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Inconsistent therapy attendance is a problem for clients and clinicians. Clients who don’t attend therapy consistently, whether because of their own actions or therapist reasons, may experience difficulty making therapy work effectively for them. Most of the literature regarding inconsistent therapy attendance has examined the demographics of those who are inconsistent and some of the reasons that may contribute to inconsistency. There are only two known studies (Defife et al., 2010; Erekson et al., 2015) that have attempted to examine the impact of inconsistent therapy attendance on therapy outcomes. This study investigated whether inconsistent therapy attendance patterns had a significant impact on client outcomes, as measured by total OQ-45 (Lambert et al., 1994) score. Participants were drawn from counseling center clientele at a large, private, religious university and included 11,794 clients with attendance data for 67,329 scheduled sessions. Hierarchal linear model was used to first determine if the intercept, linear, and quadratic trends had enough initial OQ-45 score variation from client to client to warrant investigating predictors, and second, to determine if consistency, as well as consistency over time, have an impact on the full score OQ-45 starting points and recovery curves. The impact of consistency was found to be significant on the intercept and linear trend of OQ-45 scores. Clients with perfect consistency scores were found to have OQ-45 starting points that were, on average, 10 points lower than their inconsistent peers. In addition, clients with higher levels of consistency across time were found to decrease their symptomology by an average of 2.19 points per session attended, while clients with high inconsistent attendance patterns did not have a significant increase or decrease in OQ-45 score per session. Implications of this study could extend to policies regarding consistency, as well as session limits that could help increase consistency.

Workforce parity among cultural groups in America has been an unobtainable goal for years. The present diversity in our society dictates a new mandate for majority managers in their approach toward working beside and supervising these cultural groups. In order to achieve full inclusion and reach their fullest potential many employees, minorities and women, in these cultural groups, along with managers, are attending or participating in diversity training classes. Although diversity has several definitions, the goal of most training is to change corporate and organizational culture so everyone is allowed to contribute equitably to achieve his/her fullest potential, ultimately achieving parity in every area of the workplace. The purpose of this grounded theory study was to investigate the perceptions of behavioral outcomes as observed and experienced by minority employees concerning their Caucasian managers who have attended a diversity training program at a government facility. A case effects matrix was used to display the data obtained through eight open-ended interviews, observations and content analysis. Data was analyzed to elicit themes or patterns that addressed three research questions: 1. To what extent did the training program meet its stated objectives? 2. What kinds of behavioral changes occurred in Caucasian managers after attending a diversity training program? 3. To what extent was the training program an effective organizational intervention? The presentation of the data was in descriptive narrative case study profiles. Two categories of major themes were identified as common among the managers and employees: (a) Changes and (b) constraints. Results revealed that the training objectives were met, that behavioral outcomes indicated no significant change in managerial behaviors and that the training was not an effective intervention. Although some improvements were made, the training was not found to have transformed the organization. Recommendations for future diversity training programs were addressed. / Ed. D.

Researchers suggest there are many outcomes associated with attending college. There is also research that suggests there are positive outcomes connected with involvement in college, and living in residence halls. Resident Advisors (RAs) are college students who are involved in college via their RA job, and are on-campus residents. Studies to assess the outcomes associated with serving as a RA, however, have been. Therefore, the purpose of this study was to measure self-reported outcomes of the RA experience. The data were gathered by administering the Student Leadership Outcomes (SLO) survey to all RAs on campus in the Spring, 1998 semester. The SLO is an instrument designed by the university at which the study was conducted to measure outcomes of student leadership experiences. Data were analyzed to determine if the outcomes associated with the RA position differed by: size of residence hall (small, medium, large); type of residence hall (single-sex, co-educational); gender of supervisor; or, status of supervisor (undergraduate versus graduate). The SLO is a 37-item instrument which asks respondents to assess the degree to which they believe they have achieved certain outcomes associated with their leadership position. Respondents rate items on a 4-point Likert-type scale (1= strongly agree, 4= strongly disagree). Data were analyzed by calculating the mean scores for each group of RAs (i.e., RAs in single-sex halls, RAs in co-ed halls) and rank ordering their scores. Then comparisons between those rankings were examined. The results of this study provided some interesting information about outcomes associated with being an RA. The findings suggest that the size of hall has a positive impact on loyalty to the university, respect towards others, and leading a group or committee. The findings also suggest that type of hall and status of supervisor has a positive affect on loyalty. In addition, the results indicated that gender of a supervisor has no affect on RA outcomes. / Master of Arts

