Recently graph theory has been successfully applied to magnetic resonance imaging data. However, it remains unclear as to what the nodes and edges in a network should represent. This problem is particularly difficult when extracting morphological networks (i.e., from grey matter segmentations). Existing morphological network studies have used anatomical regions as nodes that are connected by edges when these regions covary in thickness or volume across a sample of subjects. Covariance in cortical thickness or volume has been hypothesised to be caused by anatomical connectivity, experience driven plasticity and/or mutual trophic influences. A limitation of this approach is that it requires magnetic resonance imaging (MRI) scans to be warped into a standard template. These warping processes could filter out subtle structural differences that are of most interest in, for example, clinical studies. The focus of the work in this thesis was to address these limitations by contributing a new method to extract morphological networks from individual cortices. Briefly, this method divides the cortex into small regions of interest that keep the three-dimensional structure intact, and edges are placed between any two regions that have a statistically similar grey matter structure. The method was developed in a sample of 14 healthy individuals, who were scanned at two different time points. For the first time individual grey matter networks based on intracortical similarity were studied. The topological organisation of intracortical similarities was significantly different from random topology. Additionally, the graph theoretical properties were reproducible over time supporting the robustness of the method. All network properties closely resembled those reported in other imaging studies. The second study in this thesis focussed on the question whether extracting networks from individual scans would be more sensitive than traditional methods (that use warping procedures) to subtle grey matter differences in MRI data. In order to investigate this question, the method was applied to the first round of scans from the Edinburgh High Risk study of Schizophrenia (EHRS), before any of the subjects was diagnosed with (symptoms of) the disease. Where traditional methods failed to find differences at the whole brain level between the high risk group and healthy controls, the new method did find subtle disruptions of global network topology between the groups. Finally, the diagnostic value of the networks was studied with exploratory analyses that found that, in comparison to healthy controls, people at high risk of schizophrenia showed more intracortical similarities in the left angular gyrus. Furthermore within the high risk group an increase of intracortical similarities could predict disease outcome up to 74% accuracy. The main conclusion of this thesis was that the new method provides a robust and concise statistical description of the grey matter structure in individual cortices, that is of particular importance for the study of clinical populations when structural disruptions are subtle.

Objective: High Risk Reminder (HRR) system is the lately mobile application technology developed by Taipei Medical University of Medical Informatics Research Institute. The objective of HRR is to provide high risk patient test results such as lab, radiology, pathology to physician immediately by mobile short message and internet e-mail. The mobile short message is to provide abstract information to physician such as patient name, inpatient bed ward number, the abcdrmal test result. The physician can receive the latest patient’s abcdrmal test information at any place, time. Therefore, the physician can take intervention treatment as soon as possible for patient treatment. Moreover, the physician wants to know more detail the high risk patient’s information can open the e-mail to review the patient’s profile in order to provide treatment plan. The purpose of using the mobile and internet technology is to improve patient safety. The WF Teaching Hospital has using the HRR system to serve its patient and physician for 6 months. There are more than 600 mobile short messages and e-mail communication for physicians. To reach the patient safety goals is the critical mission of WF Hospital. Therefore, the evaluation of HRR patient safety contribution needs to analyze.。This study is introducing HRR system functions and evaluating HRR’s contribution.。This research is based on the empirical study. We investigate the HRR’s impaction to assist high risk patient severe test result information communication for physician to assist patient’s treatment for physician and hospital. Meanwhile, the two mobile short message and e-mail communication media which one is more effective for physician is analyzed also. Design: This study measures dimensions of information quality, system quality, use, user satisfaction, individual impact and organizational impact based on the D&M IS Success Model. Multivariate techniques were used to evaluate the relationships of the Model. Measurements: The dimensionality of each scale and degree of association of each item with the attribute of interest were determined by principal components factor analysis with orthogonal varimax rotation. The reliability of each resultant scale was computed using Cronbach’s alpha coefficient. Construct validity was examined through factor analysis and by correlation analyses. Multiple regression techniques were used to evaluate the relationship between the set of six dimensions and comparison of PHS and e-mail. Results: Physicians have using the HRR systems are the surveyors composed of this survey samples. There are 56 questionnaires had been distributed the physicians. Seven questionnaires are invalid due to rarely using the HRR system. The valid questionnaires are 85%。Of the respondents, 93% were male; 73% were undergraduate; 90% were primary physicians.。 From the research finding , the two communication medias of short message, and e-mail are positive relationships for effective and efficiency communication for physicians to assist high risk patient severe test result information delivery. The research two constructs of PHS and e-mails’ indicators are positive for improving better communication; The information quality for user’s effectiveness, satisfaction relationship impacts for users and organization. Comparison effective communication between PHS and e-mail media, the research finding is PHS is more powerful than e-mail to deliver information for physician. From regression analysis, each □ value of PHS is higher than e-mail. The individual using PHS and e-mail is positive to effect the hospital to diffuse of HRR system. Conclusion: The survey of user’s satisfaction of using the HRR system is reached over 70%. However, 60 % of physicians indicates the HRRS provides efficiency and effectiveness each high risk patient’s information causing the information overload. This is the drawback of the implementation HRR system. How to decrease the information overload pressure needs to solve in the near future to improve HRR system. Furthermore, utilization mobile technology to provide two channel communication for physician to access the patient‘s database treatment, test, medication information to integrate all required information to develop the well treatment plan to improve patient safety and reduce patient risk.

