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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.
11

Approaches for Improved Positional Proteomics

Jiang, Yanjie 06 August 2013 (has links)
Positional proteomics is emerging as an attractive technique to characterize protein termini, which play important biological roles in cells. Even with the advances in past decades, there still are areas for improvement. This thesis focuses on improving data quality and assignment confidence in positional proteomics. A novel workflow was designed for the large-scale identification of protein N-terminal sequences. 4-sulfophenyl isothiocyanate (SPITC) is used for N-termini sulfonation; Upon higher energy collisional dissociation (HCD), SPITC peptides in electrospray ionization ESI generate predominately y-type ion series; such simplification of spectra enables the identification of N-termini with high fidelity. The presence of b1 + SPITC product ions upon HCD furthers the confidence for N-terminal identifications. Secondly, sulfonated N-terminal peptides possess one negative charge site at low pH, which was exploited to enrich the SPITC modified N-terminal peptides by electrostatic repulsion hydrophilic interaction (ERLIC) chromatography. Such enrichment process allows both N-termini enriched and N-termini deficient fractions to be collected and analyzed by LC-MS/MS. This method was applied to an E. coli cell lysate, identifying approximately 350 N-terminal peptides (85% represented neo-N-termini from protein degradation and 15% from leading methionine excision). These N-terminal peptides represented 274 distinct E.coli proteins, 224 of which were also identified in the analysis of flow-through fractions from internal peptides. Another approach we took to boost the identification confidence is by exploiting iTRAQ (isobaric tag for relative and absolute quantitation) in the positional proteomics workflow. This approach allows for multiplexed comparison between different samples, and thus is well-suited for degradadomics analyses where degraded samples are compared to control samples. Both control and protease treated sample are labeled by different tags which allows direct comparison of protein N-termini with neo-N-termini. In addition, samples are analyzed duplicate by labeling with two tags, aiming for quick validation of peptides by internal replicates. In this study, Asp-N digested E.coli cell lysate is taken as a model system. A total of 500 N-terminal peptides, corresponding to 370 proteins, were identified with high confidence in one experiment, with 87% of those proteolytic products matching the expected protease digestion specificity, validating the assignment accuracy of this approach.
12

Avaliação posicional de dados altimétricos gerados por diferentes sistemas de varredura a laser terrestre: estudo de caso

