Dissertations / Theses: 'Longer-term impacts and outcomes'

1

Fréchette, Sabrina. "Corporal Punishment: National Trends, Longer-Term Consequences, and Parental Perceptions of Physical Discipline." Thesis, Université d'Ottawa / University of Ottawa, 2016. http://hdl.handle.net/10393/35110.

Full text

Abstract:

Corporal punishment is a controversial form of discipline. To inform the debate on corporal punishment, one of the objectives of the current dissertation was to characterize parental use of this disciplinary strategy and to examine its long-term developmental outcomes. The dissertation drew on data from the National Longitudinal Survey of Children and Youth (NLSCY) to understand potential social change in corporal punishment and to characterize parents who continue to use this strategy. Over a 14-year period (1994-1995 to 2008-2009), results revealed a significant decrease in the use of corporal punishment and other negative strategies (e.g., psychological aggression), as well as a significant increase in the use of positive strategies (e.g., reward/praise and explain/teach). Nevertheless, approximately 25% of Canadian parents still use corporal punishment with children aged 2–11 years; therefore, it remains an issue that merits continued attention. While several socio-demographic factors significantly distinguished parents who use corporal punishment, other more dynamic variables may be important to consider, such as parental stress and their attitudes toward corporal punishment. For the outcomes associated with corporal punishment, NLSCY data revealed that experiences of corporal punishment at 2-3 years are associated with increased externalizing behaviours at 8-9 years. Results also indicated that, within a certain disciplinary context (more hostile and punitive parenting), early corporal punishment is associated with increased externalizing behaviours at 14-15 years, increased internalizing behaviours at 8-9 and 14-15 years, and reduced prosocial behaviours at 8-9 and 14-15 years. Overall, results confirmed that corporal punishment represents a small but non-trivial risk factor for child development. The second objective of the current dissertation was to address one of the central limitations of the existing literature on corporal punishment by clarifying what parents self-label as corporal punishment. Using a sample of 338 Canadian caregivers, the study assessed the relation between responses to a general question on corporal punishment and responses to questions on specific physical disciplinary strategies. Predictors (e.g., cultural norms, attitudes toward and childhood experiences of corporal punishment) of this relation were then investigated. Results suggested that questions such as the one used in the NLSCY may reflect parental use of milder forms of corporal punishment. Results also revealed that some caregivers remain undetected by general questions on corporal punishment. Factors such as attitudes toward corporal punishment can help identify those caregivers who use physically punitive strategies but who do not endorse corporal punishment. Results from the current dissertation offers support for the anti-corporal punishment perspective and calls for the de-legitimatization of this disciplinary strategy across society.

APA, Harvard, Vancouver, ISO, and other styles

2

Winter, Joanne. "A mixed methods study exploring the longer term outcomes of 'successful' managed transfers between secondary schools focusing on the students' experience." Thesis, University of Essex, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.605582.

Full text

Abstract:

Managed transfers were first introduced into government guidance in 2004 and are generally recognised as the process of moving disaffected students onto new schools or provisions to avoid permanent exclusion. The local authority involved in this study has experienced a significant increase in the number of managed transfers over the past seven years, with the majority of these taking place in the secondary sector. The aim of this research was to provide the local authority with a better understanding of how these managed transfers were working, focusing on the student's experience. This study utilised a sequential mixed-methods design encompassing both quantitative and qualitative approaches. In the first stage, the quantitative findings provided the local authority with descriptive statistics on the numbers, outcomes, patterns and characteristics of students placed on managed transfers. It highlighted the importance of quantitative data collection for monitoring managed transfers, influencing policy formation and practice. In the second stage of this study, Interpretative Phenomenological Analysis (IPA) was used to analyse six secondary-aged students' experiences of managed transfers to mainstream secondary schools. The findings revealed a number of pertinent themes and issues which, it was hoped, would enable the local authority to improve and build upon current practice. These were identified as: the importance of including and listening to students' voices in the early stages of a managed transfer; the importance of student reflection during a managed transfer; experiences that enabled students to settle into new placements and students' experiences of transformation and change

APA, Harvard, Vancouver, ISO, and other styles

3

Geraci, Angela Ann. "The Impact of Psychosocial Outcomes in Long-Term Bariatric Patients." Diss., North Dakota State University, 2015. https://hdl.handle.net/10365/27937.

Full text

Abstract:

The disease of obesity is a serious and significant public health epidemic affecting more than 78 million Americans. The increase in human life expectancy also increases the chance of reduced quality of life and well-being by those suffering from obesity. Obesity?related factors may mean years of physical and psychosocial discomfort, lack of mobility, and chronic ill health. This study analyzed long-term bariatric patient outcomes, specifically, factors regarding postprocedure weight regain, surgeon follow-up, and psychosocial issues related to quality of life (i.e. self-concept and obesity discrimination). The overarching research design for this study employed survey methods, using a cross-sectional, self-reported questionnaire and enlisted both a combined quantitative and qualitative approach to analyze data. Participants over the age of 18 and at least 18-months post-procedure were recruited either from public bariatric support forums (n = 133) or through a regional weight management center in the Midwest (n = 534), which specializes in bariatric surgery. Results suggests that although some weight regain after surgery is likely, weight regain decreases as a patient continues to maintain adherence to the recommended post-operative diet, as well as the importance of bariatric follow-up and support. Additional results revealed that different aspects regarding the ?self? such as body image, the continued struggle to develop alternative coping strategies to eating, and obesity stigma have an impact for a multitude of years post-bariatric surgery, and therefore can overshadow the benefits of surgery. It is recommended that a critical key to success for long-term bariatric patients is having access and care of multidisciplinary teams including a bariatric surgeon, gastro-intestinal specialist, endocrinologist, nutritionist, and psychiatrist at minimum. Finally, there is also a significant need for long-term bariatric research in the future.

