Dissertations / Theses on the topic 'Screening'

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Comunicação e Expressão. Programa de Pós-Graduação em Letras/Inglês e Literatura Correspondente
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A análise da construção do suspense através da manipulação do espaço e do tempo em duas adaptações cinematográficas de Alfred Hitchcock, A Janela Indiscreta e Os Pássaros. Propõe que os filmes mostram uma articulação entre tempo e espaço que parece aumentar o suspense dos contos nos quais foram baseados e que o aumento do suspense é criado por elementos como o privilégio à montagem e o modelo clássico de cinema. A relação entre espaço, tempo e tema, isto é, entre forma e conteúdo, subjaz à leitura dos filmes. Considera-se que no processo de adaptação o filme adquire um significado independente através das inescapáveis e essenciais diferenças da obra literária. Assim, pretende mostrar que os contos, apesar de sua própria articulação entre tempo e espaço, não produzem a quantidade de suspense criada no filmes, devido a uma série de fatores que vão da edição e da mudança de meio e propriedades ao estilo Hitchcockiano.

Installing an electrical submersible pump can be a way to increase the production in a well. This report will explain some ways the electrical submersible pump can be installed and describe the different components in an electrical submersible pump. The report will also give an insight in how electrical submersible pumps have been used and improvements done to the electrical submersible pump on two different fields. The main part will describe a method to screen wells and find out if installing an electrical submersible pump will be profitable. The method is to estimate future oil production, based on real-time production, with and without an ESP installed, and calculate the net present value. The method takes into account costs of installing, running and removing an electrical submersible pump. The ESP screening tool is screening the wells automatically. In addition it does an ESP simulation to find applicable pumps. For the ten wells screened by the ESP screening tool, the net present values have been negative, due to weak water cut estimation.

DNA was directly extracted from a number of water and sediment samples taken from the soda lakes of the Kenyan-Tanzanian Rift Valley. A limited number of microbial specific enrichments of these were also extracted in the same way. 16S rDNA genes were amplified by the polymerase chain reaction (PCR) and microbial diversity studied using denaturing gradient gel electrophoresis (DGGE) and terminal restriction fragment length polymorphism (t-RFLP). DGGE had relatively poor resolution, as shown by the limited number of bands on gels as compared to the minimal number of amplicons represented by t-RFLP profiles. Cloning and sequencing of some of the DGGE bands indicated that they usually contained mixed amplicons. Amplicon sequencing enabled the identification of possible members of the soda lake community. Several sequences had high identity to the 16S rDNA genes of organisms previously isolated from soda lakes, others were only distantly related. Amplicons recovered from enrichment cultures were similar to those recovered from environmental DNA. In general, enrichment cultures showed comparable diversity to environmental samples in terms of DGGE and t-RFLP analysis. Genomic DNA libraries were also made from DNA recovered from an environmental soda lake sample, and three different enrichment cultures. DNA was extracted from the samples and digested with Sau 3AI. Fragments of between 2 and 10kbp were gel purified and ligated into ZAP express vector (Stratagene) for packaging into the XL1-Blue MRF' Escherichia coli host cells. pBK-CMV phagemids were excised from the libraries and screened by direct enzyme assays for enzyme activities. Two cellulase and three esterase/lipase activity clones were found. Sequence data indicated that one cellulase activity clone had highest amino acid identity to an endo-beta-1,4-glucanase gene from the glycoside hydrolase family 5. The second active cellulase clone was not fully sequenced.

Background: Preeclampsia (PE) affects 2-3% of all pregnancies and is a major cause of maternal and perinatal morbidity and mortality. It is thought to occur due to abnormal placentation characterised by poor trophoblastic invasion resulting in oxidative stress and release of factors that promote endothelial dysfunction and inflammation. The current approach of screening for PE is to identify risk factors from maternal demographic characteristics and medical history. In the United Kingdom, the National Institute for Health and Clinical Excellence (NICE) has issued guidelines recommending that women should be considered to be at high risk of developing PE if they have any 1 high-risk factor or any 2 moderate-risk factors. With this approach, defined by NICE, at a screen positive rate of 11%, the detection rate (DR) for total PE is 35%. Such a screening approach has two main limitations. Firstly, it does not provide individualised, patient specific results and secondly, it does not allow the integration of biomarkers for improving the performance of the screening test. However, the integration of such biomarkers is essential in achieving an effective screening strategy for PE. Objectives: The aims of the papers included in this thesis are firstly, to identify and quantify the effects of variables from maternal characteristics and medical history on specific biochemical markers, secondly to present a model for standardising biochemical marker measurements in all three trimesters of pregnancy into multiples of the normal median (MoM) values, thirdly to summarize the distribution of MoM values in pregnancies with normal outcomes and those that subsequently develop PE and fourthly, to examine the potential improvement in performance of screening for PE at 30-34 weeks’ gestation by maternal factors alone with the addition of biophysical and biochemical markers. Methods: The data for this thesis were derived from prospective screening of women with singleton pregnancies attending for three routine hospital visits at 12, 22 and 32 or 36 weeks’ gestation. We have recorded a series of maternal characteristics and history, measured the maternal weight and height as well as the uterine artery pulsatility index (UTPI), mean arterial pressure (MAP), serum concentration of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFLIT-1). The pregnancy outcomes were obtained from the hospital maternity records or the general medical practitioners of the women. Bayes theorem was used to combine the a priori risk from maternal factors with various combinations of biomarker MoM values. The potential value of biophysical and biochemical markers in improving the performance in screening for PE were evaluated. Results: Firstly, in pregnancies that developed PE, serum PlGF is decreased, while sFLIT-1, MAP and UTPI were increased, secondly, the separation in MoM values from normal is greater with earlier than later gestational age at which delivery for PE is necessary and thirdly, the slope of the regression lines of PlGF MoM with gestational age at delivery in pregnancies that develop PE increases with gestational age at screening. Combined screening at 30-34 weeks’ gestation by maternal factors, MAP, UTPI, PlGF, and sFLIT-1 predicted 98% (95% confidence interval, 88- 100%) of preterm PE and 49% (95% confidence interval, 42-57%) of term PE, at a false positive rate of 5%. Conclusions: This thesis has demonstrated that biophysical and biochemical markers increase significantly the performance of screening for PE and as a result the timing and content of clinical visits can be defined by the patient-specific risk of developing the disease. The vast majority of women would be screened low risk and these can follow the routine antenatal care, whereas those few who are high risk could be directed to a more specialized pathway, where early therapeutic interventions prophylactically may lead to the prevention of the disease and close follow-up will reduce the adverse consequences of PE.

