With the threat of avian influenza, influenza laboratory testing and surveillance capacity has increased globally. Data from global surveillance activities have been used to identify circulating influenza strains for vaccine policy decisions, and have provided evidence of influenza disease among various populations. A recent meta-analysis, which includes findings from these surveillance efforts, has shown that influenza contributes to 10% of pediatric respiratory hospitalizations. Although statistical models indicate a high burden of influenza-associated morbidity among older adults and pandemic studies reveal an increase in hospitalizations among young adults, the global burden of seasonal influenza among adults remains unknown. In order to estimate the global burden of seasonal influenza among adult respiratory hospitalizations, we conducted a systematic review of the published literature, and identified 48 eligible articles published between January 1996 and June 2012 that met our inclusion criteria. We combined these published datasets with 29 eligible, unique datasets from year-round, influenza hospital-based surveillance. These combined data covered 50 countries with varying income and vaccine policies. Extracting numbers tested and positive for influenza, we calculated crude median positive proportions and evaluated potential differences in crude proportions among variables using Kruskal-Wallis non-parametric tests. We observed differences by data source and country development status when we included the 2009 pandemic year. With the exclusion of the 2009 pandemic year, we then generated adjusted pooled estimates using the log binomial model. We found 11% of cases from adult respiratory hospitalizations worldwide were laboratory-confirmed for influenza. This pooled estimate was independent of age but increased as country development or income level decreased. Our findings suggest that influenza is an important contributor to severe acute respiratory illness among both young and older adult populations. For countries without reliable influenza data, we provide an estimate that they may use in planning and allocating resources for the control and prevention of influenza.

Bakgrund: Uppskattningsvis lider 10 % av världens befolkning utav någon form av stickrädsla. Vaccinationer och blodprovstagning är vanligt förekommande i dagens moderna sjukvård och stickrädda patienter kan undvika sjukvården och på så vis försämra sin hälsa. Sjuksköterskan kan lindra lidandet som rädslan medför hos den enskilda individen genom beprövad kunskap om stickrädsla. Syfte: Belysa omvårdnadsmetoder sjuksköterskan kan använda sig av för att lindra patientens lidande vid stickrädsla. Metod: Litteraturstudie baserad på kvalitativa artiklar med kvalitativ ansats. Resultat: Resultatet redovisas i enligt med de fyra teman som framkom i analysen. Miljö som visat sig spela stor roll för den stickrädda patienten och om sjuksköterskan kan skapa en mindre klinisk miljö samt dölja nålar och dylikt så hjälper det patienten att klara sin rädsla bättre. Tid som ges till patienter som känner rädsla och obehag inför vaccinationer, blodprovstagning eller dylikt, har visat sig lugna stickrädslan. Likaså sjuksköterskans förmåga att göra proceduren kort om så önskas, uppskattas utav patienten. Distraktion har visat sig som en mycket bra metod att omhänderta stickrädda patienter och kan ske i form utav samtal, andningstekniker, ordspel eller pussel. Bli tagen på allvar är ofta avgörande om patienten upplever vården som god och en förutsättning för att en stickrädd patient vid ett senare tillfälle skall förlita sig på sjukvården och söka sig dit om behov finns. Slutsats: Det finns vetenskapligt bevisade omvårdnadsmetoder sjuksköterskan kan använda sig utav för att lindra lidandet hos patienter med stickrädsla. Klinisk betydelse: Ett stort problem hos vårdpersonal är kunskapsbrist om att stickrädsla förekommer hos vuxna. Därför hoppas författarna att genom att belysa ämnet inom sjukvården, skall även vuxna få likvärdigt omhändertagande för sin stickrädsla som barn har tillgång till. / Background: Approximately 10% of the world population suffers from some kind of needle fear. Vaccinations and blood sampling is common in today's modern health care and patients with needle fear may therefore avoid medical care which in turn could have a negative impact on their health. The nurse can alleviate suffering caused on the individual through proven knowledge of needle fear. Aim: To illustrate different nursing practices that can be used to relieve patients suffering from needle fear. Method: Literature review. Result: The results are reported under four themes. The Environment is shown to play a major role for the needle fear patient. The nurse can create a less clinical setting and hide needles, which have shown to help the patient cope with their fears better. The Time given to patients who feel fear and discomfort with vaccinations, blood tests or similar, have been shown to calm the needle fear. Likewise, the nurse's ability to make the process short, if desired, is appreciated by the patient. Distraction has been proven as a very good method to take care of needle fear patients and good examples are conversations, breathing techniques, word games or puzzles. Being taken seriously is often important to give a needle fear patient a good care experience and has also shown to be crucial as to whether the needle patient at a later date would rely on medical services and seek help or not. Conclusion: There are nursing care methods, which have been scientifically proven, that nurse can use to alleviate the suffering from patients with needle fear. Clinical significance: A major problem within the health profession is a lack of knowledge that needle fear occurs among adults. Therefore, the authors hope that by highlighting the topic in health care, adults should receive the same considerate needle fear care as children have access to today.

