Clostridium perfringens (CP) was evaluated as an additional indicator in assessing impacts and sources of microbial pollution in the Idaho-Utah Cache Valley . Point , nonpoint, river water, and animal fecal samples were analyzed for CP, total coliforms, fecal collforms, and fecal streptococci. Monthly river samples consistently contained <20 CP/100 mL , but concentrations of the other indicators varied significantly by location and date. Two sample stations consistently had CP concentrations greater than 20 / 100 mL . One of these stations was influenced by an upstream wastewater discharge . Chlorinated effluent from this trickling filter plant contained greater than 103 CP / 100 mL, but met a 400 FC/100 mL discharge standard. A consistent decrease in CP concentrations in samples taken downstream from this wastewater source were fo und, despite significant impact from adjacent nonpoint pollution. Lagoon and oxidation ditch wastewater effluents sampled contained <20 CP/100 mL. Nonpoint sources sampled (e.g . , cattle feedlot runoff) contained <20 CP / 100 mL and 102-104/100 mL coliforms and fecal streptococcus. Cattle, horse, and sheep feces analyzed contained 104-107/g coliforms and fecal streptococcus, but less than 102 CP/g. Nonpoint pollution from such animals may contribute significant coliforms and streptococci but not CP. Wastewater treatment effluents may or may not contain elevated levels of CP depending on factors such as wastewater residence time and particular treatment process employed. The occurrence of relatively high, i.e., >102 CP/100 mL, in areas impacted by nonpoint sources may suggest a municipal wastewater input. Coliform and streptococci indicators may not be able to distinguish municipal or domestic microbial loading in the presence of nonpoint source interferences in many circumstances.

Class of 2016 Abstract / Objectives: Pain management in the pediatric population is crucial when providing emergency medical care, as inadequate pain control is a significant cause of morbidity and mortality. The use of adjunctive therapy can potentially decrease opioid requirements, thereby reducing potential opioid related adverse effects. The purpose of this study was to evaluate the use of adjunctive therapy and impact on morphine dose requirements for pediatric pain management in the emergency department (ED). Methods: This study was an IRB approved retrospective review of pediatric patients ages 1 to 18 years, who received intravenous (IV) morphine therapy in the ED. Patients were excluded based on opioid-tolerance (using opioids prior to ED visit), diagnosis of sickle cell disease, and oncologic disorders. Data collection included baseline demographics, medical diagnoses and comorbidities, morphine total dose by weight, type, dose by weight and frequency of adjunctive analgesia agents, and pain scores. Results: The use of adjunctive analgesia in addition to morphine did not reduce the total morphine doses given, repeat morphine dose requirements, admission rates, or length of stay but did increase the time to a repeat dose of morphine. In those patients who received adjunctive analgesia before morphine, we saw a statistically significant decrease in the total amount of morphine received, total morphine doses given, repeat morphine dose requirements, and admission rates. Conclusions: In pediatric patients who require pain management in the ED, adjunctive analgesia should be given before morphine to reduce the amount of morphine required.

The purpose of this paper was to investigate whether or not the use of a biographical inventory would be a feasible and viable adjunctive means of making more accurate predictions of student success in programs of upper-division and graduate study in speech pathology and audiology. During the past years, biographical inventories have been found to be predictive of creativity, performance as a military officer, performance in varied occupations, and academic performance. It was hypothesized that a biographical inventory could be developed which, when used in conjunction with the existing academic predictors of Grade Point Average and Graduate Records Examination scores, would add to the established selection instruments. As a means of identifying and distinguishing among several levels of competency of students, a student evaluation form was constructed and validated. Items cores from a 257 item biographical inventory were correlated with scores obtained from the student evaluation form and a 52 item biographical inventory for speech pathology and audiology students was developed. Admissions criteria data, student evaluation form scores and biographical inventory scores were placed in two step-wise multiple regression equations and analyzed statistically. Results indicate that biographical factors appear to be of importance to undergraduate success in programs of speech and hearing therapy. Student success in the more rigorous programs of graduate study appears to depend much more on academic ability. Disparate results indicate that the use of a biographical inventory as an adjunctive academic predictor should be approached with caution until further studies can be conducted.

