A sinvastatina é um agente antilipêmico, da classe das estatinas, utilizado no tratamento de primeira escolha em pacientes com hipercolesterolemia primária. A apresentação referência da sinvastatina no Brasil é o medicamento Zocor® (Merck Sharp & Dohme Farmacêutica Ltda.). Os medicamentos genéricos e similares podem ser considerados “cópias” do medicamento de referência e para o registro de ambos medicamentos, há obrigatoriedade de apresentação dos estudos de biodisponibilidade relativa e equivalência farmacêutica. Por isso este trabalho teve por objetivo o desenvolvimento e validação de um método bioanalítico para aplicação em estudos de biodisponibilidade relativa do fármaco sinvastatina em voluntários sadios. Aplicou-se a técnica de extração líquido-líquido para purificação das amostras e para quantificação foi utilizada a cromatografia líquida de ultra performance acoplada a espectrometria de massas (UPLC-MS/MS). O método desenvolvido e validado apresentou uma faixa linear de 0,4 - 40,0 ng/mL, com seletividade, recuperação, precisão, exatidão e estabilidades adequadas segundo a RE 899/2003 da ANVISA e o Guia de Validação de Métodos Bioanalíticos do FDA. Após a validação o método foi aplicado para estudo de biodisponibilidade relativa de sinvastatina. Os resultados dos parâmetros farmacocinéticos foram obtidos através das curvas de concentração plasmática do fármaco em função do tempo, e analisados estatisticamente para determinação da bioequivalência. Os seguintes parâmetros farmacocinéticos foram determinados: ASC, Cmax e tmax. O método desenvolvido apresentou preparo de amostras simples, baixo limite de quantificação e tempo de corrida curto, adequados a estudos com grande volume de amostras e baixos níveis plasmáticos. Portanto, o método desenvolvido e validado, bem como o estudo de bioequivalência foram adequados para avaliação das formulações de sinvastatina comprimido de 40 mg (teste e referência). O produto teste analisado não foi considerado bioequivalente ao produto referência. / Simvastatin (member of the statin class) is an antilipemic agent used in the primary treatment of primary hypercholesterolemia. The simvastatin reference drug in Brazil is Zocor® (Merck Sharp & Dohme Pharmaceutical Ltda.). The generic and similars drugs can be considered as “copies” of the reference drug. Relative bioavailability studies and pharmaceutical equivalence studies are needed before submitting the registration petition of these drugs. Thus, the aim of this work was the development and validation of a bioanalytical method for application in relative bioavailability studies in healthy volunteers. Liquid-liquid extraction was employed as a purification technique and the ultra performance liquid chromatography/tandem mass spectrometry (UPLC-MS/MS) as a quantitative technique. The method was developed and validated and presented a linear range of 0.4 – 40.0 ng/mL, and fulfilled all preset criteria for selectivity, recovery, precision, accuracy and stabilities according to ANVISA`s RE 899/2003 and FDA`s Bioanalylical Method Validation Guidance. After the validation, the method was applied to the relative bioavailability study of simvastatin. The pharmacokinetics parameters results was obtained through the blood concentration-time curves, and statistically analyzed for the determination of bioequivalence. The following pharmacokinetic parameters were obtained: AUC, Cmax, tmax. The developed method showed simple sample preparation, low lower limit of quantification and short running time, which was suitable for applying. Therefore, the proposed bioanalytical method and the bioequivalence study showed adequate for evaluating the simvastatin 40 mg tablet formulations (reference and test). The test drug analyzed was not considered bioequivalent to the reference drug. / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES

O presente estudo objetivou desenvolver um método para determinação simultânea de fármacos antineoplásicos por cromatografia líquida de ultra performance acoplada ao espectrômetro de massas em tandem (UHPLC-MS/MS), para ser aplicado no monitoramento de superfícies de trabalho, em locais de manipulação dessas substâncias químicas. Os compostos alvos foram a ciclofosfamida (CP), a doxorrubicina (DOXO), o docetaxel (DOC) e a 5-fluoruracila (5-FU), escolhidos em função do seu uso e/ou considerados indicadores de exposição aos antineoplásicos. O metotrexato (MTX) também foi avaliado, todavia não foram obtidos resultados satisfatórios para esse composto, nas condições otimizadas para os outros analitos. As análises foram realizadas no modo de ionização positivo, exceto para a 5-FU, e monitoramento de reação múltipla (MRM). A separação cromatográfica foi realizada em 15 minutos, utilizando coluna Shim-pack® XR-ODS C18 (100 x 3,0 mm, 2,2 