Ce travail avait pour objectif, de caractériser le poids des infections au cours de la grossesse et d’étudier la construction de l’immunité anti-PfEMP1 chez le jeune enfant. La première partie, aborde la conséquence des infections et l’efficacité des traitements chez la mère. Cette étude réalisée sur la cohorte de femmes d’une étude prospective au Bénin, a démontré l’impact des infections à bas bruit sur le taux d’hémoglobine maternel et le faible poids de l’enfant. Le TPI-SP, a montré les limites quant à sa capacité à débarrasser les femmes enceintes infectées au moment du traitement de leur parasite. Nos résultats soutiennent davantage la nécessité de trouver des moyens alternatifs de prévention qui offrent une meilleure couverture de la grossesse. La deuxième partie aborde la construction de l’immunité anti-PfEMP1 dans la première année de vie chez l’enfant. Un résultat majeur de cette étude est la démonstration que l’acquisition des anticorps contre les PfEMP1 associés aux complications du paludisme est dépendante des infections patentes de l’enfant. La troisième partie aborde les phénotypes des parasites responsables de diverses formes cliniques du paludisme chez l’enfant Africain âgé de 0 à 5 ans. Cette étude a permis de mettre en évidence un marqueur de mauvais pronostic du paludisme cérébral. Sur un deuxième volet, nous avions montré que les isolats adhérant faiblement à ICAM-1, transcrivent fortement les gènes codant pour les PfEMP1 contenant des motifs DC8. Ces résultats soulèvent la question du rôle de EPCR dans la physiopathologie du neuropaludisme. Le travail développé dans cette thèse a permis de décrire pour la première fois la construction de l’immunité anti-PfEMP1 dans la première année de vie, de mettre à jour les connaissances sur la physiopathologie du paludisme cérébral chez le jeune enfant et de dégager des pistes à explorer prioritairement dans la perspective du développement d'un vaccin contre les formes graves du paludisme. / This work aimed to characterize the burden of P. falciparum infections during pregnancy and to study the construction of the anti-PfEMP1 immunity in the early life. The first part discusses the consequence of infection and the effectiveness of treatments in the mother. This study on the cohort of women from a prospective study in Benin, demonstrated the impact of infections with low parasitemia on the maternal hemoglobin and low weight of the child. IPT-SP, has shown the limits of its ability to rid infected pregnant women in the processing of their parasite. Our results further support the need to find alternative means of prevention that provide better coverage of pregnancy. The second part treated the construction of the anti-PfEMP1 immunity in the first year of life in children. A major finding of this study is the demonstration that the acquisition of antibodies against the PfEMP1 associated with complications of malaria depends on patentes infections in children. The third part studies parasites phenotypes responsible of various clinical forms of malaria in African children aged 0-5 years. This study allowed finding a marker of poor prognosis of cerebral malaria. On a second component, we showed that isolates bind to ICAM-1, highly transcribe the genes encoding PfEMP1 containing DC8. These results raise the question of the role of EPCR in the pathophysiology of cerebral malaria. The work developed in this thesis has allowed describing for the first time the construction of the anti-PfEMP1 immunity in the first year of life, to update knowledge on the pathophysiology of cerebral malaria in young children and identify Options to be primarily from the perspective of developing a vaccine against severe forms of malaria.

This study investigates the conceptions of information literacy held by student nurses on a BSc Nursing Studies course and asks whether the information skills sessions taught are successful from the students’ viewpoint. Additionally, it compares attitudes to, and use of information literacy within the artificial environment of the university and the ‘real world’ of the nurse as perceived by participants on their clinical and community placements. The inquiry introduces the concept of information literacy and charts its development before discussing it in relation to the changing context of nurse education and evidence-based practice. The research adopts the interpretive paradigm with phenomenography as its methodology. It uses focus groups and twenty-one individual interviews to obtain rich data from a purposive sample of students across the three years of the course. Such data were analysed to produce categories of description representing the collective experience of information literacy across the sample. The thesis questions whether learning to nurse effectively is best achieved through training along traditional lines, education, or a combination of both. For the latter it is imperative to find an appropriate balance between academic and clinical skills. The findings reveal a tension between the academic and clinical aspects of learning to be a nurse which some students struggle to resolve. The study concludes that while information literacy is perceived as part of a nurse’s professional role in supporting evidence-based practice, participant observations suggest that its use is context dependent and variable. The thesis recognizes that the adoption of evidence-based practice may depend on the presence or absence of particular personal and organisational barriers. Suggestions for further research include the relationship between academic and clinical learning, the importance and influence of informal learning, and the nature of the transition from student nurse to autonomous practitioner.

