Дисертації з теми "Analytical clinic"
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1
Faure, Nathalie. "La pulsion olfactive - intérêts et perspectives : Pour une prise en compte de l'odeur dans la métapsychologie analytique." Electronic Thesis or Diss., Université Côte d'Azur, 2023. http://www.theses.fr/2023COAZ2019.
Повний текст джерелаАнотація:
Bien que l'odorat soit étudié dans les disciplines relevant des sciences humaines, il semblerait qu'en psychologie clinique d'orientation analytique nous soyons confrontés au peu de recherches effectuées sur cette thématique. Il existe quelques références dans le Moi-peau (Anzieu, 1995), ou dans le travail de Tristani (1978) qui propose de concevoir un stade de la construction psychique fondé sur l'action de respirer, mais il ne fait que survoler l'importance de l'odeur dans ce stade. Nous nous sommes donc demandés si l'odeur a une place dans notre construction psychique, avec l'hypothèse qu'il existe une pulsion olfactive qui participe à l'organisation du sujet. Pour répondre à la problématique introductive, notre première partie présentera une revue de littérature spécifique, axée sur la littérature analytique. Nous commencerons par évoquer les recherches de Freud et Fliess sur le lien entre odorat et hystérie. Nous poursuivrons avec le travail de Lacan concernant notre sujet. Cette partie se poursuivra par une réflexion sur l'apport de la psychologie du développement. Il s'agira ici de confronter nos idées aux expériences et de discuter d'un possible trajet pulsionnel. La deuxième partie de cette thèse se penchera sur les critères de la pulsion chez Freud, Irme Hermann et Jacques Lacan. La troisième partie, sera consacrée à un modèle théorique de la pulsion olfactiveAlthough the sense of smell is studied in the disciplines of the human sciences, it would seem that in psychology of analytical orientation, we are confronted with the little research carried out on this topic. There are a few references in the Skin-ego (Anzieu, 1995), or in the work of Tristani (1978) who proposes to conceive a stage of psychic construction based on the action of breathing, but he only hovers over the importance of odor in this stage. We therefore asked ourselves whether the smell has a place in our psychic construction, with the main hypothesis that there is an olfactory drive that participates in the organization of the subject. To answer the introductory problem, our first part will present a specific analytic literature review. We will begin by evoking the research of Freud and Fliess on the link between smell and hysteria. We will continue with the work of Lacan concerning our subject and a reflection on the contribution of developmental psychology. It will be discussing a possible drive circuit. The second part of this thesis will look at the criteria of the drive in Freud, Hermann and Lacan drive theory. The third part are a theoretical model of the olfactory drive
2
Safari, Leila. "A clinical data analytics language (CliniDAL)." Thesis, The University of Sydney, 2014. http://hdl.handle.net/2123/12858.
Повний текст джерелаАнотація:
This work aims to propose CliniDAL as a generic solution for a special purpose query language for Clinical Data Analytics, which can compute answers to any question that is answerable from a Clinical Information System (CIS), with a specific focus on addressing temporal issues in CISs. The research begins with the investigation of common questions in the clinical domain, which led to the definition of 6 classes of question and answer categories. A set of syntactic rules has been generated to support these query categories which enables direct question answering and supports answering research-oriented queries requiring data analytics functionalities. Also, a framework is proposed for scientific experimentation which resolves time-event dependencies in the queries. A free text search facility for string searching and semantic concept searching (using SNOMED-CT) is provided to enhance the results. In addition, a temporal model is proposed and integrated into CliniDAL which enables the use of natural language temporal expressions in query composition. A generic mapping algorithm is proposed using a similarity based top-k algorithm (accuracy of more than 84%), which automatically maps the query terms to the underlying data or schema of CISs with design models of ER, EAV or hybrid models of ER and EAV. Also, a generic translation algorithm is proposed to translate an initial text query to a set of SQL queries, mainly to resolve complexity of data extraction from CISs with an EAV model. The experimental results based on testing more than 270 clinical queries and 4 case studies reflect the capability of the language at creating the desired queries via the restricted natural language of the provided web-interface. So, it is not only much easier for naïve database users like clinicians to apply CliniDAL’s approach in comparison to an SQL approach, but also they do not need to have any knowledge of data or schema of the underlying CIS for the composition of queries.
3
NUNES, GABRIEL CUNHA. "THE CLINIC OF TRAUMA AND THE REGRESSIVE STATES IN THE ANALYTIC SETTING." PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO, 2018. http://www.maxwell.vrac.puc-rio.br/Busca_etds.php?strSecao=resultado&nrSeq=34242@1.
Повний текст джерелаАнотація:
PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIROCOORDENAÇÃO DE APERFEIÇOAMENTO DO PESSOAL DE ENSINO SUPERIOR
FUNDAÇÃO DE APOIO À PESQUISA DO ESTADO DO RIO DE JANEIRO
PROGRAMA DE SUPORTE À PÓS-GRADUAÇÃO DE INSTS. DE ENSINO
BOLSA NOTA 10
O presente trabalho tem como objetivo investigar o conceito de trauma na psicanálise, bem como a regressão terapêutica como via de elaboração do evento traumático não representado psiquicamente a partir da situação analítica. Para isso, na primeira parte deste trabalho, analisaremos a noção de trauma a partir da perspectiva de Sándor Ferenczi, considerando o percurso teórico do autor que lhe permitiu formular a ideia do trauma constituído em dois tempos, a partir de uma confusão de línguas. Na segunda parte, acompanharemos os desdobramentos diretos e indiretos dessa teoria na Escola Inglesa de Psicanálise, representada por dois autores pertencentes ao grupo independente: Donald W. Winnicott e Michael Balint. Exploraremos então o funcionamento psíquico primitivo do indivíduo e o papel exercido pelo ambiente na constituição subjetiva, assim como as intensas falhas ambientais e as funções patogênicas das mesmas, ou seja, as repercussões do trauma como um evento catastrófico que interrompe o desenvolvimento emocional. Na terceira parte, adentraremos uma discussão clínica, reconhecendo as bases que constituem o setting analítico, compreendendo os diferentes usos das interpretações e as manifestações clínicas da regressão como uma nova chance de liquidação e elaboração do material traumático. Por fim, realizaremos um exame sobre as propostas da psicanálise contemporânea a partir das ideias da psicanálise do colapso, de Christopher Bollas; do terceiro analítico, de Thomas H. Ogden; e da empatia psicanalítica, de Stefano Bolognini, mostrando novas concepções a respeito da clínica do trauma e do manejo de casos regressivos no pensamento psicanalítico atual.
The present work aims to investigate the concept of trauma in psychoanalysis, as well as therapeutic regression as a way to elaborate the unrepresentable traumatic event through the analytical situation. To achieve this goal, on the first part of this work, we will analyze the notion of trauma from Sándor Ferenczi s perspective, considering the theoretical course that allowed him to formulate de idea of a trauma constituted in two times, from a confusion of tongues. On the second part, we will follow the direct and indirect unfolding of this theory in the English School of Psychoanalysis, represented by two authors belonging to the independent group: Donald W. Winnicott and Michael Balint. We shall explore then the primitive psychic functioning of the individual and the role played by the environment on the subjective constitution, as well as the severe environmental flaws and their pathogenic functions, i. e. the repercussions of the trauma understood as a catastrophic event that disrupts the emotional development. On the third part we will enter a clinical discussion, recognizing the principles that shape the analytical setting, comprehending the different uses of interpretations and the clinical manifestations of regression as a new opportunity to liquidate and elaborate the traumatic material. Lastly we shall examine the contemporary psychoanalysis suggestions over the ideas of the psychoanalysis of breakdown, by Christopher Bollas; the analytic third, by Thomas H. Ogden; and the psychoanalytic empathy, by Stefano Bolognini, show new concepts over the clinic of trauma and about how to handle regressive cases in the current psychoanalytic thought.
4
Barve, Chinmayee. "Individual factors as buffers against parental expressed emotion : a path-analytical model." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0006/MQ44124.pdf.
Повний текст джерела
5
Busson, Laurent. "Evolution of direct diagnostic techniques in Virology; analytical performances and clinical input." Doctoral thesis, Universite Libre de Bruxelles, 2020. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/313391.
Повний текст джерелаАнотація:
Le diagnostic virologique est un sujet d’actualité particulièrement du fait des récentes épidémiesou pandémies telles que la pandémie d’influenza A(H1N1) en 2009 ou la diffusion du virus Zika dansles Amériques et la région du Pacifique entre 2014 et 2017, associée à des cas de microcéphalie et dessyndromes de Guillain Barré. Encore plus récemment, en août 2018, le ministre de la santé de laRépublique Démocratique du Congo annonçait la 10e épidémie de virus Ebola dans le pays et endécembre 2019, le coronavirus SARS-CoV-2 est à l’origine d’une pandémie au départ de la Chine. Avecle nombre croissant de migrants et de voyageurs favorisant la dissémination des maladies virales, leslaboratoires diagnostiques doivent être parés à la fois pour l’identification des virus communs maisaussi de ceux importés.Les techniques les plus anciennes de diagnostic virologique tendent à devenir obsolètes suite audéveloppement rapide des techniques moléculaires depuis les années 90. Cependant, nous utilisonstoujours un mélange de techniques moléculaires et non moléculaires au sein de notre laboratoire.Les objectifs de ce travail sont de passer en revue les différentes techniques communémentutilisées pour la détection directe des virus avec leurs avantages et leurs inconvénients et de fournirune réflexion sur la place de chaque technique, en 2020, dans un laboratoire diagnostique.Nous aborderons tout d’abord les cultures cellulaires et nous insisterons sur leur polyvalence quipermet parfois de mettre en évidence des micro-organismes que l’on ne suspectait pas. Nousillustrerons ce point par un article relatant la mise en évidence de Chlamydia trachomatis du serovar Lresponsables de la lymphogranulomatose vénérienne dans des prélèvements envoyés pour suspiciond’infection herpétique.Le travail se focalisera ensuite plus particulièrement sur le diagnostic des infections viralesrespiratoires. Nous verrons les principes des tests de détection antigéniques et discuterons de leurslimites en se basant sur un article qui traite du diagnostic des virus influenza A et B par 3 différentstests immunochromatographiques. Cet article montre que la sensibilité des tests varie en fonction dela charge virale dans le prélèvement ainsi que du sous-type de virus.Nous poursuivrons avec les tests d’amplification d’acides nucléiques (tests moléculaires) enexpliquant la technique de PCR (Polymerase Chain Reaction) et une technique d’amplificationisothermique (Nicking Enzyme Amplification Reaction - NEAR). Nous illustrerons par un article portantsur l’évaluation du test Alere i influenza A&B (technique NEAR) en comparaison du test Sofia influenzaA+B (immunochromatographie). Cet article montre un gain de sensibilité de l’Alere i par rapport auSofia pour le diagnostic de l’influenza A mais pas pour l’influenza B. Il constitue également un travailpréliminaire sur l’appréciation de l’utilité d’une technique PCR rapide dans la prise en charge despatients. La conclusion est qu’il pourrait y avoir un apport de ce type de technique pour la diminutiondes hospitalisations, de la prescription des examens complémentaires et des antibiotiques. Celapermettrait également une prescription plus adéquate de l’oseltamivir pour le traitement de la grippe.Le point important est que l’impact du résultat est d’autant plus grand qu’il est délivré précocementdans la prise en charge des patients, idéalement lorsqu’ils sont encore aux urgences.Suite au travail sur l’Alere i, nous avons entrepris d’évaluer un test PCR multiplex (FilmArrayRespiratory Panel) pour le diagnostic des virus afin de voir si la détection d’un plus grand nombre depathogènes pourrait avoir un impact plus grand sur la prise en charge des patients. Cette évaluation adonné lieu à deux articles. Le premier détaille les avantages et inconvénients des différents outils dediagnostic pour la détection des virus respiratoires et sert d’état des lieux sur les tests utilisésactuellement dans les laboratoires de virologie. Le deuxième article porte plus particulièrement surl’apport du FilmArray dans la prise en charge des patients. La conclusion est que ce n’est pas le résultatdu test qui a un impact sur cette prise en charge mais plutôt d’autres facteurs notamment l’âge ou desmarqueurs inflammatoires biologiques.Nous terminerons ce travail par un aperçu des techniques de séquençage qui seront sans aucundoute de plus en plus utilisées pour le diagnostic en virologie.Doctorat en Sciences médicales (Médecine)
info:eu-repo/semantics/nonPublished
6
Giori, L. "IDENTIFICATION OF NEW BIOMARKERS AND INNOVATIVE ANALYTICAL METHODS IN VETERINARY CLINICAL PATHOLOGY." Doctoral thesis, Università degli Studi di Milano, 2012. http://hdl.handle.net/2434/168079.
