Background: Prenatal exposure to opioids, cocaine, and methamphetamine is associated with alterations in fetal brain that lead to structural changes in the brain postnatally, contributing to developmental and behavioral effects seen throughout childhood. Opioid exposure is associated with withdrawal in newborns, effects on somatic growth of infants, difficulty with executive functions and a tendency towards externalizing behaviors in older children. Cocaine and methamphetamine exposure are associated with effects on somatic growth, irritability and feeding issues in infants, problems with executive functions, and externalizing behaviors. Many substance-exposed children are placed in foster care and the pre-licensure training for foster parents does not specifically address how to care for substance-exposed children. Purpose: To create and evaluate a video that outlines common effects of prenatal exposure to opioids, cocaine, and methamphetamine, as well as evidenced-based caregiver interventions. Methods: The script for the video “Caring for Children with Prenatal Substance Exposure: Opioids, Cocaine, and Methamphetamine” was written by the author and evaluated by two clinical experts. The video was filmed and was presented to 6 licensed foster parents and 1 unlicensed adoptive parent who evaluated the video’s presentation at Devereux Foster Care Agency in Tucson, AZ using the Patient Educational Materials Assessment Tool for Audio/Visual (PEMAT-AV). Responses were entered into the PEMAT Autoscoring tool and component scores for understadability and actionability were calculated. Results: Both clinical experts evaluated the video’s content as being factual, and consistent with evidence-based research. Mean PEMAT-AV understandability and actionability scores were both 100%. Discussion: The video’s content and presentation are both strong as evidenced by high evaluation scores from clinical experts and foster parents, making it a useful educational tool for educating foster parents on caring for substance-exposed children. Further research is needed to determine if the viewing video increases foster parent knowledge and produces long-term change in parenting practices. Additionally, the video was designed to also be used to educate biological parents of substance-exposed children, but future studies are needed to determine if the video is an effective educational tool for this population.

The Occupational Safety and Health Administration estimates that each year, approximately 30 million people are occupationally exposed to hazardous noise. While many are aware of the noise exposure associated with industrial occupations, there has been little research conducted on bartenders who often work in environments that have high levels of noise. The majority of current published research on occupational noise exposure of bartenders has only evaluated noise levels on one night of business. Bartenders often work multiple days per week, which vary in the amount of patrons and entertainment provided, this variation in business leads to variation in the amount of noise to which they are exposed. The purpose of this research study was to gather occupational noise exposure data for bartenders during a workweek at a Tampa Bay bar establishment that hosts live music on weekends. Personal noise dosimeters were used to collect personal noise exposure data. Area noise level data were collected using a sound level meter. While several bar establishments were approached, one bar establishment part pated as the study site and noise data were collected for seven consecutive days (Thursday-Wednesday). Personal noise exposure data were collected for an entire 8-hour work shift for the Thursday-Sunday portion of the study, and for 6 hours for the Monday-Wednesday portion of the study. Area noise data were collected for the Thursday-Saturday portion of the study. Results of this study indicate that the highest noise exposure for either bartender occurred on Saturday (Bartender 1: 93.1 dBA; Bartender 2: 83.6 dBA) when a live band was performing in the establishment. Using the OSHA Hearing Conversation and OSHA PEL measurement methods, Bartender 1 was exposed to excessive noise levels (>85 dBA) on four (4) nights of the study, while Bartender 2 had no exposures over 85 dBA. However, using the ACGIH measurement method, Bartender 1 was exposed to excessive noise levels six (6) nights of the study, while Bartender 2 was exposed to excessive noise levels two (2) nights of the study.