abstract: Many researchers have pointed out that sentence complexity plays an important role in language maturity. Using cohesive devices is a critical method to composing complicated sentences. Several grammatical researchers give cohesive devices different definitions and categories in the perspective of pure linguistics, yet little is known about the Chinese learners' acquisition situations of cohesive devices in the field of Teaching Chinese as a Foreign Language (TCFL). Combined with these definitions and pedagogical theories, the acquisition situations of four grammatical features of cohesive devices and eleven logical relations are discussed in this thesis. This thesis expects that through discovering different features of cohesive devices among different student levels, educators of Chinese will gain a more comprehensive understanding of the acquisition orders and features of conjunctive devices. In this study, I examine the teaching orders of cohesive devices in selected textbooks from first-year Chinese through fourth-year Chinese. Three groups of students were required to complete two essays based on the same topics and prompts. Twenty-eight valid writing samples are examined in total, including ten writing samples from fourth-year students, another ten from third-year students, and eight from second-year students. The results show that there are no obvious differences among the three levels of students in their use of certain grammatical features and logical relations of cohesive devices. Students in these three levels have difficulty understanding how to connect paragraphs together fluently and accurately in their compositions. Pedagogical implications include some suggestions about designing instructional writing assignments in order to give more clearly pedagogical instructions for teaching cohesive devices. In addition, comprehensible directions that explain which logical relations should be taught every academic year are proposed. / Dissertation/Thesis / M.A. East Asian Languages and Civilizations 2013

Falk's pivotal 1961 study showed that rats would drink excessive amounts of water when exposed to a time based schedule of reinforcement. Since then, schedule-induced drinking or polydipsia, has been demonstrated with several species and with a variety of different behaviors. Rats, the most commonly used animal, have been shown to drink excessive amounts of water under a variety of different time based schedules of reinforcement; exclusively during a free operant procedure. The current study shows that water drinking can be induced during a discrete trial procedure, and instead of using a time-based schedule of reinforcement, this study used a variable-ratio schedule of reinforcement. The results showed that excessive water drinking was induced under these conditions with a canine.

Benzodiazepines have been widely prescribed since the 1960s for the management of adverse symptoms related to anxiety, depression, and sleep problems. They were regarded as an efficacious medication when compared with their predecessor, barbiturates. Within 10 years of their introduction, concerns began to be raised regarding their potential to produce dependence and withdrawal symptoms when ceased, including symptoms not present prior to their being prescribed. Subsequent research focussed on establishing effective strategies to ameliorate the adverse symptoms experienced even when the daily intake was slowly reduced. The aim of the work undertaken for this doctorate was to establish whether there was a role for cognitive behaviour therapy (CBT) in benzodiazepine cessation. The initial step in conducting the research for this doctorate was to obtain a detailed understanding of the current state of research on benzodiazepine cessation. Study 1 therefore focussed on establishing the effectiveness of treatment approaches used to assist individuals to cease benzodiazepine use. A Meta-analysis of treatment strategies undertaken in general practice and outpatient settings established that brief intervention resulted in superior cessation rates at post-treatment than routine care. Gradual dose reduction plus CBT was slightly superior to gradual dose reduction alone. However, substitutive pharmacotherapies in combination with gradual dose reduction did not result in a superior outcome to gradual dose reduction alone, and substitutive pharmacotherapy plus abrupt benzodiazepine cessation was less effective than gradual dose reduction. While, providing CBT in conjunction with gradual dose reduction offered a superior outcome than gradual dose reduction alone, current evidence does not identify the CBT strategies that contributed to the superior outcome. The next step in the development of the CBT intervention involved obtaining a deep appreciation of the issues relating to cessation from the perspective of General Practitioners (GPs) and Benzodiazepine Users (BzUs). Accordingly, Study 2 administered semi-structured interviews about benzodiazepine use and its cessation to 28 GPs and 23 BzUs. Responses were analysed using the Consensual Qualitative Research approach, as it enabled comparisons to be made between the views of the two groups of interviewees. The study identified commonality between GPs and BzUs on reasons for commencing use, the role of dependence in continued use, and the importance of lifestyle change in its cessation. BzUs felt there was greater need for GPs to routinely advise patients about non-pharmacological management of their problems and potential adverse consequences of long-term use before prescribing benzodiazepines. Few GPs had assisted a patient to cease use reportedly due to the required time and the expectation of a poor outcome. There was a perception that patients wanted a pharmacological solution to their problems. A critical gap in assessment instruments that are needed for a comprehensive assessment of the outcomes from a treatment trial was identified. In particular, there was no measure of benzodiazepine expectancy or self-efficacy concerning maintenance of benzodiazepine dose reduction. Therefore, Study 3 adapted existing expectancy and self-efficacy measures form other substance domains to verify their applicability to benzodiazepines. Current BzUs (n = 155) were invited to complete two questionnaires either online or via hard copy. Principal component analysis (PCA) of a newly developed Benzodiazepine Expectancy Questionnaire (BEQ) resulted an 18-item, 2-factor scale, while a Benzodiazepine Refusal Self Efficacy Questionnaire (BRSEQ) formed a 16-item, 4-factor scale, Confirmatory factor analysis (CFA) in a second sample (n = 139) confirmed these internal structures, reducing the BEQ to 12 items and the BRSEQ to 14 items respectively. The qualitative study suggested that many GPs would be reluctant to engage in psychological support for benzodiazepine cessation and it was evident that specialist services would be unable to provide substantial support especially in rural and remote areas. Accordingly, it was decided to develop a treatment that was remotely delivered. The initial pilot used a correspondence-based approach, delivered via the postal service. Study 4 comprised a small pilot comparing GP managed gradual dose reduction, plus CBT via mail (M-CBT), which was either delivered immediately (IM-CBT) or after 3 months (DM-CBT). Despite substantial efforts over a 2 year period to recruit GPs and BzUs, only 6 received the allocated intervention. It was decided to trial the intervention as an internet-delivered program to enhance its accessibility to BzUs. Access to the program was promoted through the project website and links from high profile support websites. Study 5 was an uncontrolled trial of internet-based CBT (I-CBT). Access was provided to all newsletters, although, participants were given a suggested sequence for access. Despite placement on the internet and cross-listing on several key websites, the study still only recruited 35 participants (3 of which received the program by mail). Of the 32 undertaking the program via the internet, 21 completed the 3-month assessments and 14 the 6-month assessments. Eight participants reduced their weekly benzodiazepine intake by at least 50%, by 3 months, with five ceasing use at 6 months. A significant increase in self-efficacy, and a decrease in depressive symptoms and dependence were seen. Providing CBT either via mail or the internet assisted some participants to reduce or cease long-term benzodiazepine use. Recruitment to both M-CBT and I-CBT was limited, despite substantial attempts to market the intervention. The studies undertaken for this doctorate make a unique contribution to improving treatment outcomes for people wishing to cease long-term benzodiazepine use. They also provide direction for more extensive studies to definitively establish the nature of effective treatment. The current evidence clearly supports the importance of gradual dose reduction and the role of CBT in further improving treatment outcomes. However, engagement of both BzUs and GPs remains challenging. Remote delivery of CBT via mail or the internet may assist with improving access to CBT, but it does not solve the problem of GP and BzU engagement. An effective system-wide program to address long-term benzodiazepine use will require that incentives for GP involvement (a disincentive for long-term prescription) are in place.

