Objectives This dissertation had two overarching objectives: 1. To determine how stakeholders perceive women’s preferences for cervical screening modalities. 2. To understand methods to measure women’s cervical screening preferences, to inform the development and testing of a person-centered, evidence-informed approach to preference-elicitation. Methods The overarching conceptual framework was the Ottawa Decision Support Framework. The first objective was addressed by interview studies with (1) guideline developers and program managers and (2) health professionals and women considering screening. This was complemented by a systematic review of quantitative, qualitative and mixed-methods studies of women’s cervical screening preferences, using the Grading of Recommendations, Assessment, Development, and Evaluation approach to developing preference-based recommendations. This approach was also used in a systematic review of methods to elicit women’s preferences, addressing the second objective. These findings led to the development and field testing of a preference-elicitation tool using International Patient Decision Aid Standards criteria, and the development of a protocol for a population-based study of women’s preferences. iv Results Objective 1 Experts disagree about whether there is enough evidence to include alternative modalities in cervical screening programs. Women and health care professionals do not recognize that women face a choice to participate in cervical screening. A narrative synthesis of relevant literature presented challenges in aggregating preferences across diverse study objectives, designs, and contexts. Objective 2 Preference-elicitation approaches for cervical screening are heterogenous in design and rigour. I therefore developed and field tested a tool to elicit women’s preferences, which demonstrated that women found the tool helpful to identify their preferences. I then propose a study that uses multiple methods to apply the tool more broadly. Conclusions Synthesized preferences data might not be the optimal approach to incorporate preferences into cervical screening guidelines. A tool grounded in shared decision-making can help women identify their informed, values-based screening preferences.

Pompe disease is a rare autosomal recessive condition caused by a deficiency in lysosomal alpha glucosidase. It is a progressive and often fatal muscular disease with wide variation in clinical presentation. Two broad clinical categories of Pompe disease have been identified; infantile- and late- onset. In the past decade, enzyme replacement therapy has shown promising results in treating the underlying pathology, resulting in improved clinical outcome. Clinical trials indicating that initiation of treatment at an earlier disease stage leads to a higher chance of preventing permanent damage have led to the proposition of introducing newborn screening for Pompe disease. All forms of Pompe disease are caused by the same pathology, and thus newborn screening has the potential to identify those affected with the more severe infantile-onset form as well as those with late-onset disease who may not present with symptoms until late in life. / The aim of this study was to investigate attitudes towards newborn screening for Pompe disease among affected adults, their family members and parents of ‘healthy’ children. Affected adults were recruited through support groups in Australia, the United Kingdom and United States; family members of affected adults were recruited from Australia; and parents of ‘healthy’ children were recruited through maternal child health clinics in Victoria, Australia. Participants completed questionnaires exploring their experiences of Pompe disease and/or newborn screening and their attitudes towards newborn screening for Pompe disease. / Support for newborn screening for Pompe disease was high among adults with Pompe disease (85.4%), parents of ‘healthy’ children (93.9%) and all three family members of affected adults who participated in this study. However, when offered a theoretical screening test that would only identify infantile-onset Pompe disease, 42.1% of adults with Pompe disease and 53.1% of parents of ‘healthy’ children preferred this screen, indicating that these stakeholders have some concerns regarding detection of late-onset disease in infancy. Factors influencing attitudes were investigated and support for newborn screening in affected adults was highly correlated with age of onset of disease; a preference to have been diagnosed in infancy; a belief that an earlier diagnosis would have made symptoms easier to cope with; and a stronger confidence in the efficacy of enzyme replacement therapy. / Potential benefits of diagnosis of late-onset disease in infancy were identified as being able to avoid the diagnosis odyssey, access enzyme replacement therapy at the optimal time, and allow individuals to make appropriate life choices. Participants identified increased anxiety in parents and the potential for over-protectiveness, in addition to possible discrimination, as harms of newborn screening for Pompe disease. / Families in which an infant is identified with the potential for late-onset Pompe disease will need assistance to adapt to and manage this diagnosis, so that anxiety is minimised and unnecessary limitations are not placed on the child. Whilst potential medical and psychosocial benefits can result from newborn screening, it is important to carefully consider the potential for harm and the resources required to appropriately manage these so that ultimately benefit outweighs harm.