Whether to screen for prostate cancer in aging men is a topic that is fairly well researched, but recommendations are controversial, because the evidence supporting any recommendation is equivocal. The evidence clearly does not support routine screening of all average-risk men, but for men aged 55 to 69 years, either not routinely screening, or engaging each man in shared decision making for his individual preference on screening, is reasonable and consistent with the evidence. Many organizations, including the American Cancer Society, have not yet reassessed their guidelines, in response to the US Preventative Services Task Force revised guideline.

Philosophiae Doctor - PhD
Background: Teledentistry is the use of information and communications technology (ICT) to provide oral health care services and enhance oral health care delivery to communities in geographically challenged areas. The public health services in South Africa needs to be overhauled to address the inadequacies in the current system. As an attempt to minimise or repair the inadequacies in the public health sector, South Africa has identified the use of ICT’s as a potential tool in improving the delivery of health care. However, although SA has recognised telemedicine as a potential solution to improve access to health care, teledentistry does not feature at all in the dental public health sector. Teledentistry and mobile health has the potential to eliminate or minimise the oral health disparities that exist in South Africa with the use of health information systems. Teledentistry can be initiated in an incremental approach by 'piggy-backing' on existing telemedicine sites, thus reducing ICT costs for the public health sector. Stake holders and government officials need to embrace technology to address some of the challenges that exist in the South African public health sector. This study could aid in providing evidence-based information to assist in the introduction of teledentistry in South Africa as an innovative dental screening and management tool. The most recent SA National Oral Health Survey showed that at least 80% of dental caries in children is untreated (Department of Health, 2003) and this poses a significant public health problem. To reduce the double burden of dental caries in children and human resource shortages in the public sector, the use of teledentistry as a school screening tool has been recommended. Teledentistry screening has the potential to improve access and delivery of oral health care to children in underserved and the rural areas. The aim of the study is to compare traditional dental screening versus teledentistry screening for dental caries in children. Methodology: This study consists of two parts: the first part a concordance study and the second part the determination of user satisfaction with regards to the technology used. The concordance study assessed the diagnostic agreement between traditional and teledentistry screening of dental caries in school children aged between 6-8 years old. The methodology included traditional face-to-face dental screening by two trained and calibrated evaluators, and the teledentistry screening method included the same two evaluators together with two trained and calibrated teledentistry assistants (who were of non-dental background). For the traditional face-to-face dental screenings the two evaluators examined 233 children at selected rural primary schools and scored them for DMFT. For the teledentistry screening method the teledentistry assistants captured intraoral images of the same children and web-based stored the images in corresponding eFiles. After a two week wash out period these intraoral images were then examined by the same two evaluators and scored for DMFT. To determine concordance across methods, Kappa Statistics was applied to the data and this revealed intra-examiner reliability. To determine user satisfaction levels, close-ended questionnaires were designed based on the role of the evaluators and TAs in the teledentistry screening process. Results: The intra-rater agreement and reliability across methods for evaluator one was 98.30%, and for evaluator two it revealed a result of 95.09%. Kappa statistics thus revealed that both evaluators were in agreement between a range of 95%-98.30% of the classifications, or 92.79% of the way between random agreement and perfect agreement (p=0.000). The high concordance level indicated that there was no statistical difference between the traditional dental screening method and the teledentistry screening method (intra-rater reliability), thus suggesting that the teledentistry screening method is a reliable alternative to the traditional dental screening method. For the user satisfaction part, both of the evaluators agreed with 8 of the 13 statements (62%). The statements that were agreed upon related mainly to user satisfaction on the technology which included accessing the intraoral images for screening and the ease of scoring decayed and missing teeth off the images; time and technology suggested the screening process of the images saved time; and indicated teledentistry as being an innovative and easy system to use that will save clinical time for dental professionals. The statements they disagreed with related to the clarity of the images, scoring interproximal caries off the images, and the dental screening method of choice. Both of the TAs agreed with 7 of the 11 statements (64%). They agreed upon statements related mainly to perception of children’s attitudes & behaviour which suggested the children were comfortable during the imaging process and in addition they were excited to see pictures of their teeth; they found teledentistry to be an innovative and easy system to use; they found teledentistry to be a sterile process and hence they were happy with infection control. Both TAs disagreed with the statement that suggested clear images could be captured irrespective of poor lighting. Discordant statements related mainly to user satisfaction on technology which related to ease of using the intraoral camera, ease of storing the captured images into the eFiles and ease of deleting unwanted images. Conclusion: The key findings of this study highlights the reliability of utilising teledentistry as a dental screening and diagnostic tool which can be valuable in the delivery of oral health care in South Africa. This research study further revealed valuable data on user satisfaction levels of the evaluators and TAs, and has an impact on the utilisation of the teledentistry screening system. To ensure adoption and adaptation of the screening process all users must be satisfied with the ICTs used in the teledentistry system. User friendliness can impact negatively on the adoption of teledentistry.

