Fetal alcohol spectrum disorder (FASD) is the leading non-genetic cause of brain damage. In an effort to reduce alcohol-exposed pregnancies, steps are needed to identify at risk women as early as possible so that appropriate intervention can occur. The objective of this dissertation was to examine screening methods validated in identifying pregnant women at risk for consuming alcohol and illicit drugs during pregnancy. A systematic review identified three main approaches including maternal self-report, use of standardized questionnaires and detection via biological markers. Since most screening tools were developed in alcoholic women, it was important to examine performance in problem drinkers. Alcohol screening tools (ASQ), currently the best method of predicting prenatal problem drinking, were not effective in a cohort representative of problem drinkers. ASQ performance improved minimally, using higher thresholds, but not enough to be used alone. Provider’s knowledge of complexities inherent in women under their care is an important component in screening. As illicit drug use is an important predictor of problem drinking, identifying maternal risk factors associated with substance use was necessary. Increased rates of STD’s, untreated psychiatric disorders, binge drinking and heavy smoking were all identified as predictors of prenatal methamphetamine (MA) use. These factors, combined with high rates of unplanned pregnancies have serious adverse implications for the fetus. The most widely used method to screen for illicit substance use is based on a practice-based approach that relies heavily on maternal self-report. Most providers do not ask about alcohol and substance use in the absence of a high index of suspicion due to the assumption that patient will deny use. But evidence suggests that maternal account can be accurate in a supportive environment. The last study examines the agreement between self-reported data, in comparison to illicit drug use based on positive hair test results. A reasonable agreement between the two approaches of identification demonstrates that maternal self-report can be reliable in women who are motivated enough to seek prenatal care. No single approach is sufficient to effectively identify at risk women. However, combining two or more methods will improve screening and help reduce the number of alcohol-exposed pregnancies.

Bakgrund: Personer som har ett riskbruk av alkohol har en måttligt förhöjd risk för sjukdom, sänkt livskvalitet och förtida död. Vid riskbruk ökar risken för att utveckla alkoholmissbruk. Alcohol Use Disorders Identification Test [AUDIT] är ett frågeformulär för att screena överdrivet alkoholdrickande. Socialstyrelsen rekommenderar rådgivning vid skadlig alkoholkonsumtion, t.ex. kort rådgivning. Syfte: Syftet med studien var att beskriva betydelsen av sjuksköterskans alkoholspecifika screening och rådgivning till vuxna personer som har ett riskbruk eller missbruk av alkohol. Metod: Studien var en systematisk litteraturstudie. Databaser som användes var Cinahl, PsycINFO och PubMed, sökorden var Alcoholism, Counseling och Nurses. De sex artiklarna som ingick i studien granskades och värderades utifrån en granskningsmall. Artiklarnas resultat bearbetades utifrån en textanalys och sammanställdes i litteraturstudien. Resultat: I studierna gav sjuksköterskorna alkoholspecifik rådgivning/samtal till personer med skadligt alkoholbruk. I de flesta studierna minskade antal standardglas per vecka och antal intensivkonsumtionstillfällen per månad mer i interventionsgruppen jämfört med kontrollgruppen efter genomförandet av interventionen. Slutsatser: Studierna i arbetet visar att sjuksköterskan har möjlighet att påverka en persons alkoholvanor på ett positivt sätt och därmed bidra till en förbättrad hälsa för individen.

