Purposes: The purpose of this study was threefold. First, to examine how both the effectiveness of valsartan centric regimens and the patient-related factors affect the control rates of the Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and combined SBP/DBP; specifically for Belgian patients with a history of failed or intolerant anti-hypertensive treatment. Secondly, to assess the effectiveness of valsartan treatment groups and the related factors concerning a patients' total cardiovascular risk (TCVR) residuals. Lastly, to attempt to estimate the cost avoidance factor associated with taking varying levels of valsartan treatment doses. Methodology: This research took the form of a secondary-data analysis study, focusing on the analysis of data collected primarily from seven prospective studies conducted between 2004 and 2009, covering different regimens of valsartan. The variants of valsartan doses given to patients included: valsartan monotherapy (80mg or 160 mg); a combination of valsartan with hydrochlorothiazide (HCTZ) (80 mg and 12.5mg, 160mg and 12.5 mg, or 160mg and 25mg); and a combination of valsartan with amlodipine (80mg and 5mg, 160mg and 5mg, or 160mg and 10mg). We applied Bailey's approach, using Kaplan-Meier curves to estimate the distribution of treatment intensity at which the target rates of SBP, DBP and SBP/DBP were achieved. The treatment intensity was calculated by dividing the daily dose prescribed to a patient by the maximum daily recommended dose of that particular drug variant. The outcomes provided by Bailey's approach included the control rates of SBP, DBP and combined SBP/DBP, in addition to the reduction in TCVR residuals. Another aspect of our methodology was the use of a simulation method to estimate the cost avoidance by using valsartan treatment groups. We used OCED data to compare health indicators between the US and Belgium in order to estimate the ratio enabling us to calculate the cost of hypertension per patient per year. This cost was then used in the simulation method to calculate the cost avoidance of using varying levels of the treatment intensity of valsartan regimens. Results: A total of 17,683 patients were included in this study, contributed to by 3,434 physician-investigators. The mean age of the population was 63.63 + 11.83 years, with a mean BMI of 28.45 + 3.13 kg/m^2 and 47.7% of the population was male and the vast majority of the total population was Caucasian (98%). As a baseline the total population who had controlled SBP, DBP and combined SBP/DBP were 1358, 5301 and 1091 respectively. The total population who were categorized as low added risk TCVR, moderate added risk TCVR, high added risk TCVR, and very high added risk TCVR were 192; 3,721; 3,888 and 9,362 respectively. Overall, there was a statistically significant increase in the proportion of patients with controlled SBP, DBP and combined SBP/DBP after 90 days of starting on valsartan-centric regimens (p<0.001). Both older age and the presence of diabetes were associated with a lower control rate of SBP, DBP and combined SBP/DBP (P<0.05). High adherence to valsartan-centric regimens was associated with an increase in the control rates of blood pressure. Substantial reductions in total cardiovascular risk, particularly in the very high added-risk category was observed 5,852 times (33.1%) (P<0.001) and an increase in the low added risk TCVR 3,331 times (18.9%) (p<0.001). The associated cost avoidance with varying levels of treatment intensity were dose related. The cost avoidance associated with the treatment intensity levels of 0.25, 0.5, 0.75, 1.0 and 1.5 were $261,164; $2,403,188; $6,384,142; $8,702,272 and $10,230,321, respectively. Conclusion: The different levels of the treatment intensity of valsartan-centric regimens were effective in increasing the control rates of SBP, DBP and combined SBP/DBP in the real practice for patients whose prior treatment failed. Not only did valsartan regimens improve the BP control rate, they also reduced the TCVR residuals. Additionally, substantial cost avoidance was found to be associated with the use of higher levels of treatment intensity. These results may support the idea that intensive anti-hypertensive treatment may be associated with higher clinical and economic benefits for both patients and payers. However, more research might be needed to validate our results and to address the questions of adverse effects that may be associated with intensive anti-hypertensive therapy and the economic consequences of treating any such effects.

