This thesis examines the benefits and costs of screening for colorectal cancer in the context of an organised population screening programme. It uses microsimulation modelling to derive an optimally cost-effective screening protocol for various combinations of the available screening tests. ¶ First a mathematical model for the natural history of colorectal cancer is derived, based on analyses of Australian population and hospital-based cancer registries combined with data from published studies. Then a model for population based screening is derived based mainly on data from published screening studies, including the four major published randomised controlled trials of faecal occult blood test (FOBT) screening. These two models are used to simulate the application of a screening programme to the Australian population. The simulations are applied to a period of 40 years following 1990 (the study’s base year), with both costs and benefits discounted back to the base year at an annual rate of 3%.¶ The models are applied to simulating a population screening programme based on FOBT with a colonoscopy follow up of positive tests. This simulation suggests that the optimal application of such a programme would be to offer annual screening to people aged 50 to 84 years. Such a programme would lead to a cumulative fall in years of life lost to colorectal cancer (YLL) of 28.5% at a cost per year of life saved (YLS) of $8,987. These costs and benefits are consistent with those arising from other currently funded health interventions. They are also consistent with the cost per YLS which Australian governments appear willing to pay for health interventions when justified on the basis of cost-effectiveness. The fall in colorectal cancer deaths from this screening programme should be first detectable by a national monitoring system after around three years of screening. However the full benefits from screening would not be realised before around 30 years of screening.¶ These simulations are based on the standard guaiac FOBT, but the results suggest that significant cost-effective gains could be made by using the newer immunochemical FOBT. Further cost-effect gains could be made by offering sigmoidoscopy every five years in addition to annual FOBT.¶ The models are then applied to simulating population screening programmes using colonoscopy and sigmoidoscopy as primary screening tools. Offering colonoscopy every ten years to all people aged from 45 to 85 leads to an overall fall in cumulative YLL of 37.6%, at a cost of $15,585 per YLS. Offering sigmoidoscopy every three years to all people aged 40 to 85 leads to an overall fall in cumulative YLL of 29.1%, at a cost of $4,862 per YLS. Both of these cost and benefit results are also consistent with the cost per YLS which Australian governments appear willing to pay. The fall in deaths with colonoscopy screening would also be detectable after three years of screening but the fall with sigmoidoscopy screening would not be detectable until after six years of screening. Sigmoidoscopy would need around 35 years of screening to reach its potential gains while colonoscopy screening would not reach its full potential during the 40 year screening period.¶ Finally the models are applied to targeting people at higher risk of cancer. The results show that offering colonoscopy every five years to people at higher risk because of a family history of colorectal cancer is a cost-effective addition to the annual FOBT screening programme.¶ An earlier version of chapter two of this thesis has been published as Stevenson CE 1995. Statistical models for cancer screening. Statistical Methods in Medical Research; 4: 19–23.¶ An expanded version of chapter two, along with parts of chapter one, has been published as Stevenson CE 1998. Models of screening. In: Encyclopedia of Biostatistics. Armitage P, Colton T, eds. John Wiley and Sons Ltd, pp 3999–4022.

The concept of magic is most often considered as a foil by scholars in the fields of philosophy and religious studies, or it is discussed as part of the investigation of “primitive” systems of belief and ritual. In this essay, magic is investigated as a system of inquiry and explanation unto itself, connected to but distinct from both philosophy and religious studies, and an argument is presented for understanding systems of magic as both natural and rational outgrowths of a particular perspective on reality.