Bakgrund: Evidens finns för att träning inriktad på neuromuskulär kontroll, styrka och medvetenhet kan minska antalet skador i nedre extremitet hos fotbollsspelare. Brister i rörelsekontroll skulle kunna predisponera för smärta, dysfunktion och skador och vara en orsak till skaderecidiv. Syfte: Att studera rörelsekontroll hos unga manliga fotbollsspelare före och efter en träningsintervention på elva veckor med särskilt fokus på ländrygg, bäcken och höftregion. Metod: Tjugo unga elitsatsande fotbollsspelare ingick i studien. Screeninginstrumentet The Matrix Movement and Performance Screen (MPS) användes för att mäta spelarnas rörelsekontroll före och efter en träningsintervention på 11 veckor. MPS identifierar okontrollerad rörelse vad avser lokalisation och riktning samt om den är relaterad till låg eller hög belastning. Träningen inriktades, utifrån testresultat vid baslinjen, på specifik motorisk kontroll träning av ländrygg, bäcken, höft och bröstrygg under låg och hög belastning och utfördes i form av hemövningar och av sjukgymnast övervakad cirkelträning. Resultat: Efter interventionen sågs en signifikant förbättring för MPS total poäng och uppdelat på högrisk områden vad avser rörelsekontroll på låg respektive hög belastning. Ett genomgående mönster av nedsatt rörelsekontroll vad avser ländrygg/bäcken och höft sågs hos spelarna vid testtillfälle ett och en genomgående förbättring av samma parametrar vid testtillfälle två. Konklusion: En träningsintervention på 11 veckor, baserad på testresultat från The Matrix Movement and Performance Screen, förbättrade deltagarnas rörelsekontroll signifikant. / Introduction: Evidence exists that training focused on neuromuscular control, strength and awareness is effective in reducing the number of injuries in the lower extremity of soccer players. Deficits in movement control might predispose to pain, dysfunction and injury and be a cause of re-injury. Objective: To investigate movement control, with extra emphasis on low back, pelvis and hip region, in young male soccer players before and after a training intervention in eleven weeks. Method: Twenty young elite soccer players entered the study. The screening tool The Matrix Movement and Performance Screen (MPS) was used to  measure the players' movement control before and after a training intervention of 11 weeks. MPS identifies the site and direction of uncontrolled movement and whether it´s related to low or high load. The training was based on the test results at baseline and focused on specific motor control training of the low back, pelvis, hip and upper back during low and high load and was conducted in the form of circuit training supervised by the test leader and home exercises. Results: There was a significant improvement for the MPS total scores and for high risk areas concerning movement control at low and high load respectively after the intervention. A pattern of uncontrolled movements in the lumbo-pelvic region and hip were seen at test occasion one of the players and an overall improvement of the same parameters were seen in test occasion two. Conclusion: A training intervention for 11 weeks, based on the test results from The Matrix Movement and Performance Screen, improved the players´ movement control significantly.

Objective: The purpose of the study is to explore and illustrate how ultrasound midwives and medical specialist in obstetrics and gynecology believe the information given to parents about the genetic soft markers should be handled. Design: A quantitative questionnaire study with cross-sectional design. Participants: 44 ultrasound midwives and 37 medical specialists in obstetrics and gynecology. Findings: Most of the participants would like to inform before the ultrasound starts that they will be looking for genetic softmarkers during the ultrasound. Likewise the majority wanted to inform the parents about possible increases in the risk for chromosomal abnormalities based on findings on the routine ultrasound. There was a difference in frequency between those who responded that they would like to inform before the ultrasound that they will be looking for genetic softmarkers and those who responded that they believe the future parents wants information before the examination. Key conclusions: It could help health care professionals in their role as information providers if there were common recommendations for the information to be given to future parents about genetic softmarkers in connection with the routine ultrasound. / Syfte: Syftet med studien är att undersöka och belysa hur ultraljudbarnmorskor och specialistläkare inom obstetrik och gynekologi anser att informationen som ges till blivande föräldrar kring genetiska ultraljudsmarkörer bör hanteras. Design: En kvantitativ enkätstudie med tvärsnittsdesign. Deltagare: 44 ultraljudsbarnmorskor och 37 specialistläkare inom obstetrik och gynekologi. Resultat: Merparten av deltagarna vill informera innan ultraljudundersökningen börjar om att de kommer att titta efter genetiska ultraljudmarkörer under rutinultraljudet. Likaså ville majoriteten informera de blivande föräldrarna om eventuella riskökningar för kromosomavvikelser utifrån upptäckter på rutinultraljudet. Det fanns en skillnad i frekvens mellan de som svarat att de ville informera innan ultraljudsundersökningen om att de kommer att titta efter genetiska ultraljudsmarkörer och de som svarat att de tror att de blivande föräldrarna vill ha denna information innan undersökningen. Slutsats: Det skulle kunna hjälpa hälso-och sjukvårdspersonal i sin uppgift som informationsgivare om det fanns genomsamma rekommendationer för vilken information som skall ges till blivande föräldrar kring genetiska ultraljudsmarkörer i samband med rutinultraljudet. På det sättet skulle vi erbjuda en mer jämställd information och vård till hela befolkningen oberoende av var de bor.

