<p>A 3D microwave imaging system suitable for clinical trials has been developed. The anatomy, histology, and pathology of breast cancer were all carefully considered in the development of this system. The central component of this system is a breast imaging chamber with an integrated 3D antenna array containing 36 custom designed bowtie patch antennas that radiate efficiently into human breast tissue. 3D full-wave finite element method models of this imaging chamber, complete with full antenna geometry, have been developed using Ansoft HFSS and verified experimentally. In addition, an electronic switching system using Gallium Arsenide (GaAs) absorptive RF multiplexer chips, a custom hardware control system with a parallel port interface utilizing TTL logic, and a custom software package with graphical user interface using Java and LabVIEW have all been developed. Finally, modeling of the breast (both healthy and malignant) was done using published data of the dielectric properties of human tissue, confirming the feasibility of cancer detection using this system.</p> / Dissertation

Over the years, considerable research has been done showing the advantages of early identification of hearing loss and its impact on children in developing speech and language skills. Although the universal early hearing detection and intervention (EHDI) program is fully functional in developed countries it has not been actualized in developing global regions like Asia, Africa and Latin America. The primary reason could be precise government policies and the necessary funds to support them. There is also a lack of awareness and initiative form the parent's side. The purpose of this paper is to describe and support the need for a universal early detection of hearing loss and intervention program in India. Objectives for developing a universal early identification and intervention program and the recommendations for actualizing them have been included. / text

Background and Aim: Globally, breast cancer is the most common cancer among women. The stage of the disease at diagnosis is a core determinant of its health outcome. In low to middle-income countries like Nigeria, advanced stage of disease presentation for medical care represents a significant problem. While mortality rates from breast cancer are declining in developed countries like Canada, they are increasing in developing countries like Nigeria. It is well documented that presentation for medical care at the early stages of the disease improves outcome. Knowledge of the factors that impact seeking medical care after breast cancer symptom discovery in women and knowledge of the factors that impact participation in breast health activities by women is important in reducing breast cancer-related mortality. Methods and Design: This integrative review critically examined the determinants of health outcomes of women living with breast cancer in Canada and Nigeria from 1990-2014. Specifically, it examined the factors that impact seeking medical care after breast cancer symptom discovery in women. It also explored the factors that impact participation in breast health activities by women in the two countries from 1990 to 2014. A total of 303 articles were identified and retrieved by searching the following databases: CINAHL, MEDLINE, and EMBASE. Grey literature from relevant organizations websites were identified using Google Scholar. Among the 303 articles identified, 55 met the inclusion criteria. Results and Conclusion: Findings from the articles that met the inclusion criteria showed that Canadians have a high level of breast health awareness. The findings also suggest that women in Nigeria have rather poor knowledge of breast health awareness and breast cancer. In Nigeria, presentation with an advanced stage of the disease made survival very low. This also compromises the quality of life of the patients. The major factors responsible for the late presentations were a lack of breast cancer awareness and education. Other social factors that mitigate against early presentations for medical care include misconceptions about breast cancer treatment and outcomes. In line with the findings of this study, it is recommended that wide spread culturally sensitive, linguistically appropriate, health education programs to teach breast health awareness should be developed and disseminated. Such health awareness programs should be targeted at women through various channels such as the media, the television, and radio. Also, within the hospital, the developed education programs should be integrated into the existing women health education programs. Non-government and other charitable organizations can also make significant contributions to breast health awareness through sponsoring health talks and workshops targeted at relevant segments of the population. Key search words: Breast cancer, breast neoplasm, diagnosis, prevention and control, health knowledge, patient attitude and practice, breast self-examination, awareness, patient education as topic, mass screening, early detection of cancer, Nigeria, Canada.

