Misophonia is a sensory disorder where specific stimuli, usually auditory, trigger the fight-flight-freeze response, causing extreme reactions, typically anger, panic, or anxiety. Research into treatment for misophonia is limited, primarily consisting of case studies applying common methods of therapy. However, research into similar disorders like tinnitus shows that there are many avenues of treatment that should be investigated, including audiological treatment. To apply audiological treatment to misophonia, selective noise cancelling must be used to control specific trigger sounds. In this research, a basic selective noise cancelling algorithm was developed using a convolutional neural network and was evaluated using a survey. Participants rated their reaction to trigger sounds, non-trigger sounds, and trigger sounds that had been selectively cancelled. The misophonic reactions to selectively cancelled sounds were significantly less than to trigger sounds. This shows that selective noise cancelling could be used to apply audiological treatments to misophonia.

Tuberculosis is one of the worlds? deadliest infectious diseases, and is one of the major causes of morbidity and mortality especially in poor countries. In Zambia, Tuberculosis remains a major health problem and is among the top ten causes of morbidity and mortality. Tuberculosis notifications have increased 5- fold in the last 20 years, mainly due to HIV/AIDS, it is estimated that approximately 70 % of all detected tuberculosis cases are also co-infected with HIV. The interaction of tuberculosis with the human immunodeficiency virus (HIV) infection has complicated and made difficult the Tuberculosis control program. Tuberculosis has become the leading cause of death among people living with HIV/AIDS. The management of tuberculosis in Zambia is faced with many challenges, such as lack of compliance to treatment by patients, poverty as well as lack of adequate finance for diagnosis, treatment and follow-up care. The main aim of my thesis was monitoring the problem of tuberculosis in Zambia, other accompanying aims were to find out how well informed the Zambian population is, about tuberculosis, monitor the diagnostic procedure for tuberculosis, analyse the tuberculosis treatment regime and lastly to analyse the preventive measures that have been implemented and how effective they have been. In this thesis, both qualitative and quantitative types of research were used. With the qualitative research, secondary analysis of data was used. Data from different sources of information like books, publications and research findings of various surveys and researches that were done not only by the Zambian Ministry of Health but also by other organizations was used. With the quantitative research, a questionnaire was formulated whose main aim was to find out about how well informed the Zambian people are about tuberculosis. This was done only in the capital city of Zambia which is Lusaka, and the number of respondents was 100. From the results obtained, the tuberculosis burden in Zambia still remains high and tuberculosis continues to be a serious public health problem. The implementation of the various preventive measures, though still facing difficulties, has however yielded positive results. There have been improvements in the treatment success rates from 77 % in the year 2000 to the current 86 %, the incidence rate per 100 000 population has also reduced from 504 in the year 2000 to the current 365 per 100 000 population. This reduction in incidence rates can be attributed to the preventive measures like the expansion of directly observed therapy treatment ? shortcourse (DOTS)strategy to all the districts in the country, the strengthening of the National Tuberculosis Control program and many others. This work can be used as a source of reference for future research in relation to the topic of tuberculosis in Zambia.

Objective:The purpose of this study was to determine factors associated with rehabilitation outcomes following vestibular rehabilitation (VR). Methods:In this prospective cohort study, 116 patients who completed at least 2 supervised sessions participated. Patient characteristics and comorbidities were recorded. Initial and discharge measures included symptom intensity, balance confidence, quality of life, time symptoms interfere with life, perceived benefits of VR, gait speed, fall risk, visual acuity during head movement, and anxiety/depression. Intention-to-treat analyses were performed to determine outcomes at discharge. Bivariate correlations between independent (group characteristics and baseline measures) and dependent (discharge measures) variables were determined. Logistic regressions were performed to identify factors associated with whether a patient would have a normal score or meaningful change at discharge. Results:There was a large effect of VR with significant improvement for the group as a whole on each outcome measure. For each outcome measure most patients improved. Based on preliminary logistic regression, 2 patient characteristics were associated with outcome: number of therapy visits predicted meaningful improvement in gait speed and falls after the onset of the UVH predicted meaningful change in the percent of time symptoms interfered with life. Initial Activities-based Balance Confidence (ABC) scale and Dynamic Gait Index (DGI) scores predicted normal ABC scores at discharge, and initial ABC scores predicted recovery of DGI scores. Preliminary prediction models were generated for balance confidence, impact of dizziness on life, dynamic visual acuity, gait speed, and fall risk. Conclusions:Therapists may use these findings for patient education or the need for adjunct therapy such as counseling. Impact:Not all people with UVH improve following VR, but there is little research examining why. This study looked at multiple factors and identified number of visits and falls after onset of UVH as patient characteristics associated with outcomes following VR, which will help therapists create better predictive models.