Повний текст джерелаАнотація:
Since laboratory tests are becoming more and more important in the diagnostic process even in the veterinary clinical practice, a specialist, able to manage the quality of the amount of work inside the laboratory itself, becomes a must.
The main challenge for the clinical pathologist, when introducing instruments or new methods in the laboratory, is the “validation phase” to ensure that all the results show the real clinical condition of the patient rather than the variable analytical nature of the test itself.
Diagnostic test or instrument validation is composed of four steps, including both the evaluation of analytical performances and the actual applicability and utility of the test/instrument in clinical practice.
The general purpose of this thesis has been to investigate some methods and instruments, through analytical validation studies regarding one or more of the 4 steps of validation process, for which information about the applicability on animal samples does not exist or is very rare. We have also looked for new molecules/techniques that could improve the performances of the traditional ones, especially considering the potential elements that would improve them. In particular, research activities have been focused to three main objectives, respectively directed to the three more studied macro areas of the clinical pathology: hematology, biochemistry and urinalysis. Specifically, the more extensive analytical and biological validation was focused on paroxonase (PON1) a new and promising acute phase reactant that would act as a fast negative acute phase proteins.
Moreover, through two sequential studies, we addressed the first step of the validation process (analytical validation) for quantitative and qualitative evaluation of proteinuria.
Other studies were focused on biological validation, in selected clinical conditions, of new hematological parameters provided by laser-based instruments or of biochemical markers. Specifically we validate an instrumental approach that might be a useful preliminary screen for detecting leukemia in dogs; we validate the possible role of high fluorescent fractions of platelets in Norfolk terriers with macrothrombocytopenia; we validate a new “GE” gate to be used in breeds with “grey eosinophils” that are underestimated by traditional instrumental hematological approaches.
As regards hematological parameters, the analytes that were already validated by others for which we investigate the biological role in veterinary laboratories were: SAA in foals after strong exercise; AGP in atypical forms of FIP and CK isoenzymes in horses.
This thesis demonstrates the importance to maintain and establish rigorous processes of validation both for analytes/methods newly introduced in clinical practice and for analytes/methods that are currently used. Only through this process of analytical and biological validation it is possible to discover novel diagnostic applications of traditional approaches (as for hematological analyzers in our case) but also to define both the advantages and the limitations of traditional diagnostic approaches that could provide unreliable results when applied to selected clinical conditions.
7
Sholademi, Benjamin Ayoola. "Identification and reduction of pre-analytical errors in clinical chemistry through expert advice." Thesis, Sheffield Hallam University, 2017. http://shura.shu.ac.uk/16823/.
Повний текст джерелаАнотація:
Background: Diagnostics in Clinical chemistry laboratory is a pivotal part of clinical decision-making but is not exempt from ‘human errors’. Scientific innovations such as automation and electronic order test requesting have contributed to substantial improvements in the field of laboratory science, but errors still occur. One major example of such failing is connected to the prevalence of errors occurring in pre-analytical phase of the Total Testing Process (TTP). Preanalytical errors can occur at the time of patient assessment, test order entry, patient identification, sample collection, sample transport, or sample receipt in the laboratory. Previous work and clinical insights suggest that most errors in the TTP are extra-laboratory (i.e. they occur before the samples reach the laboratory for analysis). Such errors are frequently the results of human mistakes during phlebotomy practice. Therefore to reduce these errors the pre-analytical phase of the TTP must be prioritised. Study objective: To investigate the sources of pre-analytical errors in the TTP, categorize these errors in order to identify the error prone steps, and evaluate errorreporting frequencies, with the aim of improving service. Methods: The first part of the study was a query of the laboratory information management system (LIMS) for samples rejected due to pre-analytical errors. Data collection was done retrospectively to cover two periods from 2007-2008 (manual paper test requesting) and 2012-2013 (after implementation of electronic test ordering, Anglia-ICE). Pre- and post- implementation Anglia-ICE error data were transferred to excel spreadsheets and compared by chi-squared test. The contribution of each error category to total sample error received in the laboratory was also determined. The second part of the study was a questionnaire survey of pre-analytical procedures to capture the attitudes of phlebotomists towards current practice in Sheffield Teaching Hospitals NHS Foundation Trust (STH NHS FT). Results: The results of the first part of the study indicated that of the 416,703 specimens collected pre-Anglia ICE, 2,055 (0.49%) were recorded as errors compared with 1,616 errors (0.11%) of 903,814 specimens collected post-Anglia ICE implementation, which represents a 0.31% (p < 0.05) absolute error reduction rate, although more samples were received post-Anglia-ICE. The results of the second part (questionnaire survey) indicate that recommended procedure for phlebotomy practice was not strictly followed by a large percentage of the staff surveyed. Conclusion: This study is the first inquiry linking venous blood sampling (VBS) practices in phlebotomy to retrospective LIMS pre-analytical data in a UK NHS Hospital. The results suggest low compliance by staff with recommended practice, which may be responsible for the prevalence of certain categories of pre-analytical errors in the TTP and may also be associated with increased risks to attending patients. It is suggested that the development of a local guideline for VBS and compliance to this guideline will improve phlebotomy practice, improve the quality of sample testing in the clinical chemistry laboratory, reduce pre-analytical errors in TTP and consequently improve the safety of patients.
8
Goodman, Corey William. "Cost effective, computer-aided analytical performance evaluation of chromosomal microarrays for clinical laboratories." Thesis, University of Iowa, 2012. https://ir.uiowa.edu/etd/3301.
Повний текст джерелаАнотація:
Many disorders found in humans are caused by abnormalities in DNA. Genetic testing of DNA provides a way for clinicians to identify disease-causing mutations in patients. Once patients with potentially disease-causing mutations are identified, they can be enrolled in treatment or preventative programs to improve the patients' long term quality of life. Array-based comparative genomic hybridization (aCGH) provides a high- resolution, genome-wide method for detecting chromosomal abnormalities. Using computer software, chromosome abnormalities, or copy number variations (CNVs) can be identified from aCGH data. The development of a software tool to analyze the performance of CGH microarrays is of great benefit to clinical laboratories. Calibration of parameters used in aCGH software tools can maximize the performance of these arrays in a clinical setting. According to the American College of Medical Genetics, the validation of a clinical chromosomal microarray platform should be performed by testing a large number (200-300) of well-characterized cases, each with unique CNVs located throughout the genome. Because of the Clinical Laboratory Improvement Amendment of 1988 and the lack of an FDA approved whole genome chromosomal microarray platform the ultimate responsibility for validating the performance characteristics of this technology falls to the clinical laboratory performing the testing. To facilitate this task, we have established a computational analytical validation procedure for CGH microarrays that is comprehensive, efficient, and low cost. This validation uses a higher resolution microarray to validate a lower resolution microarray with a receiver operating characteristic (ROC)-based analysis. From the results we are able to estimate an optimal log2 threshold range for determining the presence or absence (calling) of CNVs.
9
Relyea, Stephen L. (Stephen Lawrence). "An analytics approach to designing clinical trials for cancer." Thesis, Massachusetts Institute of Technology, 2013. http://hdl.handle.net/1721.1/82727.
Повний текст джерелаАнотація:
Thesis (S.M. in Operations Research)--Massachusetts Institute of Technology, Sloan School of Management, Operations Research Center, 2013.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 67-71).
Since chemotherapy began as a treatment for cancer in the 1940s, cancer drug development has become a multi-billion dollar industry. Combination chemotherapy remains the leading treatment for advanced cancers, and cancer drug research and clinical trials are enormous expenses for pharmaceutical companies and the government. We propose an analytics approach for the analysis and design of clinical trials that can discover drug combinations with significant improvements in survival and toxicity. We first build a comprehensive database of clinical trials. We then use this database to develop statistical models from earlier trials that are capable of predicting the survival and toxicity of new combinations of drugs. Then, using these statistical models, we develop optimization models that select novel treatment regimens that could be tested in clinical trials, based on the totality of data available on existing combinations. We present evidence for advanced gastric and gastroesophageal cancers that the proposed analytics approach a) leads to accurate predictions of survival and toxicity outcomes of clinical trials as long as the drugs used have been seen before in different combinations, b) suggests novel treatment regimens that balance survival and toxicity and take into account the uncertainty in our predictions, and c) outperforms the trials run by the average oncologist to give survival improvements of several months. Ultimately, our analytics approach offers promise for improving life expectancy and quality of life for cancer patients at low cost.
by Stephen L. Relyea.
S.M.in Operations Research
10
Wheeler, Zachary. "Treatment of schizoid personality| An analytic psychotherapy handbook." Thesis, Pepperdine University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3604648.