μm) e uma pré-coluna similar, gradiente de eluição, para a fase móvel, ácido fórmico 0,1% em água e acetonitrila, em uma vazão de 0,3 mL min-¹. As transições de massa, utilizadas para quantificação, seletivamente monitoradas para cada composto, foram: 261,0 > 140,0 m/z para CP; 830,3 > 304,0 m/z para DOC; 544,1 > 396,9 m/z para DOXO e 129,1 > 42,1 m/z para o 5-FU. O método analítico validado foi linear, apresentando r² ≥ 0,9939, no intervalo avaliado de 5 a 300 μg L-¹, para CP e de 10 a 300 μg L-¹, para DOC, DOXO e 5-FU; preciso, com valores de desvios-padrão relativos menores que 15%, para todas as concentrações e todos os analitos estudados. Os limites de detecção e de quantificação foram determinados entre 0,5-1,3 ng mL-¹ e 1,7-4,3 ng mL-¹, respectivamente. Após análise de 54 superfícies, adicionadas com os analitos, em uma quantidade de 150, 250 e 500 ng, as recuperações médias obtidas foram entre 59,9-104,8%, com erros-padrão relativos de até ±6%. Os resultados obtidos, no presente estudo, sugerem que o método desenvolvido é adequado para identificar, simultaneamente, quatro, dos cinco, antineoplásicos estudados, constituindo uma promissora e importante ferramenta analítica para o monitoramento da exposição ocupacional a tais fármacos. / The present study aimed to develop a method for simultaneous determination of antineoplastic drugs by ultra performance liquid chromatography coupled to tandem mass spectrometer (UHPLC-MS/MS), to be applied in monitoring work surfaces, in handling locations of these chemicals. The targed compounds were the cyclophosphamide (CP), the docetaxel (DOC), the doxorrubicin (DOXO) and the 5-fluorouracil (5-FU), chosen according to their use and/or considered exposure indicators to antineoplastics. The methotrexate (MTX) was also evaluated, but satisfactory results were not obtained for this compound, under optimized conditions for other analytes. The analyses were carried out in the positive ionization mode, except for the 5-FU, and multiple reaction monitoring (MRM). The chromatographic separation was performed in 15 minutes using Shim-pack® XR-ODS C18 column (100 x 3,0 mm, 2,2 ƒÊm) and a similar pre-column, gradient elution, to the mobile phase, formic acid 0,1% and acetonitrile, at a flow rate of 0,3 mL min-¹. The mass transitions used to quantify selectively monitored for each compound, were: m/z 261,0 > 140,0 for CP; m/z 830,3 > 304,0 for DOC; m/z 544,1 > 396,9 for DOXO and m/z 129,1 > 42,1 for 5-FU. The validated analytical method was linear, with r² . 0,9939, in the assessed range of 5 to 300 ng mL-¹, for CP and of 10 to 300 ng mL-¹, for DOC, DOXO and 5-FU; accurate, with relative standard deviations lower than 15%, for all concentrations and all studied analytes. The limits of detection and quantification were determined from 0,5-1,3 ng mL-1 and 1,7-4,3 ng mL-¹, respectively. After analysis of 54 surfaces, spiked with the analytes, in a quantity of 150, 250 and 500 ng, the obtained mean recoveries were between 59,9-104,8%, with relative standard errors of up to ±6%. The obtained results, in this study, suggest that the developed method is suitable to identify, simultaneously, four, of the five, studied antineoplastics, becoming a promising and important analytical tool for the occupational exposure monitoring to these drugs. / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES

Synthetic cannabinoids have become a growing concern in society. The extensive list of synthetic cannabinoids and the abuse rate has drawn the attention by government agencies throughout the world. These synthetic cannabinoids can adopt a number of different structures, while still acting on endogenous cannabinoid (CB1 and CB2) receptors. In addition, due to structural modifications of these synthetic cannabinoids, many of these compounds can bind to CB1 and CB2 receptors with greater affinity causing severe adverse and life-threatening effects. Because of their structural dissimilarity to the phytocannabinoid Δ9-THC, combating the rapid growth and emergence of synthetic cannabinoids with conventional THC-based methods has become an ongoing struggle. The purpose of this research was to develop and validate a robust and reliable method to accurately identify and quantify 17 synthetic cannabinoids in human whole blood using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The method was validated in accordance to SWGTOX guidelines for quantitative analysis using the following analytes: 4-cyano-CUMYL-BUTINACA, 5F-3,5-ABPFUPPYCA, 5F-ADB-PINACA, 5F- PY-PINACA, ADB-PINACA, APP-PICA, CUMYL-THPINACA, EMB-FUNICACA, JWH-250, MDMB-FUBICA, MEP-CHMICA, MO-CHMINACA, NM2201, PB-22, RCS-8, UR144, and XLR11. With this developed method, total analysis time was 8 minutes with samples eluting from 3.8 to 5.8 minutes. Calibration curves