Ferraz, Rodrigo da Silva January 2017 (has links)
As utilizações de dados altimétricos, nesse estudo analisados a partir de modelos digitais de terreno (MDT), são as mais variadas assim como as técnicas de obtenção desse tipo de dado. Pode-se obter MDT por radar de abertura sintética que é utilizado para o levantamento de grandes áreas e de difícil acesso. Também pode-se gerar esse tipo de dado por Fotogrametria, por Topografia utilizando estação total com apoio GNSS (Global Navigation Satellite System). Uma tecnologia mais atual para a obtenção de dados altimétricos é a utilização de tecnologia Lidar (light detection and ranging) que consiste na medição de distância e coordenadas através de um pulso eletromagnético que interage com os alvos. O produto básico dos sistemas que utilizam a tecnologia Lidar, seja em plataformas aéreas ou terrestres, é denominado de nuvem de pontos. Essas nuvens de pontos possuem coordenadas tridimensionais (X, Y e Z) referenciadas ao centro de fase do sensor. Nesse estudo foram realizados experimentos com dois sistemas de varredura a laser terrestre. O primeiro é um sistema de varredura modelo Optech Ilris 3D e outro Faro Focus 3D, nesse estudo denominados de SVLT Optech e SVLT Faro. Assim, o objetivo desse trabalho é estimar a qualidade posicional dos dados altimétricos gerados por dois SVLT. Os estudos foram executados em dois experimentos. No primeiro experimento foram realizados escaneamentos num campo de calibração. Nessa etapa foi gerada uma nuvem de pontos de cada sistema de varredura, e esses dados foram georreferenciados e a partir de pontos de checagem medidos no mesmo e assim foi estimada o controle de qualidade posicional. No segundo experimento, os dois SVLT foram utilizados para efetuar um levantamento topográfico planialtimétrico em um percurso de aproximadamente um quilômetro. Os dados gerados pelos SVLT passaram por um processo de registro, que consiste na junção de pares de nuvens de pontos, e foram georreferenciados a partir de pontos de controle medidos no terreno. Nesse percurso foram realizados circuitos de nivelamento cujos vértices foram utilizados para se estimar o controle de qualidade posicional, planimétrico e altimétrico, das nuvens de pontos oriundas dos dois sistemas de varredura. Assim, após a realização de testes estatísticos, no primeiro experimento, obteve-se valores de acurácia altimétrica de 1,5 cm para o SVLT Faro e de 1,3cm para o SVLT Optech e no segundo experimento acurácia altimétrica de 1,9 cm para o SVLT Faro e de 5,9 cm para o SVLT Optech. / The uses of altimetric data, in this study approached from digital terrain models (TDM) are the most varied as well as the techniques for getting this type of data. It can be get DTM by synthetic aperture radar that is used for surveying wide areas and with difficult access. As well it can be this type of data by Photogrammetry, by conventional Topography using total station with GNSS (Global Navigation Satellite System) support. A more actual technology for obtaining altimetric data is the use of light detection and ranging technology, which consists of measuring distance and coordinates through an electromagnetic pulse that interacts with the targets. The basic product of the systems that use the technology lidar, be it in aerial or terrestrial platforms, is denominated a point cloud. These point clouds have three-dimensional coordinates (X, Y, and Z) referenced to phase center of the sensor. In this study, will be performed experiments with two systems of terrestrial laser scanning (STLS). One STLS of the brand Optech Ilris 3D and another of the brand Faro Focus 3D, in this study called of STLS Faro and STLS Optech. Therefore, the aim of this work is to estimate the positional quality of digital terrain models generated by these two STLS. The studies were executed in two experiments. In the first experiment, scans has been made on a calibration wall. The generated point clouds were georeferenced and from the checkpoints measured in this calibration wall, the positional quality of these data was estimated. In the second experiment, the two STLS were has been made a planialtimetric topographic survey of a course of approximately one kilometer. In this course a leveling network was created and the vertices of this network were used to estimate the positional quality control of the points clouds from the two STLS. Therefore, after realization statistical tests, in the first experiment, it was obtained altimetric accuracy values of 1.5 cm for the STLS Faro and 1.3 cm for the STLS Optech were obtained and in the second experiment, the altimeter accuracy of 1.9 cm for the STLS Faro and 5.9 cm for the Optech STLS.
13

Demographic profile, clinical data and radiographic analysis of patients for third molar surgery under general anaesthesia at the Faculty of Dentistry at the University of the Western Cape

Nabee, Mahomed Ridhwaan Goolam January 2018 (has links)
Magister Scientiae Dentium - MSc(Dent) / Aim To analyze the demographic profile, clinical data and radiographs of patients who had third molar surgery under general anaesthesia at the Faculty of Dentistry at the University of the Western Cape over a 10 year period. Introduction Minor oral surgical procedures are carried out by Maxillofacial and Oral Surgeons daily. The surgical removal of third molars is a large part of Minor Oral Surgery which is common throughout the world. The general impression of third molar surgery performed by experienced professionals is the ease of the operation, however no-matter how experienced one may be, a simple procedure should never be underestimated (Carvalho and Do Egito Vasconselos, 2011). New surgical techniques, as well as extensive training, skill and experience have led to the evolution of oral surgery and allowed this procedure to be carried out in a less traumatic manner. Certain factors precipitate third molar surgery to be performed in theatre as opposed to the dental clinic setting. These factors will be discussed in this research report.
14

