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Dissertations / Theses on the topic 'Philosophy of disease'
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Reznek, L. "The concept of disease." Thesis, University of Oxford, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.371729.
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Lukong, Paul Foka. "The integration of geospatial data into the surveillance and management of HIV/AIDS in Cameroon : thesis submitted for the degree of Doctor of Philosophy /." Title page, table of contents and abstract only, 2004. http://web4.library.adelaide.edu.au/theses/09PH/09phl9549.pdf.
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Ricciardone, Chiara Teresa. "Disease and Difference in Three Platonic Dialogues| Gorgias, Phaedo, and Timaeus." Thesis, University of California, Berkeley, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10615142.
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This study traces a persistent connection between the image of disease and the concept of difference in Plato’s Gorgias, Phaedo, and Timaeus. Whether the disease occurs in the body, soul, city, or cosmos, it always signals an unassimilated difference that is critical to the argument. I argue that Plato represents—and induces—diseases of difference in order to produce philosophers, skilled in the art of differentiation. Because his dialogues intensify rather than cure difference, his philosophy is better characterized as a “higher pathology” than a form of therapy.
An introductory section on Sophist lays out the main features of the concept of difference-in-itself and concisely presents its connection to disease. The main chapters examine the relationship in different realms. In the first chapter, the problem is moral and political: in the Gorgias, rhetoric is a corrupting force, while philosophy purifies the city and soul by drawing distinctions. In the second chapter on Phaedo, the problem is epistemological: if we correctly interpret the illness of misology, as the despair caused by the inability to consistently distinguish truth and falsity, we can resolve the mystery of Socrates’ cryptic last words (“We owe a cock to Asclepius; pay the debt and do not neglect it”). In the third chapter on Timaeus, Plato treats diseases of the soul, the body, and the cosmos itself. There, the correlation between disease and difference actually helps humans situate themselves in the vast universe—for in both cases, proper differentiation is the key to a healthy, well-constructed life.
My emphasis on Plato’s theory of difference counters the traditional focus on his theory of Forms. Elucidating the link between the concept of difference and the experience of disease has broader impact for the ageless question of how we should live our lives. In Plato’s system, neither disease nor difference is a wholly negative element to be eradicated. Instead, difference and disease, in their proper proportions, are responsible for the fullness of the world and the emergence of the philosophical subject.
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James, Katharine Ann. "Relationships between psychosocial stress, cortisol, apolipoprotein є4, beta-amyloid, hippocampal volumes and Alzheimer's disease in a sample of South African older adults." Doctoral thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/11796.
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Includes bibliographical references.Many factors contribute to age-related changes in cognitive functioning. There is no single defined profile of factors that is clearly associated with the presence, or rate of progression, of cognitive changes in older adults. Stress, both psychosocial and physiological, may play a role. Aims: The general aim of this study was to explore the relationships between cognitive functioning and cognitive decline, on the one hand, and psychosocial and physiological stress, as well as a range of sociodemographic, psychosocial and physiological factors, on the other, in older adults with a range of cognitive function including healthy and impaired. Methods: Both cross-sectional (Study 1) and longitudinal (Study 2) designs addressed these aims. Study 1 examined the contribution of stress and sociodemographic, psychosocial, and physiological factors to cognition. Participants were 69 cognitively healthy older adults and 65 possible or probable Alzheimer’s disease (AD) patients. They were all over the age of 60 and resided in the greater Cape Town metropolitan region of South Africa. Cognitive functioning was assessed using a battery of neuropsychological tests. Salivary cortisol levels, apolipoprotein E (APOE) genotype, and plasma beta-amyloid levels were determined at baseline.
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Laflèche, Ginette C. "A comparative study of memory retrieval and scanning speed in Parkinson's disease and senile dementia of the Alzheimer type implications for the concept of fronto-subcortical syndrome." Thesis, University of Ottawa (Canada), 1987. http://hdl.handle.net/10393/5413.
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Traykova, Aleksandra Krumova. "Optimizing hybridism : a critique of naturalist, normativist and phenomenological accounts of disease in the philosophy of medicine." Thesis, Durham University, 2017. http://etheses.dur.ac.uk/12312/.
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This dissertation represents an investigative critique of the philosophical approaches to defining health and disease, going beyond pure conceptual analysis and straight into historical-philosophical analysis in an attempt to unpack the very discourse which underpins the discussion. Drawing on the notion of language as a medium of social instruction, it problematizes various specific features of the debate’s intellectual format, for example pointing out that its preoccupation with linguistic precision ought to be replaced with a focus on expressing the complex multidimensional nature of disease in a relatable manner. After presenting evidence of clinical reasoning’s inherent susceptibility to bias, the thesis exposes naturalism’s historical roots as an ideologically driven counter-reaction to nineteenth century vitalism, thereby discrediting the ideal of neutrality. Despite this skeptical start, it rejects eliminativist positions that philosophical attempts to produce health/disease definitions are pointless and unnecessary, and argues that the debate needs to be maintained due to such discussions’ important implications for medical and social identities, patient narratives, the negotiation of treatment objectives, or even the effectiveness of public health programmes (as a population’s inclination to comply with state-mandated public health measures is directly influenced by the notions it holds about health and disease). This is followed by an exploration of the conceptual limitations faced by the most commonly applied strategies of defining disease, after which their advantages are re-combined in an optimized hybrid account of disease supported by a philosophical distinction between the categories of ‘symptoms’ and ‘clinical signs’. Finally, this account is tested on a wide range of problematic cases, to ensure its capacity to deliver the promised results whilst also overcoming challenging influences such as the ones posed by bias, discursively shaped diagnostic labels, or unwarranted pathologization.
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Holden, Chelette Cummings. "Hear My Voice| A Phenomenological Study Examining the Premature Mortality of People with the Comorbidity of Serious Mental Illness and Chronic Disease." Thesis, University of Louisiana at Monroe, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10639207.
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This qualitative study explored the relationship between premature mortality and patients diagnosed with SMI and a co-morbid medical condition. The interviews with participants sought to address the research question: What is the treatment experience medical and psychological, of patients with SMI, and comorbid physical health concerns? Using the phenomenological research design, six patients diagnosed with SMI and a comorbid medical condition were interviewed to gain an understanding of their perceptions of both medical and psychological healthcare services.
Participants were found to have a detached patient-doctor relationship, which was tied to communication barriers. Long histories of traumatic interactions were also contributing factors to their mental health challenges. A sense of helplessness often presented itself, despite long-term treatment, multiple treatment modalities and medications. The majority of the participants perceived a connection between their mental health and biophysical health. They received predominantly physical wellness advice from their primary care physician, but reported being encouraged to follow-up with their mental health professional. Participants felt that collaboration between their various health care providers would be helpful to their treatment process. The key benefits of this collaboration were to prevent misdiagnosis and improve the prescribing of medication and treatment. From the viewpoint of the SMI participant, it emerged that cross-functional mental health treatment training, out-of-office patient support, and routine treatment re-evaluation would assist both health service providers in diagnosis and treatment of SMI patients with additional biomedical illnesses.
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Verma, Anju. "Ontology based personalized modeling for chronic disease risk evaluation and knowledge discovery an integrated approach : a thesis submitted to Auckland University of Technology in fulfilment of the requirements for [the] degree of Doctor of Philosophy (PhD), 2009 /." Click here to access this resource online, 2009. http://hdl.handle.net/10292/784.
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Populations are aging and the prevalence of chronic disease, persisting for many years, is increasing. The most common, non-communicable chronic diseases in developed countries are; cardiovascular disease (CVD), type 2 diabetes, obesity, arthritis and specific cancers. Chronic diseases such as cardiovascular disease, type 2 diabetes and obesity have high prevalence and develop over the course of life due to a number of interrelated factors including genetic predisposition, nutrition and lifestyle. With the development and completion of human genome sequencing, we are able to trace genes responsible for proteins and metabolites that are linked with these diseases. A computerized model focused on organizing knowledge related to genes, nutrition and the three chronic diseases, namely, cardiovascular disease, type 2 diabetes and obesity has been developed for the Ontology-Based Personalized Risk Evaluation for Chronic Disease Project. This model is a Protégé-based ontological representation which has been developed for entering and linking concepts and data for these three chronic diseases. This model facilitates to identify interrelationships between concepts. The ontological representation provides the framework into which information on individual patients, disease symptoms, gene maps, diet and life history can be input, and risks, profiles, and recommendations derived. Personal genome and health data could provide a guide for designing and building a medical health administration system for taking relevant annual medical tests, e.g. gene expression level changes for health surveillance. One method, called transductive neuro-fuzzy inference system with weighted data normalization is used to evaluate personalized risk of chronic disease. This personalized approach has been used for two different chronic diseases, predicting the risk of cardiovascular disease and predicting the risk of type 2 diabetes. For predicting the risk of cardiovascular disease, the National Nutrition Health Survey 97 data from New Zealand population has been used. This data contains clinical, anthropometric and nutritional variables. For predicting risk of type 2 diabetes, data from the Italian population with clinical and genetic variables has been used. It has been discovered that genes responsible for causing type 2 diabetes are different in male and female samples. A framework to integrate the personalized model and the chronic disease ontology is also developed with the aim of providing support for further discovery through the integration of the ontological representation in order to build an expert system in genes of interest and relevant dietary components.
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Sutton, E. "Re-writing 'the laws of health' : William James on the philosophy and politics of disease in nineteenth-century America." Thesis, University College London (University of London), 2013. http://discovery.ucl.ac.uk/1401848/.
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This thesis argues that medical concerns, concepts and values underpin many of the texts produced by the nineteenth-century psychologist and philosopher William James (1842-1910). The medical themes in question deal with the ethical and aetiological nature of disease, hygienic principles, mental therapeutic practices and the political standing of the invalid. They are discussed explicitly in The Principles of Psychology (1890), Talks to Teachers (1899), The Varieties of Religious Experience (1902) and other essays and lectures. Analysis of James’s extensive personal papers indicates, moreover, that this same set of themes comprises an extremely significant intellectual context within which to situate other well-known works, including The Will to Believe (1897) and Pragmatism (1907). The central aim of this thesis is to trace the multiple, and mutable, ways in which illness and philosophy were profoundly interconnected within James’s writings. From early adulthood onwards, he closely identified the concept of evil with the existence of disease and infirmity and was fervently devoted to the notion of health as an ethical ideal. To this end he championed the importance of hygienic practices, for himself as an individual and for society at large. These twin commitments, to the prevention of disease and the promotion of health, are in evidence across the disciplinary breadth of James’s corpus. They are also the locus of a significant epistemological transformation. During the mid-1880s James lost faith in the medical profession and their exclusive worship of the physiological “laws of health”. He began to embrace the world of unorthodox practitioners and “mystical” medicine and moved towards a more inclusive, pragmatic theory of (medical) truth. Ultimately, James concluded that both scientific and religious forms of knowledge may facilitate the quest for health: a state that he came to understand as having “bodily mental and moral” dimensions.
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Dickinson, Annette R. "Within the web the family/practitioner relationship in the context of chronic childhood illness : a thesis submitted to Auckland University of Technology in partial fulfilment of the degree of Doctor of Philosophy, March 2004." Full thesis. Abstract, 2004.
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Díaz, Patricia I. "Studies on the oxidative stress response of porphyromonas gingivalis : a thesis submitted in fulfillment of the requirements for admission to the degree of Doctor of Philosophy /." Title page, summary and table of contents only, 2002. http://web4.library.adelaide.edu.au/theses/09PH/09phd5426.pdf.
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Fleck, Kenneth. "Finding the shadows in the mirror of experience an ontological study of the global co-worker : a thesis submitted to Auckland University of Technology in fulfilment of the requirements for the degree of Master of Philosophy, 2008." Click here to access this resource online, 2008. http://hdl.handle.net/10292/468.
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This study explores the phenomenon of a personal exploratory field visit to HIV programmes in Malawi and how that informs my future plans to work cross-culturally with HIV. I use hermeneutic phenomenology with the guidance of Heidegger and Gadamer, and draw on Ackermann, Hill, Maluleke, Moltmann, and Thielicke for theological direction. This study analyses how personal formation takes place and how the meaning of that experience can inform future cross-cultural interaction. The data of this study is drawn from a range of people interviewing ‘me’. This includes a pre and post interview in relation to my three week exploratory visit to Malawi, and recorded daily reflections during the visit. Upon return I was interviewed about my experience by ten people from the following areas: nursing, counselling, development, theology, business, medicine, clergy, an Expatriate Malawian, and a women working from a Maori paradigm. These interviews focused on my experience with questions framed from the interviewer’s specialty area. The transcripts become further data for my study. The findings of this thesis suggest that people wishing to work cross-culturally need to understand their motivation for their work, and understand who they are before entering a foreign land. This transformative journey also needs to continue as part of the process of working with people because we can only be effective with change if we are listening and hearing the other’s perspective. It is in being open to this difference between persons that we continue to find ourselves. While perhaps we have a tendency to want to make everybody like us, we can only grow into our full potential in relationship with truly different others. Tensions I experienced demonstrate that there is a complex need to understand how the context controls how HIV is perceived. This requires uncovering some of the deeper issues of HIV and culture, and knowing how to conceptualise these in both positive and informative ways. This thesis asks four key questions for the global-co-worker to work through before embarking on cross-cultural mission: 1. How do you know you should go?; 2. How are you going to make a difference?; 3. Who are you going to be?; and 4. What will sustain your involvement? My own experience has drawn me into a deeper awareness of the need for a vital connectedness of faith, hope and love underpinning the everydayness of such an experience.
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Mamykina, Lena. "Designing ubiquitous computing for reflection and learning in diabetes management." Diss., Atlanta, Ga. : Georgia Institute of Technology, 2009. http://hdl.handle.net/1853/28093.
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Thesis (M. S.)--Computing, Georgia Institute of Technology, 2009.Committee Chair: Elizabeth D. Mynatt; Committee Member: Abowd, Gregory; Committee Member: Bruckman, Amy; Committee Member: Dourish, Paul; Committee Member: Nersessian, Nancy.