Prostatos, vėžys. yra pati dažniausia ir antra pagal mirtingumą vyrų onkologinė liga Lietuvoje. Prostatos specifinio antigeno (PSA) testo naudojimas ankstyvai patikrai leidžia tikėtis šios ligos užleistumo ir mirtingumo mažėjimo. Mažos rizikos prostatos vėžio gydymas radikaliais metodais yra tapęs neatsiejamu ankstyvos patikros palydovu. Nėra žinoma ar bendros praktikos gydytojų (BPG) siūloma informuoto paciento PSA patikra realioje populiacijoje turės tokį patį poveikį kaip klinikiniuose tyrimuose. Šis tyrimas yra pirmas nacionaliniu mastu atliekamos PSA tyrimu pagrįstos patikros programos poveikio sergamumui prostatos vėžiu vertinimas. Išanalizuota organizuotos patikros skvarba populiacijoje pagal skirtingas amžiaus grupes ir BPG teikiamos paslaugos galimybės mažinant skirtingo amžiaus vyrų prostatos vėžio užleistumą. Sukurta duomenų bazė jungianti PSA patikros ir sergamumo prostatos vėžiu duomenis leidžia nagrinėti organizuotos patikros efektyvumą. Nustatyta, kad ankstyvos patikros skvarba ypač maža 50-54 metų vyrų grupėje, tačiau jau po dvejų metų BPG teikiama informavimo ir PSA patikros paslauga lėmė ne tik lokalaus, bet vietiškai išplitusio prostatos vėžio atvejų mažėjimą visoje 50–75 metų vyrų grupėje. Remiantis tyrimo rezultatais rekomenduojama naudoti papildomas informavimo priemones, įtraukiant jaunesnius nei 60 metų vyrus į ankstyvos patikros programą, bei plačiai naudoti mažos rizikos prostatos vėžio aktyvią stebėseną. / Prostate cancer is most common and second deadliest tumour diagnosed in Lithuanian men. Prostate specific antigen (PSA) test in early detection of prostate cancer could result in decreased morbidity and mortality. Radical treatment of low-risk prostate emerged as an inevitable satellite of early detection. It is unknown if PSA testing offered to informed men by general practitioners (GP) could have the same results as in clinical trials. This study is the first evaluation of the nation wide prostate cancer detection program based on PSA testing. GP based early detection program is analysed according to the penetration of PSA testing in different age groups and the potential to decrease prostate cancer morbidity. The created database integrating data of PSA testing and incidence of prostate cancer permits in analysis of the effectiveness of early detection. Penetration of PSA testing was determined to be the lowest in 50-54 years men. After two years GP based PSA testing service resulted in decreased incidence of localized and locally advanced prostate cancer across 50-75 years men group. Results of the study suggest that men younger than 60 years need to be involved in early detection program by additional means of information. The active surveillance should be widely used for management of the low-risk prostate cancer.

Prostatos, vėžys. yra pati dažniausia ir antra pagal mirtingumą vyrų onkologinė liga Lietuvoje. Prostatos specifinio antigeno (PSA) testo naudojimas ankstyvai patikrai leidžia tikėtis šios ligos užleistumo ir mirtingumo mažėjimo. Mažos rizikos prostatos vėžio gydymas radikaliais metodais yra tapęs neatsiejamu ankstyvos patikros palydovu. Nėra žinoma ar bendros praktikos gydytojų (BPG) siūloma informuoto paciento PSA patikra realioje populiacijoje turės tokį patį poveikį kaip klinikiniuose tyrimuose. Šis tyrimas yra pirmas nacionaliniu mastu atliekamos PSA tyrimu pagrįstos patikros programos poveikio sergamumui prostatos vėžiu vertinimas. Išanalizuota organizuotos patikros skvarba populiacijoje pagal skirtingas amžiaus grupes ir BPG teikiamos paslaugos galimybės mažinant skirtingo amžiaus vyrų prostatos vėžio užleistumą. Sukurta duomenų bazė jungianti PSA patikros ir sergamumo prostatos vėžiu duomenis leidžia nagrinėti organizuotos patikros efektyvumą. Nustatyta, kad ankstyvos patikros skvarba ypač maža 50-54 metų vyrų grupėje, tačiau jau po dvejų metų BPG teikiama informavimo ir PSA patikros paslauga lėmė ne tik lokalaus, bet vietiškai išplitusio prostatos vėžio atvejų mažėjimą visoje 50–75 metų vyrų grupėje. Remiantis tyrimo rezultatais rekomenduojama naudoti papildomas informavimo priemones, įtraukiant jaunesnius nei 60 metų vyrus į ankstyvos patikros programą, bei plačiai naudoti mažos rizikos prostatos vėžio aktyvią stebėseną. / Prostate cancer is most common and second deadliest tumour diagnosed in Lithuanian men. Prostate specific antigen (PSA) test in early detection of prostate cancer could result in decreased morbidity and mortality. Radical treatment of low-risk prostate emerged as an inevitable satellite of early detection. It is unknown if PSA testing offered to informed men by general practitioners (GP) could have the same results as in clinical trials. This study is the first evaluation of the nation wide prostate cancer detection program based on PSA testing. GP based early detection program is analysed according to the penetration of PSA testing in different age groups and the potential to decrease prostate cancer morbidity. The created database integrating data of PSA testing and incidence of prostate cancer permits in analysis of the effectiveness of early detection. Penetration of PSA testing was determined to be the lowest in 50-54 years men. After two years GP based PSA testing service resulted in decreased incidence of localized and locally advanced prostate cancer across 50-75 years men group. Results of the study suggest that men younger than 60 years need to be involved in early detection program by additional means of information. The active surveillance should be widely used for management of the low-risk prostate cancer.

