Angina pectoris är bröstsmärta orsakat av myokardischemi, till följd av kranskärlsjukdom med eller utan stenoser eller icke kranskärlsjukdom. Arbetsprov är den vanligaste undersökningen för angina pectoris. Diffusa symtom och angina pectoris varianter utan stenoser med låg sensitivitet för elektrokardiografi (EKG) sänker den diagnostiska säkerheten i arbetsprov på kvinnor. Litteraturstudiens syfte var att utreda om hemodynamiska parametrar och riskbedömning med Pre-test sannolikhet (PTP) samt Dukes Löpbands Index (DTS, Dukes Treadmill Score) kan öka den diagnostiska säkerheten i arbetsprov på kvinnor. Inklusionskriterierna var vetenskapligt granskade kliniska studier på engelska, med information om etiskt godkännande eller samtycke. Snowballing metoden, PUBMED, MEDLINE och CINAHL användes. Studier som inkluderades i resultatet granskades återigen och jämfördes med varandra. Hemodynamiska parametrar, PTP och DTS ökar den diagnostiska säkerheten i arbetsprov på kvinnor. Denna diagnostiska säkerhet beror dock också på PTP metod, PTP riskgrupp, etnicitet och angina pectoris variant. Vidare forskning behövs om etnicitetspecifika PTP metoder, mekanismen bakom blodtrycksreaktionen, DTS på icke kranskärlsjukdomar samt metoder som kan skilja mellan olika icke kranskärlsjukdomar. Utan studier om Systematic COronary Risk Evaluation (SCORE) och Diamond Forrester Score (DFS) samt deras påverkan på arbetsprov, kan inte resultatet i litteraturstudien generaliseras till arbetsprov i Sverige. / Angina pectoris is chest pain and myocardial ischemia due to Coronary Artery Disease (CAD) or Non-Coronary Artery Disease (non-CAD). Exercise stress test (EST) is the most common diagnostic procedure for angina pectoris. Non-CAD, low sensitivity for exercise electrocardiography (ex-ECG) and diffuse symptoms lower the diagnostic accuracy for females. This review’s aim was to study whether haemodynamic parameters and risk stratifications with Pre-test probability (PTP) or Duke Treadmill Score (DTS) improves the diagnostic accuracy of EST for females. Inclusion criterions were English peer reviewed, clinical studies with mentioned ethical approval or consent. Snowballing, PUBMED, MEDLINE and CINAHL were used. Articles that were included in the results, were reviewed once again, and compared to one another. Hemodynamic parameters, PTP and DTS increase the diagnostic accuracy of EST in women. This diagnostic accuracy depends on PTP method, risk group, ethnicity, and angina pectoris variant. Further research regarding ethnic specific PTP methods, mechanism behind the blood pressure reaction, DTS for diagnosis of non-CAD and methods for differentiation of subtypes of non-CAD, would be valuable. Without studies about the Systematic Coronary Risk Evaluation (SCORE), Diamond Forrester Score (DFS), and their impact on ex-ECG, the result of this review cannot be generalized to ex-ECG in Sweden.