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Koenane, Mojalefa Johannes. "Ethical perspectives on surveillance and preventive strategies for HIV/AIDS in South Africa." Thesis, Stellenbosch : University of Stellenbosch, 2000. http://hdl.handle.net/10019.1/16419.
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Thesis (MPhil)-- University of Stellenbosch, 2000ENGLISH ABSTRACT: It is a well-known fact that the sub-Saharan Africa is a continent most affected by HIV/AIDS. The HIV/AIDS pandemic has in other words become our disease. For many of us, this fact may be difficult to fully accept. There are elements of prejudice in our reactions. Ignorance and intolerance can be found around the world. Therefore, by presenting the facts about HIV/AIDS, this assignment challenges the misconceptions and focuses on the profound dilemmas confronting society. I think the success in combating the HIV/AIDS pandemic could be found in President Thabo Mbeki's terminology "Partnership against HIV/AIDS". In his speech, the President appealed to both the private and public sectors and all South Africans to work together with greater determination than before to fight against HIV infection and AIDS. Arguably, this was the best speech President Thabo Mbeki ever made on HIV/AIDS on October 9, 1998. Back then, the government seems to have had a direction and led from the front in the battle against HIV/AIDS. The title of this thesis reads: "Ethical perspectives on surveillance and preventive strategies for HIV/AIDS in South Africa". Presently, the South African Government through the Ministry of Health is seriously considering making AIDS a notifiable medical condition. This is a serious and a controversial move that has serious ethical and legal implications that will be discussed. Should partners of HIV-infected individuals be informed? If the answer is on the affirmative, who should inform them? I am also looking at the ethical obligation of health care workers to treat HIV/AIDS patients despite the fear of being accidentally infected. Tough questions need to be asked. Should health workers be informed of the HIV status of every patients they treat? On the other hand, some patients have some fears too that HIV-infected health professionals may infect them. Again, the fundamental ethical concerns related to confidentiality, privacy, the right to treatment will also be discussed. The country is divided on this issue. Ethical principles are directly involved in such a decision, for instance, the principle of confidentiality, respect for autonomy and informed consent. How can the government go about implementing this without disregarding these fundamental ethical requirements?Another ethical issue that comes to mind regarding HIV/AIDS concerns AIDS vaccine trials, which are so far dominantly manufactured in 'developed countries' while subjects of these trials are from 'third world' or 'developing countries '. The ethical concerns here are: How will informed consent be protected, especially where subjects of the trials are not educated and do not understand the terms used? What are the cost-effects or benefits of such trials? What are the risks involved? Together with this, other issues include ethical debates concerning market prices of drugs, which are too expensive for poorer countries and affordable for richer countries. Finally, this work does not treat everything that needs to be dealt with insofar as HIV/AIDS is concerned. However, I hope that this thesis will contribute (in a small way) in making people appreciate the ethical dilemmas that are presented by HIV/AIDS.
AFRIKAANSE OPSOMMING: Dit is algemeen bekend dat Afrika suid van die Sahara die gebied is met die hoogste voorkoms van MIV/vIGS. Die MIV/VIGS-pandemie het dus ons siekte geword. Dit is vir baie van ons moeilik om hierdie feit te aanvaar, en ons reaksies is dikwels bevooroordeeld. Onkunde en onverdraagsaamheid oor MIV/vIGS word trouens wereldwyd aangetref. Hierdie verhandeling Ie klem op die feite van MIV/VIGS, en konfronteer sodoende hierdie wanopvattings terwyl daar gefokus word op die diepgaande dilemmas waarmee die samelewing gekonfronteer word. President Thabo Mbeki se woorde "Vennootskap teen MIV/VIGS" verwoord myns insiens die enigste oplossing vir die MIV/VIGS-pandemie. Die President doen in sy toespraak 'n beroep op al1e Suid-Afrikaners, in private en openbare sektore, om met groter determinasie saam te veg teen MIV-infeksie en VIGS; Hierdie toespraak, gelewer op 9 Oktober 1998, toe die regering klaarblyklik nog rigting gehad het en op die voorfront was in die styd teen MIV/VIGS, was moontlik President Thabo Mbeki se beste ooit oor die onderwerp MIV/VIGS. Die titel van hierdie verhandeling is "Etiese perspektiewe ten opsigte van waarnemende en voorkomende strategiee vir MIV/VIGS in Suid-Afrika". Die Suid-Afrikaanse regering, by monde van die Ministerie van Gesondheid, oorweeg dit tans sterk om VIGS 'n aanmeldbare mediese kondisie te verklaar. Die ernstige etiese en regsimplikasies van so 'n daadwerklike en kontroversiele stap sal in die verhandeling bespreek word. Behoort die rnetgesel1e van MIV-positiewe persone ingelig te word? Indien wei, wie moet hulle in kennis stel? Daar sal ook gekyk word na die etiese verpligting van gesondheidsorgwerkers om MIV/VIGS-pasiente te behandel ten spyte van hul1e vrees om per ongeluk besmet te word. Indringende vrae moet gevra word. Behoort gesondheidsorgwerkers ingelig te word oor die MIV-status van elke pasient wat hul1e behandel? Aan die ander kant vrees sornmige pasiente dat hul1e deur MIV-positiewe gesondheisorgwerkers besmet kan word. Die fundamentele etiese aangeleenthede rakende vertroulikheid, privaatheid en die reg tot mediese behandeling sal ook bespreek word. Suid-Afrika is verdeeld oor hierdie kwessies. Etiese waardes, soos die beginsel van vertroulikheid, respek vir outonomie en ingeligte goedkeuring is direk betrokke by besluite oor etiese kwessies. Die regering kan nie hierdie aangeleenthede implementeer sonder om die fundamentele etiese vereistes in ag te neem nie. VIGS-entstofproefnemings is'n verdere etiese kwessie wat ter sprake kom. Hierdie proefnemings word grotendeels deur "ontwikkelde" lande uitgevoer, tewyl die proefpersone van "derdewereldse" of "ontwikkelende" lande afkomstig is. Die etiese kwessies hierby betrokke is: hoe sal ingeligte goedkeuring beskerm word, veral wanneer proefpersone onopgevoed is en nie die tersaaklike terme verstaan nie? Wat is die kosteeffektiwiteit of voordele van hierdie proefnemings? Watter risiko's is betrokke? Die etiese debat oor die markprys van medisyne, wat heel bekostigbaar vir ryk lande, maar duur vir armer lande is, word ook aangeraak. Hierdie verhandeling dek nie alle relevante kwessies wat betref MIV/VIGS nie. Tog hoop ek dat dit 'n bydrae sal lewer tot mense se bewuswording van die etiese dilemmas wat MIV/VIGS inhou.
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Dittmer, Keren Elizabeth. "Inherited rickets in Corriedale sheep : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy at Massey University, Palmerston North, New Zealand." Massey University, 2008. http://hdl.handle.net/10179/882.
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Inherited rickets of Corriedale sheep is a newly discovered skeletal disease of sheep with simple autosomal recessive inheritance. The clinical signs resemble rickets in other species and include decreased growth rate, thoracic lordosis and angular limb deformities. Radiographic features include physeal thickening, blurred metaphyseal trabeculae and thickened porous cortices. Computed tomography scanning of long bones reveals increased bone mineral content and cortical area, but decreased bone mineral density. Gross lesions include segmental thickening of physes, growth arrest lines, collapse of subchondral bone of the humeral head, thickened cortices and enthesophytes around distal limb joints. Microscopically there is persistence of hypertrophic chondrocytes at sites of endochondral ossification, inappropriate and excessive osteoclastic resorption, microfractures and wide, unmineralised osteoid seams lining trabeculae and filling secondary osteons. Affected sheep are persistently hypophosphataemic and hypocalcaemic. Normal serum 25-hydroxyvitamin D3 concentration accompanied by a two-fold elevation in 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) suggested a defect in endorgan responsiveness to vitamin D as a likely mechanism, but this was not supported by in vitro studies using cultured skin fibroblasts. These studies revealed normal vitamin D receptor function and the presence of 24- hydroxylase mRNA in cells from affected sheep, even without induction by 1,25(OH)2D3. Inappropriate overexpression of 25-hydroxyvitamin D3-24- hydroxylase, the enzyme that breaks down active vitamin D, is therefore considered the probable cause of inherited rickets in Corriedale sheep. Such a mechanism has not previously been described as a cause of inherited rickets in humans or other animal species. Treatment of affected sheep with high oral doses of vitamin D3 weekly for 3 months showed a trend towards increased bone mineral density, thus supporting an intact vitamin D receptor. Preliminary studies on immune function revealed reduced numbers of CD4+ and CD8+ lymphocytes and reduced interferon-? production by lymphocytes stimulated with parasite antigen. This new form of inherited rickets may be widespread in
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Bergman, Mette. "Hand i hand i mörkret : En studie av de närståendes livsvärld när partnern drabbats av Alzheimers sjukdom." Thesis, Stockholm University, Department of Education, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-31470.
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Studien utforskade de närståendes livsvärld när partnern drabbats av Alzheimers sjukdom. Deras livsvärld och existentiella villkor var i fokus. Studien utgick från ett existentiellt fenomenologiskt tolkande perspektiv. Den teoretiska grunden bestod av ett tänkande kring de närståendes livsvärld utifrån fyra existentialer: det levda rummet, den levda tiden, den levda kroppen och den levda relationen. Datainsamling skedde utifrån Max van Manens utforskande intervjuer med tio närstående, fem kvinnor och fem män i yrkesverksam ålder 40 till 64 år, de levde alla tillsammans med en partner som fått sin diagnos för ett år sedan eller längre. Data analyserades genom att lyssna igenom de digitala inspelningarna flera gånger, transkribering av desamma och genomläsning av de utskrivna texterna, nya genomlyssningar och genomläsningar. Analysen utvecklades genom en hermeneutisk, fenomenologisk reflektion beskriven av van Manen. Studiens resultat kategoriserades och dessa analyserades sedan i fyra delar utifrån de fyra existentialerna. Resultatet visade att upplevelsen av den levda tiden blev annorlunda mot tidigare då framtiden fick stå tillbaka för nuet, som var det som de närstående måste förhålla sig till för att vardagen skulle fungera. Det levda rummets aspekter förändrades utifrån skyddsaspekten och nya roller inom familjen. Den levda kroppen krävde egen återhämtning och längtade efter närhet. Den levda relationen förändrades, när upplevelsen av närhet och behovet av distans ändrades. De existentiella villkoren förändrades radikalt och nya strategier gav en ny livsstil i en förändrad och sammanflätad livsvärld.
The study explored the lifeworld of being a partner to a person with Alzheimer’s disease. Lived experience and existential conditions were focused. The study has an existential phenomenological hermeneutic perspective. The theoretical underpinnings consist of thinking of lifeworld by means of four life existentials: lived space, lived body, lived time and lived relations. Data collection was done by Max van Manens reflective dialog interview with ten respondents, five women and five men at age between 40 and 64, living with a partner who had had their diagnosis the last year or longer. Data analyses took place listening and re-listening the recorded interviews, transcribing, reading and re-reading the texts. The analysis evolved through hermeneutic, phenomenological reflection described by van Manen. The result of the study was categorized and the analysis was done in four parts following the four life existentials. The result showed that lived time is different than before since the future has to stand back in favour of here and now in order to be able to cope with everyday life. The lived space changed to secure the partner and everyday roles changed in the family. The lived body needed to rest and longed for closeness. The lived relation changed when the need of closeness and distance changed. The existential conditions changed radically and a new way of living was found in new strategies in a changed and interlaced lifeworld.
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Darrason, Marie. "Y a-t-il une théorie génétique de la maladie ?" Thesis, Paris 1, 2014. http://www.theses.fr/2014PA010596/document.
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Alors qu’il n’existe pas de définition consensuelle du concept de maladie génétique, ce concept s’est progressivement élargi pour désigner des maladies communes, non héréditaires, non mendéliennes et polygéniques, aboutissant à une généticisation des maladies. Pour résoudre ce paradoxe de la génétique médicale contemporaine, les philosophes réfutent généralement cette généticisation comme une extension génocentriste abusive du concept de maladie génétique et cherchent à redéfinir un concept plus strict de maladie génétique. Nous montrons que cette stratégie échoue et proposons au contraire d’abandonner le concept de maladie génétique et de supposer que la généticisation révèle l’élaboration d’une explication du rôle commun des gènes dans toutes les maladies, que nous appelons une « théorie génétique de la maladie ». Nous définissons les conditions de possibilité et les critères nécessaires d’une théorie génétique a minima et aboutissons à un spectre des théories génétiques possibles. Nous proposons alors de tester si la généticisation des maladies révèle plutôt une théorie génétique des maladies, c’est-à-dire un ensemble de théories génétiques spécifiques à chaque classe de maladie, ou une théorie génétique de la maladie, reposant sur une définition générale de la maladie qui unifie le rôle commun des gènes dans toutes les maladies. Pour ce faire, nous analysons deux exemples de théories génétiques contemporaines : la théorie génétique des maladies infectieuses et la théorie génétique de la médecine des réseaux. Nous concluons à la coexistence nécessaire de plusieurs formes de théories génétiques dans la littérature biomédicale contemporaineWhile there is no consensual definition of the concept of genetic disease, this concept has gradually extended to designate common, non-hereditary, non-Mendelian, polygenic diseases, leading to the geneticization of diseases. In order to solve this paradox of the contemporary medical genetics, philosophers usually discard geneticization as an inappropriate genocentrist extension of the concept of genetic disease and attempt to define a stricter concept of genetic disease. We demonstrate the failure of this strategy and argue on the contrary that we should give up the concept of genetic disease and understand geneticization as the elaboration of an explanation of the common role of genes in diseases, what we call “a genetic theory of disease”. We define the conditions of possibility and the necessary criteria for a genetic theory a minima and end up with describing the spectrum of potential genetic theories. We then suggest to test whether geneticization of diseases reveals rather a genetic theory of diseases, that is, a set of genetic theories specific to each class of disease, or a genetic theory of disease, that is, a general definition of disease unifying the common role of genes in disease explanations. In order to do so, we analyse two examples of contemporary genetic theories: the genetic theory of infectious diseases and the genetic theory of network medicine. We conclude that several forms of genetic theories coexist in the contemporary biomedical literature and that this coexistence is necessary
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Mkosi, Barbara Nomsa. "Confidentiality as value in the management of HIV/AIDS in South Africa." Thesis, Stellenbosch : Stellenbosch University, 2000. http://hdl.handle.net/10019.1/51663.
