This thesis explores male medicine from 1850-1930, and demonstrates that to reduce gender to biology is a fallacy. It becomes apparent from this that historians need to theorise gender. An examination of the historiography on male medicine (and a particular historiographical moment, in fact) is used to illuminate a key problem with the way many historians write about gender. The thesis shows how the cultural reduction of gender to biology caused a misreading of the history of male bodies in medicine. It illustrates the fundamental flaws in the existing historiography on male medicine, and shows how this 'shorthand' leads many historians to completely ignore the subject. The thesis, then, builds on the contention that many historians do not theorise masculinity or gender. Chapter One opens up the arena for debate about male medicine by questioning the widely held historical assumption that women's bodies, and not men's, were 'problematised' in the nineteenth century. Chapters Two to Seven undermine the existing historiography about male medicine, and demonstrate that historians tend to reduce gender to biology. They do this by examining particular body zones that self-evidently seem to provide insight into masculinity and gender. Chapters Two and Three, which examine circumcIsIon, take issue with the assumption that intervention on male bodies was necessarily an issue about masculinity. On the contrary, contemporary medical debates demonstrate that the foreskin was 'a part beyond reason' . Chapter Four explores the gendered meaning of castration, and argues that it was frequently perceived as a threat to masculinity. In Chapter Five, showing that castration could also mean the restoration of male identity attenuates this view. Chapters Six and Seven question and examine gendered meanings of hermaphrodites' bodies. Alice Dreger's work typifies how historians enact a cultural reduction of gender to biology by assuming that hermaphrodites destabilised the gender order. Indeed, the treatment of hermaphrodites illuminates the' gender process' . The final two chapters examine male medicine at 'ground level,' and show that genito-urinary societies and institutions do not concur with the conventional historical wisdom about male medicine. Again, these chapters provide a challenge to accepted views on the subject. The conclusion explores the reasons why historians have tended to undertake a cultural reduction of gender to biology. It ends by suggesting how the work of one gender theorist, Judith Butler, can help historians write more informed accounts of male bodies.

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Medical prognosis is the prediction of the future course and outcome of a disease and an indication of the likelihood of recovery from that disease. Prognosis is important because it is used to guide the type and intensity of the medication administered to patients. Patients are usually concerned with how long they will survive after diagnosis. Survival analysis describes the analysis of data that corresponds to the time from when an individual enters a study until the occurrence of some particular event or end-point. It is concerned with the comparison of survival curves for different combinations of risk factors. Analytical methods that are transparent for the clinician's understanding and explain individual inferences need to be considered when dealing with medical data. This thesis describes a methodology for modelling survival by utilising the application of the Adaptive Neuro-Fuzzy Inference System (ANFIS). A hybrid intelligent system which combines the fuzzy logic qualitative approach and adaptive neural network capabilities towards better performance. The ANFIS approach was applied in modelling survival of breast cancer based on patient groups derived from the Nottingham Prognostic Index (NPI). A comparison of the proposed method with the existing methods in the capability to predict the survival rate is presented. The use of a fuzzy inference system (FIS) in modelling survival is expected to offer the capability to deliver the process of turning data into knowledge that can be understood by people. The design of rules can be performed either by human experts or using appropriate approaches to build high quality PIS to represent the knowledge. In this thesis, represent an automatic generation of membership functions and rules from the data. Further, corresponding subsequent adjustments have been made to the model to give towards more satisfactory performance. The final premise and consequent parameters obtained are then used to predict the survival for each time interval. A framework for modelling survival with the application of fuzzy inference system and back-propagation neural network was developed and is described in this thesis. In this framework, a different way of partitioning the input space can be selected to define the membership functions for examples using expert knowledge, equaliser partitioning, fuzzy c-means or subtractive clustering techniques. Further, the rule base can be established by enumerating all possible combinations of membership functions of all inputs. After the initialisation of the fuzzy inference structure, the replication data (until time to event) will be subject to training using the gradient descent and nonnegative least square algorithm to estimate the conditional event probability. This framework is validated over a synthetic dataset and a novel dataset of patients following operative surgery of ovarian cancer. The proposed framework can be applied to estimate the hazard and survival curve between different prognostic factors and survival time with the explanation capabilities.

