Dysfagi, sväljningssvårigheter, är en vanlig komplikation vid Alzheimers sjukdom och är väl utforskat i det sista av de tre stadierna vid demens (lindrig, måttlig och svår). Sväljningssvårigheter som har kopplats samman med Alzheimers sjukdom är ett förändrat ätbeteende, reducerad höjning av larynx och en längre oral fas. Syftet med studien var att undersöka om och vilka symtom vid dysfagi som kan ses i de tidigare stadierna av Alzheimers sjukdom vid användning av icke-invasiva undersökningsmetoder. En enkätundersökning med 16 deltagare och en sväljningsscreening med fyra deltagare genomfördes. Sväljningsscreeningen bestod av fyra delar: oralmotorik, sväljningstest och sväljningskapacitetstest med vatten och tuggfunktion. Resultaten från enkäten visade ingen högre andel med sväljningssvårigheter i den testade gruppen jämfört med tidigare forskning av normalpopulationen. Inga signifikanta samband mellan olika parametrar såsom poäng på Mini Mental Test (MMT), tid för diagnos och poäng på enkäten hittades. Resultaten från sväljningsscreeningen visade en tendens till förlängd orofaryngeal fas vid ett sväljningskapacitetstest vilket indikerar att undersökning av sväljningskapacitet kan vara en användbar metod för att identifiera tidiga sväljningssvårigheter vid Alzheimers sjukdom. Testet är lätt att genomföra och inte tidskrävande. / Dysphagia, eating disorders, is a common complication associated with Alzheimer’s disease and has been studied extensively in the three late stages of dementia (mild, moderate and severe). Eating disorders that have been linked to Alzheimer’s disease are a changed eating behaviour, reduced laryngeal elevation and a prolonged oral phase. The purpose of this study was to investigate if and which symptoms of dysphagia can be identified using non-invasive methods. A survey with 16 participants and a swallowing screening with four participants were conducted. The swallowing screening consisted of four parts: oral motor abilities, a swallowing test and a swallowing capacity test with water and chewing function. The results from the survey did not show an increased prevalence of eating disorders in the test group compared to what previous research suggests could be expected for the normal population. No significant correlations between parameters such as Mini Mental Test (MMT), time elapsed since diagnosis or score of the survey were found. The results from the swallowing screening showed a tendency towards a prolonged oropharyngeal phase in a swallowing capacity test, indicating that examination of swallowing capacity could be a useful method for identifying early eating disorders in Alzheimers disease. The test is easy to perform and is not time consuming.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 6 uppsatser.

Thesis (M.Ph.)--Georgia State University, 2007. / Title from file title page. Russ Toal, committee chair; Rebecca Cowens-Alvarado, Ike Okosun, committee members. Electronic text (119 p. : col. maps) : digital, PDF file. Description based on contents viewed June 4, 2008. Includes bibliographical references (p. 90-96).

Thesis (Ph. D.)--University of Alabama at Birmingham, 2007. / Title from first page of PDF file (viewed Oct. 13, 2008). Includes bibliographical references (p. 174-183).

Thesis (M.Sc.)--Memorial University of Newfoundland, 2004. / Restricted until October 2005. Bibliography: leaves 76-78.