No description available.

Title Evaluation of the effect of physiotherapeutic approaches in painful conditions of the cervical spine. Objectives The aim of this thesis is to find out, which physiotherapy methods and techniques are used for pain of cervical spine, and to evaluate their effect. The study also aims to summarize current knowledge on this issue. Methods The thesis is processed through the method of literature review and is of analytical and descriptive nature. The used studies meet all pre-determined criteria. The thesis is divided into several parts. The first part, general information, describes mainly the physiotherapy methods and techniques that are used for treatment of pain in cervical spine. The second part, results, summarizes these physiotherapy approaches and evaluates their effect. The study concludes with a discussion that is focused on the two main questions of the thesis. Results A total of 25 studies met the criteria for inclusion in this thesis. These studies show that the physiotherapy methods and techniques currently used in painful conditions of cervical spine, include: mobilization and manipulation of cervical, possibly thoracic spine, therapeutic exercise, massage, McKenzie therapy, transcutaneous electrical nerve stimulation, conservative interventions, and educational and physical programs....

L’objectif de ce travail était de développer des stratégies éducatives en association avec une cure thermale à destination de patients porteurs de gonarthrose, avec un objectif non seulement d’efficacité clinique et psychologique mais aussi d’amélioration du niveau d’activité physique. Au total, 745 patients souffrants de gonarthrose ont été recrutés sur les 9 stations thermales membre du Cluster Innovatherm et répartis dans les 3 études composant ce projet. La première étude porte sur l’analyse qualitative des freins et des leviers à la pratique d’activité physique. La seconde étude a mesuré le niveau d’activité physique et analysé les facteurs influençant la régularité de la pratique. La troisième étude a évalué les effets d’un programme d’éducation à l’exercice en milieu thermal. L’analyse des résultats des 2 premières études a montré que le niveau d’activité physique des gonarthrosiques était significativement dépendant de certaines données sociodémographiques, anthropométriques (genre, indice de masse corporelle, obésité), de facteurs extrinsèques (lieu de vie, situation familiale) et de facteurs intrinsèques (motivation, bien être, « self-efficacy », fatigue, vieillissement, peur d’aggraver la gonarthrose). La troisième étude a montré que le traitement thermal associé ou non aux ateliers d’éducation à l’exercice permettait d’augmenter significativement le niveau d’activité physique, avec un effet taille moyen de 0.53 [0.28;0.77] à 3 mois. Les ateliers d’éducation à l’exercice ont un effet bénéfique significatif sur l’anxiété, la dépression et les peurs et croyances (sous item médecin du KOFBeQ), à 3 mois. Ces études confirment l’impact du traitement thermal sur les paramètres cliniques de la gonarthrose et fournissent de nouvelles données concernant ce traitement sur l’évolution du niveau d’activité physique. Cette étude argumente en faveur de l’effet cognitif et psychologique du programme d’éducation à l’exercice. / The aim of this work was to develop educational strategies in association with spa therapy treatment for patients with knee osteoarthritis, with a goal not only of clinical, psychological but also of improvement of the level of physical activity. A total of 745 patients with knee osteoarthritis were recruited from the 9 member’s thermal spa of the Innovatherm Cluster and distributed among the 3 studies building this project. The first study looked at the qualitative analysis of facilitators and barriers to physical activity. The second study on the level of physical activity and the analysis of the factors influencing the practice. The third study evaluated the effects of a self-management exercise education program in spa therapy resort. Analysis of the results of studies 1 and 2 showed the level of physical activity was significantly dependent on certain anthropometric data (gender, BMI, obesity), extrinsic factors (life situation, family situation) and intrinsic factors (motivation, well-being, self-efficacy, fatigue, aging, fear of aggravating knee osteoarthritis). Study 3 showed that spa treatment associated with or without self-management exercise program significantly increases the physical activity level, with medium effect size 0.53 [0.28; 0.77] at 3 months. Exercise education has a significant beneficial effect between groups in favor of the intervention group on anxiety, depression and fears and beliefs. These studies confirm the impact of spa therapy treatment on the clinical parameters of osteoarthritis and provide new data on the increase of the physical activity level and argue in favor of the cognitive and psychological effect of the self-management exercise program.

