The 5-year survival rate for ovarian cancer is only 45% largely due to lack of effective screening methods. Current methods include palpation, transvaginal ultrasound, and the CA-125 blood test. Finding disease reliably and at an early stage increase survival to 92%. We have designed and built a 0.7 mm endoscope for the early detection of ovarian cancer. Inserted transvaginally through the working channel of a hysteroscope, the falloposcope creates a minimally invasive procedure for the screening of high risk women. To improve the ease-of-use and safety of falloposcope deployment, we are working to create an everting balloon. Currently, the falloposcope would require a skilled user to operate due to the challenging anatomy of the fallopian tubes - a small opening from the uterus (< 1 mm), tortuous path, and delicate lumenal features. A balloon delivery system would gently open the fallopian tube and guide the falloposcope down the center of lumen. We show balloon design and discuss integration with the falloposcope prototype. We test possible mechanical damage to the tissue due to scraping, puncture, or overstretching. Successful introduction of the everting balloon to simplify falloposcope delivery could expand screening beyond specialized centers to smaller clinical locations.

Thesis (M.S.)--University of Michigan, 1985. / "A research report submitted in partial fulfillment of the requirements for the degree ..."

Thesis (M.S.)--University of Michigan, 1985. / "A research report submitted in partial fulfillment of the requirements for the degree ..."

Thesis--Wisconsin. / Includes bibliographical references (leaves 139-144).

Resumo: A síndrome do cromossomo X frágil (SXF) é a forma mais comum de deficiência mental herdada. A doença ocorre pela expansão das repetições de trinucleotídeos na região 5' não traduzida do gene FMR1 no cromossomo X. Dependendo do número de repetições CGG originam-se 4 tipos de alelos: normal (NL), pré-mutado (PM), gray zone (GZ) e mutação completa (FM). A instabilidade e expansão das repetições, aliado à metilação do DNA, causam a diminuição ou ausência na produção da proteína FMRP, a qual é essencial para a função cerebral. O diagnóstico da SXF tem sido realizado principalmente por análise molecular Southern blot. Porém, este método é trabalhoso, demorado e de custo elevado. Recentemente foi desenvolvido um novo método molecular para triagem da SXF por PCR, que segundo os autores, é rápido, de baixo custo, e eficiente na detecção das repetições CGG em homens e mulheres. No entanto, notou-se a ausência de informações importantes para reprodução do método. Os objetivos deste estudo foram: (i) padronizar a técnica de PCR proposta por Tassone et al., (2008), adaptando-a, devido a carência de informações metodológicas; (ii) comprovar a exatidão (acurácia), sensibilidade e especificidade do método, comparando-a ao Southern blot; (iii) avaliar a aplicação da técnica utilizando DNA extraído de diferentes materiais biológicos/métodos de extração; (iv) estimar o custo e o tempo de execução do método no mercado nacional. Os materiais biológicos utilizados foram: sangue coletado por sistema à vácuo e células da mucosa oral, que foram extraídos por solventes orgânicos e sangue coletado em cartões FTA, purificado pelo kit Whatman. Obtevese sucesso na reprodução do método da PCR em 75 indivíduos utilizando a enzima Expand Long Template PCR System (Roche Diagnostics). A exatidão (acurácia), sensibilidade e especificidade foram... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Fragile X Syndrome (FXS) is the most common form of inherited mental retardation. The disease occurs by the expansion of triplet nucleotide repeats in the 5' untranslated of the FMR1 gene on chromosome X. Depending on the number of CGG repeats four types of alleles originate from it: normal (NL), pre-mutated (PM), gray zone (GZ) and full mutation (FM). The instability and expansion of these repetitions, together with the methylation of DNA, cause a decrease or absence in the production of the protein FMRP, which is essential for the brain function. The diagnosis of FXS has been done mainly by molecular analysis Southern blot. However, this method is laborious, time consuming and expensive. Recently we have developed a new molecular method for FXS screening by PCR, which according to the authors, is rapid, inexpensive, and efficient in the detection of CGG repeats in male and female. However, we noted the absence of important information for breeding method. The objectives of this study were: (i) to standardize the PCR technique proposed by Tassone et al. (2008), adapting it, due to the lack of methodological information, (ii) verify the accuracy, sensitivity and specificity of the method, comparing it to the Southern blot, and (iii) to evaluate the technique using DNA extracted from different biological materials / extraction methods, and (iv) estimate the cost and time of the method execution in the domestic market. The biological materials used were: blood collected by vacuum system and oral mucosal cells, which were extracted by organic solvents and blood collected on FTA cards, purified by Whatman kit. Success was achieved in the reproduction of the PCR method in 75 individuals using the enzyme Expand Long Template PCR System (Roche Diagnostics). The accuracy, sensitivity and specificity were 100% when analyzing the total sample, indicating that the technique can detect the presence... (Complete abstract click electronic access below) / Orientador: Regina Maria Barretto Cicarelli / Coorientador: Raquel Mantuaneli Scarel Caminaga / Banca: Robson Francisco Carvalho / Banca: Débora Aparecida Rodrigueiro / Mestre

