Early local recurrence of breast cancer most commonly (over 90%) occurs at the site of the primary tumour. This is true whether or not radiotherapy is given and irrespective of the margin status. Whole-organ analysis of mastectomy specimens on the other hand, reveals that 63% of breasts harbour occult cancer foci and 80% of these are situated remote from the index quadrant. Therefore, these occult cancer foci may be clinically irrelevant and it may not be necessary to treat the whole breast with radiotherapy. This 6-wks long course of post-operative radiotherapy after breast conserving therapy is not only inconvenient and costly, but may cause many women from geographically remote areas to choose mastectomy. Targeted Intraoperative radiotherapy (TARGIT) to the peri-tumoural area alone might provide adequate local control. ‘Intrabeam’ (PeC) is a portable electron-beam driven device that can deliver therapeutic radiation (soft x-rays) in 20-30 minutes within a standard operating theatre environment. The pliable breast tissue - the target - is wrapped around a spherical applicator - the source - providing truly conformal radiotherapy. The prescribed dose is 5 & 20Gy at 1cm and 0.2cm respectively, from the tumour bed. The biologically effective dose is 7-53Gy for α/β=10 and 20-120Gy for α/β=1.5. In our pilot study of 26 patients (age 30-80 years, T=0.42-4.0cm), we replaced the routine post-operative tumour bed boost with targeted intra-operative radiotherapy. There have been no major complications and no patient has developed local recurrence, although the median follow-up time is short at 34 months. The cosmetic outcome is satisfying to both the patient and the clinician. Having established the feasibility, acceptability and safety in the pilot study, we started in March 2000, a randomised trial that compares TARGIT with conventional postoperative radiotherapy for infiltrating duct carcinomas, with local recurrence and cosmesis as the main outcome measures. Patient accrual in this trial has been excellent and it has attracted several international collaborative groups. If proven effective, TARGIT could eliminate the need for postoperative radiotherapy potentially saving time, money and breasts.

Study 1. Using a cognitive-process approach, 25 schizophrenic patients were matched with 25 healthy volunteers and compared on tests of memory and executive function. The schizophrenia group was found to have a significant impairment in immediate memory with relatively spared long-delay and recognition memory. Memory deficits were irrespective of the encoding strategies used and were unrelated to chronicity. In addition, the schizophrenic patients performed worse than controls on tests of executive function which was supported by some significant correlations between aspects of memory and executive function. The pattern of performance resembled that found in patients with subcortical or frontal lesions. Study 2. To examine further executive aspects of memory, an attempt to demonstrate confabulation in schizophrenia was made. Twelve schizophrenic patients were matched with 12 volunteers, 8 of whom were normal healthy subjects, with the remained being depressed patients. The subjects were asked to recall a set of experimental narratives, with confabulation being defined as the recall of ideas not present in the narrative. Subjects were also examined on a number of neuropsychological tests and the patients were assessed on the Krawiecka scale. Variable amounts of confabulation were observed in all the schizophrenic patients while only one control subject confabulated. The form of confabulation differed from those observed in other patients in that the original ideas were spontaneously rearranged to produce new ones. Confabulation was found to be related to difficulties in suppressing inappropriate responses and formal thought disorder. Study 3. Three schizophrenic patients previously identified as confabulators, were intensively studied to establish the mechanisms of narrative confabulation in schizophrenia. Patients were administered experimental tasks as well as standard neuropsychological tests of memory and executive function. Assessment of current symptoms was made using the SANS and SAPS scales. The severity of cognitive impairment was found to reflect the severity of confabulation, but memory impairment was neither nor sufficient to account for confabulation. Within the spectrum of executive deficits, impairments in response suppression and response monitoring, but not planning or generation were consistently associated with confabulation. The findings from the experimental tasks suggest that faults occur at both input and output. At the input stage, narrative material is encoded in a disorganised manner while at the output stage, this disorganisation is compounded by faulty editing processes. Study 4. Four schizophrenic patients who were known confabulators with narrative material, were subjected to an experimental autobiographical questionnaire designed to establish whether schizophrenic patients confabulate in response to questions calling on the recollection of personal facts and events. In addition, a number of neuropsychological tests were administered and current symptoms was assessed with the SANS and SAPS scales. All patients were observed to confabulate to varying degrees, particularly in response to questions relating to personal episodes rather than facts. For two patients, personal delusional systems were found to play a role in confabulation by providing a framework on which to base certain confabulatory recollections. Memory impairment was not found to be a necessary component to autobiographical confabulation but deficits in response suppression and response monitoring were observed to be related to the verification process performed during this task. Study 5. In an attempt to establish which anatomical regions may be at fault in schizophrenia when patients are engaged in response suppression tasks, six normal subjects were studied using positron emission tomography (PET) to identify anatomical regions involved when performing the Hayling Test. Subjects were also required to perform a control condition in which they had to read out the last word of given sentences. Compared to the control task, response initiation was associated with left sided activation of the frontal operculum, inferior frontal gyrus, middle temporal gyrus and right anterior cingulate gyrus, whereas response suppression was associated with left frontal operculum, inferior frontal gyrus and right anterior cingulate gyrus activation only. The difference between the two parts of the Hayling Test was in the increased activation of the left middle temporal gyrus and the left inferior frontal region (Brodmann's area 44/6) during response initiation.

