Orientador: Jose Paulo Cabral de Vasconcellos / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T23:02:33Z (GMT). No. of bitstreams: 1 Okanobo_Andre_M.pdf: 2897473 bytes, checksum: 5bad5928ff037c8396c72781f5829cc1 (MD5) Previous issue date: 2014 / Resumo: Avaliação da qualidade de Vida dos Pacientes Antes e Após Realização de Transplante Penetrante de Córnea. OBJETIVO Verificar o impacto do transplante de córnea sobre a qualidade de vida dos indivíduos submetidos à cirurgia no serviço de Oftalmologia HC-UNICAMP no período de outubro de 2005 a outubro de 2006. METODO: O estudo foi aprovado pelo comitê de ética e pesquisa da FCM-UNICAMP. Foram inclusos indivíduos com indicação de transplante de córnea do ambulatório de Doenças Externas da Oftalmologia do HC UNICAMP no período de outubro de 2005 a outubro de 2006 e que aceitaram em participar do estudo. Foram incluídos 32 indivíduos. Os critérios de exclusão foram transplante tectônico, indivíduos com déficit visual importante causado por outra afecção ocular além das alterações corneanas. Realizou-se exame oftalmológico assim como aspectos demográficos e história ocular dos pacientes incluídos no estudo. Métodos objetivos como claridade do transplante e melhor acuidade visual corrigida e método subjetivo, a qualidade de vida, através do questionário SF-36 adaptado. RESULTADOS: Houve diferença significativa de satisfação entre gêneros com maior escore no sexo masculino (p = 0.0319). No método objetivo como a acuidade visual corrigida teve aumento significativo do olho transplantado (p<0.0001); A AV média antes do transplante era de 0,98 ± 0,1 logMAR e após 0,48 ± 0.38 logMAR. Quanto o escore de qualidade de vida (SF-36), método subjetivo, após o transplante houve um aumento significativo (p<0.0001). O escore do SF-36 antes do transplante foi de 49,11% ± 19,28 (média ± DP) e após o transplante de 71, 98% ± 24,28 (média ± DP) com uma melhora de 22, 87% (p<0.0001).Os indivíduos mais satisfeitos foram aqueles que tiveram a pontuação mais alta no SF-36 (r = 0.60; P = 0.0002). A satisfação parece não estar correlacionada com a melhora da AVCC no olho transplantado (r = 0.3186; P = 0.0755). Ocorreu uma fraca correlação entre a melhora da AVCC no olho transplantado e a melhora do SF-36 (r=0.28382; p=0.1154). Não houve diferença significativa do SF-36 nos indivíduos com visão baixa nos dois olhos quando comparado com os pacientes com visão boa em um dos olhos (p=0.2998 ) CONCLUSÃO: O transplante penetrante de córnea proporcionou melhora na pontuação dos métodos subjetivo e objetivos. Os indivíduos com maior satisfação foram melhor avaliados através do método subjetivo (SF-36). Não houve diferença significativa na qualidade de vida dos indivíduos com pior acuidade visual no olho contralateral quando comparado com os indivíduos com boa visão no olho contralateral, mas análise de um maior número de indivíduos é necessária / Abstract: Purpose: To assess and measures the patient satisfaction before and after penetrating keratoplasty. Methods: The study of approved by the ethics committee of FCM-UNICAMP. Data were collected from 32 patients who underwent penetrating keratoplasty (PK) between October 2005 and October 2006. Demographic, ocular history, objective treatment outcome measures such as clarity of the graft and best-corrected visual acuity (BCVA) of both eyes were collected prospectively. In addition to assessment of quality of life were obtained by an interview before the PK and after at least one year of postoperative. Results: The average age of subjects was 42 ± 22 (mean ± SD) years and 68.75 % were women. On average, men were most satisfied. BCVA was 0,98 ± 0,1 logMAR before and 0,48 ± 0.38 logMAR after PK showing a significant improvement on BCVA (P < 0.0001). SF-36 score was 49.11% ± 19.28% before and 71.98% ± 24.28% after PK showing a significant improvement after the PK (p< 0.0001). The most satisfied patients where those who had a better score on SF-36 (r = 0.60; p = 0.0002). Satisfaction seems not to be correlated to improvement in BCVA at the transplanted eye (r = 0.3186; p = 0.0755). There was weak correlation between improvement in BCVA on the transplanted eye and improvement of SF-36 score (r = 0.28382; p=0.1154). There was no significant improvement in SF-36 in patients with worse BCVA in the other eye (p = 0.2998). Conclusions: Penetrating keratoplasty has a positive effect on objective and subjective outcome measures. Patient satisfaction is better predicted by subjective outcomes. There is no significant difference in quality of life in patients with worse BCVA in the contralateral eye when compared to eye with good BCVA in the contralateral eye, but analysis of a larger number of patients is necessary to confirm that / Mestrado / Oftalmologia / Mestre em Ciências Médicas