Chapter 1. Deciphering the toxicity of Helicobacter pylori clinical isolates from gastric diseases patients using MALDI-TOF/MS and multivariate analysis. Helicobacter pylori (H. pyloyi) infection is associated with gastric diseases such as gastric polyp, chronic gastritis, gastric ulcer, gastric cancer, etc. In fact, most of the people infected not have the symptoms of gastric diseases due to the high degree of variability of gene with H. pyloyi and the specific immune responses of the hosts. In order to investigate the relationship between H.pylori and gastric diseases, the clinical strains of H. pylori isolated from patients from nine gastric diseases were extracted from the optimized extraction and analysis by MALDI-TOF/MS, then the high reproducible spectra were combined with multivariate statistical analysis including Principal Component Analysis (PCA), Hierarchical Cluster Analysis (HCA), Discriminant Analysis (DA) . In the result of PCA, there is no specific potential marker to discriminate the clinical strains to nine gastric diseases. In the result of HCA, the strains from different gastric diseases were clustered together means they have the similarity of the protein and metabolite. In the result of DA, the strains from gastric and non-gastric cancer were discriminanted by the discriminant function composed of thirty-eight discriminant variables in the spectra. This discriminant function would be confirmed by other clinical strains isolated from gastric diseases patients in the future and then would help to predict the the similarity of the protein and metabolite of the strains isolated from the gastric diseases patients whether gastric cancer or not. Chapter 2. Biomarker discovery in the stools of gastric cancer patients using MALDI-TOF/MS. According to the statistics of Republic 100 years from the Department of Health, cancer was the first of the ten lesding to death. With the modern change of eatiog habbits, gastrointestinal cancer has increased steadily. Gastrointestinal cancer accompanied occult gastrointestinal bleeding, and it is commonly detected by the fecal occult blood test (FOB). FOB including Guaiac-based fecal occult-blood test and immunochemical tests. Guaiac-based fecal occult-blood tests make use of the pseudoperoxidase activity of heme, and the reagent turns blue after oxidation by oxidants or peroxidases in the presence of an oxygen donor such as hydrogen peroxide, so it would have the potential of false-positive result. Immunochemical tests, which use antibodies detect against human hemoglobin with great sensitivity, but the tests are limited by loss of hemoglobin antigenicity at room temperature and require processing in a laboratory. In order to decrease the false-positive of detecting heme and decreasing the cost of the detection against hemoglobin in stools, in the study, we ues the distill water to extract the heme (m/z 616) and hemoglobin in stools and analysis with the reflectron and linear mode of MALDI-TOF/MS. In this study, at first, we used the stimulated stomach acid decomposing the hemoglobin to release the heme, to stimulate the gastrointestinal bleeding. Second, we used the distill water to extract the hemoglobin in stools, and detected by the linear mode of MALDI-TOF/MS, and the detection limit of MALDI-TOF/MS against hemoglobin in stool was better than the immunochemical tests. Third, the same strategy was applied to fifty-nine patients (including nineteen esophageal cancer patients, twenty gastric cancer patients and colorectal cancer patients) stools to detect heme and hemoglobin by MALDI-TOF/MS and the results were compared with the fecal occult blood test. In the detection of heme, MALDI-TOF/MS had not detect heme, but the Guaiac-based fecal occult-blood test had detected, it would be that the stools had the oxidants (not heme) to react the reagent. In addition, MALDI-TOF/MS had detected heme, but the Guaiac-based fecal occult-blood test had no results, those cases would be catched up in the future. In the detection of hemoglobin, using immunochemical tests to be the reference index, MALDI-TOF/MS had the false-negative result might come from the complicated matrix effect of stools, so that the hemoglobin could not form the good crystalline with matrix CHCA. The false-positive results of MALDI-TOF/MS might come from the criteria of hemoglobin signal.

William Butler Yeats and Aleister Crowley created literary works intending them to comprise religious systems, thus negotiating the often-conflicting roles of religion and modern art and literature. Both men credited Percy Bysshe Shelley as a major influence, and Shelley's ideas of art as religion may have shaped their pursuit to create working religions from their art. This study analyzes the beliefs, prophetic practices, myths, rituals, and invocations found in their literature, focusing particularly on Yeats's Supernatural Songs, Celtic Mysteries, and Island of Statues, and Crowley's "Philosopher's Progress," "Garden of Janus," Rites of Eleusis, and "Hymn to Pan." While anthropological definitions generally distinguish art from religion, Crowley's religion, Thelema, satisfies requirements for both categories, as Yeats's Celtic Mysteries may have done had he completed the project.

Colorectal cancer poses a serious threat to the health and well-being of individuals, especially those at high risk or over the age of 50. Gone undetected, colorectal cancer is often fatal, however, preventive screening greatly reduces the number of people who may develop this disease. The Centers for Disease Control and Prevention developed the Colorectal Cancer Screening Demonstration Program in 2005 to assess the feasibility of a national colorectal cancer screening program serving low-income and un- or underinsured populations. Qualitative case study data from the Colorectal Cancer Screening Demonstration Program evaluation were analyzed in order to examine the start-up experiences of two of the programs involved. Results from this multiple case study document program models and describe facilitators, challenges, and participant perception of the expected impact on screening behavior. Further research on program implementation is needed to understand how program models perform and impact behavior once screening begins.