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Thesis (M.Phil.)--Stellenbosch University, 2000.ENGLISH ABSTRACT: AIDS is the most important threat to world health. Recent years have seen a dramatic spread of HIVand AIDS in South Africa. Health education directed at modifying risk behaviour appears to be the only way in which the disease can be contained. Controlling AIDS is not only by controlling the virus, but also involves tackling social, economic and political issues and putting AIDS into the broader context of sexuality and gender roles. This requires a broader understanding of this aspect of HIV-AIDS ranging from population dynamics, through to research on individual behaviour and its socio-economic impact; so that we can dispel the myths and rumours that surround AIDS and answer searching questions that will be asked by the community. In South Africa, HIV-AIDS remains a stigmatized disease. There have been calls from courageous and influential people for those who are living with HIV-AIDS to be open about their status and to destigmatise the disease. Institutions too have been drawn into the controversy about whether to remain silent or speak out. Southern African Anglican bishops, as well as some politicians declared their intention to undergo testing for HIV status in order to sensitise the public to the seriousness of the epidemic. Were AIDS not regarded as intolerable, the entire issue of confidentiality would fall away. Calls to destigmatise the disease through openness cannot stand alone. Government must put effective treatment programmes in place. In the absence of treatment, AIDS may represent only frustration and hopelessness to those who test positive; and fear, danger and resultant animosity to those who are HIV negative. The text is in four chapters. Chapter 1 focuses on confidentiality as an important principle in the management of disease. In HIV -AIDS, confidentiality is a more sensitive issue as AIDS is particularly viewed as a social stigma, accompanied by discrimination and harassment. The chapter also addresses HIV infection, transmission, counseling and screemng. Chapter 2 deals with the principles of biomedical ethics namely, autonomy, to enable the patient to determine his/her course of treatment; informed consent, designed to protect the interests of patients from exploitation and harm, and encourage health professionals to act responsibly; beneficence and nonmaleficence, to protect the welfare of others; and justice, to ensure access to health care for all. It also highlights the aspects of and limitations to confidentiality. Chapter 3 discusses broadly the ethical dilemmas pertammg to professional-patient relationships, women and HIV-AIDS, religion, prisoners and employer-employee relationships. When the AIDS epidemic started, very few people suffered from the disease, and the disease was treated with great caution and confidentiality. Today, AIDS is a pandemic and emphasis should shift from the ethic of autonomy and confidentiality, to a social ethic, which emphasizes the responsibility of minimizing the risk of spread of infection. The chapter also examines the role of the Department of Health, the participation of health professional bodies and the legal aspects relating to confidentiality in HIV-AIDS. Chapter 4 attempts to construct an argument to destigmatise HIV-AIDS by arguing the responsibility of the government to make sufficient resources available for the treatment and control of the pandemic. Health professionals are challenged to engage their expertise and skills in the service of the sick with dignity and respect. The community is encouraged to support the drive towards controlling the spread of HIV infection and enable people living with AIDS to disclose their status without fear of harassment.
AFRIKAANSE OPSOMMING: Vigs is die gevaarlikste bedreiging van wéreldgesondheid. Die afgelope paar jaar het 'n dramatiese verspreiding van mv en VIGS in Suid-Afrika plaasgevind. Gesondheidsopvoeding wat gemik is op die verandering van risiko-gedrag is skynbaar die enigste metode wat die siekte kan beheer. Die kontrolering van VIGS is nie net die kontrolering van die virus nie, maar dit betref ook herbesinning oor sosiale, ekonomiese en politiese en geslagsrolle. Dit vereis 'n omvattender verstaan van hierdie aspek van HIV-VIGS, wat strek vanaf van bevolkingspatrone tot by die navorsing oor individuele gedrag en die sosio-ekonomiese impak van 19. So kan ons hopelik help om die mites rondom VIGS te besweer. In Suid-Afrika bly mV-VIGS 'n gestigmatiseerde siekte. Daar rus 'n veranbtwoordelikheid op invloedryke mense wat met mV-VIGS leef en wat as rolmodelle sou kon dien, om hul mv -status te openbaar en sodoeonde te help om die siekte te destigmatiseer. Instansies is ook by hierdie twispunt betrek om vas te stelof die mense moet praat of swyg. Suider-Afrikaanse Anglikaanse Biskoppe, asook somige politici het hulle intensies aangekondig om die mv -toets te ondergaan om sodoende die publiek te help opvoed oor die gevaar van hierdie epidemie. Oproepe om die siekte te destigmatiseer deur openbaarheid kan nie in isolasie funksioneer nie. Die staat moet effektiewe kuratiewe en voorkomingsprogramme hier rondom loods en kontinueer. In die afwesigheid van 'n geneesmiddel, sal VIGS slegs frustrasie, hopeloosheid, en vrees skep by diegene wat positief getoets is, sowel as vyandigheid onder diegene wat nie mv positief is nie. Die teks het vier hoofstukke. Hoofstuk 1 fokus op vertroulikheid as 'n belangrike beginsel in die bestuur van die siekte. In mV-VIGS is vertroulikheid 'n meer sensitiewe beginsel aangesien VIGS in die besonder as 'n sosiale skandvlek, aangevreet deur diskriminasie, gesien word. Die hoofstuk bespreek ook mv -infeksie, transmissie, raadgewing en toetsing. Hoofstuk 2 gaan oor die beginsels van die biomediese etiek, naamlik, outonomie, waaronder ingeligte toetstemming, ontwerp om die belange van die pasiente te beskerm teen eksploitasie en gevaar: om gesondheids professionele aan te moedig om hulle op 'n verantwoordelike manier te gedra. Ander beginsels is goedwilligheid en niekwaadwiligheid om die welsyn van ander te beskerm, asook geregtigheid, om toegang tot gesondheidshulp vir almal te verseker. Dit beklemtoon ook die aspekte verwant aan beperkinge tot vertroulikheid. Hoofstuk 3 bespreek breedweg die etiese dilemmas met betrekking tot die verhouding tussen pasiënye en professionele gesondheidswerkers, vrouens en mV-VIGS, godsdiens, gevangenes en werkgewer-werker verhoudings. Toe die VIGS-epidemie begin het, het min mense aan die siekte gely, en die siekte is met groot sorg en vertroulikheid behandel. Vandag is VIGS 'n pandemie en die klem moet geskuif word vanaf outonomie en vetrouilikheid na 'n sosiale etos wat verantwoordlikheid en die vermindering van die risiko van die verspreiding van die infeksie beklemtoon. Die hoofstuk kyk ook na die rolle van gesondheidsdepartmente, deelname van gesondheids professionele organisasies en die juridiese aspekte met betrekking tot vertroulikheid van HIV-VIGS. Hoofstuk 4 poog om 'n argument te ontwikkel wat daartoe sou kon bydra dat HIV-VIGS gedestigmatiseer sal word. Klem word gelê op die verabtwoordelikheid van die staat om soveel moontlike bronne beskikbaar te stel vir die behandeling van en beheer oor hierdie pandemie. Gesondheids professionele word uitgedaag om hulle deskundigheid en bekwaamheid in die diens van die siekes met waardigheid en respek te gebruik. Die gemeenskap word aangemoedig om die poging tot die beheer van die verspreiding van die HIV -infeksie te ondersteun en om die mense wat met VIGS leef in staat te stelom hul status sonder die dreigement van stigmatisering bekend te maak.
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Prattley, Deborah Jayne. "Risk-based suveillance in animal health : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Massey University, Palmerston North, New Zealand." Massey University, 2009. http://hdl.handle.net/10179/1011.
Full textAbstract:
Animal health surveillance is an important part of animal health care, particularly in countries dependent on livestock for food production and international trade. There are two major issues related to the provision of e®ective surveillance activities. Firstly, for good information to become available, the design and conduct of data collection activ- ities should be carried out following sound statistical principles. In reality, constraints such as imperfect tests and unavoidably-biased sampling strategies hinder straightfor- ward analysis and interpretation of survey results. Risk-based surveillance is used to target high-risk sub-populations to increase e±ciency of disease detection; however, biased datasets are generated. This thesis develops methodologies to design risk-based surveillance systems and al- low statistically valid analysis of the inherently biased data they generate. The ¯rst example describes the development of a method to analyse surveillance data gathered for bovine spongiform encephalopathy (BSE). The data are collected from four dif- ferent surveillance streams of animals tested for BSE, with each stream containing unavoidable biases and limitations. In the BSurvE model, these data are combined with demographic information for each birth cohort to estimate the proportion of each birth cohort infected with BSE. The prevalence of BSE in a national herd can then be estimated using the method of moments, whereby the observed number of infected animals is equated with the expected number. The upper 95% con¯dence limit for the prevalence is estimated both for infected countries and for those where no BSE has previously been detected. A similar approach to that used in BSurvE is then applied to surveillance data for trichinellosis, for which risk-based post-mortem testing is also performed. Negative results from multiple species using di®erent, imperfect tests are combined to give an estimate of the upper 95% con¯dence limit of the national prevalence of trichinellosis in a reference population. This method is used to provide support for freedom from trichinellosis in Great Britain. A di®erent approach to risk-based surveillance is explored as the surveillance strategy for detection of exotic causes of abortion in sheep and goats in New Zealand is examined. Using a geographic information system (GIS) maps of disease risk factors were overlain to produce a risk landscape for the lower North Island. This was used to demonstrate how areas of high- and low-risk of disease occurrence can be identi¯ed and used to guide the design of a risk-based surveillance programme. Secondly, within one surveillance objective there may be many ways in which the available funds or human resources could be distributed. This thesis develops a method to assess BSE surveillance programmes, and provides tools to facilitate BSE detection on the basis of infection risk and to increase the e±ciency of surveillance strategies. A novel approach to allocation of resources is developed, where portfolio theory con- cepts from ¯nance are applied to animal health surveillance. The example of surveil- lance for exotic causes of sheep and goat abortion is expanded upon. Risk of disease occurrence is assessed for a population over di®erent time periods and geographical areas within a country, and portfolio theory used to allocate the number of tests to be carried out within each of these boundaries. This method is shown to be more likely to detect disease in a population when compared to proportional allocation of the available resources. The studies presented here show new approaches that allow better utilisation of imperfect data and more e±cient use of available resources. They allow development of surveillance programmes containing an appropriate balance of scanning and targeted surveillance activities. Application of these methods will enhance the implementation and value of surveillance in animal health.
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Methot, Pierre-Olivier. "Historical epistemology of the concept of virulence : molecular, ecological, and evolutionary perspectives on emerging infectious diseases in the 19th and 20th century." Thesis, University of Exeter, 2011. http://hdl.handle.net/10036/3494.
Full textAbstract:
This thesis focuses on the trajectory of the biomedical concept of virulence from 1880 until the present. Following the concept across disciplinary boundaries, from a longue durée history perspective, it explores how virulence was shaped through two distinct, although sometimes overlapping, “styles of reasoning”. Located at the intersection of several distinct research domains in biology and medicine, the concept of virulence provides, in addition, a window into the complex and changing relations between evolutionary biology and the health sciences (broadly construed) over the past two centuries. Moving back and forth between field experiments and the laboratory, this work examines, through the lens of historical epistemology, the emergence of what I call the molecular and the ecological styles, and their respective conceptual practices. It focuses on the ways in which these styles operationalize the distinction between virulent or avirulent organisms in sometimes opposite sense: Whereas in the molecular (or endogenous) style the expression of virulence is explained by properties of internal structures of the infectious agent (e.g. polysaccharide capsule, virulence gene, or pathogenicity island), the concept of virulence in the ecological (or exogenous) style reflects, in contrast, either a lack of adaptation between two species (avirulence hypothesis) or the existence of one or more ecological compromises between, say, the mode of transmission of a pathogen and its host’s recovery rate (trade-off model). Both styles can be said to originate in the medical bacteriology of the late-nineteenth century, but while the former grew mostly out of the work of Louis Pasteur and Robert Koch in Europe, the latter was primarily shaped by Theobald Smith in the United States. Nearly a century later, the introduction of the category of emerging infectious disease within public health discourses in the mid-1990s facilitated a rapprochement between the two styles that had, so far, remained apart. Employing the 1918–1919 influenza pandemic as an example in which to illustrate the trajectory of the molecular and the ecological approaches, the diversity of explanatory schemes developed to account for the pandemic’s exceptional virulence points toward an unresolved, and yet productive, epistemic tension between the two styles, on the one hand, and the intrinsic polarity of the concept of virulence itself, on the other.
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Currier, Erika. "A Study To Investigate The Significance Of Knowing One's Prognosis In People Diagnosed With Life-Limiting Illnesses." ScholarWorks @ UVM, 2015. http://scholarworks.uvm.edu/graddis/432.
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ABSTRACT
Background: For patients with life-limiting illnesses, having adequate knowledge of prognosis can strongly impact the choice between curative and supportive treatment.
Objectives: The purpose of this research study is to explore patient understanding of prognosis and to illuminate the experience of having or not having prognostic information in people diagnosed with life-limiting illnesses. This study aims to investigate the patient's understanding of the term "prognosis", the significance of the term "prognosis" to the patient, and how prognosis may or may not affect future treatment choices. In addition, this study aims to further understand the experience of prognostic communication between provider and patient. The over-arching goal is to capture the personal perspectives of participants with a view to exploring their experiences around knowledge of their prognosis.
