The otolith organs (the saccule and utricle) are located in the inner ear and sense linear acceleration, head tilt, and gravity. Recently, the vestibular evoked myogenic potential (VEMP) and the subjective visual vertical (SVV) have been described as clinical tests for otolith function. VEMPs are short latency electromyograms (EMG) evoked by high-level acoustic and vibratory stimuli recorded from surface electrodes over the tonically contracted SCM muscles (cervical VEMP) or extra-ocular muscles (ocular VEMP). The SVV is a psychophysical measure of the angle between perceptual vertical and true (gravitational) vertical and can be measured during unilateral centrifugation (off-axis eccentric rotation). The purpose of this paper is to discuss the clinical use and recent developments of the cervical VEMP, ocular VEMP, and SVV as tests of saccular and utricular function.

Anxiety and depression are two disorders frequently diagnosed in adults. Given serious adverse affects such as physical health problems, interpersonal relationship difficulties, and suicide, differentiation in treatment of these often comorbid disorders is a necessity in providing appropriate care. The tripartite model of anxiety and depression (Clark & Watson, 1991) proposes that these disorders are linked by a common trait (Negative Affect) and differentiated by a trait common to depression (lack of Positive Affect) and a trait common to anxiety (Physiological Hyperarousal). The Clinical Assessment of Depression (CAD; Bracken & Howell, 2004), a recently published selfreport narrow-band measure of depression, includes a measure of anxiety related symptoms in its subscale structure. This study explores the validity of the CAD with two established measures: the Beck Depression Inventory – II (Beck, Steer, & Brown, 1996) and the Beck Anxiety Inventory (Beck, & Steer, 1993). College students of 18 to 52 years of age (n = 295) enrolled in undergraduate courses in psychology at a south central Kentucky university provided the study data. These individuals were divided into nonclinical and clinical samples based on self disclosure of a clinical diagnosis to examine differences between groups. Strong positive correlations (above r = .60) between similar CAD scales and total scores on the BAI and BDI-II supported convergent validity for the nonclinical sample. All comparisons supported convergent validity for the clinical sample except the correlation between the BDI-II Total Score and the CAD - Depressed Mood subscale (r = .56). Weak to moderate correlations (r = 0.0 to .59) between dissimilar scales supported divergent validity for all dissimilar comparisons in both samples except the correlation between the BDI-II and the CAD-Anxiety/Worry subscale in the nonclinical sample (r = .66). Hotelling-Williams t-tests were performed to compare correlations of similar and dissimilar constructs. Significant results emerged most comparisons in the nonclinical group support the use of the CAD diagnostic assessment. However, nonsignificant findings for the CAD Anxiety/Worry subscale indicate that this measure lacks the ability to aid diagnose significant levels of anxiety. Only one significant difference between correlations was found for the clinical sample with the CAD – Diminished Interest subscale evidencing significantly stronger correlations with the BDI-II than the BAI. The lack of significant differences for the other CAD scales is discussed relative to the small clinical sample size and the heterogeneity of disorders represented. Results support the use of the CAD as an adequate diagnostic tool for depression with college students. Results did not support the use of the CAD in differential diagnosis of anxiety with college students within the framework of the tripartite model. Implications of the findings are discussed to aid in practice and to suggest further research.

Coronary heart disease (CHD) is the single largest killer of American males and females in the United States. According to the American Heart Association, (2005) approximately 41% of Americans that experience a coronary attack in a given year will die from it (AHA, 2005). To combat this growing problem, strategies need to be evaluated to assess how the identification of actual and potential CHD risks are made. This study utilized the Social Judgment Theory to gain insight into nurse practitioner's decision-making strategies. Sixty family or adult specialty nurse practitioners affiliated with the University of South Florida (USF) College of Nursing volunteered to take part in a pretest-posttest experimental design. They were randomly assigned to one of three conditions. Condition 1 and 2 received educational interventions and Condition 3 served as the control group, which received no education. This design was used to assess the effects of educational feedback on improving judgment accuracy, achievement, and insight. The findings indicated nurse practitioners agreement with the Framingham prediction model of CHD risk did improve significantly for the two intervention groups from Time 1 to Time 2 (p <.05). the participants also showed a relatively high degree of cognitive control when judging and performing the policy-capturing task (average Rs = .88) as compared to Framingham (Re = .96). Significant amount of unconditional bias (F(2, 57) = 9.85, p < .01) and conditional bias (F(2, 57). 5.42), p < .05) was present in this sample. Nurse practitioners overall performed well when compared with the Framingham Heart Study risk equation, however, nurse practitioners showed little insight into their judgment process. The results of this study may provide the opportunity for nurse practitioners to offer patients more appropriate medicinal and diagnostic treatments. Future cardiac events may be avoided through evidenced-based CHD education for nurse practitioners.

