Thesis (doctoral)--Lund University, 1992. / Added t.p. with thesis statement inserted.

Thesis (M. Phil.)--University of Hong Kong, 1994. / Includes bibliographical references (leaves 192-201).

Thesis (PhD--Bioengineering)--University of Auckland, 2010. / "Supervised by Dr. AP M.H. Tawhai and Dr E.J. Crampin." " A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Bioengineering." "Auckland Bioengineering Institute." Includes bibliographical references (p. 204-255).

Thesis (Ph.D.)--Aberdeen University, 2008. / Title from web page (viewed on June 11, 2009). Includes bibliographical references.

Thesis (doctoral)--Lund University, 1992. / Added t.p. with thesis statement inserted.

Thesis (Ph.D.)--Baylor University, 2009. / Includes bibliographical references (p. 107-129).

Background: In the United States, minorities are numerous and account for 28% of the population. It is well known that some of the cultural elements are related to the patients’ health. Therefore, it is an obligation of healthcare providers to become culturally competent to improve minorities’ overall healthcare. PURPOSE: This study was conducted to assess the cultural attitudes, skills, and knowledge of undergraduate and graduate respiratory therapy (RT) students at an urban university located in the southeastern United States. METHODS: The study used a descriptive exploratory design with a self-reporting survey. The survey instrument used was a short version of the Cultural Competence Self-Assessment “ASK” (Attitude–Skills–Knowledge) Scale. The survey was administered to a convenience sample of first and second-year BSRT and MSRT students attending an accredited RT program. The survey consisted of 24 items on a five-point Likert scale. The collected data were analyzed using descriptive statistics and independent samples t-test. RESULTS: Fifty-three students were surveyed; around two-thirds of the respondents were female. Sixty-eight percent of respondents were BSRT and 22% were MSRT students. First-year students accounted for 56.6% of the respondents and second-year students accounted for 43.4%. The majority of the respondents were under the age of 25. The respondents reported to be ready to practice in the attitude and skills subscale (4.49±.49, 4.20±.62 respectively) but they need practice based on the knowledge subscale (3.80±.86). The statistically significant findings were found between first-year and second-year respondents in the skills subscale, knowledge subscale, and the total scale. However, there were no statistically significant difference between BSRT and MSRT students. CONCLUSION: This study found that respondents made progress throughout the RT program. Also, it found that level of education has no effect on cultural competency. This may be because student’s level of cultural competence improves as they advance in their clinical course work and their educational training. The results may assist RT educators to recognize the students’ needs for more information to improve their cultural competency.

Porcine Reproductive and Respiratory Syndrome (PRRS) is a global disease which takes a significant toll on the pork industry and the welfare of pigs. The causative agent – PRRS virus (PRRSV) – is a single-stranded, positive-sense RNA virus of the Nidovirales order. In the process of replication, PRRSV induces the rearrangement of cellular membranes to form double-membrane vesicles (DMVs). These structures are thought to have a role in a) concentrating viral structures to increase their chances of interacting with one another, and b) preventing elements of the cellular immune response from detecting viral structures. Previous work has suggested that the DMV originates from the autophagy pathway – a highly-conserved mechanism for cells to recycle extraneous organelles and proteins during times of stress. Other work suggests that the DMV may be a co-opted EDEMosome – a recently-discovered vesicle which is involved in regulating the level of endoplasmic reticulum-associated degradation (ERAD). This thesis explores these possibilities – using immunofluorescent imaging as well as examining the proteomic and ribonucleic acid composition of the DMV as isolated by flow cytometry or separated from other organelles by density gradient – calling both candidate pathways into question and suggesting other candidate structures such as exosomal vesicles.

