This study was designed to investigate, at laboratory and pilot scale, the effects of various loading and climatic factors on the nitrification perfon-nance of four media, and to undertake a comparative assessment of the media. The media used were blast furnace slag and three random plastic media: Flocor RS, Etapak 160 and a new medium, Etapak 210. Laboratory experiments using pure cultures of Nitrosomonas europaea have determined the effect on nitrification of temperature, pH and substrate, BOD and inhibitor concentrations. Optimal values have been resolved for the temperature and pH and half- saturation constants for the substrate and inhibition are calculated for pure culture conditions. The presence of glucose and glutamic acid has been shown to have a beneficial effect on nitrification, although this observation could not be adequately explained. Pilot scale research, conducted over a two year period, has provided an accurate representation of a nitrifying trickling filter by using effluent from Cranfield STW in filters exposed to the full climadc variation. Data obtained from these filters have indicated the superior performance of the blast furnace slag media due mostly to its ability to maintain a large active bacterial Population without excessive accumulation. Results have been used to support or challenge previous publications, and to generate a set of desion curves. Conclusions from this research have been used in the design of a full scale nitrifying trickling filter which has been constructed at Cranfield STW, early data from which are presented.

Critics of user charges for government primary health care have focussed on the deterrent effect these charges might have on the poor, but there is little convincing empirical evidence that supports or contradicts these claims. The main research aims were to assess the equity effects of user charges for curative PHC services on households in 2 rural districts of Sierra Leone, a country that has suffered severe economic hardship in the last decade. Secondary objectives were to assess the feasibility of using objective means-testing to identify patients for exemption, and to recoimiend a simple methodology for acquiring the same information for local, operational purposes. A survey of 1156 households was carried out in the dry post-harvest season, and covered a range of household economic factors in addition to the actions taken in response to all reported illness episodes. A followup survey was made the following rainy season to assess seasonal effects. Supplementary information was obtained through focus groups and case studies. The data were analyzed within the framework of a conceptual model which assumed that preferences, access, and ability to pay were the main factors (or groups of factors) that determined which of several medical and non-medical treatment options would be used. Multiple regression models were used to assess the effects of each group of factors. The main findings were that, while wealthier households used cheap market drugs and expensive medical treatment options more than the poor, there was little difference in use of medium-priced PHC treatment. Household wealth and income factors correlated weakly with amounts actually paid for treatment. The immediate availability of money in the household appeared to be the economic factor most affecting utilization, with wealthier households nearly as likely = to have the amounts needed for PHC treatment on hand as poorer ones. Distance was a much more important determinant of choice of treatment than was income or assets, as were certain preference factors. However, the poor spent a much higher proportion of household income on treatment than the wealthy, so a way of limiting total expenditures for the poor would be more important than limiting their deterrence. Several readily-ascertained household factors correlated well with household income, but means-testing was concluded to be an inefficient way to accomplish the objective of selectively limiting expenditures unless incorporated into a prepayment scheme.

2012年，全球大約有1410萬人患上癌症， 820萬人死於癌症。我國惡性腫瘤發病率亦高達235.23/10萬。目前公認的放化療不僅存在副作用，且嚴重影響患者免疫功能，與之不同的是，針灸干預並非直接作用於腫瘤，而是機體的神經-內分泌-免疫網路、心理（安慰）甚至基因方面，使機體產生抗腫瘤的效應，其中提高機體的免疫力即相當於中醫的“扶正固本。本研究擬以針灸抗腫瘤免疫臨床研究試驗中，分析放化療基礎上運用針灸療法的臨床療效，以期進一步臨床指導。 方法：選用國內權威數據庫中國期刊全文數據庫（ CNKI ）、中國優秀碩士學位論文全文數據庫、中國博士學位論文全文數據庫、維普中文期刊數據庫（ VIP ）、萬方學術期刊全文數據庫、中國生物醫學文獻服務系統（ CBM ）以及MEDLINE(OVID)等作為資料來源。選擇在針對放他療治療基礎上運用針灸療法（治療組）抗腫瘤免疫的臨床試驗文獻，進行穴位頻次等基礎數據的綜合分析，並將經Jadad量表評分2分以上的文獻納入系統評價（Meta分析） 結果：經嚴格篩選，最終納入文獻64篇，涉及4286例患者，進行基礎數據的綜合分析並從中選擇品質較高的18篇文獻進行系統評價。從統計結果分析，與對照主比較，治療組在抗腫瘤提升免疫功能方面具有統計學意義， 證實針灸抗腫瘤免疫的療效肯定。 結論：針灸抗腫瘤免疫治療優勢明顯，對各型腫瘤存在廣泛治療作用，但能否實現對某一型腫瘤或某一類免疫細胞靶向性治療仍有待研究。故還需要設計良好的隨機對照及多中心臨床試驗做進一步探討，為尋找腫瘤治療的新出路提供依據。

