Stroke is the second most common cause of death worldwide. However stroke is not invariably fatal and survivors may experience major physical, social and psychological problems. The United Kingdom government identified the improvement of the quality of life of stroke survivors as a key objective in the recent "Health of the Nation" consultative document. The concept of health related quality of life has developed over the past few years. Although there is no one universally agreed definition, there are several instruments which claim to measure at least some aspects of health related quality of life. These instruments have not been extensively tested in stroke patients, so the hypothesis which I shall test in this thesis is as follows: that a simple instrument can prove a feasible, valid, reliable, and clinically useful measure of health related quality of life in stroke survivors. I selected a simple measure of health related quality of life (the EuroQol questionnaire) and evaluated its validity in a sample of patients with stroke. A small, but important proportion of patients were unable to complete EuroQol questionnaires either by themselves or by interview, so I investigated whether a proxy (e. g. a spouse or carer) could assess the patient's health status after stroke accurately and without bias. Previous studies comparing one or more different health status instruments did not involve strictly random allocation, so could not provide reliable information on the "best" measure of quality of life to use in stroke patients. I therefore performed a study in a sample of survivors of stroke which directly compared the EuroQol and SF- 36 by using a strict random allocation of questionnaires. It was not possible to compare quantitatively the reliability and validity of the EuroQol and SF-36; however, a qualitative comparison suggested their reliability was similar and they appeared to be sampling broadly the same areas of health. I finally investigated patients' perception of their own quality of life after stroke. The data suggested that many disabled stroke survivors might not view survival in a dependent state as badly as one might expect. This somewhat surprising finding will inform decisions about whether to accept the high risks associated with certain treatments (e. g. thrombolysis) in order to reduce the chances of survival in a dependent state. Assessments of health related quality of life may therefore provide a more comprehensive and relevant view of the patients' outcome than simple measures of disability or impairment.

Fetal overgrowth is associated with adverse outcomes for offspring and with maternal obesity. Results from a systematic review and meta-analysis showed that maternal obesity is associated with fetal overgrowth, defined as birthweight ≥4000g (OR 2.17, 95% CI 1.92, 2.45), birthweight ≥4500g (OR 2.77, 95% CI 2.22, 3.45) and birthweight ≥90%ile for gestational age (OR 2.42, 95% CI 2.16, 2.72). A retrospective cohort study revealed that mothers whose infants are macrosomic are more likely to require induction of labour (OR 1.42, 95% CI 1.10-1.98) and delivery by Cesarean section (OR 1.45, 95% CI 1.04-2.01), particularly for maternal indications (OR 3.7, 95% CI 1.47-9.34), if they are obese. Infants from these pregnancies are significantly more likely to require neonatal resuscitation in the form of free flow oxygen (OR 1.57, 95% CI 1.03, 2.42) than macrosomic infants of non-obese mothers. Thus, co-existing maternal obesity and macrosomia increases the risk of adverse pregnancy outcomes.

This study focusses on the examination of the recorded absences of compulsory age students. The main purpose was to identify emergent patterns of school non-attendance, critical periods of absences and key factors within and beyond the school that might contribute to school non-attendance and the impact such non-attendance has on student achievement and perceptions of schooling.A review of literature on school non-attendance was undertaken and presented to highlight the number of factors that are often linked with non-attendance. As a result of the literature review a comprehensive list of factors for further investigation was distilled and a conceptual framework was developed. It was this conceptual framework, together with the research questions, that guided the research design and the subsequent collection and analysis of data.The research was undertaken in Perth, Western Australia utilising one State Government secondary school and five of its contributory (or feeder) primary schools. The research constituted a retrospective study spanning seven years (1989 to 1995 inclusive) incorporating the complete attendance records of 61 students.The first phase of the study involved the establishment of an empirical database developed from records compiled by the five feeder schools and the secondary school under study. Data derived from the schools were analysed to establish the patterns of non-attendance and trends.The second phase involved a series of case studies in which student perceptions on school non-attendance were investigated alongside the student's characteristics and attendance patterns in order to provide greater insight into key factors contributing to school non-attendance.The case studies not only provided greater insight into key factors contributing to school non-attendance but also the impact non-attendance had on the educational outcomes of the deemed ++ / 'at risk' students.Finally, the thesis provides a number of conclusions and action statements to all key stakeholders including the schools at the centre of this research, policy makers within the State Government Education Department, parents, and personnel from other schools within Western Australia, for future action and continuing research. There is a collective responsibility to ensure all students maximise their learning outcomes through the educational programs provided in the schooling system.The study also has the potential to provide a framework at both the national and international level as the outcomes of this research have potential significance for a number of interested organisations involved in providing educational and other programs for 'at risk' students.