In the United States, approximately 3% of infants are diagnosed with a major birth defect each year. Whereas prevention efforts have led to decreases in some birth defects, the cause of approximately 70% of birth defects remains unknown. More recently, there has been increasing concern regarding exposures to environmental agents, such as air pollution during pregnancy, and the risk of birth defects. Over the past decade, there has been an increase in research studies examining the association between air pollution and birth defects. The results have been inconsistent, with some studies reporting that higher levels of exposure from the same pollutant increase the risk of birth defects, whereas others report no risk or even a decrease in risk. These inconsistencies may arise from differences in exposure assessment methods across epidemiological studies. A comprehensive series of sensitivity analyses were conducted to evaluate the impact of different exposure estimation decisions on the adjusted measures of associations between ambient air pollution exposure and birth defects. For each of six decisions – spatial scale, spatial limit, temporal scale, temporal limit, data aggregation sequence, and weighting scheme – two alternative choices were considered, and maternal exposure to PM2.5 and benzene were estimated for each ‘sensitivity case' (unique combination of choices across all decisions). For each sensitivity case, adjusted prevalence ratios (aPRs) and 95% confidence intervals (CI) were estimated from multivariable regression models comparing each exposure quartile to the first quartile; each measure of association represented the associations between either benzene or PM2.5 and one of the birth defects under study. To then evaluate the impact of selecting alternative choices for each exposure assessment decision, three metrics were used: 1) the percent difference in the aPR point estimates between alternative choices for a specific decision (calculated for each sensitivity case pairing); 2) the percent of sensitivity cases in which the aPR 95% CIs for alternative choices for a specific decision overlapped (i.e., were not statistically significantly different); and 3) the percent of sensitivity cases in which there was agreement in the substantive conclusion of the association between exposure (pollutant) and outcome (defect), the conclusion being either statistically significant increased risk, statistically significant decreased risk, or no statistically significant difference in risk. Second, a retrospective cohort study was conducted to investigate the association between maternal exposure to ambient benzene and PM2.5 and the risk of musculoskeletal birth defects in offspring. For both analyses, data on singleton infants born from 2000 to 2013 were obtained from the Florida Birth Defects Registry and air pollution data were obtained from the Environmental Protection Agency Air Quality System database. Exposure estimates were calculated for all birth defect cases and non-affected births during etiologically relevant time windows and multivariable regression models were used to obtain aPRs and 99% CIs comparing each quartile of exposure to the first. For PM2.5, across all exposure-outcome pairs under study, the alternative choices for the decision of spatial scale resulted in the largest median percent difference in aPRs (e.g., between county and block group) when results were aggregated for all quartiles. This was followed by the temporal scale and spatial limit decisions. For benzene, spatial limit resulted in largest median percent difference in aPRs, followed by spatial scale and temporal scale. However, for both pollutants, when evaluating the agreement in aPRs between alternative choices on the direction and significance of the association (i.e., statistically significant increase, decrease, or no risk), the decision of spatial limit resulted in the lowest percent agreement (biggest impact). Temporal limit had the second lowest percent agreement for PM2.5, whereas spatial scale had the second lowest for benzene. Finally, the metric assessing the level of overlap in 95% CIs for the measures of association was inconsequential, suggesting little impact of any exposure assessment decision, and doing little to differentiate between the relative impacts of each decision. That is because, for all exposure-outcome pairs, when comparing alternative choices for each decision, there was 100% overlapping intervals (i.e., no aPRs were statistically significantly different from each other). Lastly, exposure assessment decisions impacted the analytic sample sizes, with some decisions resulting in a three-fold difference in the sample size alone. Mothers of singleton infants exposed to higher levels of ambient PM2.5 were more likely than mothers with lower exposure levels to give birth to an infant with isolated anomalies of the skull and face bones, any rib and sternum anomalies, any skull and face anomalies, any spine anomaly, and other congenital anomalies of lower limb including pelvic girdle. Higher PM2.5 exposure was also associated with an increased risk of non-isolated anomalies of skull and face bones, any skull and face anomalies, and reduction deformities of the upper limb. Exposure to higher levels of benzene was associated with an increased risk of isolated congenital hip dislocation and congenital valgus deformities of feet as well as multiple inverse associations. The findings presented here indicate that measures of association between maternal pollutant exposures (PM2.5 and benzene) and selected birth defect outcomes in offspring are sensitive to exposure assessment decisions, with some decisions more impactful than others. The findings can be used, not only to explain the lack of consistency in results across existing epidemiological studies, but to guide decision-making in future studies. This study also adds to the growing body of epidemiological studies suggesting an association between specific air pollutants and birth defects. In the current political climate, it is important that researchers continue to provide evidence of the detrimental health effects of air pollution in order to circumvent change in current policies established to regulate and reduce pollution emissions.

