Thesis (M.A.)--Naval Postgraduate School, September 2003. / Title from title screen (viewed Jan. 22, 2004). Includes bibliographical references. Also issued in paper format.

Hjärtinfarkt är en av de vanligaste orsakerna till dödsfall i Sverige. Det är vanligt att de som drabbats har svårt att hantera sin förändrade livssituation eftersom sjukdomen påverkar vardagen fysiskt, psykiskt, socialt och ekonomiskt. Kvinnor har oftare svårare att anpassa sig till livet efter hjärtinfarkten än män. Syftet med studien var att beskriva hur kvinnor upplever det dagliga livet efter en hjärtinfarkt. Metoden för studien var en litteraturöversikt av 10 kvalitativa artiklar. I resultatet framkom fem olika kategorier; En förändrad livssituation som innebär förändrad social roll och hur kvinnan hanterade livet efter hjärtinfarkten. Förändrade relationer beskriver hur relationerna till vänner, familj och arbetskamrater påverkas. Behov av stöd omfattar stödet som kvinnan behöver för att kunna hantera sin nya livssituation. Den förändrade kroppen tar upp vilka kroppsliga symtom som kan komma efter en hjärtinfarkt och Känslomässiga reaktioner beskriver det psykiska måendet som kom med den nya situationen. Slutsatsen är att kvinnorna ofta förlorar kontroll över det dagliga livet och är i behov av stöd både från vårdpersonal och närstående. / Myocardial infarction is one of the most common causes of death in Sweden. It is common for the affected person to have difficulties managing the changes in his or her life situation caused by the disease both physically, mentally, socially and economically. Women have more often difficulties adapting to her life after a myocardial infarction than men do. The aim of this study was to describe how women experience daily life after a myocardial infarction. The methodology for this study was a literature review of ten qualitative studies. The result showed five different categories; A changed life situation, which describes changed social roles and how woman managed life after a myocardial infarction. Changes in relationships, which describes how relationships with friends, family and co-workers are affected. The category Need of support process the assistance that women need in order to manage their new life situation. The changed body, which involves the physical symptoms that can occur after a myocardial infarction and Emotional reactions, which describes the mental condition that accompanies the new situation. The conclusion is that women often lose control over their daily lives and are in need of support from both health care professionals and relatives.

The goal of this study was to examine differences in the psychological characteristics of patients admitted to the hospital for acute or chronic Myocardial Infarction (MI) or Unstable Angina (UA). Depression, anger, anxiety, curiosity, defensiveness, social support, and coping were evaluated for 165 patients (86 MI and 79 UA), who were tested on the Cardiology Stepdown Ward of Tampa General Hospital. The following psychological measures were administered to these patients: the Beck Depression Inventory (BDI), the State-Trait Anger Expression Inventory (STAXI-2), the Rationality/Emotional Defensiveness (R/ED) Scale, the Adult Form of the Coping Responses Inventory (CRI-Adult), the Interpersonal Support Evaluation List (ISEL), the Illness Perception Questionnaire (IPQ), the State-Trait Personality Inventory (STPI), and the Structured Clinical Interview (SCID-I) for the DSM - IV. Significantly more chronic patients than acute patients met criteria for depression as measured by the SCID following admission to the hospital, and more UA than MI patients also met these criteria. However, no differences were found between the acute and chronic MI and UA patients two weeks prior to admission. Results of this study also indicated that chronic patients and UA patients reported a greater frequency of illness symptoms and tended to cope with their heart disease through avoidant strategies. Chronic patients endorsed higher levels of state and trait anger compared with acute patients, and UA patients were less likely to believe that their illness could be cured or controlled (Control of Cure) than MI patients. Based on the results of this study, it appears that avoidance coping may be an insufficient strategy for addressing negative emotions of chronic patients and UA patients. In addition, perceived lack of control over the success of treatment may be related to depression for UA patients. These findings have important implications for the development and implementation of interventions designed to address perceived control over treatment effectiveness and coping skills for negative emotions in the treatment and rehabilitation of cardiac patients.

Cyberwar challenges future endeavors of state security. As technological capability has improved, and access to information has become more widespread the importance of the issue in today's ever-globalizing world grows each day. A primary objective is to evaluate the place of cyber-warfare against nation-states and any repercussions under an international law paradigm. Utilizing an English School perspective, emphasis will be applied to the argument that disruptive circumstances could come to fruition if international conventions are not created to bring consensus and order among nation-states on this subject. This study hypothesizes that a future application could be an agreement under international law, beyond current regional cooperative initiatives. Since cyber-related attack is a relatively new development, the issue lacks adequate historical context. In addition, since state behavior is a major contributor to the interpretation of international law, the matter is in need of a clear delineation of the norms that define the phenomena and what acceptable responses might entail. Case study analysis will highlight recent examples of state behavior and cyber-related attacks and sabotages.

Background: Mexican-American women are a burgeoning population and are at increased risk for heart disease. However, there are no studies published yet describing acute myocardial infarction (AMI) symptoms unique to this Hispanic subgroup. Aims: Guided by vulnerability theory, the aims were to describe Mexican-American women's perceptions of the AMI symptom experience and to measure their self-reported acute and prodromal MI symptoms. Methods: A convenience sample of eight Mexican-American women mean age 63 years (range 41-78 years) with recent AMI from the U.S.-Mexico border region participated in a semi-structured interview and completed the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS). Qualitative description was used to analyze codes from interview data and descriptive statistics to analyze the MAPMISS responses. Results: Mexican-American women's symptom experience was incongruent with what they knew to be symptoms of a heart attack. They attributed AMI symptoms to non-cardiac causes and did not think they were having an MI. Women self-managed symptoms and delayed seeking health care until symptoms became severe. "Asphyxiatia" (asphyxiating) and "menos fuerza" (less strength) were the most commonly described symptoms in the interviews. On the MAPMISS, Mexican-American women reported a mean of 11.25 (range 5-22) acute and 8.75 (range 0-17) prodromal symptoms. Sleep disturbance and weakness and nausea were the most frequently reported prodromal and acute symptoms, respectively, as measured by MAPMISS. Prodromal leg pain was reported with more frequency than prodromal general chest pain. Conclusions: Delays in seeking health services by Mexican-American women in the U.S.-Mexico border region reflect (1) the difference in their actual MI symptoms compared to preconceived ideas of a heart attack, (2) different terms used to describe their MI symptoms, and (3) not initiating healthcare services themselves. These findings can be used to inform Mexican-American women and healthcare providers in the U.S.-Mexico border region about the unique experiences of Mexican-American women. The findings that participants were not able to recognize or attribute their AMI symptoms suggest that heart health education should be tailored to Mexican-American women and targeted to Mexican-American families and communities.

Context: As one of the major causes of death and disability in Canada, research into the treatment and prevention of acute cerebrovascular syndrome (ACVS) remains a priority for clinicians, researchers and the general public. Understanding the relationship between current treatment practices of a rapid stroke clinic and patient outcomes is an essential part of measuring success and considering opportunities for quality improvement. Objective: This study compared the 90-day and 1-year hospital admission and mortality outcomes of patients who were referred to and seen in a rapid stroke clinic (the shows) following an initial transient neurological event (TNE) with those who were referred to but not seen in the same clinic (the no-shows). The specific outcomes examined were stroke events, cardiovascular events and all other hospital events. Methods: In this post-test only non-equivalent group design, data on patient outcomes was collected in the Victoria-based Stroke Rapid Assessment Unit (SRAU) between 2007 and 2013. Analysis included an assessment of group equivalency for possible confounders (age, sex and severity score) and two sets of multivariate logistic regressions were conducted on nine outcomes. Results: An independent t-test revealed there was a statistically significant difference between the mean age of the shows (mean= 68.26) and no-shows (mean= 69.90) (p<0.01). While the proportion of males and females in each of the groups was similar (Fisher’s Exact test, p = 0.831, ns), the severity score of the treatment group (mean= 3.64) was statistically more severe in the show group than the no-show group (mean= 3.50; t = 2.137, p<0.05). Controlling for age, sex and severity score, the odds ratios (ORs) were calculated to compare the odds of various outcomes in the treated (shows) versus the untreated (no-shows) patients groups. ORs for the 90-day and 1-year hospital admissions for stroke-related events were 0.071 (p<0.01) and 0.091 (p<0.01), respectively; the OR for 1-year stroke deaths was 0.167 (p<0.01), indicating a strong protective factor related to attending the clinic appointment. For the cardiovascular outcomes, the ORs for hospitalizations were 0.967 (ns) at 90-days and 0.978 (ns) within 1-year and the OR for the 1-year cardiac-related deaths was 0.391 (ns). For all other outcomes, the ORs were 0.525 (p<0.01) for hospitalizations within 90-days, 0.579 (p<0.01) for hospitalizations within 1-year and 0.299 (p<0.01) for deaths within 1-year. These findings remained consistent with re-analysis excluding subjects who had an event within 5.4 days of their initial TNE. These latter finding largely rules out the possibility that the primary reason the no-shows did not make their clinic appointment, was due to a subsequent hospital event. Conclusion: The ORs for the outcomes show a protective effect of stroke and all other hospital outcomes (but not cardiac events) for patients treated in the rapid assessment clinic. The exclusion of patients who experienced an outcome while waiting for a clinic appointment, lowered the protective effect of the treatment and emphasized the need for rapid assessment but did not alter the main study conclusions. Future research that explores factors influencing appointment adherence and patient attitudes towards acute treatment of TNEs might reveal strategies that could help to reduce the number of patients that remain untreated and at a higher risk for poor outcomes. / Graduate

Το συμπλήρωμα είναι βασικός παράγοντας της φυσικής ανοσίας (innate immunity) και αποτελεί γέφυρα για την ενεργοποίηση της ειδικής ανοσίας (adaptive immunity). Αποτελείται από ένα σύστημα πρωτεϊνών, που συναντώνται ως ανενεργά προένζυμα και ενεργοποιούνται μέσω πρωτεόλυσης πυροδοτώντας έναν καταρράκτη αντιδράσεων. Οι οδοί ενεργοποίησης του συμπληρώματος καταλήγουν στον σχηματισμό ενός λυτικού συμπλόκου (Membrane Attack Complex – MAC) που καταστρέφει τους παθογόνους μικροοργανισμούς. Οι πρωτεΐνες, συστατικά του συμπλόκου, ανήκουν στην οικογένεια MACPF (MAC – Perforin). Σημαντικό ρόλο στη λειτουργία τους παίζει η πρωτεϊνική περιοχή (module) FIMAC (Factor I Membrane Attack Complex). Η περιοχή αυτή υπάρχει στα συστατικά C6 (Complement component 6) και C7 (Complement component 7) του συμπλόκου MAC και φαίνεται να είναι η περιοχή πρόσδεσής τους με την περιοχή C345C του C5b. Επιπλέον, η περιοχή FIMAC υπάρχει και στον παράγοντα Ι του Συμπληρώματος (Complement Factor I, CFI), ο οποίος συμμετέχει στην αποσταθεροποίηση της κομβερτάσης C3/C5, μέσω του καρβοξυτελικού άκρου της FIMAC που φαίνεται να συνδέεται αλλοστερικά με την πρωτεϊνική περιοχή SP (Serine Protease), που αποτελεί την ενεργή του περιοχή. Το μοντέλο, για την ανάλυση της περιοχής FIMAC βασίστηκε στην περιοχή της πρωτεΐνης φολιστατίνη (follistatin, FS) FD (follistatin Domain), η οποία αναλύθηκε πρόσφατα κρυσταλλογραφικά και με την οποία εμφανίζει ομοιότητα στην αλληλουχία της. Η δομή FD αποτελεί ένα υβρίδιο μιας αμινοτελικής περιοχής EGF (Epidermal Growth Factor) και μίας καρβοξυτελικής περιοχής του ωοβλεννοειδούς (ovomucoid) που ομοιάζουν με τις πρωτεϊνικές περιοχές KAZAL και συναντώνται σε πολλούς αναστολείς σερινικών πρωτεασών. Η περιοχή FD περιέχεται, επίσης, στην πρωτεΐνη αγκρίνη (agrin, AGRN) που αποτελεί συστατικό της βασικής μεμβράνης και παίζει σημαντικό ρόλο στην νευρομυϊκή σύναψη. Η μελέτη των πρωτεϊνικών περιοχών FIMAC και KAZAL αναφορικά με την λειτουργία, την δομή και την εξέλιξή τους αποτέλεσε το αντικείμενο της παρούσας εργασίας. Για την εκπόνηση αυτής της μελέτης χρησιμοποιήθηκαν δεδομένα από βάσεις βιολογικών δεδομένων και εργαλεία βιοπληροφορικής ανάλυσης. Πρωτογενές υλικό της μελέτης αποτέλεσαν οι νουκλεοτιδικές και αμινοξικές αλληλουχίες των γονιδίων C6, C7, CFI, AGRN και FS σε όλους τους οργανισμούς που βρέθηκαν (σπονδυλωτά και ασπόνδυλα), και πιο συγκεκριμένα οι αλληλουχίες που αντιστοιχούν στις πρωτεϊνικές περιοχές FIMAC και KAZAL. Οι πρωτοταγείς δομές των FIMAC ( ̴ 78αα) και KAZAL ( ̴ 55αα) διαφέρουν ως προς το μήκος τους, με μερικές εξαιρέσεις που αφορούν περιοχές KAZAL των πρωτεϊνών AGRN και FS (>80αα). Οι δευτεροταγείς δομές των FIMAC και KAZAL παρουσιάζουν μεγάλη ομοιότητα, φέροντας δομές α – έλικας και β – πτυχωτής επιφάνειας στην αλληλουχία τους. Τέλος, τα μοντέλα προσομοίωσης τριτοταγούς δομής και των δύο περιοχών FIMAC και KAZAL οπτικοποιούν τη διαμόρφωση των δομών της α – έλικας και των β – πτυχωτών επιφανειών στον χώρο. Αξιοσημείωτη είναι η παρουσία σημαντικού αριθμού κυστεϊνικών καταλοίπων στις αλληλουχίες των περιοχών FIMAC (8 – 10 Cys), με μεγαλύτερη συγκέντρωση στο αμινοτελικό άκρο, και KAZAL (4 – 6 Cys) με ομοιόμορφη κατανομή. Εξελικτικά, η εμφάνιση γονιδίων που συμμετέχουν και στις τρεις οδούς ενεργοποίησης του συμπληρώματος και καταλήγουν στη διαμόρφωση του συμπλόκου MAC συνοδεύεται με την εμφάνιση των χονδριχθύων. Πιο συγκεκριμένα, όσον αφορά τα γονίδια του συμπληρώματος που περιλαμβάνουν τις περιοχές FIMAC και KAZAL, ο CFI πρωτοεμφανίζεται στα άγναθα, το C6 στους χονδριχθείς και το C7 στους οστεϊχθείς. Η παρουσία των γονιδίων AGRN και FS έχει πιστοποιηθεί νωρίτερα εξελικτικά στο στάδιο των κεφαλοχορδωτών καθώς και στους πλατυέλμινθες των πρωτοστομίων. Έτσι, φαίνεται ότι η περιοχή KAZAL στις πρωτεΐνες AGRN και FS στα ασπόνδυλα αποτελεί προγονική περιοχή όλων των FIMAC και KAZAL που υπάρχουν σήμερα. Ωστόσο, νέες πρωτεϊνικές περιοχές KAZAL εμφανίστηκαν και αργότερα κατά την εξέλιξη των ειδών. Η συντηρητικότητα και των δύο περιοχών FIMAC και KAZAL στο επίπεδο της γονιδιακής τους κληρονόμησης είναι μεγάλη. Όλα τα intron phases των εξονίων που κωδικοποιούν τις περιοχές KAZAL και FIMAC σε όλα τα γονίδια όπου συναντώνται είναι 1, εκτός από τα αντίστοιχα εξόνια για την περιοχή FIMAC της γραμμικής θέσης 1 στις πρωτεΐνες C6 και C7 (intron phase 2), που φαίνεται να είναι εξελικτικά μεταγενέστερες περιοχές, και δημιουργήθηκαν με διπλασιασμό εξονίου, σε μεταγενέστερα εξελικτικά στάδια. / The complement system is a key component of the innate immune system and links the innate and adaptive immunity. It consists of more than 35 soluble and membrane proteins that initially are found as inactivated proenzymes and they can be activated by a proteolytic cascade. All three pathways that activate the complement leads to the formation of a Membrane Attack Complex (MAC) that lyses the pathogenic microorganisms. Proteins that participate in the formation of MAC, belongs to the MACPF (MAC – Perforin) family. The FIMAC (Factor I Membrane Attack Complex) module plays significant role in the function of MACPF proteins. The Complement proteins 6 (C6) and 7 (C7) that are components of the MAC, include the FIMAC module in their sequences and it seems that this module is their binding region with C345C of C5b. Moreover, the FIMAC module exists in Complement Factor I (CFI), which is a serine protease (SP) and degrades C4b and C3b molecules. The carboxyl - terminal of FIMAC module binds allosteric with the SP region in CFI and seems to be important for the function of CFI as a serine protease. The model for the analysis of FIMAC module was based in Follistatin Domain (FD) of follistatin (FS) protein, which has been analyzed by crystallography. FIMAC and FD modules seem to have homologous sequences. The FD structure is a hybrid of an amino – terminal EGF (Epidermal Growth Factor) subdomain and of a carboxyl – terminal similar to ovomucoid subdomain, which is called KAZAL and is present in many serine protease inhibitors. The FD module is also present in the Agrin (AGRN) protein. AGRN is an extracellular matrix molecule released by the nerve and is critical for the formation of the neuromuscular junction. The subject of this work was the study of FIMAC and KAZAL modules concerning their function, structure and evolution. There were used data from biological databases and bioinformatic tools for analysis. The nucleotide and amino acid sequences of C6, C7, CFI, AGRN and FS genes from the organisms that were found (vertebrates and invertebrates), and more specific, FIMAC and KAZAL sequences, were the primary material of this study. There are differences in the length of the primary structures of FIMAC ( ̴ 78aa) and KAZAL ( ̴ 55aa) modules, except for some KAZAL modules of AGRN and FS proteins (>80aa). The secondary structures of FIMAC and KAZAL modules seem to be similar as both of them contain α-helix and β-sheet conformations. Simulation models of tertiary structure of both FIMAC and KAZAL modules revealed a common conformation of α-helix and β-sheet in space. The presence of cysteine residues are very conserved and seem to be important in FIMAC (8 – 10 Cys) and KAZAL (4 – 6 Cys) modules, although the concentration of cysteine residues in FIMAC modules are denser in amino – terminal region compared with their corresponding concentration in KAZALs, where they follow an equable distribution. Evolutionary, the genes that participate in all three pathways of complement activation and result in MAC formation, first appeared on chondrichthyes. Moreover, FIMAC and KAZAL modules included in CFI sequence found firstly on agnatha, on chondrichthyes in C6 sequences and on osteichthyes in C7 sequences. The presence of AGRN and FS genes were certified earlier in evolution on cephalochordates and platyelminthes of protostomes. As a result, it seems that the KAZAL modules of AGRN and FS proteins in invertebrates are the ancestors of all FIMAC and KAZAL modules. Nevertheless, new KAZAL modules appeared later during evolution of species. At the genomic level, exons corresponding to the FIMAC and KAZAL modules are highly conserved in different taxa. Intron phases of all exons corresponding to the FIMAC and KAZAL modules in all genes are 1, except for exons of FIMAC modules in first position of C6 and C7 genes (phase 2) that seem to be evolutionary posterior and were emerged by exon duplication, later in evolution.

Das Fuzzy Vault ist ein beliebter Ansatz, um die Minutien eines menschlichen Fingerabdrucks in einer Sicherheitsanwendung geschützt zu speichern. In dieser Arbeit werden verschiedene Implementationen des Fuzzy Vault für Fingerabdrücke in verschiedenen Angriffsszenarien untersucht. Unsere Untersuchungen und Analysen bestätigen deutlich, dass die größte Schwäche von Implementationen des Fingerabdruck Fuzzy Vaults seine hohe Anfälligkeit gegen False-Accept Angriffe ist. Als Gegenmaßnahme könnten mehrere Finger oder sogar mehrere biometrische Merkmale eines Menschen gleichzeitig verwendet werden. Allerdings besitzen traditionelle Fuzzy Vault Konstruktionen eine wesentliche Schwäche: den Korrelationsangriff. Es ist bekannt, dass das Runden von Minutien auf ein starres System, diese Schwäche beheben. Ausgehend davon schlagen wir eine Implementation vor. Würden nun Parameter traditioneller Konstruktionen übernommen, so würden wir einen signifikanten Verlust an Verifikations-Leistung hinnehmen müssen. In einem Training wird daher eine gute Parameterkonfiguration neu bestimmt. Um den Authentifizierungsaufwand praktikabel zu machen, verwenden wir einen randomisierten Dekodierer und zeigen, dass die erreichbaren Raten vergleichbar mit den Raten einer traditionellen Konstruktion sind. Wir folgern, dass das Fuzzy Vault ein denkbarer Ansatz bleibt, um die schwierige Aufgabe ein kryptographisch sicheres biometrisches Kryptosystem in Zukunft zu implementieren.

Coronary heart disease, including acute myocardial infarction (AMI), is the nation's leading cause of death. This study examined the characteristics and outcomes of 397 African American (AA) patients within one year of hospitalization due to AMI at Grady Memorial Hospital (GMH) in Atlanta. The PREMIER study, a nationwide registry, maintained by John Spertus MD, included data from patient interviews, medical records, and clinical characteristics like diabetes, hypertension, smoking, angina frequency and quality of life was used. Patient characteristics, associated with a major adverse event (MAE) within one-year post AMI were evaluated using SAS. Results showed a trend of higher odds of younger age, hypertension, and diabetes in women than men at the time of hospitalization. Although this study did not show any gender differences in the outcomes of AA patients following AMI, a trend of effect modification by gender on various variables was seen. Further research is recommended to examine factors contributing to gender differences in outcomes after an AMI.

It is very important to study the mental health impact of disasters to provide adequate mental health services when there is an increased demand of mental health services and a concurrent deterioration of mental healthcare capacity after disasters. This study examined the mental health impact of 9/11 attacks among the individuals living close to the disaster area and compared them to the individuals living farther from the disaster area. New York (NY) state and Washington DC were selected as the disaster areas and Illinois (IL) was selected to study individuals living farther from the disaster area. The study also assessed the effects of mental health on risky behaviors such as cigarette smoking and alcohol consumption and how they vary based on age, gender and proximity to the disaster. Ten year Behavior Risk Factor Surveillance System (BRFSS) data from 1996-2005 was obtained for NY, DC and IL. Significant increase in mental distress was observed in NY and DC but not in IL. Increased use of alcohol was found among DC and NY residents but the increase in IL was not significant. Logistic regression showed that increase in alcohol consumption was not associated with mental health. An overall decrease in cigarette smoking was observed and there was no impact of disaster on smoking rates. Mental distress was much higher among the female respondents as compared to the male respondents. Mental distress was highest among 35- 49 year old respondents as compared to other age groups. In future longitudinal studies should be conducted in order to establish the causal relationship of mental health and risk behaviors such as smoking and alcohol consumption after disasters. Most of the interventions regarding post-disaster mental health focus on PTSD but other mental disorders should also be addressed.