Patients with dementia are often unaware of their disease and do not seek medical attention; thus, health care providers must shift to "active detection" to identify at-risk patients early. No previous studies have focused on promoting this shift, so this study evaluates the efficacy of a new program to improve the knowledge and confidence of primary care providers in the early detection, diagnosis, and management of mild dementia. Physicians and nurses (n = 38) were recruited from 14 practices in Ontario, Canada. The Mild Dementia Knowledge Transfer Program was run at each practice. As a Neuroscience Master’s student I demonstrated the cognitive assessment procedures, and recipients assessed remaining patients with my guidance. Assessments included patient interviews using a Data Gathering Form –developed for the Program – to provide informal cognitive assessment, and the Montreal Cognitive Assessment (MoCA) test. The procedures were discussed between assessments to enhance learning. Later, recipients discussed the assessment results with the dementia specialist and myself; diagnoses and initial care plans were formulated collaboratively. Questionnaires measuring knowledge and confidence regarding detection, assessment and care of mild dementia were developed to measure change pre-post and three months after the Program. Linear mixed-effects models analysis with time as fixed effect and intercept as random effect was conducted to test change. Program recipients showed increases in knowledge-confidence score after the program (10.3; P < .001) paralleling increases in both knowledge and confidence sub-scores; there was no decline after three months (P = .83). No differences were observed between medical and nursing staff. The number of assessments done by recipients was positively associated with knowledge-confidence change (P = .01). Most recipients (70%) rated the program as excellent; 65% rated interactivity as the best part, 34% rated time commitment as the worst part, and 91% rated the program as making it easier to detect dementia. Due to the complex nature of dementia, the Program was performance-oriented, specialist-supported, clinic-based, and flexible to the needs of recipients. It showed acceptability and feasibility within primary care, and the results support its’ efficacy to improve primary care providers’ self-rated knowledge and confidence in mild dementia care. / Thesis (Master, Neuroscience Studies) -- Queen's University, 2010-07-26 21:38:54.945