Cognitive behaviour therapy and interpersonal psychotherapy are the leading treatments for eating disorders. Little is understood regarding their mechanisms of action. The research described in this thesis investigated the purported mechanisms of action of two transdiagnostic versions of these treatments; enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy for eating disorders (IPT-ED). A series of mediation studies were embedded within a randomised controlled trial comparing CBT-E and IPT-ED in a transdiagnostic sample of patients with eating disorders. An analytic strategy using multilevel and structural equation modelling was used to assess for statistical mediation. Three of the key purported mediators of action of CBT-E (regularity of eating, frequency of weighing, and frequency of shape checking) and the key purported mediator of IPT-ED (interpersonal problem severity) were studied. Only regularity of eating demonstrated a strong case for being a mediator of the effect of CBT-E (on frequency of binge eating). The findings were inconclusive regarding other putative mediators of the effect of CBT-E, and for interpersonal problem severity being a mediator of the effect of IPT-ED. Limitations of the research included the non-optimal choice of measures and non-optimal timing of measurements for establishing temporal precedence. Future research should investigate the mediating role of both cognitive (e.g. interpretation of weight) and behavioural processes (e.g. frequency of weighing) in CBT-E, and the role of interpersonal functioning in CBT-E and IPT-ED. Research should use daily, or session by session measurement to better assess the temporal relationship between the purported mediator/s and the outcome/s. Experimental designs comparing dismantled versions of treatment would also help determine the relative effects that different treatment procedures have on treatment outcome/s.

Purpose: To develop a Ray Cast/Dose Superposition (RC/DS) algorithm for proton grid therapy. Its functionality needed to include automatic positioning of small proton pencil beams in a grid-pattern and superimposing thin beam Monte Carlo (MC) dose distribution data on a Computer Tomography (CT) density volume. The purpose was to calculate and store un-weighted volumetric dose distributions of individual proton energies for subsequent optimization. Materials & Methods: Using the programming language Python 3.6, CT and Volume Of Interest (VOI) data of various patients and phantoms were imported. The target VOI was projected to either two or four planes, corresponding to the number of used gantry positions. Rays were then traced through the CT voxels, which were converted from Hounseld Units to density using a look up table, to calculate Water Equivalent Distance and proton energy needed to reach the proximal and distal edge of the target volume. With automated grid-pattern beam positioning, thin beam MC calculated depth dose distribution files were interpolated, scaled and superimposed on the CT volume for all beamlet positions. The algorithm reliability was tested on several CT image sets, the proton range estimation compared to a commercial TPS and the depth dose interpolation analyzed using MC simulations. Results: The RC/DS algorithm computation time was on average around 6 hours and 30 minutes for each CT set. The dose distribution output visually conformed to target locations and maintained a grid pattern for all tested CT sets. It gave unwanted dose artifacts in situations when rays outside the beamlet center passed a significant length of low/high density regions compared to the center, which yielded dose distributions of unlikely shape. Interpolating MC dose distribution values showed comparability to true MC references of same energy, yielding results with 0.5% difference in relative range and dose. Conclusions: The developed algorithm provides unweighted dose distributions specific for small beam proton grid therapy and has been shown to work for various setups and CT data. Un-optimized code caused longer computation times then intended but was presumed faster than MC simulations of the same setup. Efficiency and accuracy improvements are planed for in future work. / Proton grid therapy group

