The discharge summary is an important document, summarizing a patient’s medical information during their hospital stay. It is crucial for communication between clinicians and primary care physicians. Creating a discharge sum- mary is a necessary task. However, it is time-consuming for physicians. Using technology to automatically generate discharge summaries can be helpful for physicians and assist them in concentrating more on the patients than writing clinical summarization notes and discharge summaries. This master’s thesis aims to contribute to the research of building a transformer-based model for an automated discharge summary with a pre-trained DistilBART language model. This study plans to answer this main research question: How e↵ective is the pre-trained DistilBART language model in predicting an automated discharge summary for multiple clinical texts? The research strategy used in this study is experimental. the dataset is MIMIC- III. To evaluate the e↵ectiveness of the model, ROUGE scores are selected. The result of this model is compared with the result of the baseline BART model, which is implemented on the same dataset in the other recent research. This study regards multiple document summarization as the process of combining multiple inputs into a single input, which is then summarized. The findings indicate an improvement in ROUGE-2 and ROUGE-Lsum in the DistilBART model in comparison with the baseline BART model. However, one important limitation was computational resource constraint. The study also provides eth- ical considerations and some recommendations for future works.

Chapter 1 gives background information on proteases and discusses the concept of protease inhibition as a therapeutic strategy for humans. It introduces the key concept that conformation defines biological activity. It also outlines how proteases almost universally bind their substrate/inhibitors in an extended β-strand conformation. The use of calpain as a prototype protease for the testing of β-strand mimics synthesised later in the thesis is also discussed. Chapter 2 describes how molecular modeling was used to rationalise the structure based activity relationships (SAR) of known calpain inhibitors. Molecular modeling was then used to successfully design a number of acyclic β-strand mimics. The synthesis and testing of eight such inhibitors is described. The most potent β-strand mimic prepared was 2.13. This was determined to have an IC₅₀ of 30 nM against calpain II. Chapter 3 outlines the history and application of ring closing metathesis (RCM) to the synthesis of cyclic compounds. The attempted synthesis of an eight membered cyclic nitrogen to nitrogen conformationally constrained dipeptide is described. The synthesis of a conformationally constrained β-amino acid calpain inhibitor (3.73) is also described. A novel calpain inhibitor motif was designed in Chapter 4. On the basis of this an in-silico combinatorial library of two hundred and eighty eight possible β-strand templates was prepared. Conformational analysis of this library was performed and from this a number of excellent β-strand templates were identified and selected for synthesis. The preparation of ten β-strand templates is described. New microwave irradiation methodology was developed to achieve this. vii The formation of a six-membered catalyst deactivating chelate is also proposed to explain why some dienes fail to undergo RCM. Two methods to circumvent the formation of such a chelate are outlined. The addition of Lewis acid chloro-dicyclohexyl borane to the RCM reaction mixture and chain length alteration are investigated. Chapter 5 describes the design of macrocyclic β-strand mimics using induced fit molecular modelling. The physicochemical properties of these were calculated in-silico. From this analysis a number of Tyr-XX-Gly based and Tyr-XX-Cys based macrocyclic calpain inhibitors were selected for synthesis. The preparation and testing of these are described. In the Tyr-XX-Gly macrocyclic system a number of variables were investigated and numerous SAR implications concluded. Aldehyde 5.14 was identified as the best electrophilic warhead macrocyclic calpain inhibitor with an IC₅₀ against calpain II of 27 nM. The best non-electrophilic warhead macrocycle (5.13) had an IC₅₀ against calpain II of 704 nM. Chapter 6 describes synthetic optimisation for the preparation of calpain inhibitors 2.13, 5.14 and 5.17. Multi-gram quantities of each were prepared. Aldehydes 2.13 and 5.14 were evaluated as anti-cataract agents using in-vivo cataract sheep model. Both of these β-strand mimics were demonstrated to retard cataract development. Macrocycle 5.14 was found to be the most effective, decreasing the rate of cataract development between forty four and forty nine per cent relative to control. Chapter 7 outlines the attempted development of RCM methodology for the chiral synthesis of α-α disubstituted amino acid lactams. In addition, methodology for the stereoselective incorporation of a C-N constrained β-amino acid carbocycle into a peptide or peptidomimetic is described.

No description available.