This thesis is about a forest hunter-gatherer people, the Mbendjele Yaka Pygmies of northern Congo-Brazzaville. The thesis is based on field research carried out between 1994 and 2001. I begin by examining certain key terms used in the thesis and by situating my research within the existing literature. Research methodologies are presented and the fieldwork experience described. I provide an overview of the historical, political and economic context of the research including an outline assessment of the main historical reconstructions of regional history. Conservationist and loggers' models of the forest are juxtaposed with Mbendjele ways of representing landscape and the forest environment. I discuss the significance of the forest in Mbendjele social experience and its role as the ideal environment for social life. I examine the way the Mbendjele classify animals and the cosmological significance of hunting and killing. This theme is continued with a presentation of ekila, a complex set of practices and beliefs that regulate the interactions of people with animals and express a complex relationship between human fertility and the correct handling of prey animals. I continue the analysis of Mbendjele collective representations with a presentation of the activity of massana. The link between children's play and adult rituals implicit in the use of this term is analysed. I then build on this understanding to present an analysis of aspects of two ritual associations, Ejengi and Ngoku, central to men's and women's power in society. The thesis is brought to a close by moving beyond the forest to examine Mbendjele relations with and conceptualisations of outsiders and property rights. New technological developments and financial incentives are increasingly transforming the Mbendjele forest into faunal and floral assets for distribution to international organizations.

People who consume alcohol at risky levels are at an increased risk of presenting to the emergency department (ED). There are a variety of methods used for detection of alcohol-related ED presentations but little guidance about the relative strengths and weaknesses for each method. This research compared and contrasted multiple detection methods for alcohol-related ED presentations and also examined the characteristics of ED patients identified as risky drinkers on a brief self-report screen compared with those detected as having an alcohol-related ED presentation. The first study, a population health survey, found that high risk drinking, high psychological distress and current smoking were all significantly associated (both independently and when combined) with a greater likelihood of presenting to an ED in the last year. The second study involved electronically searching three years of ED nursing triage text data (N=263,937) for alcohol-related terms and found that over 5% of ED presentations were related to alcohol. The third study involved comparing a number of detection methods for alcohol-related ED presentations. It found that nearly a fifth (19%) of ED presentations were detected to be alcohol-related. The strongest method was a medical records audit (72%), followed by patient self-report (67%), nursing triage text (49%) then diagnostic codes (10%). Over a fourth of ED patients were identified as risky drinkers (28%), however, just over half (51%) of these did not present to the ED for an alcohol-related reason. Among alcohol-related ED presentations, nearly a third (31%) were not identified as risky drinkers. In a survey of ED staff, it was found that management of alcohol-related problems was not routine, and many staff appeared to lack the confidence to fully and appropriately manage ED patients with alcohol-related problems. In summary, not all patients who have an alcohol-related ED presentation usually drink at risky levels, nor do all risky drinkers present to the ED for an alcohol-related reason. Using a variety of detection methods for alcohol-related problems in the ED is recommended to enhance the impact of any intervention strategies. ED staff require additional training, resources and support to enhance their management of patients with alcohol-related problems.

Thesis (M.H.A.)--University of Michigan, 1957.

Thesis (M.H.A.)--University of Michigan, 1957.

Thesis (M.S.)--University of Wisconsin--Madison, 1968. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1975. / Typescript. Vita. Description based on print version record. Includes bibliographical references.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1970. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1981. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 107-112).