Självbild hos barn med ADHD-diagnos och deras syn på hur de betraktas av sin närmaste omgivning / Self-images of children with ADHD and their beliefs of how they are perceived by their immediate environment

Granqvist, Linda January 2015 (has links)
Inledning: Många studier har fokuserat på ADHD-barn, föräldrars, lärares och syskons olika perspektiv på ADHD och hur det är att leva med diagnosen. Studier har också visat att barn med ADHD ofta överskattar sin prestation i förhållande till hur andra uppfattar den. Detta fenomen kallas ”positive illusory bias” (Hoza, Pelham, Dobbs, Owen & Pillow, 2002). Syftet med denna studie är att undersöka hur barn med ADHD beskriver sig själva och hur de uppfattar att de betraktas av sin familj, lärare och kompisar. Detta perspektiv har inte studerats tidigare. Frågeställningar: Vilka föreställningar har barn med ADHD om sig själva? Vilka föreställningar har barn med ADHD om hur de betraktas av sina familjer, lärare och kompisar? Metod: Åtta barn med diagnosticerad ADHD i åldrarna 9-12 år har i en kvalitativ studie intervjuats med semistrukturerade frågor och svaren har analyserats utifrån tematisk analysmetod. Resultat: Till skillnad från tidigare forskningsresultat uttryckte de flesta barnen ingen tydlig ADHD-identitet i synen på sig själv. Däremot uppfattade flertalet att föräldrar och lärare såg ADHD-symtom hos barnet. Detta i kontrast till kompisarnas syn som oftast inte uttryckte sig i ADHD-symtom. Diskussion: Utifrån begreppet ”positionell objektivitet” (Sen, 1993) diskuteras resultaten där flera tänkbara positionella parametrar presenteras. / Introduction: A number of studies have examined children with ADHD, how it is to live with this diagnosis, and the different perspectives of parents, teachers and siblings. In several studies, it has been shown that children with ADHD often overestimate their capability compared to other persons’ assessment of their capability. This phenomenon is called “positive illusory bias” (PIB) (Hoza, Pelham, Dobbs, Owen &Pillow, 2002). The aim of this study is to examine how ADHD-children describe themselves and how they think that they would be described by their family, teachers, and mates. It seems that this has not previously been studied. Questions: How do children with ADHD describe themselves? How do these children think that they would be described by their family, teachers and mates? Method: Eight children, diagnosed with ADHD and between 9 and 12 years of age, are interviewed with semi-structured questions and the answers have been analysed by thematic methodology. Result: In contrast to previous studies, most children did not express any clear ADHD-identity in their description of themselves. However, ADHD-symptoms were quite common in their accounts of how they thought that their parents and teachers would describe them. This was in contrast to their accounts of how they thought that their mates would describe them, where the children seldom mentioned aspects related to ADHD-symptoms. Discussion: The discussion of the results is based on the concept of “positional objectivity” (Sen, 1993), in which several plausible positional parameters are presented.
15

Functional morphology of mammalian sacra and caudal vertebrae : implications for tail loss and positional behaviors in extinct primates