APA, Harvard, Vancouver, ISO, and other styles

4

Hall, Alastair Eaton. "The new survivors : the longer term cognitive, scholastic and motor outcomes of a total Scottish population of surviving very low birthweight infants." Thesis, University of Glasgow, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.366189.

Full text

APA, Harvard, Vancouver, ISO, and other styles

5

Sissons, P. "The longer-term labour market and community impacts of deindustrialisation : a comparison of the Northumberland coalfield and the Monongahela Valley mill towns." Thesis, University College London (University of London), 2009. http://discovery.ucl.ac.uk/15811/.

Full text

Abstract:

The research focuses on the longer-term impacts of past regional deindustrialisation and, more specifically, the ways in which individual and household decisions have interacted with the local public welfare and cultural context to produce profound long-term community changes, critically affecting future generations of workers. It compares the reasons for, and impacts of, these adjustments in two study areas; the Northumberland coalfield in Northeast England, and the Monongahela Valley steel towns of Southwestern Pennsylvania. Very different patterns of initial responses to job losses were observed between the two areas. These may be characterised as a distinction between ‘place-based’ coping mechanisms in Northumberland, where workers adopted strategies which allowed them to remain in place, and the ‘mobility-response’ in the Mon Valley, as large numbers of industrial workers migrated away to seek employment elsewhere. Individual workers decisions were influenced by several factors. Most significant were the types of alternative work available locally, and the opportunities and constraints arising from different public welfare systems, transport infrastructures and education and training systems. Prevailing local cultural attitudes, norms and values, were also crucial in informing opinions. It is found that in the longer-term there has been no self-righting of the labour market. Instead, a new, more troublesome equilibrium has been established. In Northumberland the growth in economic inactivity has created areas where worklessness has become a norm among social networks, influencing the aspirations, motivations and expectations of subsequent generations. This reflects the failure of British public welfare policy to mitigate the place-specific impacts of industrial decline. In contrast, the longer-term impacts of migration from the Mon Valley left a collapsed housing market, creating a social-demographic shift as the former working class population was been replaced by an incoming population more dependent on benefits or marginal employment. This process reflected the broader failures of American social policy.

APA, Harvard, Vancouver, ISO, and other styles

6

Cheung, Him-chun Horace, and 張謙俊. "The impact of POSSUM score on long-term outcome of patients with colorectal cancer." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B45160752.

Full text

APA, Harvard, Vancouver, ISO, and other styles

7

Brännlund, Annica. "Non-market outcomes of education : the long-term impact of education on individuals' social participation and health in Sweden." Doctoral thesis, Umeå universitet, Sociologiska institutionen, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-88369.

Full text

Abstract:

In research, it is typical to analyse and discuss the utility of education in economic terms—specifically the market value of a particular degree or the financial returns associated with additional years in higher education. However, education may also generate outcomes that belong to the non-market sphere, such as open-mindedness, societal cohesion, community involvement, better health, and gender equality; yet these outcomes have received little scholarly attention. The main objective of this thesis, therefore, is to investigate the relationship between education and four non-market outcomes: agency, voice, health behaviour and psychological distress. By utilizing two longitudinal data sets, the Swedish Survey of Living Conditions and the Northern Swedish Cohort, it is possible to assess the long-term effects of education on each of these four non-market outcomes. Results clearly demonstrate that education has a critical impact on each of the outcomes of interest. Having a higher education—and in particular a university degree–enhances individuals’ agency and voice, reduces psychological distress, and improves individuals’ health behaviour. Further, results show that different academic subjects generate field-specific resources. In contrast to a market perspective, where the value of the specific field of study is assessed only in economic terms, results indicate that fields that are commonly viewed as having low market value may actually yield non-economic rewards that benefit individuals in critically important ways. Analyses also show that individual and social factors shape the extent to which education leads to positive outcomes. In terms of agency and voice, results indicate that education can compensate for social differences. Among those with a working class background, earning a university degree contributes to increasing levels of agency and voice, while no significant effects of education exist for those with a white-collar background. Results also demonstrate that the impact of education on psychological well-being differs for men and women. For men, labour market resources (i.e., being employed) was important for reducing psychological distress, while for women social resources (i.e., having a partner) was more important. Due to its use of high quality, longitudinal data, this thesis makes a significant contribution to the scholarly literature and to what we know about the impact of education attainment. A limitation of cross-sectional analyses is that it is difficult to separate causal effects from selection effects. By adopting a longitudinal approach, it is possible to control for earlier (baseline) circumstances and therefore assess the causal impact of education on individual outcomes. This strategy yields robust results that make clear the long-term effects of educational attainment on individuals.

APA, Harvard, Vancouver, ISO, and other styles

8

Chan, Raymond. "A long-term evaluation of the impact of rehabilitation in home (RIO) program on health outcomes in older adults." Thesis, Queensland University of Technology, 2008. https://eprints.qut.edu.au/16623/1/Raymond_Chan_Thesis.pdf.

Full text

Abstract:

Background: Older adults experience health deconditioning during hospitalization. There are many facets of care impacting on older adults' health characteristics and their self confidence in managing their health. The aim of this follow-up study is to examine the long term effect of comprehensive discharge planning and nursing in-home follow-up for older adults (over 65 year old) incorporating physiotherapy exercise strategies on health characteristics. No published studies were located that had examined the impact of a comprehensive discharge program on the functional status and psychosocial among older frail adults at 12 months post-discharge. Design and methodology: Rehabilitation in Older People (RIO program) is a randomised controlled trial which evaluates the intervention of a comprehensive discharge program, exercise program incorporating nursing follow up. Participants of the RIO study were randomly allocated into usual care control group and an intervention group. The intervention group received a comprehensive training from an advanced practice gerontic nurse (APGN) and exercise strategies by physiotherapists. The APGN visited the participants in their home 48 hours post discharge, followed by telephone follow-up at 4, 8, 12 and 24 weeks. This study followed-up this cohort at 12 month via telephone interviews to evaluate their functional ability, quality of life, psychosocial characteristics and the levels of self-efficacy. The General Self-efficacy Scale (GSE) was used to measure their self-efficacy. Results: There is no difference between the demographic and health characteristics between the control and intervention group. There are significant difference in their functional ability, psychosocial health, measured by the tools mentioned above at 4 weeks (p < 0.05), 12 weeks (p < 0.05), and 24 weeks (p < 0.05), but not at 52 weeks. The possible reason could be due to lack of telephone follow up. Moreover, the levels of self-efficacy in this sample have been found to correlate with the functional ability and psychosocial at 12 months after discharge from an acute hospital.