Baggrunden er de mange forebyggelige indlæggelser, der kan mindskes ved tidlig opsporing og intervention i primær sektor Formål:Atafprøve udvalgte værktøjer i et design, som vil udgøre en effektiv metode til at lave tidlig opsporing af udsatte borgere i primær sektor, der viser tegn på begyndende sygdom som kan forebygges. Dernæstatudvikle og testeet IT-system til attriagere og risikovurderedisse borgere, samt et nyt spørgeskemaredskab til at vurdere forandringenaf den sundhedsfagligepraksis. Metode: Mikset metodologi anvendesfor atbesvare forskningsspørgsmåleneog formålet. Først testesi klinisk praksiset nyt sæt af metoder til tidligopsporing med efterfølgende triage og risiko-scoring af borgerne og dernæst afprøves en nyudviklet IT-platformhertil.Metoderne som afprøves er: Ændrings-skemaet med triage og TOBS (Tidlig Opsporingaf Begyndende Sygdom). Endeligpilottestes et nyt spørge-skema til at undersøge forandringen i den sundhedsfaglige praksis. Hovedresultater: Det er lykkedes at afprøve Ændringsskemaet med triage i trepleje-grupper (n=105)–således at alle borgeres habitualtilstand registreres og triageres. Alle borgere var ved testperiodens slutning monitoreret påoversigtstavler i plejegrupperne. Man havde fundet de kategorier som havde mindrefunktionstab og sygdomstegn(12,4%)og dem som var i risiko for forværring eller indlæggelse(8,6%). Der var iværksat opfølgende handling og forebyggende indsatser i forholdtil disse borgere.TOBS måling af vitale værdier (Puls, vejrtrækningsfrekvens, temperatur, bevidsthedsniveau og systolisk blodtryk) er introduceret og afprøvet på udvalgte risiko patienter –men der var ikke tilstrækkelig systematisk registrering af den analoge deli alle testgrupperne endnu. Testentyder dog på, at det godt kan kombineres med Ændrings-skemaet til at få systematiserede målinger af vitale værdier og opfølgning på deudsatte borgere.Der er udviklet en tilpasset IT-platform med Ændringskemaet, triage og TOBS til at få plejepersonalet til at lave tidlig opsporing af borgere med begyndende sygdomstegn. Endelig er der lavet et spørgeskema, der kan bruges til at undersøge oplevelsen af forandringer i den sundhedsfaglige praksis i forbindelse med indsatsen for tidlig opsporing og det er pilottestet i to plejegrupper (n=45). Der er ikke fundet tegn på systematisk bortfald på enkelte items, men der var for stort generelt bortfald i den sidste testgruppe til at opnå en fuld repræsentativitet i forhold til deres besvarelser. Konklusion: Tidlig opsporing i primær sektor, kræver enklemetoder tilpasset praksis ogfaggrupperne. Der er testet og fundet et virksomtmetodisk designtil tidlig opsporing i primær sektor, et tilpasset IT-redskabtil at understøtte udførelsen afÆndringsskemaet med triage og TOBS måling af borgere i risikozonen. Endvidere erpilottestet etnytspørgeskematil at undersøge forandringen af den sundhedsfaglige praksis, som den opleves af de involverede fagpersoner / Background.New methods and interventions in the primary sector can increase early disease detection and avoid unnecessary hospitalization. Aim:This study aimed to test a powerful set of early detection methods for vulnerable citizens who exhibit signs of incipient disease or preventable deterioration, including (i) an IT system customized to perform triage, (ii) Timely Observation of Beginning Sickness (TOBS) to measure at-risk citizens, and (iii) a questionaire that assesses change in healthcare practice. Methods. The mixed methods in this study included clinical testing, a triaged changing table, TOBS, risk scoring, and a new IT platform. We also pilot-tested a new questionnaire to investigate change in the healthcare practice. Main Results: After testing the triaged changing table in three healthcare groups (n=105), we registered citizens according to risk. Information boards allowed care groups to identify patients who experienced less loss of function and fewer signs of disease (12.4%); others experienced several major changes and were at risk of deterioration or hospitalization (8.6%). We initiated follow up and preventive measures to care for these citizens. TOBS included measurement of vital signs (i.e., heart and breathing rate, temperature, level of consciousness and systolic blood pressure) in selected risk patients, providing systematic risk scoring and suggestions for actions. Finally, we developed and pilot-tested (in two care groups, n = 45) a simple questionnaire that can prospectively examine change in healthcare practices. There are no signs of systematic errors on single items but in the last test group there was too large a general lapse of answers to achieve a full representation in relation to their responses. Conclusion: Early detection of preventable diseases in the primary sector requires methods that are adapted to the clinical setting and professional groups. Our results suggest that combining TOBS with the changing table may enable systematic measurement in vulnerable citizens detected and a quick follow up with preventive measures to care for these citizens. A well-customized IT platform will help healthcare providers detect early signs of disease. Using data entered during patient visits, the system can perform an online triage, create summaries of categorized citizens, and provide reminders of important follow up / <p>ISBN 978-91-86739-80-5</p>