Prompt-gamma imaging (PGI) was proposed in the 2000s as a promising in vivo range-verification method to maintain the physical advantage of proton beams by reducing unwanted range-uncertainties. Recently, PGI with a slit camera has been successfully implemented in clinical application. Despite its high accuracy and sensitivity to range deviation being shown in several studies, the clinical benefits of PGI have not yet been investigated. Hence, to fully exploit the advantages of PGI, this thesis aims to investigate the feasibility of PGI-based range verification for the automatic classification of treatment deviations and differentiation of relevant from non-relevant changes in the treatment of head-and-neck (H&N) tumors. In the first part of this thesis, the four most common types of treatment deviations in proton therapy (PT) were investigated regarding their PGI signature and by considering clinically relevant and non-relevant scenarios. A heuristic decision tree (DT) model was iteratively developed. To gain understanding of the specific signature of the error sources, different levels of geometrical complexities were explored, from simple to complex. At the simplest level, a phantom with homogeneous density was used to distinguish range-prediction and setup errors. Next, in the intermediate complexity level, a phantom with heterogeneous density was used to inspect the additional error scenarios of anatomical changes. Finally, real patient CT scans were used to investigate the relevance of changes based on clinical constraints. In the final model, a five-step filtering approach was used during pre-processing to select reliable pencil-beam-scanning spots for range verification. In this study, five features extracted from the filtered PGI data were used to classify the treatment deviation. The model is able distinguish four introduced scenarios into six classes as follows: (1) overestimation of range prediction, (2) underestimation of range prediction, (3) setup error with larger air gap, (4) setup error with smaller air gap, (5) anatomical change, and (6) non-relevant change. To ensure the application was effective, independent patient CT datasets were used to test the model. The results yielded an excellent performance of the DT classifier, with high accuracy, sensitivity, and specificity of 96%, 100%, and 85.7%, respectively. According to these findings, this model can sensitively detect treatment deviations in PT based on simulated PGI data. In the second part of this work, an alternative approach based on machine learning (ML) was taken to automatically classify the error sources. In the first stage, the two approaches were compared, using the same features as well as the same training and test datasets. The results show that the ML approach was slightly better than the heuristic DT approach in terms of accuracy. However, the performance of both approaches was excellent for the individual scenarios. Thus, these results confirm that the PGI-based data classification with five features can be applied to detect individual sources of treatment deviation in PT. In the second stage, there was an investigation of more complex and more realistic combinations of error scenarios, which was out of the scope of the DT approach. The results demonstrated that the performance of the ML-based classifiers declined in general. Furthermore, the additional features of the PG shift did not substantially improve the performance of the classifiers. As a consequence, these findings mark important issues for future research. Potentially, usage of the spatial information from the spot-based PGI data and more complex techniques such as deep learning may improve the performance of classifiers with respect to scenarios with multiple error sources. However, regardless of this, it is recommended that these findings be confirmed and validated in simulations under measurement-like conditions or with real PG measurements of H&N patients themselves. Moreover, this classification model could eventually be tested with other body sites and entities in order to assess its compatibility and adaptation requirements. In summary, this study yielded promising results regarding the automatic classification of treatment-deviation sources and the differentiation of relevant and non-relevant changes in H&N-tumor treatment in PT with PGI data. This simulation study marks an important step towards fully automated PGI-based proton-range verification, which could contribute to closing the treatment-workflow loop of adaptive therapy by supporting clinical decision-making and, ultimately, improving clinical PT.:1 Introduction 2 Background 2.1 Proton therapy 2.1.1 Rationale for proton therapy 2.1.2 Uncertainties and their mitigation 2.2 In vivo range-verification techniques 2.2.1 Range probing 2.2.2 Proton tomography 2.2.3 Magnetic