APA, Harvard, Vancouver, ISO, and other styles

9

Chan, Raymond. "A long-term evaluation of the impact of rehabilitation in home (RIO) program on health outcomes in older adults." Queensland University of Technology, 2008. http://eprints.qut.edu.au/16623/.

Full text

Abstract:

Background: Older adults experience health deconditioning during hospitalization. There are many facets of care impacting on older adults' health characteristics and their self confidence in managing their health. The aim of this follow-up study is to examine the long term effect of comprehensive discharge planning and nursing in-home follow-up for older adults (over 65 year old) incorporating physiotherapy exercise strategies on health characteristics. No published studies were located that had examined the impact of a comprehensive discharge program on the functional status and psychosocial among older frail adults at 12 months post-discharge. Design and methodology: Rehabilitation in Older People (RIO program) is a randomised controlled trial which evaluates the intervention of a comprehensive discharge program, exercise program incorporating nursing follow up. Participants of the RIO study were randomly allocated into usual care control group and an intervention group. The intervention group received a comprehensive training from an advanced practice gerontic nurse (APGN) and exercise strategies by physiotherapists. The APGN visited the participants in their home 48 hours post discharge, followed by telephone follow-up at 4, 8, 12 and 24 weeks. This study followed-up this cohort at 12 month via telephone interviews to evaluate their functional ability, quality of life, psychosocial characteristics and the levels of self-efficacy. The General Self-efficacy Scale (GSE) was used to measure their self-efficacy. Results: There is no difference between the demographic and health characteristics between the control and intervention group. There are significant difference in their functional ability, psychosocial health, measured by the tools mentioned above at 4 weeks (p < 0.05), 12 weeks (p < 0.05), and 24 weeks (p < 0.05), but not at 52 weeks. The possible reason could be due to lack of telephone follow up. Moreover, the levels of self-efficacy in this sample have been found to correlate with the functional ability and psychosocial at 12 months after discharge from an acute hospital.

APA, Harvard, Vancouver, ISO, and other styles

10

Funaki, Takeshi. "Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease." Kyoto University, 2015. http://hdl.handle.net/2433/195941.

Full text

APA, Harvard, Vancouver, ISO, and other styles

11

Yamane, Keiichiro. "Impact of Platelet Reactivity on Long-term Clinical Outcomes and Bleeding Events in Japanese Patients Receiving Antiplatelet Therapy with Aspirin." Kyoto University, 2013. http://hdl.handle.net/2433/174767.

Full text

APA, Harvard, Vancouver, ISO, and other styles

12

Kim, Grace Eunhae. "The impact of obesity and age at diagnosis on the chronic quality of life and long-term outcomes of psoriasis patients." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17295917.

Full text

Abstract:

Background: Psoriasis is a chronic inflammatory skin disorder that detracts from quality of life, including elements of physical, psychological, and social functioning. Objective: The purpose of this study was to (1) investigate whether retrospective questions about chronic quality of life (CQoL) were better predictors of poor socioeconomic and medical outcomes than the current Dermatology Life Quality Index (DLQI) and (2) to evaluate the relative impact of body mass index (BMI) and (3) age at diagnosis on the long-term outcomes and CQoL of psoriasis patients. Methods: 114 subjects were examined and asked to complete a self-administered questionnaire regarding disabilities, relationships, education, as well as medical and economic outcomes. Participants also answered the ten questions used in the Dermatology Life Quality Index (DLQI) modified to ask “over the last week,” “over the last year,” and “over your lifetime with psoriasis.” Survey responses were compared amongst BMI groups (normal, overweight, obese) and age-at-diagnosis quartiles. Results: Greater lifetime DLQI (LT DLQI) correlated with lower satisfaction with treatment (P=0.007), greater concern that psoriasis will worsen (P=0.012), worse perceived general health (P=0.003), younger age at which weight became problematic (P=0.002), greater likelihood of believing psoriasis had caused weight gain (P<0.001), shorter retention of current job (P=0.001), more experiences of discrimination at work (P=0.002) and in social settings (P<0.001) over one’s lifetime, and more severe discrimination in social settings over one’s lifetime (P=0.002). Greater LT DLQI predicted more packs smoked per day (P=0.005), greater likelihood of believing psoriasis caused smoking (P=0.012), greater likelihood of recreational drug use (P=0.004), greater likelihood of a depression diagnosis (P<0.001), greater likelihood of having felt depressed (P=0.011), and greater likelihood of believing psoriasis caused depression (P<0.001). Patients with elevated BMI were more likely to rate their general health lower (P<0.001), believe that psoriasis caused their weight gain (P=0.014), experience sleep problems over their lifetime (P=0.016), hide their psoriasis over their lifetime (P=0.010), have their self-confidence affected by their psoriasis over their lifetime (P=0.011), and avoid common activities over their lifetime (P=0.012). Those diagnosed at a younger age were more likely to have a greater LT DLQI (P<0.001), have felt depressed (P=0.003), believe that their psoriasis had caused their depression (P<0.001), experience sleep problems over their lifetime (P=0.004), use recreational drugs (P<0.001), hide their psoriasis over their lifetime (P<0.001), and experience more severe discrimination in social settings over their lifetime (P=0.002). Conclusion: Compared to the standard LW DLQI, LT DLQI was a better predictor of patient outcomes related to weight, discrimination, and depression. While obesity is linked to impaired self-confidence, early-onset psoriasis is associated with depression, social discrimination, and greater LT DLQI. Both BMI and age at diagnosis independently cause a negative effect on sleep quality and recreational drug use.

