Amyotrophic Lateral Sclerosis (ALS) is a rapid and fatal neurodegenerative disease marked by progressive muscle weakness and wasting. Approximately 50% of people with ALS experience changes in cognition and behaviour. Previous research has been mixed as to whether cognition declines over the course of ALS, or whether it is related to proxies of disease progression (e.g., functional disability scales). However, this research has suffered from limitations including the use of inappropriate measures of cognition, imprecise measures of disease progression, high attrition, practice effects, and biased analytic approaches. Fortunately, recent advances in clinical assessment have provided accurate measures of neuropsychological functioning and disease progression, namely, the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) and the King's Clinical Disease Staging. The present study aims to utilise recent advances in ALS disease metrics to overcome previous limitations and explore the evolution of cognitive and behavioural dysfunction over the course of ALS. Specifically, the aims of the present project are to 1) develop alternate forms of the ECAS to accommodate repeated longitudinal assessment; 2) examine how cognition and behaviour relate to clinical disease stages in ALS; 3) evaluate how cognitive and behavioural symptoms evolve over the course of the disease in ALS; and 4) explore clinicians' attitudes toward cognitive and behavioural screening in ALS. To achieve Aim 1, two new versions of the ECAS (ECAS-B and ECAS-C) were developed and administered to a group of age, education, and gender matched controls to that of the original ECAS-A validation study. Results demonstrate that the alternate forms of the ECAS (B and C) were equivalent to the original ECAS-A, reducing practice effects and possessing excellent inter-rater reliability. The ECAS forms were administered longitudinally to a separate group of healthy controls. Over an interval of 4 months, the ECAS-A-B-C showed no evidence of practice effects and excellent test-retest reliability validating their utility in the longitudinal monitoring of cognition in ALS. The ECAS forms were then used in an international multi-centre clinical sample of 161 ALS patients and 80 matched controls to achieve Aim 2. Patients were grouped into their King's Clinical Disease Stage at time of testing. Analysis revealed a significant cross-sectional relationship between disease stage and ALS-Specific cognitive functions, driven by a decline in verbal fluency performance. A significant relationship was also observed between disease stage and behavioural features. By end-stage disease 80% of patients demonstrated neuropsychological impairment. Participants were followed up longitudinally to explore the progression of cognitive and behavioural symptoms. Latent Growth Curve models of the ECAS subdomains (utilising the alternate versions) demonstrated a significant decline in ALS Specific cognitive, but not behavioural, functioning over time. This decline was explained by advancing disease stage, the presence of the C9orf72 repeat expansion, and years of education. Rate of change in ALS Non-Specific functions was dependent on baseline performance. Visuospatial functions and perseveration declined at similar rates and were distinct from language, fluency, apathy, and disinhibited behaviour. Cluster analysis of patients revealed a three-cluster solution with one group demonstrating no significant decline, a second group with mild cognitive and behavioural decline, and a third group with more severe neuropsychological decline. When data was restructured by diseases stage, rather than time, longitudinal results were similar to cross-sectional findings. To examine clinician's attitudes to cognitive and behavioural screening. Fourteen Health Care Professionals (HCP) working in ALS (Neurologists, Psychologists, and Clinical Care Specialists) were interviewed. Thematic analysis revealed that HCPs recognised the importance of cognitive and behavioural screening in ALS, but that it is not common practice. Important barriers to screening were reported including other members of staff, a lack of resources, and issues concerning patients and their families. Participants suggested increasing training and psychology input, and making screening a standardised protocol to all patients may alleviate these barriers. Cognition and behaviour are critically related to advancing disease stage, both cross-sectionally and longitudinally. Declining cognitive and behavioural symptoms has important implications for clinical practice, caregiver impact, and end-of-life decision making. However, clinicians report that cognitive and behavioural screening is not common practice and that significant barriers exist. The newly developed alternate forms of the ECAS provide an accurate, effective, and clinically useful means of monitoring cognitive function over the course of the disease in ALS.