Introduction: Musculoskeletal pain is a common problem in the working population. In Sweden, 40% of women and 30% of men report suffering from neck and shoulder pain weekly. The underlying cause for neck pain is often not known and the treatment is commonly guided by the individual’s symptoms. However, there is a lack of knowledge on how to receive the best effect based on the individual’s symptoms and functional limitations, and therefore this has been scarcely evaluated in research. Furthermore, the impact of work exposure and stress on long-term treatment for persons with neck pain is not clear. Aims: To develop (paper 1) and to evaluate a decision model for tailored treatment in women with neck pain (paper 2). Moreover, to determine if risk factors at work and stress influence intermediate and long-term treatment results (paper 3). Further, to investigate if changes in self-reported pain and disabilities are associated with changes of physical test outcomes of the neck and shoulder region after treatment (paper 4). Methods: In an RCT, 120 working women with non-specific neck pain were randomized to three different groups – tailored treatment (TT), non-tailored treatment (NTT) or treatment-as-usual (TAU) for an 11 weeks intervention with short-term, intermediate-term and long-term follow-ups. The TT group was guided by a decision model with cut-off levels to indicate impairments. The NTT group received two established treatment components randomly from those not indicated, and TAU group did not receive any treatment within the study. The RCT primary outcomes were self-reported neck pain and neck disability. A linear mixed model was used for analysing the effects. One week after the end of intervention work exposure and stress were assessed at a work-place visit and associations to treatment results were tested for, and mixed models were used to estimate longitudinal associations. Associations between self-reported neck problems and physical outcomes were estimated with univariate and multiple regressions analysis. Results: No differences between TT and NTT were revealed for neck pain and disability. In comparison to TAU, the TT and NTT groups both showed improvements at short-term follow-up, but not at intermediate and long-term follow-up. High stress level and low self-estimated control at work were associated with more pain and disability at the intermediate and long-term follow-ups. After intervention and at the intermediate-term follow-up, reduced neck pain, disability and frequency of symptoms were associated with increased peak speed of head rotation and cervical range of motion. Conclusion: Tailored treatment according to the decision model was not superior to the non-tailored treatment in women with non-specific neck pain. One explanation for this can be the weak relationships found between neck pain and disability and physical test outcomes. Further, perceived stress and psychosocial work exposure were associated with self-reported neck problems and should be taken into account to optimize the effects in neck pain rehabilitation. / Bakgrund: Nack- och skulder-smärta är ett vanligt tillstånd som förekommer över hela världen. I Sverige skattar 30-40% besvär från nacke och skuldror mätt under en veckas tid. Generellt rapporterar kvinnor mer nack- och skulder-besvär än män. I avhandlingen är det ospecifik nacksmärta som har studerats, det inkluderar inte t.ex. Whiplash-skador, diskbråck eller andra mer specifika diagnoser. Den bakomliggande orsaken till ospecifik nacksmärta är, precis som beteckningen antyder, ofta inte känd och individens symptom och funktion är istället vägledande i undersökning och behandling samt utvärdering av behandling. Studier har visat att i jämförelse med friska har individer med ospecifika nackbesvär ofta sämre muskulär nackstyrka, minskad rörlighet i nacken och är något långsammare vid test av huvudrörelser. Behandlingen riktar sig ofta mot något av dessa fynd med