APA, Harvard, Vancouver, ISO, and other styles

13

Hascoët, Sébastien. "Thérapies avancée de l'hypertension artérielle pulmonaire associée aux cardiopathies congénitales Pumpless Lung Assist as a Bridge to Medical Therapy in a Teenager With Pulmonary Arterial Hypertension and Partial Anomalous Pulmonary Venous Return Transplantation for Pulmonary Arterial Hypertension with Congenital Heart Disease: Impact of Current Therapeutic Approach Including a High-Priority Allocation Programme on Outcomes Outcome of adults with Eisenmenger syndrome treated with drugs specific to pulmonary arterial hypertension: A French multicentre study Long-term outcomesofpulmonaryarterial hypertension underspecific drugtherapyin Eisenmenger syndrome." Thesis, université Paris-Saclay, 2020. http://www.theses.fr/2020UPASQ010.

Full text

Abstract:

Résumé : Les cardiopathies congénitales sont les anomalies congénitales les plus fréquentes. Grâce aux progrès dans la prise en charge chirurgicale, environ 90% des enfants ayant une cardiopathie congénitale vivent désormais jusqu’à l’âge adulte. Néanmoins, l’évolution clinique de ces patients peut être marquée par des complications, dont l’hypertension artérielle pulmonaire. Celle-ci peut se développer secondairement à l’absence ou au retard de prise en charge dans l’enfance ou à des lésions résiduelles. L’hypertension artérielle pulmonaire est associée à un pronostic altéré, essentiellement par défaillance ventriculaire. L’hypertension artérielle pulmonaire chez ces patients se caractérise par la variabilité des aspects hémodynamiques selon les lésions anatomiques sous-jacentes. Sa prise en charge demeure variable, complexe et controversée. La correction de la cardiopathie congénitale sous-jacente est recommandée ou contre-indiquée selon la sévérité de l’hypertension artérielle pulmonaire. Les traitements spécifiques médicamenteux vasodilatateurs pulmonaires pourraient être bénéfiques dans les atteintes les plus évoluées. Les patients avec atteinte terminale pourraient bénéficier de la transplantation cardio-pulmonaire. L’objectif principal de cette thèse a été d’étudier l’impact hémodynamique et sur le pronostic des différentes approches thérapeutiques avancées actuellement disponibles pour la prise en charge de l’hypertension artérielle pulmonaire associée aux cardiopathies congénitales. Ont été étudiés en particulier les traitements médicamenteux spécifiques, la correction du shunt par voie percutanée, l’assistance circulatoire et la transplantation cardio-pulmonaire. Cette thèse a permis de montrer qu’une prise en charge pro-active de l’hypertension artérielle pulmonaire chez les patients ayant une cardiopathie congénitale est associée à une amélioration des paramètres hémodynamiques, des paramètres cliniques et par une amélioration du pronostic. Les résultats de cette thèse invitent à poursuivre le recours aux thérapies avancées et leur évaluation afin d’affiner les algorithmes de prise en charge clinique
Abstract: Congenital heart disease is the most common birth defect. Thanks to advances in surgical management, about 90% of children with congenital heart disease now live to adulthood. Nevertheless, the clinical course of these patients may be marked by complications, including pulmonary arterial hypertension. It may develop secondary to the absence or delay of treatment in childhood or to residual lesions. It is associated with an altered prognosis, primarily due to ventricular failure. Pulmonary arterial hypertension in these patients is characterized by variability in hemodynamic aspects depending on the underlying anatomical lesions. Its management remains variable, complex and controversial. Correction of underlying predisposing congenital heart disease is recommended or contraindicated depending on the degree of severity of pulmonary arterial hypertension. Specific pulmonary vasodilator drug therapies may be beneficial in more advanced disease. Patients with end stage disease may benefit from cardiopulmonary transplantation. The main objective of this thesis was to study the hemodynamic and prognostic impact of the different advanced therapeutic approaches currently available for the management of pulmonary arterial hypertension associated with congenital heart disease. Specific drug therapies, percutaneous shunt correction, circulatory support and cardiopulmonary transplant were studied. This thesis has shown that proactive management of pulmonary arterial hypertension in patients with congenital heart disease is associated with improved hemodynamic parameters, clinical parameters and improved prognosis. The results of this thesis call for further use and evaluation of advanced therapies to refine clinical management algorithms

APA, Harvard, Vancouver, ISO, and other styles

14

Hamy, Anne-Sophie. "Identification of Factors Predicting Sensitivity or Resistance to Neoadjuvant Chemotherapy in Breast Cancer Neoadjuvant treatment : the future of patients with breast cancer Neoadjuvant treatment for intermediate/high-risk HER2-positive and triple-negative breast cancers: no longer an “option” but an ethical obligation Long-term outcome of the REMAGUS 02 trial, a multicenter randomised phase II trial in locally advanced breast cancer patients treated with neoadjuvant chemotherapy with or without celecoxib or trastuzumab according to HER2 status BIRC5 (survivin) : a pejorative prognostic marker in stage II/III breast cancer with no response to neoadjuvant chemotherapy Beyond Axillary Lymph Node Metastasis, BMI and Menopausal Status Are Prognostic Determinants for Triple-Negative Breast Cancer Treated by Neoadjuvant Chemotherapy Pathological complete response and prognosis after neoadjuvant chemotherapy for HER2-positive breast cancers before and after trastuzumab era: results from a real-life cohort The presence of an in situ component on pre-treatment biopsy is not associated with response to neoadjuvant chemotherapy for breast cancer Chemosensitivity, tumor infiltrating lymphocytes (TILs), and survival of postpartum PABC patients treated by neoadjuvant chemotherapy Lymphovascular invasion after neoadjuvant chemotherapy is strongly associated with poor prognosis in breast carcinoma New insight for pharmacogenomics studies from the transcriptional analysis of two large-scale cancer cell line panels Biological network-driven gene selection identifies a stromal immune module as a key determinant of triple-negative breast carcinoma prognosis A Stromal Immune Module Correlated with the Response to Neoadjuvant Chemotherapy, Prognosis and Lymphocyte Infiltration in HER2-Positive Breast Carcinoma Is Inversely Correlated with Hormonal Pathways Stromal lymphocyte infiltration after neoadjuvant chemotherapy is associated with aggressive residual disease and lower disease-free survival in HER2-positive breast cancer Interaction between molecular subtypes, stromal immune infiltration before and after treatment in breast cancer patients treated with neoadjuvant chemotherapy COX2/PTGS2 Expression Is Predictive of Response to Neoadjuvant Celecoxib in HER2-negative Breast Cancer Patients Celecoxib With Neoadjuvant Chemotherapy for Breast Cancer Might Worsen Outcomes Differentially by COX-2 Expression and ER Status: Exploratory Analysis of the REMAGUS02 Trial Comedications influence immune infiltration and pathological response to neoadjuvant chemotherapy in breast cancer." Thesis, Université Paris-Saclay (ComUE), 2019. http://www.theses.fr/2019SACLS129.

