京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第23824号 / 人健博第95号 / 新制||人健||7(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 十一 元三, 教授 林 悠, 教授 小林 恭 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(工学) / 甲第23498号 / 工博第4910号 / 新制||工||1767(附属図書館) / 京都大学大学院工学研究科都市環境工学専攻 / (主査)教授 米田 稔, 教授 高岡 昌輝, 教授 平井 康宏 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

Background: Although exposure is considered an active ingredient in evidence-based treatments (EBTs) for anxiety, it is infrequently used in routine clinical care settings. Therapist-level barriers to the use of exposure include inadequate training and negative beliefs about exposure. Prior efforts to train therapists in exposure therapy have resulted in knowledge but not behavior change. This study employed a novel training strategy, experiential learning, designed to improve the translation of knowledge into clinical practice. This study’s aims were to assess the feasibility and acceptability of experiential training (ET), as well as to conduct exploratory inferential analyses examining knowledge, attitudes, and use of exposure following training. Methods: Participants included 28 therapists working in routine clinical care settings. They were randomized to one of two conditions to learn about exposure therapy: training as usual (TAU) or ET (i.e., undergoing a one-session treatment for fear of spiders). Both workshops lasted one day, and participants were expected to attend weekly consultation calls for three months after training. Qualitative interviews were conducted at the end of the consultation call period. Results: The ET was feasible and acceptable to participants. Qualitative interviews suggested that participants, including those who were fearful of spiders, had a positive response to the training and found it to be useful. Quantitative analyses found that there was a significantly greater increase in the number of exposures used following ET than TAU at 1-month follow up. Both conditions demonstrated significant increases in knowledge, attitudes toward exposures, and self-efficacy following the training. Conclusions: The findings suggest that, consistent with previous research, a one-day training resulted in significant improvements in therapist-level factors that may affect the use of exposure. In addition, there is initial evidence that ET resulted in greater use of exposure after training, which applied more broadly, could increase the number of clients receiving an EBT for anxiety. The results provide promising evidence for the utility and acceptability of ET as a strategy to increase the use of EBTs in clinical practice. / Psychology

Objectives: To investigate differences in the modulus of elasticity, tensile strength, and load at breakage for elastic thread alone and elastic thread with gold chain in combination used in force application of palatally impacted and exposed maxillary canines. Methods: Two groups with n=6 in each were tested. A circular portion of elastic thread was cut, tied and measured to the nearest hundredth of a millimeter and recorded. Five links of a gold chain were cut and an elastic thread was tied to the fifth link opposite the bondable eyelet. The length of the elastic thread and the total apparatus was measured to the hundredth of a millimeter and recorded. An Instron with a ramp speed of 100 mm/min was used for all testing. Results: The addition of the gold chain, as compared to the elastic thread alone, increased the modulus from 8.8 MPa (SD 3.7) to 17.0 MPa (SD 5.03), (p< 0.04) and significantly decreased the maximum tensile stress at breakage from 92.1N (SD 5.0) to 84.1N (SD 1.6), (p<0.004) and the tensile stress at maximum load from 107.8 N (SD 6.7) to 93.8N (SD 4.8), (p<0.002). The stress-strain curve for both groups demonstrated an initial linear behavior followed by non-linear behavior, partially obeying Hooke’s Law, due to the inherent nature of the elastic thread. The addition of the gold chain introduced a rigid element by reducing the of length of the elastic thread by one-half, altering the properties of the assembly. Conclusions: The modulus of elasticity (stiffness) increases and the toughness and resiliency decreases when a gold chain is added to the assembly and compared to elastic thread alone. This could indicate that in the gold chain group, more initial force/strain is delivered to the tooth and there is less stress relaxation over time due to the decrease in the amount of elastic thread. Therefore, the elastic thread alone delivers a more constant and continuous force to the tooth. The use of elastic thread alone may provide a biomechanically more efficient approach to orthodontic movement of impacted and open exposed teeth. / Oral Biology