A retrospective pre-then-post survey instrument design was intentionally used as a good fit for the SMART programming in order to evaluate learning outcomes both before and after the program for several reasons (see Marshall, Higginbotham, Harris, & Lee, 2007; Moore & Tananis, 2009) summarized below. The experimental pretest-posttest design using a control or comparison group is considered to be one of the most respected methods that can be used to measure change in individuals (Campbell & Stanley, 1966; Kaplan, 2004). This design is highly regarded because of its control over internal validity concerns and ability to compare results from the same people or groups of people at multiple time points. While there are advantages to using the pretest-posttest method, there are some limitations with this research method as well. One limitation comes with finding an adequate comparison group, which can be difficult or impossible for the researchers to locate. Another limitation concerns the possible lack of resources and time available for community-based programs to complete comprehensive pretest-posttest comparisons (Brooks & Gersh, 1998). Also, in order for the pretest-posttest comparisons to be meaningful, participants must attend the complete program from start to finish (Pratt, McGuigan, & Katzey, 2000). Due to the nature of community education programs, attrition and sporadic attendance are common issues (Pratt, McGuigan, & Katzev, 2000). While the pretest-posttest information must be complete for comparisons to be made, it may be challenging for researchers to see the actual changes in attitudes, behaviors, or skills if the participants overstate their original attitudes, behaviors, or skills when completing the pretest (Howard & Daily, 1979; Moore & Tananis, 2009). This overestimation may occur when the participants do not have a clear understanding of the attitudes, behaviors, or skills that the program is targeting (Pratt, McGuigan, & Katzev, 2000). A lack of knowledge on certain topics (e.g., attitudes, behaviors, skills) often supports the initial need for a program intervention, but this same issue may show participants during the program that they actually knew much less than they thought when they completed the pretest. Thus, one must be aware of the potentially misleading information from pretest-posttest comparisons due to the participants’ change in perspective (Howard & Daily, 1979). “Response shift bias,” first referred to by Howard and Daily (1979), explains the “program-produced change in the participants’ understanding of the construct being measured” (Pratt, McGuigan, & Katzev, 2000, p. 342). Response shift bias was assessed in this study by administering a pre-test at the beginning of programming and a pre-then-post test at the end of programming. Results indicate that response shift bias was present in a majority of the variables studied and that the design of administering a pre-test and then a retrospective pre-then-post test is a good fit for exposing response shit bias. Specific results will be discussed.

Syftet med den elevcentrerade empiriska studien var att undersöka lässtrategierna ”läsfixarnas” inverkan på elevers förmåga att förstå och tolka texter. Läsförståelsestrategierna som används i studien är detektiven och spågumman. Studien syftade även till att undersöka hur strategianvändningen påverkar elevers testresultat i läsförståelse. Den tidigare forskningen betonar hur elevers läsförståelse försämrats under de senaste årtiondena, något som syns tydligt i resultat från PISA och PIRLS. Barbro Westlund, lektor, uttrycker att det finns en brist vad gäller forskning om hur strategiundervisning bör gå till och att detta kan vara en bidragande faktor till resultaten. Vår studie grundar sig på en elevgrupp i årskurs 4 som är obekanta med strategianvändning sedan tidigare. Studien har utförts genom att låta eleverna utföra ett pre-test i form av läsförståelsetest för att sedan bedriva undervisning om vad strategier är samt hur vi kan använda de specifika strategierna vid läsandet av en text. Efter undervisningstillfällena har ytterligare ett läsförståelsetest utförts och eleverna har intervjuats om sin upplevelse beträffande de båda testen. Studien har inte resulterat i något entydigt resultat, däremot framgår det ur elevintervjuerna att flertalet elever upplevt användningen av detektiven som strategi som givande för deras läsförståelse.

BACKGROUND:Patients receiving complementary and alternative medicine (CAM) therapies often report shifts in well-being that go beyond resolution of the original presenting symptoms. We undertook a research program to develop and evaluate a patient-centered outcome measure to assess the multidimensional impacts of CAM therapies, utilizing a novel mixed methods approach that relied upon techniques from the fields of anthropology and psychometrics. This tool would have broad applicability, both for CAM practitioners to measure shifts in patients' states following treatments, and conventional clinical trial researchers needing validated outcome measures. The US Food and Drug Administration has highlighted the importance of valid and reliable measurement of patient-reported outcomes in the evaluation of conventional medical products. Here we describe Phase I of our research program, the iterative process of content identification, item development and refinement, and response format selection. Cognitive interviews and psychometric evaluation are reported separately.METHODS:From a database of patient interviews (n = 177) from six diverse CAM studies, 150 interviews were identified for secondary analysis in which individuals spontaneously discussed unexpected changes associated with CAM. Using ATLAS.ti, we identified common themes and language to inform questionnaire item content and wording. Respondents' language was often richly textured, but item development required a stripping down of language to extract essential meaning and minimize potential comprehension barriers across populations. Through an evocative card sort interview process, we identified those items most widely applicable and covering standard psychometric domains. We developed, pilot-tested, and refined the format, yielding a questionnaire for cognitive interviews and psychometric evaluation.RESULTS:The resulting questionnaire contained 18 items, in visual analog scale format, in which each line was anchored by the positive and negative extremes relevant to the experiential domain. Because of frequent informant allusions to response set shifts from before to after CAM therapies, we chose a retrospective pretest format. Items cover physical, emotional, cognitive, social, spiritual, and whole person domains.CONCLUSIONS:This paper reports the success of a novel approach to the development of outcome instruments, in which items are extracted from patients' words instead of being distilled from pre-existing theory. The resulting instrument, focused on measuring shifts in patients' perceptions of health and well-being along pre-specified axes, is undergoing continued testing, and is available for use by cooperating investigators.