MPH, University of the Witwatersrand, Faculty of Health Sciences / Introduction Sex workers are considered to be a high risk group in the acquisition and transmission of sexually transmitted infections which include Human Immunodeficiency Virus (HIV) and Human Papillomavirus (HPV). Infection with HPV has been clearly established as a causative agent that infects the cells of the cervix and slowly causes cellular changes (dysplasia) or abnormal cells that can later develop into cancer. Women who are HIV positive are thought to be at higher risk of having HPV infection, and subsequently also at higher risk of having abnormal cervical lesions. Objectives The main focus of this study is to describe the prevalence of abnormal Pap-smears among sex workers and to further identify the difference between Pap-smear results of sex workers who are HIV-positive and HIV negative. Methods This is a retrospective descriptive study, where data was obtained from sex workers records from January 2004 to December 2006. The study population included all sex workers who attended the Esselen Street Clinic and sex worker outreach clinic in Hillbrow, in the inner-city of Johannesburg. Three hundred and nine records were randomly selected, of which 200 met the inclusion criteria. Data was collected on socio-demographic information including the age and place of residence, laboratory results (Pap-smear and HIV) and history of sexually transmitted infection at the last physical examination. Extracted data was captured in excel spreadsheet and transferred to Stata Computer Package software version 9.0 for data management and analysis. Descriptive analysis included frequency distributions of categorical variables (e.g. residence, Pap-smear results, HIV status and age group) and summary statistics of continuous variables (e.g. age). Pearson chi-square test or Fisher Exact test when necessary, where conducted to obtain proportions of the sex workers with abnormal Pap-smear results corresponding to each category of the explanatory variables for example age, HIV status and place of residence or business or business transactions. For continuous explanatory variables, such as age, two sample t-tests were used to determine differences between sex workers in terms of abnormal and normal Pap-smears. In all statistical considerations, a probability level of ≤0.05 was used. Results There were 200 records which were analysed to achieve the study objectives. These included 146 records of HIV positive (73%) and 54 of HIV negative sex workers (27%). Their ages ranged from 18 to 45 years with a mean of 26.85 years and median of 26.0 years. More than 70% (n=141) of the sex workers were below the age of 30 years. More than two thirds of sex workers lived in hotels and almost 90% was considered to be symptomatic for STIs. Eighty-eight (44%) of the sex workers were found to have had an abnormal smear result, of whom 58 (65.9%) were below the age of 30 years. Age, as a continuous variable, and place of residence (living on the street) was found to be statistically significantly associated with having an abnormal smear result. However, age (being older than 30), having symptoms of an STI and being HIV positive was not found to be statistically significantly associated with having an abnormal Pap-smear result. Conclusion This study has shown that the prevalence of abnormal Pap-smears among Hillbrow sex workers was high, especially in young sex workers. Sex workers who operated from the street were found to have a higher percentage of abnormal smear results as compared to those operating from the brothels and flats, signifying a need for a controlled environment and to improve sex workers access to health care services. No significant association was found between HIV status and abnormal Pap-smears. Further studies are required in this area. The study indicates that they may be a need to review the National Cervical Cancer Screening Policy to take into consideration the needs of high risk population, such as sex workers.

Having a child who is suffering with chronic pain can profoundly impact a parent’s life. Reciprocally, parent cognitive, emotional, and behavioral responses to their child’s chronic pain can influence the child pain experience. We developed the Parent Risk and Impact Screening Measure (PRISM) to assess parent physical and emotional functioning, behavioral responses to child pain, and impact on daily life due to their child’s chronic pain. In an effort to validate this screening tool, we examined the PRISM in relation to existing measures of parent distress, parent behavior, and child functioning. The 30-item PRISM was administered via RedCAP survey to 112 parents of children with persistent pain presenting to a multidisciplinary pain clinic at Boston Children’s Hospital. Parents also completed the Patient Reported Outcomes Measurement Information System (PROMIS-29), Bath Adolescent Pain Questionnaire-Parental Impact Questionnaire (BAQ-PIQ), Adult Responses to Children’s Symptoms (ARCS), and Pain Catastrophizing Scale (PCS). Children completed the Functional Disability Inventory (FDI), Fear of Pain Questionnaire (FOPQ), and Pediatric Quality of Life Inventory (PedsQL). Parents were predominantly mothers (84%), married (74%), and college- educated (70%). Their children (ages 8-18) were predominantly female (88%) and endorsed daily pain (84%; Mean=6/10). PRISM total scores were strongly correlated with parent general symptoms of depression, anxiety, fatigue, social restrictions, and pain interference (PROMIS-29; r=0.47, 0.54, 0.59, 0.57, 0.38). PRISM total scores were also highly associated with parent pain-specific domains including self-blame and helplessness (BAP-PIQ; r=0.62), parent behavior (BAP-PIQ; r=0.54), and protective responses (ARCS; r=0.59). For child outcomes, higher PRISM scores correlated with more disability (FDI; r=0.49), higher fear of pain (FOPQ; r=0.53), and lower functioning within emotional, social, and psychosocial domains (PedsQL; r=0.36, 0.34, 0.48). Altogether the PRISM tool appears to be a brief and clinically important means of screening parent distress and behaviors associated with child pain-related dysfunction. Future work will include item level analysis with the goal of reducing the length of this screening tool.