<b>Introduction:</b> Respiratory Syncytial Virus is the major viral cause of lower respiratory tract disease in young children worldwide, with the greatest burden of disease in infants aged 1-3 months. Consequently, vaccine development has centered on a vaccine to directly protect the infants in this age group. The fundamental problem is that these young infants are poor responders to candidate RSV vaccines. This thesis focuses on the use of mathematical models to explore the merits of vaccination. <b>Methods:</b> Following development and analysis of a simple non-age-structured ODE model, we elaborate this to a Realistic Age Structured model (RAS) capturing the key epidemiological characteristics of RSV and incorporating age-specific vaccination options. The compartmental ODE model was calibrated using agespecific and time series hospitalization data from a rural coastal Kenyan population. The determination of Who Acquires Infection From Whom (WAIFW) matrix was done using social contact data from 1) a synthetic mixing matrix generated from primarily household occupancy data and 2) a diary study that we conducted in the Kilifi Health and Demographic Surveillance System (KHDSS). The vaccine was assumed to elicit partial immunity equivalent to wild type infection and its impact was measured by the ratio of hospitalized RSV cases after to before introduction. of vaccination. Uncertainty and sensitivity analysis were undertaken using Latin Hypercube Sampling (LHS) and partial rank correlation respectively. Given the importance of households in the transmission of respiratory infections, an exploratory household model was developed to capture the transmission dynamics of RSV A and B in a population of households. <b>Results:</b> From the analytical work of the simple ODE model, we have demonstrated that the model has the potential to exhibit a backward bifurcation curve within realistic parameter ranges. Both the diary and the synthetic mixing matrices had similar characteristics i.e. strong assortative mixing in individuals less than 30 years old and strong mixing between children less than 5 years and adults between 20 and 50 years old. When the two matrices were jointly linearly regressed, their elements were well correlated with an R2 ~ 0.6. The RAS model was capable of capturing the age-specific disease and the temporal epidemic nature of RSV in the specified location. Introduction of routine universal vaccination at ages varying from the first month of life to the 10th year of life resulted in optimal long-term benefit at 7 months (for the diary contact model) and 5 months (for the synthetic contact model). The greatest benefit arose under the assumption of age-related mixing with the contact diary data with no great deal of effectiveness lost when the vaccine is delayed between 5 and 12 months of age from birth. Vaccination was also shown to change the temporal dynamics of RSV hospitalizations and also to increase the average age at primary infection. From the sensitivity analysis, we identified the duration of RSV specific maternal antibodies, duration of primary and tertiary infections as the most important parameters in explaining the imprecision observed in predicting both the age specific hospitalizations and the optimal month at vaccination. Results from the household model have demonstrated that the household epidemic profile may be different from the general population with strong interaction of the viruses in the household that do not necessarily reflect at the population level. <b>Conclusion:</b> The synthetic matrix method would be a preferable alternative route in estimating mixing patterns in populations with the required socio-demographic data. Retrospectively, the synthetic mixing data can be used to reconstruct contact patterns in the past and therefore beneficial in assessing the effect of demographic transition in disease transmission. Universal infant vaccination has the potential to significantly reduce the burden of RSV associated disease, even with delayed vaccination between 5 and 12 months. This age class represents the group that is being targeted by vaccines that are currently under development. More accurate data measuring the duration of RSV specific maternal antibodies and the duration of infections are required to reduce the uncertainty in the model predictions.