Amyloid $\beta$ (1-42) (A$\beta$42) is a seminal neuropathic agent in Alzheimer’s disease (AD), a multifaceted neurodegenerative disorder for which no preventative measures or disease modifying therapies currently exist. Aggregation of this peptide plays a key role in the synaptic dysfunction and neuronal death associated with the disease. Perturbing the aggregation process, therefore, represents a key strategy for the development of new AD therapeutics. A variety of issues with current screening methods, including lack of reproducibility, high reagent consumption and spectral interference from the test molecules, can limit efforts to identify new small molecule inhibitors. Furthermore, the lack of robust, time- and cost-efficient methods for screening compounds in cellular or in vivo models limits the throughput with which seemingly active small molecules can be validated and prioritised. Herein, this thesis describes efforts to overcome such limitations through the development of a unified in vitro to in vivo assay system, in which hits identified in the ‘nanoFLIM’ microfluidic-based assay can quickly be tested in cellular and whole organism disease models. The assay platform designed relies on the use of an amyloid aggregation fluorescence lifetime sensor. A$\beta$42 aggregation is monitored by changes in the fluorescence lifetime of an attached fluorophore, which is significantly quenched upon amyloid formation. To take advantage of the benefits associated with miniaturisation, an in vitro microfluidic platform was employed. A microfluidic chip capable of trapping 110 precisely ordered droplets was designed, allowing for increased sample size and greatly lowering reagent consumption relative to conventional assay formats. Optimisation of the lifetime sensor technique permitted real-time compound screening in SH-SY5Y neuroblastoma cells, as well as in disease model Caenorhabditis elegans (C. elegans). To demonstrate the potential of this assay, a selection of novel chemical libraries developed in the Spring research group was screened, resulting in the identification of a key library of interest. The inhibitory activity of the lead compound from this collection was validated using a variety of biophysical tests, and was also shown to suppress amyloid aggregation in the live cell fluorescence lifetime sensor assay, as well as in whole organism disease model C. elegans. Whilst assay development was underway, additional screening of structurally diverse chemical libraries was performed using a conventional Thioflavin T spectroscopic assay. Such work identified another molecular scaffold capable of exerting a strong inhibitory effect against A$\beta$42 aggregation. A selection of analogues was synthesised to improve the in vivo profile of this library, giving rise to a second lead inhibitory compound. The activity of this compound was subsequently validated in biophysical and cellular tests, and was also tested in disease model Drosophila melanogaster. The aggregation of A$\beta$42 lies at the root of Alzheimer’s disease. In light of the relatively few drug candidates in clinical trials for this disorder, the development of improved translational screening approaches and continued screening of novel chemical libraries is necessary to identify new potential therapeutics. In this study, an in vitro to in vivo fluorescence lifetime imaging assay has been established. Using this assay system and conventional screening approaches, two A$\beta$42 aggregation inhibitors have been identified and validated. These represent promising candidates for the development of new AD therapeutic agents, or for use as molecular probes to further dissect the mechanisms underlying this devastating disease.

Current status: Although it was developed and published in many studies pointing to the impact of malnutrition and its relationship to the patient and the economy of the health systems, malnutrition remains a silent guide of hospitalized patients. In the year of 2014, the authors of the study group feedM.E. indicate in their articles the worldwide prevalence of malnutrition as a common and a costly (especially for the elderly). The rate of prevalence of malnutrition in a group of hospitalized patients is around 50%, according to this working group. Objectives: The goal of the project was to describe the methods for screening the patients with nutritional needs interventions by the nurses, the continuity of the care for patients in the risk of malnutrition, transmitting the information about the nutritional status of the patient during his hospitalization and delivery of care to another provider of health services and interdisciplinary co-workers involved in the care of patients in the risk of malnutrition. Methods: The research investigation conducted by the method of the qualitative research. The research subject was the process of detecting malnutrition and continuity of nutritional care for recipients of health services from the perspective of persons providing these services. The research method was chosen a depth interview. The sample of respondents was intentional and the file size was determined by saturation of the collected data. For data processing was used open coding and following categorization of the data which was obtained from interviews. The results were interpreted by using the "showdown". Participants: The request to facilitate the initiation of research has been mostly refused and addressed to the health service providers. Selection of interviewees was intentional by the circle of my former colleagues. With research have expressed their consent five nurses and five dietitians, which are working in the Czech Republic. Results: For identification of patients at the risk of malnutrition, all respondents have described the identification of patients at the risk of malnutrition on admission to the hospital by collecting of nursing history. During the interviews, the respondents have reported the problems both with the absence the reports including detection of patients at the risk of malnutrition from some stations at hospitals, as well as the jurisdictional disputes about the role of the dietitians in patient nutrition at intensive care unit, the complications with material and technical equipment of nursing stations and its applicability for use in specific patients. Also expressed the ignorance of screening tools which are used at the sites of all respondents, including dietitians. The inaccurate ideas of some respondents were in the terms of the skills and the competencies of individual professionals which are involved in the care of patients in the risk of malnutrition. Three nurses of the five indicated that information about the nutritional balance of the patient and their needs should affect the assessment of the patient's overall condition and could lead to changes in the nursing care plan or risk assessment (eg. the risk of pressure ulcers, etc.). Conclusion: The method of providing nutritional care in hospitals, in which respondents are employed, is headed toward pursuing the recommendations of the professional associations. In detail, however, they differ and are often close to the boundaries defined as a legal standards. Breaks are noticeable in continuity of the care, or are put excessive approval procedures, which can lead to delay of required nutritional interventions. Here is a lack of information about the various screening tools and their applicability to the certain groups of patients. Therefore I recommend issuing guidelines by professional society, in the direction of the definition of screening tools and their using in the certain groups of patients, for the healthcare providers in