Made available in DSpace on 2016-04-29T13:18:00Z (GMT). No. of bitstreams: 1 Dissertacao Thais Martins Sales.pdf: 1293785 bytes, checksum: 6161405c79ed51ec0c3dacacebe67ee1 (MD5) Previous issue date: 2006-05-29 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study was an attempt to investigate possible relations between responding that is reinforced according to schedules based on a temporal parameter and performing other activities to which no reinforcement contingencies are programmed. These activities have been called adjunctive behavior, collateral behavior or interim activities. Two questions guided this study: a) is there any difference in response rate, average time between reinforcers, and percentage of reinforced responses when an FI schedule or a DRL schedule is in force, if the subject can engage in other activities; b) are typical sequential patterns developed between responses when these schedules are in force? Four male food deprived rats were subjects of this experiment. The apparatus was an experimental box with seven chambers in which subjects could perform different activities, such as bar pressing, eating, running, drinking, and wood-chewing. For two subjects, bar pressing was reinforced according to three DRL schedules (DRL 4s, DRL 5s, and DRL 20s). One of the subjects was first kept in the chamber with the bar and food dispenser and then was allowed to access the other chambers, the other was first allowed to access the other chambers and then was kept in the chamber with the bar and food dispenser. For the other two subjects, bar presses were reinforced according to two FI schedules (FI 5s and FI 10s). One of the subjects first had access to all chambers and then was kept in the chamber with the bar and food dispenser, and the other was kept in the chamber with the bar and food dispenser during the whole experiment. Bar presses, reinforcement deliveries, and occupancy of chambers were recorded. Results show there was a difference in response rate, average time between reinforcers, and percentage of reinforced responses in both schedules, depending on the access condition, mainly when responses were reinforced according to schedules higher than FI 5s and DRL 4s. Higher response rates, lower average time between reinforcers and higher percentage of reinforced responses were observed for the DRL subjects when access was possible than when it was not possible, and higher response rates, higher average time between reinforcers and higher percentage of reinforced responses were observed for the FI subjects when access was possible than when it was not possible. No typical sequential patterns were observed when access was possible and either of the two studied schedules was in force. Results are discussed in terms of possible controlling variables to performing activities other than bar pressing when responding is being reinforced according to FI and DRL schedules / O presente trabalho é uma tentativa de investigação de possíveis relações entre o responder reforçado segundo dois esquemas de reforçamento que envolvem parâmetros temporais e o engajamento em atividades para as quais não há reforço programado, chamadas de atividades ínterim, comportamento adjuntivo ou comportamento colateral. Duas perguntas dirigiram a realização deste trabalho: a) há diferença na taxa de respostas, tempo médio entre reforços e porcentagem de respostas reforçadas segundo esquemas DRL e FI, caso haja possibilidade de engajamento em outras atividades? e b) alguma seqüência típica de engajamento em outras atividades é formada no intervalo entre respostas reforçadas segundo estes esquemas? Os sujeitos do experimento foram quatro ratos machos privados de alimento. Foi utilizada uma caixa experimental com sete compartimentos, nos quais era possível o engajamento em diferentes atividades: pressionar a barra, comer, beber, correr, roer madeira. Dois sujeitos tiveram as respostas de pressão à barra reforçadas segundo esquemas DRL com três valores diferentes (4s, 9s e 20s). Um deles passou, primeiro, por uma condição na qual o acesso a todos os compartimentos era permitido, chamada de aberta, e, segundo, por uma condição na qual era mantido no compartimento onde havia a barra e o comedouro, chamada de fechada, e o outro sujeito passou, primeiro, pela condição fechada e, segundo, pela condição aberta. Os outros dois sujeitos tiveram as respostas de pressão à barra reforçadas segundo esquemas FI com dois valores diferentes (5s, 10s). Um sujeito passou primeiro pela condição aberta e, depois, pela condição fechada e o outro passou apenas pela condição fechada. As pressões à barra, os reforços e a permanência nos compartimentos foram registrados. Os resultados mostraram que houve diferença na taxa de respostas, tempo médio entre reforços e porcentagem de respostas reforçadas em função da condição de acesso, especialmente quando as respostas de pressão à barra foram reforçadas segundo o esquema DRL 9s e DRL 20s, para os dois primeiros sujeitos, e segundo o FI 10s, para os outros dois sujeitos. Na condição aberta com esquema DRL em vigor, observou-se uma menor taxa de respostas, menor tempo entre reforços e maior porcentagem de respostas reforçadas do que na condição fechada, com o mesmo esquema em vigor. Na aberta com esquema FI em vigor, observou-se uma menor taxa de respostas, maior tempo entre reforços e maior porcentagem de respostas reforçadas do que na condição fechada, com o mesmo esquema em vigor. Seqüências típicas de engajamento em outras atividades não foram observadas quando o acesso era possível e o responder era reforçado segundo os esquemas FI e DRL. Os resultados são discutidos em termos de possíveis variáveis que controlam o engajamento em outras atividades, quando respostas são reforçadas segundo estes dois esquemas

