published_or_final_version / Dentistry / Master / Master of Dental Surgery

The effect that organic urinary macromolecules have on the crystallization of calcium oxalate from a synthetic urine-like solution was studied in a mixed suspension-mixed product removal (MSMPR) continuous crystallizer. Precipitation of calcium oxalate crystals occurs during the continuous passage of urine through the renal system (kidney, bladder and tubules). While in normal circumstances these crystals remain small in size and exit the system unimpeded, in the pathologic condition calcium oxalate crystals are observed to aggregate and grow beyond a critical size where there is a significant probability of being trapped inside the renal system, e.g., on the kidney wall or in the tubules. Once trapped, the crystals become a nidus for further solute deposition and aggregation, giving origin to a renal calculus or stone. It is shown that this process is significantly affected by the presence or absence of organic macromolecules that act as modifiers of crystal growth, nucleation, and aggregation. An ultrafiltration technique was used to fractionate urine specimens from normal (N) and stone-forming (SF) persons into organic compounds of different molecular weight. These compounds were then added to the MSMPR system to test their effect on calcium oxalate crystallization. Significant differences were found to exist between N and SF urines in the composition, molecular weight distribution, and total quantity of these organic macromolecular compounds. The fraction of macromolecules responsible for the major effects on calcium oxalate crystallization was isolated, and its effect on crystal growth and nucleation rates was quantified. The steady state driving force (supersaturation) in the MSMPR system was measured. Striking differences in supersaturation versus residence time behavior between N and SF macromolecules were observed. The experimental conditions under which calcium oxalate crystals agglomerate were identified. Evidence which supports agglomeration as a key mechanism in urinary stone formation is presented.

I utbildningen till lärare ingår verksamhetsförlagd utbildning, VFU. VFU genomförs på en skola, förskola eller fritidshem hos en lärare i verksamheten, en VFU-lärare. För bedömning och kvalitetssäkring av utbildningsmomentet besöker en lärarutbildare från universitetet den lärarstuderande på VFU-platsen. Under besöket genomför i regel den lärarstuderande ett utbildningsmoment med barnen/eleverna där den besökande universitetslärarens observation av undervisningsmomentet tillsammans med information från VFU-läraren och den studerande utgör det bedömningsunderlag som lärarutbildaren behöver för att kunna examinera den lärarstuderandes VFU. Bedömningen, som görs mot kursplanens lärandemål, sker i det s.k. VFU-samtalet där parterna deltar och som vanligen hålls efter den studerandes undervisningsmoment. Det är inte ett tvång att dokumentera den lärarstuderandes prestation och samspel med barnen/eleverna, vilket medför en viss rättsosäkerhet eftersom en ny bedömning utifrån det genomförda undervisningstillfället inte är möjlig. Den besökande universitetsläraren antas ha underlag för ett godkännande eller ett underkännande. Den verksamhetsförlagda utbildningen sker inte sällan på förskolor/skolor som befinner sig på ett betydande avstånd från universitetet, vilket innebär långa restider för lärarutbildaren och därmed förlorad arbetstid. Syftet med denna studie är att undersöka om den ovan beskrivna gången kan ersättas med videoinspelning av undervisningsmomentet samt ett VFU-samtal via telebild med bibehållen kvalitet och rättssäkerhet. Under höstterminen 2011 genomfördes ett mindre försök med en grupp frivilliga lärarstuderande som alla tidigare hade erfarenhet av besök under sin VFU. De tre aktörerna genomförde sedan, via telebild, ett regelrätt VFU-samtal, som samtidigt spelades in. Försöket visar att modellen, om den justeras något, kan vara ett alternativ till besök på VFU-platsen. De lärarstuderande var övervägande positiva till möjligheten att själva välja ett undervisningstillfälle och de hade inte heller någon direkt negativ inställning till VFU-samtal via telebild. Det störningsmoment som en lärarutbildare utgör då denne besöker VFU-platsen, både för barnen/eleverna och för den lärarstuderande, bortfaller vid videoinspelning. En ökad förståelse för den egna lärargärningen och med resultat ett fördjupat VFU-samtal borgar för en ökad kvalitet i utbildningen. Rättsäkerheten i examinationen går inte förlorad vid en videoinspelning av undervisningsmomentet eller vid genomförande av ett VFU-samtal via telebild.