Methods: A qualitative research design using a phenomenological approach was employed to examine how people experience prognosis. An invitation to participate in the study was publically announced via local newspapers, social media venues, and word of mouth. Participants who responded to study advertisements and who met inclusion criteria were asked to participate in one interview answering open-ended questions aimed at examining their experience with and knowledge of their prognosis. In addition, questions about prognostic communication between patient and health care provider were explored. All interviews were recorded, transcribed verbatim and analyzed using phenomenological methods.
Results: Three study participants met the study criteria and were interviewed. Several themes emerged from the data including 1) patients have need for information about their illness, 2) prognostic data inform treatment choices, 3) patient experiences are unique and 4) patients feel a connection to nurses involved in their care.
Conclusions: This study illuminated the patients' desire and need for information during their illness, the desire for patient autonomy, the difficulty of starting and having prognostic conversations, the downstream impact of having prognostic information, and the important role that nurses play for patients facing serious health issues. It is hopeful that the themes identified during the course of this research ultimately contribute to the knowledge base by informing healthcare providers on the importance of conveying prognostic information in a timely, direct, and sensitive manner.
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Svanefjord, Natasha. "Hälsans fenomenologi : Medicinens roll i hälsa." Thesis, Södertörns högskola, Filosofi, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-34746.
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This master thesis explores health as a primarily active process and what role theoretical and practical medicine should play in health. Health is divided up into four rooms: the room of the theoretician who works in medicine, the meeting between the theoretician and practician, the meeting between practician and patient, and lastly the individual’s cultural room. By phenomenologically unveiling the transmutation of life defined as death within the cartesian framework of mind-body dualism and its influences on modern Western medicine it becomes apparent that health as defined by biomedicine (lack of disease) is a problematic concept in regard to the experience of being ill in the individual’s room, which is the phenomenological starting point. In the West there exists a cultural tendency among both natural scientists and laypersons to use natural science and medical theory to explain and give meaning to individual diseases and healths, which has also lead to a cultural crisis in the ill individuals’ identity as the cartesian mind-body dualism is more complex than two opposing forces – it is more correct to describe this relation of mind and body identity as a ‘trialism’. The thesis mainly rests on the works of Drew Leder and Jenny Slatman; their works on health and illness in relation to cartesian dualism, and on their concepts of authentic materialism and differential materialism respectively, to formulate a phenomenological theory of health (from the room of the individual) understood as primarily an activity. It concludes that health within the individual’s room is an activity in the now that consists in accepting one’s bodily state and the choices one has made in life to land oneself in the body one now experiences. A healthy choice is grounded in a will to be one’s self, to be one’s own body, although one does not coincide with it. The role of practical medicine is to help the individual want to be themselves, their own body, – by working with the two concepts of health presented as the theoretical health (absence of disease) and the phenomenological (will to be oneself).
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Chng, Soon Fang. "Microbial factors associated with the natural suppression of take-all in wheat in New Zealand : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy at Lincoln University, Canterbury, New Zealand /." Diss., Lincoln University, 2009. http://hdl.handle.net/10182/863.
Full textAbstract:
Take-all, caused by the soilborne fungus, Gaeumannomyces graminis var. tritici (Ggt), is an important root disease of wheat that can be reduced by take-all decline (TAD) in successive wheat crops, due to general and/or specific suppression. A study of 112 New Zealand wheat soils in 2003 had shown that Ggt DNA concentrations (analysed using real-time PCR) increased with successive years of wheat crops (1-3 y) and generally reflected take-all severity in subsequent crops. However, some wheat soils with high Ggt DNA concentrations had low take-all, suggesting presence of TAD. This study investigated 26 such soils for presence of TAD and possible suppressive mechanisms, and characterised the microorganisms from wheat roots and rhizosphere using polymerase chain reaction (PCR) and denaturing gradient gel electrophoresis (DGGE). A preliminary pot trial of 29 soils (including three from ryegrass fields) amended with 12.5% w/w Ggt inoculum, screened their suppressiveness against take-all in a growth chamber. Results indicated that the inoculum level was too high to detect the differences between soils and that the environmental conditions used were unsuitable. Comparison between the Ggt DNA concentrations of the same soils collected in 2003 and in 2004 (collected for the pot trial), showed that most soils cropped with 2, 3 and 4 y of successive wheat had reduced Ggt DNA concentrations (by 195-2911 pg g-1 soil), and their disease incidences revealed 11 of the 29 test soils with potential take-all suppressiveness. Further pot trials improved the protocols, such that they were able to differentiate the magnitudes of suppressiveness among the soils. The first of the subsequent trials, using 4% w/w Ggt inoculum level, controlled conditions at 16°C, 80% RH with alternate 12 h light/dark conditions, and watering the plants twice weekly to field capacity (FC), screened 13 soils for their suppressiveness against take-all. The 13 soils consisted of 11 from the preliminary trial, one wheat soil that had been cropped with 9 y of wheat (considered likely to be suppressive), and a conducive ryegrass soil. The results revealed that 10 of these soils were suppressive to take-all. However, in only four of them were the effects related to high levels of microbial/biological involvement in the suppression, which were assessed in an experiment that first sterilised the soils. In a repeat trial using five of the soils H1, H3, M2, P7 (previously cropped with 3, 3, 4 and 9 y successive wheat, respectively) and H15 (previously cropped with 5 y of ryegrass), three of them (H1, H3 and M2) had reduced Ggt DNA concentrations (>1000 pg g-1 soil reductions), and were confirmed to be suppressive to take-all. A pot trial, in which 1% of each soil was transferred into a γ-irradiated base soil amended with 0.1% Ggt inoculum, indicated that soils H1 and H3 (3 y wheat) were specific in their suppressiveness, and M2 (4 y wheat) was general in its suppressiveness. The microbial communities within the rhizosphere and roots of plants grown in the soils, which demonstrated conduciveness, specific or general suppressiveness to take-all, were characterised using PCR-DGGE, and identities of the distinguishing microorganisms (which differentiated the soils) identified by sequence analysis. Results showed similar clusters of microorganisms associated with conducive and suppressive soils, both for specific and general suppression. Further excision, re-amplification, cloning and sequencing of the distinguishing bands showed that some actinomycetes (Streptomyces bingchengensis, Terrabacter sp. and Nocardioides sp.), ascomycetes (Fusarium lateritium and Microdochium bolleyi) and an unidentified fungus, were associated with the suppressive soils (specific and general). Others, such as the proteobacteria (Pseudomonas putida and P. fluorescens), an actinomycete (Nocardioides oleivorans), ascomycete (Gibberella zeae), and basidiomycete (Penicillium allii), were unique in the specific suppressiveness. This indicated commonality of some microorganisms in the take-all suppressive soils, with a selected distinguishing group responsible for specific suppressiveness. General suppressiveness was considered to be due to no specific microorganisms, as seen in soil M2. An attempt to induce TAD by growing successive wheat crops in pots of Ggt-infested soils was unsuccessful with no TAD effects shown, possibly due to variable Ggt DNA concentrations in the soils and addition of nutrients during the experiment. Increasing numbers of Pseudomonas fluorescens CFU in the rhizosphere of plants, during successive wheat crops was independent of the Ggt DNA concentrations and disease incidence, suggesting that increases in P. fluorescens numbers were associated with wheat monoculture. This study has demonstrated that TAD in New Zealand was due to both specific and general suppressiveness, and has identified the distinguishing microorganisms associated with the suppression. Since most of these distinguishing microorganisms are known to show antagonistic activities against Ggt or other soilborne pathogens, they are likely to act as antagonists of Ggt in the field. Future work should focus on validating their effects either individually, or interactively, on Ggt in plate and pot assays and under field conditions.
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Humphris, Teneille Patricia. "On the Origins of the Modern Concept of Syphilis: Eighteenth Century Debate, Ludwik Fleck, and the Enlightenment." Thesis, University of Canterbury. School of Social and Political Sciences, 2013. http://hdl.handle.net/10092/8443.
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The enlightenment period is often considered a dark age within the history of medicine. Contrary to this sentiment, I argue that the enlightenment spirit of inquiry regarding venereal disease was vibrant, dynamic, and profoundly influenced how syphilis was understood in the subsequent century. Historiography frequently minimises advances of medical knowledge made in the eighteenth century by focusing on the inefficacy of treatments, rather than on developments in medical theories and concepts. This thesis attends to this gap by examining a case study within venereology to demonstrate that physicians engaging in public debate significantly advanced knowledge of syphilis. In doing so, this counters a historiographical trend that claims that French physician Philippe Ricord (1800-1889) was the first to distinguish syphilis from gonorrhoea in the nineteenth century. It uses historical evidence to show that the nature of syphilis was debated throughout the preceding centuries and that this distinction was clearly established in 1793 by Scottish surgeon, Benjamin Bell (1749-1806). This thesis uses the epistemic concepts devised by Ludwik Fleck in his Genesis and Development of a Scientific Fact (1979 [1935]) to illustrate how enlightenment ways of thinking substantially contributed to the development of modern medicine. This thesis therefore invites a reconsideration of the era, not as a dark age, but as a rich period of scientific endeavour.
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Baum, Matthew L. "Ethical issues in the bioprediction of brain-based disorder." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:9978211b-5b61-4dba-bbba-157239664b2c.
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The development of predictive biomarkers in neuroscience is increasingly enabling bioprediction of adverse behavioural events, from psychosis to impulsive violent reaction. Because many brain-based disorders can be thought of as end-states of a long development, bioprediction carries immense therapeutic potential. In this thesis, I analyse issues raised by the development of bioprediction of brain-based disorder. I argue that ethical analysis of probabilities and risk information bioprediction provides is confounded by philosophical and social structures that have, until recently, functioned nominally well by assuming categorical (binary) concepts of disorder, especially regarding brain-disorder. Through an analysis of the philosophical concept of disorder, I argue that we can and ought to reorient disorder around probability of future harm and stratify disorder based on the magnitude of risk. Rejection of binary concepts in favour of this non-binary (probability-based) one enables synergy with bioprediction and circumnavigation of ethical concerns raised about proposed disorders of risk in psychiatry and neurology; I specifically consider psychosis and dementia risk. I then show how probabilistic thinking enables consideration of the implications of bioprediction for two areas salient in mental health: moral responsibility and justice. Using the example of epilepsy and driving as a model of obligations to protect others against risk of harm, I discuss how the development of bioprediction is poised to enhance moral responsibility. I then engage with legal cases and science surrounding a predictive biomarker of impulsive violent reaction to propose that bioprediction can sometimes rightly diminish responsibility. Finally, I show the relevance of bioprediction to theories of distributive justice that assign priority to the worse off. Because bioprediction enables the identification of those who are worse off in a way of which we have previously been ignorant, a commitment to assign priority to the worse off requires development of and equal access to biopredictive technologies.
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Horn, Lynette (Lynette Margaret). "Theories of justice and an HIV/AIDS health care policy for South Africa : a comparative analysis." Thesis, Stellenbosch : Stellenbosch University, 2003. http://hdl.handle.net/10019.1/53662.
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Thesis (MPhil)--University of Stellenbosch, 2003.ENGLISH ABSTRACT: On The io" of May 1994 Nelson Mandela was inaugurated as the first democratically elected black president of South Africa. The occasion was regarded, both nationally and internationally, as a triumph for humanity and perfused with a widespread optimism for the future of South Africa. Mandela proclaimed in his inaugural speech that "Never, never and never again shall it be that this beautiful land will experience oppression of one by another .... The sun shall never set on so glorious an achievement." However, now, less than 10 years later the rapidly accelerating and devastating HIV/AIDS epidemic is again 'obscuring the sun'. Those people affected so negatively by the racial, economic and gender injustices of the apartheid past, seem again to be suffering a possible injustice, because of a health and welfare system that is struggling to meet the needs of the HIV affected population. The purpose of this dissertation is to examine the concept of distributive justice in South Africa, within the context of this devastating epidemic. I begin by discussing the Bill of Rights in the South African Constitution. I argue that an acceptable framework for a theory of justice for health care in South Africa, must be worked out against the background of this egalitarian Bill of Rights. I then consider the extent of the HIV epidemic, the effect it is having on the people of South Africa and the consequent implications for health care needs. It is within this context that I examine and compare three theories of distributive justice, namely utilitarianism, John Rawls' theory of "Justice as Fairness" and a libertarian concept of justice, as proposed by Robert Nozick. Utilitarianism is a consequentialist theory that focuses on producing the 'greatest happiness for the greatest number'. I argue that many health policy decisions in South Africa are in fact guided by this principle. However utilitarianism has both strengths and weaknesses which are critically examined. Within the framework of health care policy making, utilitarian justice dictates that rights are derivative and that the welfare of the majority usually takes precedence over the pressing needs of a minority. This issue in particular is discussed. Rawls' theory of "Justice as fairness" is critically discussed next. This theory has been adapted to health care by Norman Daniels, who argues that the Rawlsian principle of "fair equality of opportunity" is a suitable founding principle for health care institutions. Apartheid entrenched a system of 'inequality of opportunity'. Consequently, a theory that focuses on equality of opportunity, has many advantages within the South African context. I examine this theory in detail and provide justification for my assertion that it could be usefully adapted to South African healthcare and the HIV/AIDS epidemic. Finally, I discuss a Libertarian (Nozickian) theory of justice and examine both the strengths and weaknesses of this theory. I attempt to demonstrate why a libertarian system, with it vigorous commitment to moral and economic individualism and belief that one is only entitled to that share of healthcare that can be paid for, would be unjust, if rigorously applied within the post-apartheid South African context. I conclude my dissertation by reiterating my assertion that "Justice as Fair Equality of Opportunity" could be used as a just foundation for a theory of justice for health care in current day, HIV/AIDS affected South Africa.
