INTRODUCTION: Spinal deformities, including adult spinal deformities (ASD) and adolescent idiopathic scoliosis (AIS), can cause significant pain and disability. Radiographic parameters are measured in order to establish quantitative relationships among spinal alignment and health related quality of life metrics. Various classification systems including the Scoliosis Research Society (SRS)-Schwab and Global Alignment Proportion (GAP) score have been developed to correlate radiographic parameters with relevant clinical outcomes. While the SRS-Schwab Classification is both a coronal and sagittal categorization that correlates to health related quality of life metrics, the GAP score is a newly developed 13-point scale that focuses on sagittal alignment to predict mechanical failure postoperatively. The study aims to evaluate the utility of the GAP score as a method of evaluating radiographic correction and maintenance over one year. METHODS: This was a retrospective analysis of ASD and AIS patients who underwent operative intervention. Patients were evaluated for GAP score changes from preoperative to postoperative and then to a one year follow up. Of the 285 screened patients, 73 had suitable radiographs for measurements. This included 45 ASD patients, 32 of which had one year follow up radiographs, and 28 AIS patients, of which only 19 had one year follow up radiographs. Measurements were obtained by three independent readers. These included pelvic incidence (PI), pelvic tilt (PT), L1-S1 lumbar lordosis (L1-S1 LL), L4-S1 lumbar lordosis (L4-S1 LL), sacral slope (SS), global tilt (GT), and sagittal vertical axis (SVA). GAP score subcategories were calculated and summed to produce the GAP score. RESULTS: The 73 included patients had an average age of 41.8 ± 24.1, BMI of 26.2 ±6.3, and consisted of 51 females (69.9%). All but one radiographic parameters exhibited an Intra Class Correlation (ICC) of over 0.66. PI had an ICC of 0.59 which was likely due to the incomplete visibility of the femoral heads in few radiographs. Among ASD patients, from pre to postoperative, PI-LL significantly decreased from 18° to 5°, PT significantly decreased from 26° to 19°, L1-S1 LL significantly increased from 37° to 47°, L4-S1 LL significantly increased from 28° to 31°, GT significantly decreased from 37° to 25°, SVA significantly decreased from 120 mm to 64 mm, and total GAP score significantly decreased from 8 to 6. For the 32 patients with long term data, the GAP score changed significantly from 9 to 6 to 7 at one year follow up. Of the 32 patients, 14 patients experienced a worsened score at the one year follow up. Among AIS patients, PI-LL increased from 0° to 3°, PT remained 13°, L1-S1 LL decreased from 56° to 53°, L4-S1 LL significantly decreased from 37° to 31°, GT increased from 14° to 16°, SVA decreased from 25 mm to 28 mm, and total GAP score increased from 3 to 4. For the 19 with long term data, the GAP score changed significantly from 3 to 3 to 2 and 2 patients experienced a worsened score at the one year follow up. DISCUSSION: The patient population showed a slight improvement in GAP score among both ASD and AIS groups. The improvement is more pronounced when evaluating with the SRS-Schwab Classification. The GAP score does not emphasize the same radiographic parameters and therefore does not correlate well with the SRS-Schwab Classification. Many patients also experienced a worsened GAP score by the one year follow up which can be attributed to the adjacent superior or inferior region (PJK), thoracolumbar region (construct failure), or compensation at the pelvis through hip flexion. Additionally, GAP is potentially oversensitive to measurement error and rounding differences. Thus, the utility of the GAP score in evaluating spinal deformity patients is questionable and requires further adjustment and evaluation based on prospective studies.

