Este estudo foi desenvolvido em duas escolas infantis do município de Porto Alegre, onde crianças de 0 a 3 anos, que apresentaram sinais de risco psíquico para seu desenvolvimento, foram acompanhadas em estimulação precoce. Nesta pesquisa, buscou-se articular a detecção precoce na primeira infância, considerando o desenvolvimento sem dissociá-lo da constituição psíquica. Abordou a importância da formação com os educadores, através de conceitos psicanalíticos que auxiliam na compreensão deste momento. Destacou a importância dos primeiros anos de vida na constituição do sujeito, considerando a subjetividade, um aspecto central e organizador do desenvolvimento infantil. Além do trabalho desenvolvido com as crianças, os pais e educadores tiveram seu espaço de escuta, o que auxiliou na detecção de sinais de risco, favorecendo a intervenção precoce. A abordagem metodológica da pesquisa foi qualitativa etnográfica, com investigação de campo e descritiva. A pesquisa demonstrou que é possível perceber indicadores que nos preocupam em relação ao desenvolvimento infantil, sendo a escola, além da família, um lugar de grande importância na história de vida das crianças e na detecção precoce de risco psíquico. / This study was conducted in two kindergarten schools in the city of Porto Alegre, where kids from 0-3 years of age, which showed psychic risk for their development, were followed in early stimulation. In this research, we sought to articulate the early detection on early childhood, considering the development without separating the psychic constitution. The study approached the importance of training teachers through psychic concepts that help in comprehending this phase. It stressed the importance of the first years of life in the constitution of the individual, considering the subjectivity, a central and organizing aspect of child development. Besides the work done with the kids, parents and educators had their communicating space, which helped in the detection of risk signs, favoring early intervention. The methodological approach of the research was ethnographic qualitative with field and descriptive investigation. The research showed that it is possible to perceive indicators that concern us in relation to child development, being the school, in addition to the family, a place of great importance in the story of life these children and in the early detection of psychic risk.

Este estudo foi desenvolvido em duas escolas infantis do município de Porto Alegre, onde crianças de 0 a 3 anos, que apresentaram sinais de risco psíquico para seu desenvolvimento, foram acompanhadas em estimulação precoce. Nesta pesquisa, buscou-se articular a detecção precoce na primeira infância, considerando o desenvolvimento sem dissociá-lo da constituição psíquica. Abordou a importância da formação com os educadores, através de conceitos psicanalíticos que auxiliam na compreensão deste momento. Destacou a importância dos primeiros anos de vida na constituição do sujeito, considerando a subjetividade, um aspecto central e organizador do desenvolvimento infantil. Além do trabalho desenvolvido com as crianças, os pais e educadores tiveram seu espaço de escuta, o que auxiliou na detecção de sinais de risco, favorecendo a intervenção precoce. A abordagem metodológica da pesquisa foi qualitativa etnográfica, com investigação de campo e descritiva. A pesquisa demonstrou que é possível perceber indicadores que nos preocupam em relação ao desenvolvimento infantil, sendo a escola, além da família, um lugar de grande importância na história de vida das crianças e na detecção precoce de risco psíquico. / This study was conducted in two kindergarten schools in the city of Porto Alegre, where kids from 0-3 years of age, which showed psychic risk for their development, were followed in early stimulation. In this research, we sought to articulate the early detection on early childhood, considering the development without separating the psychic constitution. The study approached the importance of training teachers through psychic concepts that help in comprehending this phase. It stressed the importance of the first years of life in the constitution of the individual, considering the subjectivity, a central and organizing aspect of child development. Besides the work done with the kids, parents and educators had their communicating space, which helped in the detection of risk signs, favoring early intervention. The methodological approach of the research was ethnographic qualitative with field and descriptive investigation. The research showed that it is possible to perceive indicators that concern us in relation to child development, being the school, in addition to the family, a place of great importance in the story of life these children and in the early detection of psychic risk.