AFRIKAANSE OPSOMMING: Teorieë van geregtigheid en 'n gesondheidsbeleid vir die VIGS epidemie in Suid Afrika: 'n vergelykende ontleding. Op die 10de Mei 1994 is Nelson Mandela ingehuldig as die eerste demokraties verkose swart president van Suid- Afrika. Die geleentheid is in beide Suid-Afrika en in die buiteland beskou as 'n oorwinning vir humaniteit. Optimisme oor Suid-Afrika se toekoms was oral tasbaar. Mandela het in sy inhuldigingstoespraak verkondig dat dit nooit weer sal gebeur dat hierdie pragtige land sal lyonder die onderdrukking van een oor die ander nie. Hy het gesê dat die son nooit salondergaan op so 'n wonderlike prestasie nie. Nou, minder as tien jaar later, is die verwoestende VIGS epidemie besig om weer die 'son te laat ondergaan'. Dieselffde mense wat alreeds onder apartheid se rasisme en ekonomiese en geslagsongeregtighede gely het, blyk nou weer verontreg te word; hierde keer omdat die gesondheids- en welsynsisteem sukkel om in die behoeftes van die VIGS-geaffekteerde populasie te voorsien. Die doel van hierdie verhandeling is om die konsep van distributiewe geregtigheid in die konteks van die dreigende VIGS epidemie te bespreek. Ek begin met 'n bespreking van die Verklaring van Regte soos vervat in die Suid-Afrikaanse Grondwet. Ek voer aan dat enige aanvaarbare teorie oor geregtigheid in die Suid-Afrikaanse gesondheidsisteem gegrond moet word op hierdie egalitêre Verklaring van Regte. Tweedens kyk ek na die omvang van die VIGS epidemie, die effek wat dit op die HIV-positiewe populasie en hulle familielede het, en die gevolglike implikasies vir gesondheidsbehoeftes. Dit is binne hierdie konteks dat ek drie teorieë van distributiewe geregtigheid ondersoek en vergelyk; naamlik utilitarisme, John Rawls se teorie van "Justice as Fairness", en 'n libertynse konsep van geregtigheid soos voorgestel deur Robert Nozick. Utilitarisme is 'n konsekwensialistise teorie wat beteken dat die regte daad die een is wat in enige situasie die grootste geluk vir die meeste persone sal meebring. Ek voer aan dat baie van die beleidsrigtings wat 'n gesondheidsorg in Suid-Afrika gevolg is, deur hierdie teorie beïnvloed is. Utilitarisme het uiteraard sterk en swak punte en beide kante word krities ondersoek. In 'n gesondheidsorg konteks beteken utilitarisme dat regte altyd afgelei is en dat die welsyn van die meerderheid gewoonlik belangriker is as die van 'n minderheid, selfs wanneer die probleme van die minderheid ernstig en dringend is. Rawls se teorie van geregtigheid word vervolgens krities bespreek. Hierdie teorie is deur Norman Daniels aangepas vir gesondheidsorg. Hy stel voor dat Rawls se beginsel van 'regverdige gelykheid van geleentheid' baie effektief aangepas kan word vir gesondheidsorginstellings. Apartheid het 'n sisteem van ongelyke geleentheids verskans; gevolglik hou 'n teorie wat gelykheid van geleentheid verseker baie voordele vir die Suid- Afrikanse situasie in. Ek bespreek hierdie teorie in detail en poog om my standpunt dat die teorie besonder geskik is vir Suid-Afrikaanse gesondheidsisteem - veral in die konteks van die VIGS epidemie - te regverdig. Laastens bespreek ek die libertynse teorie van geregtigheid soos voorgestel deur Robert Nozick. Ek probeer aantoon waarom hierdie teorie, wat gebaseer is op morele en ekonomiese individualisme en gevolglik aanvoer dat mense geregtig is op gesondheidsorg alleenlik as hulle daarvoor kan betaal, onregverdig is in die Suid-Afrikaanse post-apartheid konteks. Ek sluit hierdie. verhandeling af deur weer te argumenteerdat Rawls se teorie en die beginsel van 'geregtigheid as gelyke geleentheide' uiters geskik is as 'n grondslag vir gesondheidsorg in Suid-Afrika vandag.
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Meghani, Zahra Iqbal. "Can medical theories be objective?" Diss., Connect to online resource - MSU authorized users, 2006.
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Zeiler, Kristin. "Chosen Children? : An empirical study and a philosophical analysis of moral aspects of pre-implantation genetic diagnosis and germ-line gene therapy." Doctoral thesis, Linköpings universitet, Hälsa och samhälle, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-4276.
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With pre-implantation genetic diagnosis (PGD), genetic testing and selective transfer of embryos is possible. In the future, germ-line gene therapy (GLGT) applied to embryos before implantation, in order to introduce missing genes or replace mutant ones, may be possible. The objective of this dissertation is to analyse moral aspects of these technologies, as described by eighteen British, Italian and Swedish gynaecologists and geneticists. The objective is systematised into three parts: research interviews and qualitative analysis, philosophical analysis, and elaboration of a framework that supports the combination of analytic methods. PGD was described as positive since it enabled some couples at risk for a genetic disease to have a child without the disease. PGD was described as in different senses ‘better’ than methods for prenatal diagnosis and selective termination of pregnancy. It was also described as positive since it provided couples at risk with one more option, even if it did not result in the birth of a healthy child. However, interviewees were concerned about the difficulty of defining and evaluating genetic disease. They were also concerned about patients’ choices, and about exaggerated use or misuse. Whereas PGD gave rise to ambivalence in terms of how to understand, describe and evaluate it, GLGT was often described as unrealistic or undesirable. The results of the qualitative analysis are used in a philosophical analysis of the concepts of choice, autonomous choice, ambivalence, trust and ambivalence in trust relations. A set of distinct characteristics of each concept are elaborated. The results of the philosophical analysis are used in the discussion of the results of the qualitative analysis. The study shows that the technologies imply both ‘new’ ways to perform ‘old’ medical practices and ‘new’ practices. Old moral questions are reformulated. New moral questions are added. Against the background of this, the concept of genetic identity is discussed. Key words: empirical ethics, pre-implantation genetic diagnosis, germ-line gene therapy, qualitative research, philosophical analysis, medical progress, genetic disease, choice, autonomous choice, ambivalence, trust, genetic identity.
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Guedes, Fernando Soares. "Encontro terapêutico: avaliação de uma abordagem integral em pacientes com dispepsia funcional, ensaio clínico controlado aleatorizado." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5137/tde-26022015-091109/.
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INTRODUÇÃO: Este estudo tem por objetivo avaliar, em pacientes portadores de dispepsia funcional, um tipo de atendimento médico que tem a sustentação de uma base epistemológica mais ampla (encontro terapêutico) comparada com o atendimento médico tradicional embasado no modelo biomédico (consulta médica). Inicia-se com um debate onde são descritas as teorias e definições acerca do tema \"pluralismo epistemológico\". O autor acredita que este é o alicerce capaz de fornecer a necessária sustentação para o exercício crítico da atividade profissional que se quer mais humanizada e humanista e para uma pesquisa em saúde que consiga integrar os múltiplos saberes. Em seguida, descreve os passos que transformam \"consultas\" em \"encontros terapêuticos\". De acordo com o autor essa transformação possibilita o resgate das características de arte da medicina. Arte no sentido de artesanal (de \"feita sob medida\") ao contrário da biomedicina que é técnica (no sentido de sistematizar, generalizar). MÉTODOS: Trata-se de um ensaio clínico randomizado e controlado por placebo, registrado no ClinicalTrials.gov. Realizado de novembro de 2007 a fevereiro de 2012. Foram recrutados 131 pacientes com dispepsia funcional a partir de 753 voluntários pertencentes ao Ambulatório de Gastroenterologia da Faculdade de Medicina do ABC. Esses pacientes foram divididos em dois grupos A e B, onde o grupo A (n = 63) foi tratado com consultas médicas tradicionais e o grupo B (n = 68) com encontros terapêuticos. Esses dois grupos foram divididos em 4 subgrupos A1, A2, B1 e B2, onde os subgrupos A1 (n = 31) e B1(n = 34) receberam o medicamento omeprazol, A2 (n = 32) e B2 (n = 34) receberam placebo. A todos os pacientes, foi aplicado o Questionário de Sintomas de Dispepsia Funcional (QSDF) no início do estudo. Aos que terminaram o tratamento, o QSDF foi aplicado no final (seis meses após o inicio). A variável desfecho foi definida como sendo a redução de 50% e mais no escore obtido entre a primeira e a segunda aplicação do QSDF. RESULTADOS: 1) Não houve diferenças entre os grupos e subgrupos com respeito ao número de pacientes, quanto à distribuição por sexo, idade e frequência de uso de medicação de resgate. 2) Dos 131 pacientes do estudo 74 (56,5%) completaram o tratamento e 57 (43,5%) abandonaram antes do término. Não há diferença significativa entre os grupos A (n = 30) e B (n = 44) quanto à proporção de pacientes que terminaram seu tratamento (p = 0,076). 3) Nos subgrupos B1 e B2, 79,5% e 80% dos pacientes, respectivamente, alcançaram a redução de 50% e mais no escore do QSDF, contra apenas 22,2% e 41,7% dos pacientes dos subgrupos A1 e A2. A diferença entre os subgrupos é significante (p < 0,001). CONCLUSÕES: Neste estudo o atendimento médico \"encontro terapêutico\" foi (2,65 vezes) mais eficaz do que a \"consulta médica tradicional\". A excelência técnica é fundamental para a boa prática da medicina, mas ela é mais eficaz quando associada à arteINTRODUCTION: This study aims to evaluate, in patients with functional dyspepsia, a type of medical care that has the support of a larger epistemological basis (therapeutic encounter) compared with standard medical care grounded in the biomedical model (medical consultation). It begins with a discussion where theories and definitions on the topic \"epistemological pluralism\" are described. The author believes that this is the foundation capable of providing the necessary support for the critical exercise of professional activity in a more humane and humanistic basis, and for a health research capable of the integration of multiple areas of knowledge. Then he describes the steps that transform \"consultation\" in \"therapeutic encounters.\" According to the author, this transformation enables the rescue of the characteristics of the art of medicine. Art in the sense of artisanal (the \"tailor made\") instead of biomedicine that is technical (in the sense of systematic, generalized). METHODS: This was a randomized, placebo-controlled clinical trial, registered in ClinicalTrials.gov., held from November 2007 to February 2012. 131 patients with functional dyspepsia were recruited from 753 volunteers belonging to the Gastroenterology outpatient clinic of Faculdade de Medicina do ABC. These patients were divided into two groups A and B, where group A (n = 63) was treated with traditional medical consultations and group B (n = 68) with therapeutic encounters. These two groups were divided into 4 subgroups A1, A2, B1 and B2, where the subgroups A1 (n = 31) and B1 (n = 34) received omeprazole, A2 (n = 32) and B2 (n = 34) received placebo. All patients answered the Questionnaire Symptoms of Functional Dyspepsia (QSFD) at study entry. Those patients who completed treatment answered the QSFD again in the end (six months after the onset). The outcome variable was defined as a reduction of 50% and more on the score obtained between the first and second application of QSFD. RESULTS: 1) There were no differences between the groups and subgroups with respect to the number of patients, according to the distribution by gender, age and frequency of use of rescue medication. 2) Among the 131 patients in the study 74 (56.5%) completed treatment and 57 (43.5%) dropped out before completion. There is no significant difference between groups A (n = 30) and B (n = 44) as the proportion of patients who completed their treatment (p = 0.076). 3) In subgroups B1 and B2, 79.5% and 80% of patients, respectively, achieved a reduction of 50% and more in the score QSFD, against only 22.2% and 41.7% of patients in subgroups A1 and A2. The difference between the groups is significant (p <0.001). CONCLUSIONS: In this study the \"therapeutic encounter\" was (2.65 times) more effective than \"traditional medical consultation\". Technical excellence is fundamental to good medical practice, but it is more effective when combined with art
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González, Sebastián. "Ideológica y realidad material. El problema de la imaginación." Pontificia Universidad Católica del Perú - Departamento de Humanidades, 2012. http://repositorio.pucp.edu.pe/index/handle/123456789/113080.
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Ideology and Material Reality. The Problem of Imagination”. Are there no more options of freedom than those determined not only by the real conditions under which each one of us live, but by the scheme of functions which force us sometimes to make/feel and sometimes only let us make/feel according to a certain number of action and passion possibilities? With this question in mind, we test the hegemony and antagonisms model (Laclau and Mouffe), more with the aim of problematizing” the theoretical alternatives whose treatment of freedom and of the role of people and groups does not emerge from transcendental considerations on the subject and her connatural rights; than with the aim of finding an answer for the determinations proposal. In this paper we propose a problematic approach to the issue of knowing whether we can or cannot give ourselves a political organization which gathers the effects of the State’s repression devices, which ignores the obscure conception of ideology as a false interpretation or as a reality deforming illusion and which does not base its considerations on the concept of subject on the already far too well known postulates of freedom, rationality, legitimate adscription to the law, dialogue and consent. Our hypothesis is that in so far as every agreement entails the at least partial stabilization of differences without implying the dissolution of antagonisms, the possibility for the complex and incomplete articulation of the involved agents arises. Consensus is therefore arrived at without exclusion. Consensus is the undecidable issue of keeping open the political link for the questioning of agents according to their demands, needs, perspectives, interests, etc. Finally, we claim that any political project with aspirations to change has a possibility in the violence of imagination.¿No hay más opciones de libertad que las determinadas ya no solo por las condiciones reales en las que cada uno de nosotros vive, sino por el esquema de funciones que nos obligan en ocasiones a hacer/sentir y en otras tan solo nos dejan hacer/sentir de acuerdo con cierto número de posibilidades de acción y pasión? Con esa pregunta en frente probamos el modelo de la hegemonía y los antagonismos (Laclau y Mouffe) pensando, más que en una respuesta al planteamiento de las determinaciones, en problematizar” las alternativas teóricas cuyo tratamiento de la libertad y del papel de las personas y los grupos no provenga de consideraciones trascendentales acerca del sujeto y sus derechos connaturales. Proponemos una aproximación problemática a la cuestión de saber si podemos o no darnos una organización política que conjure los efectos de los aparatos de represión de Estado, que haga caso omiso a la oscura concepción de la ideología como falsa interpretación o ilusión deformante de la realidad y que no base sus consideraciones en la concepción del sujeto en los ya muy manoseados postulados de la libertad, la racionalidad, la adscripción legítima a la autoridad, el diálogo, el consenso. La hipótesis es que en la medida en que cualquier acuerdo supone la estabilización parcial de las diferencias sin la disolución de los antagonismos, se abre la posibilidad de la articulación compleja e incompleta de los agentes en pugna. El consenso se plantea, en consecuencia, sin exclusión. El consenso, si se permite decirlo nuevamente, es el indecidible asunto de mantener abierto el vínculo político a la interpelación de los agentes según sus exigencias, urgencias, perspectivas, intereses, etc. Al final sostenemos que cualquier proyecto político que tenga aspiraciones de cambio tiene posibilidad en la violencia de la imaginación.