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Ligia J. Zarate College of Nursing Master of Science Peripheral catheter-related phlebitis is the inflammation of a superficial vein that can lead to infection or thrombus formation if untreated. About 150 million peripheral intravenous catheters (PIVC) are inserted in the United States each year with phlebitis rates reported between 5% and 70%. Many PIVCs are started on trauma patients, but the rate of phlebitis in trauma patients whether the PIVC is started outside the emergency department (ED) or inside the ED is unknown. Therefore, the purpose of this pilot study was to determine phlebitis rates in trauma patients when PIVC's are started inside or outside the emergency department. Variables investigated, which may influence phlebitis rates were duration of time the catheter was in place, the anatomical placement site of the PIVC, the catheter gauge, where the PIVC initially was placed (inside or outside the ED), and the injury severity score (ISS). This was a prospective descriptive design. Results indicated 432 catheters were placed inside or outside the ED in trauma patients that met the inclusion criteria. The overall phlebitis rate was 5.79 %. The rate of phlebitis when the PIVC was started inside the ED was 2.92%. The rate of phlebitis when the PIVC was started outside the ED was 6.94%. If the PIVC was started outside the ED by EMTs the rate was 6.09%. When the PIVC was started outside the ED by paramedics the rate was 7.78%. There was no significant difference in rates of phlebitis according to where the PIVC was started when a Chi Square analysis was performed. No variables predicted phlebitis no matter where the PIVC was started when regression analyses were conducted. The rate of phlebitis in PIVCs started in the ED, or by EMTs or Paramedics outside the ED in this study was similar to and low according to the literature. The Center for Disease Control and Prevention (CDC) suggests removal of the PIVC within 48 hours if placed under emergency situations. However in this study, phlebitis rates of trauma patients meet the benchmark of best practice and perhaps removal of the PIVC within 48 hours should be reconsidered. Complete documentation of medical records was 87.4%. However, best practice of recording information and patient response to treatment should be higher.

Policies delegating control of educational policy to the local level are widespread, yet there has been little examination of the effects of such distributed decision making in the area of advanced education programming. We used propensity score matching to examine the effectiveness of locally developed policies for identifying intellectually gifted children identifying themselves as Black or from low-socioeconomic backgrounds across one large U.S. state (Florida) that has a state-level gifted education mandate. Ongoing underrepresentation of traditionally marginalized groups in gifted education was evident, even among districts with policies specifically designed to ameliorate disproportional representation. However, the presence of such a policy reduced the degree of underrepresentation.

Background: Gestational Diabetes Mellitus (GDM) has been linked with later metabolic abnormalities in offspring due to subsequent overweight and obesity. In Sub-Saharan Africa, there is a paucity of data on the outcomes of children exposed to GDM in utero. Aims: The primary aim of this sub-study was to investigate the prevalence of overweight and obesity in 5 and 6-year-old children from GDM complicated pregnancies and macrosomia at birth in the same cohort. The secondary aim was to identify risk factors associated with overweight and obesity in these 5 and 6-year-old children. Outcome measures: The main outcome was the prevalence of overweight and obesity in these children as measured by their age-specific body mass index (BMI) and Z-scores. Additionally, the association between other risk factors, overweight and obesity was investigated. Methods: A cross-sectional sub-study design was employed nested within a larger study that is investigating the progression to type 2 diabetes in women managed for GDM during 2010 and 2011. Mothers who participated in the larger study were informed about the sub-study and invited to allow their children to participate in the sub-study. Written informed consent was obtained from the mothers for the sub-study. The following data were collected: anthropometric data at birth and pregnancy related information from the mothers’ hospital record, additional demographic, social and medical information by questionnaire from the mother and at the research center. In addition, the children were weighed and had their height measured using standardized methods. Anthropometry was standardized using WHO standards. Risk factors for overweight and obesity were tested using a BMI>1 Z-score cut-off, (as a binary variable) in a manual multivariate logistic regression model. Results: The sub-study recruited 176 participants; 78 boys (44.3%) and 98 girls (55.7%). The mean (SD) Z-scores for the children’s anthropometry at ages 5 to 6 years were 0.28 (1.40) for weight, 0.01 (1.07) for height and 0.37 (1.63) for BMI. The overall prevalence of macrosomia at birth (birth weight>4000 gm) was 12.3 % (95% CI 8.2-9.1). The overall prevalence of overweight in the 5 and 6-year-old children was 13.4% (95% CI 8.6-20.4), while the prevalence of obesity was 14.2% (95% CI 9.2-21.2). The combined prevalence of overweight and obesity was 27.6% (95% CI 20.6-35.9). The prevalence of macrosomia (P=0.53) or overweight/obesity proportions (P=0.37) at ages 5 to 6 years did not differ by gender. In multivariate logistic regression analysis, factors independently associated with the risk of overweight and obesity were: mothers’ oral glucose tolerance test 2-hour blood glucose level during pregnancy (AOR=2.06, 95% CI 1.14-3.74, P=0.02), birth weight (AOR=1.00, 95% CI 1.00-1.00, P=0.01), child’s age in years (AOR=0.03, 95% CI 0.002-0.29, P=0.004) and number of adults in the house (AOR=0.38, 95% CI 0.17-0.86, P=0.02). Conclusion: This is the first study to report the prevalence of overweight and obesity in children born from GDM complicated pregnancies, in the Western Cape, South Africa. The combined prevalence of overweight and obesity found in 5 and 6-year-old children exposed to GDM in the Western Cape is higher than overweight and obesity in children reported in other South African studies. This can imply a higher tendency towards overweight and obesity in children exposed to GDM which needs further exploration.