Cette thèse analyse les effets d'une libéralisation du commerce de services en Afrique. Au-delà d'un chapitre introductif (chapitre 1), la thèse contient trois chapitres: le chapitre 2 analyse les déterminants du pouvoir de marché dans le secteur des télécommunications. Le troisième étudie l'impact du commerce des services sur la croissance économique en mettant l'accent sur les services de télécommunications et de finances. Le quatrième procède à la simulation de l'impact de la libéralisation des services sur la pauvreté en s'appuyant sur le cas des télécommunications au Cameroun. Les chapitres 2 et 3 sont basés sur des données agrégées de 30 pays africains entre 1997 et 2004. Ils s'appuient sur les modèles structurels et utilisent les estimations du 3SLS. Leurs principales conclusions empiriques sont les suivantes: (i) Concernant les télécommunications, l'industrie africaine est confrontée à un fort pouvoir de marché. Trois facteurs politiques semblent avoir une incidence négative sur le pouvoir de marché: les efforts unilatéraux, en termes de libéralisation (en nombre d'opérateurs) et de renforcement de la réglementation sectorielle, aussi bien que les engagements multilatéraux à libéraliser dans le cadre de l'AGCS. Toutefois, il apparaît que l'effet des contacts multi-marchés des opérateurs de télécommunications est un important facteur de renforcement des comportements de coopération et de collusion. (ii) En ce qui concerne l'effet sur la croissance, le niveau de la concurrence a un effet important sur l'accès aux services de télécommunications, qui à son tour, influence de manière significative la croissance des revenus. (iii) Dans le cas du secteur financier, la libéralisation du commerce s'avère être un important déterminant de la structure du marché, mesurée par le niveau de concentration, tandis que les indicateurs de performances sectorielles (crédit au secteur privé) apparaissent comme d'importants déterminants de la croissance. Le quatrième chapitre utilise les elasticités déterminées dans les deux précédents et adopte l'approche de micro-macro simulation pour analyser la pauvreté (Shen et Ravallion, 2004). Il se base sur la MCS camerounaise de 2001 et sur l'enquête sur les revenus de ménages camerounais en 2001 (ECAM II). Les résultats montrent que la libéralisation des télécommunications contribue à réduire la pauvreté au Cameroun, l'essentiel des gains étant généré par les effets de productivité.

No description available.

Chapter 1 gives background information on proteases and discusses the concept of protease inhibition as a therapeutic strategy for humans. It introduces the key concept that conformation defines biological activity. It also outlines how proteases almost universally bind their substrate/inhibitors in an extended β-strand conformation. The use of calpain as a prototype protease for the testing of β-strand mimics synthesised later in the thesis is also discussed. Chapter 2 describes how molecular modeling was used to rationalise the structure based activity relationships (SAR) of known calpain inhibitors. Molecular modeling was then used to successfully design a number of acyclic β-strand mimics. The synthesis and testing of eight such inhibitors is described. The most potent β-strand mimic prepared was 2.13. This was determined to have an IC₅₀ of 30 nM against calpain II. Chapter 3 outlines the history and application of ring closing metathesis (RCM) to the synthesis of cyclic compounds. The attempted synthesis of an eight membered cyclic nitrogen to nitrogen conformationally constrained dipeptide is described. The synthesis of a conformationally constrained β-amino acid calpain inhibitor (3.73) is also described. A novel calpain inhibitor motif was designed in Chapter 4. On the basis of this an in-silico combinatorial library of two hundred and eighty eight possible β-strand templates was prepared. Conformational analysis of this library was performed and from this a number of excellent β-strand templates were identified and selected for synthesis. The preparation of ten β-strand templates is described. New microwave irradiation methodology was developed to achieve this. vii The formation of a six-membered catalyst deactivating chelate is also proposed to explain why some dienes fail to undergo RCM. Two methods to circumvent the formation of such a chelate are outlined. The addition of Lewis acid chloro-dicyclohexyl borane to the RCM reaction mixture and chain length alteration are investigated. Chapter 5 describes the design of macrocyclic β-strand mimics using induced fit molecular modelling. The physicochemical properties of these were calculated in-silico. From this analysis a number of Tyr-XX-Gly based and Tyr-XX-Cys based macrocyclic calpain inhibitors were selected for synthesis. The preparation and testing of these are described. In the Tyr-XX-Gly macrocyclic system a number of variables were investigated and numerous SAR implications concluded. Aldehyde 5.14 was identified as the best electrophilic warhead macrocyclic calpain inhibitor with an IC₅₀ against calpain II of 27 nM. The best non-electrophilic warhead macrocycle (5.13) had an IC₅₀ against calpain II of 704 nM. Chapter 6 describes synthetic optimisation for the preparation of calpain inhibitors 2.13, 5.14 and 5.17. Multi-gram quantities of each were prepared. Aldehydes 2.13 and 5.14 were evaluated as anti-cataract agents using in-vivo cataract sheep model. Both of these β-strand mimics were demonstrated to retard cataract development. Macrocycle 5.14 was found to be the most effective, decreasing the rate of cataract development between forty four and forty nine per cent relative to control. Chapter 7 outlines the attempted development of RCM methodology for the chiral synthesis of α-α disubstituted amino acid lactams. In addition, methodology for the stereoselective incorporation of a C-N constrained β-amino acid carbocycle into a peptide or peptidomimetic is described.