REVIEW OF UNIVERSAL NEWBORN HEARING SCREENING: RATIONAL PROSPECTS OF GENETIC SCREENING FOR DFNB1 RELATED DEAFNESS Introduction: Hearing loss (HL) is the most common human birth defect occuring in 1 to 3 per thousand infants. Recent evidence for a critical period for language acquisition promoted the adoption of Universal Newborn Hearing Screening (UNHS) in many countries. In Italy UNHS was first introduced in 1997; in 2002, some hospitals of Veneto region were involved in a pilot project on UNHS and now almost all hospital birth centers has adopted it. Concurrent with the enforcement of UNHS programs, an explosion of knowledge occurred in the field of genetics with the identification of over 100 genes associated with hearing loss. However, more than half of infants with nonsyndromic sensorineural hearing loss have identifiable mutations in only two genes: GJB2 and GJB6, located on DFNB1 locus. As GJB2 and GJB6 mutations are responsible up to 50% of autosomal recessively inherited hearing loss (the so called: DFNB1 sensorineural hearing loss, DFNB1 SNHL), even if with changes in prevalence and in specific mutation frequencies in different populations, the association of genetic screening for DFNB1 SNHL to UNHS may have several clinical and financial advantages. The use of genetic testing for DFNB1 SNHL as an adjunct to bedside UNHS has been discussed but there are open questions limiting its implementation: what type of testing should be done: common mutations or sequencing the entire gene? How will the results be explained (e.g. the genetic test finds out a single GJB2 mutation)? What is the cost/benefit ratio? Purpose: The aim of this thesis is to perform a critical analysis of the UNHS done in five hospitals in the region of Veneto and to discuss the advantages of the possible implementation of genetic screening for DFNB1 SNHL. Methods: Between 2008 and 2010, a survey of five well-baby nurseries in Veneto region has been conducted to evaluate the progress of the UNHS in achieving goals established by the Joint Committee on Infant Hearing (JCIH) and to identify critical aspects of the UNHS program. Particulary, the analysis aims to describe: percentage screening coverage, type of UNHS methodological protocol, number of infants affected by SNHL identified and cases of DFNB1 SNHL, extent of the population “lost to follow up”. The hospitals envolved were Padova, Thiene (VI), Castelfranco Veneto (TV), Abano Terme (PD) and Monselice (PD). The UNHS program in these centers is organized as follows: all the nurseries screened newborns by automated transient evoked otoacoustic emissions (A-TEOAEs), the ones resulted REFER at A-TEOAEs are evaluated by automated auditory brainstem response (A-ABR) in the Pediatric Clinic of Padova within the first three months of life, if this test confirms the suspicion of hearing loss, at five months of age, the infant undergo the audiological evaluation at the Pediatric Audiology Unit of Padova Hospital. Cases of SNHL identified are addressed to the Rare Disease Laboratory of the Pediatric Clinic of Padova to perform genetic testing consisting of the complete sequencing of GJB2 and GJB6. Results: .The coverage rate for all the centers is about 100%. Each hospital has his own UNHS protocol based on JCIH guidelines, adapted to the characteristics of the birth center (birthrate, personnel responsible for the UNHS, neonatal intensive care level). The prevalence of HL detected is 0.8%. About a half of patients with SNHL underwent DFNB1 SNHL genetic test. The percentage of patients “lost to follow up” is about 30% for infants born in the Pediatric Clinic of Padova and about 46% for the ones born in Thiene and Castelfranco Veneto. Conclusions: All the centers perform UNHS according to JCIH guidelines, the prevalence of HL detected is concordant with the one reported in Italian infants. Characteristics of the HL as the degree of hearing loss and the bilaterality are concordant with literature. Patients affected by DFNB1 SNHL present the phenotypic variability reported by literature. Percentage of infants “lost to follow up” is considerable but slightly lower in comparison to the American reality of UNHS. Newborn genetic testing in this setting may be helpful in reducing the percentage of patients “lost to follow up”. However, as the above mentioned questions on DFNB1 SNHL genetic testing have not yet univocal answers, before its implementation, further studies are needed.
CRITICITA’ DELLO SCREENING UDITIVO NEONATALE: PROSPETTIVE RAZIONALI DELLO SCREENING GENETICO DELL’IPOACUSIA Introduzione: L’ipoacusia è il deficit neurosensoriale più comune alla nascita, la sua prevalenza è stimata 1-3 ogni 1000 nati vivi. Da studi recenti emerge come vi sia un periodo critico per l’acquisizione del linguaggio, tale evidenza ha sostenuto l’adozione dello screening uditivo neonatale universale (Universal Newborn Hearing Screening, UNHS) in molti paesi. In Italia lo UNHS è stato introdotto per la prima volta nel 1997; in 2002, alcuni ospedali della regione Veneto hanno aderito a un progetto pilota sullo UNHS e oggi la quasi totalità dei centri nascita veneti lo ha adottato. Parallelamente all’adozione dei programmi di UNHS e all’identificazione precoce dei casi di ipoacusia, si è verificato un corrispondente ampliamento delle conoscenze nel campo della genetica dell’ipoacusia preverbale. In alcune popolazioni, più della metà dei casi di deficit uditivo è dovuta a mutazioni unicamente a carico di GJB2 e GJB6, poste sul locus DFNB1. Il fatto che mutazioni dei geni GJB2 e GJB6 rendono conto di almeno il 50% delle perdite uditive autosomiche recessive (chiamate DFNB1 sensorineural hearing loss, DFNB1 SNHL), benché con variazioni di prevalenza e variazioni nella frequenza di mutazioni specifiche nelle diverse popolazioni studiate, ha indotto a considerare che l’associazione dello screening genetico di DFNB1 a UNHS può presentare numerosi vantaggi da un punto di vista clinico ed economico-sanitario. Molti studi hanno valutato l’opportunità di affiancare lo screening genetico di DFNB1 a UNHS, ma vi sono ancora molte questioni non risolte: che tipo di test andrebbe eseguito: la ricerca delle mutazioni più comuni o il sequenziamento completo? Come verrebbero interpretati determinati risultati (nel caso, per esempio lo screening genetico individuasse solo una mutazione di GJB2) Il rapporto costo beneficio è favorevole? Scopo: lo scopo di questa tesi è di analizzare la modalità di esecuzione di UNHS in cinque centri nascita della regione Veneto e di valutare il razionale dell’eventuale attuazione dello screening genetico di DFNB1 SNHL. Metodi: tra il 2008 e iI 2010, è stata condotta un’indagine in 5 punti nascita della regione Veneto al fine di valutare se le modalità di esecuzione di UNHS rispondevano ai criteri stabiliti dalle linee guida internazionali stese dal Joint Committee on Infant Hearing (JCIH) e di identificare le criticità del programma di UNHS. In particolare sono stati valutati i seguenti parametri: copertura dello screening, tipo di protocollo per l’esecuzione di UNHS, numero di soggetti con ipoacusia neurosensoriale identificati e casi di DFNB1 SNHL, percentuale di pazienti che non hanno interrotto l’iter di valutazioni audiologiche (lost to follow up). I centri nascita coinvolti nello studio sono stati Padova, Thiene (VI), Castelfranco Veneto (TV), Abano Terme (PD) and Monselice (PD). Il programma di UNHS in questi ospedali è così organizzato: presso ciascun centro di accoglienza neonatale, il personale paramedico eseguiva lo screening su tutti i neonati mediante le emissioni otocusiche transienti automatiche (A-TEOAEs), coloro che risultano REFER vengono sottoposti al test dei potenziali evocati uditivi del tronco (A-ABR) presso gli ambulatori della Clinica Pediatrica di Padova entro i tre mesi di vita, se questo test conferma il sospetto di un deficit uditivo, attorno al quinto mese di vita, il bambino esegue una valutazione audiologica presso il servizio di Audiologia pediatrica dell’Ospedale di Padova. I casi di ipoacusia identificati vengono inviati al Laboratorio di Malattie Rare della Clinica Pediatrica di Padova per eseguire il test genetico che consiste nel sequenziamento completo di GJB2 e GJB6. Risultati: la copertura in tutti i centri raggiunge circa il 100%. Ogni ospedale ha redatto un protocollo per l’esecuzione del UNHS basandosi sulle linee guida internazionali del JCIH e adattandole alle peculiarità della propria realtà (natalità, personale addetto all’esecuzione di UNHS, livello di terapia intensiva neonatale). La prevalenza di ipoacusia è stata stimata 0,8%. Circa la metà dei soggetti si è sottoposta al test genetico per mutazioni di DFNB1. La percentule di pazienti che non ha seguito l’iter delle valutazioni audiologiche è circa del 30% nella popolazione nata presso la Clinica Pediatrica di Padova e di circa il 46% di coloro che provengono dai centri di Thiene e Castelfranco Veneto Conclusioni: tutti i centri eseguono UNHS secondo le linee guida interazionali di JCIH, la prevalenza di ipoacusia rilevata è nel range di quella riportata in alcuni lavori sulla popolazione italiana. Anche le caratteristiche della perdita uditiva in termini di entità del deficit e bilateralità sono concordi con quanto riportato in letteratura. Per quanto riguarda i soggetti affetti da DFNB1 SNHL, possiamo affermare che, come riportato in numerosi studi vi è variabilità fenotipica per quanto concerne la gravità della perdita. La percentuale di pazienti che interrompono il percorso diagnostico-terapeutico è importante ma minore rispetto a quella rilevata nella realtà americana. L’introduzione dello screening genetico neonatale potrebbe ridurre tale percentuale. Tuttavia, poiché le questioni precedentemente sollevate in merito allo screening genetico di DFNB1 SNHL non hanno ancora ottenuto risposte univoche, prima della sua attuazione, sono necessari ulteriori studi.