Повний текст джерелаАнотація:
This volume presents a contemporary psychodynamic treatment for schizoid personality and related non-psychotic schizophrenia-spectrum personality disorders. Recent theoretical advances in psychodynamic nosology and important contributions from a century of psychoanalytic research on schizoid phenomenon are operationalized to provide clinicians with comprehensive suggestions with respect to assessment, technique, format, areas of thematic focus, countertransference, defense, and the process of change with schizoid patients. This handbook was developed as a Stage I treatment manual sufficient for an initial evaluation of feasibility and efficacy in clinical trials. Developing an understanding of the schizoid's personality organization and object relations is the ultimate goal of this handbook and the springboard from which treatment implications are suggested. New research on issues including attachment, neurobiology, etiological factors, relevant adjunct treatments, and medication are included to inform a broad and integrated approach to treatment. Short case vignettes are built in to help the practitioner understand how clinical theory becomes therapeutic process, while navigation tools, including outlines, indexes, summaries, and original flow sheets are included to summarize important concepts and reinforce learning. Self-adherence measures have been developed to aid the therapist in adhering to treatment guidelines.
Keywords: schizoid personality disorder, avoidant personality disorder, schizotypal personality disorder, transference-focused psychotherapy
11
Dörffler-Melly, Janine. "Experimental, clinical, and meta-analytical studies of antithrombotic therapies in venous and arterial thrombosis." [S.l. : Amsterdam : s.n.] ; Universiteit van Amsterdam [Host], 2001. http://dare.uva.nl/document/59215.
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Weinschenk, Toni. "Multi-peptide-based vaccines for personalized cancer therapy analytical fundamentals translated into clinical applications /." [S.l. : s.n.], 2004. http://www.bsz-bw.de/cgi-bin/xvms.cgi?SWB10976223.
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Vincent, David. "Group analytic clinical mind-lines : an interview study of the working theories of group analytic psychoterapist." Thesis, University of Essex, 2015. http://repository.essex.ac.uk/17175/.
Повний текст джерелаАнотація:
The Introduction lays out the problem that this research project attempted to examine : the importance of the ‘therapist factors’ in therapy outcome, and the difficulty of ascertaining the working theories of Foulksian group analysts, which , it is suggested, are held in the group analyst ’s mind as implicit, pre - conscious , procedural or tacit knowledge. The concept of the clinical mind - line is then suggested as a useful way of describing and structuring the manner in which clinical working theories are held, reached, when required, and then used by the group - analyst. Chapter 1 reviews the relevant literature about the development, theory and practice of group psychotherapy. Chapter 2 reviews some relevant philosophical and psychological work about knowledge and theory. Chapter 3 describes the chosen methodology: interviews of experienced group - analysts, which were recorded, transcribed and analysed using a thematic analysis. Chapter 4 lays out the findings from the interviews, giving a narrative account followed by the thematic analysis. Chapter 5 discusses these findings in detail in the light of the group psychotherapy literature and the concepts of tacit knowledge and the clinical mind - lines. It is suggested here that the two themes and four sub - themes that were revealed by the thematic analysis usefully formed a basis for a tentative formulation of the group - analytic clinical mind - lines as consisting in a mental structure of inter - connecting clusters and nodes. This structure enables the group - analyst, pre - consciously, to organise their tacit, implicit knowledge , and to integrate it into their conscious explicit knowledge, at any one moment-of-time-in-the-group, into a clinical decision and therapeutic action. The conclusion then describes the limitations, usefulness and possible future development of this study. There are, finally, two appendices, which provide an extract from a coded interview, and list of all the themes and codes from the thematic analysis.
14
Zheng, Haoran. "Contextual Affordances of Social Media, Clinical Prosess Changes and Health Service Outcomes." FIU Digital Commons, 2018. https://digitalcommons.fiu.edu/etd/3852.
Повний текст джерелаАнотація:
Never had consumers been empowered by information technologies such as social media-enabled portals that permit them to access and conduct all aspects of life and work activities through a mobile phone at any time from anywhere. WeChat, with over 963 million active monthly users, represents such a revolutionary platform. In healthcare, patients can use WeChat to make doctor appointments, access health and lab results, consult with doctors, and check on the queuing status and parking conditions in the health clinics and hospitals. Such social-media-enabled systems have transformed the relationships between consumers and businesses into a new paradigm in which the supply-side is driven by the demand-side. As a result, the new technology is fundamentally changing; not only the context in which business is conducted but also the business itself.
The extant literature on technology acceptance, however, has mostly focused on technical functionalities and user characteristics without adequately considering the specific context in which the technology is used. Although these affordance concepts have advanced our knowledge about the interactions between technology and users, the specific contexts in which such interactions occur have been largely ignored. There is a critical literature gap that hinders our ability to understand and provide guidelines to help organizations deal with the complex challenges they face in managing social mediaenabled technologies in today’s changing environment.
Our research attempts to bridge this critical literature gap by conceptualizing the concept of contextual affordance, and by examining its determinants and consequences in healthcare services. We use a combination of qualitative method and quantitative method. Research sites are in China across multiple healthcare facilities. The anticipated findings include validated dimensions of contextual affordance and relationships between contextual affordance and its determinants and impacts on clinical process changes and health service outcomes. Theoretically, this study extends the current understanding of affordance by considering contextual dimensions of affordance, and by examining the relationships between contextual affordance and its determinants and consequences. Practically, this study sheds new lights on how organizations should go beyond the out-of-context interactions between technologies and users by considering users’ perceived affordance of technology within the specific contexts of use.
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Pesic, Aleksandra [Verfasser]. "Analytical and clinical evaluation of the HPV DNA Array E1-based genotyping assay / Aleksandra Pesic." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2019. http://d-nb.info/1202042368/34.
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Schlief, Michelle L. "Adaptation of the Internal Family Systems Model Among Analytically-Trained Therapists." Thesis, Massachusetts School of Professional Psychology, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3644242.
Повний текст джерелаАнотація:
There is significant anecdotal evidence of a growing number of psychoanalytically trained practitioners adapting aspects of the internal family systems (IFS) model into their clinical practice. The purpose of this study was to gain an understanding of how these therapists make sense of their approach. Data were collected in the form of semi-structured interviews with practitioners and analyzed using constructivist grounded theory. Eleven participants revealed a wide array of experiences that were theoretically conceptualized within a unified framework. Three themes emerged from the data analysis process: (a) therapists' relationships with experiential IFS practice, (b) the therapist-client relationship, and (c) IFS/psychoanalytic hybrid theory. Therapists' relationships with experiential IFS work were found to be diverse and complex, but related to their own experiences in the role of client. Therapists' feelings about the perceived lack of theory underpinning the IFS model were related to their stated relationships with intellectual protector parts. Therapists' feelings about the clinical utility of the therapist-client relationship were complex and tended to deviate from the canonical IFS model in ways that are consistent with the psychodynamic use of the relationship in treatment. Specifically, participants described using the therapist-client relationship to facilitate parts work, many viewed part-to-part relating between therapist and client as providing significant clinical information, and they cited a belief in the importance of using IFS-based psychoeducation and interpretations to help clients gain insight into their internal dynamics. Finally, the ways in which therapists combine the IFS model and psychoanalytical theory into a new, hybrid theory is described, including a view of the unconscious as populated by IFS phenomena, viewing clinical stuckness as related to early psychological trauma that requires experiential work to abate, and the view of the Self-to-part healing relationship in the IFS model through an attachment theory lens. It is proposed that the IFS model traverses divides across the major psychoanalytic models. This may reduce feelings of foreignness among psychodynamic practitioners and create a fertile ground in which hybrid theory can grow. The limitations of this study and implications for practice, training, and further research are discussed.
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DAGLIATI, ARIANNA. "LONGITUDINAL DATA ANALYTICS FOR CLINICAL DECISION SUPPORT IN TYPE 2 DIABETES." Doctoral thesis, Università degli studi di Pavia, 2017. http://hdl.handle.net/11571/1203391.
Повний текст джерелаАнотація:
Type 2 Diabetes Mellitus (T2DM) is assuming epidemic proportions, which will progressively worsen as the population ages. Managing T2DM is a complex task, such complexity being embodied in long clinical histories, lasting longer than 10 years and characterized by substantial variability in the type and frequency of clinical events that are manifested across the population and within a single patient history. In addition, the pathology itself entails a number of complications and comorbidities. These issues suggest the difficulty in managing T2DM chronic patients (World Health Organization 2016).
A major source of complexity in the management of T2DM patients arises from events such as hospital admissions, follow-up clinic visits, laboratory tests, and therapy changes. During these events, patients are treated by many different health professionals. These events are stored in different data repositories using different formats and occurring in temporal sequences that represent the patient careflow.
Although these data are distributed in sources such as the Electronic Health Record (EHRs) and, Administrative Data Warehouses, new data management technologies are able to gather and merge them, and consequently enable researchers and other to access a huge quantity of complex data for the interpretation and exploitation of these data for a management of chronic diseases. The application of longitudinal analysis and careflow discovery to these data enable the recognition of hidden temporal patterns, population stratification and cohorts’ identification, and phenotypes definition.
Temporal data analysis and careflow mining techniques can automatically detect the most frequent patterns and careflows from routinely collected data. Once identified, the enacted careflows might be used for comparison with clinical protocols to check their adherence to best practices, but they can be also exploited to identify different sub-groups of individuals in large cohorts of patients. These temporal data mining techniques can be used as a type of electronic phenotyping., which has been defined as the detection of computable phenotypes through query to EHRs and clinical data repository using specific data elements and logical expressions.
Clinical guidelines and health care protocols are well-established tools used to improve and standardize health care services. Nevertheless, in the absence of effective technology-based solutions to automatically extract frequent patterns and careflows, it is often impossible to measure their implementation. Patients’ management processes can be improved through an overall system that integrates longitudinal heterogeneous data, and implements temporal data mining methods that illustrate the evolution of the disease and the individual and population variability. The detection of temporal patterns makes possible to reconstruct clinical pathways and forecast the complications that might arise during the process of care, to identify interesting clusters of patients with similar care histories and re-assess their risk profiles accordingly. The identification of healthcare pathways through methods derived from temporal and careflow mining research can be used for Decision Support.
These facts suggest the need to investigate novel methods for improving the clinical decision support in T2DM and the utility of creating an analytics methodological framework. This is the overall goal of this dissertation, which was successfully retained completing these three specific aims: (i) To implement a system that integrates a large amount of unstructured and structured data from heterogeneous sources; (ii) To extend longitudinal analytic approaches to enable recognition of trending patterns and enhance temporal electronic phenotypes description; (iii) To create an expansion of existing methods for clinical decision support that is based on a more complete and easily understood description of patient health status.