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Nearly 80% of children treated for cancer are expected to survive, but not without cost. Survivors face unprecedented challenges associated with long-term consequences of treatment, also called late effects. Approximately half of children treated for cancer are at risk for experiencing cognitive late effects, which typically emerge several years post diagnosis. The nature and extent of cognitive late effects appear to be developmental and related to patient, disease, and treatment variables. However, the relationships between these variables is not well understood because there have been few prospective and longitudinal studies that report on the contributions of these variables over time. This dissertation examined the effects of patient, disease, and treatment variables, as well as their interactions over time on neurocognitive functioning in childhood cancer survivors. It comprises part of a large prospective, randomized clinical trial designed to examine changes in cognitive function over three years as a function of different levels of monitoring of school-based intervention based on individual educational plans (IEPs). This dissertation uniquely contributed a new measure (the Treatment Intensity Rating Scale) that was used to systematically classify treatment severity across different types of cancer and cancer treatments. Participants included 61 children ages 7 to 12 years at enrollment who were two to five years from completion of treatment for a brain tumor, leukemia, or lymphoma. Participants received yearly neuropsychological evaluations for a follow-up period of 3 years. Results of these evaluations were used to develop IEPs. Participants were randomized to have their IEPs monitored on a quarterly or annual basis for the duration of the study. Contrary to the progressive decline in neurocognitive functioning that is typically anticipated in pediatric cancer survivors, analyses revealed relative stability of performance on neurocognitive measures over time. Higher neurocognitive performance was noted in children whose IEPs were monitored more frequently versus less frequently. Results also supported gender-specific risk for late effects, with lower performance on select neurocognitive measures in females compared to males. Results of this study provide encouraging evidence of the positive effects of school-based interventions and their close monitoring. This has important implications for quality of life as these children survive well beyond childhood into adulthood.

Children with phonological disorder are at risk of developing reading and writing impairments. Phonological difficulties may also influence a child’s social interaction and it is for this reason that effective treatment of phonological disorder is important. One factor that may influence treatment efficacy, is treatment intensity. There has been little research done in Sweden, on the effects of intensity of phonological intervention. Further research into phonological intervention is therefore needed to determine which treatment intensity is the most effective. The aim of this study is to evaluate the possible effects of intensive treatment of two preschool children with phonological disorder. The research questions focus on the nature of the possible effects of phonological treatment and if they lead to generalization, and whether caregivers notice any changes in their children’s speech. A single-subject design was used with three baseline measurements, followed by treatment and two follow up measurements. The treatment was given three times a week over the course of three weeks, and every treatment session lasted for approximately 40 minutes. The results of the baseline and follow ups were calculated with Percentage Consonants Correct (PCC), Percentage Words Correct (PWC), and the percentage of manner of articulation correct. Both participants displayed improvements between the baseline and the second follow up, in all the measurements. Changes could be seen in the target phonemes both in new positions and in new words, but also in untrained phonemes. The caregivers of both participants experienced an improvement in their children's speech. How the estimated intensity affected the results is unclear. However, the results indicated that intensive treatment led to generalization and that it showed effect. Thus, the results of the present study could have clinical relevance. / Förskolebarn med fonologiska svårigheter riskerar att få läs- och skrivsvårigheter i skolåldern och påverkan på det sociala samspelet. Det är därför viktigt med effektiv fonologisk intervention, som kan påverkas av intensiteten. Det finns sparsamt med svenska studier om intensitetens påverkan vid fonologisk intervention. Föreliggande studie syftar till att utvärdera eventuell effekt av intensiv behandling hos två förskolebarn med fonologiska svårigheter. Frågeställningarna innefattar hur den eventuella effekten av fonologisk behandling ser ut, om den leder till generalisering, samt om vårdnadshavarna upplever någon förändring.  Studien hade en single-subject design med tre baslinjemätningar och två uppföljande mätningar. Fonemtestet LINköpingsUnderSökningen (LINUS) användes vid samtliga mätningar. Behandlingen genomfördes vid nio tillfällen, tre gånger i veckan i tre veckor. Varje behandlingstillfälle var cirka 40 minuter långt. Resultatet av LINUS-testningen beräknades med Percentage Consonants Correct (PCC), Percentage Words Correct (PWC) och andel korrekt artikulationssätt och analyserades även kvalitativt. Resultaten jämfördes mellan de olika mätningarna. Båda deltagarna uppvisade förbättringar för samtliga mått mellan baslinjemätningarna och den sista uppföljande mätningen. Förändringar kunde ses av tränade ljud till nya ord och positioner samt av ljud som inte tränades i behandling. Vårdnadshavarna till de deltagande barnen upplevde att deras barns tal hade förbättrats efter behandlingen. Det är svårt att uttala sig om vilken inverkan den uppskattade intensiteten hade på behandlingsutgången. Resultatet indikerar dock att intensiv behandling hade effekt och att den ledde till generalisering, och skulle således kunna vara till nytta i klinisk verksamhet.