New treatments are being constantly developed and introduced into practice.  The randomised controlled trial is widely seen as the ‘gold standard’ method of evaluating treatments.  However, its use in evaluating surgical techniques has been contentious.  Since surgeons may not be as experienced in the new technique, the comparison may be biased, failing to represent the true worth of the new technique.  This ‘learning curve effect’ is one of the major reasons for the low usage of clinical trails in surgery. A literature review of fibreoptic intubation, which was acknowledged to have a learning curve effect, was performed with a view to measuring the learning curve.  However, it was not possible to ascertain the approximate magnitude of the learning curve features.  A number of statistical methods had been suggested as suitable for modelling of learning curves in health technologies.  A comparison of Bayesian and maximum likelihood estimation hierarchical models and generalised estimating equations was made using data from trainees performing fibreoptic intubation.  It was concluded that statistical methods that account for the hierarchical structure of learning data should be used.  The use of non-linear hierarchical models for modelling learning curve effects was evaluated and it was recommended that Bayesian non-linear hierarchical modelling should be the preferred statistical method to model learning data, where feasible. Finally, a randomised controlled trial was assessed for the existence of learning effect.  A pragmatic <i>three step</i> approach was used to identify the existence of a learning curve effect in each outcome.  Twenty-one outcomes were evaluated with four outcomes concluded to have a learning curve effect.  The trial analysis was repeated using Bayesian hierarchical models, to account for the existence of learning.  In the last chapter the results were discussed and areas for further research were highlighted.

The scope of this project is to present a semi-automated vessels segmentation algorithm, to describe its usage and results. This will be achieved combining several segmentation algorithms to get proper vessel segmentation and visualization. Consequently, automatic segmentation can significantly reduce the scan-to-diagnosis time, thus helping the clinicians to reach the fundamental goal of efficient patient management. In order to complete our project, we can identify different phases: - Correct reading of CT and MR images and extraction of data needed for the post-processing. - Processing of these images using the most appropriate segmentation techniques to get the desired contour. - Visualization of the contour. / -

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Cette thèse avait pour but d’élargir le champ d’application des ultrasons en cardiologie, dans le domaine de l’imagerie et dans le domaine de la thérapie. Concernant l’imagerie, ce sont les capacités, les atouts et les limites des ultrasons à hautes cadences d’image (ultrafast echo) qui ont été explorés. Dans un premier temps, nous avons montré la possibilité et l’intérêt d’estimer la rigidité du myocarde par ultrason en pratique clinique, chez l’enfant et chez l’adulte. La technique de l’élastographie par onde de cisaillement, utilisant une nouvelle approche de l’imagerie par sommation cohérente harmonique ultrarapide (imagerie non-linéaire), a été appliquée pour la première fois chez l’humain en cardiologie. De plus, nous avons montré que la rigidité du foie, également estimée grâce à l’élastographie par onde de cisaillement, était directement corrélée aux pressions de remplissage du cœur droit, qui sont difficiles à évaluer de manière quantitative en pratique clinique. Dans un second temps, nous nous sommes intéressés à caractériser l’orientation des fibres myocardiques durant le cycle cardiaque en développant l’imagerie du tenseur de rétrodiffusion ultrasonore en trois dimensions. Le but était de réaliser la preuve de concept sur un cœur battant afin d’ouvrir sur les possibilités d’applications. Dans un troisième temps, le doppler de puissance en ultrafast echo nous a permis d’estimer les capacités des ultrasons à visualiser et analyser les flux (et donc les débits) intra coronariens. C’est à l’heure actuelle la seule technique d’imagerie clinique ayant une résolution spatiale (et temporelle) suffisante pour voir les flux dans des vaisseaux ayant un diamètre inférieur à 500 micromètres. Enfin, l’ultrafast echo nous a permis de visualiser les micro déplacements du myocarde, qui sont eux-mêmes initiés par l’activité électrique intra-myocardique, dans un intervalle de temps très réduit. Ceci est le couplage électromécanique, et y avoir accès par ultrason ouvrirait de multiples perspectives. Nous avons commencé à l’appliquer chez le fœtus humain et chez l’adulte en transthoracique. Concernant la thérapie, nous avons exclusivement utilisé les effets mécaniques des ultrasons focalisés à hautes intensités (phénomène de cavitation). Plusieurs équipes avaient déjà montré que cela était applicable en médecine cardiovasculaire, notamment pour perforer le septum inter-atrial (zone musculaire séparant les deux oreillettes cardiaques) ou pour détruire un thrombus intravasculaire. Nous avons décidé de montrer que le phénomène de cavitation peut avoir deux autres applications distinctes : 1) la section de cordage valvulaire mitral, qui est une technique utilisée actuellement en chirurgie (donc à cœur ouvert et en circulation extra-corporelle) visant à diminuer une fuite valvulaire à cause de cordage restrictif ; 2) l’assouplissement des feuillets valvulaires calcifiés, qui est une maladie représentant un enjeu de santé publique touchant des millions de personnes, et n’ayant à ce jour aucune stratégie non invasive disponible et applicable en pratique clinique. Pour ces deux applications, nous avons réalisé des preuves de concept in vitro puis in vivo à cœur battant, sur modèle animal (ovin). L’application humaine sera la prochaine étape. C’est donc la translation de nouvelles technologies ultrasonores vers des applications cliniques en cardiologie qui a motivé et guidé ce travail de thèse. / No abstract