Electro convulsive therapy (ECT) is amongst the most controversial treatments used within the National Health Service. While advocates have described it as one of the safest and most effective treatments available to psychiatrists, critics have censured it as barbaric, harmful and ineffective. In this thesis I present the results of a discourse analysis of accounts about ECT that were generated during semi-structured interviews I conducted with four psychiatrists, two nurses and two anaesthetists. I begin by describing the procedure and profiling its use in the United Kingdom – I illustrate the dualistic way in which ECT has been represented in the professional literature and critically assess previous attempts to investigate the accounts of those who are professionally involved with the procedure. After detailing theoretical and procedural issues associated with a discourse analytic approach, I describe and illustrate a variety of rhetorical features that appear in the accounts of the professionals I interviewed on the subject of ECT. I pay close attention to the wider professional literature and propose that the availability of descriptions used by participants may have certain effects, which I describe. I conclude by contextualising these findings, by discussing how they might be usefully applied and by offering a reflexive critical review of the research.

Electrical capacitance tomography (ECT) is a low cost and fast imaging technique able to obtain cross sectional images of dielectric permittivity distribution. ECT has been successfully used in industrial process tomography mainly for 2D imaging. One of the key challenges in 3D ECT imaging is a large scale forward problem arising with a large number of elements in the meshed ECT sensor model. Notably a complete sensor model will provide the most appropriate solution to the forward problem. A complete sensor model requires modelling a shielded area behind electrodes, which leads to increase in density of the finite element mesh. In this thesis, an approximation error model (AEM) has been applied to the ECT modelling for the first time. In addition to 3D AEM modelling and to further evaluate the effectiveness of the proposed AEM algorithm, it was implemented to compensate for uncertainty in electrode size and mesh density in 2D ECT. The results achieved using AEM are promising. In terms of application area, this thesis focuses on fundamental development for possible use of ECT in non-destructive evaluation (NDE) application. In more traditional industrial process application the object is surrounded by a number of electrodes on its boundary. In NDE applications a planar array ECT and volumetric imaging is needed. This thesis presents a 3D planar array ECT sensor using a 3D reconstruction algorithm. The results are validated with a number of experimental tests. 3D planar array ECT imaging was further extended to image both dielectric and metallic samples. To quantify the limitations of planar array ECT, a 3D ECT sensor and 3D ECT software have been implemented and used to evaluate the performance of the 3D ECT imaging with missing sides, with planar array ECT being the most extreme case of missing sides. The underlying inverse problem was analysed using singular value decomposition of the sensitivity matrix for the first time. This thesis introduces the use of a resolution matrix to analyse the performance of a 3D ECT reconstruction algorithm. These analysis methods, which enabled an in depth analysis of imaging performance with missing sides, are able to quantify the performance of planar array ECT.

No description available.

Bakgrund: Elektrokonvulsiv terapi, ECT, är en behandlingsmetod som används vid och har klinisk effekt på allvarliga psykiatriska tillstånd som depression och akuta psykoser. Det är inte klarlagt exakt hur ECT fungerar. Befintlig forskning visar på att patienters erfarenheter av ECT varierar både när det gäller effekt och biverkningar. Sverige placerar sig i det övre skiktet när man jämför hur många ECT-behandlingar per 10 000 patienter som görs i världen. Syfte: Att belysa patienters erfarenheter av ECT. Metod: Utifrån sökningar i tre databaser hittades elva vetenskapliga artiklar som mötte uppsatta inklusions- och exklusionskriterier. Artiklarnas resultat analyserades för att skapa en ny helhet. Resultat: Resultatet sammanfattades i två huvudkategorier: ”Information och kunskap formar patienters erfarenheter” och ”Erfarenheten präglas av ambivalenta känslor”. Konklusion: ECT-erfarenheten varierar mellan individer. Det är en behandling som väcker mycket känslor. Det finns förbättringsområden om man vill öka förutsättningarna för att göra patienters erfarenheter mer positiva. Ökad och bättre information och ökad medvetenhet om maktförhållanden i vårdrelationer är vid sidan av bättre allmän omvårdnad områden som kan förbättras vid ECT. / Background: Electroconvulsive therapy, ECT, is a treatment for severe affective disorders including depressive illness and acute psychotic episodes. The patophysiological effects of ECT are elusive. The patients’ experiences of ECT vary greatly, both in beneficial and adverse effects. ECT is used throughout the world and in a global comparison Sweden can be found in the 75th percentile in given ECT treatments per capita. Aim: To illuminate patients’ experiences of electroconvulsive therapy.    Methods: Articles were sought for through three different search engines. Eleven articles that met set criteria where read and analyzed.   Result: Two main categories and six sub categories were identified. “Information and knowledge construct the ECT experience” and “Ambivalent feelings define the ECT experience.”     Conclusion: ECT is a treatment that leaves patients with mixed emotions and a vast array of experiences. There are several areas to improve to make patients’ experiences of ECT better. More and better information and a better awareness of the power losses and hierarchial structures within healthcare are two of those areas. There is also a need for better nursing strategies.