for each analyte had acceptable R2 values > 0.99 using a weighting factor of 1/x. A linear dynamic range of 0.5 – 25 ng/mL was used for all analytes, except for APP-PICA and NM2201 which were quantifiable at 0.1 ng/mL and PB-22 which used a quadratic model. Extraction of analytes using supported liquid extraction (SLE) cartridge improved sample-prep time by more than half, compared to traditional solid phase extraction (SPE) methods. Percent recovery of analytes using SLE was determined to be from 54.92 to 83.36%. Bias and Precision was assessed at 1, 3, 7, and 20 ng/mL for all analytes. All samples had acceptable calculated percent bias and percent coefficient of variation (%CV) within ±20%. No carryover was observed with this method. Matrix effect, using 10 different sources, did not have any interfering effects on detection and quantification of analytes. Ionization suppression and enhancement was observed at various levels, from -4.47 to 76.67%, but had little effect on other validation parameters. Analysis of other commonly encountered drugs (clonazepam, diazepam, (+) methadone, morphine, fentanyl, cocaine, amphetamine, 3,4-methylenedioxymethamphetamine (MDMA), 25I-NBOMe, and phencyclidine (PCP)) does not show any source of interference. The overall development and validation of this method demonstrates a sensitive and reliable way to positively identify 17 different synthetic cannabinoids in human whole blood in rapid time. / 2020-01-31

In attempts to explore the usefulness of the newly introduced electron capture dissociation (ECD) mass spectrometry for structural analysis of peptides/proteins, different fundamental aspects of the ECD method were investigated using a combination of controlled experiments and high-level theoretical calculations. The relative propensity for dissociation (RPD) of different amino acid residues were extracted from a series of ECD experiments using a common peptide model of RGGGXGGGR, where X was varied systematically among 20 common amino acid residues. Although polar and aromatic amino acid residues were found to behave differently, there exists a fair correlation between the experimental RPD values of aliphatic amino acid residues and the corresponding calculated hydrogen atom affinities of the nearby carbonyl groups. The existence of this correlation reinforces the importance of "hot hydrogen-atom model". From the same set of experiments, the side chain loss reactions of the reduced precursor ions and the zn+• species were extracted. To account for the observed secondary fragments, several generalized dissociation pathways were proposed. The energetics of these dissociation pathways were evaluated theoretically with truncated peptide models using ab initio and DFT calculations; and the kinetics of several competitive reactions were evaluated using Rice-Ramsberger-Kassel-Marcus (RRKM) calculations. / The effect of charge carriers on ECD of peptides/proteins was also studied. Peptides charged through protonation of different basic amino acid residues were found to give ECD spectra of different complexities. The formation of b-/y- and atypical internal fragment ions in peptides with histidines (and lysine, to a lesser extent) as proton carriers was attributed to the higher electron-proton recombination energy as revealed from the energy cycle diagram. Peptides charged through attachment of divalent metal ions were found to give very different ECD spectra. It was believed that typical c/z • fragments were formed from neutralization reactions involving electron-proton recombination; whereas a/b/y fragments were formed from reaction involving electron-metal ion recombination. The preference of recombination channels was somehow related to the electronic configurations of the divalent metal ions. / Fung Yi Man. / "July 2006." / Adviser: T. W. Chan. / Source: Dissertation Abstracts International, Volume: 68-08, Section: B, page: 5254. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 180-185). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Um sistema de referência para determinação do equivalente de dose pessoal, HP (10), e um programa de controle da qualidade de sistemas geradores de raios X utilizados em radioproteção inclui a verificação periódica da constância dos feixes de raios X empregados na calibração de instrumentos medidores de radiação em laboratórios de calibração de instrumentos. Neste trabalho foram desenvolvidas duas câmaras de ionização de placas paralelas inseridas em objetos simuladores de tronco humano. Uma das câmaras de ionização possui eletrodo coletor de grafite, para a medida do equivalente de dose pessoal; a segunda câmara de ionização foi confeccionada com eletrodo coletor de alumínio para, juntamente com a primeira câmara de ionização, formarem um sistema Tandem. A