Purpose To evaluate the effectiveness and safety of Selective Laser Trabeculoplasty (SLT) with the SLT mode of the VISULAS ® green laser in patients with primary open-angle glaucoma (POAG). Methods This prospective, interventional multicenter clinical investigation included patients with POAG who either needed a treatment escalation because the individual intraocular pressure (IOP) target was not met or treatment initiation and had an IOP ≥ 17 mmHg at baseline in the study eye. The study was conducted in five research centers across Germany. Approximately 100 laser applications were delivered to 360° of the trabecular meshwork. Glaucoma medications were not modified during the 3-month follow-up to allow evaluation of the sole effect of VISULAS ® green with SLT. Efficacy outcomes were postoperatively absolute and relative IOP changes at 1 and 3 months. Safety outcomes analyzed the rate of intra- and postoperative adverse events. Results Thirty-four eyes of 34 POAG patients were included. The overall mean number of preoperative glaucoma medications was 2.2 ± 1.4 in 29 treated eyes, 5 eyes were treatment naïve. Mean baseline IOP (mmHg) was 21.0 ± 2.69 and was reduced by − 3.53 ± 3.34 [95% CI − 4.61; − 2.45] and − 3.59 ± 3.41 [95% CI − 4.64; − 2.53] at the 1- and 3-month follow-up, respectively (p < 0.0001), with 48.5% of cases achieving a ≥ 20% IOP reduction at 3 months [95% CI = 30.8%; 66.5%]. The mean relative IOP reduction was − 16.4% and − 16.3% at 1 and 3 months, respectively (p < 0.0001). Potentially device- or procedure-related adverse events were mild to moderate and included 3 postoperative IOP-spikes and 6 reports regarding eye pain and discomfort. All were resolved without sequelae. Conclusions SLT performed with the VISULAS ® green laser achieved clinically significant additional IOP reductions in medically treated as well as in treatment naïve eyes with POAG and there were no relevant safety issues. The results are comparable to other reported SLT studies.