Submitted by Rodrigo Andrade (rodrigo.bomfim@fgvmail.br) on 2014-04-24T15:32:00Z No. of bitstreams: 1 diss_RodrigoAndrade.pdf: 591074 bytes, checksum: 533c9582d0fd79341698968896535e09 (MD5) / Approved for entry into archive by ÁUREA CORRÊA DA FONSECA CORRÊA DA FONSECA (aurea.fonseca@fgv.br) on 2014-04-30T19:55:08Z (GMT) No. of bitstreams: 1 diss_RodrigoAndrade.pdf: 591074 bytes, checksum: 533c9582d0fd79341698968896535e09 (MD5) / Approved for entry into archive by Marcia Bacha (marcia.bacha@fgv.br) on 2014-05-08T13:35:03Z (GMT) No. of bitstreams: 1 diss_RodrigoAndrade.pdf: 591074 bytes, checksum: 533c9582d0fd79341698968896535e09 (MD5) / Made available in DSpace on 2014-05-08T13:40:17Z (GMT). No. of bitstreams: 1 diss_RodrigoAndrade.pdf: 591074 bytes, checksum: 533c9582d0fd79341698968896535e09 (MD5) Previous issue date: 2014-03-17 / This paper studies cost-sharing rules under dynamic adverse selection. We present a typical principal-agent model with two periods, set up in Laffont and Tirole's (1986) canonical regulation environment. At first, when the contract is signed, the firm has prior uncertainty about its efficiency parameter. In the second period, the firm learns its efficiency and chooses the level of cost-reducing effort. The optimal mechanism sequentially screens the firm's types and achieves a higher level of welfare than its static counterpart. The contract is indirectly implemented by a sequence of transfers, consisting of a fixed advance payment based on the reported cost estimate, and an ex-post compensation linear in cost performance. / Este trabalho estuda regras de compartilhamento de custos sob seleção adversa dinâmica. Apresentamos um modelo típico de agente-principal com dois períodos, fundamentado no ambiente canônico de regulação de Laffont e Tirole (1986). De início, quando da assinatura do contrato, a firma possui incerteza prévia sobre seu parâmetro de eficiência. No segundo período, a firma aprende a sua eficiência e escolhe o nível de esforço para reduzir custos. O mecanismo ótimo efetua screening sequencial entre os tipos da firma e atinge um nível de bem-estar superior ao alcançado pelo mecanismo estático. O contrato é implementado indiretamente por uma sequência de transferências, que consiste em um pagamento fixo antecipado, baseado na estimativa de custos reportada pela firma, e uma compensação posterior linear no custo realizado.

