A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Background: The International Prognostic Scoring System (IPSS) for myelodysplastic syndrome (MDS) is commonly used to predict survival and assign treatment. We explored whether markers of frailty add prognostic information to the IPSS in a cohort of older patients. Design, Setting, Participants: Retrospective cohort study of 114 MDS patients ≥ age 65 who presented to Dana‐Farber Cancer Institute between 2006‐2011 and completed a baseline quality of life questionnaire. Measurements: We evaluated questions corresponding to frailty and extracted clinical‐ pathologic data from medical records. We used Kaplan‐Meier and Cox proportional hazards models to estimate survival. Results: 114 patients consented and were available for analysis. The median age was 72.5 years, and the majority of patients were white ( 94.7%), male ( 74.6%), and over half had a Charlson comorbidity score < 2. Few patients ( 23.7%) had an IPSS score consistent with low‐risk disease and the majority received chemotherapy. In addition to traditional prognostic factors (IPSS score and history of prior chemotherapy or radiation), significant univariate predictors of survival included low serum albumin, Charlson score, the ability to take a long walk, and interference of physical symptoms in family life. The multivariate model that best predicted mortality included low serum albumin (HR=2.3; 95%CI: 1.06‐5.14), previous chemotherapy or radiation (HR=2.1; 95%CI: 1.16‐4.24), IPSS score (HR=1.7; 95%CI: 1.14‐2.49), and ease taking a long walk (HR=0.44; 95%CI: 0.23‐0.90). Conclusions: In this study of older adults with MDS, we found that markers of nutritional status and self‐reported physical function added important prognostic information to the IPSS score. More comprehensive risk assessment tools for older patients with MDS that include markers of function and frailty are needed.

Thesis (M. Sc.)--University of Hong Kong, 2002. / Includes bibliographical references.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第21305号 / 人健博第61号 / 新制||人健||5(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 足立 壯一, 教授 藤井 康友, 教授 羽賀 博典 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

The purpose of this study was to revise and revalidate the scoring procedure of the DISCOVER Mathematics Assessment to allow evaluators to better measure creative problem solving ability in mathematics, identify gifted students, and evaluate the programs developed for fostering creative problem solving. The data for this study consisted of 233 students selected from five different grade levels. I conducted descriptive statistics and regression analyses to compare the relationships of both the original and revised versions of the scoring system with general creativity. I found that range increased from the original to the revised version of the scoring system for mathematical problem solving performance in semi-open-ended problems, however it decreased for overall performance and performance in open-ended problems. Variance, on the other hand, increased for both overall problem solving performance and performance in semi-open-ended problems, and decreased for performance in open-ended problems from the original to the revised version of the scoring system. Furthermore, in the revised model all three variables of the creative mathematical problem solving performance (overall performance, performance in semi-open-ended problems, and performance in open-ended problems) explained more variance in general creativity than the original version. Statistically, the differences between the original and the revised versions were significant for all three variables, except for creative mathematical problem solving performance in open-ended problems. Across grade levels, I found that for the group Lower Grade Levels (grade levels 1 and 2), the explained variance in general creativity increased from the original to the revised version for both overall performance and performance in semi-open-ended problems. However, it decreased for performance in open-ended problems. On the other hand for the group Higher Grade Levels (grade levels 3, 4, and 5) the explained variance in general creativity increased for all three variables from the original to the revised version. Statistically, the only significant difference between the original and the revised versions was for overall problem solving performance in Higher Grade Levels. I concluded that the revised version of the scoring system was more effective when predicting variance in general creativity for overall problem solving performance, and performance in semi-open-ended problems. Also, it predicted more variance in general creativity for the group Higher Grade Levels than the group Lower Grade Levels. Therefore, I suggested that quality should be considered as well as fluency, flexibility, and originality when scoring assessments for creative problem solving ability in mathematics.