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Dasgupta, Shruti. "Understanding Revictimization Utilizing Traditional and Cluster Analytic Approaches." Miami University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=miami1387818551.
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Hamilton, Erin Kinzel. "Multiscale and meta-analytic approaches to inference in clinical healthcare data." Diss., Georgia Institute of Technology, 2013. http://hdl.handle.net/1853/47600.
Повний текст джерелаАнотація:
The field of medicine is regularly faced with the challenge of utilizing information that is complicated or difficult to characterize. Physicians often must use their best judgment in reaching decisions or recommendations for treatment in the clinical setting. The goal of this thesis is to use innovative statistical tools in tackling three specific challenges of this nature from current healthcare applications.
The first aim focuses on developing a novel approach to meta-analysis when combining binary data from multiple studies of paired design, particularly in cases of high heterogeneity between studies. The challenge is in properly accounting for heterogeneity when dealing with a low or moderate number of studies, and with a rarely occurring outcome. The proposed approach uses a Rasch model for translating data from multiple paired studies into a unified structure that allows for properly handling variability associated with both pair effects and study effects. Analysis is then performed using a Bayesian hierarchical structure, which accounts for heterogeneity in a direct way within the variances of the separate generating distributions for each model parameter. This approach is applied to the debated topic within the dental community of the comparative effectiveness of materials used for pit-and-fissure sealants.
The second and third aims of this research both have applications in early detection of breast cancer. The interpretation of a mammogram is often difficult since signs of early disease are often minuscule, and the appearance of even normal tissue can be highly variable and complex. Physicians often have to consider many important pieces of the whole picture when trying to assess next steps. The final two aims focus on improving the interpretation of findings in mammograms to aid in early cancer detection.
When dealing with high frequency and irregular data, as is seen in most medical images, the behaviors of these complex structures are often difficult or impossible to quantify by standard modeling techniques. But a commonly occurring phenomenon in high-frequency data is that of regular scaling. The second aim in this thesis is to develop and evaluate a wavelet-based scaling estimator that reduces the information in a mammogram down to an informative and low-dimensional quantification of the innate scaling behavior, optimized for use in classifying the tissue as cancerous or non-cancerous. The specific demands for this estimator are that it be robust with respect to distributional assumptions on the data, and with respect to outlier levels in the frequency domain representation of the data.
The final aim in this research focuses on enhancing the visualization of microcalcifications that are too small to capture well on screening mammograms. Using scale-mixing discrete wavelet transform methods, the existing detail information contained in a very small and course image will be used to impute scaled details at finer levels. These "informed" finer details will then be used to produce an image of much higher resolution than the original, improving the visualization of the object. The goal is to also produce a confidence area for the true location of the shape's borders, allowing for more accurate feature assessment. Through the more accurate assessment of these very small shapes, physicians may be more confident in deciding next steps.
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OLIVEIRA, FERNANDO GOMES DE. "FROM DEVELOPMENT TO ANALYTIC ENCOUNTER: A CLINICAL JOURNEY THROUGH WINNICOTT’S WORK." PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO, 2012. http://www.maxwell.vrac.puc-rio.br/Busca_etds.php?strSecao=resultado&nrSeq=19882@1.
Повний текст джерелаАнотація:
PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIROEste trabalho fundamenta-se nas teorias propostas por Donald W. Winnicott e tem por objetivo elucidar alguns eixos norteadores da classificação diagnóstica nas diversas configurações subjetivas descritas pelo analista inglês. Para alcançar esse objetivo, em um primeiro momento descreve-se a teoria do amadurecimento emocional, ressaltando o processo de integração, a questão da trama psicossomática ― a habitação da psique no soma ― e as relações de objeto. Na sequência, busca-se delinear os critérios diagnósticos propostos por Winnicott ao longo de sua obra, traçando um quadro a partir de cinco tipos clínicos: neurose, psicose, esquizoidia, tendência antissocial e falso self. Essa classificação demonstra as preocupações do autor com a dimensão humana do processo terapêutico, a criatividade e a saúde, bem como com a gravidade dos distúrbios psíquicos elencados no tratamento psicanalítico. Nesse sentido, descrevem-se algumas experiências do manejo clínico e a importância do holding e da interpretação, sobretudo naquilo que se denomina de interpretação-holding. Com isso, aponta-se para a existência de interpretações que assumem a função de holding no percurso analítico. Assim, acredita-se que os conceitos e as indicações clínicas postuladas por Winnicott ao longo de sua obra podem trazer elementos e subsídios para pensar as múltiplas manifestações de sofrimento psíquico que surgem na clínica psicanalítica contemporânea.
This study was based on the theories proposed by Donald W. Winnicott and aimed at elucidating some guidelines for diagnostic classification in several subjective configurations described by this English psychoanalyst. In order to reach this goal, at first, the Theory of Emotional Development was described, highlighting the integration process, the psychosomatic process– psyche indwelling in the soma – and the object relations. Therefore, a chart based on five diagnostic categories (neurosis, psychosis, schizoidism, anti-social tendency and true self and false self) was created with the purpose of outlining the diagnostic criteria established by Winnicott throughout his work. This classification shows Winnicott’s concern with the human dimension of the therapeutic process, creativity and health, as well as with the gravity of psychic disorders involved in psychoanalytic treatment. In this sense, some episodes of clinical management and the important role of holding and interpretation were described (especially in the so-entitled holding-interpretation experiences). By doing so, it was possible to indicate the existence of interpretations which took the place of holding along the therapeutic journey. Consequently, it is believed that the concepts and clinical indications postulated by Winnicott throughout his work can provide us with elements and principles to consider the multiple symptoms of psychical suffering that intersperse contemporary psychoanalitic practice.
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Roeske, Danielle. "From self-doubt to uncertainty in the analytic act| A narrative study of therapist maturation." Thesis, California Institute of Integral Studies, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3594745.
Повний текст джерелаАнотація:
This qualitative study explored and analyzed the narrative experiences of senior psychotherapists and their capacity to tolerate and make meaning of uncertainty in their clinical work. While research on therapist development tends to agree that the maturation of the clinician is an ongoing process (Bruss & Kopala, 1993; Eckler-Hart, 1987; Gold, 2005; Guinee 1998; Kaslow & Rice, 1985; Lamb, Baker, Jennings & Yarris, 1982; Solway, 1985; Suran & Sheridan, 1985), little research has been conducted that documents this process from the perspective of the senior analyst. In addition, despite widespread acknowledgment of uncertainty as an ever-present phenomenon among clinicians, there have been few studies that address how a relationship to uncertainty unfolds. In other words, how does one move from a primary position of insecure self-doubt into an openness and tolerance for analytic uncertainty? This study employed a theoretical framework to help organize the inquiry and data analysis. Using Ogden's (1986) interpretation of Klein's (1946/1994) paranoid-schizoid/depressive model, the experiential constructs of analytic uncertainty and insecure self-doubt were explored in the form of an ongoing dialectic. Semistructured interviews were conducted among eight San Francisco Bay Area psychoanalytically oriented psychologists and data were analyzed through open coding. The results yielded a total of 11 core themes and 9 subthemes, distributed among 3 principle sections: Integration of Uncertainty, Early Encounters With Uncertainty and Self-Doubt, and Abstract Analysis: An Ongoing Dialectic. Key findings from the present study include (a) uncertainty is core to analytic work and is what allows for creative discovery; (b) despite its value, uncertainty is difficult to bear; (c) early encounters with clinical uncertainty often lead to feelings of self-doubt; (d) self-doubt, when experienced as a personal failing, has a tendency toward shutting therapists down; (e) therapists' experiences of self-doubt and uncertainty remain in an ongoing dialectic; and (f) faith is the impetus behind tolerance for uncertainty and it enables productive use of self-doubt.
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FERNANDES, JULIA BRAGA DO PATROCINIO. "THE INTERSUBJECTIVE ANALYTIC-THIRD AND THE AUTISTIC-CONTIGUOUS POSITION: NEW MODALITIES OF LISTENING AND COMMUNICATION IN CONTEMPORARY PSYCHOANALYTICAL CLINIC." PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO, 2016. http://www.maxwell.vrac.puc-rio.br/Busca_etds.php?strSecao=resultado&nrSeq=27251@1.
Повний текст джерелаАнотація:
PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIROCONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO
O presente trabalho tem como objetivo central discutir as diversas modalidades de escuta e comunicação presentes na clínica psicanalítica atual. Amparados nos conceitos de Thomas Ogden de terceiro-analítico intersubjetivo e posição autista-contígua, buscaremos apresentar as transformações da técnica psicanalítica ao longo dos anos e o consequente surgimento da relevância do campo analítico como dimensão essencial da relação entre analista e analisando, principalmente no que se refere a pacientes severamente traumatizados. A partir das contribuições de Melanie Klein, Donald Winnicott e Wilfred Bion, veremos a inauguração de um modelo de constituição psíquica pautada pela intersubjetividade e nas experiências primitivas reguladas pela linguagem não verbal.
This work is mainly aimed to discuss the various listening modes and communication present in the current psychoanalytical clinic. Supported in the Thomas Ogden s concepts of intersubjective analytic third and autistic-contiguous position, we will seek to present the transformations of psychoanalytic technique over the years and the consequent emergence of the relevance of analytical field as an essential dimension of the relationship between analyst and analysand, especially as regards the severely traumatized patients. From the contributions of Melanie Klein, Donald Winnicott and Wilfred Bion, we will see the inauguration of a psychic constitution model guided by the intersubjective and in primitive experience regulated by the non-verbal language.
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Fong, Bonnie Mei Wah. "Development and applications of liquid chromatography-tandem mass spectrometry in clinical areas." HKBU Institutional Repository, 2013. http://repository.hkbu.edu.hk/etd_ra/1530.
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Kang, Wenjing. "Point-of-care Sensors for Determination of Manganese in Clinical Applications." University of Cincinnati / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1471346294.
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Goswami, Bhavesh Dineshbhai. "Optimizing Cost and Data Entry for Assignment of Patients to Clinical Trials Using Analytical and Probabilistic Web-Based Agents." [Tampa, Fla.] : University of South Florida, 2003. http://purl.fcla.edu/fcla/etd/SFE0000202.
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Odani, Motoi. "A Bayesian meta-analytic approach for safety signal detection in randomized clinical trials." 京都大学 (Kyoto University), 2017. http://hdl.handle.net/2433/225514.
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Huang, Qianyang. "Development and Validation of UPLC/MS/MS Methods for Quantification of Gangliosides in the Clinical Study of Ganglioside GM3 Synthase Deficiency." Cleveland State University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=csu1472042152.