Under an adversarial legal system, witnesses� testimony may be challenged by the opposing lawyer during cross-examination. Cross-examination has been shown to negatively affect the accuracy of children�s event reports, but as yet, the mechanisms driving this effect are unknown. Experiment 1 aimed to tease apart the roles of question type and repeated interviewing in mediating children�s cross-examination performance. Five- and 6-year-olds (N = 82) and 9- and 10-year-olds (N = 103) took part in a staged event, and 1 to 2 days later they took part in a direct examination interview. Next, either 1 to 3 days or 6 months later, all children were interviewed for a second time. For half of the children, this second interview was a repeat of their direct examination interview. The remaining children were interviewed in a cross-examination format. A second interview reduced response accuracy after both short and long delays, however, cross-examination questioning impaired the accuracy of children�s reports the most. Although, overall, children have considerable difficulty answering cross-examination questions correctly, variation in their performance has been observed. Experiment 2 assessed whether individual differences in cognitive abilities mediate cross-examination performance. Five- and 6-year-olds (N = 116) and 9- and 10-year-olds (N = 58) visited the police station and subsequently reported their experiences in direct examination and cross-examination interviews. Children�s memory, receptive language ability, expressive language ability, and intelligence were also measured. Age, intelligence, and memory predicted aspects of cross-examination performance. Overall, these cognitive factors accounted for between 16.6% and 19.5% of the variance in cross-examination outcome measures. Given the negative effect of cross-examination on children�s responding, and our inability to identify the children who are most at risk of poor performance during this interview, Experiment 3 assessed our ability to facilitate children�s responding to cross-examination questioning. Specifically, the effect of manipulating the timing of a pre-trial intervention, which gives children practice and feedback at cross-examination questioning, was investigated. Five- and 6-year-olds (N = 88) and 9- and 10-year-olds (N = 108) visited the police station. One to 3 days later they completed the direct examination interview and 6 months after the event, children were cross-examined. The timing of the preparation intervention was varied (1-day, 1-week, 1-month before cross-examination), and the children�s subsequent cross-examination performance was compared to that of children in the control group. When the preparation intervention was delivered 1 day or 1 week before the cross-examination interview, children�s cross-examination performance was significantly improved. The findings from the three experiments suggest that cross-examination is likely to pose considerable problems for children, especially younger children. Our greater understanding of factors that influence children�s responding to cross-examination questioning may guide reform of the cross-examination process for child witnesses. Bottom-up initiatives, such as pre-trial preparation, and top-down changes, including educating professionals, expert testimony, and reducing the delay to cross-examination, may improve the reliability of child witnesses� testimony during cross-examination.