Full text

Abstract:

La chimiothérapie néoadjuvante (CNA) est utilisée dans les cancers du sein agressifs ou localement avancés (CS). Au delà des bénéfices cliniques, elle représente une opportunité pour monitorer in vivo la sensibilité d’une tumeur à un traitement.A partir de l’analyse de sets de données de patients traités par CNA, nous souhaitons identifier des mécanismes associes à la résistance ou sensibilité au traitement. Dans la première partie, nous avons évalué des paramètres, cliniques, anatomopathologiques et transcriptomiques. Nous avons démontré que des éléments non explorés comme la présence d’embols après CNA revêtaient une information pronostique importante. Dans une 2ème partie, nous avons analysé l’impact de l’infiltrat immunitaire dans le cancer du sein, et avons décrit les changements observés entre des échantillons avant et après CNA. Nous avons montré que l’impact pronostique des TILs était différent avant et après CNA, et était opposé dans les CS triple négatif ou HER2-positif. Finalement, nous avons analysé l’impact des comédications pendant la CNA. Nous avons trouvé des effets positifs – via l’augmentation de l’infiltrat immunitaire et la réponse au traitement – et des effets négatifs avec des effets délétères dans certains sous groupes de patients. En conclusion, la situation néoadjuvante représente une plateforme pour générer et potentiellement valider des hypothèses de recherche. La mise à disposition de jeux de données de patients traités par chimiothérapie néoadjuvante constituerait une ressource majeure pour accélérer la recherche contre le cancer du sein
Neoadjuvant chemotherapy (NAC i.e. chemotherapy before surgery) is increasingly being used for aggressive or locally advanced breast cancer (BCs). Beyond clinical benefits, it represents an opportunity to monitor in vivo sensitivity to treatment. Based on the analysis of datasets of BCs patients treated with NAC, we aimed at identifying mechanisms associated with resistance or sensitivity to treatment.In the first part, we evaluated biological, clinical, pathological and transcriptomic patterns. We demonstrated that unexplored pathological features such as post-NAC lymphovascular invasion may carried an important prognostic information.In a second part, we analyzed impact of imune infiltration in BC and we described extensively the changes of tumor infiltrating lymphocytes (TILs) between pre and post-NAC samples. We showed that the prognostic impact of TILs was different before and after NAC, and was opposite in TNBC and HER2-positive BCs. Finally, we investigated the impact of comedications use during NAC. We found both positive effects - while enhancing immune infiltration and response to treatment - and negative effects with deleterisous oncologic outcomes in specific patients subgroups. In conclusion, the neoadjuvant setting represents a platform to both generate and potentially validate research hypotheses aiming at increasing the efficacy of treatment. The public release of real-life datasets of BC patients treated with NAC would represent a major resource to accelerate BC research

APA, Harvard, Vancouver, ISO, and other styles

15

(9183350), Laura Elizabeth Leavens. "After the Project is Over: Measuring Longer-Term Impacts of a Food Safety Intervention in Senegal." Thesis, 2020.

Find full text

Abstract:

We followed up with about 2,000 smallholder households in Senegal, two years after these households participated in a randomized controlled trial (RCT) aimed at reducing levels of aflatoxins in smallholders’ stored maize. In the initial intervention, treated households were provided with training on proper post-harvest practices, low-cost moisture meters for testing if maize was sufficiently dry to store, plastic tarps for drying maize of the ground, and hermetic (airtight) storage bags to mitigate aflatoxin development in stored maize. Using cross-sectional follow up data on aflatoxins levels and drying and storage practices from 2019 along with baseline demographic data from 2016, we estimate both the longer-term intention-to-treat (ITT) effects and the treatment on the treated (TOT) effects that the four inputs provided on households’ aflatoxins levels in stored maize. The ITT analyses estimate the intervention’s average effect by treatment group, but this may underestimate the true impact for households who complied with recommended post-harvest practices and adopted the recommended technologies. The TOT analyses estimate the local average treatment effects (LATE) of the intervention, that is its impacts on those who were driven by the intervention to follow best practices or use a given technology. Since the decision to follow these practices or adopt a technology was not random, we instrumented the usage decision with the exogenous, random treatment group assignment to get an unbiased estimate. Outside of our main models, we conducted a heterogeneity analysis to test if households with different characteristics benefit differently from the intervention. We interacted each treatment assignment with various household characteristics, including the woman’s level of involvement in the intervention. Additionally, we estimate the cost-effectiveness of providing training and a tarp, according to WHO guidelines for public health interventions.

APA, Harvard, Vancouver, ISO, and other styles

16

Guo, Fei. "The impact of term-time working on college outcomes in China." Thesis, 2014. https://doi.org/10.7916/D8ZC811D.