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Furr, Jami Michele. "Disasters and Youth: A Meta-analytic Examination of Posttraumatic Stress." Diss., Temple University Libraries, 2010. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/77524.
Повний текст джерелаАнотація:
PsychologyPh.D.
Objective: A sizable body of literature has now examined posttraumatic stress (PTS) symptoms in youth in the aftermath of disaster. Meta-analysis is the preferred tool with which to inform funding decisions, service delivery, and public policy. Method: The present meta-analysis quantitatively synthesized this literature (k=96 studies; Total N = 74,154), summarizing the magnitude of overall associations between disasters and youth PTS, and identifying child, disaster, and study method factors associated with variations in the magnitude of these associations. Results: Despite variability across studies, disasters had a significant effect on youth PTS symptoms, falling in the small-to-medium range of magnitude. Aspects related to pre-existing child characteristics, the disaster and the child’s disaster exposure, and study methodology are significantly associated with variations in the magnitude of disaster effects on youth PTS symptoms. Specifically, female gender, higher death toll, closer proximity, personal loss, and perceived threat and distress at the time of the event were each associated with increased post-disaster PTS in youth. Regarding methodological factors, studies conducted within the first year postdisaster, studies that used established PTS measures, and studies that relied on childreport data identified a significant effect on youth PTS, whereas studies conducted after the first year, studies relying on non-established measures, and studies relying on parentreport data did not. Conclusion: In the aftermath of disasters, governmental funding agencies and private foundations provide substantial resources for child services following disasters. The present meta-analytic findings can help to inform optimal allocation of these resources and targeted intervention efforts, as well as the development and refinement of new interventions for youth suffering in the aftermath of disasters.
Temple University--Theses
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Åberg, Anna-Maja. "Carbon monoxide in biological systems : An experimental and clinical study." Doctoral thesis, Umeå universitet, Kirurgisk och perioperativ vetenskap, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1427.
Повний текст джерелаАнотація:
Background: Carbon monoxide (CO) is a toxic gas, but it is also produced endogenously when haem is degraded. When produced in vivo, CO is believed to have positive biological effects. For example it activates the production of cyclic guanosine mono-phosphate and causes vasodilatation. CO is also believed to have anti-inflammatory properties by binding to Mitogen activated protein (MAP) kinase. Several studies in cells, mice and rats support this opinion regarding both the circulatory as well as the anti-inflammatory properties. However, studies in larger animals regarding circulatory effects have demonstrated contradictory results. The only study in humans regarding anti-inflammatory properties of CO could not demonstrate such effects. Methods: This thesis consists of four different models. In paper I a method for analysis of CO in blood was developed using gas chromatography. In paper II a porcine model was used to investigate the elimination time for CO. The pigs in paper II had a high concentration of CO administered via blood, and CO concentrations were followed over time and kinetically parameters calculated. Circulatory parameters were also measured to evaluate if there were any circulatory changes after CO administration. In paper III CO´s anti-inflammatory properties were investigated in an endotoxin-induced systemic inflammatory model in pigs. Paper III was a randomized study where one group inhaled CO and the other group served as controls. Plasma cytokine concentrations were measured and followed over time as an indication of the inflammatory state. In paper IV, CO concentrations in blood from blood donors at the Blood Centre in Umeå were investigated. The blood donors also completed a questionnaire about age, smoking history and other possible sources for exogenous contamination of CO in the blood. Results and conclusions: In paper I we developed a method suitable for analysis of low concentrations of CO in blood. The half-life of CO at levels of 250 µM in pigs was found to be 60 minutes. CO did not show anti-inflammatory effects after an endotoxin-induced systemic inflammation in pigs. In banked blood CO was present at concentrations up to six times higher than normal concentrations. This could be a risk when transfusing such blood to susceptible patients.
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Marsavela, Anda-Gabriela. "Assessment of the clinical validity of ctDNA Analysis for melanoma management." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2021. https://ro.ecu.edu.au/theses/2407.
Повний текст джерелаАнотація:
Metastatic melanoma is responsible for almost 80% of all skin cancer-related deaths and the incidence of people affected continues to rise worldwide. The emergence of targeted therapy and immune-checkpoint inhibitors has improved the clinical management of melanoma, but durable survival benefit is only seen in a minority of patients. The use of these very expensive systemic therapies on all appropriate patients also poses a high economic burden on health systems across numerous countries. Currently, surveillance for treatment failure is not optimal. Thus, reliable and accurate biomarkers of patient disease status are urgently required.
Circulating tumour DNA (ctDNA) analysis has emerged as a potential “liquid biopsy” for melanoma. Plasma-derived ctDNA are short DNA fragments released into the bloodstream by apoptotic tumour cells. Studies have shown that ctDNA levels in blood correlate with tumour burden and can comprehensively capture the molecular heterogeneity of melanoma metastases. Thus, ctDNA appears to be a viable biomarker for monitoring treatment response and disease progression in melanoma patients. However, further studies aimed at comparing ctDNA and current standard clinical assessments are needed to fully define its suitability as a complementary test to guide treatment decisions.
This thesis aims to provide important information that will assist with the implementation of ctDNA as a biomarker for melanoma in the clinical management of the disease. This thesis is comprised of 7 chapters: a comprehensive literature review (Chapter 1. Introduction); a materials and methods chapter (Chapter 2); 4 results chapters (Chapter 3 – 6); and a final chapter with a general discussion of main findings and future directions (Chapter 7. General Discussion and Future Directions).
The first chapter of the thesis includes a thorough review of the literature on ctDNA as a potential biomarker for melanoma disease (Chapter 1). This is then followed by a detailed description of our protocol for plasma ctDNA extraction and quantification using droplet digital PCR (Chapter 2). Using this methodology, we evaluated the ctDNA detection rate in untreated BRAF mutant melanoma patients, as a potential alternative to tumour genotyping (Chapter 3), where the potential economic benefit of implementing plasma ctDNA testing by ddPCR relative to tissue BRAF testing was also investigated.
The study in Chapter 4 demonstrated that pre-treatment plasma ctDNA is predictive of patient outcomes in the first-line treatment setting. However, baseline ctDNA level was not predictive of outcomes in the second-line immunotherapy setting, especially in patients that were pre-treated with BRAF/MEK inhibitors. Moreover, we found preliminary evidence that patients with high pre-treatment ctDNA may benefit from combined anti-CTLA-4/anti-PD-1 therapy.
Chapter 5 discusses the validity of ctDNA as a surveillance biomarker for melanoma. The kinetics of ctDNA decline were found delayed in patients treated with immunotherapy compared to those receiving MAPK inhibitors. Nonetheless, decreasing ctDNA levels within 12 weeks of immunotherapy or BRAF/MEK inhibitors was strongly concordant with treatment response and significantly associated with longer progression-free survival (PFS). Furthermore, exploratory analysis of nine patients commencing anti-PD- 1 therapy showed a trend of high tumour mutational burden (TMB) and neoepitope load in responders compared to non-responders.
Chapter 6 evaluates the validity of ctDNA to accurately detect disease progression using both a retrospective and a prospective cohort of melanoma patients. The results indicated a moderate detection rate, suggesting that more sensitive methodologies are required to achieve a limit of detection comparable to current medical imaging.
Finally, Chapter 7 provides a general discussion of the studies covered in this thesis. It underscores the clinical validity of ctDNA as a biomarker of prognosis and therapeutic response in melanoma patients, while highlighting important limitations inherent to ctDNA analysis that need to be thoroughly addressed before it can be successfully implemented in the clinic.
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Tang, Yuanyuan. "Nitric Oxide/Peroxynitrite Imbalance Induces Adhesion of Cancer Cells to Lymphatic Endothelium - Clinical Implications for Cancer Metastasis." Ohio University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1439563414.
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VIEIRA, FLAVIA DE ALMEIDA. "DEVELOPMENT OF AN ANALYTICAL METHOD FOR THE DETERMINATION OF TMSB, SB(V) AND SB(III) IN CLINICAL SAMPLES BY IC-ICPMS." PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO, 2003. http://www.maxwell.vrac.puc-rio.br/Busca_etds.php?strSecao=resultado&nrSeq=4472@1.
Повний текст джерелаАнотація:
PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIROA administração de antimoniais no tratamento da leishmaniose é uma rara oportunidade para estudar o metabolismo de antimônio e das suas espécies químicas. Tais estudos são de grande relevância, uma vez que não se tem conhecimento sobre os metabólitos formados no corpo humano e da sua possível importância na erradicação dos parasitas causadoras da doença, assim como sobre os mecanismos de eliminação deste elemento tóxico. Ao contrário do arsênio, existem poucas metodologias reportadas para a análise de especiação de antimônio em amostras clínicas. O presente trabalho é uma continuação de pesquisas realizadas e publicadas anteriormente, nas quais a técnica de espectrometria de massas (ICPMS) acoplada à cromatografia iônica de alta eficiência IC-(HPLC) foi utilizada para separação e quantificação, em linha, de antimoniato de N-metil glucamina, Sb(V) e Sb(III) em amostras de plasma e urina. Assim, serão apresentados resultados recentes obtidos com o emprego de uma coluna com melhor resolução (Metrosep - A Supp5; 250 mm x 4,0 mm; Metrohm, Suíça) na separação de trimetil antimônio (TMSb), Sb(V) e Sb(III). Testes de otimização mostraram que uma solução de EDTA (0,006 mol L-1, pH 4,7) é adequada como fase móvel para a separação das três espécies. Os tempos de retenção para TMSb, Sb(V) e Sb(III) foram de 44,2 s, 150,6 s e 548,4 s, respectivamente, permitindo uma perfeita e repetitiva (DPR <3 por cento) separação dessas espécies. Repetitividades melhores que 4 por cento foram também obtidas na quantificação das áreas dos três picos cromatográficos correspondentes. Curvas analíticas, construídas a partir de soluções padrão das espécies em solução aquosa e em amostras de urina fortificadas, apresentaram ótima linearidade com coeficientes de correlação maiores que 0,999. Para volumes de amostra de 100 uL, injetados na coluna e utilizando-se o espectrômetro ELAN 5000 (PE-Sciex, EUA) como detector multielementar, em combinação com o nebulizador concêntrico tipo Meinhard e uma câmara ciclônica, limites absolutos de quantificação de 0,02 ng de antimônio foram obtidas para as três espécies estudadas. Testes de estabilidade mostraram que Sb(V) sofre alterações químicas já em intervalos de tempo relativamente curtos (maiores que 8h em água, e que 4h em urina fortificada) enquanto que TMSb e Sb(III) evidenciaram estabilidades consideravelmente maiores em ambos os meios.
