The aim of this study was to gain insight into the exercise practices, in conjunction with dietary habits and medication routine of insulin dependent diabetics. The study design adopted for the study was that of descriptive and analytical survey. The gathering of data was conducted over a period of seven months using a questionnaire as a data collection instrument, which was administered to 200 insulin dependent diabetics utilizing the outpatient facilities at 12 hospitals in Kwa-Zulu Natal. In determining the respondent's attitude towards exercise, the significant (p<0.001) overall majority (85%) had a positive attitude towards exercise. In probing the perceived efficacy of exercise as a therapeutic modality, a significant (p<0.001) majority (93%) of the respondents stated that exercise/sport is beneficial to a diabetic. Of the overall sample, the significant (p<0.001) majority (68%) of respondents were active participants in exercise (exercisers) versus 32% who were not active (non-exercisers). The profile of the exercisers indicated that the significant (p<0.001) majority participated in exercise of an aerobic type at frequency of 4 or more times per week, at an intensity eliciting an approximate heart rate of between 110 to 130 beats per minute corresponding with an RPE of 11 to 13, for a duration of 20 to 45 minutes. A significant (p<0.001) overall majority (98%) stated that a good diet is an important factor when trying to achieve near normoglycemia. In probing the respondent's knowledge as to what group certain types of food belong to, an overall significant (p<0.001) majority (82%) was accurate in this regard, while significantly (p<0.1) more exercisers (84%) were aware of correct food grouping than non-exercisers (67%). In probing their knowledge of the normal range of blood glucose levels, an overall significant (p<0.001) number of respondents (66%) stated a correct response, while exercisers (67%) were significantly (p<0.1) more knowledgeable than non-exercisers (52%) in this regard. The significant (p<0.001) majority of respondents injected themselves three and more times a day (54%), before meals (71%), in the thigh (35%) and abdominal areas (48%), as opposed to the gluteal area (10%) and the arm (8%). The mean overall dosage of long-acting insulin (12.2 units) and short-acting insulin (10.5 units) for lunch was significantly lower (p<0.1) than for breakfast and supper, however there was no significant difference (p>0.1) between the breakfast and supper dosages. The same pattern was observed for non-exercisers and exercisers. The respondent's knowledge of good diabetic management goals reflected that a significant (p<0.001) overall majority (83%) were aware that diet, insulin and exercise are all important constituents in obtaining good diabetic management, while significantly (p<0.1) more exercisers (84%) than non-exercisers (71%) were aware of this. A significant (p<0.001) majority (83%) of non-exercises stated that they were willing to participate in exercise, but cited time constraints and physical discomfort, inter-alia, as antecedents to non-participation. In conclusion, the results indicated that the provision of educational support for insulin dependent diabetics to overcome the perceived barriers to exercise would increase participation, enhance appropriate exercise prescription and compliance to this important aspect of the diabetic regimen. / Dissertation (MA (Human Movement Science))--University of Pretoria, 2002. / Biokinetics, Sport and Leisure Sciences / unrestricted

