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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.

Assessment of movement in the elderly during sleep with reference to pressure sore prevention

Wheatley, David Christopher January 1982 (has links)
This thesis describes the assessment of movement in the elderly with reference to pressure prevention. Chapter 1 provides an introduction to the problem of pressure sores, and outlines the importance of age and immobility in their causation. Chapter 2 contains a review of the literature pertaining to the aetiology and epidemiology of pressure sores. A study conducted by the author at McGill University, into the pathophysiology of pressure sores - using the pig as an experimental model, is described. Chapter 3 discusses the previous published work on movement during sleep. Typical patterns of movement during sleep, and principles and techniques used to monitor overnight mobility are described. Chapter 4 describes an investigation into the relationship between body - support surface interface pressure and overnight mobility. Previously established monitoring systems were utilised. A high degree of correlation between the two variables was established. Chapter 5 deals with the desig n and development of a mobility monitoring system for routine use in the clinical environment. The system consists of three elements, force transducers, processing instrumentation - the output of which is representative of the size of move by the patient, and an F.M. analogue tape recorder - used to transfer the mobility data between the hospital and the laboratory. Chapter 6 contains a review of present methods of assessment of patients with reference to their risk of developing sores, selection of elderly subjects, an outline of the experimental protocol utilised and techniques of analysing the data. Chapter 7 contains the results of the experimental investigation into overnight mobility of elderly patients in hospital, with associated discussion. These results indicate the feasibility of developing simple, reliable parameters to characterise body movements during sleep in a clinical environment and that there are clinical factors associated with consistently low mobility. Chapter 8 provides a summary of this thesis. Relevant appendices and bibliography are included at the end of the thesis.

Origins and development of forensic medicine and forensic science in England, 1823-1946

Ward, Jennifer January 1993 (has links)
This study traces the development of forensic medicine, forensic science and police science from their roots in nineteenth-century England and shows that the main factors which make up the present-day disciplines were in place well before the First World War. The elite practice of forensic medicine had evolved into the laboratory-based sciences of special pathology and Home Office toxicological analysis by the 1900s and it is shown that in creating forensic science in the 1930s on this elite medical model as an aid to police investigations, other science and medicine in court, particularly in the civil courts, were excluded from the meaning of the new term 'forensic science' and perhaps also from the far older and wider 'forensic medicine'. There is confusion in the public mind as to the difference between forensic medicine and forensic science, or whether one is included in the other. By outlining the history of the separate specialities the meanings of the terms is clarified, not only for the present day, but at each earlier stage. Forensic medicine's role working for the state in criminal cases has always been badly funded, as the discipline has been unable to compete for public funds against more pressing needs. poor teaching and little or no original research. The creation of the Forensic Science Service was an attempt in part to salvage forensic medicine and to put it finally on an institutionalised footing, but this failed, and as the period of review closed in 1946 forensic medicine was still struggling for survival. Forensic science too looked set for failure as the government had made no provision for research or for training the new 'forensic scientists'.

Make or break : factors influencing the development of nursing practice within the UK National Health Service

Unsworth, John January 2002 (has links)
The development of nursing practice has become a central feature of modern healthcare. The advent of clinical governance has resulted in the development of an organisational climate where practitioners are encouraged to develop direct care and health services. Despite the desire of many professional groups to develop practice within the NHS, there has been a shortage of research which has specifically examined the processes of practice development in such a way as to identify the factors which facilitate or hinder developments. This study examines the nature of practice development and how this process is influenced by organisational, structural, individual and contextual factors. Using techniques developed by Walker and Avant (1995), the critical attributes of practice development were identified and it was contended and accepted that practice development was a specialist form of innovation. The study identified positive and negative factors which were shown to influence practice development using two principal methodologies. Firstly, a UK-wide Delphi survey was carried out with 139 Directors of Nursing in order to identify their perceptions of key influences on practice development. A total of 24 positive and 23 negative categorisations was identified from the surveys; these were grouped using principal component analysis into 8 components. Following on from this a series of case studies was carried out to examine which factors influenced the development of practice, and how this influence manifested itself. Findings from the case studies highlighted that there was some congruence between the perceptions of Directors of Nursing and the factors which were found to influence development. Several factors were identified as having a positive influence including championship, participation, ownership and flat management structures; whereas factors such as leader dependence, pressures and inter-professional tensions had a negative influence in some developments. In addition the study identified that the influence of other factors such as personal interest, merger and organisational transition are often underestimated.