In Australia, colorectal cancer (CRC) is the most common registrable cancer affecting both men and women, and the third most common cause of cancer deaths. Clinical data from randomised, controlled trials indicate that population-based screening utilising the faecal occult blood test (FOBT) can reduce mortality from this disease. However, high adherence rates with repeated testing are required to secure these outcomes. This study examines repeat adherence with FOBT screening in a rural community two years after a first screening round was conducted. Patients, aged 50 to 74 years, registered with four local general practices were mailed a FOBT kit with a letter of invitation from their general practitioner. Following the intervention, 119 telephone interviews were conducted with adherers and non-adherers to examine knowledge and attitudes related to screening. Compliance with screening was recorded and compared with first round-data. Participation in the screening program was modest. Of the 3,406 participants eligible for both screening rounds, 34.1% and 34.7% participated in rounds 1 and 2, respectively. A majority of participants (56.8%) did not adhere to either screening, a quarter (25.7%) participated in both rounds, and 17.5% participated in one of the two rounds. First-round adherence was the strongest predictor of second-round adherence (OR=16.29; 95% CI: 13.58, 19.53) with 75.2% of first-round adherers completing a FOBT in round 2. Females were also more likely to adhere in both rounds, although the difference between females and males decreased across rounds. Knowledge and attitudes differed between adherers and non-adherers and are discussed within the context of the major findings. Results from this trial indicate that achieving high levels of compliance in a national screening program will be challenging. Strategies to increase repeat adherence are suggested.

My interest in criminology was inspired by Dennis Challinger who tolerated a student taking ten years to finish the Diploma in Criminology, and Stan Johnson who encouraged broad-mindedness to which I was unaccustomed. Stan challenged my attitudes, beliefs and conclusions. My interest in cults was inspired by Anne Hamilton-Byrne whose "children'" especially Sarah, taught me a great deal. They introduced me to their personal experience of growing up in strange isolation from the world. I received assistance and constructive criticism from the police Task Force investigating the Hamilton-Byrne “Family” especially Detective Sergeant DeMan. I began this task searching to understand “The Family”, its origins and its meaning. The path towards an understanding of cults took me in unexpected directions. I learned about the Satanic allegations and began accumulating material. Initially, some therapists with an interest in this area saw me as a potential ally, but as I began to question there assumptions I was rejected as a disbeliever, on the basis that “anyone who is not with us, must be against us”.