Background. Prenatal screening programs, in which screening is routinely offered to all pregnant women, have been implemented in a number of regions in Canada and other countries. Such programs are typically marketed as having the goal of providing women with the opportunity to make an informed choice about screening. Studies have suggested, however, that structural and cultural factors related to the rise of surveillance medicine have combined to effectively routinize the offer and uptake of prenatal screening, potentially hindering the capacity to ensure true autonomy and informed choice for women. Purpose. This study was conducted to explore the concept of the routinization of prenatal screening by examining women's accounts of their decision making about accepting or declining prenatal screening and what judgments they made about the value of prenatal screening for themselves and others. Methods. This was a descriptive, exploratory study using qualitative research methods for data collection and analysis. Data were collected from 18 women who had delivered healthy babies using semi-structured interviews. Both data collection and analysis were conducted using methods of Grounded Theory. Results. Routine uptake of prenatal screening was described by many women. Themes arising from interviews included: the recognition of choice and/or the need for deliberation; the ways in which prenatal screening is presented; the value placed on the information provided by screening; varying conceptions of risk; and the relationships between prenatal screening, abortion, disability, and responsibility. Conclusions. Factors contributing to the routinization of prenatal screening operate at a variety of levels: individual, structural, and cultural. Further research is needed to clarify and quantify the effects of routine acceptance of screening on women and their families, and to determine the most effective and appropriate ways of ensuring that women's choices are truly informed and deliberated.