resonance imaging 2.2.4 Ionoacoustic detection 2.2.5 Treatment-activated positron-emission tomography imaging 2.2.6 Prompt-gamma based detection 3 Prompt-gamma imaging with a knife-edged slit camera 3.1 Current state-of-the-art 3.2 Prompt-gamma camera system 3.3 Data acquisition and analysis 4 Error-source classification using heuristic decision tree approach 4.1 Study design 4.1.1 Case selection 4.1.2 Investigated scenarios 4.1.3 Prompt-gamma simulation and range shift determination 4.2 Development of the model 4.2.1 First-generation model 4.2.2 Second-generation model 4.2.3 Third-generation model 4.3 Model testing 4.4 Discussion: decision-tree model 5 Error-source classification using a machine-learning approach 5.1 Machine learning for classification 5.1.1 Support-vector-machine algorithm 5.1.2 Ensemble algorithm – random forest 5.1.3 Logistic-regression algorithm 5.2 Study design 5.2.1 Case selection 5.2.2 Feature selection 5.3 Model generation 5.4 Model testing 5.5 Discussion 6 Summary/ Zusammenfassung Bibliography Appendix List of Figures List of Tables List of Abbreviations

Treatment verification is demanded to mitigate the range uncertainties in proton therapy and, hence, to enhance treatment precision and outcomes. As a non-invasive approach for range verification, the prompt γ-ray timing (PGT) measures the time distribution of the promptly produced γ-rays using fast uncollimated scintillation detectors. However, the measured time spectra of the prompt γ-rays (PGs) are sensitive to phase instabilities between the accelerator radiofrequency (RF) used as the reference time and the actual arrival time of the therapeutic particles at the patient and require online monitoring of the arrival time of the proton bunches. Within this thesis, the development of a PGT system including an appropriate proton bunch monitor (PBM) for range verification in proton therapy was studied. In the first part of the work, two PBM options were explored and characterized under near-to-clinical beam conditions to find a suitable PBM satisfying the prerequisites and constraints for the application in the PGT-based range verification. The selected PBM prototype comprises scintillating fibers read out on both ends with silicon photomultipliers (SiPMs). By placing the PBM at the beam halo, sufficient counting statistics and processable trigger rates could be achieved for the monitoring of the proton bunch periodicity with reasonable statistical precision, while minimizing the interference to the clinical beam delivery. In the second part of the work, a proof-of-principle experiment of the PGT-based range verification with a heterogeneous target was performed together with online monitoring of the proton bunch instabilities. The sensitivity and the overall uncertainty of the PGT technique were evaluated for two proton energies, different thicknesses of air cavity inserts, various tissue-equivalent material inserts, different selections of the PG energy window, and other PGT parameters. The experimental results confirmed that real-time monitoring of the proton range during treatment using the PGT technique is feasible with millimeter precision and submillimeter accuracy at close-to-clinical beam currents and clinically relevant proton energies. The integration of the PBM to the PGT-based range verification marks another important step toward the clinical application of the PGT technique for in vivo verification and qualitative assessment of the proton range during treatment.:List of figures List of tables List of abbreviations 1. Introduction 2. Background 2.1. Uncertainties in proton therapy 2.2. Treatment verification in proton therapy 2.3. Prompt γ-ray timing (PGT) 2.3.1. PGT principle 2.3.2. PGT detection system 2.3.3. Time instabilities in the PGT-based range verification 2.4. Aim of the work 3. Development of a proton bunch monitor 3.1. The IBA Proteus 235 System at OncoRay 3.2. General requirements 3.3. Coincidence detection of scattered protons 3.3.1. Detection principle 3.3.2. Motivation 3.3.3. Characterization and performance of the detector 3.4. Scintillating fiber detector 3.4.1. Detection principle 3.4.2. Motivation 3.4.3. Characterization of a single-sided PMT readout fiber 3.4.4. Characterization of a double-sided PMT readout fiber 3.4.5. Characterization of a double-sided SiPM readout fiber 3.5. Comparison of the two proton bunch monitors 3.6. Summary 4. PGT proof-of-principle with the proton bunch monitor 4.1. Materials and methods 4.1.1. Experimental setup 4.1.2. Measurement program 4.1.3. Data