The focus of my research is teachers' planned professional development experience and the effect of context on teachers' learning and changes to practice. It seeks to understand effective approaches to teachers' learning, contribute to knowledge and identify implications for practitioners and policy makers. The research begins with an investigation into young people's and teachers' perceptions of effective classroom work. A significant mis-match is found between what is experienced and what they perceive is effective . This is analysed in terms of inhibiting forces and contradictions influencing teachers' practice. An in-service programme is designed as a change strategy for the teachers involved. The research findings suggest this is only partially successful in bringing about change. From a critique of theoretical perspectives of professional development an expanded approach is created. This approach forms the basis of another programme for teachers which includes working collaboratively and integrating personal and professional learning. The research findings demonstrate that this in itself is not enough to bring about changes to professional practice. A typology of teachers' planned development experiences is created and a set of hypotheses used to investigate teachers' personal constructs of the effectiveness of professional experiences for change to professional practice . The significance of the learning context and subjective experiences emerge. This leads to the redesign of the programme to include an explicit focus on learning and the use of action research to bring about change within teachers' own contexts. The research continues to focus on contextual influences in organisational learning. It analyses the effects of a change that contributes to organisational learning by tracking one organisation's revision of its appraisal scheme. Key conclusions emerge: teachers' learning, the processes of learning and the organisational context have strong influences on one other. Effective professional learning for positive outcomes requires both a multi-dimensional and context specific view of learning.

Class of 2011 Abstract / OBJECTIVES: The objective of this study was to compare patient clinical outcomes, vascular access line administration complications, and piperacillin-tazobactam costs before and after implementation of an extended infusion piperacillin-tazobactam protocol in adult patients at an academic medical center. METHODS: In this IRB-approved retrospective project, the effect of the implementation of a piperacillin- tazobactam extended infusion protocol at a tertiary care, academic medical center was accessed. The use of piperacillin-tazobactam was accessed during 3 one-month time periods in 2010: Time Period 1 (pre-education and implementation of protocol), Time Period 2 (post-education of pharmacists and infectious disease physicians), and Time Period 3 (post-education of healthcare professionals and implementation of extended-infusion piperacillin- tazobactam protocol). Patients were excluded if piperacillin-tazobactam therapy was prescribed for less than 72 hours. Data collected in each one-month period included demographic data, culture results, number of piperacillin-tazobactam grams prescribed per day, percentage of patients who received extended-infusion piperacillin-tazobactam, other antimicrobial therapy prescribed, medications prescribed with intravenous incompatibilities with piperacillin-tazobactam, number of intravenous line lumens before and after start of piperacillin-tazobactam therapy, length of stay, and all-cause 30 day mortality. RESULTS: During a three step process, the use of extended infusion piperacillin-tazobactam was implemented at an academic medical center after administration approval, education of healthcare professionals, and development of an electronic piperacillin-tazobactam order set. Use of extended-infusion piperacillin-tazobactam protocol significantly decreased the average daily piperacillin-tazobactam dose per patient. CONCLUSION: Implementation of extended-infusion piperacillin-tazobactam protocol for adult patients did significantly decrease the average daily dose of piperacillin-tazobactam per patient (reduced drug cost) but increased vascular access requirements.

Class of 2013 Abstract / Specific Aims: The purpose of this study was to assess the clinical and economic predictors associated with rural emergency department visits in stroke patients. Methods: The current research was a retrospective, observational, cohort study. Multivariate regression was used to assess data from the Agency for Healthcare Research and Quality (AHRQ) 2009 Nationwide Emergency Department Sample (NEDS). Inclusion criteria were at least 18 years of age and rural ED admission with principle diagnoses of stroke. Main Results: Significant results for risks included: Intubation for increased mortality (OR = 17.432, p = 0.001), increased length of stay (IRR = 1.643, p = 0.018) and increased charges (exp β = 2.289, p = < 0.001); myocardial infarction for increased mortality (OR = 1.969, p = 0.006), decreased charges (exp β = 0.862, p = 0.013) and decreased length of stay (IRR = 0.853, p = 0.001); moderate to severe liver disease for increased mortality (OR = 62.691, p = 0.001) and reduced length of stay (IRR = 0.517, p = 0.025); congestive heart failure for increased mortality (OR 1.978, p = 0.003) and increased charges (exp β = 1.118, p = 0.039); non-specific cancer (OR = 2.447, p = 0.017) and metastatic cancer (OR = 4.799, p = 0.016) for mortality; hemiplegia/paraplegia for increased charges (exp β = 1.173, p = < 0.001). Conclusion: The current study found a better understanding of national estimates of burden of illness to further define clinical decision rules for stroke in rural emergency departments.