This study investigates the perceptions of key stakeholders in midwifery education concerning the involvement of service users in student assessment. It identifies the key stakeholders in specific interest groups, as expert professional and expert lay people, parents, student midwives, qualified midwives who mentor students in clinical practice and the heads of midwifery education in University Departments. The work starts from the premise that assessment is an underestimated means of enhancing students' learning and the development of competence to practise as a registered midwife. The inquiry opens by examining the professional context in which maternity services are provided. It identifies the relationships that midwives form with the women and their families for whom they care. These considerations are followed by an interrogation of the literature that reveals a rich variety of interlocking concepts that are apposite considerations in terms of the assessment of student midwives and the involvement of women in it. This finely links the problem to previous research and provides a sound rationale for the conduct of the study. Interpretivism is advanced as a suitable philosophical framework for the prosecution of the study that offers a methodological rationale for a pragmatic, mixed methods investigation. The study design presents a raison d'dtre for a phased approach to the work and data are accrued variously from qualitative and quantitative sources. Although the focus of the work concerned the role of users of maternity services in student assessment and found considerable support for their involvement, what emerged has wider consequences for teaching and learning, the overall student experience and also for women as health service consumers. Having examined the principle dynamics that influence student learning in clinical placements, the study concludes that there is a superficial disharmony between learning and assessment yet it claims the two are mutually complimentary. The inclusion of women in teaching and learning is seen as a potent means to add an extra element to the definition of competence and to add to the authenticity of its assessment.

Background: The rationale for this study was developed from the personal and professional experience of the researcher living in a Muslim community in Nigeria where HIV/STIs are major health and social care problems. Most literature reviews on HIV/STIs and polygamy in Nigeria and in sub-Saharan Africa, have focused mainly on case studies and surveys. Aim: This study explores the experience and impact of HIV/STIs on Muslim women living in polygamous marriages in Nigeria. The objectives of this study are to explore their perceptions, knowledge and awareness of HIV/STIs, examine the effect of polygamy and identify factors to empower Muslim women to protect themselves. Method: The study adopts a qualitative approach, consisting of one-to-one in-depth interviews, within a feminist framework, with 20 women living in polygamous marriages in Nigeria. The qualitative approach was valuable because the words of the women who live in polygamous relationships cannot be quantified. A narrative, descriptive approach to the one-to-one in-depth interviews helped the researcher to listen and to describe their perspective; this was necessary because it is about their lived experience in polygamy. Using feminism, as the theoretical framework, offers an understanding of how polygamous women can be understood in relation to the dominant ideologies existing within a particular socio structure and it provides the lens to review the situation and suggest the necessary changes. The extract from the interview transcript was used to illustrate how the polygamous women’s accounts were explored in their own vernacular ways of speaking. Through the use of thematic analysis ten themes emerged. Findings: Ten themes were initially identified and four concepts finally emerged after coding and recoding of the similarities. These are the four concepts that emerged. They are; Education, Testing, Condom usage and an Economic empowerment (ETCE) approach. This means that there is a need for education, especially sex education as well as economic empowerment. The women’s accounts in this study area highlight the problems that polygamous women frequently experience such that, they cannot negotiate their sexual needs and cannot refuse their husbands taking on additional wives, within this kind of marriage system. The knowledge systems of polygamous women were evaluated and positioned in terms of women’s subjectivity and experiential knowledge. This study reveals that polygamy creates asymmetrical positioning, such asymmetrical positioning creates unequal power positions, not only among spouses, but among the co-wives within the polygamous marriage. The ways in which these social relations are negotiated and experienced are shaped by religion and traditions. This study also reveals that power and gender issues are critical factors in disempowering polygamous women, as they appear to be voiceless on issues that affect them in their polygamous marriage. Therefore, this means that there is a need for sexual education and for an improvement in the socio-economic status of women. Conclusions: Power and gender issues are critical factors in subordinating and disempowering polygamous women in their community; they are voiceless on their reproductive rights and limited in their option to control the spread of HIV/STIs. This study therefore, calls upon policy makers in Nigeria to consider these four concepts of Education, Testing, Condom Use and Economic empowerment (ETCE), as identified in the study, to help enhance the issue of economic empowerment of the polygamous women. Also this is to say that a window of opportunity exists; planners should develop partnerships with religious and community leaders to change the detrimental behaviours of polygamous men and women on issues of prevention and the control of HIV/STIs.

No description available.