This Master's Thesis "The Role of a Nurse in the Care of a Patient's Nutrition" is written in a purely theoretical plane, deals with the basic pillar of the existence of the human organism the correct and sufficient nutrition of a human, and studies the extent of an involvement of the general nurse in satisfying biological, psychological aspects of patient's nutrition in the nursing process. The topic of nutrition plays an important part of the complete spectrum of each medical expertise. The satisfaction of patient's need for nutrition in all of the stages of his life is a part of a nurse's job in a nursing process not only in Intensive Care Units, Resuscitation Care Units and Standard Care Departments, but even in Geriatric Units and Social Care Institutes. The thesis is methodically divided into separate parts, each logically following its preceding one. In the Introduction we define malnutrition as a global medicinal and social problem, introduce principles and theoretical starting points of an organisation of an optimal nutrition care and introduce international activities, which contribute to creating guidelines using the Evidence Based Practice method, and implementation of effective methods in providing complex care of a patient's nutrition in medical facilities and institutes of social care. We follow with the summarisation of basic nutrients, emphasising their importance for the right function of a human body, and negative effects of their insufficiency in the food intake. The thesis presents an algorithm of an evaluation of a patient's nutrition state in a nursing process, comparing available screening standardised questionnaires, which are usable in detecting sings of a malnutrition. We present the possibilities of food fortification, specify targets of nutritional support in medical facilities, focusing on indications, benefits, risks and paths of application of enteral and parenteral nutrition, and provide complete summary of nutritional interventions in the context of nursing care, which is oriented on ensuring the food intake. In the Conclusion, we identify those aspects of the patient's nutrition care, which are hard to fulfil and realise, and those psychological and social-cultural aspects, which the nurse can in the nursing process satisfy only when using holistic and empathetic approach. The altruistic, but controversial and ethical-philosophical topic represents not initiating or ending the interventions of nutritional support, where this decision respects principles of beneficence and non-maleficence of The Hippocratic Oath, the quality of a patient's life and human dignity.

É comum, em problemas de inferência bayesiana, deparar-se com uma distribuição a priori para o parâmetro de interesse, theta, que seja intratável analítica ou computacionalmente. Como a priori é uma escolha do pesquisador, tal situação ocorre por conta da intratabilidade da função de verossimilhança. Por meio de algoritmos ABC, é possível simular-se uma amostra da distribuição a posteriori, sem a utilização da verossimilhança. Neste trabalho, aplica-se o ABC no contexto de Environmental Stress Screening - ESS. ESS é um procedimento de estresse, em um processo de produção industrial, que visa evitar que peças de qualidade inferior sejam utilizadas no produto final. A partir de uma abordagem bayesiana do ESS, depara-se com uma verossimilhança (e, consequentemente, uma posteriori) intratável para o vetor de parâmetros de interesse. Utiliza-se, então, o ABC para obtenção de uma amostra da posteriori e calcula-se o tempo ótimo de duração de um futuro procedimento de estresse a partir da simulação feita. É também proposta uma generalização do problema de ESS para a situação em que existem k tipos de peças no processo de produção. Quantifica-se o problema e, novamente, aplica-se um algoritmo ABC para a obtenção de uma simulação da posteriori, bem como calcula-se o tempo ótimo de duração de um futuro teste de estresse. / In Bayesian inference problems, it is common to obtain a posterior distribution for the parameter of interest, theta, which is analytically or computationally intractable. Since the priori is chosen by the researcher, this situation arises from the intractability of the likelihood function. Through ABC algorithms it is possible to simulate a sample from the posterior distribution, without the analytical use of the likelihood function. In this work ABC is applied in the context of Environmental Stress Screening - ESS. ESS is a stress procedure, in an industrial production process, which aims to avoid low quality parts to be used in the final product. Under a Bayesian approach to ESS, an intractable likelihood (consequently, a posterior) is obtained for the paramater of interest. ABC is used to simulate a sample from the posterior and the optimal duration for a next stress procedure is calculated afterwards. A generalization of the ESS is also proposed considering that there are k types of parts in the production process. Again, ABC is used to simulate a sample from the posterior, and it is calculated the optimal duration for a next stress procedure.