Die Abschlussarbeit beschäftigt sich mit der Klauengesundheit von Deutschen Holsteins Kühen in einem Sächsischen Milchviehbetrieb. Ziel war die Erfassung und Bewertung der Klauenmaße und Klauen­gesund­heit bei unterschiedlicher Laufflächengestaltung. Aufgrund einer hohen Prävalenz von 89,1 % im Bereich Klauen und Gliedmaßen und der starken Abnutzung des vorhandenen Gussasphaltes im Laufstall, wurde nach der Ist-Aufnahme (Klauenschnitt, Erfassung von Klauenkrankheiten und –maßen) im Mai 2016 eine Stallhälfte am Futtertisch komplett mit Gummiboden (Kraiburg Kura P) ausgelegt und zwei Versuchsgruppen (N=178) gebildet. Während der 93-tägigen Versuchsphase wurden Daten zum Locomotion Score, Hygienescore, Anzahl aktiver Kühe, Gruppenstärke sowie Klimadaten erhoben. Am Ende der Beobachtungsphase wurden alle Versuchstiere einer weiteren Klauenpflege unterzogen, die Klauenmaße und eventuelle Klauenerkrankungen erfasst. Im Ergebnis konnte gezeigt werden, dass sich die Klauengesundheit der Versuchsgruppe, auf einer Kombination von Gummiboden und Gussasphalt, im Vergleich zur Kontrolle, bei der nur Gussasphalt berücksichtigt wurde, verbessert hatte. Zudem konnte verdeutlicht werden, dass Klauenerkrankungen multifaktoriell sind. Der Einbau von Gummiboden kann gesundheitsfördernd wirken, z. B. durch geringere Belastung und besseres Wohlbefinden, aber das Management hat einen essentiellen Anteil der Klauen- und Gliedmaßen­gesundheit. Als Empfehlung wird eine Kombination aus weichen und abrasiven Laufflächen als sinnvoll angesehen. Jedoch wird eine Analyse des gesamten Managements und der Haltungsumwelt der Tiere unerlässlich, da der Mensch der wichtigste Einflussfaktor auf die Klauen- und Gliedmaßengesundheit ist.:Inhalt Abkürzungsverzeichnis V Abbildungsverzeichnis VI Tabellenverzeichnis VIII 1. Einleitung 1 2. Literaturteil 2 2.1 Physiologische Grundlagen der Hornqualität und des Hornwachstums 2 2.1.1 Anatomie der Klaue und der Klauenhaut 2 2.1.2 Hornqualität 5 2.1.3 Messung der Klauenhornhärte zur Darstellung der Hornqualität 6 2.1.4 Erfassung der Klauenmaße zur Überprüfung des Hornschuhs 9 2.2 Übersicht zu den wichtigsten Klauenerkrankungen 12 2.3 Faktorenkrankheit Dermatitis Digitalis 17 2.4 Bewertung des Gangverhaltens mittels Locomotion Score 20 2.5 Bewertung der Stallhygiene mittels Hygienescore 23 2.6 Liegeflächenmanagement und Liegeverhalten 26 2.7 Gussasphalt vs. Gummibelag, Vor- und Nachteile der dargestellten Bodenbeläge 30 2.8 Stallklima 34 2.9 Management der Klauen- und Gliedmaßengesundheit 36 3. Material und Methoden 39 3.1 Tierbestand und betriebliche Gegebenheiten 39 3. 2 Versuchsaufbau 41 3.3 Datenerfassung 46 3.3.1 Bestimmung der Klauenmaße 46 3.3.2 Erfassung der Klauenbefunde 48 3.3.3 Erfassung Locomotion Score 49 3.3.4 Erfassung Hygienescore 50 3.3.5 Erfassung weiterer Parameter für die Beurteilung Klauengesundheit 50 3.3.6 Bestimmung Klimadaten 51 3.4 Datenauswertung 52 4. Ergebnisse 53 4.1 Prävalenz 53 4.1.1 Auswertung aller Klauenerkrankungen 53 4.1.2 Auswertung Dermatitis Digitalis 56 4.2 Klauendaten 57 4.3 Locomotion Score 59 4.4 Hygienescore 61 4.5 Auswertung weiterer Parameter für die Beurteilung der Klauengesundheit 62 4.6 Klimadaten 67 5. Diskussion und Schlussfolgerungen 69 5.1 Ist-Situation der Klauengesundheit in Bezug auf die gesamte Herde 69 5.2 Entwicklung der Klauengesundheit und Klauenmaße in den Untersuchungsgruppen 70 5.3 Weitere Einflussfaktoren auf die Klauengesundheit 75 5.4 Locomotion Score 79 5.5 Hygienescore 80 5.6 Schlussfolgerungen für die Praxis 81 6. Zusammenfassung 83 Literaturverzeichnis 85 Anhang 97 / The current work focuses on claw health within a herd of German Holsteins on a Saxon dairy farm. The aim was to record and