During the past decade the effects of macromolecular crowding on reaction pathways is gaining in prominence. The stress is to move out of the realms of ideal solution studies and make conceptual modifications that consider non-ideality as a variable in our calculations. In recent years it has been shown that molecular crowding exerts significant effects on all in vivo processes, from DNA conformational changes, protein folding to DNA-protein interactions, enzyme pathways and signalling pathways. Both thermodynamic as well as kinetic parameters vary by orders of magnitude in uncrowded buffer system as compared to those in the crowded cellular milieu. Ignoring these differences will restrict our knowledge of biology to a “model system” with few practical understandings. The recent expansion of the genome database has stimulated a study on numerous previously unknown proteins. This has whetted our thirst to model the cellular determinants in a more comprehensive manner. Intracellular extract would have been the ideal solution to re-create the cellular environment. However, studies conducted in this solution will be contaminated by interference with other biologically active molecule and relevant statistical data cannot be extracted out from it. Recent advances in methodologies to mimic the cellular crowding include use of inert macromolecules to reduce the volume occupancy of target molecules and the use of immobilization techniques to increase the surface density of molecules in a small volumetric region. The use of crowding agents often results in non-specific interaction and side-reactions like aggregation of the target molecules with the crowding agents themselves. Immobilization of one of the interacting partners reduces the probability of aggregation and precipitation of bio-macromolecules by restricting their degrees of freedom. Covalent linkage of molecules on solid support is used extensively in research for creating a homogeneous surface of bound molecules which can be interrogated for their reactivity. However, when it comes to biomolecules, direct immobilization on solid support or use of organic linkers often results in denaturation. The use of bio-affinity immobilization techniques can help us overcome this problem. Since mild conditions are needed to regenerate such a surface, it finds universal applicability as bio-memory chips. This thesis focuses on our attempts to design a physiologically viable immobilization technique for following rotein-protein/protein-DNA interactions. The work explores the mechanism for biological interactions related to transcription process in E. coli. Chapter 1 deals with the literary survey of the importance and effects of molecular crowding on biological reactions. It gives a brief history of the efforts been made so far by experimentalists, to mimic macromolecular crowding and the methods applied. The chapter tries to project an all-round perspective of the pros and cons of different immobilization techniques as a means to achieve a high surface density of molecules and the advancements so far. Chapter 2 deals with the detailed technicality and applicability of the Langmuir-Blodgett method. It discusses the rationale behind our developing this technique as an alternate means of bio-affinity immobilization, under physiologically compatible conditions. It then goes on to describe our efforts to follow the sequence-specific and sequential assembly process of a functional RNA polymerase enzyme with one immobilized partner and also explore the role of omega subunit of RNAP in the reconstitution pathway. This chapter uses the assembly process of a multi-subunit enzyme to evaluate the efficiency of the LB system as a universal two-dimensional scaffold to follow sequence-specific protein-ligand interaction. Chapter 3 discusses the application of LB technique to quantitatively evaluate the kinetics and thermodynamics of promoter-RNA polymerase interaction under conditions of reduced dimensionality. Here, we follow the interaction of T7A1 phage promoter with Escherichia coli RNA polymerase using our Langmuir-Blodgett technique. The changes in mechanistic pathway and trapping of kinetic intermediates are discussed in detail due to the imposed restriction in the degrees of freedom of the system. The sensitivity of this detection method is compared vis-a-vis conventional immobilization methods like SPR. This chapter firmly establishes the universal application of LB technique as a means to emulate molecular crowding and as a sensitive assay for studying the effects of such crowding on vital biological reaction pathway. Chapter 4 describes the mechanistic pathway for the physical binding of MsDps1 protein with long dsDNA in order to physically protect DNA during oxidative stress. The chapter describes in detail the mechanism of physical sequestering of non-specific DNA strands and compaction of the genome under conditions where a kinetic bottleneck has been applied. The data obtained is compared with results obtained in the previous chapter for the sequence-specific DNA-protein interaction in order to understand the difference in recognition process between regulatory and structural proteins binding to DNA. Chapter 5 deals with the evaluation of the σ-competition model in E. coli for three different sigma factors (all belonging to the σ-70 family). Here again, we have evaluated the kinetic and thermodynamic parameters governing the binding of core RNAP with its different sigma factors (σ70, σ32and σ38) and performed a comparative study for the binding of each sigma factor to its core using two different non-homogeneous immobilization techniques. The data has been analyzed globally to resolve the discrepancies associated with establishing the relative affinity of the different sigma factors for the same core RNA polymerase under physiological conditions. Chapter 6 summarizes the work presented in this thesis. In the Appendix section we have followed the unzipping of promoter DNA sequence using Optical Tweezers in an attempt to follow the temporal fluctuations occurring in biological reactions in real time and at a single molecule level.