Background: Mild Cognitive Impairment (MCI) is a clinical construct reputed to represent an intermediate stage on a continuum between normal aging and cognitive decline. Conceptual and prognostic ambiguity can lead to significant diagnostic challenges and there is a need for accurate screening tests which can assist clinicians with decision-making. A diagnosis of MCI is also associated with considerable uncertainty for patients who may be adjusting to cognitive difficulties along with an increased risk of developing dementia. Beliefs about MCI may influence psychosocial adjustment, and individual differences in ‘psychological flexibility (PF)’, as conceptualised by the Acceptance and Commitment Therapy (ACT) model, may also be involved in this process. Objectives: In order to evaluate the accuracy and clinical utility of a recently developed screening tool for MCI, the Montreal Cognitive Assessment (MoCA), a systematic review of validation and diagnostic test accuracy (DTA) studies for this measure was conducted. Psychosocial adjustment to a diagnosis of MCI was also a key focus. An empirical study was therefore carried out with the aim of evaluating the possible relationships between cognitive impairment, illness representations about MCI, psychological wellbeing and quality of life (QoL), and to assess the potential involvement of PF. Method: Following a systematic search of relevant electronic databases and reference lists, validation and DTA studies of the MoCA were identified and evaluated for methodological quality. For the empirical study, patients recently diagnosed with MCI were recruited from local NHS memory clinic services and completed the MoCA and a questionnaire pack assessing illness representations, PF, mood, anxiety and QoL. Results: The systematic review identified 18 validation and DTA studies. Few of the studies achieved high ratings for methodological quality and problems with representativeness and generalisability were identified. Nevertheless, sensitivity levels appeared robust across studies, though specificity was variable. For the present empirical study, participants reported a spectrum of positive and negative beliefs about MCI. Distress attributed to MCI was associated with anxiety, along with perceptions of more serious illness consequences, while higher PF was associated with higher perceived QoL and mood. Lived experience of MCI appeared to have more relevance to psychosocial adjustment than objective cognitive impairment. Conclusions: The results of the systematic review indicate that while the MoCA is a robust tool overall in the identification of cognitive impairment, estimates of accuracy may be exaggerated by inter-study variation and bias. More rigorous validation studies are therefore needed. Implications for clinical decision-making regarding MCI are discussed and recommendations for future accuracy studies are outlined. The empirical study supported the findings of previous studies of the relevance of illness representations to psychosocial adjustment in MCI and added to the evidence base by providing preliminary support for the possible involvement of PF. The results suggest that both cognitive content and PF may represent possible vehicles for therapeutic change in patients with adjustment difficulties, and indicate that further investigation of these factors is warranted. Conclusions are limited, however, by small sample size and low statistical power. Replication of these findings with a larger and more representative sample is therefore recommended.

The purpose of this study was to compare NSST data (Lee, 1969, 1971) with data obtained in Portland, Oregon for children 4.0-4.11 years of age. The questions this study sought to answer were: 1) Is there a significant difference between the expressive and receptive scores obtained by Lee, (1969, 1971) and the scores obtained in Portland, Oregon? 2) What are the means, standard deviations and percentiles of the NSST scores of a select group of four-year-old children in Portland, Oregon?

One of the more widely-used methods for pinpointing children in need of more in-depth language evaluation is screening. One language screening instrument designed to accomplish this in an effective and efficient way was the Clinical Evaluation of Language Functions Elementary Screening Test (CELF-S) (Semel & Wiig, 1980). The purpose of this study was to determine the effectiveness of the CELF-S in identifying those children in a second grade setting, who were in need of more thorough evaluation. This study sought to answer the following questions: 1) What is the percentage of false negatives produced by the CELF-S?, and 2) What is the percentage of false positives produced by the CELF-S?