bl.a. styrketräning av nackmuskler och/eller manuella tekniker för rörelseökning. Studier har dock visat att behandlingen endast ger måttliga resultat och att de positiva resultaten bara är kortvariga. I kliniken försöker man individanpassa behandlingen utifrån patientens behov men det finns väldigt lite forskning om detta utan studier utvärderar likadan behandling för hela grupper. Det saknas fortfarande kunskaper om hur man på bästa sätt individanpassar behandling så att den blir skräddarsydd utifrån individens symptom och funktion samt utvärderar detta. Syftet med avhandlingen var att undersöka om en intervention med skräddarsydd behandling (som också innehöll specifik aktiv träning) utifrån en beslutsmodell med fysiska tester och frågor om symtom är effektivt för att uppnå positiva effekter i självskattad smärta och funktion (artikel 1 och 2).  Den skräddarsydda behandlingen jämfördes mot en grupp som fick samma upplägg men inte skräddarsydd behandling. Vidare undersöktes om båda dessa behandlingsgrupper var effektivare än en grupp som inte fick någon behandling i studien. Dessutom undersöktes om påverkan från arbetsmiljön i form av fysisk och psykosocial belastning samt upplevd stress påverkade behandlingsresultaten efter interventionen (artikel 3). Slutligen undersöktes om de fysiska testerna och den självskattade smärtan, funktionen och symptomen hade koppling till varandra dels före interventionen och dels i termer av förändringar efter interventionen (artikel 4). Metod: I en randomiserad kontrollerad interventionsstudie (RCT) inkluderades 120 kvinnor i åldrarna 20-65, alla i arbete, och som hade ospecifika nackbesvär.  De lottades till tre grupper, (1) skräddarsydd behandling (Tailore treatment, TT), (2) icke-skräddarsydd behandling (Non-tailored treatment, NTT) och (3) en kontrollgrupp (Treatment-as-usual, TAU) som inte fick någon behandling i studien men var fria att söka vård på egen hand. Kvinnorna i TT-gruppen fick behandlings-komponenter utifrån testresultaten i beslutsmodellen. Det kunde läggas till någon behandlingskomponent om det visade sig behövas utifrån individens behov i vardagen. Detta undersöktes genom en strukturerad intervju-teknik som kallas Problem Elicitation Technique (PET). Kvinnorna i NTT-gruppen fick två lottade behandlings-komponenter som inte matchade deras behov utifrån testerna i beslutsmodellen. För båda behandlings-grupperna var interventionen 11 veckor med inbokade behandlingstillfällen 2-3 gånger per vecka, samtliga tillfällen vägledda av fysioterapeut. Data för alla tre grupper samlades in innan interventionen samt 3, 9 och 15 månader efter start av interventionen. Gruppskillnaderna analyserades med en ”linear mixed model”. En vecka efter intervention gjordes ett arbetsplatsbesök hos individerna i alla tre grupper. En erfaren ergonom observerade individernas fysiska arbetsbelastning med ett ergonomiskt bedömningsinstrument, Quick Exposure Check (QEC), och individerna skattade också den psykosociala arbetsmiljön i ett frågeformulär, QPS Nordic, samt upplevd stress. För att undersöka om den fysiska och psykosociala arbetsbelastningen samt stress påverkade resultaten från interventionen analyserades data med linjär regression och mixed model. För att undersöka om de fysiska testerna och den självskattade smärtan, funktionen och symptomen hade något samband användes linjär regressionsanalys. Resultat: Att skräddarsy behandlingen utifrån den testade beslutsmodellen var inte effektivare än att inte skräddarsy. I jämförelse med kontrollgruppen självskattade båda behandlingsgrupperna mindre smärta, bättre funktion och mindre symptom efter interventionen. I de länge uppföljningarna (9 och 15 månader) var dock skillnaderna mellan grupperna inte längre signifikanta förutom att båda behandlingsgrupperna, till skillnad från kontrollgruppen, upplevde sig bättre än innan behandling. Det visade sig att upplevd hög stressnivå och låg kontroll på arbetet hade samband med mer självskattad