Clinical applications of antimonials in the treatment of leishmaniasis are a unique opportunity to study the metabolism of antimony and its species in the human body. As little is known about antimony metabolism, studies are required to improve the knowledge about the excretion mechanism of this toxic element; in particular, those which deal with antimony metabolites and the action of antimonials for the eradication of leishmaniasis causing parasites. In contrast with its chemical analogue arsenic, only a few methods concerning antimony speciation in clinical samples have been described in the literature. The aim of the present work was to improve a method previously developed to separate and quantify N-methyl meglumine antimoniate, Sb(V) and Sb(III) in blood plasma and urine samples by using anion exchange high performance liquid chromatography (IC-HPLC) coupled with inductively-coupled plasma mass spectrometry (ICPMS). Results on the application of an ion chromatography column (Metrosep - A Supp5; 250 mm x 4.0 mm; Metrohm, Swiss) with better resolution for the separation of TMSb, Sb(V) and Sb(III) are presented. The optimum conditions for the separation of the three species were established with 0.006 mol L-1 EDTA at pH 4.7 as the mobile phase. The retention times for TMSb, Sb(V) and Sb(III) were 44,2 s, 151,6 s and 548,4 s, respectively. A robust linear relationship between concentration and peak area was obtained for the three species, both, in aqueous standard solutions and spiked urine samples, with an associated correlation factor higher than 0,999. Relative standard deviations below 4 percent have been obtained in the peak area quantification mode. When using the ELAN 5000 (PerkinElmer-Sciex, EUA) equipped with a concentric Meinhard nebulizer in combination with a cyclonic spray chamber as detector, and employing a 100-uL injection loop in the HPLC system, typical absolute limits of quantification were 0.02 ng of Sb for each of the three antimony species studied. Stability tests showed that Sb(V) suffers chemical alterations within a short time period (>8h in aqueous solutions and >4h in spiked urine), whereas TMSb and Sb(III) presented better stability conditions in both solutions.
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Gabel, Matthew Christopher Edward. "Defining disease progression in ALS : a novel analytic approach using existing clinical and imaging datasets." Thesis, University of Brighton, 2017. https://research.brighton.ac.uk/en/studentTheses/4ac7bff1-f3f2-40ab-8191-4d05b433c54a.
Повний текст джерелаАнотація:
Background: A key aim of medical science is modelling patterns of disease progression; these patterns increase understanding of the disease, and help construct staging systems that assist diagnosis and treatment. Within Amyotrophic Lateral Sclerosis (ALS) disease progression modelling, there is a need to integrate clinical observation-based staging systems such as Roche et al. (2012), which suffer from low temporal resolution, with ‘unbiased’ staging of biomarkers. To this end, I have adapted and extended an EventBased Model (EBM) for ALS from previous work in Alzheimer’s disease (Fonteijn et al., 2012; Young et al., 2014). Unlike traditional models of disease progression, eventbased models do not rely on a priori staging of patients but extract the event ordering directly from the data, thus minimising subjective bias. In MR imaging, Fractional Anisotropy (FA) derived from diffusion tensor imaging is an obvious candidate to test the hypothesis that imaging events can be staged in the ALS-adapted EBM. Objectives: Using contemporary and historical ALS datasets comprised of diffusion MRI, clinical and neuropsychological data, I have adapted and extended a novel event-based model to analyse the likely ordering of these biomarkers in the progression of ALS. Materials and Methods The contemporary dataset was derived from a cross-sectional sample of 23 ALS patients and 23 matched controls (Broad et al., 2015). The two historical datasets were similarly derived from samples of i) 36 ALS patients and 22 matched controls, and ii) 28 ALS patients and 25 matched controls (Tsermentseli et al., 2015). The ALSspecific adaptations to the EBM were i) the fitting of Gaussian mixture models by constrained Expectation Maximisation, ii) the calculation of event probabilities from the cumulative distribution function to preserve the monotonicity of biomarker reading progression, and iii) accounting for the clearly delineated patient and control cohorts by performing Markov Chain Monte Carlo (MCMC) sampling on only the patient cohort. Finally, a fully Bayesian approach to Event-Based Modelling is demonstrated. Results: The most likely order of progression of imaging events showed that FA changes in the lower aspect of the corticospinal tracts (CSTs) occur at an early stage of disease evolution, with changes in the upper aspect occurring at a later stage. This result was found individually in all three datasets, as well as when combining them. Discussion: This proof-of-principle study shows that data-driven models of ALS progression are feasible, as well as demonstrating a fully Bayesian approach to Event-Based Modelling. The diffusion MRI event ordering results suggest very robustly that damage to the CSTs starts in the lower aspect. Nevertheless, a general important limitation must be discussed: The small sample size may have biased our results. I have tried to address this issue by assessing how the results varied across three separate datasets, both individually and combined. While the CST results were consistent across the entire process, results for other regions such as the corpus callosum were less constant, suggesting that the biomarker ordering in the wider population may diverge from this sequence. In order to generalise these results to the wider spectrum of ALS, future studies on larger datasets are warranted. Conclusion: These findings provide the first solely data-driven evidence supporting a directional hypothesis of motor neurone degeneration.
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Michael, Brett C. "Attrition in Behavioral Parent Training Programs in Clinical and Community Settings: A Meta-analytic Review." UNF Digital Commons, 2018. https://digitalcommons.unf.edu/etd/780.
Повний текст джерелаАнотація:
Abstract
It is estimated that approximately 16-20% of youth will develop a diagnosable behavior disorder. Behavioral parent training is a valuable approach to address disruptive behaviors by teaching parents how to effectively manage their child’s challenging behavior with non-physical disciplinary techniques. While these programs are generally effective, attrition rates have been found to be as high as 60% in some cases. This review provides information about the characteristics commonly associated with these programs, the attrition rates of each program, and the general effectiveness of the programs. Meta-analytic procedures were implemented to identify contributing factors leading to withdrawal from intervention.
Keywords: parent training, behavioral parent training, parent management training, parent child interaction therapy
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Martin-Vallas, François. "La chimère transférentielle : proposition épistémologique, neuroscientifique et clinico-théorique du transfert psychanalytique comme système complexe." Thesis, Lyon 2, 2015. http://www.theses.fr/2015LYO20029/document.
Повний текст джерелаАнотація:
Ce travail, qui s’inscrit dans le cadre de la psychologie analytique développée par Jung, propose d’introduire le concept de chimère transférentielle comme dimension du transfert qui ne peut être assignée ni à l’un ni à l’autre des deux protagonistes d’un travail analytique, bien que les concernant tous deux. Cette dénomination repose autant sur le travail de Michel de M’Uzan que sur le champ sémantique complexe associé au mot chimère. La méthodologie de ce travail est celle, théorico-clinique, développée par Widlocher sous le nom de cas singulier. Elle conduit à la recherche d’une preuve d’existence, et non à une preuve d’universalité. Une première partie propose une discussion épistémologique qui prenne en compte les changements profonds des paradigmes scientifiques résultant du développements de la physique depuis le début du XXe avec l’avènement de la relativité restreinte, rapidement suivie de la relativité générale et de la mécanique quantique puis de la théorie des systèmes complexes, aussi appelée théorie du chaos. Il est soutenu dans ce travail qu’une révision des positions épistémologiques fondées sur le travail de Popper, et une meilleure prise en compte d’approches telles que proposées par Adorno ou Morin, est nécessaire. Cette discussion conclut à l’importance de notions telle que celles d’émergence ou d’énaction, en ce qu’elles rendent compte du fait que ce qui apparaît à un moment donné de l’expérience ne préexiste pas nécessairement à sa manifestation. Enfin cette discussion épistémologique tente d’éclairer la profonde divergence entre les approches de Freud et de Jung, divergence qui apparaît ici comme résultant principalement d’une différence de point de vue épistémologique. Là aussi, le recours à la physique, précisément à la notion de section de Poincaré, permet d’éclairer cette divergence autrement que par une simple opposition. Cela permet de comprendre pourquoi, dans le champ de la psychologie clinique autant que dans celui de la psychanalyse, des théories divergentes, parfois opposées, peuvent et doivent coexister afin de pouvoir construire une représentation aussi exhaustive que possible de la réalité. Dans une seconde partie l’hypothèse de la chimère transférentielle est abordée au regard des neurosciences. Il est ainsi proposé une représentation neuroscientifique de la relation analytique. Cette représentation n’a aucunement pour objet de se prétendre vraie, mais, plus modestement, possible. Elle vise à proposer une nouvelle manière d’articuler neurosciences et théories psychanalytiques, postulant que l’expérience de la clinique psychanalytique est un niveau de complexité très supérieur à ce qui est aujourd’hui accessible aux neurosciences, ce qui permet de rendre compte de l’existence de dynamiques propres au processus analytique du fait de leur émergence entre les niveaux de complexité accessibles à la recherche neuroscientifique et celui de l’expérience psychanalytique. Enfin, dans une troisième partie, ce travail aborde différents aspects de la chimère transférentielle telle qu’elle est se manifeste dans la clinique psychanalytique. Un premier cas clinique est exposé en détail afin d’apporter une preuve d’existence de cette dimension. D’autres cas cliniques suivent, centrés sur une dimension ou un moment particulier de la cure, afin d’apporter la preuve de cette existence dans d’autres contextes, et avec des patients dont le fonctionnement et la structure psychique diffèrent autant du premier cas exposé qu’entre eux. Enfin, chacun de ces cas a été l’occasion de focaliser la discussion théorico-clinique sur un aspect particulier, saillant dans le cas considéréThis thesis, intended as a contribution to analytical psychology as developed by CG Jung, proposes the notion of a transferential chimera as a dimension of the transference which may not be assigned to either one of the protagonists in the analytic dyad, while still attached to them both. This denomination draws as much on the work of Michel de M’Uzan as it does on the complex semantics associated with the term chimera. The methodology used here is the clinical and theoretically underscored approach to the single case. It is predicated on the search for a proof of existence, and not a proof of universality. The first part is devoted to an epistemological discussion which takes account of the fundamental changes in theoretical understanding brought about in the field of physics since the beginning of the XXth century. This encompasses restrained relativity, quickly followed by general relativity and, laiter, by the theory of complex systems and chaos theory. It is contended that Carl Popper’s position on epistemology is in need of revision and that account needs to be taken now of the developments put forward by Theodore Adorno and Edgar Morin. The present discussion concludes that ideas such as emergence and enactment are central to the proposition in that they explain how events that occur in experience at a given time do not necessarily exist prior to their manifestation. Finally, this epistemological discussion seeks to throw light on the profound divergence between the approaches of Freud and Jung that appear to stem from a difference in their particular epistemologies. Here again, reference to physics, specifically to Poincare’s map, allows this divergence to be understood as other than a simple opposition. It assists in the understanding why in clinical psychology as in the field of psycho analysis, divergent and sometimes opposing theories, can and need to co-exist in order to construct as exhaustive a representation of reality as may be possible. In part two the chimera hypothesis is examined in the light of neurosciences. An attempt is made to represent the analytic relationship in terms of neurosciences. In no sense is such a representation to be taken as real, merely as possible. The aim is to postulate a new method of articulating neuroscience and psychoanalytic theory, whereby the experience of psychoanalytic practice is at a far greater level of complexity than it is currently possible to express neuroscientifically. This enables an account to be given of the existence of dynamics inherent in the psychoanalytic process from their observed emergence between the levels of complexity that are amenable to neuroscientific research and being experienced during psychoanalysis. Finally, in part three, different aspects of the transferential chimera will be examined as it manifests in psychoanalytic practice. With the aid of a detailed clinical example an attempt is made to establish the existence of this phenomenon. Other clinical cases will centre on an aspect or a specific moment during treatment, in order to support the proof of its existence in other contexts, that is, with patients whose functioning and psychic structure contrasts as markedly from the first case as they do amongst themselves. Finally, each case gives the opportunity to focus the theoretical and clinical discussion on a salient feature of each case.Thus the working potential of this hypothesis shall have been informed by the archetypal nature of the transference according to Jungian theory, by the potential connection between it and Freudian theory, starting with primary seduction as envisaged by Laplanche, followed by the containing function of the chimera, still in the context of Jungian theory
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Mulcahy, Susan. "Transforming intensive care data to inform clinical insights : using predictive analytics for traumatic brain injury patients." Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/47975.