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Lee, Sangbum. "Nietzsches Gesundheitsphilosophie." Doctoral thesis, Humboldt-Universität zu Berlin, Philosophische Fakultät I, 2015. http://dx.doi.org/10.18452/17108.
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Die Krise der Philosophie, die Nietzsche diagnostiziert hat, ist eine Krise der Abstraktheit der Philosophie, einer Philosophie, die nicht mehr als existenziale Luft des Lebens und als existenziale Atmung des Menschen funktioniert. Für Nietzsche ist die Konkretheit als Begriff im Verhältnis mit der wirklichen Lebenswelt des Menschen nicht bloß die Diagnose der Krise des Lebens, sondern eine Philosophie der Heilung, die der Handlung eines Arztes entspricht. In Nietzsches Philosophie als Gesundheitsphilosophie wird die Krankheit als eine Chance bestimmt, wieder gesund werden zu können. Das heißt, die Krankheit ist ein wichtiger Grund für die Hoffnung auf Gesundheit und die Gesundheit ist eine wichtige Antwort auf den Sinn der Krankheit.The Crisis of Philosophy that Nietzsche has diagnosed, is a Crisis of the Abstractness of Philosophy, a Philosophy that no longer functions as the existential air of Life and existential Breath of Humans. For Nietzsche the Concreteness as understood as a Conceptual unit is in Proportion with the real Life and World of Humans not only the diagnosis of the Crisis of Life, but a Philosophy of Healing, which corresponds to the Cure of a Doctor. In Nietzsche''s Philosophy as a Philosophy of Health the disease is determined as a chance to be Healthy once more. Disease is an important reason for the Hope of Health and Health is an important Response to the sense of the disease.
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Mosley, Robert Arthur. "Effects of an early return-to-work program on the costs of workers' compensation." Connect to this title online, 2003. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1054657698.
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Thesis (Ph. D.)--Ohio State University, 2003.Title from first page of PDF file. Document formatted into pages; contains ix, 147 p. Includes bibliographical references (p. 143-147). Available online via OhioLINK's ETD Center
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Lefebvre, des Noettes Véronique. "Le sentiment d'exister des malades d'Alzheimer : esprit es-tu là?" Thesis, Paris Est, 2016. http://www.theses.fr/2016PESC0053.
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La philosophie nous dit Pascal ne vaudrait pas même une heure de peine si elle ne rendait la vie moins tragique. Quoi de plus tragique que la maladie d’Alzheimer ? Cette maladie neurodégénérative va modifier l’ identité sédimentée depuis la naissance qui s’étiole au point de ne plus reconnaitre les visages familiers, de se perdre dans des endroits familiers, et ne plus être capable de parler, d’exprimer ses émotions. Comment interroger le sentiment d’exister ? Comment révéler le souffle de l’esprit qui murmure encore une envie de vivre ? Pour se sentir exister ne faut- il pas non seulement ressentir des émotions, mais les analyser, les communiquer et méta-communiquer ? Mais quand il s’agit de malades d’Alzheimer qu’en est-il puisqu’ils sont de-mens ? Pour que l’esprit se manifeste nous prendrons des chemins de traverse dans cette sollicitation sensorielle : le goût sera réveillé par le goût des autres, le toucher par cette main noueuse dans la notre et le toucher du cœur, la vue par le regard et la perception de soi, l’odorat dans les parfums de la mémoire, l’ouïe par les sons, les cris, la parole, la prosodie et la musique qui berce les chagrins et qui nous émeuvent. Autant d’interrogations que de questions d’éthiques du quotidien: Esprit qui es-tu ? Esprit es-tu là dans ce visage figé? Esprit es-tu là dans ces mots qui butent ?, dans ces traits d’humour, dans ces rêves ? Esprit es-tu là dans ce corps qui lui aussi se délite ? Cet être précaire, fragile et vulnérable interroge les limites, les frontières, les confins entre la de-mens-folie et la démence dégénérative, la philosophie, l’anthropologie et les sciences humaines et les trois spécialités médicales que sont la psychiatrie, la neurologie et la gériatrie. C’est dans ce tissage imparfait, dans ce travail d’équilibriste qui interroge, les lisières de l’altérité que nous forgerons notre concept d’ontologie des confins. Riche de ces partages qui viennent interroger les liens de l’esprit et de l’âme, du corps et de la chair, notre travail proposera, à la manière kantienne une anthropologie philosophique des patients atteints de la maladie d’Alzheimer et tentera de répondre à ces quatre questions : Que puis-je savoir? Que puis-je faire et comment faire? Que m'est-il permis d'espérer ? En partant de ce que nous percevons mais aussi de ce que « nous apercevons» nous conceptualiserons une éthique des petites perceptions reprenant ici les théories de Leibniz qui accorde à l’humain « la potentialité de la raison, une certaine raison par intermittence, une raison à éclipse », que l’on peut retrouver chez les malades d’Alzheimer, au point qu’elle soit imperceptible pour la plupart des hommes.Alors esprit es-tu là? La réponse jaillit pleine de surprises et de joies dans ces pagesThe philosophy says Pascal would not be worth even a sentence of time if it made the least tragic life. What could be more tragic than Alzheimer's disease? For this neurodegenerative disease will alter identity sedimented from birth that is fading to the point of not recognizing familiar faces, not to be able to perform simple gestures, to get lost in familiar places, and not being able to speak, to express emotions, out of the human world to take root in the plant world. How to query the sense of existence? How to reveal the breath of the spirit which still murmur and until the end. To feel alive must we do to be able to listen to oneself, not only feel emotions, but analyze, communicate and meta-communicate; but when it comes to Alzheimer's patients that is it because they are de-mens? What makes sense it is precisely the senses and emotions. For the spirit is manifest we will take short cuts in this sensory solicitation: the taste will be awakened by the taste of others, by touching this gnarled hand in our and touch the heart, view the look and self-perception, smell the scents in the memory, hearing by sounds, cries, speech, prosody and music that rocks the sorrows and that move us. So many questions that ethical issues of daily life: Spirit who are you? Spirit are you there in these words stumble? In those flashes of humor in these dreams? Esprit are you here in this body also disintegrates? This being precarious, fragile and vulnerable challenge the limits, borders, the borders between the de-mens-madness and degenerative dementia, philosophy, anthropology and humanities and three medical specialties such as psychiatry, neurology and geriatrics. It is in this imperfect weaving in this work balancing questioner, edges of otherness that we will develop our confines of ontology concept. Rich those shares that come to question the bonds of spirit and soul, body and flesh, our job offer, like Kant's philosophical anthropology of patients with Alzheimer's disease and attempt to answer these four questions: What do I know? What can I do and how to do? What may I hope? Starting from what we perceive but also that "we see" conceptualiserons us an ethical perceptions of small repeating here the theories of Leibniz which grants the human 'potentiality of reason, some reason intermittently, one reason to eclipse "that can be found in Alzheimer's patients, so that it is imperceptible to most men.So mind are you there? The answer springs full of surprises and joy in these pages
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Corvol, Aline. "Valeurs, attitudes et pratiques des gestionnaires de cas en gérontologie : une éthique professionnelle en construction." Phd thesis, Université René Descartes - Paris V, 2013. http://tel.archives-ouvertes.fr/tel-00987270.
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La gestion de cas est une pratique professionnelle qui s'implante actuellement en France, en particulier dans le domaine des soins aux personnes âgées en perte d'autonomie. Les " gestionnaires de cas " interviennent auprès de personnes âgées vivant à domicile dont la situation est jugée particulièrement complexe sur le plan médical et social. Ils ont pour mission d'évaluer les besoins des personnes suivies, de mettre en place les soins et les aides nécessaires, et d'assurer un suivi à long terme. Ils participent au processus d'intégration de l'organisation des soins en identifiant les dysfonctionnements au niveau de leur territoire, dans le cadre du " dispositif MAIA ". L'apparition de cette nouvelle pratique professionnelle soulève des enjeux éthiques spécifiques, du fait du positionnement particulier des gestionnaires de cas vis-à-vis des personnes accompagnées et de leur rôle nouveau dans le système de soins. L'objectif de ce travail est de proposer un cadre cohérent pour penser l'éthique de la gestion de cas, à partir de l'analyse des valeurs, des attitudes et des pratiques des gestionnaires de cas. Notre approche méthodologique s'appuie sur une recherche qualitative permettant un dialogue permanent entre faits observés et constructions théoriques, selon les principes de l'éthique empirique intégrée. Notre recueil de données comprend des entretiens approfondis avec des gestionnaires de cas, des entretiens semi-structurés avec les " pilotes " qui les encadrent, des groupes de discussions et un questionnaire écrit. L'étude française est complétée par une étude de cas visant à évaluer les conséquences sur l'éthique des professionnels d'un contexte organisationnel différent, à partir de groupes de discussion réalisés au Québec (Sherbrooke) et en Allemagne (Greifswald). L'analyse des données nous a amené à reconnaitre l'individualisation de la relation comme une valeur phare de la gestion de cas. L'engagement des professionnels dans une relation soignante leur permet de faire face aux conflits de valeurs que crée leur double mission de protéger des personnes vulnérables et de respecter leurs choix. Les gestionnaires de cas s'appuient en effet sur cette relation pour négocier avec la personne accompagnée un projet de soin qui fasse sens dans son histoire de vie. Cette individualisation de la relation entre en tension avec la nécessaire à une organisation du système de soins juste et efficiente. Le développement d'une éthique professionnelle spécifique à la gestion de cas nécessite donc de penser conjointement le rôle clinique du gestionnaire de cas, vis-à-vis des personnes accompagnés, et son rôle institutionnel. L'équilibre entre ces deux rôles est à construire dans le cadre d'une éthique organisationnelle, compatible avec l'éthique des professionnels et garante des droits des personnes accompagnées, propre à chaque système de santé.
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Duclos, Harmony. "Théorie de l'esprit et connaissances sociales dans la maladie d'Alzheimer et la démence sémantique." Thesis, Normandie, 2017. http://www.theses.fr/2017NORMC031.
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La cognition sociale fait référence à un ensemble de processus cognitifs fonctionnant en interaction permettant de se comporter de manière adaptée dans le monde social. La théorie de l’esprit (TDE) est considérée comme étant l’élément central de la cognition sociale, mais les liens entre les processus sont encore mal connus. Les capacités de TDE se manifestent au quotidien au travers des relations interpersonnelles, mais l’effet du contexte sur la TDE demeure encore mal connu. L’objectif principal de ce travail de thèse consistait à étudier conjointement la TDE et les connaissances sociales ainsi que les liens existant entre ces deux dimensions. Nous résultats mettent en évidence que les capacités à attribuer des états mentaux sont modulées par le contexte et plus précisément par l’intégrité des connaissances sociales dans la maladie d’Alzheimer et dans la démence sémantique. Les troubles des patients pourraient avoir une origine différente, en lien avec l’atteinte cérébrale. La cognition sociale pourrait ainsi être un élément utile dans le cadre du diagnostic différentiel des maladies neurodégénérativesSocial cognition refers to a set of processes working interactively that allows to behave appropriately in the social world. Theory of mind (TOM) is considered to be the central element of social cognition, but the links between its different processes are still poorly understood. TOM’s abilities are used daily through interpersonal relationships, but the effect of the context on TOM remains poorly explored. The main aim of this thesis was to study both TOM and social knowledge, as well as the links between them. Our results highlight how the ability to attribute mental states is modulated by the context and more specifically by the integrity of social knowledge in Alzheimer's disease and semantic dementia. Patients’ disorders may have a different origin depending on their brain lesions. Therefore, social cognition could be a useful element in the differential diagnosis for neurodegenerative diseases
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Calderon, Plata Johanna. "Développement des fonctions exécutives et des théories de l’esprit chez l’enfant ayant une cardiopathie congénitale cyanogène opérée en période néonatale." Thesis, Paris 5, 2013. http://www.theses.fr/2013PA05H123/document.
