A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Chlamydia and gonorrhea are among the most frequently reported infectious diseases in the United States. These two diseases are easily treated with antibiotics; however, challenges exist in providing treatment to cases and their sexual partners. Maricopa County implemented a Field Delivered Therapy (FDT) protocol to treat chlamydia and gonorrhea cases and contacts in 2009. Ultimately, this project sought to inform other public health departments across the United States regarding the benefits of FDT program to treat gonorrhea and chlamydia and provide better insight on how to treat the two most commonly reported infectious diseases. Existing data was analyzed from April 1, 2011 to October 31, 2014 (42 months) for all patients that received FDT in Maricopa County utilizing pharmacy records and electronic health records (PRISM and eClinicalWorks). The following pieces of information were collected from these data sources: gender, age, race/ethnicity, diagnosis, number of partners, and time to treatment. The data were then divided into four FDT groups (FDT, expedited partner therapy via FDT, FDT attempted and FDT planned). There were 172 patients in this analysis; 140 diagnosed or in contact with chlamydia and 16 diagnosed or in contact with gonorrhea. There were 79 patients (45.9%) in the FDT group, 28 (16.3%) in the FDT EPT group, 28 (16.3%) in the FDT attempted and 37 (21.5%) in the FDT planned group. The median age of these patients was 23.8 (range 16.6‐31); 111 (64.5%) were female. The median time to treatment for these patients was 24.6 days (range 0‐64.5 days). Most patients (79.6%) lived outside of central Phoenix. The median number of sexual partners reported by these patients was 6.6 (range 1‐19.7 partners). A majority of the patients were <25 years old, except for in the FDT EPT group where 100% of patients were >25 years old. And the group with the largest <19‐year‐old population (32%) was in the FDT group. All the groups had a female majority, except in the FDT EPT group where 75% of the patients were male. Most patients in the FDT only group received testing at an outside hospital or outpatient clinic, while the FDT attempted and planned were more often tested at the STD clinic. Future Direction/Conclusion Many of the patients that received FDT are young women, some pregnant, that lived outside of Central Phoenix. However, a majority of the overall clients that received expedited partner therapy via FDT were male, a typically hard to reach population for treatment of potentially asymptomatic infections. This study demonstrates an effective method of delivering partner treatment to men. This study can be used to inform other public health departments about this novel practice and to help Maricopa County grow their FDT program to reach even more untreated patients.

The purpose of this study was to examine the effects of parent delivered non-contingent reinforcement (NCR) on decreasing throwing behavior exhibited by a young child with autism. During the pretreatment phase of the experiment the participant went a functional analysis to determine the target behavior of throwing. Baseline data was collected followed by the intervention phase. During the intervention phase, the non-contingent reinforcement (NCR) procedures were conducted. Attention was given to the participant on a fixed-time schedule and was influenced based on the participant’s behavior. The schedule of reinforcement was slowly increase with the decrease or lack of throwing attempts. Furthermore, this study aimed to determine whether parent delivered fixed-time schedules of non-contingent reinforcement decrease the non-preferred activities of throwing objects.

The advent of the Internet in personnel selection has brought with it many opportunities, challenges and concerns. The opportunities afforded to the employer include, among others, increased security, a reduction in the resources needed, reduced geographical constraints, reduced time to hire, immediate scoring and a lowering of costs. Owing to these benefits, the use of the Internet for psychological testing will continue to become more prevalent in personnel selection over the next few years. The use and acceptance of the Internet has encouraged organisations and assessment practitioners to make use of Internet-delivered testing as the preferred mode of administration, especially in view of the benefits that it offers to the employer, as well as to the candidate. Internet-delivered testing brings with it a few concerns and many organisations are still making use of the paper-and-pencil version of an instrument even though it is available in an online version. This is because of concerns over measurement equivalence, as the paper-and-pencil version is seen as a “safer” and more accepted mode of administration. There are also many test publishers that would like to take advantage of the practicability of Internet-delivered testing by converting their current selection procedures to an Internet format. This conversion cannot simply be assumed and needs to be examined and documented for each instrument. The primary purpose of this study is to determine the construct equivalence of the Customer Contact Styles Questionnaire (CCSQ7.2) when it is administered via paper-and-pencil in the presence of a proctor and when it is administered online in the absence of a proctor. The aim is to determine whether the online version of the CCSQ7.2 can be considered equivalent to its paper-and-pencil counterpart without loss of psychometric property. The results of the study revealed that the mode in which the CCSQ7.2 is administered does not compromise scale reliabilities and that the relationship between scales of the CCSQ7.2 are not affected by modes of administration. It can thus be said with confidence that the online version of the CCSQ7.2 can be considered equivalent to its paper-and-pencil counterpart without loss of psychometric property. Copyright / Dissertation (MCom)--University of Pretoria, 2008. / Human Resource Management / unrestricted