Background. Impaired insight, or unawareness of illness, is a common symptom of schizophrenia. Clinical insight is awareness of having a mental disorder; cognitive insight is ability to self-reflect (self­reflectiveness) and certainty in cognitions (self­certainty). In schizophrenia insight is associated with brain function and improving insight is a potential early intervention point. This study investigated whether insight is impaired in youth at ultra high-risk (UHR) for psychosis, and if it is related to major brain networks. Methods. Data from a larger UHR study was used, including 55 UHR adolescents and 55 controls assessed with the Structured Interview of Prodromal Symptoms, MATRICS Consensus Cognitive Battery, Scale to Assess Unawareness of Mental Disorder, and Beck Cognitive Insight Scale, as well as resting state functional MRI scans. UHR and control groups were tested for differences in self-reflectiveness and self-certainty, and correlations between insight dimensions and clinical and cognitive measures. Functional connectivity was calculated for the default mode, the cingulo-opercular, and central executive networks and regressed on participants’ reported clinical and cognitive insight, while covarying for head motion. Results. Self-reflectiveness was higher in the UHR group (d = 1.28), but the groups did not differ in self-certainty (d = 0.28). Among UHR, poorer clinical insight was related to greater symptom severity. Default mode connectivity was negatively correlated with self-reflectiveness (R2 = .091) and clinical insight (R2 = .399) in UHR, but no such correlations were found in controls. Cerebello-prefrontal cortex connectivity was negatively associated with self-certainty in the UHR group (R2 = .089 - .138). Conclusions. Default mode connectivity appears to be associated with the facets of insight concerning self-awareness, whereas cerebello-prefrontal connectivity appears to be associated specifically with self-certainty. This is the first study to relate major brain networks to insight before the onset of psychosis, and is consistent with models proposing that different facets of insight are related to self-awareness and executive functioning through networks associated with these processes.

Class of 2009 Abstract / OBJECTIVES: To compare possible differences in the proportion of serious potential ADEs associated with high-risk medications that were avoided by the use of AID technology in adult and pediatric ICU patients and to investigate the proportion of serious ADEs associated with high-risk medications as identified by root cause analyses (RCA) that occurred before and after AID implementation. METHODS: Study Site: This retrospective study was conducted at a tertiary care, academic medical center in Tucson Arizona. Design: This was a two-part retrospective study involving data obtained from an AID database and root-cause analyses. Information on high-risk medications obtained from the AID database was used to compare the proportion of serious ADEs avoided by the use of AID technology in adult and pediatric patients. Information on high-risk medications (administered by continuous infusion) obtained from root-cause analyses was used to compare the proportion of serious ADEs that occurred during the 5-year period before and the 5-year period after AID implementation. RESULTS: A total of 261 infusions (225 in the adult and 36 in the pediatric) generated an alert where the final outcome resulted in a reprogramming event when the limit was exceeded by 2.5 times or greater. The pediatric population was 1.68 time (95% CI=1.18 to 2.38) more likely to require a reprogramming event than the adult acute care population for all high-risk medications combined. Significantly more reprogramming events occurred in the pediatric patients with potassium (RR=2.77, 95 CI=1.15 to 6.68) and insulin (RR=2.73, 95% CI=1.15 to 6.45) infusions. Overrides accounted for 80% of the total reprogramming and override events when the maximum limit was exceeded by 10 times or more. There were significantly more overrides in the pediatric compared to the adult population for the high-risk medications (RR=1.82, 95% CI=1.32 to 2.53), however, there were significantly fewer overrides in the pediatric versus adult patients on fentanyl (RR=0.34, 95% CI=0.17 to 0.70). CONCLUSIONS: We found that medication errors involving high-risk medications with the potential to cause ADEs can occur frequently during the administration phase of drug delivery. While smart AIDs cannot intercept all errors, it did show that it was able to intercept certain errors, especially key=pad entry errors. We also determined that when an alert was generated involving our high-risk medications, clinicians were more apt to reprogram the AID when the alert occurred in our pediatric population. While smart pumps have shown great improvement and allow for safer drug delivery, more research is needed in this area before the ability of these smart AIDs to improve drug administration safety can be shown.

It´s important to consider all the risks that the players are exposed to and have a holistic view on the matter. The conclusions from my sponsor and looking through research in the area I came to the conclusion that surface and shoes have minimal consequences and are not an area of interest for me in this project.