Thesis (Psy. D.)--Wheaton College Graduate School, 2003. / Abstract. Includes bibliographical references (leaves 80-85).

Thesis (Psy. D.)--Wheaton College Graduate School, Wheaton, IL, 2003. / Abstract. Includes bibliographical references (leaves 80-85).

Thesis (Psy. D.)--Wheaton College Graduate School, Wheaton, IL, 2003. / Abstract. Includes bibliographical references (leaves 80-85).

Red blood cells are a scarce resource whose demand often exceeds its supply. Intraoperative red cell salvage has proven to be a highly effective blood conservation strategy, as it can reduce the need for allogeneic blood transfusion. However, the use of cell saver alone is not sufficient. Without specific blood ordering guidelines, the amount of allogeneic blood product requested and cross&ndash;matched is often much greater than the real level of consumption. Efficient blood ordering guidelines have been developed in the past, and have succeeded in providing a more accurate prediction of actual need for intraoperative blood transfusion and minimizing waste. Few studies attempted to examine the blood ordering and utilization pattern with an emphasis on surgical cases that involve the use of intraoperative cell salvage. With the use of intraoperative cell salvage devices to reduce the amount of blood bank products required during surgery, considerable change in the practice of ordering cross&ndash;matched blood should be made. We retrospectively assessed the effectiveness of one Standardized Clinical Assessment and Management Plan (SCAMP) in improving the efficiency of blood utilization and reducing waste. This SCAMP was introduced at our Boston Children's Hospital in July 2012 as a blood ordering guideline for all pediatric orthopedic patients who are scheduled for intraoperative cell salvage. We retrospectively compared demographic variables, clinical characteristics, and blood utilization patterns of patients who underwent orthopedic procedure and received cell saver blood during the 17 months prior to the introduction of SCAMP (n = 455) and those who underwent similar procedures during the 15 months after the introduction of SCAMP (n = 487). Results suggested that demographic variables including age, weight, and sex were similar between the pre&ndash;SCAMP and post&ndash;SCAMP groups. It also demonstrated that after the introduction of SCAMP, the mean percentage utilization of blood (number of units used/number of units ordered x 100%) increased by 24.4% (p < 0.001), while the difference between the number of units ordered and number of units used reduced by 0.5 units (p < 0.001). In conclusion, the introduction of a SCAMP for blood product ordering has led to an increase in the efficiency of blood utilization and a reduction in blood waste. However, further evaluation and modification of the SCAMP need to be made in order to better predict actual level of utilization of blood products.