dependência energética diferente da resposta das duas câmaras de ionização é que permite a formação do sistema Tandem, que apresenta grande utilidade na verificação da constância de feixes de radiação X. Foram ainda implantados feixes padronizados de radiação X de energias médias (48 keV a 118 keV), nível radioproteção, por meio do desenvolvimento de uma metodologia dosimétrica e da análise dos parâmetros físicos destes feixes. As câmaras desenvolvidas foram testadas em relação às suas características operacionais e foram calibradas em feixes de radiação X, níveis radioproteção, radiodiagnóstico, mamografia e radioterapia, e ainda em campos de radiação gama, seguindo as recomendações internacionais. Apresentaram bom desempenho. Foi estabelecido o procedimento da determinação do equivalente de dose pessoal, Hp (10). / A reference system for the determination of the personal dose equivalent, HP (10), and a quality control program of X-ray equipments used in radioprotection require the periodic verification of the X-ray beams constancy. In this work, two parallel-plate ionization chambers were developed with inner electrodes of different materials, and inserted into PMMA slab phantoms. One ionization chamber was developed with inner carbon electrodes and the other with inner aluminium electrodes. The two ionization chambers can be used as a Tandem system. The different energy response of the two ionization chambers allowed the development of the Tandem system that is very useful for the checking of the constancy of beam qualities. Standard intermediary energy X-ray beams (from 48 keV to 118 keV), radioprotection level, were established through the development of a dosimetric methodology and the analysis of their physical parameters. The ionization chambers were studied in relation to their operational characteristics, and they were calibrated in X-ray beams (radioprotection, diagnostic radiology, mammography and radiotherapy levels) in accordance to international recommendations. They presented good performance. The determination procedure of personal dose equivalent, HP (10), was established.

The potentially oncogenic human pathogen BK Polyomavirus (BKPyV) was first identified in 1971 and has since been associated with a number of diseases primarily in immunosuppressed patients. Infection is established in early life and by adulthood up to 90% of populations show seroconversion for the major capsid protein VP1. Despite this infections are rarely cleared, maintaining a silent asymptomatic persistence punctuated with periods of viral shedding in the urine. The virus is non-enveloped and comprises a simple ~5.2 Kb dsDNA genome which expresses just seven known proteins, necessitating a heavy reliance on, and interactions with, host mechanisms in order to efficiently replicate and disseminate within a population. The poorly understood lifelong persistence and failure to clear infection highlights our lack of understanding of the viral life cycle and viral interactions with host processes and responses to infection. Indeed, non-enveloped viruses are thought to spread solely through infected cell lysis but such large-scale lysis should trigger an acute inflammatory response, which is rarely seen in healthy immunocompetent individuals. The research conducted for this thesis first investigates the egress of BKPyV in a non-lytic manner, presenting evidence for an active non-lytic method of viral egress that is dependent on cellular anion homeostasis. Moreover, data generated for this thesis suggests that virions egress via an unconventional secretion pathway which traffics directly from the endoplasmic reticulum (ER) to the plasma membrane in single-membraned vesicles. Further research undertook a whole cell quantitative temporal viromic (QTV) approach, post-experimentally tagging whole cell lysate peptides with isobaric labels (Tandem Mass Tagging, TMT) to provide a greater understanding of host cell proteomic changes throughout BKPyV infection in two primary human cell types over 72 hours of infection. Such an approach identified ~9000 cellular proteins, of which a surprisingly small number changed significantly in abundance in response to BKPyV infection. Of those that were changed in abundance a large proportion were related to cell cycle, revealing that BKPyV infection induces a pseudo-G2 arrest, similar to the G2/M checkpoint. Validation of TMT results in both cell types provided confidence in this robust data set, and further studies highlighted the importance of not only cell cycle status, but the activity of CDK1 for efficient viral infection and replication. Additionally, TMT generated data emphasised the lack of innate immune induction in response to BKPyV infection, suggesting BKPyV exhibits a sophisticated evasion of pathogen recognition.