Red cell adhesion molecules, foetal haemoglobin and endothelial factors in sickle cell disorders

Mundee, Yuttana January 2001 (has links)
Sickle cell anaemia (SS) is a haemoglobinopathy involving production of sickle haemoglobin (HbS, β⁶Glu-->Val), which is able to polymerise leading to vaso-occlusion. Hydroxyurea (HU) treatment increases foetal haemoglobin (HbF) levels but decreases vaso-occlusion and red cell adhesion molecule (AM) expression, and therefore improves clinical symptoms. In this thesis, the contribution of AMs, HbF and endothelial factors to the severity of sickle cell disease has been studied. Flow cytometry for measurement of HbF-containing red cells (F⁺cells), AM-expressing red cells (AM⁺cells) and reticulocytes (retics) was developed and validated using single-, double- and triple-colour staining procedures. The AMs examined were CD36, CD41 and CD49d. F⁺cells are increased in SS patients over normal control subjects. In the controls, the percentage of F⁺mature red cells (%F⁺MRCs) is equal to %F⁺retics leading to an enrichment ratio (ER = %F⁺MRCs / %F⁺retics) close to 1.0, indicating no survival advantage of F⁺cells. However in SS patients, the ER is about 1.5-2.5 indicating a survival advantage of F⁺cells. AM⁺cells in SS patients are also increased over the controls. In both the controls and SS patients, the AM⁺cell depletion ratio (AMDR = %AM⁺MRCs / %AM⁺retics) is decreased to less than 0.05, indicating a rapid shedding of AMs from reticulocytes during maturation. This shedding is confirmed by a reduction of %AM⁺cells to undetectable levels after 5 days of reticulocytes in culture. In HU-treated SS patients, F⁺cell increment and AM⁺cell reduction are found. The %AM⁺retics for pre- and post-HU treatment is not different, suggesting that AM⁺cell reduction is dependent on the reduction of reticulocytes. In the controls, proportion of F⁺cells expressing AMs is higher than F⁺cells, indicating that F⁺cells are more primitive. In SS patients, these proportions are similar. However, in HU-treated SS patients, the proportion of F⁺cells expressing AMs is lower than F⁺cells, confirming that F⁺cells survive longer so that they have more time to shed more AMs. This finding is similar in both reticulocyte and MRC populations. Vascular endothelial growth factor (VEGF) may be involved in vasoocclusion. It is significantly increased in SS patients. VEGF is able to induce nitric oxide metabolite (NOx) release. However in this thesis, NOx levels were not increased in SS patients and no correlation was found between NOx and VEGF levels. No relationship was observed between VEGF and either erythropoietin or Hb levels, suggesting that VEGF increment may not be due to generalised anaernia. Increases in soluble endothelial selectin (sE-Selectin) and soluble vascular cell adhesion molecule 1 (sVCAM-1) found in SS patients indicate endothelial activation. Beta-thromboglobulin (BTG) and platelet factor 4 (PF4) were also increased in SS patients, due to local platelet activation in vivo. Platelets as well as endothelial cells contain VEGF, therefore the increased VEGF levels in SS could be a consequence of local ischaernia resulting from vaso-occlusion and local platelet and endothelial cell activation.

Unreliable water supplies and household coping strategies in peri-urban South Africa

Majuru, Batsirai January 2015 (has links)
Many developing countries face severe challenges with the reliability of water supplies. These supplies are often characterised by intermittence, low pressure and poor water quality. Despite its contribution towards water-related illness and the significant coping burden it imposes on households, water supply reliability remains a difficult attribute to measure. A key challenge is the lack of a universal definition of water supply reliability. The issue of unreliability in water supply and the financial cost it imposes on households is of profound relevance in South Africa – a country whose social policies include a Free Basic Water policy which entitles all households to a free lifeline supply of 6,000 litres per month. This thesis examines household experiences of unreliable water supplies and in particular, explores the question as to what constitutes a reliable water supply, and household responses to unreliable water supplies. The analysis draws on literature reviews and a household survey conducted in peri-urban communities in the Limpopo Province of South Africa in 2012. A systematic review of definitions and assessment criteria used in studies of water supply reliability demonstrates that there is no consensus on what constitutes a reliable water supply. Assessment criteria also vary greatly, with the most common criterion in urban settings being the duration and/or continuity of supply in hours per day. In rural settings, the proportion of functional water systems is commonly assessed. A discrete choice experiment was conducted to elicit households’ preferences for a reliable water supply. Results indicate that overall, households value notification of interruptions and having water available for longer durations during the day, and would be willing to pay for these improvements. However, there is some heterogeneity in these preferences as wealthier households, who have drilled their own wells and are no longer dependant on the public supply are less willing to pay for improvements in the water supply. Findings from a systematic review of household strategies to cope with unreliability reveal that relatively wealthy households incur significant direct costs from strategies such as drilling wells and installing water storage tanks, poor households expend time and energy in collecting water from other sources. Income, level of education, land tenure and extent of unreliability are the main determinants of which strategies are adopted. Results from the survey in Limpopo highlight that Free Basic Water is not actually free; households spend significant proportions of their income on buying water, ii drilling wells and treating the water prior to consumption. Coping costs increase with wealth status and are higher in communities without alternative water sources such as springs. Notably, for many households the lifeline supply of 6,000 litres per month is unmet. The findings from this thesis highlight the need for consensus on the definition, and assessment approach for water supply reliability. Further, the analysis of households’ responses to unreliable water supplies in South Africa draws attention to how poor reliability negates the Free Basic Water policy. Without reliable water supply services, the objectives of improving public health and promoting equity cannot be met.