Orientador: Silvia Regina Brandalise / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T06:04:53Z (GMT). No. of bitstreams: 1 Ortolan_PaulaElias_M.pdf: 1487828 bytes, checksum: be685d82f4ca5f0dd98e57f99c46ab70 (MD5) Previous issue date: 2012 / Resumo: INTRODUÇÃO: As leucemias são os tipos mais comuns de câncer em crianças e adolescentes e correspondem a 25% - 35% de todos os casos de câncer na faixa etária pediátrica. De acordo com o Registro de Câncer de Base Populacional dos Estados Unidos (SEER)2, desde 1970, tem ocorrido aumento das taxas de cura e sobrevida, sendo que aproximadamente 80% das crianças são curadas3. Apesar do elevado índice de cura da LLA, os sobreviventes podem desenvolver problemas relacionados à saúde ou efeitos tardios decorrentes do tratamento. Diversos estudos demonstraram que, neste grupo, os sobreviventes podem apresentar comprometimentos psicossociais relacionados à saúde mental, relacionamentos interpessoais, escolaridade, inserção profissional e qualidade de vida (QV)4,5,6,7,33,34. OBJETIVOS: Avaliar e correlacionar a percepção da QV de adultos jovens sobreviventes de LLA com aspectos psicossociais e clínicos, em relação ao sexo, nível de escolaridade, renda familiar mensal, vida conjugal, religião, atendimento psicológico, idade ao início do tratamento e atual, tempo desde o término do tratamento, modalidade do tratamento utilizado, índice de massa corporal (IMC) atual, estatura atual e efeitos tardios. MÉTODOS: Estudo observacional, analítico, do tipo corte transversal, realizado de maio a novembro de 2011, com 71 adultos jovens sobreviventes de LLA, com idade mínima de 18 anos, fora de terapia há no mínimo 3 anos, em seguimento na Clínica Após o Término da Terapia (CATT), no Centro Infantil Boldrini, avaliados através do questionário genérico de QV Short-Form Health Survey SF-36. RESULTADOS: Os sobreviventes do sexo feminino apresentaram escores inferiores em capacidade funcional, dor, vitalidade (p < 0,001), aspectos sociais (p = 0,013) e saúde mental (p = 0,001). Sobreviventes com filhos registraram escores menores em capacidade funcional (p = 0,043), dor (p = 0,022) e vitalidade (p = 0,025). Sobreviventes que realizaram atendimento psicológico durante o tratamento, demonstraram resultados inferiores em aspectos sociais (p = 0,049). Os adultos jovens que afirmaram realizar atendimento psicológico atual na cidade de origem apresentaram comprometimento em vitalidade (p = 0,047), aspectos emocionais (p = 0,008) e saúde mental (p = 0,047). Associações entre menor nível de escolaridade paterna e QV dos sobreviventes foram identificadas em capacidade funcional (p = 0,041), aspectos emocionais (p = 0,043) e saúde mental (p = 0,041). A modalidade do tratamento quimioterapia e radioterapia craniana foi associada com capacidade funcional (p = 0,010), dor (p = 0,006), vitalidade (p = 0,018) e saúde mental (p = 0,031). Sobreviventes com efeitos tardios registraram escores inferiores em aspectos físicos (p = 0,011) e aspectos sociais (p = 0,013). Sobreviventes com IMC alterado apresentaram resultados inferiores em aspectos físicos (p = 0,002) e dor (p = 0,023). Observou-se correlação inversa estatisticamente significativa entre capacidade funcional e dor e maior idade no momento da entrevista (rs = - 0,39, p < 0,01; rs = - 0,30, p = 0,01, respectivamente). Adicionalmente, observou-se correlação inversa estatisticamente significativa entre dor e maior tempo fora de terapia (rs = - 0,27, p = 0,01). Observou-se correlação direta estatisticamente significativa entre aspectos físicos e maior valor de renda familiar mensal (rs = 0,26, p = 0,02). CONCLUSÕES: Os resultados do presente estudo sugerem que os sobreviventes de LLA demonstram comprometimentos na QV, relacionados à saúde física e mental. Com base nos dados obtidos neste estudo, as variáveis associadas a escores inferiores no questionário SF-36 foram: sexo feminino, menor nível de escolaridade paterna, menor valor de renda familiar mensal, realizar atendimento psicológico, maior idade na entrevista, maior tempo desde o término do tratamento, modalidade do tratamento utilizado quimioterapia e radioterapia craniana, IMC alterado e presença de efeitos tardios / Abstract: BACKGROUND: Leukemias are the most frequently childhood cancer and correspond 25% - 35% of all cases of cancer at the pediatric ages1,2. According to Surveillance Epidemiology and End Results (SEER)3, since 1970, the cure and survival rates has increased. Currently and approximately 80% of them are cured4. Despite the high cure rate of leukemia, the survivors may develop health related problems or late effects from the treatment. Researches have shown that in this group, survivors may experience psychosocial impairment related to mental health, interpersonal relationships, education, employability and quality