Data for which the number of predictors exponentially exceeds the number of observations is becoming increasingly prevalent in fields such as bioinformatics, medical imaging, computer vision, And social network analysis. One of the leading questions statisticians must answer when confronted with such “big data” is how to reduce a set of exponentially many predictors down to a set of a mere few predictors which have a truly causative effect on the response being modelled. This process is often referred to as feature screening. In this work we propose three new methods for feature screening. The first method we propose (TC-SIS) is specifically intended for use with data having both categorical response and predictors. The second method we propose (JCIS) is meant for feature screening for interactions between predictors. JCIS is rare among interaction screening methods in that it does not require first finding a set of causative main effects before screening for interactive effects. Our final method (GenCorr) is intended for use with data having a multivariate response. GenCorr is the only method for multivariate screening which can screen for both causative main effects and causative interactions. Each of these aforementioned methods will be shown to possess both theoretical robustness as well as empirical agility.

Teachers report that there are an increased number of students engaging in persistent antisocial behaviour in their classrooms. Teachers need to identify these students early because if there is early identification then there is the potential for early intervention, which in turn may prevent negative long-term outcomes for these students as well as long-term costs to society. The aims of this study were (1) develop a psychometrically sound, cost effective, three-step multiple gating behaviour screening procedure that teachers could use in their kindergarten/classroom so that they could identify those students at-risk of antisocial development, (2) examine if the third gate of this procedure was necessary for the accurate identification of these students, and (3) could such a screening procedure be adapted for classroom teacher use in New Zealand kindergartens and schools. Forty eight teachers from three kindergartens and 10 primary/intermediate schools volunteered for the study, of which 34 teachers completed all three gates of the screening procedure. Results indicate the three gate screening procedure was easily adapted for kindergarten and classroom use with, at Gate 3, teachers’ self-recording 30 direct observations of a nominated and control student during their normal teaching lesson with good accuracy. All three gates were effective in identifying those students at-risk of antisocial development but Gates 1 and 2 were the most effective in terms of accuracy, time and resourcing. The teachers found the three gate procedure manageable, required very little training and did not interrupt classroom routine or schedules. The implications of these findings are discussed.

Interferon regulatory factor 5 (IRF5) is a protein with different functions including theactivation of genes that encode different cytokines. Overexpression of IRF5 has been observedto lead to different types of stress in the cells, including an overproduction of cytokines, whichis referred to as a cytokine storm. Clinical states in which dysregulated cytokine release in theform of a cytokine storm can be referred to with an umbrella term: Cytokine storm syndrome.The aim of this study was to test for inhibitors for IRF5 that could be developed and used as apharmaceutical drug to treat Cytokine Storm Syndromes including autoimmune diseases andCOVID-19. The method for this screeing consisted of finding possible inhibitors usingcomputer based drug design which resulted in the selection of 21 possible inhibitors. Thesesubstances were then tested on induced macrophages that are cytokine producing. The abilityfor inhibition is based on the amount of cytokines present in the sample after exposure. Thiswas tested using an ELISA based assay which measures the amount of cytokines in the sample..A handful of substances was found to be effective and substances 11 and 17 stood out asespecially effective. This indicates the possibitily for a drug to be developed that would inhibitIRF5, which could be used for treatment of cytokine storm syndromes.Keywords: IRF5,

Safety net clinics across the country struggle with a lack of resources to tackle the needs presented. Screening programs set up for children and elderly have proven to be effective in triaging need, prioritizing care, and maximizing resources. These programs do not currently exist for working uninsured adults. Research was initiated to answer the question: Does the screening process improve patient care for the community clinic? During a 6-week pilot study a licensed dental hygienist performed 30 screenings in the community clinic setting. Findings were recorded and coded according to patient’s level of need identified. Pre- and posttest data for patient care factors were attained. Statistical tests showed a significant effect on patient care factors. While the evidence existed to support the implementation of screening, more research would quantify the specific impact on this population.