Background: Concussion assessments rely on a multifaceted approach where evaluation of balance and postural control plays an important role. Following a concussion, 67% of individuals report dizziness as a persistent symptom and 30% experience balance impairments. Studies incorporating the common Balance Error Scoring System (BESS) tool suggest that these impairments return to pre-injury baselines within ten days of incident. In contrast, however, studies incorporating more advanced posturography methods observe significant differences in balance up to one year following injury. While the BESS is consistently associated with low sensitivity and poor reliability scores, advanced posturography systems using force plates are not practical or accessible in most recreational sports environments. Recently, the Wii Balance Board (WBB) has been identified as a potential force plate proxy. Research confirms that the WBB is both valid and reliable in collecting center of pressure data. Thus, the WBB may be useful for investigating post-concussion balance deficits. Objective: The purpose of this study was to investigate the potential utility of a customized WBB program to assess postural balance in an athletic population. The study aimed to assess change in postural balance using the clinical BESS and WBB assessment tools to evaluate balance at fixed intervals during a regular athletic season and following concussion. Design: Prospective partial cohort. Methods: Balance was assessed at baseline, mid-, and post-season. Individuals who sustained a concussion during the study period were further assessed weekly for four weeks post-injury. Results: No significant differences were observed in raw BESS scores across regular season or post-concussion time points. In contrast, significant differences in several WBB outcome measures were observed. In the single stance condition, COPML worsened by 24% and COPT worsened by 9% between baseline and post-season time points (p=.002 and p=.007). In contrast, participants improved by 14% on a timed dynamic task (p=.003) between baseline and post-season time points. Following concussion, only the WBB dynamic outcome measures were found to be statistically significant. A positive trend was observed post-concussion, suggesting that a learning effect exists with the dynamic WBB program. Conclusion: Study results emphasize the importance of considering the progression of athletic season when interpreting baseline and post-concussion balance measurements. Study results support the use of a quantitative balance assessment, such as with a WBB, to improve measurement of static and dynamic postural balance. / Graduate / 0566 / hilarymcullen@gmail.com

Purpose: To introduce the simplified therapeutic intervention scoring system (TISS-28), the original therapeutic intervention scoring system (TISS-76) and simplified acute physiological score (SAPS) version II in critically ill adult patients, in order to describe the validity and reliability of TISS-28 as a suitable measure of quantifying nursing workload in the adult intensive care units (ICU) of a public sector hospital in Johannesburg. Objectives: To describe the profile of patient admissions to the intensive care units, to investigate the impact of the patients’ profile on the requirements for nursing workload and to validate the use of TISS-28 as a measure of quantifying nursing workload in this setting. Design: A non-experimental, comparative descriptive, correlational and prospective two-staged design was utilized to meet the study objectives. Stage I involved face and content validation of TISS-28 by a panel of ICU nurse experts (n=6). Stage II involved assessment of concurrent and construct validity as well as inter-rater reliability of TISS-28 using participants (n=105) drawn from trauma, cardiothoracic and multidisciplinary ICUs. Data necessary for the calculation of TISS-28, TISS-76 and SAPS II were recorded for each patient in the ICU at 24 and 48 hours after admission and in the wards after discharge within 24-48 hours. Descriptive and inferential statistics were used to analyze data. Results: Content Validity Index (CVI) of 0.93 was found for TISS-28. A significant positive correlation was found between TISS-28 and TISS-76 scores (r = 0.7857, p = 0.0001) as well as TISS-28 and SAPS II scores (r = 0.2098, p = 0.0317). A significant difference was found between TISS-28 scores among patients in the ICU and patients in the ward (t = 25.59, p = 0.0001; t = 21.48, p = 0.0001) respectively. A significant correlation was found between the data collected from a sample of patients by the researcher and the expert assistant researcher with an intra-class correlation coefficient of 0.99 and a p-value of 0.0001. Conclusions: The findings support validity and reliability of TISS-28 hence its feasibility for use in South African ICUs. Recommendations for nursing education, practice, management and research are proposed.