Triggering direct cytotoxicity has been the most common strategy for developing cancer treatments. The cytotoxic regimens currently used in the clinic mainly include radiation therapy, classic chemotherapeutic drugs (e.g. DNA damaging drugs and anti-mitotic drugs) and selected new targeted drugs. Although these therapies are the standard of care for most cancer patients, they suffer significant limitations: responses to these therapies vary significantly between cancer types and patients; sensitive cancers tend to acquire resistance; and they cause serious toxicity, particularly to dividing cells in the bone marrow and gut, and to neurons. It is not clear whether major improvements in cytotoxic anticancer therapies are possible; if they are, progress is likely to come from either new methods for identifying sub-populations of patients that respond well to current drugs, or developing new therapies with novel cytotoxic mechanisms. To pursue the above two avenues towards potential improvement of cytotoxic therapies, this thesis investigates: biomarkers that determine the sensitivity of distinct cancer cell types to common anti-mitotic chemotherapeutics; and the mechanistic basis to employ alternating electric field and Natural Killer cells as alternative methods to trigger cancer cell death. The study uses time-lapse microscopy as the major technique to characterize and quantify response dynamics to the different cytotoxic treatments, and the results provide important new insight not only for understanding existing cytotoxic anticancer drugs but also for developing novel cytotoxic regimens.

背景：膝痹因勞損或年高，膝失精血充養，經氣不利等原因所導致並以膝部長期固定疼痛，活動時關節內有聲響等為主要表現的肢體屏病類疾病。多發於老年人, 西醫的膝骨性關節炎、退行性膝關節病、膝關節滑膜炎，髏骨軟他症等屬於該疾病的範疇。該疾病所導致的疼痛以及活動障礙嚴重影響了人們的生活質量，亦極大地增加了家庭以及社會負擔。中醫學認為膝痹是因為肝腎虧虛，精血不足，筋骨失養，風、寒、濕、熱等邪氣趁虛而人，阻滯經脈氣血所致。 目的：通過對近十二年文獻的研究，分析溫針治療膝痹的臨床療效，作用機制，以及評價當前文獻質量，反映國內外溫針治療膝痹的研究現狀，為進一步的研究提供思路和依據。 方法：採用計算機檢索國內外相關臨床研究文獻。中文文獻檢索數據庫為： 中國 期刊全文資料庫（ CNKI ），檢索主題詞為“溫針，’ ，“針灸療法，’，"溫針療法 ,“溫針灸， "膝"，“膝關節 。英文文獻檢索數據庫為PubMed ，檢索主題詞為 “ acupuncture and moxibustion ,“warm needling’,“warm acupuncture,“warming needle moxibustion , “arthralgia syndrome’,“ knee arthralgia,“knee osteoarthritis,“osteoarthritis of the knee",“osteoarthritis of knee join t , “degenerative arthritis of the knee" , 九enile knee osteoarthri ti s 。檢索年限為2005 至2016 年。 將篩選後的文獻進行樣本量，診斷標準，隨機方法，臨床分期，療效評價方法，幹預措施，幹預週期及遠期隨訪，不良反應及脫失率，文獻評價等方面的統計與比較。 結果： 多數文獻認為溫針治療膝屏有較好的療效，但日前國內溫針治療膝痹的文獻質量普遍不高，通過對近十二年來溫針治療膝蟬的臨床研究進行回顧，發現國內臨床研究在樣本量估算，隨機方法，分級、分期進行治療，診斷標準和療效評價標準’遠期療效隨訪，不良反應和脫失率，隨機對照試驗質量等方面存在一定問題。且在單一療法的評價方面尚缺乏較強的說服力。本次研究通過Meta 分析雖然可得出溫針較口服西藥與單純針刺的療效為佳，但由於納入研究的試驗數量有限, 文獻質量亦參差不齊，故所得出的結論有一定的侷限性。 結論：由於文獻質量存在一定的問題，故而單一療法的評價方面尚缺乏較強的說服力。為了進一步證明溫針治療膝痹的療效，需要開展更多的設計合理，執行嚴格的大樣本、多中心、高質量的隨機對照試驗，並且在試驗中應進行遠期療效觀察，詳細描述研究過程中的不良反應以及脫失率， J,,j、期提供更加全面可靠的臨床依據。溫針治療膝痹的機制研究方面尚未完善對溫針治療的影響因素如灸量選擇，針刺深度選擇等方面亦未達成共識，這些方面亦可以作為未來研究的發展方向。