BIM som är en arbetsmetodik möjliggör simuleringar av en byggnads energianvändning medtillämpning av tillhörande program som exempelvis IDA ICE och RIUSKA. Efter att få enuppfattning av byggnadens energianvändning ska det vara möjligt för brukarna att vidtaåtgärder i syfte till att effektivisera byggnadens energianvändning.Energieffektivisering i byggnader kan även genomföras med fenomenet IoT. Detta innebär attbyggnader kan ha ingående sensorer som kan kommunicera med varandra men även enheterutanför. Sensorerna ska kunna leverera betydelsefull information för en byggnad som kan skapaunderlag för energieffektivisering. Det finns nämligen intelligenta IoT-produkter idag som kanbalansera en byggnads effekttoppar genom att använda den gratisenergi som uppstår ibyggnaden.Syftet med denna studie är att ta reda på energibesparingspotentialer för användning av IoT-system kopplat till BIM. Denna studie har även målet att skapa underlag för intressenter somvill investera i förvaltningsskedet med inriktning på energibesparing.För att skaffa sig en kännedom av valt område och ansatser samt forskningar, har enlitteraturgenomgång gjorts. Teorin för denna studie baseras på insamlat material. Detsammagörs för de framtagna resultaten. För komplettering av saknad information harsemistrukturerade intervjuer med lämpliga aktörer ägt rum. Den kvantitativa metoden ansesvara en lämplig metod för denna studie med tanke på syftet och målet, därför har denna metodvalts.Energianvändningen skiljer sig markant beroende på vilken byggnadstyp som gäller närhandelslokaler, flerbostadshus och kontor kategoriserades. Handelslokaler har en uppdelningav energianvändning där verksamhetselen är dominant i omfattning vid jämförelse meduppvärmningsaspekten och fastighetselen medan för flerbostadshus har uppvärmningen endominant roll. Även för kontor har energianvändningen till största del en omfattning föruppvärmning men att byggnadstypen inblandar även verksamhetselen som en viktig aspektomfattningsmässigt.Vad gäller byggnaders åtgärdspotentialer gällande energieffektivisering hänger mycket påvilken byggnadstyp som gäller. För handelslokaler är belysningsåtgärder ochventilationsåtgärder de åtgärder som uppmärksammas.Flerbostadshus uppmärksammar uppvärmningsaspekten och individuell debitering vad gälleråtgärder. Enligt de resultat som har inhämtats ska individuell debitering möjliggöra en störstabesparingspotential medan värmeåtervinningssystem ska möjliggöra 22 % ibesparingspotential.Åtgärders potentialer för kontorsbyggnader är ganska lika åtgärderna för handelslokaler. Dockframgår även space management med en hög besparingspotential men att denna skulle endastbaseras på en fallstudie.Hur lönsam användningen av ett installerat IoT-system kopplat till BIM är för byggnadervarierar beroende på vilken byggnadstyp som gäller. I resultaten av studien finns en högstamöjlig energibesparingspotential på 50 % för flerbostadshus med konceptet, men för ett annatfall ska en annan möjlig potential ligga på 15 % fast detta behandlar en kontorsverksamhet. / BIM is a method that provide opportunities to simulate energy usage in buildings byenforcement of appurtenant programs like IDA ICE and RIUSKA. After getting a perceptionof the buildings energy use it is possible for the users to take measures in order to make moreefficiency the buildings energy usage.There is a potential in the IoT phenomena aswell that is related to affect buildings energy usagenowadays. By implementing sensors in buildings, it is possible to make buildings smart in away of communication between the buildings sensors. For example, it is possible for a sensorsystem to balance the energy usage of a building by collecting data from free heat additions thatcomes from inhouse activities.The purpose of this study is about to make a description of the use of IoT system linked to BIM.This study also aims to provide a basis for future investments in the management phase focusingon energy savings.In order to acquire a knowledge of chosen area and approaches as well as research, a literaturereview has been made. The theory of this study is based on collected material and literature.The same process is done for the obtained results. Semi-structured interviews with appropriateactors takes place to complete missing information. The quantitative method is considered anappropriate method for this study in view of the purpose and the goal, therefore this method hasbeen chosen.By implementing an intelligent network with sensor nodes linked with BIM, a potential ofenergy savings should take place. Case studies revealed data of potential energy savings thatcomprises situations from residential buildings and office buildings. A case study of ageneralized and residential apartment revealed a potential of 50 % in energy savings with animplemented BIM- and IoT-concept.