Abstract According to the latest statistical data from Ministry of Finance, it is found that domestic consuming loan is growing up continuously these years. Up to the end of September in 2000 the sum of this business is 3984.9 billion. It is equal to 34.1% among loan of native banks. Personal small-scale consumer credit is increasing at 18% rate per year from 148.6 billion in 1994 to 365.1 billion in the end of September in 2000. It is developed vigorously, and even to be the main profit for banks. This is because consumers have slowly changed their concepts about how to use their money. Another reason is that the banks are actively to provide small-scale consumer credit with easy formality. But its potential risk is becoming higher since depression in economy and unemployment are getting higher. ¡§How to do the credit estimation for your consumers; how to make the lost of breaking an appointment lower¡¨ is the most urgent for the banks who would like to have good performance in the field of consuming finance. This research takes 1764 consumers who have small-scale consumer credit from a specific bank as samples for analysis. We found 29 elements that will affect the payment from literature and credit estimation from other branches. After concluding 6 types of credit risk, 25 influent elements offered by sample bank are listed for the purpose of analysis. ¡§K-W independent check¡¨ and ¡§Spearman¡¦s rho related analysis¡¨ are used to gain 17 variables. They are interactive and remarkable for credit. The summarized introduction of this research is as follows. 1. Age is notable for payment. The risk between ages of 41 ~45 is higher than the average. Seniority around 7 ~10 years is also dangerous. The above appearance is figured out to be concerned about transition of economical environment such as depression in economy and unemployment. The thought ¡§ higher ages or seniority means lower risk¡¨ should be done some amendment. 2. Actual net income should be considered while estimating the credit. Higher income is not necessarily equal to lower risk. People with high income were easily to obtain more loans since they would have better payment capacity. It is observed from credit estimation of each bank. In fact income is unable to reflect payment capacity. Debt will be important reason to influence payment capacity. 3. Having real property doesn¡¦t mean having no risk. We could find that consumer¡¦s property usually took large percentage in credit estimation. Sometimes consumers would become dangerous since they had debt for real property. The banks had better to correct their illusion ¡¨land is wealth¡¨ as soon as possible. 4. More or less guarantees are not essential for credit risk. Simple and fast formality appeals to the popular while the banks are promoting small-scale consumer credit. In the past the banks believed that more guarantees could lower the risk. It is wrong and will be the block in developing business. The banks should focus on payment capacity as main accordance for credit estimation. Key words: Consumers loan; Credit risk management, Credit scoring system.