Le traitement thermique est basé sur la modification chimique des biopolymères par thermodégradation, en évitant l'ajout de produits chimiques. Ce traitement améliore la stabilité dimensionnelle et la durabilité fongique du bois. Ces améliorations se font au détriment des propriétés mécaniques qui ont tendance à s'affaiblir. Aujourd'hui, plusieurs types de procédés sont utilisés. Ils se distinguent entre autre par la nature du milieu dans lequelle se déroule le traitement. La durabilité de ce nouveau matériau bois est liée au degré de thermodégradation, dépendant des conditions et de l'intensité du traitement. Un pilote de traitement par conduction, travaillant sous vide ou sous azote, mesurant la masse en dynamique est utilisé afin de mieux comprendre l'influence de l'atmosphère. Les résultats obtenus montrent que l'utilisation du vide permet d'éliminer, de l'enceinte de traitement, les produits volatils formées au cours du traitement conduisant à des taux de lignine de Klason plus faibles du fait de la non recondensation des produits de dégradation. Cette limitation de recondensation des produits volatiles engendre des pertes de masse, pour une même intensité de traitement plus faibles, confirmés par des taux de polysaccharides plus élevés pour un traitement sous vide. Des études de cinétiques des réactions de thermodégradation ont confirmé la plus grande sensibilité des feuillus vis-à-vis de la thermodégradation (comparé aux résineux). De plus, ces analyses ont permis d'identifier les principaux produits de thermodégradation du bois qui varient en fonction de l'intensité du traitement et a permis de montrer une thermosensibilité plus importante de la lignine que de l'holocelluloses pour la gamme de températures utilisée. Le fruit de ces travaux est donc une progression significative des connaissances de bases sur les mécanismes de thermodégradation et leurs relations avec les paramètres de traitement / Thermal treatment is based on biopolymer chemical degradation by heat transfer, without additional chemical products impregnation. This process improves the dimensional stability and the decay resistance of wood. These improvements come at the expense of wood mechanical properties of wood which weak. Several types of heating processes exist currently differing mainly by the nature of the inert atmosphere used during treatment. The durability of this new wood material is correlated to the degree of polymers thermal degradation depending on the conditions and the treatment intensity. A conducting heat treatment pilot using nitrogen or vacuum and allowing dynamic record of mass loss is used to understand better the atmosphere influence. The results show that utilization of vacuum permit the elimination of volatile products formed during heat treatment and accumulated in oven, leading to lower extractives and Klason lignin contents due to the non recondensation of thermal degradation products. Limitation of the formation of recondensation products generates a lower mass loss for same treatment intensity and explains the lower polysaccharides degradation during a vacuum process. Fine chemical analyses and the study about thermal degradation reaction kinetics have allowed confirming the higher sensibility of hardwood than softwood to thermal degradation. In addition, these analyses have permitted the volatile thermal degradation products identification related to the treatment intensity. Subsequently, results have shown a higher thermal sensibility of lignin than holocelluloses for temperatures below 230°C. This work is a significant increase in basic knowledge about the mechanisms of wood thermal degradation and their relations with the processing parameters

The relationship between speech articulation therapy dose (frequency, intensity, duration) and treatment outcomes are poorly understood. Identifying optimal therapy doses for specific articulation disorders is essential to providing efficient clinical care. Recent research indicates that intensive speech therapy doses-known as boot camps-may promote rapid improvement and generalization for certain speech disorders. Therefore the present investigation examined the effects of a boot camp speech therapy approach to remediate interdental /s/ production in an 8-year-old male. The boot camp included two days of speech therapy involving visual, tactile, and auditory feedback approaches. Therapy was administered 5.5 hours per day across morning and afternoon sessions. Treatment outcomes were evaluated using auditory-perceptual ratings of pre- and post-treatment word pairs. The results indicated that /s/ production improved significantly immediately following the boot camp and improvements were sustained at one week post-treatment (p < 0.05). Medial and final /s/ productions improved more so than the initial /s/ productions. These findings suggest that the speech therapy boot camp approach may be effective for certain individuals with speech sound disorders. Future research should explore dose-response relationships among speech articulation therapy dose in other children with speech sound disorders.