The aims of this research were to establish the drug use patterns of an elderly population in the southern suburbs of the Cape peninsula and to determine the extent of knowledge with respect to their medicines. In addition, the relationship between drug use patterns and medication knowledge and the socioeconomic status of the elderly, the health care services utilised by them and the amount of information conveyed on medicine container labels was assessed. Two hundred and sixty non-institutionalised Caucasian elderly over the age of 65 years and living in old age residences were interviewed. The interviews were structured with 4 major components: 1. a questionnaire designed to collect participant particulars; 2. an interview schedule to collect information on drug use patterns and to assess participant knowledge of medicines used (Knowledge score). 3. a container label assessment schedule (Label score); 4. a cognitive function test to identify and exclude severely cognitively impaired elderly from the study population. Analysis of the data showed the majority of the participants were English-speaking women of social class 1 or 2. Approximately one fifth of all participants were male. The State-run health care services were utilised by 38% of the participants whilst 73% retained their own general practitioner. A total of 843 medicines were used with an average of 3.2 medicines per capita. Ninety-five percent of all participants took prescribed medicines, with diuretics, non-narcotic analgesics/antipyretics, and tranquillisers the 3 most frequently prescribed classes. A smaller percentage - 41.5% - of participants used self-prescribed medicines, of which non-narcotic analgesics, homeopathic and herbal medicines, and vitamins were taken most frequently. When assessed against container label directions approximitely one third of participants were non-compliant with their dosage regimens. The majority of all medicines had been used on a continuous basis for 1 to 10 years. Average knowledge score was 58%. The majority of participants had very little knowledge about interactions, side effects, and maximum permissible dose for their medicines. Just over one fifth of all participants could correctly state both the name and the strength of their medicine. Average knowledge score was found to decline with increasing age, but no relationships were found to exist with the other patient characteristics. Similarly, no relationship was found to exist between knowledge score and label score. Participants utilising the public health care services tended to have a lower knowledge score than those receiving treatment from the private sector. Twenty-six percent of all labels did not have specific usage directions. The private sector suppliers were most frequently culpable of omitting instructions. Label legibility also proved to be a problem for the elderly participants. The drug use patterns identified in this study are similar to those of the American and British elderly and should be of value in compiling a health care plan for the South African elderly, although further research involving other race and cultural groups is needed.

INTRODUCTION: To address a lack of population-level studies that examine the association between ambulatory care utilization and cardiovascular outcomes among Asian Americans, this study examined 1) ambulatory care utilization among different racial/ethnic groups and 2) the association between ambulatory care utilization and cardiovascular outcomes. METHOD: This was a retrospective analysis of 2009–2012 Medicare fee-for-service data. Primary outcomes were 1) hospitalization for angina, an ambulatory care sensitive condition, and 2) inpatient AMI mortality. Intermediate outcomes of interest were ambulatory care utilization. First, a descriptive analysis of patients’ predisposing and enabling factors was performed, and then bivariate association between these predisposing and enabling factors and ambulatory care utilization was examined. Lastly, using multivariate logistic regression models I estimated the association between ambulatory care utilization and cardiovascular outcomes, adjusting for socio-demographic and geographical characteristics. RESULTS: There were 999,999 people in the analytic sample, drawn from 21.6 million Medicare fee-for-service enrollees. In 2009, there were significant differences in racial/ethnic ambulatory care utilization. Significantly lower percentage of Asians had frequent ambulatory care visits (>30 visits) and outpatient cardiology clinic visits (>30 visits) (both p-values<0.01), after adjusting for predisposing and enabling factors. Asians had the highest observed inpatient mortality (15.9%) and low ambulatory utilization was associated with increased odds (OR=1.85 [1.11–3.08]) of inpatient AMI mortality. CONCLUSION: Among Medicare fee-for-service enrollees, Asians had fewer ambulatory clinic visits. Low ambulatory care utilization was associated with increased odds of AMI mortality. Further research is needed to understand the causal relationship between ambulatory care utilization and cardiovascular outcomes. / 2018-11-08T00:00:00Z