通过检索2003年1月一2013年12月中国期刊全文数据库(CNKI)全部医学期刊，对所筛选出的55篇临床文献的操作方法、硏究过程和结论进行归纳和分析。 结果表明温针不但能起到针刺效果还能作用到深层组织温通经络，消炎镇痛；温针对所有四型的膝痹（风寒湿阻型、阳虚寒凝型、瘀血阻滞型和肾虚髓亏型）均有治疗的作用，但对阳虚寒凝型的作用较弱；温针治疗膝痹常用犊鼻和膝眼等局部穴位，并可结合辨证配1-2穴；针刺常用普通剌法，平补平泻；施以何种灸量，要根据患者的身体状况而定，一般2壮适中。 在文献中多用温针治疗与其他疗法进行对比，对比发现：温针缓解关节僵硬的作用明显；电针则侧重于抗炎镇痛；中频治疗可以解除软组织的粘连，同时修复损伤组织；局部阻滞能减小关节软骨间的摩擦，较快起效，减轻疼痛症状；口服中药可以从内而外的改善关节病变；西药口服能较快缓解疼痛和部分临床症状;推拿、康复、运动训练等疗法的配合，有助于缓解肌肉痉挛，同时减少膝关节软骨之间的压力等等。由于众多疗法起效的侧重方向不同，因此在临床治疗中，为了提高治愈率常将温针与电针、中频、局部阻滞、口服中药或西药等疗法联合应用。但采用何种疗法还要根据患者的实际情况，切勿使用过多种手法，增加患者的关节负担。 虽然温针治疗膝痹的作用已经得到较多的临床试验验证，但其作用机制的探讨仍然不足。接下来的硏究应注重临床硏究方法的改进，规范温针灸的操作过程，重视温针治疗膝痹的作用机制，从而提高温针治疗的膝痹的临床疗效和理论依据。 关键词：温针 膝痹 临床试验 综述文献

This work addresses some of the difficulties encountered while working in psychotherapy with a residual schizophrenic. While there is an abundance of literature on psychotherapy for schizophrenia, both supporting and also refuting its merit, what the literature fails to reveal is that there appears to be a class of schizophrenic who, while apsychotic and able to communicate in the everyday sense of the word, is in a psychic space which speaks of a break with the basic relational elements of the human order. The quality of the patient's psychic life is such that almost nothing of what the literature describes as useful and appropriate in working with schizophrenics seems to help in the psychotherapeutic work with this type of patient. This study describes these issues with relevance to a particular residual schizophrenic. The Illustrative-didactic case-study method was used to discuss the four-and- a-half month psychotherapy with this patient. The patient's early developmental history, premorbid personality functioning, family and interpersonal relationships, mental state, diagnosis and a rationale for psychotherapy were presented and considered in detail. The structure of the psychotherapeutic process was reviewed in depth. The hermeneutic guidelines to understanding the case were drawn from Object-Relations Psychoanalytic theory, particularly Balint, Khan, Karon & VandenBos, Bollas, Romanyshyn, Perry, Symington, Fordham and others. Various psychic and personality features, as unveiled through the psychotherapeutic process, were elaborated and the implications of these for the therapeutic endeavour were considered as follows: Firstly, the psychic space of the patient, which precluded mirroring, symbolization find object-relationship - and which made psychotherapy untenable, was discussed. Secondly, therapeutic ambivalence and other counter-transference issues were reviewed. Thirdly, the shadow sides of both therapeutic optimism and of psychotherapeutic change were considered. Fourthly, the issues of therapeutic failure and of other treatment possibilities for a residual schizophrenic patient were examined. It was concluded that there needs to be an important countertransference shift with regard to the psychotherapeutic goals for those patients whose condition may be chronic, and for whom it appears that psychotherapy is not going to be of any therapeutic benefit - find where an 'empathic accompaniment' might be as much as it is possible to hope for or achieve.