Bakgrund: När ett barn blir kritiskt sjukt och behöver intensivvård kan det innebära enorma kroppsliga och mentala påfrestningar för föräldrarna. Föräldrarna har oftast en central roll i barnets vård och tillfrisknande, men kan uppleva besvär med att få sina personliga behov uppfyllda under barnets vårdtid. Syfte: Beskriva föräldrars uttryckta behov av stöd från sjuksköterskor när deras barn vårdas på BIVA. Metod: Litteraturöversikt med analys av kvalitativ data. Resultat: Fem kategorier presenteras i studien; stöd i form av begriplig information, stöd till att bevara föräldrarollen, stöd i form av tillit till sjuksköterskor, stöd till kroppsligt välbefinnande samt emotionellt stöd. Slutsats: Föräldrar kan uppleva en förlorad känsla av kontroll när barnet vårdas på BIVA. Tankar och känslor, så som osäkerhet gällande barnets överlevnad, kan hindra dem från att ta hand om sig själva vilket i sin tur kan leda till utmattning. Information, delaktighet och goda relationer till sjuksköterskor uttrycks främja föräldrarnas välbefinnande, känsla av kontroll och trygghet. Klinisk betydelse: Resultatet i studien skulle kunna bidra till hur sjuksköterskor kan stödja och hjälpa föräldrar till sjuka barn. Resultatet skulle även kunna bidra till diskussion och reflektion över attityder och förhållningssätt inom hälso- och sjukvården när det kommer till föräldrars roll och välmående i vården av sjuka barn. / Background: When a child becomes critically ill and needs intensive care, it can involve enormous bodily and mental strain for parents. Parents often have a central role in the child's care and recovery, but can experience trouble with getting their personal needs met during the child's hospital stay. Aim: Describe parents expressed needs of support from nurses when their child is cared for in the PICU. Method: Literature review, analyzing qualitative data. Results: Five categories is presented in this study; support in the form of understandable information, support to preserve the parental role, support in the form of trust in nurses, support for bodily well-being and emotional support. Conclusion: Parents can experience a loss of control when the child is cared for in the PICU. Thoughts and feelings, such as uncertainty regarding the child's survival, can prevent them from taking care of themselves which can lead to exhaustion. Information, participation and trusting relationships with nurses can promote parents well-being, feelings of control and security. Clinical significance: The results of this study could contribute to how nurses can support and help parents of ill children. The results could also contribute to the discussion and reflection on the attitudes of health care when it comes to the role and well-being of parents in the care of ill children.

This thesis comprises three studies that empirically evaluate the perceptions of sports managers and academics of the importance of competencies for sports managers in Taiwan. First, a systematic review technique is conducted to review the literature on competency-based studies in sports management and this is followed by three empirical studies. Study I is designed to develop an appropriate research instrument for the evaluation of the perceptions of the importance of competencies to the successful conducting of a sports manager's job in Taiwan. Study II analyzes the underlying features in these competencies and provides a comparison of the perceptions of the two populations. Study III identifies and evaluates the process of curriculum construction in three leading academic institutions and its relationship to competency-based education. The thesis concludes that although there are many globaUshared phenomena in the development of sports management, the perceptions of important competencies of sports managers may vary in different local contexts and thus locally based analysis is necessary to identify culturally specific features.