analysis 4.1.4. Evaluation of PGT spectra 4.2. Results 4.2.1. Characteristics of PGT spectra 4.2.2. Relative proton range verification 4.3. Discussion and conclusion 4.4. Summary 5. General discussion 5.1. Time instabilities 5.2. Toward clinical translation of the PGT technique 5.3. Conclusion 6. Summary / Zusammenfassung 6.1. Summary 6.2. Zusammenfassung Bibliography / Die Verifikation der Behandlung ist erforderlich, um die Reichweiteunsicherheiten in der Protonentherapie zu verringern und damit die Behandlungspräzision und die Behandlungsergebnisse zu verbessern. Das Prompt-γ-Ray-Timing (PGT) ist eine nicht-invasive Methode zur Reichweitenverifizierung, bei der die Zeitverteilung der prompt erzeugten γ-Strahlung mit schnellen, nicht-kollimierten Szintillationsdetektoren detektiert wird. Die gemessenen Zeitspektren der prompten γ-Strahlung (PGs) sind jedoch empfindlich gegenüber Phaseninstabilitäten zwischen der als Referenzzeit verwendeten Radiofrequenz (RF) des Beschleunigers und der tatsächlichen Ankunftszeit der therapeutischen Teilchen am Patienten und erfordern eine Online-Überwachung der Ankunftszeit der Protonenmikropulse. Im Rahmen dieser Arbeit wurde die Entwicklung eines PGT-Systems einschließlich eines geeigneten Proton-Bunch-Monitors (PBMs) für die Reichweitenverifikation in der Protonentherapie untersucht. Im ersten Teil der Arbeit wurden zwei PBM-Optionen untersucht und unter kliniknahen Strahlbedingungen charakterisiert, um einen PBM, der die Voraussetzungen und Einschränkungen für die Anwendung in der PGT-basierten Reichweitenverifikation erfüllt, auszuwählen. Der ausgewählte PBM-Prototyp besteht aus szintillierenden Fasern, die an beiden Enden mit Silizium-Photomultipliern (SiPMs) ausgelesen werden. Durch die Platzierung des PBMs im Strahlhalo konnten ausreichende Zählstatistiken und verarbeitbare Triggerraten für die Überwachung der Periodizität der Protonenmikropulse mit einer angemessenen statistischen Genauigkeit erreicht werden, während gleichzeitig die Beeinträchtigung der klinischen Strahlapplikation minimiert wird. Im zweiten Teil der Arbeit wurde der experimentelle Machbarkeitsnachweis für die PGT-basierte Reichweitenverifikation in einem heterogenen Target zusammen mit der Online-Überwachung der Instabilitäten der Protonenmikropulse erbracht. Die Empfindlichkeit und die Gesamtunsicherheit der PGT-Technik wurden für zwei Protonenenergien, unterschiedliche Dicken der Lufthohlraumeinsätze, verschiedene gewebeäquivalente Materialeinsätze, andere Auswahlen der PG-Energiefenster und weitere PGT-Parameter quantifiziert. Die experimentellen Ergebnisse bestätigten, dass die Echtzeitüberwachung der Protonenreichweite während der Behandlung mit Hilfe der PGT-Technik mit Millimeterpräzision und Submillimetergenauigkeit bei kliniknahen Strahlströmen und klinisch relevanten Protonenenergien möglich ist. Die Integration des PBMs in die PGT-basierten Reichweitenverifizierung ist ein weiterer wichtiger Schritt auf dem Weg zur klinischen Anwendung der PGT-Technik für die In-vivo-Reichweitenüberprüfung und die qualitative Bewertung der Protonenreichweite während der Behandlung.:List of figures List of tables List of abbreviations 1. Introduction 2. Background 2.1. Uncertainties in proton therapy 2.2. Treatment verification in proton therapy 2.3. Prompt γ-ray timing (PGT) 2.3.1. PGT principle 2.3.2. PGT detection system 2.3.3. Time instabilities in the PGT-based range verification 2.4. Aim of the work 3. Development of a proton bunch monitor 3.1. The IBA Proteus 235 System at OncoRay 3.2. General requirements 3.3. Coincidence detection of scattered protons 3.3.1. Detection principle 3.3.2. Motivation 3.3.3. Characterization and performance of the detector 3.4. Scintillating fiber detector 3.4.1. Detection principle 3.4.2. Motivation 3.4.3. Characterization of a single-sided PMT readout fiber 3.4.4. Characterization of a double-sided PMT readout fiber 3.4.5. Characterization of a double-sided SiPM readout fiber 3.5. Comparison of the two proton bunch monitors 3.6. Summary 4. PGT proof-of-principle with the proton bunch monitor 4.1. Materials and methods 4.1.1. Experimental setup 4.1.2. Measurement program 4.1.3. Data analysis 4.1.4. Evaluation of PGT spectra 4.2. Results 4.2.1. Characteristics of PGT spectra 4.2.2. Relative proton range verification 4.3. Discussion and conclusion 4.4. Summary 5. General discussion 5.1. Time instabilities 5.2. Toward clinical translation of the PGT technique 5.3. Conclusion 6. Summary / Zusammenfassung 6.1. Summary 6.2. Zusammenfassung Bibliography