No description available.

With the advantages of low cost, high imaging speed, non-intrusive and non-invasive, electrical capacitance tomography (ECT) becomes one of most maturely developed industrial tomography modalities. However, ECT had not been considered for medical applications before this work. This thesis is to explore medical applications of ECT, especially for root canal treatment (RCT) and revision total hip replacement (THR).A dental ECT system based on impedance analyser has been designed for RCT for two purposes: (1) to visualise the tooth surface in real time and (2) to determine the position of an endodontic file. To adapt the limited space in oral cavity, a miniature two–plate dental ECT sensor with either 2×2 or 2×3 array has been designed and fabricated. The sensor has a similar performance to the conventional ECT sensor and can provide good image quality. By registering and fusing with the radiograph based on a Major-axis method, a real-time image with high resolution can be obtained. A piecewise linear function has been used to locate the axial position of the apex of an endodontic file. The results show that high accuracy can be achieved near the ‘End Point’ as it is one of the reference points, determined by the sudden change in capacitance when a grounded metallic file touches the root apex (conductive media or solution).For revision THR, a conventional 8-electrode single plane sensor has been used, generating real-time 3D images of a metallic rod using a model based method. By this method, the 3D image reconstruction is simplified to estimate the cross-sectional and axial potions of the rod in the sensing area and to draw an image of the rod with prior knowledge. A high accuracy can be achieved with the maximum absolute error of 0.13 cm in estimating cross-sectional position using a weighted mean method and 0.4 cm in estimating axial position by the linear function based on the relative change in capacitance between file and electrodes. A preliminary experiment has been carried out to generate an electrical impedance tomography (EIT) image of a metallic object in conductive solution with high permittivity. Using the impedance analyser based system, the EIT image can be obtained with a conventional ECT sensor and the result is promising, providing the possibility of obtained a real-time EIT 3D image of a milling/drilling tool during revision THR.

Electroconvulsive therapy (ECT) is used worldwide to treat severe mental disorders. The most common mental disorder, and the third leading cause of disease burden in the world is depression. The clinical efficacy of ECT for severe depression is well-established. However, both the pathophysiology of depression and the mechanism of action of ECT remain elusive. The main aims of this thesis are to address the following issues: 1) the use and practice of ECT in Sweden has not been systematically evaluated since 1975, 2) cognitive side-effects (memory disturbances) are a major concern with ECT and 3) the mechanism of action of ECT remain elusive. The neurobiological aspects of ECT focus on two hypotheses. First, the recent years´ preclinical studies that have provided evidence that ECT induces hippocampal cell proliferation, including neurogenesis. Second, that enhanced functional inhibition of neuronal activity is a key feature. Current use and practice of ECT in Sweden (paper I) is based on data from the national quality register for ECT, the mandatory patient register of the National Board of Health and Welfare and a survey. Treated person rate (TPR) in Sweden 2013 was found to be 41 individuals / 100 000, and thus unchanged since the latest systematic investigation in Sweden 1975. In more than 70% of treatment series the indication was a depressive episode. The selection of patients for ECT and treatment technique in Sweden was similar to that in other western countries, but the consent procedure and the involvement of nurses and nursing assistants in the delivery of ECT differ. Data also shows that there is room for improvement in both the specificity of use and availability of ECT. The second study in this thesis is a longitudinal observational trial where 12 (paper II and III) and 14 (paper IV) patients with depression referred for ECT were investigated. Patients underwent a 3 T MRI structural scanning and DSC-MRI perfusion, a neuropsychological test battery and clinical ratings before ECT, within one to two weeks after ECT and after 6 and 12 months.  In line with preclinical findings and the plasticity hypothesis of mechanism of action of ECT, the hippocampal volume increased after ECT in patients with depression. However, this increase was transient and returned to baseline levels within 6 months. No correlation was found between volumetric changes and clinical effect or cognitive outcome. Instead our results suggested an association to the number of treatments, without relation to the side of stimulation. A right-sided decrease in frontal blood flow distinguished remission from non-remission after ECT. There were significant impairments in verbal episodic memory and verbal fluency within one week after ending the ECT course, but these impairments were transient and no persistent cognitive impairments were seen during the follow-up. In summary, this thesis present the first update on the use and practice of ECT in Sweden in the last 40 years as well as a pioneering MRI-study on the hippocampal volume increase in the treatment of depression with ECT. Supportive to earlier findings we also found the cognitive side-effects that are measurable after ECT to be transient. Furthermore, we found that a decreased frontal blood flow is of importance for the anti-depressive response to ECT.