Depression, a sequela of stroke, is underrecognized and underreported. The American Heart/Stroke Association estimated 1/3 of patients develop depression after a stroke. Depression after a stroke has negative influence on stroke recovery through decreased participation in rehabilitation, and increased morbidity and mortality. The American Heart/Stroke Association recommended that depression screening be conducted on stroke patient; however, there is a lack of guidance regarding the optimal time and tools for depression screening. The practice problem identified was the absence of depression screening in poststroke patients at the project site. The project question focused on identifying evidence-based approaches for depression screening in poststroke patients. The goal of the project was to develop clinical practice guidelines for depression screening poststroke. The framework used to develop the project was the John Hopkins Evidence-Based Nursing model. An expert panel was used to evaluate the developed clinical practice guidelines. Serving as participants, expert panelist were selected based on their background in stroke care management. Panelists evaluated the guidelines using the Appraisal of Guidelines for Research and Evaluation Instrument II standard instrument tool. Twenty-five percent of reviewers recommended using the guidelines and 75% recommended using the guidelines with minor modifications. Implementation of clinical practice guidelines support depression screening after stroke leading to increased awareness, education, recognition and reporting. The findings of this project have the potential for positive social changes by improving depression screening in stroke patients and increasing early recognition and reporting of depression poststroke.

Adolescent substance use is a key public health problem in rural Ohio. Primary care nurses lack substance use screening knowledge and skills. Early screening and detection of possible substance use issues aids in directing patients to appropriate health services. This project involved the implementation of an educational intervention on the CRAFFT screening tool for primary care nurses in rural Ohio. Guided by Kurt Lewin's 3-step model to emphasize prevalence of substance use and need for screening among adolescents, the purpose of this project was to provide training on the CRAFFT screening approach and share guidelines to implement routine substance abuse screening for adolescents seen in this rural primary healthcare setting. The project, based on a pretest and posttest design, was implemented among a sample of 7 nurses to evaluate whether the educational intervention had a significant impact on nurses' knowledge on using the CRAFFT screening tool. Data were collected using a questionnaire and were analyzed using descriptive and inferential statistics. The results showed a significant increase in the pretest scores (M =51.43, SD = 19.51) and the posttest score (M =94.29, SD = 7.868); t(6)=7.039, p = .000). The project findings support that the benefit of this educational intervention to improve the nurses' substance use screening knowledge using a lunchtime educational training to ensure that vulnerable adolescent patients with substance use receive early and appropriate preventive and treatment measures. For positive social change, early identification of substance use among adolescents may inform the adoption of preventive and treatment measures such as referral to mental health specialists, thereby improving adolescent health outcomes.

Objective: The objective of this thesis was to estimate the impact on newborn screening (NBS) results of changing screening technology from tandem mass spectrometry (MS/MS) to an approach using targeted next-generation sequencing (T-NGS) and MS/MS in parallel. Methods: We integrated results of an analysis of MS/MS screening data for phenylketonuria (PKU) and medium-chain acyl-CoA dehydrogenase (MCAD) deficiency; and a query of genetic compendia for variants of genes associated with the two disorders. Results: The introduction of T-NGS into NBS may reduce nearly 80% of false positives that are generated using the current screening approach. Based on estimated NBS results, T-NGS may be applied using a second-tier approach, which may improve specificity while maintaining sensitivity at its current level. Discussion: T-NGS may enhance the performance of NBS for PKU by improving specificity when used as a second tier test, but may be limited by feasibility and cost under current circumstances. Future studies should consider the cost-effectiveness of T-NGS for all infants undergoing NBS.

With the rise of technology, the way people may communicate is becoming infinitely more creative and complex. Dual-screening, or second screening, is one way in which people may now engage with live television events. Dual-screening occurs when an individual uses their phone, while watching television, in such a way that aids them in their viewing of television: this is called hybrid media. Previous research has been done that has indicated people who dual-screen typically are more politically active. According to Hybrid Media System Theory, as dual-screening rises in relevance, the political power of normal citizens increases. Therefore, this study uses political dual-screeners as the independent variable. By surveying 235 college students, this study found a number of strong correlations between political dual-screening and political activism, trust in social media, and psychological motivations to meet their needs for coordination and affection. By running bivariate correlation analysis and multiple regression analysis, this study discovered that political dual-screening individuals are strongly to all of these dependent variables.