In Multi-Agenten-Systemen (MAS) kooperieren und konkurrieren Agenten um ihre jeweiligen Ziele zu erreichen. Für optimierte Agenten-Interaktionen sind Kenntnisse über die aktuellen und zukünftigen Handlungen anderer Agenten (Interaktionsparter, IP) hilfreich. Bei der Ermittlung und Nutzung solcher Kenntnisse kommt dem automatischen Erkennen und Verstehen sowie der Vorhersage von Verhalten der IP auf Basis von Beobachtungen besondere Bedeutung zu. Die Dissertation beschäftigt sich mit der automatischen Bestimmung und Vorhersage von Verhalten der IP durch einen Modellierenden Agenten (MA). Der MA generiert fallbasierte, adaptive Verhaltens-Modelle seiner IP und verwendet diese zur Vorhersage ihrer Verhalten. Als Anwendungsszenario wird mit dem virtuellen Fußballspiel des RoboCup ein komplexes und populäres MAS betrachtet. Der Hauptbeitrag dieser Arbeit besteht in der Ausarbeitung, Realisierung und Evaluierung eines Ansatzes zur automatischen Verhaltens-Modellierung für ein komplexes Multi-Agenten-System. / In multi-agent-systems agents cooperate and compete to reach their personal goals. For optimized agent interactions it is helpful for an agent to have knowledge about the current and future behavior of other agents. Ideally the recognition and prediction of behavior should be done automatically. This work addresses a way of automatically classifying and an attempt at predicting the behavior of a team of agents, based on external observation only. A set of conditions is used to distinguish behaviors and to partition the resulting behavior space. From observed behavior, team specific behavior models are then generated using Case Based Reasoning. These models, which are derived from a number of virtual soccer games (RoboCup), are used to predict the behavior of a team during a new game. The main contribution of this work is the design, realization and evaluation of an automatic behavior modeling approach for complex multi-agent systems.