Introdução. Hepatite B oculta é caracterizada pela presença do HBV-DNA em pacientes que não expressam o antígeno B de superfície (HBsAg) e é relatada com maior freqüência em pacientes infectados pelo vírus da hepatite C (HCV). Nesse estudo avaliamos a prevalência de hepatite B oculta em transplantados renais infectados ou não pelo HCV e avaliamos a função hepática nos diferentes grupos. Material e métodos. Amostras de soro de 101 pacientes transplantados renais foram avaliadas para testes de função hepática, marcadores sorológicos e reação de polimerização em cadeia (PCR) para o HBV-DNA. Todos os pacientes eram HBsAg negativos e havia 51 pacientes anti- HCV reagentes e 50 pacientes não reagentes. A pesquisa do HBV-DNA foi feita por técnica de PCR aninhado para os genes S e “core”. Resultados. A pesquisa do gene S do HBV-DNA resultou positiva em 2 pacientes, sendo um do grupo anti-HCV reagente e o outro do grupo não reagente. A pesquisa do gene da região do “core” foi positiva em um paciente do grupo anti-HCV não reagente. A análise demonstrou que os pacientes do grupo anti-HCV reagente apresentam maior tempo de tratamento dialítico (50,8 + 34,6 e 32,02 + 20,87; p<0,001). Da mesma forma o grupo anti-HCV reagente apresentou valores mais elevados de aminotransferases: ALT: 34.5 ± 26.7 x 20.9 ± 10.0; (P < 0.001); AST: 31.7 ± 17.7 x 24.9 ± 14.9; (P < 0.05); gama glutamiltranspeptidase : 66.1 ± 82.4 x 33.4 ± 44.6; (P < 0.02) e fosfatase alcalina : 307.9 ± 397.7 x 186.9 ± 63.4; (P< 0.04). Os níveis de ciclosporina sérica também mais elevados também foram encontrados no grupo anti-HCV reagente 170.9 ± 69.8 and 135.0 ± 48.1 respectivamente (P < 0.02). No modelo de análise multivariada evidenciou-se que apenas a presença de infecção pelo HCV é determinante das alterações nas provas de função hepática. Conclusão. Hepatite B oculta foi um achado infreqüente na nossa população de pacientes transplantados renais, não tendo sido encontrada diferença na sua prevalência em pacientes infectados ou não pelo HCV. Pacientes anti-HCV reagentes apresentam alterações significativas das provas de função hepática e dos níveis sangüíneos de ciclosporina. / Background: Occult hepatitis B (HB) is characterized by the presence of HBV-DNA in patients who do not present HB surface antigen (HBsAg) detectable in sera. This condition is frequently described in patients with hepatitis C virus (HCV) infection and its clinical implications are uncertain. Since transplant patients were at risk for hepatitis B and/or C infection by blood transfusions, dialysis treatment and the transplant procedure itself we aimed to evaluate the prevalence of occult HB either with or without HCV infection. Patients and Methods: One hundred and one HBsAg negative renal transplant patients were evaluated. Fifty-one were anti-HCV reagents (Elisa III). Sera was analyzed for the presence of the S and core genes of the HBV-DNA by a nested PCR technique. Serological markers of HBV infection, liver function testes and ciclosporine through levels were also analysed. Results: The core gene of the HBV-DNA was identified in one HCV infected patient and in one anti-HCV negative who also presented the S gene (prevalence: 2% and 1% for each gene respectivelly). HCV infected patients presented longer pre-transplant dialysis time (50.8 ± 34.6 versus 32.0 ± 20.9; p<0,001). Results of liver function tests were also increased in the HCV infected group: ALT: 34.5 ± 26.7 x 20.9 ± 10.0; (P < 0.001); AST: 31.7 ± 17.7 x 24.9 ± 14.9; (P < 0.05); GGT: 66.1 ± 82.4 x 33.4 ± 44.6; (P < 0.02) and alkaline phosphatase: 307.9 ± 397.7 x 186.9 ± 63.4; (P< 0.04). Ciclosporine through levels were also significantly higher in HCV infected patients 170.9 ± 69.8 and 135.0 ± 48.1 respectivelly (P < 0.02). Multivariate analysis revealed that only HCV infection was determinant of the increased results of the LFTs. Conclusion: We found that occult hepatitis B is infrequent condition in our population of renal transplant patients and that HCV infection seems not to be a risk factor. In accordance with our previous work HCV we showed that infected renal transplant patients present evidence of liver damage and altered metabolism evidenced by the elevated liver function testes a higher ciclosporine through levels.