Most modern product development utilizes computational models. With increasing demands on reducing the product development lead-time, it becomes more important to improve the accuracy and efficiency of simulations. In addition, to improve product performance, a lot of products are designed to be lighter and more flexible, thus more prone to nonlinear behaviour. Linear finite element (FE) models, which still form the basis of numerical models used to represent mechanical structures, may not be able to predict structural behaviour with necessary accuracy when nonlinear effects are significant. Nonlinearities are often localized to joints or boundary conditions. Including nonlinear behaviour in FE-models introduces more sources of uncertainty and it is often necessary to calibrate the models with the use of experimental data. This research work presents a model calibration method that is suitable for mechanical systems with structural nonlinearities. The methodology concerns pre-test planning, parameterization, simulation methods, vibrational testing and optimization. The selection of parameters for the calibration requires physical insights together with analyses of the structure; the latter can be achieved by use of simulations. Traditional simulation methods may be computationally expensive when dealing with nonlinear systems; therefore an efficient fixed-step state-space based simulation method was developed. To gain knowledge of the accuracy of different simulation methods, the bias errors for the proposed method as well as other widespread simulation methods were studied and compared. The proposed method performs well in comparison to other simulation methods. To obtain precise estimates of the parameters, the test data should be informative of the parameters chosen and the parameters should be identifiable. Test data informativeness and parameter identifiability are coupled and they can be assessed by the Fisher information matrix (FIM). To optimize the informativeness of test data, a FIM based pre-test planning method was developed and a multi-sinusoidal excitation was designed. The steady-state responses at the side harmonics were shown to contain valuable information for model calibration of FE-models representing mechanical systems with structural nonlinearities. In this work, model calibration was made by minimizing the difference between predicted and measured multi-harmonic frequency response functions using an efficient optimization routine. The steady-state responses were calculated using the extended multi-harmonic balance method. When the parameters were calibrated, a k-fold cross validation was used to obtain parameter uncertainty. The proposed model calibration method was validated using two test-rigs, one with a geometrical nonlinearity and one with a clearance type of nonlinearity. To attain high quality data efficiently, the amplitude of the forcing harmonics was controlled at each frequency step by an off-line force feedback algorithm. The applied force was then measured and used in the numerical simulations of the responses. It was shown in the validation results that the predictions from the calibrated models agree well with the experimental results. In summary, the presented methodology concerns both theoretical and experimental aspects as it includes methods for pre-test planning, simulations, testing, calibration and validation. As such, this research work offers a complete framework and contributes to more effective and efficient analyses on mechanical systems with structural nonlinearities.

Purpose of Review: To review the landmark studies in predicting obstructive coronary artery disease (CAD) in symptomatic patients with stable chest pain and identify better prediction tools and propose a simplified algorithm to guide the health care providers in identifying low risk patients to defer further testing. Recent Findings: There are a few risk prediction models described for stable chest pain patients including Diamond-Forrester (DF), Duke Clinical Score (DCS), CAD Consortium Basic, Clinical, and Extended models. The CAD Consortium models demonstrated that DF and DCS models overestimate the probability of CAD. All CAD Consortium models performed well in the contemporary population. PROMISE trial secondary data results showed that a clinical tool using readily available ten very low-risk pre-test variables could discriminate low-risk patients to defer further testing safely. Summary: In the contemporary population, CAD Consortium Basic or Clinical model could be used with more confidence. Our proposed simple algorithm would guide the physicians in selecting low risk patients who can be managed conservatively with deferred testing strategy. Future research is needed to validate our proposed algorithm to identify the low-risk patients with stable chest pain for whom further testing may not be warranted.