This study investigated outcomes of a parent training curriculum: Helping Our Toddlers Developing Our Children's Skills (HOT DOCS), using secondary analyses of existing data collected between May 2007 and March 2009. The evaluation studied the impact of specific components of the parent training program on both participants' knowledge and attitudes and their perceptions of target children's behavior. Caregivers (n = 334) of children between the ages of 18 months and 5.11 years of age who were participants in the parent training program were included in the study. Measures included a pre/post knowledge test, pre/post rating scales of child problem behavior, and a program evaluation survey. Results indicated significant increases in caregiver knowledge following participation in the program, but non-significant differences between groups of participants based on various demographic variables. Prior to participation in the program, caregivers' perceptions of the severity of child problem behaviors were significantly different from that of the normative population. Following participation in the program, results showed a significant decrease in caregiver perceptions of the severity of child problem behaviors, regardless of caregiver/target child demographic variables. Caregiver feedback indicated high levels of satisfaction with the program.

Mental health disorders are a leading cause of disability and mortality worldwide. Mental health services do not meet demand due to accessibility issues, financial burden, and increasing needs. Technology can provide affordable, accessible mental health care and some research suggests internet-delivered Cognitive Behavior Therapy (iCBT) may be an effective treatment. In iCBTs, participants typically complete Cognitive Behavior Therapy modules and videos and are supported by a therapist. Advantages of iCBT over face-to-face therapy include lower cost, no travel time, easy access, no waitlists, and trackable progress. To our knowledge there have been no naturalistic studies of iCBT programs. Therefore, this study will evaluate the usage and effectiveness of one iCBT program, SilverCloud, in a university counseling center. Participants (N=5568) were students at a large, private western university. Participants were either self-referred to the program, chose to enroll at intake as a standalone intervention, or were referred by their treating clinician as an adjunct to regular treatment. We compared the outcomes and usage of participants using SilverCloud concurrently with psychotherapy to participants using SilverCloud alone, and participants in psychotherapy alone.