No description available.

Syfte: Att undersöka patienters upplevelse av ECT-behandling. Metod: En systematisk litteraturstudie med deskriptiv ansats. Artikelsökning av både kvalitativa och kvantitativa artiklar har gjorts i fritextdatabaserna Cinahl, ELIN och Whiley interscience. Artiklar granskades enligt granskningsmallar för kvalitetsbedömning och var en modifierad version av Willman, Stoltz, Bahtsevani, (2006) och Forsberg, Wengström, (2008).Litteratur i introduktionsdelen har inhämtats enligt ett bekvämlighetsurval på respektive uppsatsförfattares hemort (Borlänge, Leksand). Resultat: Rädsla är ett återkommande tema när det gäller patienters upplevelse av ECT. De flesta kände rädsla före och under behandlingen, men upplevde en lägre grad av rädsla efteråt. Patienternas upplevelse av ECT-behandlingen var komplex vad gäller det egna ställningstagandet till positiv eller negativ behandlingsmetod, upplevelsen av ECT sågs dock som övervägande negativ. Minnesförlust och minskad kognitiv förmåga sågs som två huvudsakliga negativa faktorer med ECT behandlingen. Många patienter upplevde att informationen och undervisningen inför och under behandlingen var dålig. Attityd och kunskap om behandlingen stod i relation till varandra då mer kunskap om ECT ger bättre attityd till behandlingen. Attityden till behandlingen förändras heller inte efter behandlingen utan patienterna håller fast vid sin inställning. Boendemiljön har en inverkan vad gäller viljan att genomgå underhållsbehandling med ECT då patienter på institution är mer benägna att vägra behandlingen än patienter som genomgår behandlingen polikliniskt.

For the evaluation of non-ferrous heat exchanger tube, there are many non-destructive testing methods; however, the eddy current testing (ECT) method is the most popular one. By using of ECT, you may find out the defects existing inside or outside the tube wall, diagnose the heat exchanger system and find out the latent problems. The problem is that an improper signal analysis will result in error in the range of 15〜25% of the tube wall thickness, or even over 40% error. This is a great discouragement to the ECT inspectors, and will reduce the confidence of the proprietors of power plants or petro-chemical industries to the use of ECT. Therefore, in this thesis, the study is mainly focus on the problems of the aluminum brass tubes in condenser using ECT method. This thesis will analyze the causes of error of aluminum brass tubes when using ECT, prepare calibration and reference tubes, and test them using eddy current instruments. The relationship among the raw data with volts, phase angle and depth has been found. Two data evaluation methods are developed, one is the defect depth modification equation and the other is the auxiliary evaluation curve. The new methods are proved to be more accurate and practical in the evaluation of heat exchanger tube after more than one year of verification by field testing in the power plant. The results obtained in this thesis are very helpful to reduce the probability of tube failure.