Introdução. Hepatite B oculta é caracterizada pela presença do HBV-DNA em pacientes que não expressam o antígeno B de superfície (HBsAg) e é relatada com maior freqüência em pacientes infectados pelo vírus da hepatite C (HCV). Nesse estudo avaliamos a prevalência de hepatite B oculta em transplantados renais infectados ou não pelo HCV e avaliamos a função hepática nos diferentes grupos. Material e métodos. Amostras de soro de 101 pacientes transplantados renais foram avaliadas para testes de função hepática, marcadores sorológicos e reação de polimerização em cadeia (PCR) para o HBV-DNA. Todos os pacientes eram HBsAg negativos e havia 51 pacientes anti- HCV reagentes e 50 pacientes não reagentes. A pesquisa do HBV-DNA foi feita por técnica de PCR aninhado para os genes S e “core”. Resultados. A pesquisa do gene S do HBV-DNA resultou positiva em 2 pacientes, sendo um do grupo anti-HCV reagente e o outro do grupo não reagente. A pesquisa do gene da região do “core” foi positiva em um paciente do grupo anti-HCV não reagente. A análise demonstrou que os pacientes do grupo anti-HCV reagente apresentam maior tempo de tratamento dialítico (50,8 + 34,6 e 32,02 + 20,87; p<0,001). Da mesma forma o grupo anti-HCV reagente apresentou valores mais elevados de aminotransferases: ALT: 34.5 ± 26.7 x 20.9 ± 10.0; (P < 0.001); AST: 31.7 ± 17.7 x 24.9 ± 14.9; (P < 0.05); gama glutamiltranspeptidase : 66.1 ± 82.4 x 33.4 ± 44.6; (P < 0.02) e fosfatase alcalina : 307.9 ± 397.7 x 186.9 ± 63.4; (P< 0.04). Os níveis de ciclosporina sérica também mais elevados também foram encontrados no grupo anti-HCV reagente 170.9 ± 69.8 and 135.0 ± 48.1 respectivamente (P < 0.02). No modelo de análise multivariada evidenciou-se que apenas a presença de infecção pelo HCV é determinante das alterações nas provas de função hepática. Conclusão. Hepatite B oculta foi um achado infreqüente na nossa população de pacientes transplantados renais, não tendo sido encontrada diferença na sua prevalência em pacientes infectados ou não pelo HCV. Pacientes anti-HCV reagentes apresentam alterações significativas das provas de função hepática e dos níveis sangüíneos de ciclosporina. / Background: Occult hepatitis B (HB) is characterized by the presence of HBV-DNA in patients who do not present HB surface antigen (HBsAg) detectable in sera. This condition is frequently described in patients with hepatitis C virus (HCV) infection and its clinical implications are uncertain. Since transplant patients were at risk for hepatitis B and/or C infection by blood transfusions, dialysis treatment and the transplant procedure itself we aimed to evaluate the prevalence of occult HB either with or without HCV infection. Patients and Methods: One hundred and one HBsAg negative renal transplant patients were evaluated. Fifty-one were anti-HCV reagents (Elisa III). Sera was analyzed for the presence of the S and core genes of the HBV-DNA by a nested PCR technique. Serological markers of HBV infection, liver function testes and ciclosporine through levels were also analysed. Results: The core gene of the HBV-DNA was identified in one HCV infected patient and in one anti-HCV negative who also presented the S gene (prevalence: 2% and 1% for each gene respectivelly). HCV infected patients presented longer pre-transplant dialysis time (50.8 ± 34.6 versus 32.0 ± 20.9; p<0,001). Results of liver function tests were also increased in the HCV infected group: ALT: 34.5 ± 26.7 x 20.9 ± 10.0; (P < 0.001); AST: 31.7 ± 17.7 x 24.9 ± 14.9; (P < 0.05); GGT: 66.1 ± 82.4 x 33.4 ± 44.6; (P < 0.02) and alkaline phosphatase: 307.9 ± 397.7 x 186.9 ± 63.4; (P< 0.04). Ciclosporine through levels were also significantly higher in HCV infected patients 170.9 ± 69.8 and 135.0 ± 48.1 respectivelly (P < 0.02). Multivariate analysis revealed that only HCV infection was determinant of the increased results of the LFTs. Conclusion: We found that occult hepatitis B is infrequent condition in our population of renal transplant patients and that HCV infection seems not to be a risk factor. In accordance with our previous work HCV we showed that infected renal transplant patients present evidence of liver damage and altered metabolism evidenced by the elevated liver function testes a higher ciclosporine through levels.

De acordo com a teologia cristã, o Diabo caracteriza-se como paradigma definitivo e origem inconteste daquilo que se convencionou chamar de Mal na mundividência ocidental. Todavia, ao transpor as fronteiras dos textos religiosos em que se originou, o Diabo veio a se tornar, nos domínios da literatura, um símbolo recorrente e de indisputável significância, como atestam suas várias e multifacetadas manifestações literárias. Destarte, partindo de uma interpretação do Adversário enquanto símbolo literário de extensa tradição, o presente trabalho objetiva analisar a representação de Satã no conto A Hora do Diabo, de Fernando Pessoa. Tenciona-se, em substância, por meio de uma leitura analítico-comparativa do discurso de Satanás, deslindar a figura do Tentador enquanto sumo conhecedor de mistérios e iniciador que, ao longo da narrativa, sumariza e expõe ao leitor o pensamento esotérico de Fernando Pessoa para, a partir daí, estabelecer uma relação entre os desígnios do Diabo, o Oculto e o fazer poético / According to the Christian theology, the Devil is the utmost paradigm and unquestionable origin of what is commonly named Evil in the Western outlook. Howeveer, by crossing the borders of the religious texts in which it sprang, the Devil became, in the realms of literature, a recurring and indisputably significant symbol, as its various and manifold literary manifestations bear witness. Starting, thus, from an interpretation of the Adversary as a literary symbol of broad tradition, this paper aims at analyzing the representation of Satan in the short-story A Hora do Diabo, by Fernando Pessoa. By means of an analytical comparative study of Satans discourse, our purpose is, essentially, to unfold the figure of the Tempter as the supreme bearer of mysteries and the initiator who, along the narrative, synthesizes and exposes to the reader Fernando Pessoas esoteric thought in order to, from this point on, establish a relation among the Devils intent, the Occult and the poetic creation.