Made available in DSpace on 2014-06-11T19:29:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2001Bitstream added on 2014-06-13T18:39:19Z : No. of bitstreams: 1 duarte_mtc_me_botfm.pdf: 367548 bytes, checksum: 0bc9456e76ceee8e0aa601ea2566a701 (MD5) / Objetivou-se, com este trabalho, identificar o abandono do seguimento médico em uma coorte de pacientes inscritos, em 1995, no atendimento ao hipertenso do Centro de Saúde-Escola (CSE) de Botucatu, no período de 1995 a 1999, e analisar os motivos de abandono do tratamento da hipertensão arterial relatados por esses pacientes. Estudaram-se 192 pacientes hipertensos, que compõem a coorte, tendo sido identificados, nesta, três grupos: grupo abandono (GAB), composto por 89 pacientes; grupo abandono-aderente (GAB/AD), composto por 41 pacientes, e grupo aderente (GAD), composto por 62 pacientes. A taxa de abandono observada foi de 46,4% e a de aderência de 53,6%. Os grupos foram caracterizados segundo as variáveis: sociodemográficas, relacionadas ao seguimento e tratamento no serviço de saúde, e doenças crônicas associadas. Na segunda parte do estudo, foram entrevistados 50 pacientes do GAB. A análise temática de conteúdo foi a técnica utilizada para tratamento das respostas dos entrevistados. A pesquisa indicou que a taxa de abandono do seguimento médico no CSE não pode ser generalizada como taxa de abandono de seguimento médico ou, ainda, como de abandono do tratamento da hipertensão, uma vez que se observou que mais da metade dos pacientes entrevistados estavam em acompanhamento médico para tratamento da hipertensão arterial em outros serviços de saúde e relataram diversas formas de cumprimento do tratamento medicamentoso e não-medicamentoso. Os motivos para o abandono do tratamento da hipertensão — considerando em separado os seus componentes... / The aim of this research is to identify the hypertension treatment dropout in a cohort assisted at a School Health Center (SHC), in Botucatu, from 1995 to 1999. This cohort (192 patients) was divided in to three groups: Dropout group – DG – (89 patients), dropout-compliant group – DCG – (41 patients) and compliant group – CG – (62 patients). The dropout rate was 46,4% and the compliance rate was 53,6%. The groups were studied according to these variables: socio-demographic, health service treatment and follow-up and chronic diseases comorbidity. Fifty DG patients were interviewed. Their answer were analyzed by content analysis. As more than half of the patients interviewed were being assisted at other health services the dropout rate at the SHC can not be considered as a treatment dropout. The causes of dropout - patient related problems, lack of symptons, better or normal arterial pressure, alcohol consumption – were the same if one considers each dropout component (medical treatment, changes in life style and health services follow-up) separetely. The lack of information about the medication and its side effects can be regarded as the main dropout causes of medical treatment. Moreover, it was observed that some health service features played an important rule in medical follow-up dropout.

The research study aimed to identify the factors contributing to premature termination of treatment for addiction. The study took the form of a differential research design based on archival data and sought to establish patient-related predictors of treatment adherence and premature drop-out. One independent variable and 14 dependent variables were chosen. The data comprised a variety of characteristics which predispose certain addicts seeking treatment to drop out of the treatment programme before completion. The most significant finding was that a history of general abuse of medication has a negative influence on treatment outcome. The limitations of the study are discussed and recommendations are made regarding further research on the topic. / Dr. J.T.R. Beuster

M.Tech. / This research was conducted to determine the effect of homoeopathic treatment on acute gout patients. Putterman (1994) conducted a research study on the effect of the homoeopathic remedy Colchicum autumnale in gout, and found partial improvement in the clinical picture of gout. No research has been conducted in South Africa on the efficacy of homoeopathic medicines in acute gout patients. This study focused on the homoeopathic Law of Similars, where a single most similar homoeopathic remedy was chosen according to the unique characteristic symptoms displayed by each participant suffering with acute gout. This was a qualitative study that used ten subjects who presented within five days of acute gout and participated in the fifteen-day study period. Participants that complied with the American College of Rheumatology (formerly American Rheumatism Association, ACR) criteria for gout were selected. Serum uric acid tests were taken on day 0 and day 6 to assess hyperuricemia. On day 0 a thorough case history and examination was taken followed by administration of the indicated remedy. Treatment efficacy was evaluated on day 1, 3 and 6, based on daily subjective impression of participant involvement, objective analysis and comparative analysis of serum uric acid. Re-examination for relapses or rebound attacks followed on day 15. In a study using allopathic remedies in acute gout, resolution of all acute gout symptoms occurred at an average of 8 days using indomethacin and 7 days using triamcinolone (Alloway et. al., 1993). In this study using homoeopathic similimum treatment, resolution of all acute gout symptoms occurred at an average of 6 days. One episode of a rebound gout attack occurred and serum uric acid decreased in 80% of patients. Homoeopathic similimum prescribing is an effective alternative treatment for acute gout. Although more research is required, the preliminary findings of this study suggest that the correct homoeopathic similimum treatment is an effective treatment for the symptoms of acute gout.