Russo, Gabrielle Antoinette 25 September 2013 (has links)
All living hominoids are characterized by taillessness and adaptations to orthograde (upright) trunk posture. Accordingly, these features have importance for our understanding of ape origins, evolutionary relationships and positional behaviors. Despite extensive study of the hominoid postcranial skeleton, researchers continue to face difficulty identifying taillessness and orthogrady from fossil material. In part, difficulties persist because although the Miocene fossil record indicates that the evolution of tail loss and orthogrady was decoupled, previous research has focused primarily on how the skeletal anatomy of extinct apes resembles that of living apes, in which these traits appear in conjunction. The remarkable diversity in tail lengths and positional behaviors exhibited by other mammals presents a valuable opportunity to employ the strength of the comparative method for testing functional hypotheses. The goal of this dissertation is to identify anatomical correlates of tail length and positional behaviors from sacral and caudal vertebral morphology among primates and other mammals in three studies. The first study examines the relationship between trabecular structure in the first sacral vertebra and positional behaviors (N= 78 primates). The second study quantifies aspects of internal (N=78 primates) and external (N= 472 mammals) sacral anatomy for correlates of relative tail length. The third study evaluates the functional morphology of caudal vertebrae among nonprehensile-tailed primates and other mammals that vary in relative tail length, offering additional insight into the anatomy associated with tail loss (N=333). The relationship between trabecular structure in the proximal sacrum and positional behaviors among living primates is somewhat unclear. Some trabecular parameters in the distal sacrum appear to have a relationship with tail length. Results support the functional links between previously and newly defined metrics from the external morphology of sacra and caudal vertebrae, and relative tail length, among primates and other mammals. Identified anatomical correlates from the extant primate sample are used to reconstruct the tail lengths of extinct primates. From the sacral data, Proconsul is reconstructed as tailless, Archaeolemur likely possessed a long tail, and Palaeopropithecus, Megaladapis and Epipliopithecus had short tails. From the caudal vertebrae data, Archaeolemur is reconstructed as possessing a long tail and Palaeopropithecus is reconstructed as having a short tail. / text
16

The Ape Ecological Niche: Posture and Hand Use in Gibbons and Macaques and the Influence of Manual Skill on Cognitive Development in Apes and Humans

Prime, Jacqueline Marie 01 May 2014 (has links)
Apes share a distinct set of morphological and anatomical characteristics that allow us to use our arms and hands in unique ways. Apes also have relatively larger brains with similar sulcal patterning indicating there is a distinctively hominoid brain structure. These features in great apes have consistently been linked with higher cognitive skills and are considered to be the precursors leading to the exceptional developments of humans over evolutionary time – establishing the physiological basis that allows us to make and use tools to modify our environments and build our unique cultures. This study examines the general model that orthogrady and suspensory postures were the antecedents for enhanced manipulative ability in apes, which consequently set the stage for enhanced cognitive abilities in early hominoids. The primary hypothesis is that if single-handed prehensility is enhanced by suspensory orthogrady, then we may predict ape feeding style will differ significantly from that of pronograde monkeys, allowing them to access foods in unique ways. Using sympatric white-handed gibbons, Hylobates lar, representative of orthograde apes, and pig-tailed macaques, Maccaca leonina, representative of pronograde monkeys, as models, the comparative feeding styles of primates were analyzed focusing on their positional behaviour and manual skill. Results support the hypothesis that gibbons exhibit a unique feeding style associated with their orthogrady/suspensory postures in comparison with pronograde macaques. This was demonstrated by their increased access to food in the trees with more stable postures, an expanded foraging radius, and more frequent use of the terminal branches, and was evident in their complex manipulative skills with larger manual repertoires, more variability in wrist use, and more sophisticated manual techniques. Moreover, significant differences in positional behaviour and manual skill demonstrated by gibbons and macaques were evident even when feeding on the same types of foods within their shared environment. This study proposes that the combined uniquely ape traits to forage in suspensory orthograde postures with precision dexterity have allowed apes to become highly selective feeders within their environments, leading to advance manual dexterity and cognitive prowess in apes.
17

Avaliação posicional de dados altimétricos gerados por diferentes sistemas de varredura a laser terrestre: estudo de caso

