OBJECTIVE: The goal of this research was to examine the clinical utility of the digital Clock in the Box (dCIB), a novel digitized cognitive screening test. This was accomplished by (1) creating cutoff scores for the dCIB, (2) evaluating performance on the dCIB relative to established cognitive screening and standardized neuropsychological measures, and (3) determining the efficacy of the dCIB to screen for subtle cognitive deficits associated with poor vascular health. Metabolic Syndrome (MetS; clinical syndrome of three or more cardiovascular risk factors) is a rising health epidemic associated with an increased risk for cerebrovascular disease and vascular dementia. Early detection of subtle deficits associated with MetS may assist in regulation of disease progression and prevention of future vascular dementia. METHODS: A community-based sample of adults with no self-reported history of cognitive impairment was recruited for a cross-sectional study in which they completed a metabolic assessment, blood draw, and a brief neuropsychological battery consisting of the dCIB, the Mini-Mental State Exam (MMSE), and measures of executive function, memory, and attention. For part of the analysis, participants were separated into MetS (n=21) and non-MetS (n=42) groups based on current diagnostic criteria for MetS. RESULTS: Participants (N=63) were older (62.49 ± 9.16 years), educated (16.46 ± 2.76 years), and diverse with 44.4% female (n=28) and 28.6% non-White (n=18). Receiver operating characteristic (ROC) analysis and Youden’s J statistic determined the optimal cutoff value for the dCIB as 5.5 (dCIB score ≤ 6 indicating suspected impairment; dCIB score ≤ 5 indicating probable impairment). Performance on the dCIB (6.32 ± 2.32) was significantly correlated with the MMSE (28.19 ± 2.06); (Pearson’s r = 0.437, p = 0.000). The dCIB had better sensitivity (72.7%) but poorer specificity (65.4%) compared to the MMSE (sensitivity 45.5%; specificity 94.2%). Using regression modeling, the dCIB significantly predicted performance on measures of executive function, memory, and attention. In a sample stratified by vascular risk, the dCIB successfully differentiated MetS (5.33 ± 2.75) and non-MetS (6.81 ± 1.93) groups, with lower dCIB scores in the MetS group relative to the non-MetS group (F = 8.975, p = 0.004). CONCLUSION: The dCIB is a novel digitized clock drawing task designed to screen for cognitive impairment. Clinical utility for the dCIB was established by determining its test validity and demonstrating its sensitivity to detect subtle cognitive deficits in a sample with vascular risk. Because the dCIB is simple to administer and brief to complete, it may be an ideal option for routine cognitive screening in primary care settings.

Two-Factor Authentication (2FA) is a two-step verification process that aims to provide an additional layer of security by requiring the user to authenticate himself/herself using a secondary means (ownership factor or inheritance factor). Without the use of 2FA, an attacker could gain access to a person’s devices or accounts solely by knowing the victim’s password, while with 2FA knowing only this password is insufficient to pass the authentication check. In this project, we analyze different methods in which 2FA could be implemented by a Digital Assessment Platform. These platforms allow test assessments to be built directly into digital content; therefore, an important requirement of these systems is secure authentication. Moreover, it is important to securely protect teachers’ account in order to avoid unauthorized people gaining access to those accounts. We investigate how 2FA could be used to add an extra layer of security to teachers’ accounts, focusing on cost, user experience, ease of use, and deployment of the solution. We arrived at the conclusion that 2FA through an ownership factor is a suitable method and we implemented a solution based upon One-Time Passwords. This thesis project will hopefully benefit Digital Assessment Platforms who wish to implement 2FA by providing broader knowledge regarding this subject. The project should also benefit society by increasing the general knowledge of 2FA, hence leading to more secure services. / Tvåfaktorsautentisering (2FA) är en tvåstegs verifieringsprocess som syftar att ge en extra nivå av säkerhet, i och med att den kräver användaren att autentisera sig själv genom en sekundär faktor (något man äger eller har ärvt). Utan användning av 2FA, kan en förövare få åtkomst till en persons mobila enhet eller konto endast genom att kunna offrets lösenord. Att enbart kunna lösenordet är inte tillräckligt för att en autentiseringsprocess ska vara godkänd om 2FA är implementerad. I det här projektet analyseras olika 2FA som skulle kunna implementeras av en digital utvärderingsplattform. Sådana plattformar  förvandlar tester och prov till digitalt innehåll och kräver därför en säker autentisering. Dessutom är det viktigt att säkra lärarnas konton för att undvika att icke auktoriserade personer loggar in på deras konton. Vi undersöker hur 2FA kan användas för att lägga till en extra nivå av säkerhet på lärarnas konton, med fokus på kostnad, användarupplevelse, lättanvändlighet och utplacering av lösningen. Vi kom fram till att 2FA via en faktor man äger är en passande metod  och vi implementerade sedan en lösning grundad på engångslösenord. Detta projekt kan förhoppningsvis vara till förmån för digitala utvärderingsplattformar  som vill implementera 2FA,  genom att ge en bredare kunskap inom detta område. Projektet skulle kunna gynna allmänheten genom att bidra till ökad generell kunskap om 2FA, och därav leda till säkrare tjänster.