Background: Respiratory conditions are prevalent and cause an enormous burden on society. In recent decades, there has been a global increase in asthma in children and adults, yet the diagnosis of asthma must be made on clinical grounds as the diagnostic use of pharmacological reversibility of airway obstruction remains controversial. It is possible however that tools exist from different medical paradigms that may assist in the clinical diagnosis of asthma. Tools such as Traditional Chinese Medicine (TCM) enquiry, Breath Holding Time (BHT) or Electro-Dermal Screening Test (EDST) may provide useful clinical information, yet their use has not been widely explored or validated. Integrative medicine may be considered to represent a new frontier in medicine where each therapy and diagnostic method is seen to have its own advantages and limitations and where an integration of both diagnostic and therapeutic techniques from conventional and complementary medicine is seen to produce the best results. However, while there is a high community use of complementary therapies for conditions such as asthma, there is also a need to maintain accepted standards of medical and scientific principles and foster high quality research into complementary therapies. Objectives: The current study sought to determine: • If there is a correlation between conventional measures of lung function such as Forced Expiratory Volume in one second (FEV1) and less conventional measures such as airways expired NO level (eNO), electrodermal measures, TCM enquiry and BHT. • If any of the lung function measures are able to distinguish between asthmatic and healthy subjects. • If the use of a rye grass extract is better than placebo in improving requirements for bronchodilator medication, peak flow, forced expiratory volume in one second or quality of life in mild to moderate childhood asthma. Rational for carrying out two separate studies as one study; The author was interested on both the integration of diagnostic techniques as well as the effect of the herbal extract on asthma so it was decided to use the opportunity and put both in one study. Method: A range of conventional and non-conventional measures were conducted in healthy and asthmatic children including demographic details, quality of life data, spirometry measures, airway nitric oxide levels, electro-dermal measures, TCM history enquiries, breath holding time, and skin prick tests. The data were analysed to determine any significant correlations between these measures. A double blind randomized controlled pilot clinical trial was also performed to assess the effect of using rye grass extract in asthmatic children aged 8 to 16 years. Results: There were significant correlations between forced expiratory volume in one second and active quality of life, TCM spleen score and fraction of exhaled nitric oxide measurements. There were also statistically significant differences between asthmatic and healthy subjects in TCM history, breath holding time and exhaled nitric oxide. The use of rye grass extract did not produce any significant improvement over placebo in any of the asthma outcome measures. Conclusions: The use of inexpensive measures such as BHT and TCM enquiry may provide useful clinical information when assessing respiratory conditions such as asthma. However, further research is required in larger populations to confirm their use. The use of the rye grass extract at the dose given in this study did not provide any clinical benefit for the asthmatic children in this study.

Presbycusis, or age-related hearing loss, is one of the most common chronic conditions to affect adults. On average individuals wait seven years from the time they notice a hearing impairment to the time they seek help from a hearing professional. This delay may have wide reaching implications for public health in the coming decades, as aging populations become more prevalent and as further research assesses the relationship between hearing loss and mental health conditions such as depression and dementia. The development of the New Zealand Hearing Screening Test (NZHST) aims to fulfil a need for a robust hearing screening test that individuals can access from home. This digit triplet test (DTT) will be particularly valuable for those in rural areas where audiological services are sparse and for those who have mobility issues which restrict attendance at clinical appointments. In order to accommodate as many New Zealanders as possible, the NZHST will have two versions, an internet version and a land-line telephone version; both of which can be delivered into their home in either New Zealand English or Te Reo Māori. This research is the third instalment in the development of the NZHST. The current research is divided into three parts; the verification of the New Zealand English DTT for the internet version, the pilot study for the Te Reo Māori DTT for the internet version, and the normalisation of the New Zealand English DTT for the telephone version. In the verification process, 50 individuals with various audiometric thresholds listened to 3 lists of 27 New Zealand English digit triplets, presented in three conditions; binaurally and to each ear separately via an internet interface. In the pilot study, 27 participants with various audiometric thresholds listened to 3 lists of 27 Te Reo Māori digit triplets via a software interface on a laptop computer. The normalisation process involved 10 individuals with normal hearing (average air-conduction pure tone thresholds of ≤ 20 dB HL) listening to 168 New Zealand English digit triplets under two different noise conditions; one as continuous speech noise and the other a noise with spectral and temporal gaps (STG noise) presented via a software interface on a laptop computer. Four conditions of the 168 digits were presented; once to each ear for the continuous noise, and once to each ear for the STG noise. Significant correlations were found between the binaural DTT and PTA (R = 0.66), and between the monaural ear DTT and PTA (R = 0.73) for the verification. The binaural DTT had a test sensitivity of 94% and a specificity of 88%. Pilot study correlation between binaural DTT and PTA was R = 0.61, and was R = 0.63 between monaural DTT and PTA; while the binaural sensitivity (100%) and specificity (100%) of the Te Reo DTT was affected by the very small number of participants with hearing loss (n = 4). The normalisation revealed that detection of the digit triplets was easier when STG noise (Lmid = -11.5 dB SNR, SD = 1.6 dB) was used as a masker, rather than continuous noise (Lmid = -8.9 dB SNR, SD = 1.4 dB).