Li, Gang. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 102-108). / Abstracts in English and Chinese. / TABLE OF CONTENTS --- p.v / LIST OF FIGURES --- p.viii / LIST OF TABLES --- p.xi / ABBREVIATIONS --- p.xii / Chapter Chapter One --- Introduction / Chapter 1.1 --- Matrix-assisted Laser Desorption/Ionization (MALDI) --- p.2 / Chapter 1.1.1 --- Laser Desorption --- p.2 / Chapter 1.1.2 --- Matrix-assisted Laser Desorption/Ionization --- p.2 / Chapter 1.2 --- Time-of-flight Mass Spectrometry --- p.6 / Chapter 1.2.1 --- Linear Time-of-flight Mass Spectrometer --- p.6 / Chapter 1.2.2 --- Reflectron Time-of-flight Mass Spectrometer --- p.7 / Chapter 1.2.2.1 --- Linear-field Reflectron --- p.9 / Chapter 1.2.2.2 --- Nonlinear-field Reflectron --- p.12 / Chapter 1.3 --- Structural Analysis Using Time-of-flight Mass Spectrometer --- p.13 / Chapter 1.4 --- Project Objectives --- p.17 / Chapter Chapter Two --- Instrumentation and Experimental / Chapter 2.1 --- Instrumentation --- p.20 / Chapter 2.1.1 --- Laser system --- p.20 / Chapter 2.1.2 --- Flight Tube and Vacuum System --- p.20 / Chapter 2.1.3 --- Ion source --- p.22 / Chapter 2.1.4 --- Deflector and Time Ion Selector --- p.24 / Chapter 2.1.5 --- Two-stage Gridless Reflectron --- p.28 / Chapter 2.1.6 --- "Detectors, Digitizer and Computer System" --- p.28 / Chapter 2.2 --- Experimental --- p.31 / Chapter 2.2.1 --- Sample preparation --- p.32 / Chapter 2.2.2 --- PSD calibration --- p.32 / Chapter Chapter Three --- "Simulation Studies of Time Ion Selector, Collision cells and Curved-field Reflectron" / Chapter 3.1 --- Introduction --- p.35 / Chapter 3.2 --- Time Ion selector --- p.37 / Chapter 3.3 --- Collision cell --- p.46 / Chapter 3.3.1 --- Simulation of Collision Induced Dissociation (CID) Conditions --- p.46 / Chapter 3.3.2 --- Design and Performance Evaluation of Different Collision Cells --- p.48 / Chapter 3.4 --- Curved-field reflectron (CFR) --- p.58 / Chapter 3.4.1 --- Introduction --- p.58 / Chapter 3.4.2 --- Derivation of Analytical Equations --- p.58 / Chapter 3.4.3 --- Effect of Floating Potential of the Collision Cell --- p.65 / Chapter 3.4.4 --- Effect of R and θ Parameters --- p.65 / Chapter 3.4.5 --- Effect of Length of the Reflectron --- p.70 / Chapter 3.5 --- Conclusions --- p.73 / Chapter Chapter Four --- Construction and Performance Evaluation of Modified Time-of-flight Mass Spectrometer / Chapter 4.1 --- Benchmark Results for the Origin Reflectron Time-of-flight Mass Spectrometer --- p.75 / Chapter 4.2 --- Hardware Modifications of Reflectron Time-of-flight Mass Spectrometer --- p.75 / Chapter 4.2.1 --- Collision Cell --- p.75 / Chapter 4.2.2 --- Curved-field Reflectron --- p.79 / Chapter 4.3 --- Evaluation of the Curved-field Reflectron --- p.81 / Chapter 4.4 --- Evaluation of the field-shaped cylindrical collision cell --- p.85 / Chapter 4.5 --- Conclusions --- p.95 / Chapter Chapter Five --- Concluding Remarks / Chapter 5.1 --- Concluding Remarks --- p.100 / References --- p.101 / Appendix / Appendix 1 User program for time ion selection --- p.108 / Appendix 2 User program for gas collision --- p.111 / Appendix 3 MATHEMATICA program used in calculation for curved-fleld reflectron --- p.114