nÃo hà / No Ãmbito da enfermagem, os estudos de acurÃcia contribuem com a melhoria da qualidade da assistÃncia por permitir a identificaÃÃo de caracterÃsticas definidoras com bom poder preditivo e influenciar diretamente na escolha do diagnÃstico de enfermagem adequado a cada situaÃÃo clÃnica. Devido à importÃncia de pesquisas relacionadas a essa temÃtica, este estudo foi realizado com o objetivo de analisar a capacidade preditiva das caracterÃsticas definidoras dos diagnÃsticos de enfermagem âPadrÃo respiratÃrio ineficaz (PRI), DesobstruÃÃo ineficaz das vias aÃreas (DIVA) e Troca de gases prejudicada (TGP)â em crianÃas com infecÃÃo respiratÃria aguda (IRA). Foi desenvolvido um estudo de coorte aberta, nos meses de janeiro a junho de 2011, em dois hospitais infantis da rede pÃblica do municÃpio de Fortaleza-CE. A amostra foi composta por 136 crianÃas as quais foram acompanhadas por um perÃodo mÃnimo de seis e mÃximo de dez dias. Para a coleta de dados, foi utilizado um instrumento baseado nas caracterÃsticas dos diagnÃsticos estudados e na literatura pertinente acerca da avaliaÃÃo pulmonar. Os dados foram coletados atravÃs de exame fÃsico da crianÃa e entrevista com os responsÃveis. As informaÃÃes obtidas foram analisadas pela pesquisadora para determinar a presenÃa ou ausÃncia das caracterÃsticas de PRI, DIVA e TGP e posteriormente foram encaminhados para enfermeiros diagnosticadores que executaram o processo de inferÃncia diagnÃstica. Foram utilizados os softwares Excel e PASW para organizaÃÃo e anÃlise estatÃstica dos dados. O nÃvel de significÃncia adotado foi de 5%. A anÃlise da evoluÃÃo temporal dos diagnÃsticos DIVA, TGP e PRI mostrou uma tendÃncia curvilÃnea, com reduÃÃo ao longo do perÃodo de acompanhamento. Para DIVA e PRI, verificou-se uma distribuiÃÃo semelhante apesar de terem ocorrido em proporÃÃes diferentes, mas DIVA manteve altos valores nos dez dias de seguimento. Quanto Ãs medidas de acurÃcia, as caracterÃsticas mais acuradas para predizer a ocorrÃncia de DIVA, TGP e PRI foram RuÃdos adventÃcios respiratÃrios, Hipoxemia e Uso de musculatura acessÃria para respirar, respectivamente. Todas as crianÃas avaliadas desenvolveram DIVA atà o final do tempo de acompanhamento e nenhuma relaÃÃo estatisticamente significante foi encontrada entre o tempo de sobrevida e as variÃveis analisadas. Do total de crianÃas acompanhadas, 86,76% desenvolveram TGP durante o perÃodo de acompanhamento. O tempo de internamento foi a Ãnica variÃvel que apresentou correlaÃÃo estatisticamente significante com o tempo de sobrevida. A mediana do tempo de sobrevida para PRI foi de um dia e do total de crianÃas acompanhadas, 86,76% desenvolveram este diagnÃstico durante o perÃodo de seguimento. Com base na anÃlise de correspondÃncias mÃltiplas, as caracterÃsticas que melhor auxiliam na diferenciaÃÃo entre os diagnÃsticos estudados sÃo: ExpectoraÃÃo, Tosse ausente, VocalizaÃÃo dificultada e RuÃdos respiratÃrios adventÃcios para DIVA; AgitaÃÃo e Irritabilidade para TGP e AlteraÃÃo na profundidade respiratÃria, Uso de musculatura acessÃria para respirar e RespiraÃÃo anormal para PRI. Estudos desta natureza sÃo importantes por fornecer informaÃÃes sobre a capacidade preditiva das caracterÃsticas definidoras bem como a evoluÃÃo temporal e as particularidades dos diagnÃsticos de enfermagem respiratÃrios em crianÃas com infecÃÃo respiratÃria aguda. / Through nursing subject, studies of accuracy contribute to improve the quality of care by allowing the identification of defining characteristics (DC) with good predictive power and directly influence the choice of nursing diagnosis appropriate to each clinical situation. Because the importance of research related to this subject, this study was made with the goal to analyze the predictive ability of the DC of nursing diagnoses Ineffective Breathing Pattern (IBP), Ineffective airway clearance (IAC) and Impaired gas exchange (IGE) in children with acute respiratory infection (ARI). It was developed an open cohort study in the months January to June 2011, two children hospitals in the public network in Fortaleza-CE. The sample was consisted of 136 children, who were followed for a minimum period of six and maximum of ten days. To collect the data, it was used an instrument based on the characteristics of the diagnostics studied and some relevant literature about the lung evaluation. The data were collected through examination of the child and interview with their responsibles. The information obtained was analyzed by the researcher to determine the presence or ausence of the characteristics of IBP, IAC and IGE and lately were sent to nurses diagnosticians that performed the diagnostic inference process. It was used Excel and PASW software for organizing and analyzing statistical data. The level of significance was 5%. The temporal evolution of the diagnostics IAC, IBP and IGE showed a curvilinear trend, with reduction over the monitoring period. For IAC and IBP, there was a similar distribution although they occurred in different proportions, but IAC maintained high values in ten days of follow-up. The measures of accuracy, the characteristics more accurated for predicting the occurrence of IAC, IGE and IBP were respiratory rales, hypoxemia and use of accessory muscles to breathe, respectively. All children evaluated IAC developed by the end of follow-up time and no statistically significant relationship was found between survival time and the variables analyzed. Of the total number of children followed, 86.76% developed IGE during the follow-up period. The time of hospital staying was the only variable that showed a correlation statistically significant with survival time. The median survival time for IBP was a day of total and accompanied children, 86.76% developed this diagnosis during the study period. Based on the analysis of multiple matches, the best characteristics that assist in differentiating between the diagnoses studied are: expectoration, cough absent, Speech and difficult to IAC adventitious breath sounds, agitation and irritability for IGE and Change in the depth of breathing, use of accessory muscles breathing and anormal breathing for IBP. Studies of this nature are important for providing information about the predictive ability of the defining characteristics and the temporal evolution and characteristics of the respiratory nursing diagnoses in children with acute respiratory infection.