Magister Artium (Social Work) - MA(SW) / A qualitative study was conducted to explore and describe the factors that hinder parent involvement in the High Five Life Skills Programme for at risk children. Parent involvement remains a challenging phenomenon, which affects not only the child, as an individual, but also the family in society. However, although parenting children is perceived to be an important responsibility, parents do not receive any formal training on how to be good parents. An explorative and descriptive research design was utilised. Data collection was done by means of semi-structured interviews and focus group discussions, with the parents/guardians and children in the High Five Life Skills Programme, as well as the teachers, who refer children to the programme. The method of non-probability sampling, employed in this study was purposive sampling. The sample was selected on the basis of the researcher’s own knowledge, as well as the purpose of the study. Data were analysed using the nine steps proposed by Creswell. The results highlighted six barriers that hindered parent involvement in the High Five Life Skills Programme, namely, Low self-esteem of parents/caregivers and children; Lack of communications between all relevant parties - caregivers, teachers and the facilitators of the High Five Life Skills programme; Lack of role models: Parents’ not being role models as their own negative behaviour hindered their involvement; Lack of an emotional bond between parents and children, coupled with absent fathers; Lack of parents’ parental skills and support networks; and the lack of resources and support with transport to and from meetings, as well as child care for younger siblings. The participants, especially the children, freely expressed themselves, and contributed to the results; thereby assisting the researcher to explore the barriers that hinder parent involvement in the High Five Life Skills Programme. It is anticipated that the results of this current study will form a basis for the High Five Life Skills Programme to develop strategies that respond to the needs of the parents and children involved in the programme.

Philosophiae Doctor - PhD / Purpose: High risk human papillomavirus (HR-HPV) is well established as a causative agent of squamous cell carcinoma (SCC) of the orophaynx. HR-HPV has also been reported in periocular cancers and precancers, but controversy exists about its overall incidence and clinicopathologic profile. The purpose of this study is to evaluate the role of HR-HPV infection in periocular cancers and precancers, using multiple methods of detection. Design: Retrospective observational case series with laboratory investigations. Methods: Sequential surgical samples of 87 carcinomas (invasive SCC, SCC in situ and sebaceous carcinoma) from three different periocular sites (conjunctiva, lacrimal sac and the eyelid) diagnosed over a 15-year period (2000-2015) were selected for evaluation. Unstained paraffin sections of 87 cases of periocular carcinomas were analyzed with immunohistochemistry (IHC) for p16 as a screening test. p16 positive conjunctival- and lacrimal sac SCC were further evaluated for HR-HPV using DNA in situ hybridization (DNA ISH), and a subset was also analyzed by DNA Polymerase Chain Reaction (DNA PCR). p16 positive periocular sebaceous carcinomas (SC) were analyzed with PCR, and a subset of 18cases was further studied with a novel method of mRNA ISH, an advanced technique with an enhanced sensitivity and specificity. Relevant patient clinical information was obtained from review of the electronic medical records.

The purpose of this study was to determine the efficacy of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) in identifying children at risk for feeding difficulties when given to parents by interview versus without assistance. Thirty subjects from Emory Developmental Progress Clinic (Emory DPC) participated in the study and were randomized to receive the BPFAS either by interview or without assistance. Mean BPFAS scores were compared by survey administration method and nutrition referral status for the total cohort as well as by age (1.5 year) and weight status (<25th percentile, 25-75th percentile, >75th percentile) using the t-test. The association between survey administration method as well as nutrition referral status and referral score category (84) was determined using the Chi-square test, as was the relationship between nutrition referral status and the response to each BPFAS question. No difference in mean BPFAS score or referral score category by survey administration method was found in the total cohort. However, a higher BPFAS score was observed for children >1.5 years of age who were referred for nutrition intervention vs. not referred (95.33 vs. 62.5, respectively; p=0.004). There was also a significant association between the number of patients referred for nutrition intervention vs. not referred and referral score (11 vs. 19, respectively; p=0.041). There was no association between responses to individual BPFAS questions and nutrition referral status. In conclusion, evaluation of other feeding assessment surveys or the in-house development of a screening tool may be better alternatives for the Emory DPC.

The United States continues to be affected by the HIV/AIDS epidemic, and now public health is faced with new challenges in mitigating the spread of the disease. African-Americans are disproportionately affected by HIV and a further understanding about the factors that influence high risk sexual behaviors needs to be continuously examined. The aim of this study was to understand and compare the the perception of HIV risk and factors associated with risk perception in high risk adult and adolescent groups. After multivariate analysis, having multiple partners was the only predictor of an increased risk perception among adults. Among adolescents, no significant relationship was found between HIV risk indicators and having an increased HIV risk perception. Both adults and adolescents appeared to underestimate their HIV risk based on their reported risk sexual behaviors. More work is necessary to help adolescents accurately assess their risk of infection.

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