This dissertation examines the determinants of competition and consumer access in the health care market, and supply- and demand-side determinants of health care use under the Affordable Care Act (ACA). The first essay studies insurer entry into the federally-facilitated health insurance market under the ACA. Motivated by the fact that insurers’ service areas can be subsets of rating areas, and the substantial variation in plan composition within a rating area, I explore variations in the type of plans offered and insurers’ decisions to enter a rating area. I find that availability of medical providers, population size, and metropolitan status are important in insurers’ decisions to enter a rating area. Medical cost affects the entry of restricted network plans. The second essay examines how supply-side incentives affect treatment choice for depression. Using claims data from Florida’s Medicaid program, I find large variations in initiating antidepressant treatment among newly diagnosed patients with three plan types: Fee-for-Service (FFS), Primary Care Case Management (PCCMs) and Accountable Care Organizations (ACOs). Compared to FFS, PCCMs and ACOs are more likely to provide antidepressant but no office-based care. I use the control function approach to mitigate the self-selection bias and find that ACOs tend to use lower cost medication options. Despite the use of low-cost alternatives for ACOs, no differences are found in subsequent psychiatric hospitalization or emergency room visits among plans. Different provider contractual relationships may partially explain treatment choice differences. The third essay investigates whether the ACA policy of free preventive services affects utilization of preventive care. I use variation in commercially-insured enrollees to examine the demand and supply prices of four preventive services. Despite an average 53 percentage point decrease in demand prices for these services, the actual service use only increased by 17 percent from 2007 to 2011, possibly due to little or no change in prices paid to providers. Using risk adjustment tools to predict and control for patient underlying health status, I find similar changes in demand prices and rates of service use across six health plan types, consistent with preventive visits being provider rather than consumer choices.

The number of African immigrants in the United States is increasing. The incidence of children diagnosed with autism spectrum disorder in the United States is also on the rise. Despite these increases, little information exists about the adequacy of care for African immigrants with autistic children in the United States. The purpose of this grounded theory study was to understand the factors that affect use of care for African immigrants with autistic children in the United States. Using Aday-Anderson model of health care utilization framework, this study focused on African immigrants in the United States who had children with Autism Spectrum Disorder from age 2- to 15-years-old. I used open, axial and selective coding to analyze my data and come up with a theory about utilization of care for African immigrants with autistic children. The results of this study showed a need for education to influence African immigrants to use care for their autistic children. Despite cultural stronghold, the use of care for African immigrant with autistic children was influenced by education, experience, need and recommendation. The African immigrant ASD Utilization of Care Model emerged. The positive social change implication of this study is improving the use of care for African immigrants with autistic children. African immigrants with autistic children in the United States will benefit from this study.

Despite antenatal care presenting opportunities to identify and monitor women at risk, use of recommended antenatal care services remains. Barriers preventing use of antenatal services vary between countries, and limited knowledge exists about the link between geographical settings and antenatal service use. The objective of this cross-sectional quantitative study was to explore geographical variations and investigate how social demographic characteristics affect use of antenatal care for women in Sierra Leone using the Andersen behavioral model. The data used were from the 2016 maternal death surveillance report of the whole counrty (N =706). Logistic regression analysis was used to determine the individual predictor effects on antenatal care, including geographical location, the age of women, marital status, parity, and institution of birth impact. Southern, Northern, and Eastern women had significantly lower odds of attending the recommended antenatal services compared to women in the Western region (OR = .517, p = .019; OR = .497, p = .021; OR = 0.014, p = .041, respectively). The odds of married women attending the recommended antenatal services was 7.3 times more than that of the single women (OR = 7.397). Also, significantly associated with less uptake of recommended antenatal visits was lower education level among women (OR = .517). This study will contribute to positive social change by highlighting inequities in antenatal care use among women, thus allowing for accurate targeting of health promotion programs and ultimately saving lives of mothers and children of Sierra Leone through more inclusive policies.