nacksmärta, sämre funktion och lägre arbetsproduktivitet. De fysiska testerna och självskattade nackbesvär hade bara svaga samband. På baslinjenivå, innan interventionen, fanns det samband mellan hög nackstyrka och låg självskattad funktion och låg frekvens på symptomen, samt mellan att vara långsam i testet av snabba huvudrörelser och hög smärta. Efter interventionen hade individernas förändring i självskattad smärta fortfarande bara samband med snabba huvudrörelser. Förbättring i självskattad funktion och symptom hade samband till ökad hastighet i snabba huvudrörelser och ökat rörelseutslag nackrotation. Sammanfattning: För kvinnor i arbete med ospecifika nackbesvär var det inte mer effektivt att skräddarsy behandling/träning utifrån en beslutsmodell jämfört med att slumpmässigt välja ut behandlingskomponenter från samma behandlingsarsenal. En förklaring kan vara att det fanns endast låga samband mellan självskattad smärta och funktion och de fysiska testerna. Upplevd stress och kontroll i arbetet visade sig ha samband med självskattad smärta, funktion och arbetsproduktivitet och bör tas i beaktande i framtida interventioner för individer med nacksmärta.

Magister Scientiae (Medical Bioscience) - MSc(MBS) / Several studies conducted in laboratories at the University of the Western Cape has demonstrated an interference with the parenchymal lung tissue of the offspring when exposed to nicotine (smoking cigarettes and/or Nicotine Replacement Therapy [NRT]), maternally i.e. during gestation and lactation. This in turn, decreases the amount of air sacs (alveolar number) resulting in a reduced surface area available for efficient gas exchange in the offspring. Since the foetus and offspring are only exposed to nicotine during gestation and lactation, emphysema- like lesions appear to develop after nicotine withdrawal in the foetus. It has been proposed that during lung development in utero, a change in the "program" that controls the maintenance of lung integrity will occur in the long term due to the initial maternal nicotine exposure. Therefore, animals that were exposed to maternal nicotine resemble lungs that have undergone rapid, premature aging caused by cellular senescence. Furthermore, energy metabolism and structural changes in the glycolytic pathways appear irreversibly slower compared to animals that were not exposed to nicotine via the mother during gestation and lactation, resulting in a reduction in the anti-oxidant capacity of lung development. Previous studies have also shown that strong anti-oxidants supplemented by smoking mothers during gestation and lactation could possibly resist change in the "program" which controls lung development and integrity of the offspring in the long term. Lycopene – as a strong anti-oxidant supplementation have shown to decrease the alveolar volume and increase the alveolar surface area for better gas exchange after the offspring has been exposed to maternal nicotine. In this study I have treated pregnant wistar rats with nicotine, tomato juice (containing lycopene among other phytonutrients), and a combination of nicotine and tomato juice during gestation, to determine various changes in the lung structure and signs of premature aging in the lungs of the offspring. I have also performed various staining techniques such as H&E, connective tissue and β- galactosidase staining which indicated whether maternal nicotine exposure indeed induced premature cellular senescence in the lungs of the offspring. / National Research Foundation

Global Savings Group - Rocket Internet SE venture currency risk management exposure. This thesis covers the theory around currency risk management, putting it into practice with the real case of GSG currency risk exposure. In the end I aim to verify if currency risk affects the performance of SMEs, and if such type of companies (in this case the GSG) are aware of such exposure and if they adopt any strategies in order to reduce such exposure.