BACKGROUND. There are various methods of health care follow-up of children born very preterm (VP, ≤31 week gestation) from a neonatal intensive care unit (NICU). Whilst the gold standard is the systematic NICU based follow-up program, which provides highly specialised neurodevelopmental and medical assessment, it is not feasible at all the appropriate times for all infants because of cost and geographical constraints. In Queensland, and elsewhere, 50% of children born VP rely on primary care-general practice for their screening and health needs once discharged from hospital. Recently, randomised and interrater agreement studies have shown the feasibility of the use of a questionnaire-based collection of late health status in children born VP. A preterm-targeted childhood primary health screening and surveillance program which draws from these methods may be effective in collecting long-term disability data and meeting the screening needs of children born VP. AIM. To (1) develop and (2) assess a Preterm-Targeted Screening and Surveillance Program against the routine National Health Medical Research Council (NHMRC) program for the early detection of sensorineural based disability in children born VP by general practitioners in the primary health setting for (1) prevalence estimation and (2) as a screening tool. METHODS. A two-part approach was chosen. Part 1 was a reconstructed cross-sectional cohort of 388 of 523 (74.2%) located and consented 2, 4 and 7 year ca (corrected age) children with a birthweight ≤ 1250 grams (g) born in Queensland. Epidemiological information was collected on child health outcomes and factors relating to the feasibility of providing a standardised targeted screening and surveillance program to be used by general practitioners to detect sensorineural based disability in children born VP. The Preterm- Targeted Screening and Surveillance Program was developed using World Health Organisation (WHO) screening program criteria and NHMRC evidence based health practice criteria. Part 2 was a multicentred randomised controlled trial to test the efficacy of the newly developed program in 202 VP infants who were randomised to receive the NHMRC or Preterm-Targeted Screening and Surveillance Program. The primary outcome was correct identification of sensorineural disability (developmental quotient >-1 standard deviation (SD), cerebral palsy, bilateral blindness or deafness requiring aids) at 12-months ca by general practitioners assessed against gold standard paediatric assessments. The odds ratios (OR) calculated the disability status (agreed vs. disagreed/unsure). Kappa statistics (k) and screening test characteristics calculated interrater agreement and screening accuracy (agreed vs. disagreed). Logistic regression investigated factors that might affect agreement between general practitioners and paediatric assessment for disability. Secondary outcomes were designed to be descriptive and included post-natal depression, parental stress, health service utilisation and satisfaction. RESULTS. Part 1 demonstrated that in Queensland there is no state-based information on 25.8% of children born VP. Children assessed suffer from sensorineural impairment and a range of other health and developmental problems. In addition, there is limited specialist child health resources located outside the major metropolitan areas and families rely heavily on general practitioners for child health care. Parents and general practitioners clearly demonstrated that they would use an evidence-based targeted childhood screening and surveillance program for children born VP. The Preterm-Targeted Screening and Surveillance Program provide parents and health practitioners with an evidence based-high accuracy standardised screening for sensorineural and non-sensorineural domains. In Part 2, 195 of 202 infants randomised were assessed for the primary outcome. There was no difference in the correct identification of sensorineural disability between general practitioners in either group shown by an OR of 0.91 (95%CI 0.50, 1.65) (preterm-targeted 65.6% vs. NHMRC 67.6%). No prognostic factors independently affected this outcome. Interrater agreement was fair (preterm-targeted k =0.30, p for Ho=0.001 vs. NHMRC k =0.29, p for Ho=0.002). The preterm-targeted group had more disability identified (73% vs. 33%) with less under-referrals (27% vs. 67%) but poorer specificity (70% vs. 92%) with more over-referrals (30% vs. 8%) compared to the NHMRC group. Secondary outcomes showed that children born VP experience high rates of health services use but their families experience similar rates of depression and parental stress compared to the general paediatric population. Satisfaction results suggest that the program was well received. CONCLUSION. A comprehensive epidemiological approach to collecting a broad range of VP child health outcomes and health service data was successfully used to develop an evidence-based Preterm-Targeted Screening and Surveillance Program which proved to have excellent uptake by parents and general practitioners. Assessing the program using a randomised methodology has allowed demonstration of its efficacy as a screening tool when used by general practitioners in the primary health setting. The Preterm-Targeted Screening and Surveillance Program is superior in identifying disability at 12-month ca compared to the standard NHMRC program. Whilst the results are promising, the program will not provide totally accurate prevalence of disability data because of the overestimation of disability.