The effectiveness of screening for type 2 diabetes within a community pharmacy setting

Willis, Andrew W. January 2015 (has links)
The overall aim of the programme of work was to evaluate the acceptability and feasibility of pharmacy based screening programmes for type 2 diabetes. A key component of this was to summarise pharmacists’ views and experiences relating to the acceptability and feasibility of the screening methods chosen, as well as gathering more general views and experiences of the provision of screening services by community pharmacists. A systematic review and meta-analysis was undertaken in order to evaluate the level of success of previous screening interventions initiated by community pharmacists. A pragmatic randomised controlled trial using existing screening tools for type 2 diabetes was then carried out: the Pharmacy Based Screening for High Risk Individuals using Stepwise Methods (PRISM) study. Key Findings: • Previous studies have shown that pharmacy initiated screening for cardiovascular disease risk factors such as diabetes can identify a high proportion of those who are at ‘high risk of type 2 diabetes and cardiovascular disease. However, studies are often of low quality and limited by incomplete follow up and poor reporting of methods. • The screening methods used in the PRISM study resulted in a high screening yield compared to other similar opportunistic methods of screening • The screening methods used were acceptable and feasible from a pharmacist’s point of view, and resulted in a number of benefits to pharmacies. These benefits included: improved job satisfaction and morale within the pharmacy team, improvements in diabetes knowledge and consultation skills and improved relationships with customers. • The qualitative study carried out highlighted the variety of work and the different roles occupied by pharmacists and pharmacy staff when carrying out screening for type 2 diabetes. Based on the findings of this programme of work, implications for future research and clinical practice are provided in order to increase the provision of screening for type 2 diabetes to improve uptake in people who are at highest risk.

Evaluation of intestinal motility with Magnetic Resonance Enterography and computer post-processing

Menys, A. H. January 2015 (has links)
Small bowel motility is an essential, physiological process central to the processing of ingested food. The small bowel is however anatomically and functionally complex, varying greatly between individuals and located deep within the abdomen making it extremely difficult to access with instrumentation. As a consequence, and in spite of its known or suspected role in a range of diseases, there remain little in the way of objective tests to evaluate or even observe this process in vivo. This thesis details the validation and application of a novel computer post-processing technique that allows the quantification of Magnetic Resonance Enterography derived time-series image data. A background to small bowel physiology and existing techniques is first provided along with an introduction to the registration algorithm used throughout this thesis to quantify small bowel motility. The technique is then applied retrospectively to two Crohn’s disease patient cohorts to explore how this inflammatory bowel disease influences contractility. A prospective evaluation of segmental motility analysis is then presented drawing attention to large within subject variation, in a cohort of healthy volunteers, as a limitation for this technique. As an alternative, a global motility analysis approach is described and validated. Although global measures of motility appeared robust, factors influencing clinical application are further addressed by expanding the technique to allow motility analysis in free-breathing data. In the final piece of research presented, the application of the global technique to a cohort of Chronic Intestinal Pseudo-Obstruction patients is detailed. The thesis is concluded with a reflection of the results and a chapter dedicated to the commercial exploitation of the research to address the ongoing need for a robust test to quantise intestinal motility.