Full text

Abstract:

This dissertation study focuses on a current and controversial phenomenon in Chinese universities and colleges--student working during academic semesters. The massification of Chinese higher education since the year of 1999 raises the level of competition in the job market of college graduates. More and more undergraduate students participate in work while enrolled, with a hope that the working experience could help them perform better in the job market. However, working during academic semesters might be harmful to students' educational achievement since it may occupy their time and energy for studying. In addition, it may not be able to provide students with valuable practical trainings, as many term-time jobs are low-skill and labor-intensive jobs. Therefore there is an increasingly passionate debate among educational policy makers on whether higher education institutions should encourage students to work during term time. The current Chinese literature consists of mostly sub-national descriptive studies with weak research design that provide little in-depth investigation on this issue. This dissertation is the first empirical study of the impact of term-time working on students' academic performance and early post-college labor market outcomes in Chinese four-year universities and colleges, using much more detailed national data and more advanced methods. The study employs a sequential explanatory mixed-method research design, involving both quantitative and qualitative methods. In the quantitative analysis, two quasi-experimental strategies including Instrumental Variable and Propensity Score Matching are used to identify the causal impact of term-time working on college outcomes. The data was collected by Tsinghua University in 2011 with a nationally representative sample of 49 institutions and 6,977 graduating students. A qualitative analysis is conducted to explore students' perceptions about the gains and losses from term-time working, in order to explain the quantitative findings. The qualitative data was collected from interviews with 18 working college students in 2 higher education institutions of different types. Overall, the study finds that working during term time has become a prevalent activity among undergraduate students in four-year universities and colleges in China. The quantitative analysis reveals that term-time working decreases students' academic performance, but increases the probability of being offered a job before graduation, though does not influence the starting salary for those who are offered a job. Such impacts vary for term-time work-study jobs, part-time jobs, and internships. Students in non-elite institutions are more vulnerable to the influence of working than those in elite institutions. The qualitative analysis reveals that students' term-time working behavior is primarily motivated by their financial need and eagerness of gaining social and practical experience, but is constrained by time availability. Term-time working influences students' academic performance through the impact on time allocation and management, and the impact on students' attitude and commitment towards studying. Students may gain valuable practical knowledge and skills and positive work attitudes in working, which contributes to their employability and competitiveness in the labor market. They may also be able to form clearer career goals through working in college. Students' motivation and job characteristics may influence their gains and losses from working. These findings have significant implications for educational policies regarding term-time working in Chinese four-year universities and colleges.

APA, Harvard, Vancouver, ISO, and other styles

17

Nenshi, Rahima N. "The Ontario Structures of Care in Colorectal Cancer Surger Study (OSCRC): Assessing Hospital Level Variation and Impact on Short Term Patient Outcomes." Thesis, 2009. http://hdl.handle.net/1807/18932.

Full text

Abstract:

Introduction: Surgical treatment is the cornerstone of the management of colorectal cancer (CRC). This study described the structures of care at Ontario hospitals performing CRC surgery. Methods: Patients diagnosed with CRC undergoing surgery were identified from 2003-2007. Data linkage identified all institutions performing CRC surgery. Multiple hospital level structures were measured. For the final year of our study, the impact of these structures on 30-day mortality was evaluated. Results: 20,784 patients underwent CRC surgery. Each year, between 106 and 109 institutions performed at least one CRC operation. There was variation in hospital level structures of care. After adjustment for patient characteristics, no hospital level structures were independently associated with 30d mortality. Conclusions: Although variation in surgical care and patient outcomes is likely related to variation in processes and structures of care, after adjusting for covariates, our study did not show any significant relationship between hospital level structures and 30-day mortality.

APA, Harvard, Vancouver, ISO, and other styles

18

Sun, Yanni. "The long term outcome and impact of multidrug-resistant tuberculosis in Henan Province, China." Phd thesis, 2013. http://hdl.handle.net/1885/150662.

Full text

Abstract:

China has the second largest burden of TB cases in the world and its burden of multidrug resistant TB (MDR-TB: resistant to the two principal chemotherapy agents - isoniazid and rifampicin) is also among the highest in the world. Henan, as one of the most populous provinces in China, bears the highest burdens of TB and MDR-TB cases in the country. Multi-drug resistant tuberculosis in Henan, particularly the impact on clinical and socioeconomic outcomes compared to non-MDR-TB, is poorly documented and requires investigation. The aim of this project was to understand the epidemiology and long term outcomes of MDR-TB in Henan, China. Two research components were employed to achieve the aim of the study. The first component characterised the epidemiology of TB and MDR-TB in Henan. Secondary data on surveillance for TB and data from periodic national surveys were used to describe epidemiological features of TB and drug resistance in Henan. For the second component, a prognostic cohort study was conducted. People with TB from 17 counties (150 non-MDR-TB & 100 MDR-TB patients) were sampled from the drug resistance survey dataset that had been generated by Henan TB Control and Prevention Institute in 2001 and long term (9-year) outcomes were ascertained. The first component of the study showed that the incidence of TB in Henan Province is in the middle range for China. In 2007, 3.0 percent of new and 21.7 percent of previously treated TB cases were MDR-TB. The second component of the study investigated 9-year outcomes for the prognostic cohort. Among MDR-TB patients at follow up the proportion who had died was twice that among non-MDR-TB patients (43.0% vs 21.6%). There was a much lower cure rate among MDR-TB patients (63.8%) than non-MDR-TB patients (92.0%). Socioeconomic outcomes also differed. The MDR-TB patients were less able to work, and more often changed their future plans and health behaviour. MDR cases had lower household incomes and were less wealthy. MDR-TB cases or relatives reported much higher TB treatment costs (30.2% vs 9.5% exceeding 10,000 Yuan), and more frequent loans (44.3% vs 26.1%) with less frequent loan repayment (19.0% vs 4.5%). Community impact was also investigated in the second part of this project. Overall, the study revealed little difference in community impact for the measured variables (reported stress, neighbour developing TB after the patient, number of registered TB patients in the community). One negative impact of MDR-TB noted for community residents was increased fear of TB. But there was no evidence that MDR-TB increased risk within the patients' communities. The main limitation of the prognostic cohort study was the difficulty in accurately categorising the social and economic outcomes many years after they occurred. Despite the limitation, this thesis produces original findings revealing and quantifying the adverse long term (9-year) clinical and socioeconomic outcomes of MDR-TB and impacts on patient, family and community in Henan Province, China. These findings will assist TB control policy and service in Henan Province and in the rest of China.

