This thesis is about the process and practice of diagnosis and the implications of new diagnostic technologies in low resource settings. As a setting and a disease which has seen significant investment in diagnostics, Lassa fever in Sierra Leone has been selected as a case study to examine these themes. In this thesis, 'new diagnostic technologies' refers to laboratory-based diagnostics which are fast, reliable, accurate and can be used in low income settings. The starting point of this thesis is a narrative surrounding such technologies which suggests that they will revolutionise low income healthcare settings by allowing accurate scientific diagnosis in places where it was not possible before. Various perspectives on diagnosis are examined and some limitations are identified in relation to their accounts of diagnostic process, context, practice and technology. To explore the case, aspects of science and technology studies, the sociology of scientific knowledge and medical anthropology are combined. A multi-sited ethnography of Lassa fever diagnosis was conducted in three settings: a rural village, a laboratory and the wards of a hospital. Documents were reviewed and interviews conducted with key actors and ex-Lassa fever patients. Analysis focused on framings (partial and subjective interpretations), narratives (persuasive storylines which make use of particular framings) and practice in relation to Lassa fever and the development of technology for its diagnosis. Assumptions about the disease, diagnostics and the process of diagnosis are identified and the conclusion considers how they compare with practice in each setting. This thesis argues that diagnosis is a complex negotiated process and that new diagnostics represent only one aspect of that process. Thus, they are not a ‘silver bullet' to transform low resource healthcare contexts. In particular, ‘improved' diagnostics do not always have the expected impacts, sometimes even introducing complexity and uncertainty. In challenging narratives about diagnostics, this thesis provides an alternative, practice-based, approach to thinking about diagnostics and innovations in health systems; this approach acknowledges the importance, and complexity, of the diverse contexts which shape innovations and technology use.

Copies of author's previously published articles inserted. / Bibliography: leaves 120-129. / 129 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Shows no significant difference in reactivity between sera from non-Aboriginals with previous rheumatic fever and matched controls. Using peptides in combination, or using related 20-mer peptides with the same panel of sera, did not reliably differentiate between subjects with rheumatic fever and those without. / Thesis (M.D.)--University of Adelaide, Dept. of Microbiology and Immunology, 1998?

Thesis (M. Med. Sc.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 51-54).

Dengue fever poses a constant serious risk and continues to be a major public health threat in Saudi Arabia, particularly in the city of Jeddah where, since 2006, despite formally introduced Control Strategies, there has been a significant increase in the number of cases. International literature suggests that a range of variables can influence the persistence of dengue, including climatic conditions, the quality of the urban environment, socioeconomic status and control strategies. The overall aims of this research are to understand neighbourhood influences on the pattern of dengue fever across Jeddah City and to make a preliminary determination of the enabling factors for, and barriers to, the effective implementation of the Control Strategies for dengue fever in Jeddah City. A mixed methods research design using quantitative and qualitative data was used. Quantitative data were obtained from administrative sources for dengue fever cases and some of the spatial and temporal variables associated with them, but new variables were created for neighbourhood status and the presence of surface water. Qualitative data are drawn from key informant interviews with 15 people who were, or who had been, working on dengue fever Control Strategies. A qualitative descriptive analysis was based on pre- determined and emergent themes. The spatial and temporal analysis of the variables related to dengue fever in Jeddah City neighbourhoods revealed that neighbourhood status has a direct relationship with dengue fever cases, which is mediated through population density and the presence of non- Saudi immigrants. While there was no relationship with the presence of swamps, seasonal variations in the incidence of dengue were most pronounced in neighbourhoods of low socioeconomic status. The qualitative review of dengue Control Strategies indicated five themes: (1) workforce characteristics and capability, (2) knowledge about dengue fever in Saudi Arabia and Jeddah City, (3) operational strategies for dengue fever control in Jeddah City, (4) the progress of implementation, and (5) overall view of the Government strategies in Jeddah City. This analysis found that the Strategies were well regarded but that aspects of implementation were not always effective. Nevertheless, both quantitative and qualitative results showed the persistence dengue fever problems in Jeddah City neighbourhoods and suggested how cases might be controlled. The number of dengue fever cases in Jeddah City neighbourhoods could continue to rise if the direct and indirect variables affecting dengue fever at the neighbourhood level are not well controlled. Careful attention to the further monitoring of patterns of dengue and specific neighbourhood Control Strategies are recommended, and established Control Strategies need to be implemented as designed. Nonetheless, there is still a need to develop new approaches that can examine and address neighbourhood level issues of dengue fever control.

No description available.

Fever has been shown to increase metabolic rate and there is evidence that there is an induction of heat production in brown adipose tissue (BAT). This thesis examines heat production in BAT during fever by measuring GDP-binding to BAT mitochondria and the gene expression of UCP and lipoprotein lipase (LPL). Rats were injected iv. with lipopolysaccharide (LPS; 10 μg/kg body weight) and developed a triphasic fever characterized by an initial decrease in core temperature. Ketoprofen (3 mg/kg body weight), an inhibitor of prostaglandin synthesis, attenuated the increases in core temperature throughout the response but had no effect on the initial hypothermia. Animals made febrile with LPS showed no increase in GDP-binding to BAT mitochondria when compared to saline controls. UCP mRNA and LPL mRNA levels in BAT were also unaffected by the fever. Acute cold exposure induced increases in all of the above parameters. Measurements of the quantity of <I>ob</I> mRNA and LPL mRNA in the WAT of febrile rats revealed no changes in the expression of either gene. Acute cold exposure decreased the levels of <I>ob</I> mRNA, with smaller, but statistically insignificant decreases in LPL mRNA. Genetically obese (<I>fa/fa</I>) Zucker rats and lean controls responded to iv. LPS (10 μg/kg body weight) with a fever characterized by an initial hypothermia. The obese rats had lower levels of UCP mRNA in BAT, but not LPL mRNA, than lean controls. In addition, levels of <I>ob</I> mRNA were considerably elevated in the obese variant but, surprisingly, these differences were not statistically significant. It is concluded that fever does not necessarily involve thermogenesis in BAT and, that changes in energy balance during fever are not manifested as changes in the expression of the <I>ob</I> gene in WAT.

Thesis (Ph. D.)--University of Adelaide, Dept. of Microbiology and Immunology, 1992. / Copies of author's previously published articles inserted. Includes bibliographical references.

Thesis PlanB (M.S.)--University of Wisconsin--Stout, 2008. / Includes bibliographical references.

"An inaugural dissertation, for the degree of Doctor of Medicine ... University of Pennsylvania, on the eighth day of June, 1803"--P. (iii). / "Errata."--P. [58]. Dedicated to Ashton Alexander, M.D., and John Parnham, M.D. Microform version available in the Readex Early American Imprints series.

Thesis (M.S.P.H.)--University of Michigan, 1941.