Increasing the odds of hit identification in screening is of significance for drug discovery. The odds for finding a hit are closely related either to the diversity of libraries or to the availability of focused libraries. There are no truly diverse libraries and it is difficult to design focused libraries without sufficient information. Hence it is helpful to consider alternative approaches that can enhance the odds using existing libraries. Multiple members of a protein family have been considered collectively in inhibitor design, on the basis of the correlation between protein families and ligands derived from specific compound classes. Such a correlation has been exploited in various drug discovery studies and a general receptor-homolog-based screening scheme may be devised. The feasibility of such a scheme in enhancing the odds of hit identification is discussed. / Singapore-MIT Alliance (SMA)

Thesis (Ph. D.)--Johns Hopkins University, 2005. / Includes bibliographical references (p. 185-204).

Syftet med studien är att belysa vilken erfarenhet personalen inom primärvården har av att fånga upp patienter med ett riskbruk av alkohol. Syftet innefattar även att undersöka deras erfarenheter av att ställa frågor kring alkohol samt vilka insatser patienter med alkoholproblem kan erbjudas. Studien har en kvalitativ metod med hermeneutiken som utgångspunkt. Vid insamling av data användes semistrukturerade intervjuer. Fem distriktssköterskor har intervjuats på fem olika vårdcentraler. Resultatet visar att alla respondenterna anser att primärvården är en av dem som har ansvaret för att upptäcka för hög alkoholkonsumtion. Det varierar emellertid i vilken utsträckning distriktssköterskorna ställer frågor om alkoholvanor och när frågorna ställs. Behandling som patienter med ett riskbruk av alkohol kan bli erbjudna är bland annat läkarbesök. För att arbetet med patientgruppen ska utvecklas ansåg respondenterna bland annat att frågan om alkohol bör avdramatiseras och att det även behövs mer struktur och rutiner inom verksamheten.

Shale gas reservoirs are gaining importance in United States as conventional oil and gas resources are dwindling at a very fast pace. The purpose of this study is twofold. First aim is to help operators with simple screening criteria which can help them in making certain decisions while going after shale gas reservoirs. A guideline chart has been created with the help of available literature published so far on different shale gas basins across the US. For evaluating potential of a productive shale gas play, one has to be able to answer the following questions: 1. What are the parameters affecting the decision to drill a horizontal well or a vertical well in shale gas reservoirs? 2. Will the shale gas well flow naturally or is an artificial lift required post stimulation? 3. What are the considerations for stimulation treatment design in shale gas reservoirs? A comprehensive analysis is presented about different properties of shale gas reservoirs and how these properties can affect the completion decisions. A decision chart presents which decision best answers the above mentioned questions. Secondly, research focuses on production data analysis of Barnett Shale Gas reservoir. The purpose of this study is to better understand production mechanisms in Barnett shale. Barnett Shale core producing region is chosen for the study as it best represents behavior of Barnett Shale. A field wide moving domain analysis is performed over Wise, Denton and Tarrant County wells for understanding decline behavior of the field. It is found that in all of these three counties, Barnett shale field wells could be said to have established pressure communication within the reservoir. We have also studied the effect of thermal maturity (Ro %), thickness, horizontal well completion and vertical well completion on production of Barnett Shale wells. Thermal maturity is found to have more importance than thickness of shale. Areas with more thermal maturity and less shale thickness are performing better than areas with less thermal maturity and more shale thickness. An interactive tool is developed to access the production data according to the leases in the region and some suggestions are made regarding the selection of the sample for future studies on Barnett Shale.