evaluate the claw dimensions and claw health on different flooring systems. Due to a high prevalence of 89.1% in the area of the claws and limbs and the heavy wear of the existing mastic asphalt in the playpen, the operational management decided to carry out a partial renovation of the flooring system. Thus, after recording the actual condition (claw cut, recording of claw diseases and dimensions) in May 2016, one half of the stable at the feeding table was completely covered with rubber flooring (Kura P by Kraiburg) and two test groups (N=178) were formed. During the 93-day trial period, data were collected on locomotion score, hygiene score, number of active cows, group strength and climate data. At the end of the observation phase, all test animals were subjected to further claw care, claw dimensions and possible claw diseases were recorded. As a result, it was shown that the claw health of the experimental group had improved on a combination of rubber flooring and mastic asphalt compared to the control that only considered mastic asphalt. In addition, it could be shown that claw diseases are multifactorial. The installation of rubber flooring can have a health-promoting effect, e.g. by reducing stress and improving well-being, but management plays a major role in claw and limb health. A combination of soft and abrasive treads is considered reasonable. However, an analysis of the overall management and housing environment of the animals becomes essential as humans are the most important factor influencing claw and limb health.:Inhalt Abkürzungsverzeichnis V Abbildungsverzeichnis VI Tabellenverzeichnis VIII 1. Einleitung 1 2. Literaturteil 2 2.1 Physiologische Grundlagen der Hornqualität und des Hornwachstums 2 2.1.1 Anatomie der Klaue und der Klauenhaut 2 2.1.2 Hornqualität 5 2.1.3 Messung der Klauenhornhärte zur Darstellung der Hornqualität 6 2.1.4 Erfassung der Klauenmaße zur Überprüfung des Hornschuhs 9 2.2 Übersicht zu den wichtigsten Klauenerkrankungen 12 2.3 Faktorenkrankheit Dermatitis Digitalis 17 2.4 Bewertung des Gangverhaltens mittels Locomotion Score 20 2.5 Bewertung der Stallhygiene mittels Hygienescore 23 2.6 Liegeflächenmanagement und Liegeverhalten 26 2.7 Gussasphalt vs. Gummibelag, Vor- und Nachteile der dargestellten Bodenbeläge 30 2.8 Stallklima 34 2.9 Management der Klauen- und Gliedmaßengesundheit 36 3. Material und Methoden 39 3.1 Tierbestand und betriebliche Gegebenheiten 39 3. 2 Versuchsaufbau 41 3.3 Datenerfassung 46 3.3.1 Bestimmung der Klauenmaße 46 3.3.2 Erfassung der Klauenbefunde 48 3.3.3 Erfassung Locomotion Score 49 3.3.4 Erfassung Hygienescore 50 3.3.5 Erfassung weiterer Parameter für die Beurteilung Klauengesundheit 50 3.3.6 Bestimmung Klimadaten 51 3.4 Datenauswertung 52 4. Ergebnisse 53 4.1 Prävalenz 53 4.1.1 Auswertung aller Klauenerkrankungen 53 4.1.2 Auswertung Dermatitis Digitalis 56 4.2 Klauendaten 57 4.3 Locomotion Score 59 4.4 Hygienescore 61 4.5 Auswertung weiterer Parameter für die Beurteilung der Klauengesundheit 62 4.6 Klimadaten 67 5. Diskussion und Schlussfolgerungen 69 5.1 Ist-Situation der Klauengesundheit in Bezug auf die gesamte Herde 69 5.2 Entwicklung der Klauengesundheit und Klauenmaße in den Untersuchungsgruppen 70 5.3 Weitere Einflussfaktoren auf die Klauengesundheit 75 5.4 Locomotion Score 79 5.5 Hygienescore 80 5.6 Schlussfolgerungen für die Praxis 81 6. Zusammenfassung 83 Literaturverzeichnis 85 Anhang 97