High efficiency solar cells can be attained by the development of two junctions one stacked on top of each other into tandem structures. So that, if a photon is not able to excite an electron-hole pair in the top cell can create a pair in the bottom cell, which has a smaller bandgap. For a two junction tandem device structure, the bandgap of the top cell should be 1.6-1.8eV and for the bottom cell should be 1eV to attain efficiencies in the range of 25%. Cadmium Zinc Telluride which has a tunable bandgap of 1.45- 2.2eV is a candidate for the top cell of the tandem structure. Cadmium Zinc Telluride (Cd1-xZnxTe) films were deposited by co-sputtering of CdTe and ZnTe. Deposition of Cd1-xZnxTe was studied in Ar and Ar/N2 ambient. Characterization of the films was done using transmission response, X-ray diffraction (XRD), Atomic Force Microscopy (AFM), Secondary Electron Microscopy (SEM), current-voltage (I-V) and spectral response measurements. CZT deposited on CdS/SnO2 substrates showed improved performance compared to other heterojunction partners. Doped graphite and copper were utilized as back contacts for CZT devices. Post deposition annealing treatments with ZnCl2 on CZT films were done and their effect on the devices was also studied. The best combination of Voc and Jsc were 530mV and 3.66mA/cm² respectively.

Mitochondrial fatty acid �-oxidation disorders are a group of clinically and biochemically heterogeneous defects mainly associated with intolerance to catabolic stress. The diseases are potentially fatal, but treatable and the prognosis for most diagnosed disorders is generally favourable. Early diagnosis is thus important to prevent morbidity and mortality. This project describes an improved and validated quantitative fibroblast acylcarnitine profile assay for the investigation of suspected fatty acid �-oxidation disorders. Intact cells were incubated with deuterium-labelled hexadecanoate and L-carnitine, and the accumulated acylcarnitines in the medium analysed using electrospray tandem mass spectrometry. This modified procedure is less demanding technically, requires fewer cells and better reflects the in vivo acylcarnitine status than previously published methods. Mitochondrial fatty acid �-oxidation is coupled to the respiratory chain. Functional defects of one pathway may lead to secondary alterations in flux through the other. The diagnostic specificity and the prognostic potential of the in vitro acylcarnitine profile assay were investigated in fibroblasts from 14 normal controls, 38 patients with eight enzyme deficiencies of fatty acid �-oxidation presenting with various phenotypes, and 16 patients with primary respiratory chain defects including both isolated and multiple enzyme complex defects. All fatty acid �-oxidation deficient cell lines revealed disease-specific acylcarnitine profiles related to the sites of defects irrespective of the severity of symptoms or of different mutation. Preliminary studies suggested a correlation between severity of symptoms and higher concentrations of long-chain acylcarnitine species. However, the fibroblast acylcarnitine profiles from some patients with respiratory chain defects were similar to those of controls, whereas others had abnormal profiles resembling those found in fatty acid �-oxidation disorders. In vitro acylcarnitine profiling is useful for the detection of fatty acid �-oxidation deficiencies, and perhaps the prediction of disease severity and prognostic evaluation facilitating decisions of therapeutic intervention and genetic counselling. However, abnormal profiles do not exclusively indicate these disorders, and primary defects of the respiratory chain remain a possibility. Awareness of this diagnostic pitfall will aid in the selection of subsequent confirmatory tests and therapeutic options.

Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 149-167).