Syftet med denna uppsats var att undersöka om den information patienter med screeningupptäckt abdominellt aorta aneurysm får av sjuksköterska, uppfattas som lagom och lättförståelig och om det blivit någon skillnad av orosnivå efter besöket. Ett frågeformulär skickades ut till 42 män som genom screeningundersökning diagnostiserats med ett ”aneurysm under utveckling” eller abdominellt aorta aneurysm. Resultatet visar att alla patienter upplevde besöket hos kärlsjuksköterskan som bra eller mycket bra. Majoriteten av de tillfrågade hade fått information om de olika områdena och de tyckte att mängden informationen var lagom. Det område där flest uppgav att de inte fått information men hade velat ha var om fysisk aktivitet/motion. De allra flesta tyckte att informationen var lätt att förstå. De områden där informationen uppgavs vara svår att förstå var framförallt informationen om orsak till pulsåderbråck och framtida behandling (operation). Patienterna skattade sin orosgrad som låg både före och efter ultraljudsundersökningen och efter sjuksköterskebesöket. Statistisk signifikant skillnad fanns mellan orosgrad efter undersökningen och oro efter sjuksköterskebesöket (p = 0,005). Att leva med vetskapen att ha en vidgad aorta eller ett AAA orsakar hos de allra flesta patienter ingen eller mycket lite oro. Sjuksköterskebesöket verkar dessutom minska den lilla stegring i orosnivån som påvisats efter diagnos i undersökningen.

Bakgrund: Över 150 000 människor i Sverige behandlas årligen för hjärt- och kärlsjukdom. En vanlig form är ateroskleros, åderförkalkning. Av alla de som idag avlider på grund av annan orsak än naturligt åldrande, gör de flesta det av komplikationer till aterosklerossjukdom. En av dessa komplikationer är aortaanerysm, mera känt som ”pulsåderbråck”. Det vanligast förekommande är abdominellt aortaanerysm, bukaortaaneurysm. Syfte: Syftet med denna studie var att belysa livssituationer, livskvalitet och omvårdnadsbehov hos patienter med diagnosen AAA samt att visa på omvårdnadsåtgärder som främjar hälsa hos patienter med denna diagnos. Metod: En litteraturgranskning gjordes i databaserna PubMed, Chinal och Psychinfo samt Högskolan Dalarnas sökmotor Elin. Artiklarna valdes ut efter relevans till syftet. Dess kvalitet värderades med hjälp av granskningsmallar. Fyra kvalitativa och 16 kvantitativa ansatser ingick i studien. Resultat: Det framkom att HRQoL hos patienter som fick diagnosen AAA försämrades signifikant perioperativt. Oro och rädsla samt känslor av overklighet, nära döden upplevelser och existentiella frågor var vanligt perioperativt. Ingen påvisbar skillnad före och efter screening i HRQoL eller upplevd hälsa iakttogs. Mer information kring exempelvis sexualitet perioperativt kunde lindra oro och rädsla. Diskussion: Omvårdnaden är otillräcklig vid diagnostillfället samt postoperativt. Screening har positiv inverkan på patienternas generella hälsa. Konklusion: Studien visade på ökat behov av omvårdnad i samband med att diagnosen ställts samt efter utskrivning postoperativt.