of life (QoL)5,6,7,8,33,34. PURPOSE: To evaluate and correlate the perception of QoL in adult survivors of ALL with psychosocial and clinical trials, in relation to sex, education level, family income, marital life, religion, psychosocial treatment, age at diagnosis and at interview, time off therapy, treatment modality, current body mass index (BMI), current height and late effects. METHODS: Observational, analytical and transversal study, with 71 ALL young adult survivors, for 7 months, aged at least 18 years, off therapy for at least 3 years. The study group consisted of ALL survivors in follow-up at the Off Therapy Clinics (CATT) at the Centro Infantil Boldrini, using the questionnaire Short-Form Health Survey SF-36. RESULTS: Female survivors had lower scores in physical functioning, pain, vitality (p < 0,001), social functioning (p = 0,013) and mental health (p = 0,001). Survivors with children reported lower scores in physical functioning (p = 0,043) and vitality (p = 0,025). Young adults who underwent in psychological care during treatment, showed lower results in social functioning (p = 0,049). Survivors who reported receiving psychological care in the city of origin, showed an impairment in vitality (p = 0,047), role function-emotional (p = 0,008) and mental health (p = 0,047). Associations between lower level of paternal education and QoL of the survivors were identified in physical functioning (p = 0,041), role function-emotional (p = 0,043) and mental health (p = 0,041). Treatment with chemotherapy and cranial radiotherapy was associated with physical functioning (p = 0,010), pain (p = 0,006), vitality (p = 0,018) and mental health (p = 0,031). Survivors with late effects reported lower scores in physical functioning (p = 0,011) and social functioning (p = 0,013). Survivors with BMI modified had lower scores in physical functioning (p = 0,002) and pain (p = 0,023). There was statistically significant inverse correlation between physical functioning and pain and current older age (rs= - 0,39, p < 0,01; rs = - 0,30, p = 0,01, respectively). Additionally, we observed statistically significant inverse correlation between pain and longer time off therapy (rs = - 0,27, p = 0,01). There was a statistically significant direct correlation between role function-physical and higher value of family income (rs = 0,26, p = 0,02). CONCLUSIONS: The results of this study suggest that survivors of ALL showed impairments in QoL related to physical and mental health. Based on data obtained in this study, the variables associated with lower scores on the SF-36 were: female gender, lower level of paternal education, lower family income, psychological care, older age at interview, longer time since off therapy, treatment with chemotherapy and cranial radiotherapy, BMI changes and late effects / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências

The European honeybee, Apis mellifera, is important economically not just for honey production but also as a pollinator. Bee pollinated plants contribute towards one third of the food eaten worldwide. However, honeybee numbers in some areas are declining. A range of interacting factors are thought to be involved, including pathogens and parasites, loss of forage, pesticide use, bad weather, and limited genetic variability. Pathogens are also known to cause changes in the behaviour of their hosts and these premortality and sublethal effects of disease may well play a role in colony declines and are the focus of this thesis. For individual bees the fungus Metarhizium anisopliae was used as a model pathogen and RT-Q-PCR was used to detect and quantify naturally occurring pathogens. In field colonies the level of infestation of the parasitic mite Varroa destructor was modified as a surrogate for disease load as the amounts of many viruses correlate with mite levels. Survival experiments showed that both disease load and forage availability had an effect on honeybee longevity and feeding the bees pollen increased their survival. Learning experiments showed that both the fungus and some of the bees’ naturally occurring pathogens caused changes in the learning ability of young adult and older forager bees. Young adult bees were better able to learn when infected with the fungus, possibly because it made them more responsive to the sucrose stimulus, whilst older forager bees where less able to learn when infected with the fungus. Harmonic radar was used to show that honeybee flight ability was affected by naturally occurring pathogens, especially deformed wing virus which caused bees to fly shorter distances and for shorter amounts of time than uninfected bees. Observation hives were used to study in-hive behaviour showing that bees with more pathogens were likely to start foraging earlier than healthier bees.