Gestational diabetes (GDM) is a potentially serious disorder requiring timely diagnosis and management to prevent adverse maternal and fetal outcomes. Of increasing concern today, when treating the woman with GDM, is the need to provide every woman with an intensive management plan to optimise the likelihood of favourable pregnancy outcomes. Early identification of those women with GDM who require insulin therapy in addition to diet therapy would be beneficial in the planning and standardisation of clinical management protocols, to enhance pregnancy outcomes and increase cost benefits with improved allocation of resources. The aim of this study was to evaluate the ability of the fasting plasma glucose level (FPG) at diagnosis to predict an increased risk to the fetus and the need for insulin therapy in a pregnancy complicated by GDM. A prospective longitudinal study design and recruitment by convenience sample was used. Data were obtained from 327 women and their babies. Diagnosis of GDM was made by a 75 gram oral glucose tolerance test (OGTT) using Australasian Diabetes in Pregnancy Society (ADIPS) criteria with the exception of seven women diagnosed on a blood glucose level >11.1mmol/l. Following consent of the women data were collected by a self report questionnaire and the medical record system at three points; at first intervention, following delivery and at the postpartum OGTT. Demographic, social, medical, maternal and neonatal outcome data were collected. The management protocol was similar for all of the women. Following nutritional intervention any woman who could not meet the glycemic targets of <= 5mmol/l fasting and/or <= 6.5mmol/l two hours postprandial was commenced on insulin therapy. The women had a mean age of 32 years, body mass index (BMI) of 25.7 and parity of 2 (range 1-12). Diagnosis was made at an average of 30 weeks and 70 women required insulin therapy with a mean dose of 34 IU per day, commencing at a mean of 31 weeks gestation. Mean birthweight was 3400G. Of the babies 12% were >4000G. Congenital abnormalities occurred in 3%, neonatal morbidities in 2% and there was 1 death in utero. Logistic regression analysis found the following significant associations: Increasing maternal BMI was related to increasing FPG levels at diagnosis and the requirement of higher insulin doses. There was a negative linear relationship to weight gain. Ethnicity was associated with maternal BMI and ethnicity with BMI was associated with birthweight in the specific ethnic group. BMI with insulin therapy as a covariate and the FPG value at OGTT were predictive of persistent glucose intolerance in 14% of women postpartum. Each value of the OGTT was a significant predictor of the need for insulin therapy as a function of the week of gestation. The FPG level was the statistical model of best fit. A 50% probability for requiring insulin was reached with a FPG at diagnosis of 4.0 mmol/l if tested at 10 weeks gestation, 5.1mmol/l at 20 weeks and 6.1 mmol/l at 30 weeks (p<.001). These results support the substantive research aim of the study. The model has the power to predict the probability (risk) of requiring insulin therapy based on the maternal FPG level at the OGTT according to the week of gestation. The study results demonstrate that glucose intolerance is linked to a number of adverse maternal and fetal outcomes in a continuous and graded fashion. The degree of reversibility of maternal and fetal risk through therapeutic interventions such as nutrition therapy, blood glucose monitoring, exercise and active patient participation aimed at improving glucose tolerance is unknown. Therefore, the rationale for, and feasibility of, new treatment strategies such as the application of this statistical model as a management approach require large scale randomised intervention studies, oriented toward measuring maternal and fetal outcomes amongst different populations.

The purpose of this dissertation is to assess the contribution of protected areas (PAs) to the attainment of both conservation and social outcomes including poverty reduction within the Greater Serengeti Ecosystem in Tanzania. The research focused on the role of governance as a factor influencing the attainment of these goals. This research was carried out in the Serengeti, Ngorongoro and Meatu districts of Tanzania in 2012. Two villages were selected from each district using stratified sampling techniques to obtain villages bordering many PAs including the core PA (i.e. Serengeti National Park). A mixed methods approach was used in this research which comprised of quantitative interviews with 389 households, key informants interviews with 88 stakeholders, 12 focus group discussion and document analysis. The study used a quantitative questionnaire to measure the effectiveness of governance as perceived at the household level. The questionnaire yielded 10 governance factors that accounted for 85% percent of the explained variance using factor analysis. The findings indicated weak governance particularly for Ikorongo-Grumeti Game Reserve. When examined across the ecosystem, weak linkages were evident between the PA actors and other actors such particularly at local community level. There was no difference in governance scoring between community-based PAs and the more traditional top-down government owned PAs. Furthermore, local communities were not adequately represented in PA governance despite being important actors. Findings indicated mixed results in terms of conservation and social outcomes. Results indicate implied relationship between mixed outcomes and weak governance with weak outcomes thought to be related to weak governance. This study recommends adaptations in the Serengeti ecosystem particularly the re-engineering of the ecosystem governance structure to bring on-board more actors in decision-making and management processes and actions through increased linkages between governance actors, governance structures and processes. / Graduate / 0366 / 0768 / 0478 / akisingo@mwekawildlife.org