This thesis presents a methodology developed to aid in the determination of potential sources and the potential scale of energy savings in commercial buildings. As a pre-screening tool, the methodology is designed to serve as the first analysis of the building’s potential for energy savings using limited data prior to a site visit. A Microsoft® Excel-based tool was developed to perform this analysis semi-automatically with user operation. A fundamental concept used in this methodology is that of the energy balance load, defined as heating plus electricity minus cooling. The methodology is designed to require only historical weather data, historical whole-building energy consumption data, the total conditioned floor area, and the basic function of the building. Upon following a short procedure developed and outlined in this thesis, this limited data yields information that can lead to conclusions about the building’s energy consumption. The output information includes estimates of a major building thermal parameter—the building’s overall heat transfer coefficient including the total outside air flow rate into the building. In addition to providing this information, the Excel tool includes already-formatted plots of the energy consumption commonly used in energy analysis. These include cooling, heating, and electricity vs. both outside air temperature and time. Three case studies illustrate the utility of this methodology. The calculated energy balance load—calculated using parameters determined through this methodology—yielded values on average within 5.4% of measured values.

Abstract The research of Knowledge and Behavior on Cervical cancer. It is an index of a nation¡¦s competition ability and merit goods referring to citizen health. In additions, it also saves amount of cost from medicine and resource regarding to overall government policy of prevention. In the 20th century, cancer is one of the most concerning matters. From 1982 to 2000,cancer has been a major cause of death. It also rapidly results in 30 thousand deaths per year. Moreover, the Cervical Cancer is a major cause of death for female. (44 out of 100,000 people are affected). It also effects highest rate of death or occurrences of cervical cancer results from overdue treatment according to 60~70% domestic female. In this period, it is essential to consider how we can prevent and reduce occurrences of cervical cancer which are harmful or have threats to all of the women, family and society. Prevention is better than treatment. Cervical Cancer is a major threat of illness to female, however, it is also one of malignance, which can easily be found. Consequently, it needs properly ideas, knowledge and attitude and aggressive actions of health such as injection of vaccine or period body examination in order to achieve the goal of ¡§early found and early treatment¡¨. According to the research, we do believe people have different attitudes, knowledge or behaviors toward cervical cancer prevention due to diverse personal attributions. (Background and character). And it causes different results of cervical cancer healing. In this research of survey, we found the younger age of females such as single female or married without pregnancy, don¡¦t get adequate information or awareness of Cervical cancer and result in readily increasing trends of cervical cancer from 16 to 30 years old female. At the moment, they are the major concerned targets as well as it should be strengthened the way in order to ease the occurrences of cervical Cancer. In this research, we also found it should be improved from ineffectiveness of national organization; consequently, it should be aggressively reinforced on public knowledge and awareness. Finally, people always concern the matters of price, safety and effectiveness of therapy. First, we should raise the functions of effectiveness of therapy and safety in order to reinforce the knowledge and effective vaccine on public. Second, we should build up welfare such as allowance of plans between the ages of 16 to 30 female. Third, government should advocate policy of vaccine injection in order to shrink most rates of cervical cancer and to achieve the goal of ¡§early found and early treatment¡¨. Key words¡Gcervical cancer, screening

Thesis (Ph. D.)--University of Hong Kong, 2010. / Includes bibliographical references (leaves 151-167). Also available in print.