The Human Immunodeficiency Virus (HIV) epidemic remains a major global public health problem, with sub-Saharan Africa (SSA) at its epicentre. Despite the use of antiretroviral therapy (ART) to reduce new infections and deaths, SSA reports the highest HIV incidence, constituting two-thirds of global new infections. Cameroon is one of SSA countries where HIV care decentralization is enforced as a national policy but follow up of people living with HIV (PLWH) is provider-oriented, with limited patient involvement in clinical monitoring. The purpose of this dissertation was to explore predominant barriers and facilitators influencing ART adherence and identify effective interventions enhancing ART adherence across SSA. Furthermore, we sought to assess the prevalence and predictors of ART non-adherence among PLWH, and factors influencing non-adherence among PLWH who have experienced ART non-adherence in Cameroon. We conducted a comprehensive systematic review and meta-analysis on studies examining barriers to ART adherence and interventions boosting adherence. Forty-five studies were selected (30 for narrative synthesis and 15 for meta-analysis). Identified barriers and facilitators to ART adherence were categorized into seven principal factors: patient-related, health system-related, medication-related, stigma, poor mental health, socioeconomic and socio-cultural-related factors. Adherence-enhancing interventions encompassed counselling, incentives, mobile phone short message service, peer delivered behavioral intervention, community ART delivery, electronic adherence service monitoring device, lay health worker lead group intervention and food assistance. The meta-analysis revealed a statistically significant difference in ART adherence between intervention and control groups (pooled OR=1.56, 95%CI:1.35 - 1.80, p=<0.01). Using a cross-sectional study of adult PLWH in HIV treatment centres in Cameroon, we explored the prevalence and predictors of ART non-adherence. A total of 451 participants with mean age 43.42 years (SD: 10.42), were enrolled. Overall, ART non-adherence was 37.78%. Reasons for missing ART include forgetfulness, business and traveling without drugs. Significant factors associated with ART non-adherence include age, education, and alcohol consumption. In a qualitative study of 43 adult PLWH who had experienced ART non-adherence, adherence barriers included those related to patient, medication, health service, stigma, use of alternative treatment, resource limitation, environmental/social, and political instability. Adherence facilitators included social support, aligning treatment with patient’s daily routines, use of reminders, health sector/caregiver support, and awareness of HIV status/ART knowledge. To harness full potential of ART and mitigate HIV burden in SSA countries, stakeholders engaged in HIV management must recognize and integrate barriers, facilitators, and adherence-enhancing interventions when formulating policies or crafting treatment strategies. Continuous information provision and unflinching support both from patients’ families and caregivers are needed to improve adherence. Future studies focusing on specific underrepresented demographics - HIV-infected children, adolescents, and pregnant women in SSA are needed to uncover appropriate barriers, facilitators and interventions tailored to each group’s unique needs. Other studies focusing on assessing long-term non-adherence trends and determinants using larger samples of PLWH in many regions are necessary. Also, studies using both in-depth and focused group discussions, and quantitative approaches are required to uncover the ART non-adherence-related burden.