Diagnosing shoulder pain conditions is a challenging area of musculoskeletal practice. Subacromial impingement syndrome (SIS) is a clinical syndrome that indicates pain and pathology involving the subacromial bursa and rotator cuff tendons within the subacromial space. The three stages of SIS are subacromial bursitis, partial thickness and full thickness rotator cuff tears. The cause of SIS is believed to be multi-factorial with both extrinsic and intrinsic factors involved in its pathogenesis. Clinicians have traditionally diagnosed SIS using a clinical examination including a subjective history followed by confirmatory clinical tests. A review of the evidence for diagnostic accuracy of clinical tests highlights that individual tests have poor diagnostic accuracy. A combination of clinical tests or a clinical examination per se may be useful at ruling out rotator cuff tears, but is less accurate at detecting rotator cuff tears when it is present. There is consensus in the literature that particular combinations of signs and clinical features may be useful in diagnosing rotator cuff tears but not for diagnosing SIS. The vast majority of research to date examining the clinical diagnosis of SIS has been focused on individual clinical tests carried out by medical practitioners in specialist and tertiary care settings. This review has established that the majority of diagnostic accuracy studies for SIS and rotator cuff tears have had poor methodological design. This exploratory study was conducted with subjects undergoing a standardized clinical examination (index test) by a physiotherapist. The decision as to which specific tests were chosen for this research was based on supporting research within the literature and the test’s actual use within the New Zealand clinical setting. This included subjective history questions, active and passive shoulder movement tests and eleven SIS tests. Subjects were referred for a diagnostic ultrasound scan immediately following the clinical examination and results from the scan stood as the criterion reference standard. Thirty eight individuals (males n=23, females n=15) with new onset shoulder pain, who met the inclusion criteria, were assessed by a participating physiotherapist. Sensitivity, specificity, positive likelihood ratios, negative likelihood ratios and respective 95% confidence intervals were calculated for all variables of the examination. Individual variables from the clinical examination were tested for their association with the diagnostic ultrasound scan reference criterion using Pearson Chi-Squared Exact test. Potential predictor variables were retained as potential predictors for use in the logistic regression analysis to determine the most accurate set of clinical examination variables for diagnosing SIS and the individual pathological stages of SIS. The results indicate that no historical, subjective or objective features from the clinical examination are accurate in diagnosing SIS or rotator cuff tears. The presence of night pain demonstrated a significant correlation (P<0.02) with the criterion reference standard for the presence of subacromial bursa fluid/bunching. Night pain and pain with overhead activity has a high sensitivity for subacromial bursa fluid/bunching being present. The absence of night pain and the absence of pain with overhead activity are two subjective phenomena from a clinical examination that are useful in ruling out subacromial bursa fluid/bunching being present. Night pain was also found to be the best predictor of subacromial bursa fluid/bunching being present (P<0.012). Male gender (P<0.034) was the best predictor of partial thickness rotator cuff tears while being 60 years of age or older (P<0.01) significantly correlated with full thickness rotator cuff tears. The Drop Arm Sign (P<0.01) and External Rotation Lag Sign (P<0.01) were significantly correlated with SIS and full thickness rotator cuff tears. Clinical tests for all three pathological stages of SIS and subacromial bursa fluid/bunching being present, had equivalent or if not greater diagnostic accuracy than previous report studies in the literature. The Hawkins-Kennedy Test and Neer Sign can be used in the primary care setting to rule out the presence of subacromial bursa fluid/bunching or SIS if the tests are negative. For mid to end stage SIS (rotator cuff tears) the Empty Can Test and Drop Arm Sign with their high sensitivity can be used to rule out rotator cuff tears especially to the supraspinatus tendon when the tests are negative. Despite the small sample size and other limitations of this study, the findings are an important addition to the current literature surrounding the diagnostic accuracy of clinical tests for SIS and rotator cuff tears. This is the first study to use physiotherapists as examiners and to be set in a primary care setting. The study is also the first to examine the diagnostic accuracy of a range of historical and subjective features from the clinical examination. The results found in the current study could be used by future studies as a starting point in the development of a clinical decision or prediction rule to assist clinicians in the diagnosis of SIS and rotator cuff tears.

Thesis (LL. M.)--Judge Advocate General's School, United States Army, 1974. / "April 1974." Typescript. Includes bibliographical references (leaf vi). Also issued in microfiche.

Thesis (Ph.D.)--University of Canterbury, 2008. / Typescript (photocopy). Includes bibliographical references (leaves 356-415). Also available via the World Wide Web.

Thesis (Ph. D.)--University of North Carolina at Greensboro, 2006. / Title from PDF title page screen. Advisor: Terry Ackerman; submitted to the School of Education. Includes bibliographical references (p. 77-84).

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This document analysis examines how historical thinking is evaluated by the Ministry of Education history examination in Québec in 2015. High school students in Québec are required to pass this examination in order to receive their diploma. The Ministry examination claims to evaluate students’ historical knowledge and skills. Almost twenty years of Ministry of Education documents were analyzed using a historical methodology and two Ministry examinations were analyzed using a rubric derived from historical thinking criteria to answer the following questions: How has historical thinking influenced the history curriculum and the evaluation of history in the province of Québec? How is historical thinking reflected in the Québec Ministry examination? Analysis of the two examinations show that they are a limited tool for evaluating historical thinking and are instead focused on evaluating historical content knowledge. The current Ministry examination generally has some elements of four domains of historical thinking: evidence, cause and consequence, continuity and change and historical perspective. However, many of the questions only require students to answer at the recall level. Overall, there are few opportunities for students to demonstrate their advanced knowledge of historical thinking on the ministry examination.