This study aims to identify the perceived barriers to eye care and to evaluate concerns about vision and eye care among patients with diabetes in the greater New Haven area. A qualitative study applying one-on-one semi-structured interviews and non-participatory observations was conducted to identify the factors that deter diabetics from seeking eye care. Patients were recruited at the Yale Primary Care Center, Diabetes Center and Eye Center, who met the following criteria: 1) have been diagnosed with type 1 or type 2 diabetes and 2) have been referred to an eye center for dilated eye exam and/or treatment. All interviews and discussions were recorded and transcribed. The transcripts were then analyzed to detect recurrent themes. Data collection continued until no new themes emerged. This study showed that lack of awareness and lack of adequate referral to regular diabetic eye exam were viewed as the most common barriers. Many patients had limited awareness that diabetes could affect the eye or lead to blindness. Patients had little knowledge of diabetic retinopathy, or the significance of early screening and intervention. Primary care providers usually emphasized diet and blood sugar control to prevent future complications; diabetic eye care education was not often prioritized. Other barriers included cost, lack of insurance, immobility due to diabetic complications, reluctance to receive medical intervention, and distrust of the services. A strong family history of diabetes and blindness due to diabetes contributed to the awareness of diabetic retinopathy, and as a result motivated patients to seek regular eye care. Raising the awareness of diabetic retinopathy and the risk of vision loss, offering more diabetic eye care education, tracking the status of patients eye exam attendance, and providing adequate eye exam referral to a patient friendly eye clinic may encourage diabetics to attend regular eye exams.

Thèse d'exercice : Médecine. Médecine générale : Paris 12 : 2006. / Titre provenant de l'écran-titre. Bibliogr. f. 53-58.

Thesis (Ph. D.)--University of Missouri--Columbia, 2003. / "December 2003." Typescript. Vita. Includes bibliographical references (leaves 146-172). Also issued on the Internet.

The aim of this thesis is to study what means are used in newspaper leaders (editorials) to influence public opinion. In order to obtain a wide range of such means, I have chosen material that has a clear timeframe and illustrates strong political antagonism, concerning the 1971 conflict between the Saco and SR unions and the Swedish state. Leaders from eight different newspapers with different party affiliations are analysed – six morning and two evening newspapers. What type of message leaders convey is examined mainly at the sentence level. Writers report what happened, assess the situation and analyse the causes and explanations for there being a labour conflict. They express criticism of those involved in various ways and exhort them to take recommended courses of action to resolve the conflict. Paragraphs can also be categorised in this way. How criticism is expressed is studied in detail because the material is rich in critical utterances of different types.  Various theories about text types and speech act theory provide a theoretical background that is applied to the material. A number of different theories about what defines a genre are presented and tested on the leaders. The results of the investigation indicate that a large number of leaders from the morning newspapers are structured in a similar way, with the paragraph as the unit. They reveal a pattern, the normal pattern, where information is presented in a given order in the majority of morning leaders and the greatest number of message types is used. There is also a pattern of analysis/criticism, with critical and analytical paragraphs alternating and the analysis substantiating the criticism, as a rule. The few leaders in the morning newspapers that do not form a pattern may be strongly critical or almost solely analytical. One of the morning newspapers has many critical leaders that argue or incite. No analysis is made of evening newspaper leaders at the paragraph level since the paragraphs are short; instead, they are analysed as a whole, as are the argumentative leaders. The analysis shows that many leaders are structured in a similar way while at the same time there is considerable variation in the material, which is attributable to there being different types of editorials.