Early detection and intervention are theorized to facilitate better outcomes in autistic children. However, response to early intervention varies considerably between individuals, some children show significant improvement, while others show minimal response to the intervention. Some pre-treatment individualized characteristics as well as intervention-specific factors were theorized to moderate outcomes, but literature revealed often mixed findings making difficult to understand whether and to what extent these factors facilitate learning during treatment. To parse the heterogeneity of the autistic population, recent studies have also attempted to investigate biological factors related to clinical and behavioral profiles. However, to date it is unknown whether and how biological information can provide insight into the variability of treatment outcomes. With this in mind, we attempted to expand the current knowledge by first investigating whether pre-treatment child’s characteristics and blood leukocyte gene expression patterns could predict developmental trajectories during treatment. Leveraging a cohort of 41 autistic toddlers who received the same early intervention and provided a blood sample, we were able to analyze the effect of starting treatment very early (i.e., &lt;24 months) on treatment trajectories. We also provided for the first-time evidence that both pre-treatment blood leukocyte gene expression patterns and clinical-behavioral characteristics are important for predicting developmental change during intervention, and that pretreatment epigenetic mechanisms such as histone acetylation may be a key biological process that influence how a child respond to early intervention. Lastly, we carried out a mega-analysis of a large international consortium, isolating individual child characteristics and treatment related factors to examine their key role in moderating child developmental trajectories throughout the course of early intervention. The final dataset comprised 645 autistic toddlers who received two types of interventions either Early Start Denver Model (ESDM) or other treatment as usual/community interventions (TAU/COM). This mega-analysis provided strong evidence that individual factors, such as cognitive level and age at treatment start, predict most outcomes, and on-average, ESDM may promote some developmental skills better than COM/TAU. Taken together, these results advance our understanding of “what works, for whom, for what and why” questions, identifying new biological predictors and providing an alternative methodology that can effectively examine the individual variability of treatment outcomes.

The purpose of this study was to examine the relationship of teacher attributes and school contextual factors to student achievement in career and technical education in Mississippi. The teacher attributes years of teaching experience, degree(s) of attainment, professional development, and national board certification were included as independent variables. Additionally, the contextual factors of enrollment, academic achievement, and socio-economic status were included as independent variables. The statewide standardized assessment for career and technical education was used as the dependent variable measuring student achievement at the school district, career and technical program area, and individual career and technical course levels. The predictor model including all independent variables resulted in statistically significant variance explained in student achievement. National Board for Professional Teaching Standards® showed a statistically significant positive impact on student achievement at the school district level, the cooperative education and marketing program level, and the following five individual career and technical courses: allied health, automotive service technology, business and computer technology, early childhood services and education, and horticulture. Additionally, at the career and technical program level, academic achievement and degree(s) of attainment showed positive impacts on student achievement. Also, on the program level, more years of teaching experience, higher enrollment, and higher levels of socio-economic status showed negative impacts on student achievement. On the school district and program levels, attendance at the professional development workshop had a negative impact on career and technical student achievement.

No description available.

No description available.

No description available.

Autism spectrum disorders (ASD) are associated with many different levels of language and social impairment, differences in levels of cognitive impairment, varying levels of aberrant behavior, and discrepancies in the presence or amount of restrictive and repetitive behavior. The heterogeneity found within the ASD population is coupled with significant heterogeneity in outcome for these individuals. Although interventions based on the principles of applied behavior analysis have been repeatedly cited as evidence-based for individuals with autism, significant discrepancies in outcome are evident within the literature. The heterogeneity in treatment outcome has been hypothesized as related to the heterogeneity of children included within the autism spectrum as well as differences related to treatment variables. The current study evaluated individual child characteristics and differences related to intervention intensity and fidelity as predictors of outcome after one year of exposure to a behaviorally based intervention. The primary goal of this study was to identify individual and treatment level characteristics that were predictive of differences in outcome for children with ASD. Information was gathered from a total of 368 students with autism spectrum disorders in kindergarten through second grade classrooms in the School District of Philadelphia. Correlational analyses and multiple regression analyses indicated that increased levels of expressive language skills at the start of the intervention year were correlated with and predictive of improved outcome. However, no other child level variables were related to differential outcomes. Additionally, higher levels of treatment intensity and treatment fidelity were associated with improved outcome. / School Psychology