Le travail présenté dans ce manuscrit porte sur la recherche de nouveaux membres de la famille des dioxygénases α-cétoglutarate et fer dépendantes (α-KAO) et leur application en synthèse organique. Dans un premier, ce travail a consisté à chercher de nouvelles enzymes selon une approche génomique basée sur l’homologie de séquence et le partage d’un motif InterPro. Deux criblages haut débit avec 79 et 127 enzymes candidates ont ensuite été effectués sur des panels constitués respectivement de 23 et 36 substrats, structurellement plus ou moins proches des substrats métaboliques. Huit nouvelles α-KAO ont ainsi pu être découvertes. Parmi ces huit nouvelles α-KAO, quatre ont été étudiées plus en détail. Après optimisation des conditions de réaction pour chaque enzyme, des montées en échelle ont été réalisées pour caractériser les produits formés. A partir de ces quatre enzymes, la (3S)-3-hydroxy-L-lysine, un dérivé cyclisé de la (4R)-4-hydroxy-L-lysine, (3S)-3-hydroxy-L-ornithine et un dérivé de la (3S)-3-hydroxy-L-arginine ont pu être produits. Nous avons proposé une synthèse biocatalytique de mono et dihydroxydiamines en couplant une ou deux α-KAO avec une décarboxylase. Les (2S)-1,5-diamino-2-pentanol, 1,5-diamino-3-pentanol, (2S)-1,4-diamino-2-butanol et (2S,3S)-1,5-diamino-2,3-pentanediol ont ainsi été obtenus avec de bonnes conversions. / The work described in this manuscript deals with the search of new members of the α-ketoglutarate and Iron-dependent dioxygenases family (α-KAO) and their applications in organic synthesis. The first part of this work presents the search of new enzymes through a genomic approach based on sequence homology and InterPro motif sharing. Two high-throughput screenings with 79 and 127 candidate enzymes have been performed on 23 and 36 substrates more or less structurally close to known metabolic substrates. 8 new α-KAOs have been discovered. Among these new enzymes, four were studied in more details. After optimization of the enzymatic reaction conditions for each enzyme, scale-up allowed to obtain compounds for isolation and characterization. With these four enzymes, (3S)-3-hydroxy-L-lysine, (4R)-4-hydroxy-L-lysine as its cyclic derivative, (3S)-3-hydroxy-L-ornithine and a derivative of (3S)-3-hydroxy-L-arginine were produced. Two of the new α-KAO were combined in a cascade process to afford the (3R,4R)-3,4-dihydroxy-L-lysine as its cyclic derivative. We proposed a biocatalytic synthesis of mono and hydroxydiamines by coupling one or two α-KAO with a decarboxylase enzyme. (2S)-1,5-diamino-2-pentanol, 1,5-diamino-3-pentanol, (2S)-1,4-diamino-2-butanol and (2S,3S)-1,5-diamino-2,3-pentanediol were obtained with good overall conversions.

Abstrakt Utbildning i dag ställer höga krav på läsförmågan. Skolans uppdrag är att säkerhetsställa att eleverna lär sig att läsa. Ett sätt att följa elevers läsförmåga är att använda sig av screeningtest och kartläggningsmaterial i kombination med att följa upp och arbeta med resultaten. Tidig identifiering är av största vikt så att skolan sätter in rätt resurser i tid. Speciallärare och specialpedagoger spelar en stor roll i detta arbete.  Syftet med vår undersökning är att se vilka screening- och kartläggningsmaterial i läsning som används i svensk grundskola samt att se hur resultaten från dessa följs upp. Frågeställningarna som vi söker svar på är: Vilka screeningtest och kartläggningsmaterial inom läsning används i Sveriges grundskolor? Hur följer skolan upp resultaten? samt Hur vill speciallärare och specialpedagoger arbeta med kartläggning och uppföljning? En enkätundersökning  skickades ut till alla Sveriges grundskolor, specifikt riktade till speciallärare och specialpedagoger. Resultatet, utifrån respondenternas svar, visar vilka screeningtest som används ute på skolorna, hur resultaten följs upp samt hur speciallärare och specialpedagoger önskar följa upp resultaten.