Повний текст джерелаАнотація:
Traumatic brain injury (TBI) patients in the intensive care unit (ICU) are monitored closely and continuously over several days, yet many of these patients develop secondary insults in the brain. Because the patient is either unconscious or sedated, the patient's condition may be worsening without other measurable signs of a failing condition and the prognosis is elusive. This thesis arises from the viewpoint that examining physiological signals recorded from the patient at high time resolution could give earlier insight into the patient's condition. This research explores heart rate variability, derived from arterial blood pressure signals, using the standard deviation of 5-minute blocks (SDNN5) of heartbeat intervals in the time domain. Significant challenges were met in obtaining real-time high resolution clinical data suitable for computational analysis. Many approaches were attempted including a direct connection through MATLAB, using the Philips Data Export Interface Programming Guide, and third-party softwares Rugloop and ixTrend. The latter, ixTrend, was found to be the most effective. The next step was to establish a data pipeline to import the data in the correct digital format and to organise the multitude of large clinical datasets into usable files (up to 21 million rows of data per file). A binary statistical classifier was developed in MATLAB to predict ICU outcomes of TBI (survivors and nonsurvivors) using supervised machine learning. This measure, SDNN5, is then used to investigate the effect of various standard interventions commonly found in the ICU, where quantifiable measures have previously been lacking. The results for therapeutic hypothermia showed no correlation but a clear effect was seen from endotracheal suctioning. Diurnal variations seem to be overridden by the clinical schedule of medication administration. Lastly, no correlation is seen between spreading depolarisations in the brain (measured by electrocorticography (ECoG)) and SDNN5.
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Kasnakian, Caroline. "Emotionally-laden words used by counselling and clinical psychologists to describe clients : a content analytic study." Thesis, McGill University, 1995. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=23221.
Повний текст джерелаАнотація:
The present study examined the influence personological variables have on therapists' style of conceptualising a hypothetical client's presenting problem. More specifically, the effects of clinical experience (novice vs. expert) and clinical affiliation (counseling psychologist vs. clinical psychologist) on therapists' style of conceptualizing a client's presenting problem was assessed. The emotional content of the therapists' verbal behaviour during a think-aloud diagnostic task, was analyzed. The Feeling Lexicon indexing procedure was used to assess the emotional content of therapists' discourse during the diagnostic task. Eighteen clinical psychologists and eighteen counselling psychologists were selected to fulfill the criteria for having either novice or expert clinical experience. The findings indicated that: (a) counseling psychologists verbalize more words that connote an emotional content than clinical psychologists and, (b) novice therapists express higher levels of emotionality than expert therapists. Implications for training and clinical practice are discussed.
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Molin, Elin. "Evaluation of different centrifugation settings using BD Microtainer® tubes." Thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-305970.
Повний текст джерелаАнотація:
In order to keep the turnaround time it is desirable to have few centrifugal programs and be able to centrifuge microtainer tubes together with vacutainer tubes. BD has launched a new type of microtainer tube that got a lower g-force than the older one on the same centrifugation program. The aims was to compare this program and three other, more powerful, programs and compare the impact on some common analytes and serum indices, especially on hemolysis. Three test parts was performed using venous samples taken from healthy individuals, 1) transfer of whole blood from serum tube to microtainer tubes, a clinical chemistry analysis; 2) whole blood from plasma tube to microtainer tubes, a clinical chemistry analysis and 3) whole blood from plasma tube to microtainer tubes for platelet count analysis. All tubes were examined for gel formation. The result showed a significant variance between some settings for some analytes but foremost at 899g and at 2000g, both in 10 min. The platelet count was below the threshold limit at 2000g. No tube had insufficient formation of the gel. The setting of 2000g was found suitable for microtainer tubes. These results correspond with the recommended settings from BD. Further studies are needed with more analytes and test subjects and a simulated transport time for plasma, because of the increased risk for hemolysis, to confirm if the same setting can be used for microtainer tubes (899g) as for the older microtainer tube and vacutainer tube (1300g).
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Dowell, Kathy Ann. "The Effects of Parent Participation on Child Psychotherapy Outcome: A Meta-Analytic Review." Ohio University / OhioLINK, 2005. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1113511633.
Повний текст джерела
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Tappe, Karyn Andrea Lowe Michael R. "A prospective test of predictors of physical activity in freshman college women using a path analytic method /." Philadelphia, Pa. : Drexel University, 2008. http://hdl.handle.net/1860/2801.
Повний текст джерела
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Novielli, Nicola. "Incorporation of meta-analyses of diagnostic test accuracy studies into a clinical/economic decision analytic framework." Thesis, University of Leicester, 2011. http://hdl.handle.net/2381/9903.
Повний текст джерелаАнотація:
An accurate diagnosis is a crucial part of an effective treatment. Diagnostic errors cause unwanted side effects for healthy individuals and witheld treatments for diseased patients. Meta-analysis techniques allow the accuracy of diagnostic tests to be estimated using all the available sources of evidence. The most common measures of diagnostic accuracy are sensitivity (true positive rate) and specificity (true negative rate). As part of this thesis, current methods developed for synthesising data from diagnostic test studies are reviewed and critiqued, and then applied to estimate the accuracy of the Ddimer test for diagnosing Deep Vein Thrombosis (DVT). The fit of the different models is assessed via the Deviance Information Criterion and the Residual Deviance and the most complex synthesis models are found to provide the best fit to the data. When covariates are added to these models, only the incorporation of study setting sensitivity is found to improve the fit of the model. Diagnostic tests are rarely used in isolation and consideration of multiple tests in combination may also require evaluation. In this thesis, a multiple equations with shared parameters approach is proposed which estimated the accuracy of a combination of tests in two stages: i) estimate the conditional accuracy of the tests; and ii) estimate the accuracy of possible combinations of tests as functions of the conditional accuracies. Such a modeling approach allows the inclusion of different sources of evidence to be used simultaneously. The final part of the thesis evaluated the cost-effectiveness of different strategies for diagnosing DVT by incorporating the results from the aforementioned evidence synthesis models into an economic decision analytic model. In conclusion, the assumption of conditional independence can affect the analyses of the effectiveness and the cost-effectiveness of combinations of diagnostic tests, thus leading to potentially wrong decisions if the dependence is not explicitly modelled.
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Cheng, Chih-Wen. "Development of integrated informatics analytics for improved evidence-based, personalized, and predictive health." Diss., Georgia Institute of Technology, 2015. http://hdl.handle.net/1853/54872.
Повний текст джерелаАнотація:
Advanced information technologies promise a massive influx of individual-specific medical data. These rich sources offer great potential for an increased understanding of disease mechanisms and for providing evidence-based and personalized clinical decision support. However, the size, complexity, and biases of the data pose new challenges, which make it difficult to transform the data to useful and actionable knowledge using conventional statistical analysis. The so-called “Big Data” era has created an emerging and urgent need for scalable, computer-based data mining methods that can turn data into useful, personalized decision support knowledge in a flexible, cost-effective, and productive way. The goal of my Ph.D. research is to address some key challenges in current clinical deci-sion support, including (1) the lack of a flexible, evidence-based, and personalized data mining tool, (2) the need for interactive interfaces and visualization to deliver the decision support knowledge in an accurate and effective way, (3) the ability to generate temporal rules based on patient-centric chronological events, and (4) the need for quantitative and progressive clinical predictions to investigate the causality of targeted clinical outcomes. The problem statement of this dissertation is that the size, complexity, and biases of the current clinical data make it very difficult for current informatics technologies to extract individual-specific knowledge for clinical decision support. This dissertation addresses these challenges with four overall specific aims: Evidence-Based and Personalized Decision Support: To develop clinical decision support systems that can generate evidence-based rules based on personalized clinical conditions. The systems should also show flexibility by using data from different clinical settings. Interactive Knowledge Delivery: To develop an interactive graphical user interface that expedites the delivery of discovered decision support knowledge and to propose a new visualiza-tion technique to improve the accuracy and efficiency of knowledge search. Temporal Knowledge Discovery: To improve conventional rule mining techniques for the discovery of relationships among temporal clinical events and to use case-based reasoning to evaluate the quality of discovered rules.
Clinical Casual Analysis: To expand temporal rules with casual and time-after-cause analyses to provide progressive clinical prognostications without prediction time constraints. The research of this dissertation was conducted with frequent collaboration with Children’s Healthcare of Atlanta, Emory Hospital, and Georgia Institute of Technology. It resulted in the development and adoption of concrete application deliverables in different medical settings, including: the neuroARM system in pediatric neuropsychology, the PHARM system in predictive health, and the icuARM, icuARM-II, and icuARM-KM systems in intensive care. The case studies for the evaluation of these systems and the discovered knowledge demonstrate the scope of this research and its potential for future evidence-based and personalized clinical decision support.
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Bhardwaj, Kalpana. "A Meta-analytic Approach for Testing Evolutionary Hypotheses of Acquired Resistance in Metastatic Cancer." Thèse, Université d'Ottawa / University of Ottawa, 2014. http://hdl.handle.net/10393/30657.
