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M.Tech. / It is difficult to manage a pregnancy when fetal age, health status or potential pregnancy risks are not known. The aim of this study was to assess the impact of routine ultrasound screening as compared to selective use of ultrasound in the mid-trimester of pregnancy, on women using South African government health services. The three objectives investigated included assessment of the availability of reliable menstrual histories in the study population, the influence of ultrasound dating on obstetric management and the effect of ultrasound on pregnancy outcome due to the early detection of high risk pregnancies. A cluster randomised trial of 962 women was performed to test the hypothesis that midtrimester routine ultrasound screening in low risk pregnancies would result in improved antenatal care and perinatal outcome. Groups of eligible pregnant women were randomly selected to have either a routine scan followed by normal antenatal care or routine antenatal care which only allows for the selective use of ultrasound, in line with South African Antenatal Care Policy. Statistical analysis of the results confirmed that ultrasound dating is a more accurate predictor of the expected date of delivery when compared to other dating methods. Improved pregnancy dating resulted in a significant reduction in induction of labour for post-term pregnancy in the ultrasound screening group, suggesting a positive effect of ultrasound screening on obstetric management. No improvement was demonstrated in perinatal morbidity or mortality. The early detection of anomalous fetuses only led to one therapeutic abortion. The study did not possess the statistical power to demonstrate improved outcomes when multiple pregnancies were detected early in pregnancy. Currently there appears to be no urgent need to implement a routine antenatal screening programme in the Gauteng public health sector. In view of the fact that a third of the participants indicated that they were unsure of menstrual dates, and one third of the participants in the ultrasound screening group presented with an unreliable menstrual history, it is proposed that unsure dates be considered as a valid indication for the selective use of ultrasound in mid-trimester pregnancy.

Mitochondria exist in a dynamic network whereby fusion and fission events are critical to the health of the mitochondria, the cell, and the organism. Dysfunctional mitochondrial dynamics underlie a plethora of diseases including various cancers, heart diseases, diabetes, neurodegenerative diseases, and a number of mitochondrial disorders. Despite a strong molecular knowledge of a handful of functional mediators of mitochondrial dynamics, much less is known about how this process is regulated at a cellular level, and what genes are involved in signaling pathways. A previously completed mitochondrial morphology genome screen was repeated with an automated confocal microscope resulting in the identification and validation of MTX2 as a novel regulator of mitochondrial dynamics. Functional characterization of the role of MTX2 in mitochondrial dynamics will further our understanding of mitochondrial biology, and has the future potential to inform therapies for some of the many diseases underscored by dysfunctional mitochondrial dynamics.

The Diploma's thesis deals with the creating of equity portfolio based on chosen indicators. After the introduction I concentrate on typology of portfolios and the approach how to create portfolio. Next chapter focuses on analysis of regions and sectors. In the third chapter I concentrate on description of ratios which I use for selection of the specific stocks. In the last chapter I concentrate on creating two portfolios - i.e. American and European. Both of them are created based on the practical application of the approach for creating of portfolio that is described in the previous chapters.

Adolescent substance use is a key public health problem in rural Ohio. Primary care nurses lack substance use screening knowledge and skills. Early screening and detection of possible substance use issues aids in directing patients to appropriate health services. This project involved the implementation of an educational intervention on the CRAFFT screening tool for primary care nurses in rural Ohio. Guided by Kurt Lewin's 3-step model to emphasize prevalence of substance use and need for screening among adolescents, the purpose of this project was to provide training on the CRAFFT screening approach and share guidelines to implement routine substance abuse screening for adolescents seen in this rural primary healthcare setting. The project, based on a pretest and posttest design, was implemented among a sample of 7 nurses to evaluate whether the educational intervention had a significant impact on nurses' knowledge on using the CRAFFT screening tool. Data were collected using a questionnaire and were analyzed using descriptive and inferential statistics. The results showed a significant increase in the pretest scores (M =51.43, SD = 19.51) and the posttest score (M =94.29, SD = 7.868); t(6)=7.039, p = .000). The project findings support that the benefit of this educational intervention to improve the nurses' substance use screening knowledge using a lunchtime educational training to ensure that vulnerable adolescent patients with substance use receive early and appropriate preventive and treatment measures. For positive social change, early identification of substance use among adolescents may inform the adoption of preventive and treatment measures such as referral to mental health specialists, thereby improving adolescent health outcomes.

Background: Over 50% of HIV-infected children in South Africa have developmental delays. Early identification of affected children will lead to early intervention and favourable long-term outcome. Screening for developmental delay is not yet routine by many primary healthcare providers due to lack of locally available, rapid and sensitive screening tool s in busy Paediatric HIV clinics. A new screening tool was developed at the Red Cross War Memorial Children's Hospital (RCWMCH) for detecting moderate to severe global developmental delay among very young HIV infected children. The diagnostic accuracy and usefulness of the new tool was evaluated in this study. Objective: to validate the new RCWMCH developmental screening too l among HIV - infected South African children. Method: Forty-seven HIV-infected children in the age category 9-36 months attending the Infectious Disease Clinic (IDC) of the RCWMCH were screened using the new tool. Full developmental assessments of same children were performed using the Bayley Scale of Infant Development (BSID - III). Developmental Delay (global) was defined as composite scores 2 standard deviations below the mean in two or more developmental domains. Results: The sensitivity of the RCWMCH tool was 78.5%, specificity 54.6%, positive predictive value was 42.6%, and negative predictive value was 85. 7 %. Discussion: The RCWMCH screening tool was found to have sensitivity within the acceptable levels recommended for developmental screening tools. Its high negative predictive value will reduce unnecessary referrals for full developmental assessments in asymptomatic infants and toddlers. It is therefore recommended for screening for developmental delay among HIV-infected children from the age of 9 months to 3 years.