Background: Considering recent advances in the field of early detection and intervention in young people with increased levels of psychotic symptoms seeking help, this thesis proposes that early attachment insecurity triggers an inability to regulate emotional distress, to engage in positive interpersonal interactions with others, to use adaptive coping mechanisms and to manage social support appropriately. These constructs appear to be linked to psychosis; however, considering continuity between subthreshold psychotic symptoms and the later development of psychosis, it is vital to understand if these underlying affective and interpersonal mechanisms increase the risk of psychosis in help-seeking young people. Objectives: This study was cross-sectional and investigated the following research questions: 1) Does attachment insecurity signpost the risk of developing psychosis? 2) Do coping strategies, interpersonal difficulties, social support and emotional distress have an indirect effect on the relationship between attachment insecurity and the risk of developing psychosis? Methods: A total of 76 help-seeking young people were recruited from Community Mental Health Services in Edinburgh. All participants completed a number of questionnaires exploring their coping strategies, interpersonal problems, perceived social support and emotional distress. A semi-structured interview was undertaken, to assess their socio-demographic background. The Comprehensive Assessment of At-Risk Mental States was administered and coded to assess their risk of psychosis and associated psychopathology, while path analysis was used to analyse the data and to address the research questions. Results: The profile of help-seeking young people in this sample (n=76) was made up of individuals with a moderate degree of difficulties in relation to coping strategies employed to manage stress and interpersonal problems dealing with others, moderate levels of emotional distress and discrepancies between their ideal and received social support. From the total help-seeking sample, the attachment dimensions anxiety and avoidance were relatively high. These young people were found to have had mild, psychotic-like experiences, especially in the domains associated with unusual thought content and perceptual abnormalities. When considering the subgroup of help-seeking young people with an at-risk mental state (ARMS) (n=46), the results revealed that this group had high levels of difficulties in interpersonal relationships, relied on non-productive coping strategies, presented emotional distress levels of clinical importance and also had discrepancies in their ideal and received social support. From the subsample of help-seeking young people with an ARMS the attachment dimensions anxiety and avoidance were reasonably high. These young people were found to have had moderately severe psychotic experiences, especially in the domains associated with unusual thought content and perceptual abnormalities. Path analysis revealed that attachment insecurity directly predicted psychotic symptoms in the total sample but not in the subgroup of young people with an ARMS. Emotional distress played a partially moderating role between attachment insecurity and the severity and distress associated with disorganised speech and perceptual abnormalities in the total sample but not when considering only those with an ARMS, while interpersonal problems did not mediate the relationship between attachment insecurity and the risk of psychosis in either group. Discrepancies between ideal and received social support fully mediated the relationship between attachment insecurity and the distress associated with disorganised speech in the total sample but not when considering those with an ARMS. The tendency to use less adaptive coping strategies was found to mediate directly the relationship between attachment anxiety and the distress associated with perceptual abnormalities in young people with an ARMS, albeit not in the total sample. Discussion: The clinical and theoretical implications of these results are discussed within the clinical staging model for intervention in psychosis. The findings strongly indicate that clinicians should take into consideration the mechanisms of attachment, coping strategies and social support, as well as the deleterious effects of associated emotional distress, when working with young people with increased levels of psychotic symptoms.

Cutaneous malignancies represent a quarter of all new cancer diagnoses in the UK. The key to reducing the tumours’ associated mortality and morbidity is early diagnosis and treatment. Prompt diagnosis remains predominately a clinical skill, but relatively little investigation of the cognitive psychology underpinning expertise in this domain has been undertaken. This thesis aims to improve understanding of these processes and investigate how lesional diagnostic expertise might be enhanced. A large database of diagnostically tagged images was captured specifically for this project. A series of separate studies were undertaken to give insight into how lesional diagnosis occurs and how it can be improved. The studies highlighted that non-analytical pattern recognition (NAPR) is likely to predominate in distinguishing malignant and non-malignant skin lesions and that the widely-promoted rules advocating analytical pattern recognition (APR) are not effective for discriminating melanoma from benign pigmented lesions. The keystone to promoting the development of NAPR and thus diagnostic expertise would seem to be increasing a novice’s personal library of examples with relevant feedback. Studies demonstrated that current undergraduate exposure was variable but universally sparse, so simulation by way of diagnostically tagged images was developed which showed accuracy could be improved by increased exposure. This improvement occurred in both a content specific and dose responsive manner. These studies also highlighted that the learning curves for skin lesions are not uniform. Further studies demonstrated that the choice of images had implications on the development of diagnostic expertise; suggesting it was important that these images represent clinical practice rather than “classic” examples traditionally advocated for teaching purposes. In addition, studies highlighted the potential benefit of the 3D models developed during this project. Building on the idea that a personal catalogue of relevant referent images was crucial to enhanced diagnostic accuracy, prototype software was developed to exteriorise the experts’ library of examples; in the tests described novices utilising the software delivered superior accuracy than medical students on the completion of their undergraduate teaching. In summation, the work described shows that by utilising dermato-informatic approaches lesional diagnostic competence can be improved significantly.

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.