Background/Objectives: The first objective of this study is to assess the relationship between cigarette access and smoking behavior in 15-17 year old students. The second objective of this study is to assess the relationship between media and smoking behavior in those students. The third objective of this study is to observe whether the smoking rate will increase if subjects have both access and exposure to the tobacco product. I propose to use the youth survey data to test the impact of exposure to smoking-related media messages and the difficulty of acquiring tobacco products. I hypothesize that there is positive relationship among youth access to tobacco products, exposure to tobacco ads/promotions on social networking sites and active smoking. Methods: I examined National Youth Tobacco Survey data from 2014 and a total number of 1293 subjects as a secondary analysis. Results: The students with one or more than one method of accessing tobacco had higher odds compared to students with no access (OR = 70.12; 95% CI: 47.71–103.07; p < 0.0001 for only one method; OR = 240.22; 95% CI: 160.25–360.09; p < 0.0001 for more than one method). Moreover, the association between exposure to tobacco ads via internet, newspaper, point stores and movies/TV and smoking behavior was significant at both moderate and heavy exposure levels (OR = 1.44; 95% CI: 1.08–1.92; p = 0.014 for moderate exposure group; OR = 1.82; 95% CI: 1.26–2.62; p = 0.002 for heavy exposure group). The multivariable model, which shows the effect of the combination of these two factors, it states access to tobacco products was significantly positively associated with an increased smoking rate (OR = 69.06; 95% CI: 47.03-101.40; p < 0.001 for only one access group; OR = 241.78; 95% CI: 160.49–364.22; p < 0.001 for more than 1 access group). However, the severity of media exposure was not significantly associated with the increased odds of cigarette smoking among adolescents (OR = 1.14; 95% CI: 0.80-1.62; p = 0.470 for moderate exposure group; OR = 1.39; 95% CI: 0.81–2.40; p = 0.227 for heavy exposure group). Conclusion: I provided further evidence that exposure to tobacco messages and have access to tobacco products can increase the smoking rates among youth. These findings could be a result of better diagnosis and reporting, but the increase may also be due to other risk factors in the population. These findings may have implications for further and more aggressive counseling for teenagers. These effects should be further explored in a larger population of adolescents. Intervention methods should be designed to help the public understand the benefits of reducing adolescent’s exposures to tobacco smoke. / Epidemiology

Upon interviewing a sample of youths, researchers who study exposure to violence are often faced with a substantial number of reports of exposure to violence and no way to confirm the veracity of these claims. The remarkably high levels of violence exposure reported by young preschool children (Richters & Martinez, 1990), paired with the low concordance between parents and children concerning what violence the child had witnessed and experienced (Howard, Cross, Li & Huang, 1999; Shahinfar, Fox & Leavitt, 2000), suggests that child self-reports of exposure to violence may not be entirely veridical. Since self-reports appear to be the only feasible method of measuring lifelong exposure to violence, determining the possible causes of false reports and investigating possible predictors should be a significant aspect of studying youth exposure to violence. With this thesis, I have investigated the veracity of child self-reports by comparing responses to a life-long exposure to violence questionnaire administered first between 1997 and 1999, and a second time two years later. Inconsistent reports, wherein an initial report of exposure to a particular violent instance was not confirmed by re-reporting at the second interview, were prevalent on a variety of violence-assessment items, including witnessing a murder and being the victim of a physical attack. For instance, when initially interviewed, approximately one in seven Chicago children aged 8 to 17 reported witnessing a shooting at least once during their lives. Alarmingly, 50% of these children did not confirm this instance of violence when interviewed again two years later. In an effort to identify self- or parent-reported characteristics and behaviours predictive of inconsistent responses concerning witnessing a shooting, I conducted several series of Binomial and Multinomial Logistic Regression analyses. Explanatory variables were selected to be representative of two main likely reasons for inconsistent self-reports: misremembering due to forgetting over time and the inaccuracy of children's memories, and misinformation due to an impulsive propensity towards lying or exaggeration. My findings suggest that, in comparison to individuals who confirmed their initial reports of having 'witnessed a shooting', individuals who retracted their initial claims were generally younger, from a higher socio-economic status level neighbourhood, admittedly lacked guilt after misbehaving, desired a lot of attention, and reported less impulsivity as measured by delinquency and behavioural impulsivity scales. / Thesis / Master of Science (MSc)

要旨ファイルを差し替え（2022-01-24） / 京都大学 / 新制・課程博士 / 博士(工学) / 甲第23492号 / 工博第4904号 / 新制||工||1766(附属図書館) / 京都大学大学院工学研究科都市環境工学専攻 / (主査)教授 米田 稔, 教授 高野 裕久, 教授 松井 康人 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DGAM