Повний текст джерелаАнотація:
Nowell (1976) first proposed that unless cytotoxic cancer therapy eradicates all tumor cells, genetic or heritable variation within heterogeneous tumors will inevitably lead to the evolution of chemotherapeutic resistance through clonal selection. This evolutionary hypothesis was formalized by Goldie and Coldman (1979), who developed one of the earliest mathematical kinetic models of resistance evolution in neoplasms. Their model predicted that the likelihood of response and cure would be increased in combination vs single agent cytotoxic therapies. In a later study, Gardner (2002) developed a computational kinetic model to predict chemotherapeutic combinations, doses, and schedules most likely to result in patient response and prolonged life. This model predicts that combination therapy involving both cytotoxic and cytostatic drugs will be more effective than combination therapy involving only cytotoxic drugs. Thus far, no systematic evaluation of the Goldie and Coldman and Gardner hypotheses have been conducted in the metastatic clinical trial setting. Here I test these hypotheses using the results of over 700 phase II, III and II/III clinical trials. I show that, as predicted by Goldie and Coldman, both overall response rate and overall survival were greater in combination arms. Moreover, median duration of response – the key indicator of the rate of resistance evolution - was also greater in combination vs single agent arms. These results suggest that generally combination chemotherapy is more effective than single agent therapy for advanced solid tumors as predicted by Goldie and Coldman (1979) hypothesis and that, at least in the metastatic setting, the potential disadvantages of combination therapy with respect to accelerated resistance evolution are outweighed by the greater waiting times for resistance mutations to arise. By contrast, although combination cytotoxic and cytostatic therapy is associated with a greater average overall response rate than multi agent cytotoxic therapy, this is not the case for both median duration of response and overall survival. Hence, there is no evidence that, in contrast to the predictions of the Gardner (2002) model, combination cytotoxic and cytostatic therapy decreases the rate of resistance evolution relative to that obtaining under combination cytotoxic therapy.
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Mattsson, Viktor. "Clinical Data Analysis for Conceptual Proof of Microwave Bone Healing Monitoring System for Craniosynostosis Patients." Thesis, Uppsala universitet, Fasta tillståndets elektronik, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-352908.
Повний текст джерелаАнотація:
In the BDAS project one of the goals is to create a new solution for monitoring bone healing to complement current techniques. Data have been collected in clinical trials from infants treated for Craniosynostosis by a craniotomic surgery. The data are collected with a biomedical sensor based in microwave technology. This sensor could be able to sense changes in the composition of the different tissues in the upper hemisphere of the head, by noticing a difference in the propagation of the microwaves, as the bone injury from the craniectomy heals over time. In this thesis I analyze the validity of a proposed analytical model for the biosensor and extend the clinical data analysis in BDAS project. The validity of the model is analyzed by comparing its outcomes to available measurements from phantoms mimicking living tissues and to numerical simulations. In the data analysis two hypotheses are formulated and tested regarding the location of the measurement points with respect to a positioning grid and the healing over time too. By deriving a set of parameters for each collected dataset in the clinical trials, a distinct pattern was found which shows visible changes over the course of the healing process with this technique.
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Heinrichs, Robin J. "The Restructured Clinical (RC) scales of the MMPI-2: an item level factor analytic examination with psychiatric inpatients." Diss., Wichita State University, 2007. http://hdl.handle.net/10057/3661.
Повний текст джерелаАнотація:
This study examined the Restructured Clinical (RC) Scales of the MMPI-2 in a sample of 400
adult psychiatric inpatients. Scale intercorrelations were calculated for the RC and Clinical Scales and
an exploratory factor analysis was conducted to assess the degree to which the developers of the scales
were successful in the process of decreasing scale intercorrelations and removing the generalized
Demoralization that artificially inflated the original basic nine Clinical Scales. Exploratory principle
axis factor analysis was conducted with promax rotation. Resulting factors are discussed as is the
finding of diminished generalized Demoralization on RC Scales 1 through 9. The authors of the RC
Scales set forth the goal to remove Demoralization from the scales and to increase the disciminant
validity of the RC Scales. This study indicates that the RC Scales, in the current inpatient sample are
largely free of Demoralization. Further, the RC Scales were found to demonstrate better discriminant
validity than that of the original Clinical Scales, though in the current sample the improvement in
discriminant correlations is more modest than those reported in the RC Monograph.Thesis (Ph.D.)--Wichita State University, College of Liberal Arts and Sciences, Dept. of Psychology
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Heinrichs, Robin J. Dorr Darwin. "The Restructured Clinical (RC) scales of the MMPI-2: an item level factor analytic examination with psychiatric inpatients /." Diss., A link to full text of this thesis in SOAR, 2007. http://hdl.handle.net/10057/1479.
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Leclair, Susan J. "The Correlation Between the Levels of Education of Clinical Laboratory Personnel and the Accuracy of Peripheral Blood Smear Results." ScholarWorks, 2001. https://scholarworks.waldenu.edu/dissertations/1393.
Повний текст джерелаАнотація:
This study correlated the performance accuracy of peripheral blood differentials evaluated by clinical laboratory scientists and clinical laboratory technicians. Fifty-one senior-year students from four clinical laboratory science baccalaureate programs and 37 second-year students from five clinical laboratory technician programs were given 10 peripheral blood differentials to perform. Results were compared to the values assigned by the Rajamaki method of proficiency testing. There was a significant discrepancy in the levels of accuracy between the two cohorts, suggesting that the results of peripheral blood differentials performed by clinical laboratory technicians is suspect. Facilities wishing to maintain or improve the quality of laboratory services should consider allowing only baccalaureate level clinical laboratory scientists to perform peripheral blood differentials.
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Mendez, Vanesa. "Carotenoids and Fatty Acids in Early Lactation: A Study of a Peruvian Population." FIU Digital Commons, 2016. http://digitalcommons.fiu.edu/etd/3007.
Повний текст джерелаАнотація:
Lipid soluble carotenoids are micronutrients present in human milk that serve as precursors of vitamin A and also play an important role protecting cells from damage arising from photooxidative processes and reactive oxygen species. Fatty acids comprise about 3-5% of human milk and are mainly present as triglycerides. They are a major energy source for the infant and are necessary to support cell growth required for normal development and maturation of critical organs. Transport of carotenoids into milk has been little studied and there has been no previous investigation of the relationship of carotenoid transport with that of individual fatty acid secretion into milk.
In the present study, levels of the carotenoids, lutein, zeaxanthin, b-cryptoxanthin, and b-carotene, in maternal serum, infant cord blood, and milk obtained from 74 Peruvian mothers were measured by HPLC methods. The fat content and fatty acid profile of maternal milk were determined by GC-FID and confirmed by GC-MS. Twenty nine fatty acids were identified and quantified after conversion to methyl esters. Statistical analysis was employed to investigate potential trends and relationships among the carotenoids in all three fluids as well as between carotenoids and fatty acids present.
Concentrations of lutein in maternal serum and milk as well as maternal serum and infant cord blood were highly correlated (r =0.43, p
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Qasrawi, Radwan. "Treatment planning methods for clinical electroporation." Doctoral thesis, Universitat Pompeu Fabra, 2017. http://hdl.handle.net/10803/441753.
Повний текст джерелаАнотація:
Two treatment modalities based on the electroporation phenomenon, electro-chemotherapy and irreversible electroporation, have been developed in the last decades to destroy solid tumors. These treatments are based on the delivery of short high voltage pulses across electrodes and their success depends on covering the whole tumor with an adequate electric field magnitude. This leads to a need for software tools capable of allowing patient-specific treatment planning. In particular, there is a need for treatment planning tools similar to those used in radiotherapy in order to plan the location of the electrodes and the voltage magnitudes to be applied across these electrodes.
Here it is described a treatment planning platform prototype which allows users to perform the complete treatment planning sequence in a single environment. The planned treatment volume is represented on the patient medical images after computing, by the finite element method, the electric field magnitude generated by needle-shaped electrodes.
Here it is also reported a study in which the above prototype was employed for analyzing the potential impact of liver blood vessels on tumor ablation by irreversible electroporation. From this study it is concluded that those vessels must not be neglected in treatment planning and that undertreatment around those vessels may be occurring frequently in current irreversible electroporation treatments of liver tumors.
Finally, it is described the implementation and characterization of a fast semi-analytical algorithm for computing the electric field distribution generated by needle-shaped electrodes. This algorithm is intended to rapidly pre-visualize the expected treatment region before proceeding with an accurate, but laborious and slow, computation based numerical methods.Dos modalidades de tratamiento basadas en el fenómeno de la electroporación, la electroquimioterapia y la electroporación irreversible, han sido desarrolladas en las últimas décadas para destruir tumores sólidos. Estos tratamientos se basan en la aplicación de pulsos cortos de alta tensión a través de electrodos y para su éxito se requiere abarcar todo el tumor con una magnitud de campo eléctrico adecuada. Esto lleva a la necesidad de herramientas software que permitan la planificación de tratamiento específica del paciente. En particular, existe la necesidad de herramientas de planificación de tratamiento similares a las utilizadas en radioterapia para planificar la ubicación de los electrodos y las magnitudes de voltaje a aplicar a través de estos electrodos. Aquí se describe un prototipo de plataforma de planificación de tratamiento que permite a los usuarios realizar la secuencia completa de planificación de tratamiento en un solo entorno. El volumen planificado de tratamiento se representa sobre las imágenes médicas del paciente después de calcular, mediante el método de elementos finitos, la magnitud del campo eléctrico generada por electrodos en forma de aguja. Aquí también se detalla un estudio en el que el prototipo anterior se empleó para analizar el impacto potencial de los vasos sanguíneos hepáticos sobre la ablación de tumores por electroporación irreversible. De este estudio se concluye que estos vasos no deben ser descuidados en la planificación del tratamiento y que alrededor de esos vasos se puede estar produciendo sub-tratamiento frecuentemente en los tratamientos de electroporación irreversible que actualmente se aplican para tumores hepáticos. Finalmente, se describe la implementación y caracterización de un algoritmo semi-analítico rápido para calcular la distribución de campo eléctrico generada por electrodos en forma de aguja. Este algoritmo está destinado a pre-visualizar rápidamente la región de tratamiento esperada antes de proceder con un preciso, pero laborioso y lento, proceso de cálculo basado en métodos numéricos.
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Mulaudzi, Ludwig Vusimuzi. "Application of flow injection in the assay of selected substances in food and clinical analysis." Diss., Pretoria : [s.n.], 1999. http://upetd.up.ac.za/thesis/available/etd-11162006-163430/.
Повний текст джерела