A variable screening method is introduced to reduce the computational cost caused by the curse of dimension of high dimensional problem in RBDO. The screening method considers the output variance of the constraint functions and uses test-of-hypothesis to filter necessary variables. Also, the method is applicable to implicit functions as well as explicit functions. Suitable number of samples to obtain consistent test result is calculated. 3 examples are demonstrated with detailed variable screening procedure and RBDO result.

Cancer screening is useful for improving survival rates and treatment outcomes, which is why there are screening recommendations for the most prevalent types of cancer. Despite gains in the reduction of cancer-related mortality rate worldwide in the past few years, the Haitian community continues to experience high mortality rates due to cancer. The prevalence of prostate cancer in the Haitian population is among the highest worldwide at 767 per 100,000, with a mortality rate of 403 per 100,000. One of the causes may be the low prostate cancer screening rate in the Haitian community; however, no studies have been focused on an association between demographic factors within this community and the low prostate cancer screening rate. This study's purpose was to address this gap through a cross-sectional quantitative design using the health belief model as a theoretical framework and a convenience sample of 282 Haitian males. The rate of prostate cancer screening among Haitian immigrants living in Brooklyn was examined based on the demographic variables of age, income, and education. Participants' perceptions regarding prostate cancer screening were also evaluated based on the same variables. Loglinear, and binary logistic regression were used for data analysis. Although education was found to be the strongest and only significant predictor variable for prostate cancer screening participation within the target population, no conclusion could be drawn regarding the effect of the select variables on the participants' perceptions on prostate cancer screening. The implications for this study include increased knowledge for public health promotion initiatives and for those in the Haitian community working to reduce the morbidity and mortality rates due to prostate cancer.

Veterans are at increased risk for developing mental illnesses because of separation from families, distressing experiences in the military, and previous injury to the brain. Approximately 30% of U.S. veterans returning from war suffer from post-traumatic stress disorder (PTSD). The incidence of acute PTSD is reduced when victims are aware of the condition and its associated factors. Through education and screening, the project bridged the gap between deployment of military veterans and treatment of PTSD in this population by addressing whether screening veterans and providing an educational process affected veterans' early PTSD recognition and treatment. The project study addressed the impact of staff education on identifying undiagnosed PTSD among veterans at the project site. The project was guided by the adult learning theory that was applied to fit the self-efficacy model. Data collection included screening of 99 veterans by clinic staff members using the PTSD checklist. Staff members also completed pretests and posttests before and after the education program. Results indicated that staff members demonstrated increased knowledge of the PTSD from pretest (50%) to posttest (93%). Of the veterans screened in the project, 30(30%) tested positive for PTSD and were referred to psychiatrists for treatment and medication to ameliorate the symptoms. Findings may be used to encourage implementation of PTSD screening and education in health care organizations ensuring positive social change by veterans suffering from PTSD and the care they need early in the progression of PTSD development.

The purpose of this study was to review the literature on English Language Learners and written expression curriculum-based measurement. In recent years, there has been little research completed in the area of curriculum based measurement for writing for English Language Learners. A systematic review of the literature was conducted and all available literature on the use of written expression curriculum-based measurement since 2006 was identified and reviewed. Given the increasing diversity in our schools, particularly non-native English speakers, this review focused on studies including this group. There were differences in some of the technical features such as sample durations, writing tasks, and scoring procedures within the schools they were conducted in. Remaining gaps in the literature are discussed in addition to future directions and limitations.

The purpose of this quantitative study was to determine to what extent the 4 M-PULSE scale scores (interpersonal difficulties, unprofessional conduct, discharge of weapon, and inappropriate use of weapon) account for variance in the MMPI-2RF (aggression and antisocial) subscales scores. Archival data was provided by a private business that conducts these screenings for multiple law enforcement organizations (local and state). Law enforcement candidates (N = 127) were evaluated by a private business during the prehiring psychological screening process using the M-PULSE and MMPI-2RF to assess their risk factors for employment as law enforcement officers. Using Social Learning theory as the basis, the scores from the 2 measures were provided for regression analysis to determine what effect the M-PULSE factors had on the MMPI-2RF factors. This research did not find any significant effect on either MMPI-2RF factor by the 4 M-PULSE factors. This study adds to the growing body of knowledge of law enforcement psychological screening processes and how different measures provide critical information on personality, aggression, and risk factors that should be considered for individuals seeking employment in a law enforcement position. This study has implications for positive social change by increasing understanding of how current psychological screening processes determine suitability of candidates and help to ensure that individuals who would put the public and law enforcement organizations at higher risk should be screened out prior to completion of any law enforcement training.