Constrained codes have been used in data storage systems, such as magnetic tapes, CD’s and DVD’s, in order to reduce the likelihood of errors by predictable noise. The study of constrained codes is based on the study of sofic shifts, which are sets of bi-infinite sequences that can be presented using labeled directed graphs called presentations. In this thesis, we will primarily focus on two classes of sofic shifts, namely shifts of finite type (SFT’s) and periodic-finite-type shifts (PFT’s), and examine their properties. We first consider Shannon covers of sofic shifts. A Shannon cover of a sofic shift is a deterministic presentation with the smallest number of vertices among all deterministic presentations of the shift. Indeed, a Shannon cover is used as a canonical presentation of a sofic shift, and furthermore, it is used when computing the capacity of the shift or when constructing a finite-state encoder. We follow an algorithm by Crochemore, Mignosi and Restivo which constructs a deterministic presentation of an SFT and we see how to derive a Shannon cover from the presentation under their algorithm. Furthermore, as a method to determine whether a given deterministic presentation is a Shannon cover of a sofic shift, we will provide, based on research by Jonoska, a sufficient condition for a given presentation to have the smallest number of vertices among all presentations of the shift. We then move our focus towards PFT’s, and investigate new properties of PFT’s from various perspectives. We define three types of periods that can be associated with a PFT and do pairwise comparisons between them. Also, we consider the zeta function of a PFT, which is a generating function for the number of periodic sequences in the PFT, and present a simple formula to compute the zeta function of a PFT. / Thesis (Ph.D, Mathematics & Statistics) -- Queen's University, 2009-08-08 14:08:36.876

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Background and aims: The overall aim of this thesis was to increase knowledge regarding the occurrence of childhood onset T1D and T2D in Sweden and in relation to that describe and elucidate important aspects on two grave complications to diabetes; end-stage renal disease (ESRD) and mortality. The two first studies included in this thesis aimed to describe and analyze the cumulative incidence of childhood onset T1D in Sweden and to assess the occurrence of undetected T2D in Swedish children. The aim with the third study was to describe the cumulative incidence of ESRD, and to analyze how ESRD risk differs with age at-onset and sex. The aim of the fourth study was to show how parental socioeconomic status (SES) affects all cause mortality in Swedish patients with childhood onset T1D. Study populations: The foundation for the studies on T1D was data from the Swedish Childhood Diabetes Registry (SCDR). When studying ESRD we also included adult onset T1D cases from the Diabetes Incidence Study in Sweden (DISS). The study on T2D was a population-based screening study where BMI was measured in 5528 school-children and hemoglobin A1c was measured in children with overweight according to international age and sex specific BMI cut-offs. To study ESRD and mortality, we linked the SCDR to various nationwide registers containing individual information on SES, mortality and ESRD. Results: The incidence rates of childhood onset T1D has continued to increase in Sweden 1977–2007. Age- and sex-specific incidence rates varied from 21.6 (95% CI 19.4–23.9) during 1978–1980 to 43.9 (95% CI 40.7– 47.3) during 2005–2007. Cumulative incidence by birth-cohorts has shifted to a younger age at-onset over the first 22 years of incidence registration. From the year 2000 there was a significant reverse in this trend (p<0.01). In contrast to the increase of T1D, we found no evidence of undetected T2D among Swedish school children. Despite a relatively high incidence in T1D in Sweden there is low cumulative incidence of ESRD, 3.3% at maximum 30 years of duration. We found difference between the sexes regarding long-term risk of developing ESRD that was dependent on the age at onset of T1D. When analyzing how socioeconomic status affects mortality in different age at death groups, we found that having parents that received income support increased mortality up to three times in those who died after 18 years of age. Conclusion: The incidence of childhood onset T1D continued to increase in Sweden 1978-2007. Between the years 1978-1999 there was a shift to a younger age at-onset, but from the year 2000 there is a change in this shift indicating a possible trend break. The prevalence of T2D among Swedish children up to 12 years of age is probably very low. There is still a low cumulative incidence of T1D associated ESRD in Sweden. The risk of developing ESRD depends on age at-onset of T1D, and there is a clear difference in risk between men and woman. Excess mortality among subjects with childhood onset T1D still exists, and low parental socioeconomic status additionally increased mortality in this group.