Performing evidence-based reviews (EBR) is a growing and important area of research, and more graduate students should be educated in this area. EBRs provide conclusions based on science and follow a specific methodology to decrease bias, consider all pertinent science on the topic, and have transparency. This thesis is two-fold and includes: 1) a faculty course manual on how to facilitate a college course on EBR and 2) an EBR manuscript on the utility of nutrition labeling to affect consumers’ ability to select more nutritious products and whether or not nutrition labeling can affect purchase and consumption of more nutritious products. This EBR is timely in that the US Food and Drug Administration (FDA) has called for a moratorium on Front-of-Pack labeling (FOP) until two Institute of Medicine Committees have produced their reports and FDA has interpreted those reports. The intention of the manuscript is that it will aid in this interpretation. Of 978 articles collected, 699 were excluded using exclusion/inclusion criteria, 253 were identified as secondary articles, and 26 were used for the EBR. Results: Ten studies answered question #1 on whether or not consumers can pick a more nutritious product by reading labels and 21 answered question #2 on whether consumers actually change their purchasing and/or eating behavior by using labels. Studies ranged from simple cross-sectional studies that used survey data to more complex studies that collected sales data or performed in-store observations. In conclusion, consumers are able to use food labels to pick more nutritious products. Preliminary evidence suggests that a subset of health conscious consumers will read food labels to select a healthier product within a product category. Less evidence exists that reading labels actually results in a change of food intake. More intervention rather than survey studies are required to address this issue. In addition, the next stages of investigation should include looking at the whole diet, rather than just individual foods, and finally what affect the whole diet may have on overall health.

The team-training literature provides favorable support for the after-action review (AAR)?s ability to improve cognitive, skill, and attitudinal outcomes in co-located and distributed environments. However, the comparative effectiveness of co-located and distributed AARs is unknown. Thus, the objective of the present study was to investigate the comparative effectiveness of co-located and distributed AARs. The present study examined the AAR?s effect on performance, declarative knowledge, team-efficacy, team voice, team cohesion, and team-level reactions. Data were obtained from 492 undergraduate students (47.66% female) assigned to 123 4-person teams who participated in a team training protocol using a 3 (type of AAR review: non-AAR versus subjective AAR versus objective AAR) x 2 (geographic dispersion: co-located and distributed training environments) x 3 (sessions) repeated measures design. The results indicate that AAR teams had significantly higher performance scores than the non-AAR teams. In addition, the AAR teams had higher perceptions of team-efficacy and higher levels of team cohesion than the non-AAR teams. With the exception of team-level reactions, there were no other significant differences between the distributed AAR and co-located AAR conditions. Similarly, there were no significant differences across any of the outcome variables between the objective and subjective AAR conditions, indicating that the type of AAR did not impact the results of the training. The findings of the present study highlight several practical and scientific implications that should be considered regarding AAR training. Primarily, regardless of the training environment or type of AAR, AAR training remains an effective intervention at increasing performance and attitudinal-based outcomes. In addition, the results suggest that the use of distributed AARs does not engender the proposed process losses that were hypothesized. Thus, the use of this training to reduce administrative costs may be a viable option for geographically dispersed organizations. Finally, practitioners should evaluate the extent to which increasing the amount of technology to allow for a more objective performance review, is providing the intended benefit to the trainees. The empirical research has consistently demonstrated that the use of objective review systems provides little to no benefit to the trainees. Future research is needed to determine the generalizability of these findings to other tasks, domains, team types, and levels of expertise.