Ferraz, Rodrigo da Silva January 2017 (has links)
As utilizações de dados altimétricos, nesse estudo analisados a partir de modelos digitais de terreno (MDT), são as mais variadas assim como as técnicas de obtenção desse tipo de dado. Pode-se obter MDT por radar de abertura sintética que é utilizado para o levantamento de grandes áreas e de difícil acesso. Também pode-se gerar esse tipo de dado por Fotogrametria, por Topografia utilizando estação total com apoio GNSS (Global Navigation Satellite System). Uma tecnologia mais atual para a obtenção de dados altimétricos é a utilização de tecnologia Lidar (light detection and ranging) que consiste na medição de distância e coordenadas através de um pulso eletromagnético que interage com os alvos. O produto básico dos sistemas que utilizam a tecnologia Lidar, seja em plataformas aéreas ou terrestres, é denominado de nuvem de pontos. Essas nuvens de pontos possuem coordenadas tridimensionais (X, Y e Z) referenciadas ao centro de fase do sensor. Nesse estudo foram realizados experimentos com dois sistemas de varredura a laser terrestre. O primeiro é um sistema de varredura modelo Optech Ilris 3D e outro Faro Focus 3D, nesse estudo denominados de SVLT Optech e SVLT Faro. Assim, o objetivo desse trabalho é estimar a qualidade posicional dos dados altimétricos gerados por dois SVLT. Os estudos foram executados em dois experimentos. No primeiro experimento foram realizados escaneamentos num campo de calibração. Nessa etapa foi gerada uma nuvem de pontos de cada sistema de varredura, e esses dados foram georreferenciados e a partir de pontos de checagem medidos no mesmo e assim foi estimada o controle de qualidade posicional. No segundo experimento, os dois SVLT foram utilizados para efetuar um levantamento topográfico planialtimétrico em um percurso de aproximadamente um quilômetro. Os dados gerados pelos SVLT passaram por um processo de registro, que consiste na junção de pares de nuvens de pontos, e foram georreferenciados a partir de pontos de controle medidos no terreno. Nesse percurso foram realizados circuitos de nivelamento cujos vértices foram utilizados para se estimar o controle de qualidade posicional, planimétrico e altimétrico, das nuvens de pontos oriundas dos dois sistemas de varredura. Assim, após a realização de testes estatísticos, no primeiro experimento, obteve-se valores de acurácia altimétrica de 1,5 cm para o SVLT Faro e de 1,3cm para o SVLT Optech e no segundo experimento acurácia altimétrica de 1,9 cm para o SVLT Faro e de 5,9 cm para o SVLT Optech. / The uses of altimetric data, in this study approached from digital terrain models (TDM) are the most varied as well as the techniques for getting this type of data. It can be get DTM by synthetic aperture radar that is used for surveying wide areas and with difficult access. As well it can be this type of data by Photogrammetry, by conventional Topography using total station with GNSS (Global Navigation Satellite System) support. A more actual technology for obtaining altimetric data is the use of light detection and ranging technology, which consists of measuring distance and coordinates through an electromagnetic pulse that interacts with the targets. The basic product of the systems that use the technology lidar, be it in aerial or terrestrial platforms, is denominated a point cloud. These point clouds have three-dimensional coordinates (X, Y, and Z) referenced to phase center of the sensor. In this study, will be performed experiments with two systems of terrestrial laser scanning (STLS). One STLS of the brand Optech Ilris 3D and another of the brand Faro Focus 3D, in this study called of STLS Faro and STLS Optech. Therefore, the aim of this work is to estimate the positional quality of digital terrain models generated by these two STLS. The studies were executed in two experiments. In the first experiment, scans has been made on a calibration wall. The generated point clouds were georeferenced and from the checkpoints measured in this calibration wall, the positional quality of these data was estimated. In the second experiment, the two STLS were has been made a planialtimetric topographic survey of a course of approximately one kilometer. In this course a leveling network was created and the vertices of this network were used to estimate the positional quality control of the points clouds from the two STLS. Therefore, after realization statistical tests, in the first experiment, it was obtained altimetric accuracy values of 1.5 cm for the STLS Faro and 1.3 cm for the STLS Optech were obtained and in the second experiment, the altimeter accuracy of 1.9 cm for the STLS Faro and 5.9 cm for the Optech STLS.
18

Avaliação posicional de dados altimétricos gerados por diferentes sistemas de varredura a laser terrestre: estudo de caso