Postural stability assessment tools are one of the many ways concussions can be assessed and return to play decisions can be made; two of which are the Balance Error Scoring System (BESS) and force plate technology. OBJECTIVE: Validate the modified BESS used by Utah State University by comparing it to equivalent tests on the NeuroCom Balance Manager System. METHODS: 114 current or previous Utah State football players ranging in age from 18-24. Each athlete conducted a baseline BESS test during their pre-participation physical and NeuroCom testing was conducted during the summer of 2011. NeuroCom testing included a modified Clinical Test of Sensory Interaction on Balance (mCTSIB) both on a firm and foam surface, a single leg stance test with eyes open and closed on both a firm and foam surface, and a tandem walk test where end sway was recorded. BESS testing was done depending on when the athlete arrived at Utah State. Correlations were reported for athletes that arrived for the current year and also for the athletes that arrived for any year prior to that. A Welch's T-Test was conducted to analyze any differences between the two groups. The tandem stance on the foam condition for the BESS had a statistically significant difference, so that variable was excluded and the adjusted correlations were then reported. There were eight correlation conditions that were determined by the individuals who could and could not complete the entire time on the single leg stance with eyes closed on a firm as well as a foam surface. RESULTS: The only variable associated with the NeuroCom Balance Manager that had consistent correlations with the composite BESS score was the CTSIB foam condition; with a 0.28 correlation with individuals regardless of single leg stance with eyes closed, 0.39 with individuals who completed the whole time on the firm without consideration for the foam, 0.27 with individuals who did not complete the whole time on the foam without consideration for the firm and 0.39 with individuals who could complete the whole time on the firm but not on the foam. CONCLUSION: There appears to be some correlation with CTSIB foam conditions and the composite BESS.

Objective: The study assesses the impact of dual enrollment participation on remediation and completion for traditional first time, full-time freshmen at a community college in Northeast Tennessee. Method: This study began with the full population of 1,232 students who enrolled between 2008 and 2012 at a community college in northeast Tennessee the fall semester after finishing high school. The population was required to have American College Testing (ACT) scores, completely fill out the Free Application for Federal Student Aid (FAFSA), enroll full-time as a degree-seeking student, and complete the first fall semester. Propensity score matching was utilized to eliminate self-selection bias and enable parametric comparisons using optimal matching of dual enrollment participants and non-participants while controlling for a range of covariates. Results: The analyses showed that community college students who participated in dual enrollment were (a) 9% or nearly 3.4 times less likely to take remediation, (b) 26% or nearly 2.5 times more likely to graduate in 2 years, and (c) 28% or nearly 1.5 times more likely to graduate in 3 years. Contributions: This study contributes to the literature showing that dual enrollment reduces remediation rates and assists in timely completions for community college students. Policy recommendations are to increase equitable participation, normalize dual enrollment for students academically able to do college coursework, align state terminology with the nation, and improve data for future research.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第19636号 / 社医博第69号 / 新制||社医||9(附属図書館) / 32672 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 佐藤 俊哉, 教授 今中 雄一, 教授 小西 郁生 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

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