The current thesis aims to address the prognosis and management of patients who have injuries necessitating orthopaedic surgery. In Chapter 1 I introduce the thesis, and in Chapter 5 I offer conclusions and summarize the contribution of the work. In Chapter 5, I address the scope, rationale, key findings, limitations and implications. Chapter 2 is a systematic review and meta-analysis investigating the effectiveness of antibiotic prophylaxis in patients with open fracture of the extremities. The results demonstrate moderate quality evidence of an important reduction in the infection rate in patients receiving, versus not receiving, antibiotic prophylaxis. We found no difference in infection rate with longer (3 to 5 days) versus shorter (1 day) duration of antibiotics – this finding warrants only low confidence. Chapter 3 is a systematic survey of current practice and recommendations regarding antibiotic prophylaxis in open fracture management. Authors of publications over the last decade strongly support early systemic antibiotics prophylaxis for patients with open fractures of extremities. In practice, most used systemic antibiotics with both gram-positive and gram-negative coverage, and continued the administration for 2 to 3 days. Most recommendations suggested gram-positive coverage for less severe injuries, and administration duration of no more than 3 days (half suggested 1 day). For more severe injuries, most recommendations suggested broad antimicrobial coverage continued for 2 to 3 days. Chapter 4 is a longitudinal study investigating predictors of persistent post-surgical pain after tibia fracture. We found significant independent associations between resolution of pain and male sex, non-smoking and alcohol consumption. Age, obesity, type of fracture (closed versus open), additional injuries, and post-operative weight-bearing status did not predict resolution of pain. Our findings suggest that clinicians should be particularly alert to the possibility of troublesome post-operative pain in female smokers who do not drink alcohol. Clinicians may consider counselling patients to discontinue smoking, inform them that they are at nearly double the risk of incidence of troublesome post-operative pain (in addition to the long-term adverse health consequences of smoking). / Thesis / Doctor of Philosophy (PhD) / Antibiotic prophylaxis reduces infection with 10% fewer event rate than the group without antibiotic prophylaxis (low to moderate confidence in estimates). The optimal antibiotic regimens and duration remain uncertain. There is a higher risk of persistent post-surgical pain in female smokers who do not use alcohol, following tibia fractures.

Over the last several decades there has been a growing recognition that children with serious emotional disturbances are considerably underserved. The Comprehensive Community Mental Health Services for Children and Their Family Program is the largest federal grant program to help communities to implement, advance, and evaluate the system of care approach to service delivery. One of the goals of the evaluation has been to determine if children who participate in system of care services demonstrate improved clinical and functional outcomes over time. Prior research has revealed that children do display significant improvements over time. While this research is promising, it is also important to explore the variability in the rates of improvement to determine who benefits the most from system of care services. This dissertation explores the predictive role of a selected group of variables (behavioral and emotional strengths, caregiver strain, and demographic variables) on differential rates of improvements in clinical and functional outcomes over time for children who participate in systems of care. These variables were also examined in relation to differences in levels of clinical and functional impairments at intake into system of care services. The results from the latent variable quadratic growth models indicated that children who are served by systems of care displayed significant improvements in clinical and functional outcomes over time, with the greatest improvement occurring in the first six months. Children's behavioral and emotional strengths, caregiver strain, sex, age, and race significantly predicted differences in instantaneous growth, as well as rates of deceleration, for clinical and functional outcomes. Clinical implications, limitations of the study, and directions for future research are discussed. / text