<p>Denna uppsats behandlar prissättningen av reklamutrymme på bio. Syftet med uppsatsen är att skapa en djupare förståelse för hur SF Media, vilka är den störta aktören på svensk bioreklammarknad, prissätter reklamutrymmen på bio i praktiken ur ett tjänsteperspektiv. Datahar samlats in genom kvalitativa och semistrukturerade intervjuer med representanter från SF Media. Slutsatserna som dragits är att SF Medias prissättning påverkas av både interna och externa faktorer. SF Media tillämpar en kundbaserad prissättningsstrategi där värdet för kunden styr. Det slutgiltiga priset fastställs efter förhandling mellan säljare och köpare där förhandlingsmöjligheten är stor. Prissättningen på SF Media gör det möjligt för olika kunder att köpa samma tjänst till olika pris vilket gör att kunder prisdiskrimineras framförallt genom att kunder erbjuds rabatter vid större köp.</p>

Bovine mastitis is recognised worldwide as the most important and costly disease affecting dairy cattle. The reduction of herd mastitis rates is crucially needed to improve animal welfare and profitability, and lessen the reliance on antibiotics. Single nucleotide polymorphisms (SNPs) within genes that have a critical role in the innate immune response, such as Toll-like receptors (TLRs) and the chemokine receptors CXCR1 and CXCR2, could impact on establishment and progression of intramammary infection, and therefore influence an animal’s susceptibility to disease. The genetic selection of animals with favourable TLR and CXCR1/2 mutations, with no impact on production traits, could be incorporated into dairy breeding programmes. In order to investigate any associations with clinical mastitis (CM) incidence and milk quality and quantity, this study identified and analysed SNPs alongside actual CM and production data from a Holstein-Friesian herd. This revealed 46 SNPs, 9 of which are novel, within boTLR1/4/5, boCD14, boCXCR1 and boCXCR2; selected SNPs were then tested for association with CM. This is the first report of boTLR1 SNPs and a non-coding boCXCR1 SNP that associate significantly with susceptibility to CM. Favourable linkage of reduced CM with increased milk fat and protein was observed, indicating selection for these markers would not be detrimental to milk quality. Furthermore, this study provides evidence that some of these SNPs underpin functional variation in bovine TLR1 and CXCR1, and possibly underlie an immunological mechanism for disease susceptibility. SNPs in boTLR1 and boCXCR1 were significantly associated with impaired transcript levels in milk somatic cells. In addition boTLR1 SNPs associated with impaired cytokine responses from cell populations when exposed to ligand or heat-killed mastitis-causing bacteria. The potential impact of boTLR1 variation on the immune response to Staphylococcus aureus is demonstrated, and this has implications for boTLR1-mediated immune responses to other pathogens.