Ferraz, Rodrigo da Silva January 2017 (has links)
As utilizações de dados altimétricos, nesse estudo analisados a partir de modelos digitais de terreno (MDT), são as mais variadas assim como as técnicas de obtenção desse tipo de dado. Pode-se obter MDT por radar de abertura sintética que é utilizado para o levantamento de grandes áreas e de difícil acesso. Também pode-se gerar esse tipo de dado por Fotogrametria, por Topografia utilizando estação total com apoio GNSS (Global Navigation Satellite System). Uma tecnologia mais atual para a obtenção de dados altimétricos é a utilização de tecnologia Lidar (light detection and ranging) que consiste na medição de distância e coordenadas através de um pulso eletromagnético que interage com os alvos. O produto básico dos sistemas que utilizam a tecnologia Lidar, seja em plataformas aéreas ou terrestres, é denominado de nuvem de pontos. Essas nuvens de pontos possuem coordenadas tridimensionais (X, Y e Z) referenciadas ao centro de fase do sensor. Nesse estudo foram realizados experimentos com dois sistemas de varredura a laser terrestre. O primeiro é um sistema de varredura modelo Optech Ilris 3D e outro Faro Focus 3D, nesse estudo denominados de SVLT Optech e SVLT Faro. Assim, o objetivo desse trabalho é estimar a qualidade posicional dos dados altimétricos gerados por dois SVLT. Os estudos foram executados em dois experimentos. No primeiro experimento foram realizados escaneamentos num campo de calibração. Nessa etapa foi gerada uma nuvem de pontos de cada sistema de varredura, e esses dados foram georreferenciados e a partir de pontos de checagem medidos no mesmo e assim foi estimada o controle de qualidade posicional. No segundo experimento, os dois SVLT foram utilizados para efetuar um levantamento topográfico planialtimétrico em um percurso de aproximadamente um quilômetro. Os dados gerados pelos SVLT passaram por um processo de registro, que consiste na junção de pares de nuvens de pontos, e foram georreferenciados a partir de pontos de controle medidos no terreno. Nesse percurso foram realizados circuitos de nivelamento cujos vértices foram utilizados para se estimar o controle de qualidade posicional, planimétrico e altimétrico, das nuvens de pontos oriundas dos dois sistemas de varredura. Assim, após a realização de testes estatísticos, no primeiro experimento, obteve-se valores de acurácia altimétrica de 1,5 cm para o SVLT Faro e de 1,3cm para o SVLT Optech e no segundo experimento acurácia altimétrica de 1,9 cm para o SVLT Faro e de 5,9 cm para o SVLT Optech. / The uses of altimetric data, in this study approached from digital terrain models (TDM) are the most varied as well as the techniques for getting this type of data. It can be get DTM by synthetic aperture radar that is used for surveying wide areas and with difficult access. As well it can be this type of data by Photogrammetry, by conventional Topography using total station with GNSS (Global Navigation Satellite System) support. A more actual technology for obtaining altimetric data is the use of light detection and ranging technology, which consists of measuring distance and coordinates through an electromagnetic pulse that interacts with the targets. The basic product of the systems that use the technology lidar, be it in aerial or terrestrial platforms, is denominated a point cloud. These point clouds have three-dimensional coordinates (X, Y, and Z) referenced to phase center of the sensor. In this study, will be performed experiments with two systems of terrestrial laser scanning (STLS). One STLS of the brand Optech Ilris 3D and another of the brand Faro Focus 3D, in this study called of STLS Faro and STLS Optech. Therefore, the aim of this work is to estimate the positional quality of digital terrain models generated by these two STLS. The studies were executed in two experiments. In the first experiment, scans has been made on a calibration wall. The generated point clouds were georeferenced and from the checkpoints measured in this calibration wall, the positional quality of these data was estimated. In the second experiment, the two STLS were has been made a planialtimetric topographic survey of a course of approximately one kilometer. In this course a leveling network was created and the vertices of this network were used to estimate the positional quality control of the points clouds from the two STLS. Therefore, after realization statistical tests, in the first experiment, it was obtained altimetric accuracy values of 1.5 cm for the STLS Faro and 1.3 cm for the STLS Optech were obtained and in the second experiment, the altimeter accuracy of 1.9 cm for the STLS Faro and 5.9 cm for the Optech STLS.
19