国立情報学研究所で電子化したコンテンツを使用している。

Objetivo: Determinar si la edad materna está asociada a un aumento o disminución de riesgo de complicaciones obstétricas y perinatales, ajustándola por diversas variables confusoras. Métodos: Estudio de cohorte retrospectiva de 67 693 gestantes en Lima, entre enero del 2000 a diciembre del 2010, usando la base de datos del Sistema informático perinatal del Hospital Nacional María Auxiliadora. Las complicaciones fueron comparadas entre gestantes adolescentes (< 20 años) y gestantes adultas (20-35 años); el grupo adolescente se clasificó en adolescentes tardías (15-19 años) y adolescentes tempranas (< 15 años). Se obtuvieron los Odds Ratio ajustados con la regresión logística simple y múltiple. Resultados: Al ajustar las diversas variables, se encontró mayor riesgo de cesárea e infección puerperal en las adolescentes menores de 15 años, así como mayor riesgo de episiotomía en el grupo total de adolescentes. Asimismo, se identificó un menor riesgo del embarazo adolescente para preeclampsia, hemorragia de la 2da mitad del embarazo, ruptura prematura de membranas, amenaza de parto pretérmino y desgarro vaginal. Conclusiones: Se encontró al embarazo adolescente como factor de riesgo para complicaciones obstétricas. Por lo tanto, se recomienda un control prenatal multidisciplinario para éste grupo etario. / Objective: To determine whether maternal age is associated with increased or decreased risk of obstetric and perinatal outcomes, adjusting by several factors. Metods: Retrospective cohort study of 67 693 pregnant women in Lima, from January 2000 to December 2010, using the perinatal database computer system from the Hospital Nacional María Auxiliadora. Outcomes were compared among pregnant adolescents (< 20 years) and adults (20-35 years); in addition, the adolescent group was divided in late adolescents (15-20 years), and early adolescents (<15 years). Adjusted odds ratios were obtained through logistic regression analysis. Results: Adjusting by several factors, an increased risk of cesarean and puerperal infection in adolescents less than 15 years was found, as well as an increased risk of episiotomy in the total group of adolescents. In addition, this study identified a lower risk of preeclampsia, 2nd half-pregnancy bleeding, premature rupture of membranes, preterm labor and vaginal tearing among adolescent mothers. Conclusion: Teenage pregnancy was found as a risk factor for adverse obstetric outcomes; hence, a multidisciplinary prenatal care for this group of adolescent is recommended. Key Word: Adolescent pregnancy, obstetric outcomes, perinatal outcomes / Tesis

faustino.perez@unizar.es / Objective: To assess the effects of vitamin D supplementation during pregnancy on obstetric outcomes and birth variables. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). Setting: Not applicable. Patient(s): Pregnant women and neonates. Intervention(s): PubMed and 5 other research databases were searched through March 2014 for RCTs evaluating vitamin D supplementation calcium/vitamins/ferrous sulfate vs. a control (placebo or active) during pregnancy. Main Outcome Measure(s): Measures were: circulating 25-hydroxyvitamin D [25(OH)D] levels, preeclampsia, gestational diabetes mellitus (GDM), small for gestational age (SGA), low birth weight, preterm birth, birth weight, birth length, cesarean section. Mantel-Haenszel fixed-effects models were used, owing to expected scarcity of outcomes. Effects were reported as relative risks and their 95% confidence intervals (CIs). Result(s): Thirteen RCTs (n ¼ 2,299) were selected. Circulating 25(OH)D levels were significantly higher at term, compared with the control group (mean difference: 66.5 nmol/L, 95% CI 66.2–66.7). Birth weight and birth length were significantly greater for neonates in the vitamin D group; mean difference: 107.6 g (95% CI 59.9–155.3 g) and 0.3 cm (95% CI 0.10–0.41 cm), respectively. Incidence of preeclampsia, GDM, SGA, low birth weight, preterm birth, and cesarean section were not influenced by vitamin D supplementation. Across RCTs, the doses and types of vitamin D supplements, gestational age at first administration, and outcomes were heterogeneous. Conclusion(s): Vitamin D supplementation during pregnancy was associated with increased circulating 25(OH)D levels, birth weight, and birth length, and was not associated with other maternal and neonatal outcomes. Larger, better-designed RCTs evaluating clinically relevant outcomes are necessary to reach a definitive conclusion. (Fertil Steril 2015;-:-–-. 2015 by American Society for Reproductive Medicine.) / Revisión por pares

An important part of almost every student‟s high school experience is participation in an extracurricular activity. Many schools encourage their students to participate in these voluntary activities because they build skills that may not be taught in the classroom, but may be important in becoming successful in school and in the community. Extracurricular activities put students in leadership positions, teach them team work, and can instill a confidence in their abilities. Previous research has shown that participation in extracurricular activities in high school can affect labor market conditions and educational achievements, but few studies have differentiated the impacts of different types of extracurricular activities on earnings and educational attainment. This paper examines the academic and labor market effects of participating in a performing arts activity in high school. The arts are of particular interest because the No Child Left Behind Act of 2001 lists it as a core academic course. The core courses are believed to increase the academic attainment of students, and are eligible for increased federal funding based on “scientifically-based research” (Arts Education Partnership, 2005; Arts Education Partnership, 2006, p. 4). A major problem in program evaluation is the possibility of selection bias due to the non-randomized way individuals self-select into activities. To reduce the bias, a treatment effects model is estimated using the covariate matching technique. I use the 1979 National Longitudinal Survey of Youth (NLSY79) to test my hypotheses.