BACKGROUND:Available measures of patient-reported outcomes for complementary and alternative medicine (CAM) inadequately capture the range of patient-reported treatment effects. The Self-Assessment of Change questionnaire was developed to measure multi-dimensional shifts in well-being for CAM users. With content derived from patient narratives, items were subsequently focused through interviews on a new cohort of participants. Here we present the development of the final version in which the content and format is refined through cognitive interviews.METHODS:We conducted cognitive interviews across five iterations of questionnaire refinement with a culturally diverse sample of 28 CAM users. In each iteration, participant critiques were used to revise the questionnaire, which was then re-tested in subsequent rounds of cognitive interviews. Following all five iterations, transcripts of cognitive interviews were systematically coded and analyzed to examine participants' understanding of the format and content of the final questionnaire. Based on this data, we established summary descriptions and selected exemplar quotations for each word pair on the final questionnaire.RESULTS:The final version of the Self-Assessment of Change questionnaire (SAC) includes 16 word pairs, nine of which remained unchanged from the original draft. Participants consistently said that these stable word pairs represented opposite ends of the same domain of experience and the meanings of these terms were stable across the participant pool. Five pairs underwent revision and two word pairs were added. Four word pairs were eliminated for redundancy or because participants did not agree on the meaning of the terms. Cognitive interviews indicate that participants understood the format of the questionnaire and considered each word pair to represent opposite poles of a shared domain of experience.CONCLUSIONS:We have placed lay language and direct experience at the center of questionnaire revision and refinement. In so doing, we provide an innovative model for the development of truly patient-centered outcome measures. Although this instrument was designed and tested in a CAM-specific population, it may be useful in assessing multi-dimensional shifts in well-being across a broader patient population.

The prevalence of HIV infection in pregnant women is still on the rise despite existing preventive programmes aimed at reducing HIV-transmission. Voluntary counselling and testing during pregnancy is the key entry point in the prevention of mother-to-child transmission (Department of Health, 2000:16; Birdsall et al. 2004:3). Women are often diagnosed as being HIV-positive for the first time when they attend antenatal clinics and consent to HIV testing (UNAIDS, 1997). The objective of this study was to determine the pregnant women's experiences of voluntary counselling and testing (VCT) and to explore and describe the impeding and facilitating factors that played a role in their choice whether or not to consent to HIV testing after having received pre-test counselling. By understanding the impeding and facilitating factors that play a role in the pregnant woman's choice to undergo HIV testing, recommendations could be made to possibly improve the uptake of HIV testing among pregnant women. The population studied in this research consisted of pregnant women making use of antenatal clinics in the Potchefstroom sub-district. Purposive sampling was used to select participants with the assistance of mediators who were working in the local clinics and the hospital. The sample size was determined by data saturation, which was reached after 10 interviews. A qualitative design was used and data was collected by means of semi-structured interviews. Data analysis was carried out simultaneously with data collection. In consensus discussions, the researcher and the co-coder reached consensus on the main and sub-themes. The main themes are the facilitating and impeding factors that play a role in the pregnant women's choice to undergo HIV testing. Based on findings, it was concluded that facilitating and impeding factors that play a role in the pregnant woman's choice to HIV testing do indeed exist. Impeding factors identified were: fear of a positive status; fear of stigmatization and discrimination; fear of lack of support; lack of opportunity to consider their choice to undergo HIV testing; lack of trust that confidentiality will indeed be honoured; fear of knowing possible positive HIV-status that can lead to feelings of depression and mental anguish; differences between counsellors' and pregnant women's characteristics. Facilitating factors consist of the desire to be aware of own HIV status; desire to protect the baby; sufficient information and the importance of trust and confidentiality. Recommendations were subsequently made to make HIV counselling and testing services to pregnant women more user-friendly in order to facilitate the pregnant woman in her choice concerning HIV-testing. Heeding these recommendations will possibly lead to more pregnant women's HIV status being known by the time they go into labour. Recommendations were made that pregnant women be counselled for HIV testing during their first antenatal visit and the HIV-testing being offered to them during the second visit. Research findings reveal that most pregnant women need time to consider their choice to undergo HIV testing and to prepare themselves for the test. Most pregnant women felt that they would possibly consent to HIV testing during their second antenatal visit. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2008.

