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Coming theses from other universities

  • CT Guided Ablation of T1 Renal Tumors Author: Vanessa Acosta Ruiz Link: Publication date: 2019-10-11 10:06

    The widespread use of medical imaging contributes to the increased detection of incidentally detected small renal tumors, a majority which are often indolent masses found in elderly patients with preexisting chronic kidney disease. In Sweden, partial nephrectomy with minimal invasive surgical approach is the current standard for removing these tumors, although another option is percutaneous image-guided tumor ablation that allows treatment of elderly patients with comorbidities for who surgery is a risk. Due to the lack of long-term follow-up studies and prospective randomized trials, ablation is still considered an alternative option to surgery in Sweden. The aim of this thesis was to evaluate treatment of T1 renal tumors with CT guided radiofrequency (RFA) and microwave ablation (MWA).

    Factors affecting the efficacy rate of complete tumor ablation with RFA after a single session were evaluated (Paper I). Optimal electrode placement and a long tumor distance to the collecting system were associated with an increased primary efficacy. Renal tumor RFA was compared with laparoscopic partial nephrectomy (LPN: Papers II-III): both methods had comparable secondary efficacy rates, but RFA involved several treatment sessions. Total session times and hospitalization times were shorter and complications less frequent for RFA than for LPN (Paper II). After treatment, renal function impact was assessed by evaluation of both renal function quantity and quality through determination of the split renal function (SRF: Paper III). Standard renal function measurements were assessed and both RFA and LPN were nephron sparing when treating small renal tumors and did not affect creatinine or GFR. However, LPN involved greater SRF reduction in the affected kidney than RFA. Initial experience with microwave ablation was evaluated and this new ablation technique demonstrated high efficacy rates with fewer complications, and was comparable with the mid-term results of now established ablation techniques (Paper IV).

    In conclusion, CT guided RFA and MWA are safe and effective treatments for the removal of T1 renal tumors. This thesis provides further insights into the field of thermal ablation of small renal masses, which can aid future treatment selection and patient management.

  • Brain, consciousness and disorders of consciousness at the intersection of neuroscience and philosophy Author: Michele Farisco Link: Publication date: 2019-10-07 13:12

    The present dissertation starts from the general claim that neuroscience is not neutral, with regard to theoretical questions like the nature of consciousness, but it needs to be complemented with dedicated conceptual analysis. Specifically, the argument for this thesis is that the combination of empirical and conceptual work is a necessary step for assessing the significant questions raised by the most recent study of the brain. Results emerging from neuroscience are conceptually very relevant in themselves but, notwithstanding its theoretical sophistication, neuroscience is not sufficient to provide a complete interpretation or an appropriate understanding of their impact. Consequently, the present thesis starts from the need for an interdisciplinary and hybrid field of research, i.e. fundamental neuroethics.

    Within this framework, the thesis takes consciousness and related disorders (i.e. Vegetative State/Unresponsive Wakefulness Syndrome, Minimally Conscious State and Coma) and the addicted brain as illustrative cases of the potential fruitful collaboration between empirical and conceptual investigations.

    The general goal of the thesis is to contribute to the overall development of bridging the gap between empirical and conceptual understandings of consciousness. The first paper sets the theoretical framework, providing an empirically-based description of the brain with significant philosophical implications for an understanding of consciousness. The last three papers of the thesis try to apply the theoretical framework to illustrative cases. Papers II and III analyse the possible application of science and technology for an easier detection and clinical care of patients with disorders of consciousness, with particular attention to communication mediated by neurotechnology and the simulation of the conscious brain, respectively; paper IV provides a potentially new ethical analysis of addiction within the elaborated general conceptual framework.

    The conclusion of the thesis is that the impact of neuroscientific results needs that a dedicated conceptual approach reveals and investigates their conceptual meaning. This conceptual analysis is not exclusive but integrative and complementary to the empirical science. The case of consciousness, analysed from both an ethical and conceptual point of view, is highly illustrative in this respect. In the end, a conceptual/linguistic work of clarification is urgently needed.

  • Child Maltreatment in Bangladesh : Perceptions, Prevalence and Determinants Author: Md. Atiqul Haque Link: Publication date: 2019-10-04 16:09

    Background: Like most low- and middle-income countries Bangladesh have no prevalence data on Child Maltreatment (CM) and lack a reporting system.

    Objectives: The overall aims of the thesis were to generate knowledge on CM in the Bangladeshi society and to estimate the prevalence and associated risk factors.

    Methods: The thesis is based on four studies. In Study I children’s experiences were explored and 24 school aged children were interviewed. Qualitative content analysis was used for data analysis. In Study II 790 newspaper articles on CM from six national daily newspapers were selected during three months in 2014. Data were analysed through descriptive content analysis. Studies III and IV were cross-sectional population surveys. The International Child Abuse Screening Tool for Children (ICAST-C) was translated for data collection. Face-to-face interviews were performed during March-April 2017 with 1,416 children aged 11-17 years. In Study III the prevalence and risk factors of child physical abuse (CPA) were estimated, while in Study IV the same for child psychological abuse (CPsyA) and neglect.

    Results: CM was a common and painful experience with serious physical and emotional consequences but highly accepted by the society. Vulnerable groups were young children, girls, and poor children (Study I). Physical and sexual abuse were the most common types of CM covered in the news articles. One third of the reported cases resulted in death. Boys were victims of physical abuse to a higher degree, while girls were reported as victims of sexual abuse. The identity of the victims was often disclosed (Study II). Approximately all children reported experiences of CPA and CPsyA. Neglect was less reported (Study III and IV). Boys, younger children, victim of family violence, and low maternal education were risk factors of CPA (Study III). Not living with parents, working, family size and victim of family violence were risk factors of CPsyA or neglect. More years of schooling was a protective factor (Study IV).

    Conclusions: The results show that almost every child in Bangladesh experience CM. The studies incorporated in this thesis contribute to the knowledge on CM in the Bangladeshi cultural context.

    Key words: Child Maltreatment, ICAST-C, Public Health, Bangladesh