O tratamento conservador do câncer de mama é hoje uma realidade em pacientes com estádio inicial da doença. Estudos randomizados demonstraram a importância da radioterapia após a cirurgia conservadora do câncer de mama. A radioterapia externa (RT) envolve 5 a 6 semanas de radioterapia com uma dose total de 50Gy, e um reforço de 10Gy no leito cirúrgico. A radioterapia intra-operatória com feixe de elétrons (IORT) tem se mostrado uma alternativa factível e viável em relação à RT e consiste na aplicação de dose única de 21 Gy no leito tumoral, durante o procedimento cirúrgico. Objetivo: Comparar os achados mamográficos encontrados em pacientes submetidas à RT com aqueles encontrados em pacientes submetidas à IORT. Pacientes e Métodos: De janeiro de 2004 a dezembro de 2007 foram comparados os achados mamográficos, em seguimento de 12 e 24 meses, de 30 pacientes submetidas à IORT e de 30 pacientes submetidas à RT após a cirurgia conservadora do câncer de mama. A média de idade das pacientes foi de 64 anos no grupo IORT e de 54 anos no grupo RT , ambos grupos apresentando tamanho tumoral menor que 3 cm. Resultados: Os dados do estudo demonstram que, apesar de se encontrar mais edema, distorção arquitetural, espessamento cutâneo e necrose gordurosa nas pacientes do grupo IORT, estas diferenças não foram estatisticamente significantes. Conclusão: Os achados mamográficos após o tratamento conservador do câncer de mama com a radioterapia externa são os mesmos esperados nas pacientes submetidas à radioterapia intra-operatória com feixe de elétrons. / Radiotherapy following conservative surgery for breast cancer decreases the risks of local recurrence. Because 85% of breast cancers relapse in or around the surgical bed there has been some debate on the need for irradiating the whole breast. Intraoperative electron radiation has been used as a viable alternative for conventional external radiotherapy. While the former requires a single dose of 21 Gy in the tumoral bed, the latter requires five to six weeks of irradiation with a total dose of 50 Gy and a boost of 10 Gy that irradiates the surgical bed. Herein, we investigated whether any significant differences exist between the mammography findings obtained from patients submitted to one of the two techniques. Two groups of 30 patients each were included in this study. All patients had mammographies taken at 12 and 24 months after finishing treatment. The mammography findings evaluated were: cutaneous thickness (> 2mm), architectural distortion secondary to fibrosis, edema, calcifications (both benign and malignant), and fat necrosis. For all variables studied, there was no statistical difference between the two groups. This indicates that the mammography findings obtained in either 12- or 24-month followup periods after breast cancer conservative surgery are similar, regardless of which of the two radiotherapy techniques (intraoperative electron radiation or conventional external radiotherapy) is employed as a treatment for breast cancer.

Examining how different media news outlets frame the same situation is an important step towards understanding how the world’s media systems behave. This study examines how four influential news media outlets, belonging to different media systems, have framed Sweden's management of the Covid-19 pandemic during two time-periods when the Covid-19 virus surged. These two media systems are state owned news outlets, consisting of RT (previously Russia Today) and Xinhua, and commercial news outlets, through BBC News and the New York Times.ThestudyusesadeductiveFramingTheorymethod,asdefinedbySemetkoand Valkenburg (2000), to understand how the framing of this case differs between the two media systems. Beyond Framing Theory, the theoretical framework is extended by including the Propaganda Model (Durham and Kellner 2012; Fuchs 2018) and Nation Branding (Potter 2009), to further understand the contextual forces that influence the news outlets. The results of the study determines that there are differences in the use of framing between the two media systems as well as where they stem from. This implies that the context in which the outlet finds itself impacts the framing of the produced articles. Overall, Attribution of Responsibility proved to be the most common frame, followed by Conflict framing. The first one wasmostcommoninthestateownedoutlets,whereasConflictwasmostcommonforthe commercial news outlets.

This project was designed to develop a method for the collection of environmental samples during prolonged Norovirus (NoV) outbreak investigations, and to develop real-time RT-PCR assays to analyze environmental samples for GI and GII noroviruses. The collection and processing of environmental samples could provide epidemiological data to facilitate investigations of prolonged NoV outbreaks and could guide public health NoV intervention strategies. Real-time RT-PCR assays for the detection of GI and GII NoVs were developed by adapting the State Hygienic Laboratory clinical GI and GII assays to the AB 7500 Fast platform. Analysis of the GI assay performance yielded a dilution curve slope = 3.28, R2 = 0.999 and a calculated amplification efficiency of 102%. The GII assay yielded a dilution curve slope = 3.39, R2 = 0.999 and a calculated amplification efficiency of 97%. Amplification efficiencies determine the sensitivity and the limit of detection of real-time RT-PCR assays. Optimum efficiencies range from 95%-105%, with a 100% efficiency indicating exponential amplification of targeted nucleic acid. To develop a method for the collection of environmental samples, multiple swab types were tested to determine their ability to recover NoV from laboratory spiked environmental surfaces. It was determined that foam swabs moistened with viral transport media were most effective in recovering NoV from spiked surfaces. A field test of the environmental sampling method was conducted by sampling environmental surfaces in four restaurants in one Iowa community. NoVs were not detected in the environmental samples. The collection and processing of environmental samples when conducting an investigation of a prolonged NoV outbreak could provide additional information on the epidemiology of NoV transmission and infection.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第22390号 / 人健博第76号 / 新制||人健||5(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 椎名 毅, 教授 精山 明敏, 教授 富樫 かおり / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

This research aims to explore the dissemination of strategic narratives around Lithuania through the set of news articles of the Russian state-funded media agency RT. As an international media platform, RT has been previously identified by scholars as an important structural element of Russian information warfare strategy. To identify the strategic narratives, this research follows the procedures of thematic analysis informed by the strategic narrative framework. The findings of this study indicate that RT, through the strategic narratives of Lithuania, seeks to criticize Western leadership and indirectly promote a positive image of Russia as an alternative to the West. While at the national level, the goals of RT’s strategic narratives on Lithuania include creating an image that Lithuanian governmental institutions are broken; showing the Lithuanian government as incompetent, and associating it with a fascist regime; presenting Lithuania not only as Russophobic but as a failing state as well. Further research could contribute to elaborating the strategical framework of the Russian information warfare effort in the post-Soviet countries.