Characterization of mild oxidative stress response in human IMR-90 fibroblasts by subcellular quantitative proteomics

Baqader, N. O. A. January 2015 (has links)
Oxidative stress is a biological state that occurs due to imbalance between reactive oxygen species (ROS) and the antioxidant system leading to subcellular disturbance. The purpose of this thesis was to determine changes in protein abundance/distribution between nuclear and cytoplasmic cell compartments in the normal human IMR90 fibroblasts subjected to mild oxidative stress. The experimental design was to exert tert- butyl hydrogen peroxide upon the IMR90 cell lines to induce mild oxidative stress followed by fractionation of the cells into nucleus and cytoplasm. Cellular response was measured by the use of subcellular spatial razor approach based on quantitative shotgun LC-MS/MS-based proteomics with SILAC isotope labeling. It has been found that, in response to the treatment, proteins were redistributed between nucleus and cytoplasm including numerous proteins that were not previously known to associate with oxidative stress. We found 121 most significant proteins with known function at unexpected subcellular location. These proteins were known to contribute to different cellular processes such as, transcription, iron/haem metabolism, TCA cycle, glycolysis, autophagy, signal transduction and ATP synthesis, and are consistent with functional networks that are spatially distributed across the cell. Specific metabolic pathways of NRF2 and proline regulatory axis were found to play an important part on the cellular response to mild oxidative stress. Iron metabolism with iron/haem as a cofactor and mitochondrial proteins were prominent into the response as well. By initial comparison of the oxidative stress fibroblasts with Cdc7 depleted fibroblasts after induction of origin activation checkpoint, it was found that both responses affect proteins related to glycolysis, TCA cycle and proline regulatory axis. Evidence suggested nuclear import/export of proteins induced by the treatment. Subcellular spatial razor results for response of fibroblasts to oxidative stress clearly suggested that, to obtain comprehensive pictures of cellular function, measurements of global changes in total protein abundance need to be combined with measurement of the dynamic subcellular spatial redistribution of proteins.

Electron beam treatment of bioresorbable polymers for the enhanced release of incorporated bioactives

Simpson, Mark Derek Wilson January 2016 (has links)
Bioresorbable polymers are being increasingly utilised in a range of biomedical applications. These polymers degrade in-vivo with their degradation by-products being metabolisable. This ability to degrade in-vivo makes them an excellent choice for many implants as the requirement for invasive surgery for implant removal is rendered unnecessary. However, the mode in which these polymers typically degrade can prove problematic. One such issue is the sudden “burst” of incorporated additives. This can be problematic when controlled release is required, such as osteoconductive or antimicrobial additives for bone repair and microbial inhibition respectively. This project investigated the use of low energy electron beam (e-beam) irradiation to surface modify bioactive (beta tri-calcium phosphate (β-TCP) & silver nano-particle (SNP)) loaded bioresorbable polymers (poly(lactic-co-glycolic) (PLGA)), with a view to achieving earlier commencement of bioactive release. Furthermore, it was investigated whether this treatment would improve the antimicrobial efficacy of antimicrobial (SNP) loaded PLGA. The work outlined has shown that low energy e-beam treatment of bioactive loaded bioresorbable polymers enhanced bioactive release by achieving earlier commencement of release. It was also shown that irradiated SNP loaded PLGA exhibited microbial inhibition when compared to irradiated non-SNP loaded PLGA. However, irradiated non-SNP loaded PLGA showed increased microbial attachment when compared to non-irradiated PLGA with the same SNP loading. The results indicated that low energy e-beam treatment of bioresorbable polymers can actually aid microbial attachment. However, the use of an antimicrobial in conjunction with irradiation treatment can null the enhanced microbial efficacy brought about by e-beam treatment. The work outlined has potential benefits for orthopaedic applications where earlier commencement of osteoconductive additives would aid bone repair in its crucial early stages. This work has potential benefits for applications where antimicrobial efficacy is not the primary function, rather to offset the favourable microbial attachment conditions caused by irradiation treatment.

多年生雑草ワルナスビの根系構造と栄養繁殖機能に関する研究 / タネンセイ ザッソウ ワルナスビ ノ コンケイ コウゾウ ト エイヨウ ハンショク キノウ ニ カンスル ケンキュウ

宮崎, 桂 23 March 2005 (has links)
Kyoto University (京都大学) / 0048 / 新制・課程博士 / 博士(農学) / 甲第11650号 / 農博第1506号 / 新制||農||910(附属図書館) / 学位論文||H17||N4043(農学部図書室) / 23293 / UT51-2005-D399 / 京都大学大学院農学研究科農学専攻 / (主査)教授 伊藤 操子, 教授 矢澤 進, 教授 山末 祐二 / 学位規則第4条第1項該当

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