CHF classes according to Cochran-Armitage trend test (p<0.05). When taking treatment into account, 3 of 8 patients (37.5%) without treatment showed mechanical alternans, and besides the same increasing trend, there is significant difference in CHF classes between groups with and without mechanical alternans according to Fisher’s exact test (p<0.05). In conclusion, the present of mechanical alternans can be detected by using HDO device, and small-breed dogs with mechanical alternans had higher CHF classes.

Platonic Craft and Medical Ethics examines the Platonic theory of craft and shows its application to different ethical problems in medicine, both ancient and modern. I begin by elucidating the Platonic use of the term “craft” or “technē”, using especially the paradigmatic craft of medicine, and explicate a number of important principles inherent in his use of the term. I then show how Plato’s framework of crafts can be applied to two ancient debates. First, I show how Plato’s understanding of crafts is used in discussing the definition of medicine, and how he deals with the issue of “bivalence”, that medicine seems to be capable of generating disease as well as curing it. I follow this discussion into Aristotle, who, though he has a different interpretation of bivalence, has a solution in many ways similar to Plato’s. Second, I discuss the relevance of knowledge to persuasion and freedom. Rhetors like Gorgias challenge the traditional connections of persuasion to freedom and force to slavery by characterizing persuasion as a type of force. Plato addresses this be dividing persuasion between sorcerous and didactic persuasion, and sets knowledge as the new criterion for freedom. Finally, I discuss three modern issues in medical ethics using a Platonic understanding of crafts: paternalism, conclusions in meta-analyses and therapeutic misconceptions in research ethics. In discussing paternalism, I argue that tools with multiple excellences, like the body, should not be evaluated independently of the uses to which the patient intends to put them. In discussing meta-analyses, I show how the division of crafts into goal-oriented and causal parts in the Phaedrus exposes the confusion inherent in saying that practical conclusions can follow directly from statistical results. Finally, I argue that authors like Franklin G. Miller and Howard Brody fail to recognize the hierarchical relationship between medical research and medicine when they argue that medical research ethics should be autonomous from medical ethics per se.