ECG-Screening for young elite athletes Abstract Background Sudden cardiac death (SCD) during physical activity is a frightening and emotional tragedy that draws huge media attentions when it occurs. Fortunately it is a relatively uncommon occurrence but happens nonetheless to young athletes who often seems to be in perfect health. SCD is used as a term for sudden unexpected complications on the cardiovascular system that leads to a deadly outcome normally within the first hour of onset of symptoms and the cause is some sort of underlying cardiovascular disease that gets triggered by physical activity.Normally athletes gets divided into two groups dependent on age, over and under 35 years, and this studies focus is on the younger group since it is often during this period athletes are at the elite level. It is also in this category the most unexpected sudden deaths occur that is not due to coronary atherosclerosis, which is the dominant cause of death, and drastically increases, for people over 35 years old. Aim The aim of this study was to scientific and unbiased analyze peer-reviewed clinical articles todescribe the pros, cons and cost to implement an ECG-screening as a standard before physicalactivities for specifically defined elite athletes. Method A systematic review was performed and after all data collection 21 articles was chosen to beused as a base for both background and analyze. At the end 10 articles was fulfilling the criteria to be used at the analyze and later the results. Results The implementation of ECG-screening has reduced SCD in Italy by 89 % between the years 1979-2004. There is a higher risk of SCD for active elite athletes. ECG-screening could be aneffective way to detect hypertrophic cardiomyopathy but a similar study showed oppositeresult. The positive negative results from ECG are relatively low. Hypertrophiccardiomyopathy is a rare disease among elite athletes. A standardized help tool for ECG can help all sorts of physicians in judging the results from ECG. The cost for implementation ofECG-screening for all young athletes is high and will probably not be implemented in countries like USA for a foreseable future. Discussion There is a lot of studies done on the matter but only a couple has shown any positive numbers that gives the implementation of en ECG-screening actually reduce the mortality to SCD. More studies are published every year and the debate will probably go on for a long time, especially concerning money and resources but also about its effectiveness. Better technology in the future will probably make it a more affordable project, especially if it develops to be amore efficient tool.

Ischemic stroke is the most common cause of handicap in adults and the third most common cause of death in Sweden. Internal carotid artery atherosclerosis is an important cause and accounts for 20% of ischemic strokes. Screening for carotid atherosclerosis has been debated over the past two decades. The aims of this thesis were (I) to study the prevalence of and risk factors associated with carotid artery atherosclerosis among 65 year old men, (II) to evaluate a simplified ultrasound protocol (the grayscale/mosaic method) for the exclusion of significant carotid artery stenosis for screening purpose, (III) to evaluate the required effect of primary preventive therapy in reducing risk of stroke among patients with asymptomatic carotid disease in order for screening to be cost-effective and (IV) to study natural history of carotid atherosclerosis and outcome five years after screening in 65-year old men. The prevalence of atherosclerotic plaques was high (25%), while the prevalence of >50% stenosis was relatively low (2.0%). Smoking, hypertension, diabetes mellitus and coronary artery disease were independent risk factors and individuals with several risk factors had a higher prevalence of stenosis. Most of those at risk were not on any preventive medication. A simplified grayscale/mosaic method was found to have a high negative predictive value for significant carotid stenosis. The minimum stroke risk reduction effect required for preventive intervention to be cost effective was 22%. Carotid atherosclerotic plaque and stenosis 50-79% has a relatively benign development during five years if treated with BMT and risk factor adjustment. Very few progressed to symptomatic disease. More severe stenosis (80-99%) had higher rate of neurological events, and may benefit from additional intervention. In conclusion, prevalence of silent atherosclerotic disease in carotid arteries was common among 65-year-old men. Most of those at risk had no secondary prevention. There is a simple DUS method that could be used for screening purpose. Screening for carotid disease is only cost-effective if the preventive strategy lowers the risk of stroke by 22%. Men with plaques and moderate stenosis have a good prognosis, but among those with severe stenosis there is a need for further intervention.
Screening for asymptomatic carotid atherosclerosis

Randomised controlled trials have demonstrated that mortality from Abdominal Aortic Aneurysm (AAA) can be cost-effectively reduced by ultrasound-screening of men. Evidence for screening women is insufficient. Reports of falling AAA incidence are emerging. In an effort to study screening for AAA in a contemporary setting, two cross-sectional multi-centre population-based studies of one-time screening of 65-year-old men, and 70-year-old women in Middle Sweden were undertaken. Cost-efficiency of one-time screening of 65-year-old men was evaluated in a decision-analysis model. Five-year outcomes in men invited to screening at age 65 and age 70, were studied in a longitudinal cohort study. A lower than expected (1.7%) prevalence of AAA in 65-year-old men was found, as well as a very low (0.4%) prevalence in 70-year-old women. Smoking was the dominating risk factor associated with AAA, but the association was stronger in women. The main cause of reduced contemporary prevalence was falling smoking rates in the population since 30 years. One-time screening of 65-year-old men was found to be cost-effective and deliver significant clinical impact. The cost per quality adjusted life-year gained, at 13-years follow-up, was €14706, which was below the recommended UK NICE threshold of €25000. 15 lives were saved by inviting 10000 to screening. Prevalence of AAA and the rate of incidental detection of AAAs in the population were important factors affecting cost-efficiency. New AAAs developed after 5 years in men screened normal at age 65, predominantly in men with sub-aneurysmal aortas (25-29mm) at 65, and smokers. The 5-year rate of AAA repair was high among men with screening detected AAAs, as was non-AAA related mortality. Ruptures were only documented among non-attenders. Conclusions: A lower than expected prevalence of AAA among 65-year-old men, an unchanged repair rate, and improved longevity of the elderly population was found. Although one-time screening for AAA was still cost-effective within a contemporary context, several issues need to be addressed; the threshold diameter for follow-up, the current rate of opportunistic detection of AAA in the population, re-screening of the entire population at a higher age, and targeted screening of smokers. Screening 70-year-old women who do not smoke is likely to be futile, thus ruling out population screening of women for AAA.

