Objectives The aims of this thesis were to (1) investigate the association of gestational exposure to environmental phthalates with maternal and perinatal outcomes, and (2) explore phthalate-induced changes to maternal inflammatory responses as potential mediators of possible health effects. Methods A systematic review was performed to summarize existing evidence on the association of gestational exposure to phthalates with obstetrical outcomes, including pre-eclampsia (PE), pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), intrauterine growth restriction (IUGR), birth weight (BW), head circumference (HC), gestational age (GA), preterm birth (PB), and Apgar scores (AS). Additionally, a secondary analysis of data from the MIREC Study was conducted to evaluate the association of phthalate metabolites with clinical outcomes in the mother and infant using multiple linear and logistic regression, and with inflammatory biomarkers using multinomial logistic regression. Results The systematic review identified a total of 24 articles, and observed inconsistent evidence on BW, HC, GA, and PB, a paucity of research on IUGR, PE, GDM, and AS, and a lack of studies on PIH. However, among studies with statistically significant (p<0.05) results, most suggest an association of phthalates with decreased BW and GA, and increased HC and PB. Findings from the MIREC Study indicate a significant (p<0.01) positive association between MBP and HC among female infants; however, null results were identified for BW, GA, PB, AS, and PIH. In relation to the exposure to phthalates, general trends among suggestive associations (p<0.05) for head circumference showed consistent increases in females and decreases in males, and for gestational age displayed decreases in both stratums. Additionally, a significant positive association of MBzP and ∑DEHP was observed with high MMP-2 and low VCAM levels, respectively. Results approaching statistical significance demonstrated a positive association of ∑DEHP with low MCP1 and ICAM levels, MCPP with low GMCSF levels, MBzP with low CRP and high ICAM levels, and MEP with high MMP-7 and IL-2 levels. Conclusion From the systematic review, the effects of phthalates on maternal and perinatal health remain unclear, possibly due to sources of heterogeneity and challenges in exposure assessment. In the MIREC Study cohort, phthalate levels were associated with GA and HC in infants in a sex-specific manner. Phthalates also appear to influence the circulating inflammatory marker levels, possibly explaining the observed adverse effects. Future research is needed to validate these findings.

The process, motivation, mechanisms, as well as examples of some of the material used in assessment at the Computer and Information Sciences Department at East Tennessee State University, are presented. More details, and the supporting forms mentioned can be found at the website www. cs. etsu. eduldepartmentlassessment. htm

The Individuals with Disabilities Education Act Part C (2004) grants federal funding to states and territories who implement early childhood intervention programs meant to assess and treat children with disabilities ages 0-3. Although each state and territory receives federal funds provided through taxpayers, there are large discrepancies in the way each state and territory determines eligibility, assesses children, implements treatment, and measures outcomes. This report examines the outcome results of 8 states and 1 U.S. territory to consider if variables such as funding, population, or enrollment numbers have an effect on outcome results. In addition, this report looks at differences in eligibility criteria and reporting methods for each state and territory included. / text

No description available.

Objective: To determine patterns of use, prescription medicine costs, office-based visit costs and quality of life (QOL) across classes of antidepressants/psychotherapy in elderly cancer patients. Methods: Medical Expenditure Panel Survey data files from 2005-2015 for cancer patients with depression aged 18 years or older were used for the study. Frequencies of patients under specific classes of antidepressants/psychotherapy were identified. Costs and QOL scores were compared using Analysis of Variance (ANOVA). Generalized linear models, linear/multinomial logistic regression were used for analyses adjusted for demographics, overall health status, number and type of comorbidities. Results: The study sample consisted of 17,671 cancer patients with depression. 32.08% patients had an antidepressant prescribed whereas 15.30% reported psychotherapy. SSRI (62.44%) was the most frequently prescribed class. The prescription and office-based visits costs were adjusted for demographics, overall health status, number and type of comorbidities. These adjusted prescription costs were the highest for SNRI (Mean = $112.92), adjusted office-based (psychotherapy) visit costs were the highest for those receiving psychotherapy only without any antidepressant (Mean = $166.39/visit). QOL scores were higher amongst patients who had combinations of antidepressants prescribed, specifically SSRI with either a TCA or SNRI as compared to those who were prescribed an individual class or those who did not receive any treatment at all. Conclusion: Antidepressants were prescribed more often than psychotherapy amongst cancer patients with depression in the United States. The prescription costs and associated QOL scores were higher amongst those with antidepressants prescribed as compared to those receiving psychotherapy with or without an antidepressant for cancer patients with depression in the United States.

The goal of the acute inpatient rehabilitation facility (IRF) is to rehabilitate patients and discharge them back into the community at their optimal level of functioning. The IRF patient is more acutely ill today than in the past, and due to a change in condition may be discharged back into the acute care hospital before achieving maximal level of function. An IRF was identified as discharging 14% of patients back into acute care, which indicated the IRF was not meeting its treatment goals. A chart review revealed a possible link between the nurse's role in patient care and the patient's discharge disposition. The purpose of this project was to design a nurse staffing care model that would support the registered nurse in providing care and treatment for the IRF patient. The missed nursing care model and Lewin's change theory were used to support the design of the new staffing model. Sources of evidence included a literature review of nurse staffing models and the nurse's role in patient outcomes. A project team of expert stakeholders participated in the development of the new model. The Appraisal of Guidelines for Research and Evaluation was used in formative and summative evaluations of the new model to systematically assess the quality of the new staffing model. Formative feedback was given by 3 project team members. Nine expert end users provided summative evaluations of the new model after revisions by the project team. All end users recommended implementation without modification. Positive social change with implementation of this model may lead to reduced acute care transfers, improved quality measures, and enhanced patient outcomes in the IRF.