This qualitative, descriptive study explored physiotherapists' experience of participating in peer review in public and private health services in New Zealand. Peer review is a professional activity where one health practitioner evaluates the practice of another. Accordingly, much professional effort has been expended on developing peer review systems and implementing review processes, yet the benefits of peer review are uncertain. A changing legislative environment where producing evidence of ongoing professional development is required, has provided impetus for this study given the limited research to support the use of peer review in this context. While the literature identifies competing focuses on professional development and accountability, there is lack of clarity about which model of peer review is being implemented in this country and which might serve the profession better. This study is a first step in clarifying the issues by identifying the personal, professional and organisational factors that influence health professionals' participation in peer review. The methodology consisted of a qualitative descriptive approach situated within a post positivist paradigm. Seven physiotherapists working in the New Zealand health system who had participated in a peer review process within the last 3 years participated in this study. Semi structured interviews were conducted, guided by broad questions relating to central themes identified during an extensive literature review. Interviews were then audio taped and transcribed verbatim to form the data. Transcripts were analysed by assigning content labels to units of text that seemed to encapsulate one complete thought or idea. The labelled groups were analysed into sub themes. Finally, the general themes that arose were described. Findings indicate that while peer review systems have been developed and are carried out as prescribed, therapists lack clarity about the intended outcomes. While recognising the benefits of receiving feedback on practice, many manage the review process to maintain positive working relationships and ensure their practice is favourably reviewed. The strategies they employ and the consequences of managing peer review in these ways are described. Current peer review processes in New Zealand do not provide reliable information about competence to practice. Neither do they fully achieve their potential as a professional development tool. Therefore, the professional emphasis and effort on peer review needs to be revisited. The findings highlight the need for consultation amongst individual physiotherapists, physiotherapy managers, physiotherapy professional organisations, and the registration board, to negotiate whether regulatory or professional development needs will drive peer review processes in New Zealand in the future.

The aim of this thesis was to review the current state of knowledge, occurrence and distribution of two polydorid (Polychaeta: Spionidae) genera, Polydora and Dipolydora, in estuaries of subtropical eastern Australia. The existing taxonomy of the polydorid group is confused and descriptions include many relative terms. A numerical taxonomy approach using Primer 6 was taken to identify species groups and characters. A standardized set of multivariate morphological characters was developed and resemblance analysis functions used to create species cluster groups. SIMPER (similarity percentages) analysis on the same dataset was used to identify the diagnostic characters for each of these species cluster groups and to identify new characters which could be useful in species diagnosis, particularly for frequently occurring incomplete specimens.Prior to this study 3 Polydora species and 4 Dipolydora species were recorded from subtropical eastern Australia. The present study found 12 Polydora species and 10 Dipolydora species from estuaries and bays of subtropical eastern Australia.Two Polydora species are new (Polydora sp. P1 and Polydora cf. woodwicki) and 7 are potentially new species (P. cf. latispinosa; P. cf. websteri; P. sp. P2S; P. sp. P3S; P. sp. P4S; P. sp. P5S and P. sp. P6S) having been described from single specimens. Polydora cornuta Bosc, 1902 is recorded from New South Wales for the first time. Polydora cf. calcarea is reported from mudblisters in oysters. The Australian form of Polydora hoplura Claparède, 1870 and P. haswelli Blake and Kudenov, 1978 are described more fully than in existing literature.Three Dipolydora species are new (Dipolydora sp. D1; D. cf. flava and D. sp. D2) and 4 from single specimens are potentially new (D. cf. aciculata/ cf. giardi; D. sp. D3S; D. sp. D4S and D. sp. D5S). Dipolydora tentaculata (Blake and Kudenov, 1978) and Australian forms of Dipolydora flava (Claparède, 1870) and Dipolydora socialis (Schmarda, 1861) are described more fully than in existing literature.Prior to this study one Dipolydora and no Polydora were recorded from the Tweed- Moreton bioregion. This study reports 6 species of Dipolydora and 5 species of Polydora from this bioregion.Dipolydora penicillata (Hutchings and Rainer, 1979) and Carazziella victoriensis Blake and Kudenov, 1978 are recommended for synonymy.It is recommended that Polydora ciliata (Johnston, 1838) be reinstated and Dipolydora ciliata (Johnson, 1838) removed from the Australian polychaete checklist following identification of an error in description translation.Important gaps in collections were identified for polydorids associated with oysters from estuaries over the whole subtropical region; and for polydorids from the Tweed-Moreton IMCRA bioregion.

Thesis (S.J.D.)--University of Toronto, 2004. / Adviser: David Dyzenhaus. Includes bibliographical rererences.

Thesis (Ph. D.)--University of Texas at Austin, 2008. / Vita. Includes bibliographical references.