This thesis quantified risks of lead (Pb), cadmium (Cd), and mercury (Hg) in the diet of First Nations peoples residing on-reserve in the province of Ontario, Canada. Data was obtained from the 2011-2012 First Nations Food, Nutrition, and Environment Study (FNFNES) and Health Canada to construct total diet studies and probabilistic assessments. Results indicated that the majority of the population is at low risk of exceeding the reference values for these contaminants. Average exposures of Pb and Hg were higher than the general Canadian population (1.7 and 1.6 times greater, respectively), whereas Cd was 59% lower than the Canadian average. The upper percentiles of the population exposure distributions were characterized for contributing food items to assist risk management strategies. For cadmium exposures, smokers had elevated exposures compared to non-smokers. Women of childbearing age had lower dietary MeHg exposures than the total population and were largely below the reference value.

A causal link between radon exposure and lung cancer was previously established through numerous epidemiological studies of miners and residential occupants exposed to radon gas. Although the health detriment to Canadians from residential radon exposure has been estimated in earlier assessments, a comprehensive radon survey by Health Canada in 2011 was the first to sample residences from every health region in the country. Further, this survey yielded higher concentration measurements than previous surveys, with an arithmetic average concentration about twice that of an older survey which was the basis for many of the previous Canadian radon risk assessments. Two exposure-response models from the US NRC were selected for this thesis, along with seasonal adjustment factors for the survey data to compute expected value, rather than conservative, risk estimates. Population-based (population attributable risk, PAR; excess lifetime risk ratio, ELRR; and life-years lost LYL) and individual-based (ELRR and LYL) indices are used to summarize the health detriment. Mean estimates of ELRR, PAR, and LYL for the Canadian population are estimated in the range of 0.31 - 0.48, 0.19 - 0.26, and 0.19 - 0.31, respectively, depending on the model used. Point estimates are also provided for individual provinces and some results are strati ed by risk factors, such as smoking history and floor level of residency. A number of sources of uncertainty in the results are identified, and some are incorporated in a two-dimensional uncertainty analysis using Monte Carlo methods.

Hyperacusis is a condition in which sufferers experience everyday sounds in their surroundings as unmanageable and disturbing. The condition is often associated with symptoms such fatigue, headaches, sleep disturbances and difficulties concentrating. Present study aimed to investigate how people are affected when exposed to noise over time. This was operationalized by collecting data from essentially three domains; subjective, physiological and cognitive. Since hyperacusis is largely defined by the individuals’ subjective experience, participants were divided into three groups based on their own subjective reports of discomfort during an exposure to white noise (60db). Cognitive performance was assessed using two well established measurements in the beginning and the end of the exposure session. Contrary to expectations, the groups did not differ significantly in cognitive performance. Heart rate variability was measured during the exposure session and was hypothesized to be lower in participants experiencing higher discomfort. As expected, the groups differed in their expressed variability in the direction of the hypothesis.

Assessing the risk of transgenic crop products is essential when determining the safety of a crop for deregulation and commercialization. The Organization of Economic and Cooperative Development (OECD), International Standards Organization (ISO), and governmental regulatory agencies require a battery of tests to demonstrate the safety of a GM product against several surrogate species of organisms that perform various ecosystem services. Assays are performed using toxicology methods established for pesticides. These methods have been applied to testing the safety, specificity and fate of Bacillus thuringiensis (Bt) Cry protein toxins engineered into crop plants and information exists on the effects on non-target organisms (NTOs). Toxicology assays are typically evaluated through a tier-based approach, where, if no or negligible risk via oral toxicity or phenotypic changes then a risk decision can be made. Long term exposure studies are often performed after commercial release of the crop occurs and provide a more in depth understanding of environmental impacts. Risk analyses are currently being performed on the product of the next generation of GM crops that express dsRNAs against Western Corn Rootworm. This thesis provides another such study, primarily focused on Folsomia candida, a microarthropod that is the subject of numerous toxicological studies. I describe the development of dsRNA stability assays, which indicate stability of dsRNA across assay time, both with and without F. candida. When exposed to dsRNA levels several orders of magnitude higher that what would be encountered in the environment, F. candida is not negatively impacted as seen through gene expression and life history trait analysis.