Thesis (MComm)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: In insurance sales organisations, the Personal Financial Advisors (PFAs) serve a pivotal function in the relationship between the organisation, product and customer. The organisation invests a great deal of time and money in recruiting, training and retaining good PFAs. However, turnover amongst these employees seem to remain high within the first 36 months of employment. The aim of this study was to explore the non-remuneration predictors of burnout and intention to quit amongst PFAs in order to shed some light on the turnover problem. Specific constructs were identified in a pilot study which would not necessarily have been explored by the organisation and may have gone unacknowledged or overlooked. These constructs are emotional labour, self-efficacy, time wasted on non-sales activities, supervisor support and their relationship with burnout and intention to quit. A convenience sample of 608 PFAs was approached from one insurance sales organisation. One hundred and twenty two (122) respondents completed and returned their questionnaires. The descriptive statistics of the sample reflected a mean age of 35 years (range 21 to 61 years), with 66% males and 34% females, and a race distribution of 64% White, 19% African, 10% Coloured and 7% Indian. The majority of the population had been working for 13 to 24 months (46%). Overall, the sample produced a satisfactory to good representation of the demographic statistics of the total population available to the researcher. Both quantitative and qualitative research techniques were utilised in this study. Analysis of the qualitative data supported the role of the theoretical constructs chosen for inclusion and additional sources of job stress were identified. Pearson productmoment correlation analysis was used to analyse the questionnaire data, followed by multiple regression analyses with work burnout, client burnout and intention to quit as dependent variables, and the remaining constructs as the predictors. Both a measurement and structural model was tested; both produced acceptable goodness-of-fit statistics. From all of the above-mentioned analyses, significant relationships were found to exist between time wasted on non-sales activities, burnout, and self-efficacy; self-efficacy, burnout and intention to quit, and burnout and intention to quit. Conclusions were drawn from the obtained results and recommendations are made with respect to future research, as well as with respect to the management of burnout and intention to quit in the sales environment. / AFRIKAANSE OPSOMMING: In versekeringsmaatskappye speel die Persoonlike Finansiële Adviseur (PFA) ‘n baie belangrike rol in die verhouding tussen die organisasie, die produk en die kliënt. Die organisasie belê heelwat hulpbronne in die vorm van tyd en geld om goeie PFAs te werf, op te lei en te behou. Ten spyte hiervan is daar steeds ‘n groot hoeveelheid PFAs wat die organisasie verlaat binne die eerste 36 maande van aanstelling. Die huidige studie se doelwit was om die nie-vergoedingsvoorspellers van uitbranding onder PFAs, asook hulle intensies om te bedank, te bestudeer, om sodoende lig te werp op die hoë omset onder PFAs. Spesifieke konstrukte wat nie noodwendig deur die organisasie bestudeer sou word nie, is geïdentifiseer in ‘n loodsstudie. Hierdie konstrukte is emosionele arbeid, selfbekwaamheid, tyd verloor op nieverkoopsaktiwiteite, en ondersteuning deur die lynbestuurder. Hierdie konstrukte se verwantskap met uitbranding en intensies om die organisasie te verlaat, is bestudeer in die huidige studie. ‘n Gerieflikheidsteekproef van 608 PFAs vanuit een versekeringsmaatskappy is genader vir deelname aan die huidige studie. Een honderd twee-en-twintig (122) respondente het hul vraelyste voltooi en ingedien. Die beskrywende statistiek van die steekproef het ‘n gemiddelde ouderdom van 35 jaar getoon (verspreidingswydte 21 tot 61 jaar), met 66% manlik en 34% vroulik, en ‘n rasseverspreiding van 64% blank, 19% swart, 10% kleurling en 7% Indiër respondente. Oor die algemeen was die beskrywende statistiek ‘n aanvaarbare tot goeie verteenwoordiging van die totale populasie. Beide kwantitatiewe asook kwalitatiewe navorsingsmetodes is gebruik in hierdie studie. ‘n Analise van die kwalitatiewe data het die rol van die konstrukte wat vir insluiting gekies is, bevestig, en addisionele bronne van werkstres is geïdentifiseer. Die Pearson korrelasie-analises is gebruik om die vraelysdata te analiseer, gevolg deur stapsgewyse meervoudige regressie-ontledings met werksuitbranding, kliëntuitbranding en intensie om te bedank as afhanklike veranderlikes, en die oorblywende konstrukte as voorspellers. Beide die metingsmodel en die strukturele model is getoets, albei het aanvaarbare pasgehalte van die model opgelewer. Uit al die bogenoemde analises is beduidende verbande tussen die veranderlikes tyd verloor op nie-verkoopsaktiwiteite, uitbranding, en intensie om te bedank; selfbekwaamheid, uitbranding en intensie om te bedank; asook uibranding en intensie om te bedank gevind. Gevolgtrekkings is gemaak vanuit die bevindinge en voorstelle is gemaak met die oog op verdere navorsing, sowel as met betrekking tot die bestuur van uitbranding en intensie om te bedank in die verkoopsomgewing.