Oral cancer is a major health problem, with over 500000 patients diagnosed each year. Although progress has been made in regards to both diagnosis and treatment, the overall 5-year survival rate has not changed much in the last 30 years and still relatively static at around 50 %. This high mortality rate is related to late diagnosis of oral malignancies. At stages III and IV the 5-year survival rate is as low as 30 %, however if diagnosed at stage I the survival rate increases substantially to approximately 80 %. Research in to viable methods for early detection of oral malignancies and potential malignancies has the potential to save lives and reduce suffering for many people word wide. The purpose of this systematic review is to find an effective and practical diagnostic test for early detection of malignancies and potential malignancies in the oral cavity. Electronic database searches were conducted in English on the 4th of February 2017, using PubMed medical database, publication date 2005 or later. Inclusion criteria: Diagnostic Test Accuracy studies for oral malignancies and potential malignancies in human patients with gold standard reference test. Search yielded 166 records, titles and abstracts was screened and evaluated, 19 records was included. Included studies were assessed in detail regarding methodological quality and diagnostic accuracy. 19 studies with a total of 11575 participants were included. The studies were subdivided in to groups based on the specific index test assessed in each study. Diagnostic accuracy results: 4 records assessed Tissue autofluorescence; sensitivity ranging from 65.5 % to 100 % and specificity ranging from 41.7 % to 97.4 %. 10 records assessed Brush biopsy sampling; sensitivity ranging from 45 % to 100 % and specificity ranging from 90 % to 100 %. 1 record assessed Blood sampling; sensitivity 64 % and specificity 80 %. 2 records assessed saliva sampling Saliva sampling; sensitivity 100 % and specificity 96.7 %. 1 record assessed Metachromatic dye staining; detection rate of experimental group was 5 % higher than control group. 1 record assessed Narrow-band imaging; sensitivity 95 % and specificity 97 %. The Brush biopsy sampling diagnostic test methods has a body of evidence that far exceeds any other category presented in this review. As for methodological quality, diagnostic accuracy and risk of bias, we deemed the category as a whole to be at an acceptable level.

Purpose: Women at familial/genetic ovarian cancer risk often undergo screening despite unproven efficacy. Research suggests each woman has her own CA125 baseline; significant increases above this level may identify cancers earlier than standard 6-12 monthly CA125>35U/mL. Experimental Design: Data from prospective Cancer Genetics Network and Gynecologic Oncology Group trials, which screened 3,692 women (13,080 woman-screening years) with a strong breast/ovarian cancer family history or BRCA1/2 mutations, were combined to assess a novel screening strategy. Specifically, serum CA125 q3 months, evaluated using a risk of ovarian cancer algorithm (ROCA), detected significant increases above each subject’s baseline, which triggered transvaginal ultrasound. Specificity and PPV were compared with levels derived from general population screening (specificity 90%, PPV 10%), and stage-at-detection was compared with historical high-risk controls.