Peripheral vascular grafts are used for the treatment of peripheral arterial disease and arteriovenous grafts for vascular access in end stage renal disease. The development of neo-intimal hyperplasia and thrombosis in the distal anastomosis remains the main reason for occlusion in that region. The local haemodynamics produced by a graft in the host vessel is believed to significantly affect endothelial function. Single spiral flow is a normal feature in medium and large sized vessels and it is induced by the anatomical structure and physiological function of the cardiovascular system. Grafts designed to generate a single spiral flow in the distal anastomosis have been introduced in clinical practice and are known as spiral grafts. In this work, spiral peripheral vascular and arteriovenous grafts were compared with conventional grafts using ultrasound and computational methods to identify their haemodynamic differences. Vascular-graft flow phantoms were developed to house the grafts in different surgical configurations. Mimicking components, with appropriate acoustic properties, were chosen to minimise ultrasound beam refraction and distortion. A dual-beam two-dimensional vector Doppler technique was developed to visualise and quantify vortical structures downstream of each graft outflow in the cross-flow direction. Vorticity mapping and measurements of circulation were acquired based on the vector Doppler data. The flow within the vascular-graft models was simulated with computed tomography based image-guided modelling for further understanding of secondary flow motions and comparison with the experimental results. The computational assessments provided a three-dimensional velocity field in the lumen of the models allowing a range of fluid dynamic parameters to be predicted. Single- or double-spiral flow patterns consisting of a dominant and a smaller vortex were detected in the outflow of the spiral grafts. A double- triple- or tetra-spiral flow pattern was found in the outflow of the conventional graft, depending on model configuration and Reynolds number. These multiple-spiral patterns were associated with increased flow stagnation, separation and instability, which are known to be detrimental for endothelial behaviour. Increased in-plane mixing and wall shear stress, which are considered atheroprotective in normal vessels, were found in the outflow of the spiral devices. The results from the experimental approach were in agreement with those from the computational approach. This study applied ultrasound and computational methods to vascular-graft phantoms in order to characterise the flow field induced by spiral and conventional peripheral vascular and arteriovenous grafts. The results suggest that spiral grafts are associated with advanced local haemodynamics that may protect endothelial function and thereby may prevent their outflow anastomosis from neo-intimal hyperplasia and thrombosis. Consequently this work supports the hypothesis that spiral grafts may decrease outflow stenosis and hence improve patency rates in patients.

Dans ce mémoire, je présente mes études sur une stratégie efficace développée pour la synthèse de cétones homoallyliques substituées à partir de l’addition en cascade de réactifs de Grignard vinyliques substitués sur des α-amino esters catalysée par des sels de cuivre. L’utilisation de ces cétones homoallyliques a permis d’obtenir des mimes peptidiques comprenant un isostère de type hydroxyéthylène du lien amide. L’étape clé de cette stratégie repose sur la synthèse de cétones homoallyliques substituées intermédiaires à partir de la réaction d’additions en cascade catalysée au cuivre, de bromure de β,β-diméthylevinyle magnésium sur des analogues d’esters de la phénylalanine et de la sérine. Les cétones homoallyliques résultantes sont réduites sélectivement en alcool, la liaison double est clivée oxydativement et l’acide carboxylique résultant est couplé à un acide aminé. Afin d’évaluer l’effet qu’ont le remplacement du lien amide central dans un coude β par un hydroxyéthylène et de la présence d’un gem diméthyle sur la chaîne carbonée sur la conformation tridimensionnelle adoptée par les tripeptides générés, des analyses à l’état solide par diffraction aux rayons X, des analyses en solution par la spectroscopie RMN et des expériences de type NOESY ont été réalisées. Ces études ont permis de définir un nouveau type de coude β. La présence de pont hydrogène intramoléculaire et l’effet de restriction de conformation induit par le gem diméthyle, généralement appelé effet Thorpe-Ingold, favorisent la formation d’un coude β. / In this thesis, I discuss my studies toward the synthesis of substituted homoallylic ketones from the copper-catalyzed cascade addition of substitued vinyl Grignard reagents to carboxylic esters. The homoallylic ketones were used to provide different peptidomimetics containing a hydroxyethylene isostere instead of an amide bond. The methyl ester of phenylalanine and serine derivatives were reacted in copper-catalyzed cascade additions of substitued vinylmagnesium bromide to provide substitued homoallylic ketone intermediates. Selective reduction of the ketone to an alcohol, oxidative cleavage of the double bond, followed by peptide coupling with amino acid lead to the desired peptidomimic. The influence of changing the central amide bond for a hydroxyethylene isostere in a β-turn and the effect of a gem dimethyl group on the backbone conformation adopted by the newly synthesized tripeptides, were studied by X-ray diffraction and solution NMR spectroscopy using NOESY experiments. From these studies, it was revealed that the iso-butyric acid hydroxyethylene isomer induced a β-turn-like conformation, and may serve as a novel scaffold for peptide mimicry.