A statistical model relating transcription factor concentrations to positional information in the early Drosophila embryo

Ilsley, Garth Robert January 2010 (has links)
The idea of morphogen gradients encoding positional information for a developing organism has long been discussed in the field of developmental biology, but only recently have quantitative models been proposed that relate measured transcription factor concentrations to enhancer activity. However, successful models are typically computationally time-consuming, thus limiting full exploration and interpretation of the data. This thesis addresses these problems using standard statistical techniques applied to a comprehensive data set with the even skipped (eve) locus as a test case. The first part of the thesis introduces the data set. This is the precellular Virtual Embryo from the Berkeley Drosophila Transcription Network project. It comprises expression measurements of almost 100 genes in more than 6,000 individual nuclei at six time points. Different modelling approaches are evaluated in the context of this data set leading to a justification of logistic regression and the methods used to prepare the data set for further analysis. The second part applies logistic regression to describe the response of the eve enhancers to known regulating transcription factors such as Hunchback. Predictions of behaviour under regulator perturbation are consistent with experimental results and the functional form is shown not to be arbitrarily flexible, both in terms of the regulators and regions of the embryo included. The third part uses the framework developed above to find minimal explanatory models in the context of statistical model selection. It is found that the best scoring models depend on well-known regulators. The model selection techniques are then extended by directing the process using previous biological observations to analyse the eve 2 and eve 3+7 enhancers. The results are consistent with published research, but suggest specific additional hypotheses for the enhancers' regulation. Finally, the thesis concludes by proposing a general model of positional information and discussing the biological implications of the results. Overall, the results show how transcriptional control can be allocated to discrete enhancers and that characterising their activity in relatively simple terms is sufficient to explain their precise spatially-defined response to transcription factor concentrations.
20

Improving the Diagnosis and Management of Benign Paroxysmal Positional Vertigo in a Rural Healthcare Setting

Rodovskaya, Liya January 2020 (has links)
Benign paroxysmal positional vertigo (BPPV) is a condition characterized by brief spinning episodes that occur with a rapid change in head position. Although considered benign, BPPV can have many personal, social, health, and financial implications. Yet, providers in a variety of settings are frequently mismanaging the condition leading to incomplete resolution of symptoms, decreased quality of life, reduced productivity, and increased healthcare spending. This study sought to better understand why providers fail to follow current evidence-based BPPV guidelines and the impact BPPV-specific education could have on improving their practices. Questionnaires assessing BPPV-specific knowledge as well as inquiring about provider barriers to following guidelines were distributed to 11 providers in a rural Colorado mountain town. A 45-minute education session was then presented to providers in order to update them on current recommendations. Following the education, similar questionnaires reassessing provider knowledge of BPPV guidelines were disseminated. Results showed an improvement in provider knowledge as evidenced by an increase in the percentage of correct response scores following the education session compared to pre-education. Additionally, providers identified difficulty in interpreting nystagmus patterns as well and remembering how to perform the various maneuvers as major barriers to guidelines adherence. Future BPPV education should focus on these two barriers to ensure better guidelines adherence. In order to evaluate long-term practice changes following the intervention, a 16-month retrospective chart analysis was performed in a small rural emergency department where three of the participating providers from the education session worked. Results from the chart analysis were inconclusive due to a scarcity of patient encounters during the post-intervention period. Future studies should be performed with a larger participation pool and longer analysis period to better evaluate the effectiveness of BPPV-specific education on improving provider practices. The ultimate goals of providing BPPV education are to promote a quicker resolution of patient’s symptoms, improve their quality of life, reduce unnecessary healthcare spending, while still allowing for appropriate provider compensation.

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