In this dissertation, I investigated computing algorithms for automated retinal blood vessel detection. Changes in blood vessel structures are important indicators of many diseases such as diabetes, hypertension, etc. Blood vessel is also very useful in tracking of disease progression, and for biometric authentication. In this dissertation, I proposed two algorithms to detect blood vessel maps in retina. The first algorithm is based on integration of a Gaussian tracing scheme and a Gabor-variance filter. This algorithm traces the large blood vessel in retinal images enhanced with adaptive histogram equalization. Small vessels are traced on further enhanced images by a Gabor-variance filter. The second algorithm is called a radial contrast transform (RCT) algorithm, which converts the intensity information in spatial domain to a high dimensional radial contrast domain. Different feature descriptors are designed to improve the speed, sensitivity, and expandability of the vessel detection system. Performances comparison of the two algorithms with those in the literature shows favorable and robust results. Furthermore, a new performance measure based on central line of blood vessels is proposed as an alternative to more reliable assessment of detection schemes for small vessels, because the significant variations at the edges of small vessels need not be considered. The proposed algorithms were successfully tested in the field for early diabetic retinopathy (DR) screening. A highly modular code library to take advantage of the parallel processing power of multi-core computer architecture was tested in a clinical trial. Performance results showed that our scheme can achieve similar or even better performance than human expert readers for detection of micro-aneurysms on difficult images.

Typical energy audits are sufficiently expensive and time-consuming that many owners and managers of buildings are not willing to invest the time and money required for a full audit. This dissertation provides a methodology to identify buildings with large potential energy savings using limited information, specifically, utility bills, total area and weather data. The methodology is developed based on the hypothesis: if a commercial building is properly designed, constructed, operated, and maintained, the measured energy consumption should approximately match the simulated value for a typical building of the same size with the most efficient HVAC system; otherwise, there may be potential for energy savings. There are four steps in the methodology: 1) testing to determine whether the utility bills include both weather-dependent and weatherindependent loads; 2) separating weather-dependent and weather-independent loads when both are present in the same data; 3) determining the main type of HVAC system; 4) estimating potential energy savings and recommending an energy audit if appropriate. The Flatness Index is selected to test whether the utility bills include both weatherdependent and weather-independent loads. An approach to separate the utility bills based on thermal balance is developed to separate utility bills into weather-dependent and weather-independent loads for facilities in hot and humid climates. The average relative error in estimated cooling consumption is only 1.1% for 40 buildings in Texas, whereas it is -54.8% using the traditional 3P method. An application of fuzzy logic is used to identify the main type of HVAC system in buildings from their 12-month weatherdependent energy consumption. When 40 buildings were tested, 18 systems were identified correctly, seven were incorrect and the HVAC system type cannot be identified in 15 cases. The estimated potential savings by the screening methodology in eight large commercial buildings were compared with audit estimated savings for the same buildings. The audit estimated savings are between 25% - 150% of the potential energy savings estimated by the screening procedure in seven cases. The other two cases are less accurate, indicating that further refinement of the method would be valuable. The data required are easily obtained; the procedure can be carried out automatically, so no experience is required. If the actual type of HVAC system, measured weather-dependent, and weather-independent energy consumption are known, the methodology should work better.

This thesis defines the Energy Balance Load ( BL E ) as the difference between the heating requirements plus the electric gains in the building and the cooling coil loads. It then applies a first law energy balance in conjunction with the concepts of analytical redundancy (AR) and trend checking to demonstrate that measured values of BL E can be compared with the simulated characteristic ambient temperature-based BL E to serve as a useful tool to identify bad data. Uncertainty and sensitivity analysis are introduced to analyze the impact of each building or system parameter to the simulated values of BL E . A Visual Basic for Application (VBA) program has been developed through this research work, which applies the methodology illustrated in this thesis to automatically prescreen the measured building energy consumption data with the inputs of several key parameters. Through case studies of six on-campus buildings, the methodology and the program successfully identified monitored consumption data that appears to be erroneous, which may result from incorrect scale factors of the sensors and the operational changes to the building that may enormously affect the key parameters as the simulation inputs. Finally, suggestions are given for the on-line diagnostics of sensor signals.