APA, Harvard, Vancouver, ISO, and other styles

19

Ferreira, Francisca Isabel Barros. "The Impact of Very Short-term Variability of Blood Pressure in Outcome after Successful Thrombectomy." Master's thesis, 2020. https://hdl.handle.net/10216/128810.

Full text

Abstract:

Objetivos: Determinar se a variabilidade da pressão arterial a muito curto prazo após trombectomia mecânica eficaz em doentes com acidente vascular cerebral (AVC) isquémico tem um impacto relevante no prognóstico clínico destes doentes. Métodos: Este é um estudo prospectivo com inclusão consecutiva de doentes com AVC isquémico por oclusão de vasos da circulação intracraniana anterior, que realizaram trombectomia mecânica e atingiram recanalização completa (modified Treatment In Cerebral Ischemia graus 2b-3). A variabilidade da pressão arterial foi avaliada por análise espectral das oscilações espontâneas da pressão arterial sistólica no período pós trombectomia. Os outcomes avaliados foram a independência funcional aos 90 dias (escala Rankin modificada 0-2) e a resposta clínica inicial à trombectomia mecânica. Resultados: Foram incluídos 121 doentes. O aumento da variabilidade da pressão arterial a altas frequências (oscilações rápidas) mostrou-se independentemente associado a pior outcome funcional aos 90 dias (unidades normalizadas, odds ratio (OR) = 0.56, 95% intervalo de confiança (CI) 0.35 - 0.88, p=0.01; rácio baixas/altas frequências OR = 0.67, CI 0.46 - 0.98, p=0.04) em análise multivariada. Conclusão: A magnitude das oscilações rápidas da pressão arterial tem um impacto significativo na recuperação neurológica precoce e outcome funcional tardio nos doentes com AVC isquémico após recanalização completa. A variabilidade da pressão arterial a muito curto prazo pode ser avaliada rapidamente durante o período pós-intervencional e contribuir potencialmente para um controlo da pressão arterial mais eficaz nestes doentes, com um impacto prognóstico importante.
Background and Purpose: We aim to determine if the very short-term blood pressure variability (BPV) after successful endovascular treatment of acute ischemic stroke has a relevant impact in the clinical outcome. Methods: This is a prospective multicenter study with inclusion of consecutive AIS patients with occlusion of intracranial anterior circulation vessels who achieved successful recanalization (modified Treatment In Cerebral Ischemia grades 2b-3) after thrombectomy. Very short-term BPV was assessed by spectral analysis of spontaneous fluctuations of beat-to-beat systolic blood pressure values recorded by finger plethysmography with Finometer device. Outcomes included independence at 90 days (modified Rankin scale 0-2) and the initial clinical response to mechanical thrombectomy. Results: We included 121 patients. Increased BPV at high frequencies (rapid oscillations) was independently associated with poor functional outcome at 90 days (normalized units, odds ratio (OR) = 0.56, 95% confidence interval (CI) 0.35 - 0.88, p=0.01; low/high frequency ratio OR = 1.38, CI 1.09 - 1.76, p<0.01) and early neurological recovery (normalized units, OR = 0.67, CI 0.46 - 0.98, p=0.04) in multivariate analysis. Conclusions: The magnitude of rapid oscillations of blood pressure has a significant impact in early neurological recovery and late functional outcome of ischemic stroke patients after successful recanalization. Very short-term BPV can be assessed quickly throughout the post intervention period and potentially contribute to a more efficient blood pressure control in AIS patients submitted to endovascular treatment.

APA, Harvard, Vancouver, ISO, and other styles

20

Ferreira, Francisca Isabel Barros. "The Impact of Very Short-term Variability of Blood Pressure in Outcome after Successful Thrombectomy." Dissertação, 2019. https://hdl.handle.net/10216/128810.

Full text

Abstract:

Objetivos: Determinar se a variabilidade da pressão arterial a muito curto prazo após trombectomia mecânica eficaz em doentes com acidente vascular cerebral (AVC) isquémico tem um impacto relevante no prognóstico clínico destes doentes. Métodos: Este é um estudo prospectivo com inclusão consecutiva de doentes com AVC isquémico por oclusão de vasos da circulação intracraniana anterior, que realizaram trombectomia mecânica e atingiram recanalização completa (modified Treatment In Cerebral Ischemia graus 2b-3). A variabilidade da pressão arterial foi avaliada por análise espectral das oscilações espontâneas da pressão arterial sistólica no período pós trombectomia. Os outcomes avaliados foram a independência funcional aos 90 dias (escala Rankin modificada 0-2) e a resposta clínica inicial à trombectomia mecânica. Resultados: Foram incluídos 121 doentes. O aumento da variabilidade da pressão arterial a altas frequências (oscilações rápidas) mostrou-se independentemente associado a pior outcome funcional aos 90 dias (unidades normalizadas, odds ratio (OR) = 0.56, 95% intervalo de confiança (CI) 0.35 - 0.88, p=0.01; rácio baixas/altas frequências OR = 0.67, CI 0.46 - 0.98, p=0.04) em análise multivariada. Conclusão: A magnitude das oscilações rápidas da pressão arterial tem um impacto significativo na recuperação neurológica precoce e outcome funcional tardio nos doentes com AVC isquémico após recanalização completa. A variabilidade da pressão arterial a muito curto prazo pode ser avaliada rapidamente durante o período pós-intervencional e contribuir potencialmente para um controlo da pressão arterial mais eficaz nestes doentes, com um impacto prognóstico importante.
Background and Purpose: We aim to determine if the very short-term blood pressure variability (BPV) after successful endovascular treatment of acute ischemic stroke has a relevant impact in the clinical outcome. Methods: This is a prospective multicenter study with inclusion of consecutive AIS patients with occlusion of intracranial anterior circulation vessels who achieved successful recanalization (modified Treatment In Cerebral Ischemia grades 2b-3) after thrombectomy. Very short-term BPV was assessed by spectral analysis of spontaneous fluctuations of beat-to-beat systolic blood pressure values recorded by finger plethysmography with Finometer device. Outcomes included independence at 90 days (modified Rankin scale 0-2) and the initial clinical response to mechanical thrombectomy. Results: We included 121 patients. Increased BPV at high frequencies (rapid oscillations) was independently associated with poor functional outcome at 90 days (normalized units, odds ratio (OR) = 0.56, 95% confidence interval (CI) 0.35 - 0.88, p=0.01; low/high frequency ratio OR = 1.38, CI 1.09 - 1.76, p<0.01) and early neurological recovery (normalized units, OR = 0.67, CI 0.46 - 0.98, p=0.04) in multivariate analysis. Conclusions: The magnitude of rapid oscillations of blood pressure has a significant impact in early neurological recovery and late functional outcome of ischemic stroke patients after successful recanalization. Very short-term BPV can be assessed quickly throughout the post intervention period and potentially contribute to a more efficient blood pressure control in AIS patients submitted to endovascular treatment.

APA, Harvard, Vancouver, ISO, and other styles

21

Tseng, Li-Jung, and 曾麗蓉. "Impact of Age-Adjusted Charlson Comorbidity Index on Hospital Survival and Short-Term Outcome of Patients with Extracorporeal Cardiopulmonary Resuscitation." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/27779r.

Full text

Abstract:

碩士
國立陽明大學
急重症醫學研究所
107
Extracorporeal cardiopulmonary resuscitation (ECPR) has gradually come to be regarded as an effective therapy, but the hospital mortality rate after ECPR is still high and unpredictable. The present study tested whether age-adjusted Charlson comorbidity index (ACCI) can be used as an objective selection criterion to ensure the most efficient utilization of medical resources. Adult patients (age 18 years) receiving ECPR at our institution between 2006 and 2015 were included. Data regarding ECPR events and ACCI characteristics were collected immediately after the extracorporeal membrane oxygenation (ECMO) setup. Adverse events during hospitalization were also prospectively collected. The primary endpoint was survival to hospital discharge. The second endpoint was the short-term (2-year) follow-up outcome. A total of 461 patients included in the study were grouped into low ACCI (ACCI 0-3) (240，52.1%) and high ACCI (ACCI 4-13) (221，47.9%) groups. The -median ACCI was 2 (interquartile range，IQR：1-3) and 5 (IQR：4-7) for the low and high ACCI groups, respectively. Cardiopulmonary resuscitation (CPR)-to-ECMO duration was comparable between the groups（ACCI 0-3＝42.1±25.6，ACCI 4-13＝41.3±20.7 min；p = 0.754). Regarding the hospital survival rate, 256 patients (55.5%) died on ECMO support. A total of 205 patients (44.5%) were successfully weaned off ECMO, but only 138 patients (29.9%) survived to hospital discharge (32.1% and 27.6% in low and high ACCI group，p = 0.291). Multivariate logistic regression analysis revealed CPR duration before ECMO run (CPR-to-ECMO duration) and a CPR cause of septic shock to be significant risk factors for hospital survival after ECPR (p = 0.043 and 0.014, respectively), whereas age and ACCI were not ( p = 0.334 and 0.164, respectively). The 2-year survival rate after hospital discharge for the 138 hospital survivors was 96% and 74% in the low and high ACCI groups, respectively ( p = 0.002). High ACCI before ECPR does not predict a poor outcome of hospital survival. Therefore, ECPR should not be rejected solely due to high ACCI. However, high ACCI in hospital survivors is associated with a higher 2-year mortality rate than low ACCI, and patients with high ACCI should be closely followed up.

APA, Harvard, Vancouver, ISO, and other styles

22

Brown, Ryan. "The Impact of a Mother's Wellbeing During Pregnancy on the Human Capital Endowment and Long Term Economic Outcomes of the In Utero Child." Diss., 2014. http://hdl.handle.net/10161/8702.

Full text

Abstract:

The focus of this dissertation is to help explore, disentangle, and mechanize the role of the social and physical environment during gestation on the in utero child's later life outcomes. Specifically this work uses theoretical underpinnings adopted from the medical and epidemiological literature to inform the use of various applied econometric techniques on population representative data to rigorously examine the impact of a mother's mental and physical wellbeing during pregnancy on the human capital endowment and long-term economic outcomes of the in utero child. After a brief introduction, the second chapter reexamines the pioneering work by Douglas Almond (2006), which is thought to establish that in utero exposure to an adverse disease environment has a large, negative impact on health and socioeconomic prosperity that reaches well into adulthood. The analysis in this section casts doubt on the identification strategy used in that seminal work, and suggests that conclusions about the deleterious impact of in utero exposure to the influenza pandemic on socioeconomic prosperity in adulthood are, at best, premature. The third and fourth chapters delve into the topic of the impact of a mother's mental health during pregnancy on the birth outcomes of the in utero child. Utilizing two traumatic and unanticipated events, the terrorist attacks of September 11th, 2001 and the surge in Mexican Drug War violence, these chapters provide strong evidence that exposure to increased maternal anxiety has a significant negative impact on the early-life health of the in utero child.

Dissertation

APA, Harvard, Vancouver, ISO, and other styles

Dissertations / Theses on the topic 'Longer-term impacts and outcomes'

Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles