Cyanobacteria, also known as blue-green algae for a long time, are the most ancient and problematic bloom-forming phylum on earth. An alert levels framework has been established by World Health Organization(WHO) to prevent the potential harmful cyanobacterial blooms. Normally, low cyanobacteria levels are found in surface water. 2000 cyanobacterial cells/mL and 100,000 cyanobacterial cells/mL are established for WHO Alert Level 1 and 2, respectively. However, eutrophication, climate change and other factors may promote the spread of cyanobacteria and increase the occurrence of harmful cyanobacterial blooms in water on a global scale. Hence, a rapid real time cyanobacteiral monitoring system is required to protect public health from the cyanotoxins produced by toxic cyanobacterial species. Current methods to control or prevent the development of harmful cyanobacterial blooms are either expensive, time consuming or not effective in the long term. The best method to control the blooms is to prevent the formation of the blooms at the very beginning. Although emerging advanced autofluorescence-based sensors, imaging flow cytometry applications, and remote sensing have been utilized for rapid real-time enumeration and classification of cyanobacteria, the need to accurately monitor low-level cyanobacterial species in water remains unsolved. Microflow cytometry has been employed as a functional cell analysis technique in past decades, and it can provide real-time, accurate results. The autofluorescence of cyanobacterial pigments can be used for determination and counting of cyanobacterial density in water. A pre-concentration system of an automated cyanobacterial concentration and recovery system (ACCRS) based on tangential flow filtration and back-flushing technique was applied to reduce the sample assay volume and increase the concentration of target cells for further cell capture and detection. In this project, a microflow cytometry platform with a microfluidic device and an automated pre-concentration system was established to monitor cyanobacteria and provide early warning alerts for potential harmful blooms. In this work, quantification of low-level cyanobacterial samples (∼ 5 cyanobacterial cells/mL) in water has been achieved by using a microflow cytometer together with a pre-concentration system (ACCRS). Meanwhile, this platform can also provide early warning alerts for potential harmful cyanobacterial blooms at least 15 days earlier before reaching WHO Alert Level 1. Results have shown that this platform can be applied for rapid determination of cyanobacteria and early warning alerts can be triggered for authorities to protect the public and the environment. / Thesis / Doctor of Engineering (DEng) / Harmful cyanobacterial blooms have been a rising risk to the public heath across the world in recent decades. Alert levels of cyanobacteria in water has also been established. In this case, a rapid on-side monitoring system for cyanobacteria is required. In this thesis, a microflow cytometer platform combined with a bacterial concentration and recovery system was built to quickly monitor the relatively low level of cyanobacteria for early warning alerts. A pre-enrichment system based on tangential flow filtration and back-flushing technique was applied to increase the concentration levels of microbial samples and a microfluidic device capable of collecting phycocyanin fluorescence was designed to count cyanobacterial cells. The limit of quantification for cyanobacterial concentration based on the microflow cytometry platform was as low as ∼ 5 cells/mL. We can claim that the microflow cytometry platform can provide useful early warning alerts for the decision-makers to control the potential harmful cyanobacterial blooms at the very early stage and protect the aquatic animals and public health.

Bakgrund: Sepsis som i vardagligt tal benämns blodförgiftning är ett allvarligt tillstånd och uppstår när kroppens immunsystem överreagerar på en infektion. Är de metabola och cirkulatoriska förändringarna påtagligt förhöjda i kombination med organdysfunktion benämns tillståndet som septisk chock. Tidig identifikation har en betydande roll för patientens överlevnad och livskvalité. Sjuksköterskan arbetar patientnära och med rätt förutsättningar möjliggörs tidig identifikation. Syfte: Syftet är att belysa sjuksköterskans omvårdnadsåtgärder för tidig upptäckt av sepsis. Metod: Studien utfördes som en litteraturöversikt där både kvalitativa och kvantitativa artiklar användes. Fribergs granskningsmall användes för att granska kvalitén. Resultat: Två huvudteman identifierades; Sjuksköterskans kunskap och Ett gemensamt förhållningssätt som sedan följs av sex subteman; Kunskapsutveckling och sepsisprotokoll, Vikten av praktisk kunskap, Teamsamverkan, Stödjande bedömningsverktyg - NEWS, Vikten av att tala samma språk och Kliniska blicken. Konklusion: Denna litteraturöversikt belyser faktorer som kan inverka på sjuksköterskans möjlighet att identifiera sepsis i tid. Eftersom sepsis är ett vanligt och allvarligt tillstånd är det av betydelse att sjuksköterskor ges möjlighet att öka kompetensen inom området. Eftersom det brister inom hälso- och sjukvården avseende huruvida sepsis upptäcks i tid, bör vidare forskning inom området studeras för att minska patientens lidande och för att minska dödlig utgång. / Background: Sepsis also known as blood poisoning, is a serious condition and occurs when the body's immune system overreacts to an infection. If the metabolic and circulatory changes are significantly increased in combination with organ dysfunction, the condition is called septic shock. Early identification has a significant role for the patient's quality of life and survival. The nurse works close to the patient and with the right conditions early identification is possible. Aim: The aim is to shed light on the nurse´s care measures for early detection of sepsis. Method: The study was conducted as a literature review where both qualitative and quantitative articles were used. Friberg's review template was used to review the quality. Findings: Two main themes were identified; The nurse's knowledge and A joint approach which is then followed by six sub-themes; Knowledge development and sepsis protocols, The importance of practical knowledge, Team collaboration, Supporting assessment tools - NEWS, The importance of speaking the same language and The clinical gaze. Conclusion: This literature review highlights factors that can influence the nurse's ability to identify sepsis in time. As sepsis is a common and serious condition, it is important that nurses are given the opportunity to increase their competence in the area. Since there are deficiencies in the healthcare system regarding whether sepsis is detected in time, further research in the field should be studied to reduce patient suffering and to reduce mortality.

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The purpose of the study was to investigate the establishment of an early warning system and subsequent intervention with college freshmen, which addressed both the academic viability and retention of first-year students. The population of interest was first-semester students who were predicted to succeed by standard admissions criteria, but fail to achieve minimum academic standards at the university level. The two main goals of the study were to: a) validate the use of a prediction model to establish a system of early identification of first-semester college students who are at-risk of academic difficulty, and b) examine the efficacy of an intervention designed to support these students. Using first-semester GPA as the outcome variable, a prediction equation was developed using multiple regression with historical data (both cognitive and non-cognitive variables) from a prior cohort of freshmen. The equation was applied to a new cohort of freshmen, who were assigned levels of academic risk. An advising-based intervention was utilized with the most academically at-risk students in the participating academic unit. The results of the study showed that the risk prediction equation was modestly correlated with first-semester GPA (r=.48, p<.001), while a step-wise multiple regression revealed that individual predictors were differentially effective among the risk levels. Comparisons of first-year academic performance indicated that the intervention was not effective in remediating risk variables for the experimental group. While the risk prediction and categorization system showed promise, modifications could be made to further enhance effectiveness across the full continuum of risk levels, including the development of the equation with subgroups of interest as well as use of more sophisticated instrumentation to measure key non-cognitive variables. In order to establish an effective intervention, future efforts should guided by knowledge of individualized risk factors and relevant theoretical approaches. / Educational Psychology

Yes / Hospital-acquired Acute Kidney Injury (H-AKI) is a common cause of avoidable morbidity and mortality. To determine if the patients’ vital signs data as defined by a National Early Warning Score (NEWS), can predict H-AKI following emergency admission to hospital. Methods: Analyses of emergency admissions to York hospital over 24-months with NEWS data. We report the area under the curve (AUC) for logistic regression models that used the index NEWS (model A0), plus age and sex (A1), plus subcomponents of NEWS (A2) and two-way interactions (A3). Likewise for maximum NEWS (models B0,B1,B2,B3). Results: 4.05% (1361/33608) of emergency admissions had H-AKI. Models using the index NEWS had the lower AUCs (0.59 to 0.68) than models using the maximum NEWS AUCs (0.75 to 0.77). The maximum NEWS model (B3) was more sensitivity than the index NEWS model (A0) (67.60% vs 19.84%) but identified twice as many cases as being at risk of H-AKI (9581 vs 4099) at a NEWS of 5. Conclusions: The index NEWS is a poor predictor of H-AKI. The maximum NEWS is a better predictor but seems unfeasible because it is only knowable in retrospect and is associated with a substantial increase in workload albeit with improved sensitivity. / The Health Foundation

Yes / Routine administrative data have been used to show that patients admitted to hospitals over the weekend appear to have a higher mortality compared to weekday admissions. Such data do not take the severity of sickness of a patient on admission into account. Our aim was to incorporate a standardized vital signs physiological-based measure of sickness known as the National Early Warning Score to investigate if weekend admissions are: sicker as measured by their index National Early Warning Score; have an increased mortality; and experience longer delays in the recording of their index National Early Warning Score. Methods: We extracted details of all adult emergency medical admissions during 2014 from hospital databases and linked these with electronic National Early Warning Score data in four acute hospitals. We analysed 47,117 emergency admissions after excluding 1657 records, where National Early Warning Score was missing or the first (index) National Early Warning Score was recorded outside ±24 h of the admission time. Results: Emergency medical admissions at the weekend had higher index National Early Warning Score (weekend: 2.53 vs. weekday: 2.30, p

Yes / The novel coronavirus SARS-19 produces 'COVID-19' in patients with symptoms. COVID-19 patients admitted to the hospital require early assessment and care including isolation. The National Early Warning Score (NEWS) and its updated version NEWS2 is a simple physiological scoring system used in hospitals, which may be useful in the early identification of COVID-19 patients. We investigate the performance of multiple enhanced NEWS2 models in predicting the risk of COVID-19. Our cohort included unplanned adult medical admissions discharged over 3 months (11 March 2020 to 13 June 2020 ) from two hospitals (YH for model development; SH for external model validation). We used logistic regression to build multiple prediction models for the risk of COVID-19 using the first electronically recorded NEWS2 within ± 24 hours of admission. Model M0' included NEWS2; model M1' included NEWS2 + age + sex, and model M2' extends model M1' with subcomponents of NEWS2 (including diastolic blood pressure + oxygen flow rate + oxygen scale). Model performance was evaluated according to discrimination (c statistic), calibration (graphically), and clinical usefulness at NEWS2 ≥ 5. The prevalence of COVID-19 was higher in SH (11.0 %=277/2520) than YH (8.7 %=343/3924) with a higher first NEWS2 scores ( SH 3.2 vs YH 2.8) but similar in-hospital mortality (SH 8.4 % vs YH 8.2 %). The c-statistics for predicting the risk of COVID-19 for models M0',M1',M2' in the development dataset were: M0': 0.71 (95 %CI 0.68-0.74); M1': 0.67 (95 %CI 0.64-0.70) and M2': 0.78 (95 %CI 0.75-0.80)). For the validation datasets the c-statistics were: M0' 0.65 (95 %CI 0.61-0.68); M1': 0.67 (95 %CI 0.64-0.70) and M2': 0.72 (95 %CI 0.69-0.75) ). The calibration slope was similar across all models but Model M2' had the highest sensitivity (M0' 44 % (95 %CI 38-50 %); M1' 53 % (95 %CI 47-59 %) and M2': 57 % (95 %CI 51-63 %)) and specificity (M0' 75 % (95 %CI 73-77 %); M1' 72 % (95 %CI 70-74 %) and M2': 76 % (95 %CI 74-78 %)) for the validation dataset at NEWS2 ≥ 5. Model M2' appears to be reasonably accurate for predicting the risk of COVID-19. It may be clinically useful as an early warning system at the time of admission especially to triage large numbers of unplanned hospital admissions. / The Health Foundation (Award No 7380) and the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC) (Award No PSTRC-2016-006) / Research Development Fund Publication Prize Award winner, Aug 2021.

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Doctor of Philosophy / Department of History / Mark P. Parillo / The Distant Early Warning (DEW) Line, a key program under President Dwight D. Eisenhower’s “New Look” policy, prepared the United States defense posture for “the long haul” in the Cold War. Eisenhower wanted to prevent the escalation of military costs while still providing an adequate defense. Eisenhower emphasized a retaliatory capability and improved continental defenses, the so-called “sword and shield,” which are key features of the New Look. The DEW Line would prove to be a vital component of both. Whereas the initial emphasis of the DEW Line was to warn against attack providing for both active and passive defense measures, soon there was a definite “counter-offensive” role for the DEW Line as well—the protection of the primary retaliatory capability of the United States: the Strategic Air Command (SAC). The place of the DEW Line in the history of the Cold War has been an under appreciated topic. With the exception of the scholarship from the 1950s and early 1960s, only recently have continental defense and particularly the DEW Line been removed from the shadows of other Cold War events, strategies, and military programs. This doctoral thesis is an account of the DEW Line’s conception, implementation, and position in Eisenhower’s New Look and deterrent strategy. The DEW Line proved to be a cardinal feature of Eisenhower’s New Look strategy: it strengthened overall U.S. defenses and defense posture as the one element of U.S. defense policy (“New Look”) that improved and connected both the active and passive measures of continental defense by providing early warning against manned bombers flying over the polar region; it bolstered the deterrent value of SAC; and it was instrumental in developing closer peacetime military cooperation between the United States and Canada. In fact, U.S.- Canadian diplomacy during the 1950s offers an important case study in “superpowermiddle power” interaction. However, despite the asymmetry in their relationship, U.S.- Canadian defense policies proved to be analogous. All of these objectives could not have been accomplished without the technological and logistical abilities necessary to construct successfully the DEW Line.