In Taiwan, colorectal cancer incidence rate and mortality rate had been increased remarkably. Colorectal cancer was the third leading cause of death in all cancers in Taiwan, which had cause serious threaten on the health condition of people. The CRC screening rate is relatively low in Taiwan, from the statistic information in Bureau of Health Promotion shows that less than 20 % of colorectal cancer cases were detected on stage 0 and stage £L in Taiwan. The early detection rate was relatively low as comparing with colorectal cancer in the United States. However, if colorectal cancer is vital for the optimal treatment to obtain a correct diagnosis promptly, the long-term survival rate can reach as high as 90% for the early staged CRC. As we know, regular screening examination for colorectal cancer was the first step to treat colorectal cancer. The key point for promoting the colorectal cancer screening rate was to realize the factors which affecting the willingness of receiving the screening examination among older adults. Due to that, this study is aimed to identify the attitude toward screening and health-belief recognition among older adults above 40 years old within the community screening program, in order to realize factors influence the older adults¡¦ willingness of the colorectal cancer screening and Colonoscopy. The study design was a cross-sectional co-relational community-based survey. The data collection period was from August 2007 to May 2008. Data were collected from older adults which above 40 years old in Taipei and Kaohsiung. There were 462 samples which included 279 samples were having an experience of CRC screening before, and 183 samples were never had such screening before. The data was analyzed with descriptive statistics and inferred statistics such as Chi-square, Independent T-Test, Logistic regression analysis, Path analysis. The Logistic regression analysis was used to determine the related factors which might affecting the willingness of CRC screening among the older adults in community, including the factors applying from Health Belief Model such as Perceived threat, Perceived benefits of taking actions, Perceived barriers of taking actions, Cues to actions, Self-Efficacy, Health Motivation. Also addressed the factors related to attitudes such as fear about cancer, worry about accurate or safety of screening method, optimistic. The results of the study were as following. (1)In health belief related sectors, Perceived threat, Barriers, Cues to actions were significant with both the willingness of receiving Colonoscopy and FOBT screening. Except for those three factors that mentioned above, Health motivation would influence the willingness of FOBT screening, instead of Colonoscopy. (2) In attitude related sectors, fear about cancer, worry about accurate or safety of screening method were significant with both the willingness of receiving Colonoscopy and FOBT screening. (3) In health status sectors,bowel symptoms were significant with the willingness of receiving FOBT screening. Health behavior would only significant with the willingness of receiving Colonoscopy. (4) Age, social activity, screening experience would affect the willingness of receiving FOBT screening. On the other hand, the willingness of receiving Colonoscopy was no significant with demographic characteristic. Besides, the results of the path analysis were shown as below. (1)Optimistic would affect Cues to actions factor, and health behavior may affect Health motivation factor, under such relation, optimistic and health behavior would indirect affect the willingness of receiving FOBT.(2)Bowel symptoms would affect Perceived threat which may indirect affect the willingness of receiving Colonoscopy. (3)The knowledge of CRC and CRC screening would also indirect affect the willingness of receiving FOBT and Colonoscopy. The major attribution of this study was to realize the factors influence the willingness of accepting CRC screening, which could provide for health promotion policy makers to develop suitable policy for CRC health protect planning. The study may be implicated in the following aspects¡G(1) Not only settle the goals of screening, and also suggest policy makers to promote the awareness and health belief toward colon cancer to target groups which the study result had shown. (2)With the union of the community and medical, physician counseling may enhance the CRC screening rate, especially Colonoscopy. (3)Fulfill the knowledge of detect colon cancer and CRC screening among older adults, make themselves know how to decrease the threat of the disease, in order to achieve the goal of improving their health and saving the expense of the injure.