Purpose: In the contemporary management of early-stage lung cancer with RadiationTherapy (RT), there is increased imaging utilization for the diagnosis and treatment and follow-up after completion of treatment. We evaluated whether this increased radiation exposure to patients with early-stage lung cancer that receive stereotactic body radiotherapy (SBRT) significantly increases the risk of radiation-induced carcinogenesis (RIC). Methods: Following IRB approval, one hundred and ninety-six consecutively treated lung cancer patients treated with SBRT were selected for analysis. Information collected included demographics and all ionizing imaging scans one year before SBRT treatment and one year following treatment. These included chest X-rays (CXR), computerized tomography scan (CT scan), positron emission tomography scan (PET-CT scan), bone scan, ventilation-perfusion scan (VQ scan), cone-beam CT scans. In addition to the lung cancer patients, comparative data on ten prostate and breast cancer patients each was collected to get an estimate of the radiation-induced risk (RIC) in other common malignancies. For each patient, the total effective dose (mSv) was calculated by the sum of all effective doses for all scans (1 year before SBRT to 1-year post-SBRT). After calculating the total effective dose, the summed dose was used to calculate the RIC using the RadRat tool. For the study, we decided that a 1% increase in the baseline risk of radiation-induced lung cancer will be considered a significant increase. Results: Among lung cancer patients, there were 87 males (44.4%) and 109 females (55.6%). The median number of Pre-SBRT CXRs (PA/lateral) was 2 (Range: 1-22), the median number of pre-SBRT CT scans was 2 (Range: 1-6), the median number of pre-SBRT PET-CT scans was 1 (Range: 1-4), the median number of Bone Scans or VQ scans pre-SBRT was 1. The median effective exposure dose from all scans was 72mSv (Range: 24-140.36mSv). The median excess lifetime risk (ELR) of developing lung cancer (a chance in 100,000) with a 90% uncertainty range was 57.15. The Excess Future risk (EFR), the risk from 2019 to the end of the expected lifetime of developing cancer (a chance in 100,000), showed a median of EFR mean of 73.75 (Range: 8.45- 416). The total future risk (TFR, a sum of baseline and excess risk) of developing cancer, from 2019 to end of an expected lifetime was 2732.5 (Range: 808-8290), the median of TFR upper bound was 2785.5 (Range: 856-8400) and median of TFR lower bound was 2679.5 (Range: 761- 8183). At 6 months, survival was 94.7% (144/152), at 1 year, 79% (94/119), at 3 years 32.5% (27/83). At five years, with survival data on 77 patients available, 9 (11.6%) were alive. Regarding the comparison of RIC from imaging before RT for patients with prostate cancer, the median total effective radiation dose from all pre-SBRT and post-SBRT scans was 20mSv (Range: 20-30mSv), and the median of mean ELR for development of RIC prostate cancer was 4.24 (per 100,000). Regarding early-stage breast cancer, the median total effective radiation dose from all pre-RT and post-RT scans was 16.56mSv (Range: 10.52-31.48mSv), and the median of mean ELR for development of RIC was 35.95 (per 100,000). Conclusion: The median excess cancer lifetime radiation-induced cancer risk for the lung cancer cohort was 0.05%, which is significantly less than the 1% risk that was determined to be clinically significant as per our study objective. The survival in this cohort of patients was poor. Enhanced imaging to enhance staging accuracy, safety during SBRT treatment, and adequate follow-up outweigh the RIC risk.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第18907号 / 社医博第65号 / 新制||社医||9(附属図書館) / 31858 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 川上 浩司, 教授 富樫 かおり, 教授 武藤 学 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Networks within data centers, such as connections between servers and disk arrays, need lossless flow control allowing all packets to move quickly through the network to reach their destination. This paper proposes a new algorithm for congestion control to satisfy the needs of such networks and to answer the question: Is it possible to provide circuit-less reliability and flow control in an Ethernet network? TCP uses an end-to-end congestion control algorithm, which is based on end-to-end round trip time (RTT). Therefore its flow control and error detection/correction approach is dependent on end-to-end RTT. Other approaches utilize specialized data link layer networks such as InfiniBand and Fibre Channel to provide network reliability. The algorithm proposed in this thesis builds on the ubiquitous Ethernet protocol to provide reliability at the data link layer without the overhead and cost of the specialized networks or the delay induced by TCP’s end-to-end approach. This approach requires modifications to the Ethernet switches to implement a back pressure based flow control algorithm. This back pressure algorithm utilizes a modified version of the Random Early Detection (RED) algorithm to detect congestion. Our simulation results show that the algorithm can quickly recover from congestion and that the average latency of the network is close to the average latency when no congestion is present. With correct threshold and alpha values, buffer sizes in the network and on the source nodes can be kept small to allow little needed additional hardware to implement the system.

No description available.

The purpose of this thesis project is to demonstrate and evaluate an enzyme-linked immunosorbent assay (ELISA) on a paper microfluidic device platform. The integration of ELISA technology onto paper microfluidic chips allows for a quantitative detection of stroke biomarkers, such as glial fibrillary acidic protein (GFAP). Dye experiments were performed to confirm fluid connectivity throughout the 3D chips. Several chip and housing designs were fabricated to determine an optimal design for the microfluidic device. Once this design was finalized, development time testing was performed. The results confirmed that the paper microfluidic device could successfully route fluid throughout its channels at a reasonable rate. For the biochemistry portion of this thesis project, antibodies were selected to target the intended stroke biomarker: GFAP. However, due to antibody pairing complications, the protein chosen for this project was natural human cardiac troponin T, which is elevated in the bloodstream of patients who have suffered a stroke. Several antibody experiments were performed to help finalize the procedure for performing an ELISA on the paper chip. The final antibody experiment was able to demonstrate that a paper microfluidic device utilizing ELISA techniques can successfully detect a stroke biomarker at physiologically relevant concentrations. Overall, this project supported the ability to accurately and effectively diagnose stroke in a timely manner through the use of a paper microfluidic device.

A surrogate arm model was created that is capable of being used for oscillometry. This model is capable of being used as a bench top model for blood pressure cuff devices. The arm consists of endplates and internal supports that are 3D printed with ABS, a silicone rubber outer sleeve, and interchangeable arteries made from two silicone rubber strips glued together at the edges. The interchangeable arteries have varying compliances that can be used as different inputs for oscillometric testing. A process was established to measure the artery compliances with a curve fit correlation of 0.95. However, testing revealed that this artery compliance relationship might not be an accurate representation of the artery compliance while it is in the surrogate arm system. A blood pressure cuff was also used with the surrogate arm model to measure changes in artery volume. Testing with the surrogate arm revealed a blood pressure cuff was capable of measuring artery volume changes of 2mL to 8mL consistently within 3.28% error. Volume changes of 1mL were unable to be repeatable measured accurately with a blood pressure cuff.