Present day trends indicate a definite movement toward building school plants more adequately and more adaptable for community use and for wider community utilization. It is the belief of many educators that the school should be designed to provide the facilities required for housing the school and its many community programs. It is not primarily a monument to the architect and the school authorities. Schools should be a learning laboratory for all members of the community. Weber County school administrators have consistently supported building utilization point of view as expressed- by Pittenger:

Environmental enrichment is a technique used at many captive animal facilities that can improve the well-being of their animals. It seeks to enhance habitat features and promote natural behavior by providing a variety of practical ways for captive animals to control their environmental settings, especially during stressful circumstances. Enclosure features, such as shelter structures, are one tool that promotes wild behavior by adding complexity to an enclosure’s physical environment. Enrichment efforts for captive wildlife are most effective when they are specialized to the biological needs of the animals. Human activity may alter captive animal behavior and utility of enclosure features, and there is concern that human presence can negatively impact the welfare of some captive animals. Captive coyotes (Canis latrans) at the USDA-National Wildlife Research Center (NWRC) Predator Research Facility in Millville, UT, USA, are maintained for research on biology, ecology, physiology and behavior. Coyotes at the research facility are routinely noticed utilizing shelter structures to hide, rest, and display vigilant behavior. Because they regularly use these simple structures, new and more complex enrichment shelter structures were installed to be evaluated. Specific research objectives aimed to assess (1) coyote enclosure utilization and shelter structure preferences, and (2) coyote spatial and behavioral responses to human activity. Using 32 mated coyote pairs rotated through eight 1.5-acre enclosures for 28-day trials over the winter months (January – March) of 2015 and 2016, spatial and behavioral patterns were monitored via the implementation of GPS-collars and live behavioral observations. Coyotes showed preference for shelter structure designs, but still spent most of their time at the perimeter and open areas of their enclosures. Complex structures were preferred over simple structures. Coyotes most often demonstrated inactive and vigilant behavior without human activity, but showed increased vigilance when there was human activity. Human activity also stimulated coyotes to become more active than inactive and reduce their utilization of enrichment structures. Although there was no clear preference for one specific type of enrichment structure, composite evidence from GPS-collars and behavioral data suggest the ramp may have heightened biological suitability. This study advances the knowledge of captive coyote spatial patterns and helps improve environmental enrichment planning for captive animals by exploring effective methods of adding complexity to animal enclosures.

Several experimental lines of forage kochia [Kochia prostrata (L. Shrad.)] have potential to provide taller forage on fall and winter rangelands than the only released variety of forage kochia, Immigrant. This study was conducted to determine differences in cattle utilization among experimental lines of forage kochia and relate them to forage quality and morphological attributes. The utilization of forage kochia was also compared to 'Ladak ' alfalfa [Medicago saliva (L.)] and two entries of winterfat [Krashnennikovia species (Guldenstaedt)]. Cattle utilization was determined by calculating a biomass consumed value and a percent biomass consumed value. Dry weights for each plant were taken after grazing and subtracted from a pre-grazing dry weight (predicted using a quadratic regression equation) that produced the biomass consumed value. The percent consumed value was calculated by dividing biomass consumed by pre-grazing dry weight. Ocularly estimated utilization scores (OU) were also used to measure utilization. Forage quality traits were analyzed on each entry using near infrared reflectance spectroscopy. Morphologic and phenological characteristics potentially related to utilization were made by physical measurements and visual evaluations. There were significant differences among forage kochia accessions for all traits evaluated. Four entries, including Immigrant and Ladak alfalfa, were significantly higher in percent herbage consumed than the other entries . These same entries were consistently high in OU ratings , forage quality analyses , and most morphological characteristics. Pre-grazing dry weight (r = -0.96 , P < 0.0001) , stem length (r = 0.67, P < 0.0001), and branch density (r = 0.63, P < 0.0001) were all highly correlated with utilization. Crude protein (partial R2 = 0.253 , P ≤ 0.0001) was the only forage quality trait associated with utilization using a stepwise regression to predict utilization. From this study we conclude that some forage kochia accessions are very palatable. They are comparable to Ladak alfalfa, and utilized more than Krashnikova spp., a desirable forage on western rangelands.