There is a dearth of validated neonatal feeding assessment instruments available for use in clinical practice in resource-constrained developing contexts. The Neonatal Feeding Assessment Scale (NFAS) was developed to identify and diagnose oropharyngeal dysphagia (OPD) in neonates. The main aim of the study was to develop and test the psychometric performance of a clinical assessment scale for the early identification and diagnosis of OPD in the high-risk neonatal population in South Africa. To meet the main aim, the research project was divided into three separate studies. The research design across the three studies was an exploratory sequential mixedmethod design. The NFAS was developed using the Delphi method in the first study. Two international and three South African speech-language therapists (SLTs) formed the expert panel that participated in two rounds of electronic questioning to develop the instrument. For the second and third studies, a comparative crosssectional within-subject design was used. In the second study the participants were 20 neonates with a median age of 35.0 weeks gestational age (GA) in a 29-bed neonatal intensive care unit (NICU). In the third study 48 participants with a median age of 35.5 weeks GA were included. During the second study the preliminary psychometric performance of the NFAS was determined and in the third study, the final psychometric properties of the NFAS were determined to describe the validity and reliability of the NFAS. The NFAS was developed and approved, using expert collaboration through the Delphi method in the first study. All participants agreed on the need for the development of a valid clinical feeding assessment instrument to use with the highrisk neonatal population. The initial NFAS consisted of 240 items across 8 sections; after the Delphi process was implemented, the final format was reduced to 211 items across 6 sections. The final format of the NFAS is scored using a binary scoring system guiding the clinician to identify the presence or absence of OPD. All members agreed on the format, the scoring system and the feeding constructs addressed in the final format of the NFAS. The second study showed that 9 out of 20 participants presented with OPD on the NFAS. Comparison of NFAS results with modified barium swallow studies (MBSS). indicated that all participants with OPD were correctly identified (100% specificity). The sensitivity was 78.6%, indicating that three participants were falsely identified with OPD on the NFAS. The instrument took approximately 30 minutes to complete during observation of a habitual feeding session with the mother. Inter-rater reliability was determined on 50% (n=10) of the study sample. Substantial agreement (80%) was obtained between two raters in five of the six sections of the NFAS and on the diagnostic outcome of the scale. The preliminary performance of the NFAS appeared to be promising. The formal validation process of the NFAS then followed on a larger sample in the third study. Results of the third study indicated that 15 of the 48 participants were identified with OPD on the NFAS, whereas 14 of these 15 infants were diagnosed on MBSS. A sensitivity score of 78.6% was obtained, with specificity determined to be 88.2% for the newly developed NFAS. The subsequent accuracy of the NFAS to identify OPD correctly was 85.4% when compared with the MBSS outcome. Inter-rater reliability was determined using 35% of the sample. The agreement on overall instrument outcome between the two raters was considered substantial beyond chance, with Cohen's Kappa at 0.598, with an asymptotic standard error of 0.211. The scale may be of use to SLTs working without MBSS equipment and to reach underserved preterm neonates. Inexperienced SLTs may benefit from observational prompts provided by the NFAS. The NFAS may be suitable for use in South Africa and similar developing contexts to identify and diagnose high-risk neonates with OPD. / Thesis (DPhil)--University of Pretoria, 2016. / Speech-Language Pathology and Audiology / DPhil / Unrestricted

This master thesis describes a journaling system for compression ultrasonography and a clinical assessment system for deep vein thrombosis (DVT). We evaluate Support Vector Machines (SVM) models with linear- and radial basis function-kernels for predicting deep vein thrombosis, and for facilitating creation of new clinical DVT assessment. Data from 159 patients where analysed, with our dataset, Wells Score with a high clinical probability have an accuracy of 58%, sensitivity 60% and specificity of 57% these figured should be compared to those of our base models accuracy of 81%, sensitivity 66% and specificity 84%. A 23 percentage point increase in accuracy.The diagnostic odds ratio went from 2.12 to 11.26. However a larger dataset is required to report anything conclusive. As our system is both a journaling and prediction system, every patient examined helps the accuracy of the assessment. / I denna rapport beskrivs ett journalsystem samt ett system för klinisk bedömning av djupvenstromboser.Vår modell baserar sig på en stödvektormaskin (eng. Support Vector Machine) med linjär och radial basfunktion för att fastställa förekomsten av djupa ventromboser samt att hjälpa till i skapandet av nya modeller för bedömning. 159 patientjournaler användes för att fastställa att Wells Score har en klinisk precision på 58%, 60% sensitivitet och specificitet på 57% somkan jämföras med våran modell som har en precision på 81%, 66% sensitivitet och specificitet på 84%. En 23 procentenheters ökning i precision.Den diagnostiska oddskvoten gick från 2.12 till 11.26. Det behövs dock en större datamängd för att rapportera något avgörande. Då vårt system både är för journalskapande och klinisk bedömning så kommer varje undersökt patient att bidra till högre precision i modellen.

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