As the global population increases, estimated to reach 9 billion by the year 2050, global food security becomes a priority. A prominent disease implicated in financial loss to the poultry industry, on a global scale, is infectious bursal disease virus (IBDV). Vaccination against IBDV is sub-optimal and difficult to deliver. Therefore it has been highlighted as a key area for the development of an oral vaccine. A highly conserved capsid protein from IBDV (VP2) was identified, and sub-cloned into a bacterial expression cassette. This protein was fused to a potential carrier protein (cholera toxin B chain), previously shown to mediate the exit from the gut lumen into the lamina propria. However, to allow this antigen to reach the mucosal associated lymphoid tissue, the protein antigen must remain in its native conformation through the stomach. This work developed a delivery system to meet this end. By encapsulation within a fatty acid coated, protein adsorbed-solid core drug delivery system (SCDDS), it was shown that a model protein antigen (GST-GFP) could be protected from low pH (i.e. pH 2.0) and proteases. Protease protection was demonstrated against the exposure of myristic acid coated, GST-GFP adsorbed silica, to both protease K (100 μU, 1hour (100% protection)) as well as a simulated in vitro stomach environment (pepsin (0.2 mg) (100% protection)). Having demonstrated protection from proteases at pH 2.0 and pH7.4, it was then shown that GST-GFP could be released from the myristic acid coated silica at pH 8.8 (consistent with the small intestine). As much as ~15% (15 μg) (w/w) GST-GFP was released from the aforementioned system. The evidence supporting this conclusion was drawn from molar ellipticity calculations that showed the proportion of helical structure in relation to regions of beta sheet remained constant, pre-adsorption and post-release (16.9% α-helix, 20.8% β-sheet, 43.3% random coil). Finally, this work has shown that if a recombinant antigen was fused to cholera toxin B chain (but not shiga toxin B chain), it was capable of mediating transcytotic passage across, differentiated, polarised Caco-2 cells (1/1000th input (10 ng)). In conclusion and based upon the evidence provided above, this system warrants further optimisation and investigation to serve as an oral vaccine delivery system to treat IBDV.

During the 1980’s the non-profit organisation RAND Corporation conducted the two-year Medical Outcomes Study with the goal of creating a comprehensive medical questionnaire. The resulting 116-item questionnaire measures health related quality of life (HRQoL) topics such as physical, mental and general health. The questionnaire is available as a free resource on their web page. SF-36, which contains 36 of these questions, is distributed for a fee by the US company Quality Metric Inc. The company has translated the questionnaire into several languages, including Swedish, and has also taken license for the translations. Registercentrum sydost has made a new Swedish translation of the same questions as in the SF-36. This survey is called RAND-36 and is license free. Because Quality Metric Inc has taken license for its Swedish translation, the surveys are similar but not identical. This study aims to compare the aforementioned HRQoL-instruments to determine whether it is possible to replace the licensed questionnaire SF-36 with the license free RAND-36. The distribution of items with response options according ordinal scale were compared with Mann-Whitney U-test. The test yielded a significant difference for eight items in the measure PF(physical functioning), MH(mental health), VT (vitality) and GH (general health perceptions). The distribution of items with response options according dichotomous scale were compared with X2-test. The test yielded significant difference for an item in the measure RE (emotional role functioning). The reliability of questionnaire was compared with ordinal alpha. In the selection the reliability between MH and VT is equivalent. The biggest difference between the surveys is the measure RP (physical role functioning) where the RAND-36 meets the requirement that the measure can be used for reliable conclusions on the individual level, which is a condition that SF-36 can’t met. The probability of entering an answer, given the respondent's ability, was compared with Rasch analysis. Wald's test gave DIF between most items within the measures PF, MH, VT and GH.

Hirsutism is excessive hair growth in women. The prevalence is estimated at 5%. The aim of this thesis was to describe different aspects of how life is affected for women suffering from hirsutism. Both qualitative and quantitative methods were used. Study I showed that hirsutism deeply affects women’s experiences of their bodies in a negative way and was experienced as a life sorrow. In Study II the patient-physician relationship was described. The patient-physician relationship from the patient’s perspective was suboptimal, as most meetings included feelings of being rejected and even humiliation. In Study III the aim was to translate and psychometrically evaluate an instrument that measures perceived social support, “The Multidimensional Scale of Perceived Social Support” (MSPSS). The translation was performed according to WHO:s official process, and validation was performed in a sample that consisted of 281 participants, 127 women with hirsutism (main sample) and 154 nursing students. MSPSS had good psychometric properties with regard to factor structure, construct validity, internal consistency and reproducibility. Study IV described different aspects of HRQoL in the main sample, the correlation of anxiety, depression, level of hairiness, age and BMI. The F-G scores were dichotomized into minor (F-G ≤14) and major (F-G≥15) hair growth. Higher levels of hair growth were significantly correlated to a lower level of QoL measured by DLQI, EQ-5D and symptoms of both anxiety and depression measured by HADS. Study V investigated if social support was associated with quality of life and outcome of HRQoL compared to a reference group of women (n=1115). SF-36, the MSPSS and the F-G scale were used. Compared to the reference group, women with hirsutism reported lower quality of life in all dimensions of SF-36 (p&lt;0.01) The dimension most affected was vitality (VT=41.2), which had a lower value than has been reported for patients with MS and myasthenia gravis. A Multiple Regression Analysis showed a significant relation between quality of life and social support, indicating its importance for the ability to adapt, in spite of low quality of life.