国立情報学研究所で電子化したコンテンツを使用している。

Bakgrund: Främre korsbandsskador (ACL-skador) är allvarliga och vanligt förkommande inom idrott, speciellt hos ungdomar i åldrarna 14-19 år. En förhöjd risk för ACL-skador har påvisats för individer aktiva inom fotboll och handboll, vilka är mycket populära sporter världen över. Inom dessa sporter har även kvinnor påvisats ha två till åtta gånger högre risk att drabbas än män. Syfte: Syftet var att undersöka om det fanns någon skillnad i knästabilitet vid en hopp-landningsrörelse mellan tjejer och killar i åldrarna 16-19 år, aktiva inom fotboll och handboll samt att undersöka om det fanns någon skillnad mellan fotbollsspelarna och handbollsspelarna, oavsett kön. Metod: Ett drop jump-test utfördes av 20 ungdomar, aktiva inom fotboll och handboll, medelålder ±SD 17,0 ± 0,9 år. Testerna filmades i frontal- och sagittalplanet och analyserades sedan med hjälp av Landning Error Scoring System (LESS). Post hoc-analyser genomfördes för att kontrollera skillnader i 1) graden av valgusställning i knäleden mellan tjejerna och killarna och 2) graden av knäflexion mellan fotbolls- och handbollsspelarna i landningsmomentet. Ett oberoende student’s t-test användes till de statistiska analyserna och signifikansnivån sattes till p ≤ 0,05. Resultat: Det fanns ingen signifikant skillnad i LESS-poäng mellan tjejerna och killarna (p = 0,694). Fotbollsspelarna hade signifikant lägre LESS-poäng än handbollsspelarna (p = 0,002). Andelen tjejer som uppvisade valgusställning i knäleden under testutförandet var högre än hos killarna. Fotbollsspelarna uppvisade enligt LESS tillräcklig knäflexion i landningsmomentet i högre utsträckning än handbollsspelarna under testutförandet. Slutsats: Ingen signifikant skillnad i knästabilitet och hopp-landningsteknik fanns mellan tjejerna och killarna. Fotbollsspelarna hade signifikant bättre knästabilitet och hopp-landningsteknik än handbollsspelarna. Tjejerna hade en större grad av valgusställning i knäleden vid testutförandet än killarna och handbollsspelarna uppvisade inte lika stor knäflexion som fotbollsspelarna vid testutförandet. Mer forskning krävs inom området för att resultaten ska kunna generaliseras. / Background: Anterior cruciate ligament injuries (ACL-injuries) are serious and common in sports, especially in adolescents between the ages of 14 and 19. An increased risk for ACL-injury has been shown in individuals active in soccer and team handball, which both are popular sports worldwide. Within these sports, women have been proven to have two to eight times greater risk for ACL-injury than men. Aim: The aim was to investigate whether there was any difference in knee stability during a jump-landing movement between girls and boys aged 16-19 years, active in soccer and team handball and also to investigate whether there was any difference between the soccer players and team handball players, regardless of gender. Method: A drop jump test was performed by 20 adolescents, active in soccer and team handball, mean ± SD age 17.0 ± 0.9 years old. The tests were recorded in the frontal and sagittal plane and were then analyzed using the Landing Error Scoring System (LESS). Post hoc analyzes were used to examine differences in 1) the degree of knee valgus alignment between the girls and the boys and 2) the degree of knee flexion between the soccer- and the team handball players in the landing movement. An independent student’s t-test was used in the statistical analysis and the level of significance was set at p ≤ 0.05. Results: There was no significant difference in LESS-score between the girls and the boys (p = 0.694). The soccer players had significantly lower LESS-score (p = 0.002). A higher frequency of the girls displayed a knee valgus alignment during the test compared to the boys. The soccer players displayed according to LESS adequate knee flexion to greater extent than the team handball players did during the test. Conclusion: No significant difference in knee stability and jump-landing technique was found between the girls and the boys. The soccer players displayed significantly better knee stability and jump-landing technique than the team handball players. The girls displayed a greater degree of knee valgus during the test than the boys did and the team handball players displayed a smaller degree of knee flexion then the soccer players did. More research is required within the area to be able to generalize the results.

A large number of organizations these days are offering some kind of digital services, relyon digital technologies for processing, storing, and sharing of information, are harvesting moderntechnologies to offer remote working arrangements and may face direct cybersecurity risks. Theseare some of the properties of a modern organization. The cybersecurity vulnerability managementprograms of most organizations have been relying on one-dimensional information to prioritizeefforts of remedying security flaws for many years. When combined with the ever-growing attacksurface of modern organizations, the number of vulnerabilities disclosed yearly and the limitedresources available to cybersecurity teams, this renders the goal of securing an organization almostimpossible. This thesis aims at reviewing existing methodologies as observed in academicliterature and in the industry, highlighting their disadvantages, as well as the importance of adynamic, data-driven and informed approach and finally providing a tool that can assist thevulnerability prioritization efforts and increase resource utilization and efficiency. The thesis isinspired by Design Science Research, to design and develop a web-based cybersecurity tool thatcan be utilized towards a data-rich and rigorous approach of Vulnerability Management, by relyingon various cyber threat intelligence metrics.