The prevalence of HIV infection in pregnant women is still on the rise despite existing preventive programmes aimed at reducing HIV-transmission. Voluntary counselling and testing during pregnancy is the key entry point in the prevention of mother-to-child transmission (Department of Health, 2000:16; Birdsall et al. 2004:3). Women are often diagnosed as being HIV-positive for the first time when they attend antenatal clinics and consent to HIV testing (UNAIDS, 1997). The objective of this study was to determine the pregnant women's experiences of voluntary counselling and testing (VCT) and to explore and describe the impeding and facilitating factors that played a role in their choice whether or not to consent to HIV testing after having received pre-test counselling. By understanding the impeding and facilitating factors that play a role in the pregnant woman's choice to undergo HIV testing, recommendations could be made to possibly improve the uptake of HIV testing among pregnant women. The population studied in this research consisted of pregnant women making use of antenatal clinics in the Potchefstroom sub-district. Purposive sampling was used to select participants with the assistance of mediators who were working in the local clinics and the hospital. The sample size was determined by data saturation, which was reached after 10 interviews. A qualitative design was used and data was collected by means of semi-structured interviews. Data analysis was carried out simultaneously with data collection. In consensus discussions, the researcher and the co-coder reached consensus on the main and sub-themes. The main themes are the facilitating and impeding factors that play a role in the pregnant women's choice to undergo HIV testing. Based on findings, it was concluded that facilitating and impeding factors that play a role in the pregnant woman's choice to HIV testing do indeed exist. Impeding factors identified were: fear of a positive status; fear of stigmatization and discrimination; fear of lack of support; lack of opportunity to consider their choice to undergo HIV testing; lack of trust that confidentiality will indeed be honoured; fear of knowing possible positive HIV-status that can lead to feelings of depression and mental anguish; differences between counsellors' and pregnant women's characteristics. Facilitating factors consist of the desire to be aware of own HIV status; desire to protect the baby; sufficient information and the importance of trust and confidentiality. Recommendations were subsequently made to make HIV counselling and testing services to pregnant women more user-friendly in order to facilitate the pregnant woman in her choice concerning HIV-testing. Heeding these recommendations will possibly lead to more pregnant women's HIV status being known by the time they go into labour. Recommendations were made that pregnant women be counselled for HIV testing during their first antenatal visit and the HIV-testing being offered to them during the second visit. Research findings reveal that most pregnant women need time to consider their choice to undergo HIV testing and to prepare themselves for the test. Most pregnant women felt that they would possibly consent to HIV testing during their second antenatal visit. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2008.

The main object of this thesis is to evaluate the results of a case study of teaching the topic of annelids. The study was carried for three years at Podkušnohorské gymnasium grammar school in Most. Another objective is to find the connection between obtained data, activity of students during classes and other chosen factors that may affected a success in the classified test and post-test. The thesis is divided into two parts. First part presents the research part which is devoted to a brief overview of textbooks for second grade of elementary and high school. The second, analytical part, is divided into three subsections. The first subsection is devoted to the evaluation of teaching methods for individual teachers Most schools with an emphasis on the level of activity of students in biology classes. The second subsection analyzes the results of the investigation and commented the results on, especially the success rate of students in the various test phases. The third subsection suggests, based on the data obtained, the best teaching methods to the topic of annelids. Key words: annelids, pupils, pre-test, classification, activity during lesson, knowledge extinction, teacher