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L’objectif général de cette thèse est d’explorer le développement des fonctions exécutives (FE) et des théories de l’esprit (TdE) chez l’enfant ayant une cardiopathie congénitale cyanogène (CCC) et ceci à une période clé dans la construction de ces capacités de « haut niveau » et dans leurs relations fonctionnelles réciproques. L’étude des enfants ayant une CCC et présentant un risque d’hypoxie circonscrit à la période néonatale permet d’explorer la vulnérabilité précoce des capacités neurocognitives à maturation tardive comme les FE et les TdE. En adoptant une approche longitudinale et transversale, nos objectifs visent à (1) déterminer la trajectoire développementale des FE (inhibition, mémoire de travail et flexibilité cognitive) et spécifier la nature et le degré de leurs dysfonctionnements (2) caractériser le développement des capacités méta-représentationnelles et évaluer le rôle prédictif des différentes composantes exécutives dans les TdE de premier et deuxième ordre, (3) explorer la généralisation des dysfonctionnements aux TdE avec un contenu mental affectif, (4) déterminer les facteurs de risque neurologique néonataux associés aux déficits exécutifs et en TdE, (5) évaluer la contribution des dysfonctionnements exécutifs, des variables médicales et démographiques sur la prévalence de prise en charge de ces enfants. Une cohorte de 45 enfants nés avec une CCC opérés à coeur ouvert en période néonatale et un groupe d’enfants sains ont été évalués à un âge moyen de 5 ans (T1) puis ont été à nouveau testés pendant deux années consécutives (T2 et T3). Nos résultats ont mis en évidence un profil de dysfonctionnement hétérogène selon l’âge et le domaine cognitif. Ainsi, naitre avec une CCC altère la progression développementale des FE et des TdE avec toutefois une normalisation pour les composantes ayant une émergence plus précoce. Les liens prédictifs observés entre les niveaux initiaux des FE et le développement ultérieur des TdE reflètent des mécanismes de construction typiques mais néanmoins décalés dans le temps. Enfin, le diagnostic prénatal de la CCC, qui a un rôle neuroprotecteur face au risque de cyanose néonatale, est également associé à un meilleur pronostic des FE et des TdE. Ce travail de thèse offre des résultats pionniers dans la compréhension de l’impact des vulnérabilités neurologiques néonatales sur la dynamique développementale de fonctions neurocognitives complexesThe general aim of this doctoral dissertation is to explore the development of executive functions (EF) and theory of mind (ToM) in school-aged children with a cyanotic congenital heart disease (CHD) at a key developmental period of progression and functional interactions between these “higher order functions”. The study of children born with a cyanotic CHD and exposed to a hypoxic risk limited to the neonatal period allows to explore the early vulnerability of late developing neurocognitive functions such as EF and ToM. We used a longitudinal and cross-sectional approach in order to: (1) determine the developmental trajectory of EF (inhibition, working memory and cognitive flexibility) and specify their nature and degree of impairment, (2) characterize the development of meta-representational abilities as well as EFs predictive roles in first- and second-order ToM, (3) evaluate the potential generalization of dysfunction to ToM with an affective component, (4) determine neonatal neurological risk factors associated to EF and ToM impairments, (5) evaluate the impact of executive impairments and medical and demographic variables on the early use of remediation services in these children. A cohort of 45 children born with a cyanotic CHD who underwent neonatal open-heart surgery and a group of comparison children were evaluated at a mean age of 5 years (T1) and then followed-up for two consecutive years (T2 and T3). Our results showed a heterogeneous pattern of dysfunction depending on age and specific domains. Cyanotic CHD affects the dynamics of development for these functions even though the earliest developing abilities tend to normalize. Predictive relations observed between early EF and later ToM suggest typical developmental mechanisms though chronologically delayed. Finally, prenatal diagnosis of the cyanotic CHD, known to play a neuroprotective role for cyanosis management is also associated to a better prognosis for EF and ToM outcomes. This work offers pioneer results on the comprehension of the impact of neonatal neurological vulnerabilities on the developmental dynamics of complex neurocognitive abilities
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Dallaporta, Bruno. "Chronicité et fin de vie en hémodialyse : tension éthique entre exactitude et vérité." Thesis, Université Paris-Saclay (ComUE), 2018. http://www.theses.fr/2018SACLS469.
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A partir de l’hémodialyse, nous étudierons certains problèmes plus généralement liés à la maladie chronique mais aussi la fin de vie pour mettre en tension trois dualités : l’exactitude et la vérité, les morales déontologiques et téléologiques, et la logique d’équivalence et de surabondance. Dans la maladie chronique, nous nous intéresserons aux cas où il existe une contradiction entre le devoir thérapeutique du médecin et la volonté de la personne malade. Nous montrerons que ces refus de soin en dialyse sont sous-tendus par une tension entre l’exactitude technique des traitements proposés et la vérité éthique et existentielle de la personne. Dans la fin de vie, nous nous poserons la question de savoir quand commence l’obstination déraisonnable, comment définir sa limite, et comment limiter ou arrêter la dialyse tout en étant certain de ne pas réaliser un homicide ? Nous montrerons également que les normes, les indicateurs et les protocoles prolifèrent pour participer à une standardisation des pratiques de plus en plus hégémonique, où plusieurs moteurs sont à l’œuvre, comme la rationalité néolibérale et la gestion du risque. Ceci aboutit à un désenchantement des soignants. Un constat apparait : l’exactitude, la technique, les morales déontologiques rabattues sous forme de protocoles et la logique d’équivalence deviennent envahissantes. A l’inverse la vérité du sujet, l’éthique, la responsabilité de l'autre vulnérable, le don d’hospitalité tendent à être précarisés. La riposte à cette dérive pourrait être la réhabilitation de la singularité du sujet et la création de métaphore vive entre exactitude technique et la vérité éthique. Enfin, nous montrerons comment lorsqu’il existe un dilemme lié à une tension entre technique et éthique, la mise en place d’une réunion d’éthique nous a permis d’apporter la réponse la plus humaine possible et de favoriser le développement d’une culture d’équipeFrom hemodialysis, we will study certain problems more generally related to chronic disease but also to the end of life bring out the tension between three dualities: the accuracy and the truth, déontological and teleological ethics, and the logics of equivalence and superabundance. In chronic illness, we will be interested in cases where there is a contradiction between the medical duty of the physician and the will of the sick person. We will show that these refusals of care in dialysis are underpinned by a tension between the technical accuracy of the proposed treatments and the ethical and existential truth of the person. In the end of life, we will ask ourselves the question of when unreasonable obstinacy begins, how to define its limit, and how to limit or stop dialysis while being sure not to perform a homicide? We will also show that norms, standards, indicators and protocols proliferate to participate in a standardization of increasingly hegemonic practices, where several drivers are at work, such as neoliberal rationality and risk management. This leads to a disenchantment of caregivers. One observation emerges: the accuracy, the technique, the déontological ethics folded in the form of protocols and the logic of equivalence become invasive. Conversely, the truth of the subject, ethics, the responsibility of the other vulnerable, the gift of hospitality tend to be precarious. The response to this drift could be the rehabilitation of the singularity of the subject and the creation of a metaphor between technical accuracy and ethical truth. Finally, we will show how, when there is a dilemma linked to a tension between technique and ethics, the setting up of an ethics meeting allowed us to provide the most humane answer possible and to foster the development of a team culture
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Biasci, Giulia. "Le discours de la maladie chez Diderot et dans les traités médicaux du XVIIIe siècle." Thesis, Paris 3, 2019. http://www.theses.fr/2019PA030046.
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La présente thèse est une étude interdisciplinaire portant sur la représentation de la maladie psychophysique dans l’œuvre de Denis Diderot, placée dans un rapport dialectique ouvert avec les théories médicales produites par l’école vitaliste de Montpellier, vers la moitié du 18e siècle. La considération de l’organisme en tant qu’animata anatome où l’esprit se fait chair par le biais de la sensibilité, est le préalable à l’étude d’une maladie qui touche au physique et au moral à la fois et c’est aussi le premier acquis d’un renouveau épistémologique et méthodologique de la médecine opéré par les vitalistes. Les traités de notre corpus, justifié par les notes de Diderot dans ses Éléments de physiologie et également les articles de l’Encyclopédie à matière médicale, présentent des tentatives de théorisation de ce type de maladie. Dans la transcription de leurs expériences, les médecins emploient des solutions poétiques qui ouvrent le traité médical aux formes et aux modes du roman. Autant de propositions poétiques s’affichent dans les Éléments de physiologie. Diderot énonce ainsi sa science de l’homme, réfléchit sur les conséquences du déterminisme physiologique e aboutit à la conception de l’homme comme un complexe enchevêtrement de besoins et de relations. Les romans et les contes de Diderot sont le laboratoire où il interroge la complexité des rapports entre l’individu et le réel et où il pourvoit la maladie psychosomatique de fonctions narratives et esthétiques. Par la représentation vraisemblable des manifestations physiologiques maladives, il s’approprie l’observation clinique propre aux médecins, implique son lecteur dans la narration et met en question la philosophie morale classiqueThis thesis is an interdisciplinary study about the representation of the psychosomatic disease in Denis Diderot’s work put in an open dialectical relationship with Vitalistic medical theories from Montpellier medical school, around the mid-18th century. The notion of the organism as an animata anatome where soul is made flesh through sensibility is the precondition for the study of a disease that affects both the body and the mind. This is also the main finding proposed by the vitalists in their epistemological and methodological renewal of medicine. The treatises taken into consideration in our corpus following Diderot’s notes in Éléments de physiologie, as well as the articles of the Encyclopédie concerning medical matters, present attempts to theorize this new type of disease. By transcribing their experiences, doctors use poetic solutions that open the medical treatise to the forms and modes of the novel. The same figurative and poetic approaches can be found in Éléments de physiologie. In this essay, Diderot thus formulates his “science de l’homme”, he reflects on the consequences of physiological determinism, and he finally envisions the human being as a complex convolution of needs and relations. Diderot's novels and tales are the laboratory where he questions the complexity of the relationship between the individual and reality and he provides the psychosomatic disease with narrative and aesthetic functions. By representing sick physiological manifestations in a realistic way, Diderot appropriates the clinical observation specific to physicians, he involves his reader in the narration, and he questions classical moral philosophy
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Machado, Mariana de Abreu. "Cuidados paliativos e a construção da identidade médica paliativista no Brasil." reponame:Repositório Institucional da FIOCRUZ, 2009. https://www.arca.fiocruz.br/handle/icict/2329.
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Made available in DSpace on 2011-05-04T12:36:18Z (GMT). No. of bitstreams: 0
Previous issue date: 2009O objetivo desta dissertação consiste em investigar o processo de construção da identidade profissional de médicos que se dedicam à assistência a pacientes que apresentam doenças progressivas e ameaçadoras da continuidade existencial e que têm contribuído para o desenvolvimento dos Cuidados Paliativos no Brasil. Buscamos conhecer a trajetória profissional destes médicos desde a escolha da medicina como profissão até o encontro com a filosofia e a prática dos Cuidados Paliativos. Com este intuito, realizamos entrevistas semiestruturadas,colhidas segundo a metodologia de História Oral de Vida. Foram entrevistados seis médicos de diferentes especialidades que ocupam cargos diretivos em uma das associações profissionais voltadas para a disseminação e legitimação política e social dos Cuidados Paliativos no Brasil. Os depoentes se destacam no cenário nacional no que diz respeito às discussões sobre esta temática e mantêm contato com importantes instituições internacionais. Por esta razão, chamamos o conjunto de entrevistados de elite médica paliativista. Percebemos uma pobre interlocução entre os médicos paliativistas, o que se reflete na ausência de uma identidade integrada desse grupo profissional. Os entrevistados acentuaram as competências humanitárias necessárias ao bom exercício da Medicina Paliativa, mas, no entanto, não foram explicitadas as competências específicas a este campo profissional, que justificariam seu reconhecimento pelas entidades médicas competentes comouma nova área de atuação ou especialidade.
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Kutac, Julie Elizabeth. "Gray matters: An interdisciplinary approach to understanding the experience of Alzheimer's disease." Thesis, 2003. http://hdl.handle.net/1911/17601.
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Since the latter half of the twentieth century, the number of people with Alzheimer's disease has grown to epidemic proportions. My project investigates the cognitive devastation of Alzheimer's disease from several perspectives. I first outline some medical models of Alzheimer's disease, incorporating Richard Dawkins' selfish gene theory. Next, I explore the linguistic experience of the patient. I study Arthur W. Frank's analysis of patient narratives and Elaine Scarry's theory of torture to explore the way in which Alzheimer's disease tortures the patient, stealing the patient's ability to speak and deconstructing the world of the patient. Finally, I think about the way in which Alzheimer's disease can support and challenge themes in Martin Heidegger's philosophy. In diagnosing Alzheimer's disease, the person experiences a conflation of fear and angst. I explore Heidegger's philosophy as it relates to the experience of the patient who shows no ability to function in-the-world, yet exists corporeally.
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Lukong, P. F. "The integration of geospatial data into the surveillance and management of HIV/AIDS in Cameroon : thesis submitted for the degree of Doctor of Philosophy / Paul Foka Lukong." 2004. http://hdl.handle.net/2440/22102.
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"May 2004"Includes bibliographical references (leaves 243-270)
xviii, 270 leaves : ill. (some col.), maps ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (Ph.D.)--University of Adelaide, School of Social Sciences, Discipline of Geographical and Environmental Studies, 2004
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Prosser, H. C. G. "Involvement of novel cardiac peptides in healthy and ischemic hearts : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Biology at the University of Canterbury /." 2009. http://hdl.handle.net/10092/2731.
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Norton, Solis. "The epidemiology of Johne's disease in New Zealand dairy herds : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy at Massey University." 2007. http://hdl.handle.net/10179/1447.