This work presents investigations into the use of the near-infrared (NIR) signals to interrogate, detect and image specific chemical compounds of interest in a security screening application, including when such compounds are hidden behind single layers of clothing fabric. In an initial set of experiments, the mechanisms governing the interaction of NIR signals with clothing fabrics and similar materials has been studied, in order to account for the influence of fabric layers when detecting hidden chemicals. Throughout the rest of the work, NIR spectroscopy has been used as a means to perform qualitative and quantitative analysis, in order to detect the presence of chemicals, and quantify the concentration in aqueous solution of liquids. It has been shown that, while the compounds can be identified on the basis of the characteristic features that appear in the relevant NIR spectra, the origin and nature of these spectra necessitate that such identification be performed with a chemometricsbased approach. Accordingly, multivariate calibration models based on neural networks and partial least squares regression (PLSR) have been developed to perform the requisite analyses. Results of calibration and testing with a range of data are reported. In order to facilitate operation in practical security screening, the development and testing of a software-based lock-in amplifier is reported, as a mean to enhance the signal-to-noise ratio (SNR) of the spectral data. It is shown that the amplifier can process up to 40 wavelength channels in parallel, to extract the spectral data buried in noise in each channel. Hence, with the SNR of the input signal set as low as -60 dB (by introducing software-generated additive white noise in the spectra), adequate noise suppression has been obtained, allowing the resulting spectral data to be used for requisite chemical detection. Finally, an integrated spectroscopic imaging application is developed to perform twodimensional cross-sectional scans of chemical samples, carry out lock-in amplification of the recorded intensity spectra, and plot the results of neural network-based chemical detection in the form of intensity images colour-coded to depict the presence of the pertinent chemicals at the scanned coordinates.

Benign prostatic hypertrophy (BPH) is a very common disease among men aged 50 and its economic burden on health services continues to grow. The advocation for adopting new screening procedure for BPH begins to emerge. However, a new proposal for screening should be under careful scrutiny and ineffective and inappropriate screening must be avoided. A prospective cohort study has been launched to study the frequency, distribution, and natural history of BPH in two well-defined small communities in Central Scotland. Using the data from the cohort study, the hypothesis that a BPH screening programme justifies the stringent criteria set by Wilson and Jungner (1968) to evaluate any proposed programme, could be tested. The hypothesis has to be rejected after taking all the criteria into account. BPH was a major health problem among apparently well middle-age and elderly men in the community. It imposed significant interference in men's daily routine as well as influenced on their psychological general well-being. Although there was a detectable asymptomatic stage, the natural history of BPH from asymptomatic to a clinical stage was not clear. Because of the obscurity of the natural history, the optimum interval between repeated screens of a continuous screening process was unknown. The facilities for diagnosis and treatment could not be met by the present health services. The economic implications of a screening programme could be enormous, though a systemic analysis to evaluate the worthwhileness of the screening programme in economic terms was not conducted.

Consumers form consideration sets by screening from all available alternatives. Consumers typically utilize one of two types of screening strategies: an exclusion screening strategy wherein alternatives not worthy of further consideration are rejected or an inclusion strategy wherein worthy alternatives are selected for further evaluation. Extant literature has documented the important role played by screening strategies in decision making. However, there is very limited understanding of when and why consumers may employ one screening strategy over the other as well the impact of the screening strategy for decision accuracy. This dissertation attempts to study the antecedent and consequence of screening strategies. Essay 1 in this dissertation, investigates the role of consumers’ perceived uncertainty on the choice of screening strategy. Four studies in this essay show that when consumers are highly uncertain they are more likely to choose exclusion screening strategy; whereas when they are less uncertain they are more likely to use inclusion screening. Mediation analyses in Studies 1 and 2 show that the choice of screening strategy is primarily driven by perceived accuracy of the strategy. Study 3 demonstrates that the effect of uncertainty on the choice of screening strategy is moderated by consideration set size. When uncertain consumers form smaller sets they are more likely to use exclusion screening, but this relationship flips when they form larger consideration sets. Finally, external validity for the relationship between uncertainty and choice of screening strategy is demonstrated in Study 4 using the popular TV game show Who Wants to be a Millionaire? Essay two in this dissertation, investigates the role of perceived uncertainty and consideration set size on the relationship between screening strategy and objective accuracy of the decision. Utilizing an experimental study with an actual choice task, I demonstrate that perceived uncertainty moderates the screening strategy-decision accuracy relationship. Further, this interactive relationship is contingent on consideration set sizes. Whereas consumers with high perceived uncertainty make higher quality decisions with inclusion while forming smaller consideration sets, their decision quality is higher with exclusion when forming larger sets. Likewise, while consumers with low perceived uncertainty make more accurate decisions with exclusion when forming smaller sets, the accuracy of their decisions increases with inclusion when forming larger sets. This dissertation contributes to literature on screening strategies by explicating perceived uncertainty as a critical factor that leads to consumers preferring one screening strategy versus the other. Furthermore, it adds to our understanding of an important consequence of using screening strategies--decision accuracy.
Ph.D.
Department of Marketing
Business Administration
Business Administration PhD