Innate immune memory has become an increasingly popular area of research in the last decade. However, much of the work done on innate immune memory using inflammatory agents such as BCG, C. albicans, and β-glucan has been pursued through systemic administration, which has been shown to induce training in circulating monocytes. In addition, little is known about whether microbial ligands can induce training. Here, we show that local mucosal exposure to an acute dose of LPS induces long-lasting phenotypic changes in airway macrophage populations. LPS-exposed macrophages display increased glycolytic metabolism and differential cytokine expression upon restimulation, whereas circulating monocytes are not affected. Finally, we show that LPS exposure provides long-lasting protection against Streptococcus pneumoniae in the lung, likely due to the higher acquisition of CD11b, which is indicative of macrophage activation and phagocytosis. As much of the work on innate immune memory has been done through systemic administration of training agents, this project aims to fill existing knowledge gaps in the induction of innate immune memory upon local mucosal exposure to inflammatory agents. / Thesis / Master of Science in Medical Sciences (MSMS) / The innate immune system is one of the first defenders in our bodies that fight against a variety of pathogens. In the last decade, the innate immune system was found to be capable of having memory, meaning it reacts faster or at a heightened magnitude in response to a wide range of subsequent pathogens after it is trained by an agent. This project explores the effect a bacteria wall component, LPS, has on the lung environment and examines if it will induce memory in the lung. Our findings show that intranasal exposure to LPS changes the cellular landscape in the lung. LPS-exposed airway innate immune cells become more activated and provide subsequent protection against bacterial infections. This work has implications for using LPS as a vaccine adjuvant in order to provide protection against a variety of pathogens in addition to specific protection brought by the vaccine.

Thesis advisor: Ann W. Burgess / Purpose: The purpose of this descriptive phenomenological study was to understand the lived experience of Black emerging adults with psychotic disorders who have community violence exposure (CVE). The aims included understanding how Black emerging adults with psychotic disorders described the experience of community violence in their lives. A secondary aim was to understand how these individuals described how their experience of community violence has impacted their ability to attain goals that are consistent with emerging adulthood.Background: CVE is a public health crisis. Black emerging adults are at an increased risk of CVE and having a psychotic disorder. CVE and psychotic disorders can cause an increased burden on life. While there is research examining the impact of CVE on mental health and research examining the effects of trauma on psychotic disorders, there is limited qualitative work in Black emerging adults with psychotic disorders and CVE. Method: This study was guided by Husserl's descriptive phenomenology philosophy, and Giorgi's descriptive psychological phenomenological approach guided data collection and analysis. Eleven participants were recruited through purposive sampling. Participants had to have a psychotic disorder, report CVE, identify as Black or African-American, and be between 18 and 29. Interviews were conducted individually with each participant to understand their experiences of CVE. Using bracketing, the data was coded and analyzed. Rigor and trustworthiness were ensured by using Lincoln and Guba's criteria for credibility, confirmability, dependability, and transferability. Results: The sample consisted of eleven participants, ranging in age from 21 to 28, with an average age of 24.6. Six identified as male, four identified as female, and one participant identified as transgender and non-binary/non-conforming. All participants identified as non-Hispanic Black/African-American and had a primary psychotic disorder. Four themes were identified: (1) CVE results in a range of emotional responses, (2) CVE results in a range of behavioral responses, (3) CVE causes disruptions in life and relationships, and (4) participants aspire for a better life without a clear pathway. These four themes represent the lived experiences of CVE in these Black emerging adults who have psychotic disorders in Boston, MA. The themes shed light on the consequences CVE had in their lives. Conclusion: Utilizing descriptive phenomenology created a comprehensive understanding of the experience of the phenomenon of CVE in Black emerging adults with a psychotic disorder. The results illuminated the complex nature CVE has on their life and mental health. Future research should focus on quantitative studies to explore the impact of CVE on various health, social, and psychological outcomes. / Thesis (PhD) — Boston College, 2024. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

This thesis has evaluated the effectiveness of GDL programs both in New Jersey and across the United States using several metrics. The New Jersey GDL program was analyzed because it is considered one of the most stringent programs in the country. It was found that GDL indeed reduces the per capita rate of crashes for teen drivers in New Jersey. However, no statistical difference was seen in the rate of fatalities in teen driver crashes. The per capita rate of violations for 16 and 17 year old drivers was lower after GDL, but the rate of point-carrying violations increased for 19 and 20 year old drivers who were licensed under GDL. The September, 2008 directive by the New Jersey Attorney General banning plea-agreements for teens significantly reduced the rate of violations further for 16 and 17 year old GDL drivers. The factors that led to teen crashes did not change in the United States after GDL. Teen drivers are still prone to distractions and inappropriate behavior while driving. Teen drivers also have higher rates of control loss and road departure crashes when compared to adults. Finally, it was found changes in the number teen driver crashes and fatalities are associated with similar changes in travel exposure. Teen crashes and fatalities have dropped with the implementation of GDL but teen VMT has also dropped. Graduated driver's licensing did not change the reasons for teen driver crashes. Also, it is likely that any reductions in the number of teen crashes or fatalities are associated with reductions in exposure and not changes in teen driver behavior. / Ph. D.