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Johne's disease (JD), caused by Mycobacterium avium subspecies paratuberculosis (MAP) is a chronic, debilitating enteritis of cattle, other domestic livestock and some wildlife species. JD was first identified in the late 1800s and today it is a worldwide problem in dairy cattle. Heavily infected cows have reduced milk production, a higher risk of removal from the herd and low slaughter value. Several countries have implemented national level control strategies. In New Zealand, JD was first reported in 1912 and today the prevalence of infected dairy herds is thought to be high. To improve our understanding of the epidemiology of JD and to evaluate the feasibility of a national control strategy, four studies were conducted. The first study was a questionnaire based case-control study to identify associations between management practices and the occurrence of clinical JD on farms from four regions of New Zealand. The second study was on the effect of sub-clinical JD on milk production and the risk of removal from the herd in four dairy herds over four milking seasons. The effect of misclassification of disease status on productivity estimates was also studied. In the third study diagnostic test result data from the productivity study was combined with a novel Bayesian regression model to estimate performance of the ELISA and faecal culture tests as a function of covariates and utilising repeated tests on individual cows. Finally, results from these three studies were used to adapt an existing JD simulation model, 'JohneSSim', to represent the epidemiological behaviour of JD in New Zealand dairy herds. Control strategies for the disease were simulated and evaluated based on their cost effectiveness. Of the 427 farmers responding to the questionnaire, 47% had suspected clinical cases of JD in their herd in the preceding 5 years. Only 13% of suspected infected herds had an average incidence of greater than 0.5 cases per 100 cow years at risk. The disease was not considered a serious problem by 20% of herd managers who reported the presence of disease in the preceding 5 years. The presence of Jersey cows in the herd and the purchase of bulls had strong positive associations with the presence of clinical JD. Grazing calves in the hospital paddock, larger herds, the purchase of heifers, and the use of induction were also positively associated with JD. In the productivity study the herd-level prevalence of JD by ELISA and/or faecal culture ranged from 4.5% (95% CI 2.6-6.9) to 14.2% (95% CI 9.2-20.6). Daily milksolids production by JD positive cows was 0.8% (95% CI -6.1%-4.5%) less than that of JD negative cows. However in herd D, JD positive cows produced 15.5%, (95% CI 6.75%-24.2%) milksolids less than JD negative herd mates daily. This equates to a loss of 53kg of milksolids/305 day lactation, or NZD 265/lactation, given a price of NZD 5/kg of milksolids. In herd D only, the annual hazard ratio of removal for JD positive cows was significantly increased. It was 4.7 times and 1.4 times higher in cows older than 5 years and younger than 5 years. The results were insensitive to misclassification. Analysis of the diagnostic test data demonstrated the strengths of our Bayesian regression model. While overall estimates of sensitivity and specificity by this method were comparable to estimates by existing methods, it showed a broad trend of increasing sensitivity in higher parity groups and higher sensitivity in early, relative to late, lactation. It also showed that estimates of prevalence may in fact decline with repeated, relative to single, testing. Our novel approach demonstrated trends that could not be shown by existing methods, but could be improved by application to a larger data set. Simulation showed that control strategies for JD based on either test-and-cull, vaccination, breeding for genetic resistance, or removal of offspring from clinically affected cows, were not cost effective for the average infected herd. Improvement of the hygiene associated with calf management provided the greatest reduction in the within-herd prevalence of JD. While JD is present in a high proportion of New Zealand dairy herds, the incidence of clinical cases is usually low, and most farmers consider it to be of little importance. However, JD causes significant losses in productivity in some herds. The disease would probably be best controlled on a herd-by-herd basis, given the limited success of national-scale control programs for JD in other countries. The education of dairy farmers regarding risky management practices, and the offer of a risk assessment to farmers wishing to control the disease, would provide a combination of wide reaching and targeted approaches, of low cost, for JD control. It seems likely that JD will persist in some capacity in the years ahead, but will remain of minor concern next to major animal health issues, such as infertility and mastitis. Clarification of the effect of genetic strain on the virulence of MAP may help explain differences in the effect of the disease between herds. This knowledge could then be used to further improve the efficiency of JD control.
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Díaz, Patricia I. "Studies on the oxidative stress response of porphyromonas gingivalis : a thesis submitted in fulfillment of the requirements for admission to the degree of Doctor of Philosophy." 2002. http://web4.library.adelaide.edu.au/theses/09PH/09phd5426.pdf.
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Kung, Nina Yu-Hsin. "Epidemiological studies of Avian influenza viruses in Hong Kong : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Massey University, Palmerston North, New Zealand." 2006. http://hdl.handle.net/10179/1487.
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Eight studies of the epidemiological dynamics of avian influenza viruses were conducted on poultry in Hong Kong, with special focus on the movement of birds through the live poultry marketing system, and the implications for avian influenza transmission. The first involved analysis of virus isolation data from faecal samples obtained from cooperating stalls in live poultry markets in Hong Kong in a routine sampling program undertaken between 1999 and 2001. This showed that two subtypes of avian influenza viruses, H9N2 and H6N1, have become well established in the Hong Kong live poultry markets, especially in chickens (mainly H9N2) and quail (mainly H6N1). In addition, a wave of H5N1 virus infection occurred in 2001 after it had been absent through the earlier period of the study. The second study was an evaluation of long term changes in the marketing systems for live poultry in Hong Kong, their likely effects on avian influenza epidemiology, and documented evidence of the prevalence of various H subtypes of avian influenza in sampling undertaken during three periods from 1975 to 2001. The third project involved two cross-sectional studies and one longitudinal study on local quail farms in Hong Kong. Results showed that quail could act as a reservoir host for H9N2 and H6N1 subtype viruses, but each subtype differed in its epidemiology. H9 virus usually infected quail at around 10 days of age, whereas H6 infected quail at 15-20 days of age. At 35 days of age (usual market age in Hong Kong), a proportion of market quail were likely to be susceptible to H6 (50%) and H9 viruses (20%), and were able to transmit the virus in the markets. Due to these findings, the Hong Kong Government closed the quail farming operations and restricted the sale of quail in live poultry markets. A longitudinal study was conducted on three live poultry market stalls to assess the time from stall entry to sale, and evaluate the influence of this delay on avian influenza virus transmission to other poultry in the same stall. Participating stalls varied from high volume/rapid turnover to low volume/slow turnover. Turnover for tagged poultry was rapid, although some chickens became infected with H9 virus before sale. Birds which stayed longer, such as quail, became infected and maintained infection in the stall. As well as spread by direct contact and on typical fomites, keeping of pet roosters and re-use of washing water were identified as factors increasing the ability of avian influenza strains to persist in market stalls. An experimental replica of a market stall was created to study the transmission of low pathogenic avian influenza virus (H9N2) in a controlled environment, with different rates of population turnover and different immune status with respect to both H5 and H9 subtypes. Transmission was influenced by distance between birds, the proportion of birds carrying antibody to H9 and the rate of introduction of susceptible birds, but not by the use of H5N2 vaccine. In order to assess the effectiveness of temporary depopulation of stalls, a study was conducted to compare the prevalence of avian influenza virus and Newcastle disease virus before and shortly after the monthly rest day in live poultry markets in Hong Kong, by virus isolation. Prevalence of H9N2 avian influenza virus was reduced by the rest day, but Newcastle disease virus prevalence was unaffected. During the 2002 avian influenza H5N1 outbreak in local chicken farms, a case-control study was undertaken to identify risk factors that may have contributed to this outbreak. A questionnaire was administered by interview to collect the data for this study. Multivariate logistic regression models showed that movement of people and fomites from live poultry markets to farms were important influences on transmission, and that the live bird markets were the likely source of virus for farms. A spatial stochastic computer model was constructed to predict the spread of avian influenza virus in local chicken farms and live poultry markets in Hong Kong, and the effectiveness of control measures. The data used in model parameter setting was derived from the case-control study. The reference model produced an epidemic curve which was similar to the true epidemic curve in the 2002 outbreak. Control strategies such as rest day and vaccination were evaluated within the model, and found to produce results comparable with field experience. Results from these studies clarify various aspects of the epidemiological features and transmission dynamics of avian influenza viruses, and provide guidance on appropriate control and prevention strategies for highly pathogenic avian influenza viruses within poultry marketing systems in Asia.
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Julião, Ricardo José Branco. "Galen on Mental Disorders." Master's thesis, 2014. http://hdl.handle.net/10362/15279.
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Este trabalho aborda a conceito de desordem psíquica na obra de Galeno (129-216). A primeira
parte enquadra o pensamento de Galeno na visão da Filosofia e Medicina em vigor no início do séc. II
d.C. De seguida descrevo a concepção Hipocrática de epilepsia, e a abordagem que Platão desenvolve no
Timeu e Fedro acerca da loucura, para de seguida abordar a concepção de doença em Galeno, onde são
analisados os conceitos de nosêma, diathesis, pathos e energeia. Após este excurso descrevo o ponto de
vista de Galeno acerca da controvérsia sobre a localização da parte dirigente da alma (hêgemonikon) que
se dividia entre defensores do encefalocentrismo (Platão, Hipócrates e Herófilo) e do cardiocentrismo
(Aristóteles e os Estóicos). De modo a aprofundar a compreensão de Galeno acerca deste tema descrevo o
trabalho anatómico-fisiológico desenvolvido pelos médicos Alexandrinos Erasistrato e Herófilo, activos
no sec. III a. C., que descobriram, através de dissecação de animais e muito provavelmente de humanos, o
papel dos nervos e tendões nas atividades cognitivas e sensório-motoras. Esta foi uma descoberta central
para a argumentação de Galeno acerca da interacção mente-corpo assim como para a descrição das
desordens psíquicas. Posteriormente apresento a metodologia de Galeno no que concerne ao processo de
diagnóstico e etiologia, essencial para se compreender como é possível aceder a ‘entidades’ não visíveis,
como o hêgemonikon e as suas diferentes faculdades: ‘imaginação’, memória e raciocínio. Por fim,
analiso alguns casos clínicos de pacientes afectados por desordens do hêgemonikon, a saber: phrenitis,
mania e melancolia. Os principais textos objecto de análise são: Acerca dos Lugares Afectados, Acerca
das Teses de Hipócrates e Platão e Que as Faculdades da Alma Seguem as Disposições do Corpo.
Todavia, outros textos de Galeno serão convocados consoante a necessidade de analisar os conceitos que
me proponho compreender, entre eles Acerca do Método Terapêutico e Acerca da Utilidade das Partes.
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Luke, Stephen. "Needle exchange networks : the emergence of 'peer-professionals' : a thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy in Sociology at the University of Canterbury /." 2007. http://hdl.handle.net/10092/1038.
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Rieske, Tegan Echo. "Alzheimer's Disease Narratives and the Myth of Human Being." Thesis, 2012. http://hdl.handle.net/1805/3183.
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Indiana University-Purdue University Indianapolis (IUPUI)The ‘loss of self’ trope is a pervasive shorthand for the prototypical process of Alzheimer's disease (AD) in the popular imagination. Turned into an effect of disease, the disappearance of the self accommodates a biomedical story of progressive deterioration and the further medicalization of AD, a process which has been storied as an organic pathology affecting the brain or, more recently, a matter of genetic calamity. This biomedical discourse of AD provides a generic framework for the disease and is reproduced in its illness narratives. The disappearance of self is a mythic element in AD narratives; it necessarily assumes the existence of a singular and coherent entity which, from the outside, can be counted as both belonging to and representing an individual person. The loss of self, as the rhetorical locus of AD narrative, limits the privatization of the experience and reinscribes cultural storylines---storylines about what it means to be a human person. The loss of self as it occurs in AD narratives functions most effectively in reasserting the presence of the human self, in contrast to an anonymous, inhuman nonself; as AD discourse details a loss of self, it necessarily follows that the thing which is lost (the self) always already existed. The private, narrative self of individual experience thus functions as proxy to a collective human identity predicated upon exceptionalism: an escape from nature and the conditions of the corporeal environment.
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Mann, Joanne L. "Modelling infectious disease epidemiology and vaccination impact : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Mathematics at Massey University, Albany, New Zealand." 2009. http://hdl.handle.net/10179/1085.
Full textAbstract:
This thesis presents mathematical models for the dynamics of vaccine preventable diseases, specifically looking at the New Zealand situation. Through the use of integral and differential equations, we develop models and compare the results of these to known data. Using game theory analysis we determine and compare the proportion of the population that needs to be vaccinated in order to minimise the expected costs to the individuals in the population and to the community. Two different scenarios and methods are considered, where the effects of vaccination last only one epidemic cycle (using an integral equation method) and where vaccination is effective over an entire lifetime (using a differential equation method). For both scenarios, we find that the minimum cost for the individuals is reached when a lower proportion of the population is vaccinated than needed for the minimum cost to the community. We then elaborate on the integral equation method to produce a model for repeated epidemics of measles in a population, where a discrete mapping is used to include the year to year demographics of the population. The results of this model show a different epidemic pattern then that produced from a differential equation model, with numerical problems encountered. From here on, we use differential equation models in our analysis. A critique and extension to an existing model for the dynamics of the hepatitis B virus is presented, with discussion on the appropriateness of the model’s construct for predicting the incidence of infection. Alternative differential equation models for hepatitis B virus and immunisation that include splitting the population into age groups with nonhomogeneous mixing are presented. The results of these models are compared with the known data on incidence of infection and carriage in New Zealand, showing how affective different immunisation schedules may have been. Differential equation models are then presented for meningococcal B virus epidemiology in New Zealand, with the models incorporating different features of the virus until the best model is found that fits the New Zealand data. Each model is compared with the known incidence of infection, with the population being either treated as a whole or split into age groups with non-homogeneous mixing. The effect of vaccination is included in this model so that we can explore the future of the infection in the population, and how best to tackle any future epidemics. The model shows that the current vaccination campaign was the best solution for controlling the epidemic, but there will be epidemics in the future that will need subsequent vaccination campaigns to limit the number of infections.
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Stewart, Jessica Anne. "A study of the intestinal microbiota in health and disease : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Molecular Microbiology at Massey University, Palmerston North, New Zealand." 2005. http://hdl.handle.net/10179/1664.
Full textAbstract:
The intestinal microbiota is a massive and complex community, essential to the human host for good health and well-being. However, this population has been associated with gastrointestinal disease, and remains poorly understood. The aim of this study was to develop and validate DNA-based assays for the intestinal microbiota and to apply these methodologies to faecal samples collected from healthy volunteers and patients with gastrointestinal disease. Over 250 faecal samples were analysed using temporal temperature gradient gel electrophoresis (TTGE) and real time PCR. Validated assays had high sensitivity and reproducibility. Healthy individuals displayed a high level of temporal stability during short term studies (≤ 6 weeks) and long term studies (1-4years). Analysis of faecal samples provided by identical and fraternal twins demonstrated an influence of host genetics over the composition of the predominant bacteria in children. Two intervention studies, bowel lavage and the Atkins' diet, were carried out to monitor the impact of environmental change on the population's stability in healthy volunteers. Following bowel lavage, microbial populations rapidly recovered to control densities, however the stability of the population was disturbed. Introduction of the Atkins' diet, led to a significant change in the composition of the microbial population. A preliminary study of the intestinal microbiota in disease groups was undertaken. Significant differences were detected between inflammatory bowel disease groups and controls. Cluster analysis in these patients indicated a potential association between the composition of the predominant bacterial population and disease localisation. The studies reported here demonstrate that the faecal microbiota in healthy individuals is a highly stable population under the influence of both host genetics and environmental variables, however the population present in patients with inflammatory bowel disease exhibits differences compared to healthy controls.