This thesis investigates how hydrocolloids can be incorporated into pet food meat products to provide novel applications. The possible applications that have been investigated for hydrocolloids are satiety and the production of more sustainable meat products. The research was carried out to improve canned pet food and the processes used to manufacture the product. The main section of the thesis looks at incorporating alginate and pectin solution into a food product which then becomes a gel in a low pH environment. The gel produced in the stomach should produce a satiety effect within the pet. Hydrocolloids used in other studies have been shown to induce satiety in humans. The gel was tested in vitro with a positive result which showed good gelation; however, when tested in vivo, no reduction in food intake was seen. These results may indicate that satiety has different trigger mechanisms in dogs compared to humans. More research is needed to understand whether dogs have the same hormonal responses to satiety as humans. The second application was the use of agar and methylcellulose (MC) to produce a thermally stable gel. The incorporation of this gel structure into a wet meat product would allow the level of meat to be reduced and additional powders to be used as a nutrient component instead. A thermally stable gel also enables the pet food to be processed more efficiently. The gel allows the meat chunks to be cut at high temperatures; therefore, no cooling step is needed in production. Agar and MC produce a strong thermally stable gel at both high and low temperatures. There is evidence that an interpenetrating network is formed in which the molecular ordering and aggregation of the individual polymers appears to be affected by the presence of the second polymer. The use of hydrocolloids for new applications in meat will transform and improve the quality of these products in the future.

Mastitis remains one of the most common, costly and intractable diseases affecting the dairy cattle industry worldwide. In spite of concerted efforts meaningful progress in reducing the incidence of mastitis has been limited over the past thirty years by our partial understanding of the epidemiology of key pathogens, such as S.uberis. The aim of this thesis was to investigate the epidemiology of S.uberis mastitis by analysis of the population structure and transmission dynamics of clinical mastitis patterns within and between commercial dairy herds in England and Wales. In Chapter 3 Multi Locus Sequence Typing (MLST) was used to describe the sub-species (sequence type) genetic heterogeneity of S.uberis isolates collected from a longitudinal study of clinical mastitis on 52 farms. The clinical cases were classified according the pattern of occurrence of the sequence types in the herds. The findings suggested that a small subset of MLST sequence types were disproportionally important in the epidemiology of S.uberis mastitis, with cow-to-cow transmission of S.uberis, potentially occurring in the majority of herds in the United Kingdom; this may be the most important route of S.uberis transmission in approximately one third of herds. In Chapter 4 cow and herd level variables, including monthly recorded milk constituents, yield and parity were evaluated against the clinical case classifications defined in Chapter 3. The temporal relationships between clinical cases and classifications were also evaluated as potential predictors of transmission dynamics within a herd. The findings indicated that the time interval between clinical cases classified by genotype as potentially contagious transmission was significantly shorter than that between successive mastitis clinical cases attributed to environmental transmission. The distribution of clinical cases throughout lactation also indicated a higher proportion of potentially contagious isolates were cultured from clinical cases originating from lactation rather than the dry period compared to those attributed to environmental transmission. In Chapter 5 Matrix Assisted Laser Desorption (MALDI) mass spectroscopy was used to generate spectral profiles of S.uberis isolates cellular composition. Spectral profiles were used successfully as an alternative method of discriminating between clinical mastitis isolates associated with contagious transmission from those associated with and environmental origin of infection defined in Chapter 3. The findings of this chapter demonstrated marked variation between herds in the spectral profiles of isolates from the same clinical case classification. In Chapter 6 selected isolates of S.uberis associated with contagious transmission and persistent intramammary infections were sequenced using next generation technology and compared by core genome multi locus sequence typing (cgMLST) to evaluate the discriminatory capacity of the MLST and MALDI. The results from this chapter confirmed the importance of the herd unit in the genotypic population structure of S.uberis suggested by the results of Chapter 5 and also support the results of Chapter3 which suggest ‘low grade’ contagious transmission of S.uberis is superimposed on a ubiquitous, environmental S.uberis mastitis pattern in many herds This thesis demonstrated that the S.uberis population is complex with variation at the bacterial, cow and herd level suggesting different patterns of disease and bacterial evolution occurring in different circumstances. Categorisation of sub-species of S.uberis within herds as being transmitted via contagious or environmental routes appears to be eminently achievable using modern, high throughput technologies; this could lead to a step change in mastitis control.