With international concern growing over the sharp increase in alcohol-related physical, psychological and social problems, effort has been directed over the past decade toward arresting the growth of the situation created by alcoholism in western society. Alcoholism is defined and treatment approaches are discussed, along with the methodological problems encountered in evaluating such approaches. An innovative technique, ALCONFRONTATION, is described and examined. Encouraging claims have been made by the author of Alconfrontation in provoking drug dependent persons to choose to become independent of their drug of choice. A study designed to evaluate the impact of the technique in comparison with another treatment approach and a control group of "no treatment" is described. Cases diagnosed alcoholic who were consecutively admitted to a psychiatric admission centre were randomly assigned to the experimental and control groups. Pre-treatment data were collected on all subjects prior to treatment. The groups were followed up six to seven months later and comparisons were made between groups on variables related to life style and sobriety using Chi-square and Federighi's Exact test. Absence of significant differences between groups indicated no evidence of treatment effect. Few subjects were sober on follow-up. It is concluded that Alconfrontation did not positively affect the drinking behaviour and life patterns of alcoholics in this study. Further research is suggested to determine if the technique has any negative impact. Recommendations for alternative management and treatment of chronic alcoholics are made. A two level programme consisting of a community co operative support system and a "Total Push" interdisciplinary team treatment facility is suggested and outlined. / Masters Thesis

Statement of the problem: Many methods for surrogate outcome validation require individual patient data which is often inaccessible by clinical trialists. Methods: A review was performed to identify statistical methods for surrogate outcome validation that may be implemented using summary data from published clinical trials. The methods were used to evaluate carotid intima-media thickness (CIMT) as a surrogate outcome for cardiovascular events in a systematic review of randomized trials of interventions for atherosclerosis. Results: the review of methods identified five procedures. At two or more years of follow-up, there was a marginally significant association of CIMT with myocardial infarction and a statistically significant association with cardiovascular mortality. At ≥ four years of follow-up, a statistically significant, negative relationship was observed between CIMT and stroke. Conclusions: CIMT may be a valid surrogate outcome for myocardial infarction and cardiovascular mortality. Additional data is needed to evaluate CIMT in specific drug classes.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Objectives: Interpregnancy interval (IPI), the time period between the end of one pregnancy and the conception of the next, can have a significant impact on maternal and infant outcomes. This study examines the relationship between interpregnancy interval and neonatal outcomes of low birth weight, preterm birth, and specific neonatal morbidities. Study Design: Retrospective cohort study comparing neonatal outcomes across 6 categories of IPI using data on 202,600 cases identified from Arizona birth certificates and the Newborn Intensive Care Program data. Comparisons between groups were made using odds ratios and 95% confidence intervals, and multivariable logisitic regression analysis. Results: Interpregnancy intervals of < 12 months and ≥ 60 months were associated with low birth weight, preterm birth, and small for gestational age births. The shortest and longest IPI categories were also associated with specific neonatal morbidities, including periventricular leukomalacia, bronchopulmonary dysplasia, intraventricular hemorrhage, apnea bradycardia, respiratory distress syndrome, transient tachypnea of the newborn, and suspected sepsis. Relationships between interpregnancy interval and specific neonatal morbidities did not remain significant when adjusted for birth weight and gestational age. Conclusions: Significant differences in neonatal outcomes (preterm birth, low birth weight, and small for gestational age) were observed between IPI categories. Consistent with previous research, interpregnancy intervals < 12 months and ≥ 60 months appear to be associated with increased risk of poor neonatal outcomes. Any difference in specific neonatal morbidities between IPI groups appears to be mediated through increased risk of low birth weight and preterm birth by IPI.

The purpose of this study was to examine factors that relate to successful adult outcomes for 28 individuals with visual impairment ages 23-30. The primary dependent variable was current employment. Independent living and completion of postsecondary educational program were secondary, related outcome measures. A secondary goal of this research was to explore self-perceived aptitude in specific skills that are related to adult outcomes and to understand how and how well participants learned these skills.A mixed-methods design was implemented and quantitative and qualitative data were collected using a highly structured 151-item telephone survey. A series of Fisher's Exact and Mann Whitney-U tests were run to explore statistically significant relationships between variables. Past employment experience was positively related to current employment. Receipt of Social Security benefits and profound vision loss were negatively related to current employment. The longer a participant had been out of high school, the more likely he/she was to have a postsecondary educational degree.Eight essential skills were examined: daily living, college preparation, social, self-advocacy, technology, transportation management, and job seeking. Overall on a scale of 1-10, participants rated their aptitude and training in essential skills areas high. Job seeking was scored the lowest and those who had worked in the past five years rated their job seeking skills higher than those without past work experience. Adults who had completed a postsecondary educational degree rated their college preparation skills higher than those who had not completed a degree program. Those who were living independently rated their overall daily living skills higher than those who were living with a parent or parents.Qualitative data suggest that some skills, such as transportation management and technology, were taught primarily by professionals in the field of visual impairment. In contrast, daily living, social and self-advocacy skills were often learned from the support of family or friends. Many adults reported that they did not receive direct instruction in social and self-advocacy skills; instead they learned them on their own. Further empirical research is needed to understand best practices for integrating effective instruction in compensatory training and their relationship to successful adult outcomes.