The production of viable germ cells during human embryonic development determines adult reproductive success. This is particularly true for females, as development of germ cells (GCs) into primordial follicles before birth is imperative for future fertility. During fetal development GCs migrate to the genital ridge to form the gonad, after which several tightly regulated events, including proliferation, differentiation, and association with somatic cells, must occur to form a functional gonad. In the ovary these processes also include the initiation and subsequent arrest of meiosis. These developmental processes are orchestrated by local autocrine and paracrine factors, many of which remain to be identified in the human. In order to decipher further the pathways by which the gonad and GCs develop, potential regulators including prostaglandin (PG) E2, the interleukin (IL)6-type cytokines, and the prokinetecins (PROKs), were examined in the human fetal ovary and PROKs in the human fetal testis. Patterns of gene expression, protein localisation, function, and interaction of the potential mediators throughout human development (8-20 weeks gestation) were determined. Primary fetal tissue was investigated, in addition to immortalized GCs (T-Cam2 cells) and a murine model of fetal ovarian development. PGE2 interacts with known regulators of GC development in non-reproductive organs. It was postulated PGE2 may regulate GC progression by modulating these factors. Examination of PGE2 receptors and precursor enzymes in the fetal ovary revealed that all were present and some were developmentally regulated, with mRNA expression increasing with gestation. These developmentally regulated components were localised to the GCs. The PGE2 receptors were among those differentially expressed, with one localised solely to mature GCs. Culture of human fetal ovary confirmed that PGE2 regulates known regulators of GC development, increasing expression of survival and anti-apoptotic factors. To test the hypothesis that PGE2 is necessary for female GC development, paracetamol, an inhibitor of PGE2 precursor enzymes, was utilised in a murine model of fetal exposure. Fetal ovaries from this experiment displayed disruption of normal development. The IL6-type cytokines are also postulated to be involved in early gonad development, and are known to regulate proliferation and differentiation of mouse embryonic stem and GCs in vitro. A significant increase in transcript levels of the shared receptor components was determined in second trimester human ovaries, as well as developmental increases of several of the IL6-type ligands. Both common receptor components were located specifically in the GCs identifying them as the target of IL6 action in the human fetal ovary. The PROKs regulate cell migration, proliferation and differentiation, and modulate secretion of PGE2 and expression of some IL6-type cytokines. To-date, PROKs have not been examined in the human fetal gonad. Transcript levels were higher in the fetal testis compared to the ovary, with receptor and ligand components increasing with gestation. Most components also increased with gestation in the ovary. However, location of PROK components was strikingly different between the two tissues, with GCs being the primary target of PROK action in the fetal ovary, and Leydig and interstitial cells being the target in the testis. PROKs interaction with other regulators of gonad development was examined utilising a GC line in the case of the ovary and primary interstitial cell cultures in the case of the testis. These studies have identified new factors involved in human fetal gonad development, and how they interact with known regulatory pathways of development.

If auditors question a company’s ability to continue existing, they should issue a going concern opinion in the audit report. Whether or not auditors will issue a going concern opinion depends on auditors’ ability to identify going concern problems, as well as their decision whether or not to issue going concern opinions. In Sweden, the going concern accuracy rate has been low compared to other countries. The aim of this study is therefore to analyse whether it is auditors’ lack of ability to identify going concern problems or their decision not to issue a going concern opinion, or perhaps both, that could explain the relatively low accuracy rate. Interviews with four auditors from the Big Four audit firms and four CFOs from middle sized companies were conducted. The results show that there are factors speaking both for and against auditors’ ability to identify going concern problems, why we cannot say for sure whether auditors’ lack of ability to identify going concern problems could be an explanation to the relatively low accuracy rate. The results do however reveal that auditors actively make decisions not to issue going concern opinions to their clients as much as possible, which could explain the relatively low accuracy rate.

Regional variation in nitrogen (N) deposition increases plant productivity and decreases species diversity, but landscape- or local-scale influences on N deposition are less well-known. Using ion-exchange resin, we measured variation of N deposition and soil N availability within Elk Island National Park in the ecotone between grassland and boreal forest in western Canada. The park receives regionally high amounts of atmospheric N deposition (22 kg ha⁻¹ yr⁻¹). N deposition was on average higher ton clayrich luvisols than on brunisols, and areas burned 1 – 15 years previously received more atmospheric N than unburned sites. We suggest that the effects of previous fires and soil type on deposition rate act through differences in canopy structure. The magnitude of these effects varied with the presence of ungulate grazers (bison, moose, elk) and vegetation type (forest, shrubland, grassland). Available soil N (ammonium and nitrate) was higher in burned than unburned sites in the absence of grazing, suggesting an effect of deposition. On grazed sites, differences between fire treatments were small, presumably because the removal of biomass by grazers reduced the effect of fire. Aspen invades native grassland in this region, and our results suggest that fire without grazing might reinforce the expansion of forest into grassland facilitated by N deposition.