Introduktion: Då allt fler immigranter kommer till Sverige och väljer att stanna här ökar mängden äldre patienter med annan språklig och kulturell bakgrund. Vården påverkas och det ställs andra krav på vårdpersonalen i form av kulturell kompetens och kunskap i att arbeta med tolk. Syftet var att utifrån litteraturen belysa utmaningar vid demensutredning av personer med annan språklig och kulturell bakgrund än utföraren. Metod: En systematisk litteraturstudie med kvalitativ innehållsanalys utfördes. Resultat: Resultatet visade fyra kategorier. Demensutredning med underkategorierna bedömningsinstrument, utbildningsnivå och integrationsnivå. Återgivande av information med underkategorierna tolkens roll, utelämnad information och känsla av kontroll. Yrkeskompetens med underkategorierna kulturell kompetens, kunskapsluckor och bristande utredning. Kultur med underkategorin skillnader och hinder. Slutsats: Vårdpersonalen hade kunskapsluckor i kulturell kompetens, bedömningsinstrument och effektiv kommunikation med hjälp av tolk. Även tolkar hade bristande kunskap och utbildning. Kulturella skillnader i syn på demens som sjukdom och kunskap om demens påverkade arbetet med att sätta diagnos.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13388号 / 論医博第2220号 / 新制||医||1048(附属図書館) / (主査)教授 羽賀 博典, 教授 佐藤 俊哉, 教授 妹尾 浩 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Lung cancer is the most common cause of cancer-related deaths in the United States. Prevention and early detection of lung cancer are imperative in decreasing lung cancer mortality. Screening for lung cancer with low-dose computed tomography (LDCT) decreases lung cancer by 20%. Several organizations introduced lung cancer screening (LCS) guidelines in 2013, including Centers for Medicare and Medicaid (CMS) and the United States Preventive Services Task Force. However, LCS participation for eligible patients remains low, due in part to the complexity of the LCS process. The goal of this practice improvement project was to increase the knowledge of rural primary care providers regarding LCS guidelines and the related CMS requirements and to increase their confidence in initiating shared decision-making (SDM) discussions. An educational intervention consisting of a LCS educational session and a toolkit was implemented in two rural clinics. Providers at both clinics reported a benefit to the educational intervention. Pre-, immediate post-, and two-month post-education surveys were collected to evaluate the impact of the educational intervention, including provider knowledge of LCS guidelines and CMS requirements, and confidence in SDM. Project results demonstrated an increased knowledge of LCS guidelines and CMS requirements with the greatest knowledge at immediate post-education and a high level of knowledge remaining at two months post-education. A small, nonsignificant, increase in provider confidence in initiating SDM discussions occurred. At both clinics, data collected through chart audit demonstrated an improvement in documentation needed to determine LCS eligibility and increased the percentage of patients identified at high risk for lung cancer and thus, eligible for LCS. At one clinic these changes were significant. The data were further examined for SDM discussions and referrals for LDCT or to specialist for LCS with one clinic increasing SDM documentation and LDCT referrals post-education. In conclusion, although further research is needed in implementation processes of LCS, specifically in consistent documentation to improve determination of LCS eligibility of patients, this practice improvement project found education increased provider knowledge and ability to complete requirements needed to improve LDCT screenings for lung cancer.

Introduction: Although colorectal cancer (CRC) is the second leading cause of cancer-related deaths among men and women combined in the United States, only 61% of eligible adults are up-to-date with current screening recommendations. Effective screening is hindered by numerous barriers and underutilization of evidence-based interventions. The purpose of this clinical dissertation project was to increase CRC screening in the rural community of Elgin, North Dakota, determine the efficacy of providing targeted educational handouts and endorsement letters, and to identify screening barriers and facilitators. Methods: Educational handouts and screening endorsement letters were developed and distributed to 75 average risk patients (without personal or family history of CRC or certain types of polyps, personal history of inflammatory bowel disease, personal history of receiving radiation to the abdomen or pelvic region, and confirmed or suspected hereditary CRC syndrome). Additional handouts were placed around the community of Elgin. Patients who presented for CRC screening were sent a questionnaire to determine the impact of the interventions. These 75 patients were also contacted via telephone and completed a questionnaire to identify barriers and facilitators and to highlight the effectiveness of the educational handout and the endorsement letter. Results: Five patients contacted the clinic to receive CRC screening. Ninety-seven percent of patients who recalled receiving the endorsement letter and educational handout (n=32) found the material to be informative, 91% of patients appreciated being contacted on behalf of the clinic, and 59% found the handwritten signature on the endorsement letter to be influential. Fifty-one patients identified screening barriers including (in descending order) lack of awareness/knowledge, cost, unpleasant previous experience, embarrassment, lack of motivation, and fear of abnormal findings. Forty-one patients identified screening facilitators including (in descending order) recommending during office visits, providing education on different screening options, sending letter reminders, calling patients, utilizing social media, and sending email reminders. Conclusion: The clinical dissertation project increased CRC screening compliance in Elgin, ND, identified barriers, and highlighted screening facilitators that can be utilized. Future projects should focus efforts on alleviating these barriers via targeted patient education and provider recommendation in order to decrease CRC morbidity and mortality.