This study investigates how educators at General Education and Training (GET) level (senior phase) go about teaching problem solving skills, reasoning and communication as indicated in the OBE Mathematics curriculum (GET). In comparison to previous curricula, the new Outcomes-Based Education (OBE) Mathematics curriculum at the GET level, places more emphasis on problem solving, reasoning and communicating mathematical ideas. If properly implemented as intended by the curriculum reformers, then many of the problems that are encountered at tertiary level might no longer exist. Thus it is interesting to investigate how educators at GET level go about teaching such skills as problem solving, reasoning and communication as indicated in the OBE Mathematics curriculum at GET level. This study describes case studies of Grades 8 and 9 Mathematics teachers in eleven secondary schools in Mpumalanga Province in South Africa. The case studies explore whether and how the mathematics teachers go about trying to achieve the outcomes mentioned in the OBE (GET) Mathematics curriculum. The educators’ pedagogical methods are investigated, and, generally, how well the learning outcomes are achieved. A third research strand focuses on whether there exists a relationship between the teachers’ contribution (input), which is the foundation laid by the teacher for the later realisation of outcomes and outcomes as attempted or demonstrated by learners (output). The data were collected through video-tape recordings by trained educators, that is, Mpumalanga Secondary Science Initiative (MSSI) project staff to ensure authenticity and credibility of results. / Dissertation (MSc)--University of Pretoria, 2007. / Mathematics and Applied Mathematics / unrestricted

Fetal overgrowth is associated with adverse outcomes for offspring and with maternal obesity. Results from a systematic review and meta-analysis showed that maternal obesity is associated with fetal overgrowth, defined as birthweight ≥4000g (OR 2.17, 95% CI 1.92, 2.45), birthweight ≥4500g (OR 2.77, 95% CI 2.22, 3.45) and birthweight ≥90%ile for gestational age (OR 2.42, 95% CI 2.16, 2.72). A retrospective cohort study revealed that mothers whose infants are macrosomic are more likely to require induction of labour (OR 1.42, 95% CI 1.10-1.98) and delivery by Cesarean section (OR 1.45, 95% CI 1.04-2.01), particularly for maternal indications (OR 3.7, 95% CI 1.47-9.34), if they are obese. Infants from these pregnancies are significantly more likely to require neonatal resuscitation in the form of free flow oxygen (OR 1.57, 95% CI 1.03, 2.42) than macrosomic infants of non-obese mothers. Thus, co-existing maternal obesity and macrosomia increases the risk of adverse pregnancy outcomes.

The motivational climate, as created by coaches, and athletes’ goal orientations are key constructs in understanding children’s experiences with sport. In this study, the relationship between the perceived motivational climates, male adolescents’ goal orientation, and their experiences of self-esteem, sport competence, enjoyment, and ultimately, intention to continue participating in sport was examined. Participants were 405 male adolescents (Sample A: n = 200; Sample B: n = 205) aged 13-15 years old. Structural equation modeling indicated an overall good fit to the structural model for both data sets. A task goal orientation was predicted by higher levels of coach-created task climate. Participants with higher task goal orientation had greater sport competence, self-esteem, and more enjoyment in sport; enjoyment was the only significant predictor of their intention to continue playing the sport they believe is most important over the next three years.

This study calls into question the use of the total incarceration response variable incorporated into sentencing studies over the past 30 years. Specifically, using data from the Pennsylvania Commission on Sentencing (PCS), it argues - and reveals - that prison and jail represent two distinct institutions, and that the judge's decision on disposition should take that factor into account. It recommends that researchers should therefore reconsider use of the total incarceration variable, which combines prison and jail into a single response category.