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Sensory inputs of hearing and vision during early childhood development support the achievement of language, speech and educational milestones. The early detection of sensory impairment is essential for facilitating early childhood development, socio-emotional well-being and academic success, in addition to obtaining sustainable educational development goals. The majority of children with sensory impairment live in low- and middle-income countries where services are often unavailable or inaccessible, because of the absence of systematic screening programmes for children, prohibitive equipment cost, a shortage of trained personnel and centralised service-delivery models. Therefore, research is needed to investigate whether a community-based mobile health (mHealth) supported service-delivery model for hearing and vision screening can increase access to hearing and vision services for children in resource-constrained settings. This study aimed to describe an implemented hearing and vision screening programme and evaluate its success in terms of acceptability (consent return numbers), coverage (number of eligible children screened), referral rates and quality indicators (duration of tests and number of hearing tests conducted under conditions of excessive noise levels). The study also explored the challenges faced during a community-based screening programme and the strategies developed to address these. Four non-professionals were appointed and trained as community health workers (CHWs) to conduct combined sensory screening using mHealth technology (hearScreen application, hearXGroup, South Africa and Peek Acuity application, Peek Vision, United Kingdom) on smartphones at preschools in low-income communities in Cape Town, South Africa. The consent form return rate was 82.0%, and the coverage rate was 94.4%. An average of 501 children were screened each month, at a cost of US$5.63 per child. The number of children who failed hearing and vision screening was 435 (5.4%) and 170 (2.1%), respectively. Failing of hearing tests was associated with longer test times (odds ratio [OR]: 1.022; 95% confidence interval [CI]: 1.021–1.024) and excessive background noise levels at 1 kHz (e.g. OR for left ear: 1.688; 95% CI: 1.198–2.377). Failing of visual screening tests was associated with longer test duration (OR: 1.003; 95% CI: 1.002–1.005) and younger age (OR: 0.629; 95% CI: 0.520–0.761). The study also aimed to describe and compare the performance of two screening protocols that were used in this preschool hearing screening programme to determine optimal referral criteria that is responsive to available resources. Secondary data analysis was done to compare a protocol using a single-frequency fail criterion (which 2,147 children were screened with between 1 October 2017 and 25 February 2018) with a screening protocol using a two-frequency fail criterion (which 5,782 children were screened with between 26 February 2018 and 30 November 2018). For both protocols, screening was done at a 25 dB hearing level (HL) at 1000, 2000 and 4000 Hz. Both protocols included an immediate rescreen at the frequencies that were failed. The referral rate was 8.7% (n = 186) for the one-frequency fail protocol and 4.3% (n = 250) for the two-frequency fail protocol. Compared to the one-frequency fail protocol, children screened with the two-frequency fail protocol were 52.9% less likely to fail (OR: 0.471; 95% CI: 0.385–0.575). Gender (OR: 0.807; 95% CI: 0.531–1.225) and age (OR: 0.996; 95% CI: 0.708–1.402) had no significant effect on screening outcomes. Maximum permissible ambient noise levels (MPANLs) were exceeded in 44.7% of cases in at least one ear at 1000 Hz across both protocols. There was no significant difference between the protocols for both true positive cases and false positive cases. Protocol (OR: 1.338; 95% CI: 0.854–2.098), gender (OR: 0.807; 95% CI: 0.531–1.225) and age (OR: 0.996; 95% CI: 0.708–1.402) demonstrated no significant effect on the odds of producing true positive results. Average time for conducting the screening was 72.8 s (78.66 SD) for the one-frequency fail protocol and 64.9 s (55.78 SD) for the two-frequency fail protocol. Estimating the prevalence and describing the characteristics of sensory loss in a preschool population in low-income communities are important steps to ensure adequate planning and successful implementation of community-based hearing and vision care in this context. The study therefore also investigated the prevalence and characteristics of hearing and vision loss among preschool children (4 to 7 years) in an underserved South African community after implementing mHealth-supported community-based hearing and vision services. Children who failed hearing and vision screening were seen for follow-up assessments at their preschools. Follow-up assessments were also performed with smartphones and hearing and vision testing applications (hearTest application, hearX Group, South Africa and PeekAcuity app, Peek Vision, United Kingdom). A total of 10,390 children were screened at 298 preschools over 22 months. Of the children screened, 5.6% and 4.4% of children failed hearing and vision screening, respectively. Community-based follow-up hearing tests were done at the preschools on 88.5% (514) of the children, of whom 240 children (54.2% female) presented with hearing loss. A preschool-based follow-up vision test was conducted on 400 children (88.1%). A total of 232 children (46.1% female) had a vision impairment, and a further 32 children passed the test but had obvious signs of ocular morbidity. Logistic regression analysis found that age was a significant predictor of vision loss (p < 0.001): with every 1-year increase in age, participants were 51.4% less likely to have vision loss (OR: 0.49, 95% CI: 0.39–0.60). Age was not a significant predictor for hearing loss (OR: 0.821; 95% CI: 0.667–1.011). Gender was not a significant predictor of hearing loss (OR: 0.850; 95% CI: 0.658–1.099) or vision loss (OR: 1.185; 95% CI: 0.912–1.540). The prevalence of hearing loss at a pure tone average (PTA) of 25 dB HL ranged between 2.3% (240 out of 10,390; assuming none of the non-attenders and children who were unable to be tested had hearing loss) and 3.1% (321 out of 10,390; assuming all the non-attenders and children who were unable to be tested presented with hearing loss). The prevalence of vision loss ranged between 2.2% (232 out of 10,390; assuming none of the non-attenders had vision loss) and 2.8% (286 out of 10,390; assuming all the non-attenders presented with vision loss). Findings of this research project indicate that mHealth-supported CHW-delivered hearing and vision screening in preschools provide a low-cost, efficient and accessible service that can improve the provision of affordable hearing and vision care. This service-delivery model is affordable and scalable, because the same staff, needing minimal training, and the same equipment are used to screen for both vision and hearing. Timely identification of sensory losses is essential to ensure optimal outcomes and can be facilitated through community-based hearing and vision services by trained CHWs using mHealth technology. Future studies should aim to report on outcomes and the uptake and impact of interventions on the children diagnosed with sensory impairments following identification through a decentralised screening programme. / Thesis (PhD (Audiology))--University of Pretoria, 2021. / Sonova AG / Hear the World Foundation / Speech-Language Pathology and Audiology / PhD (Audiology) / Unrestricted

Relapse prevention after pain management is a neglected area and Internet-based interventions have the potential to partly fill this gap. A challenge in designing effective relapse prevention program is how to motivate patients to persist throughout the full length of treatment. Following a regular pain management program, 29 participants underwent a 20 week long Internet–based relapse prevention program based on acceptance-oriented CBT. Qualitative analyses showed changes in attitudes towards their pain and body during the course of treatment. Degree of personal commitment in treatment goals seemed to affect gains relating to new perspective on self and future. Therapeutic strategies of defusion and mindfulness seemed to ease perspective changes and persistence to comply. Values interventions are hypothesized to be a plausible therapeutic strategy to engage participants in continuous behavior change. Further studies on non-compliers and drop-outs could enhance understanding of interventions necessary to maintaining motivation. When and how to give therapist support during Internet-based treatment for chronic pain is another area in need of further studies.

For years educators have struggled to ensure students meet the rigors of state mandated tests. Challenges that often impede student success are student absences, school closings due to weather, and remediation for students who need additional help while advanced students can move ahead. Many educators, especially secondary math and science teachers, have responded to these issues by implementing a teaching strategy called the flipped classroom where students view lectures, power points, or podcasts outside of school and class time shifts to allow opportunities for collaborative learning. The purpose of this research was to evaluate teacher and student perceptions of high school flipped science classrooms. A qualitative phenomenological study was conducted to observe 3 high school science teachers from Georgia, North Carolina, and Tennessee selected through purposeful sampling who have used the flipped classroom method for a minimum of 2 years. Analysis of data from an online survey, direct observation, teacher interviews, and student focus groups helped to identify challenges and benefits of this teaching and learning strategy. Findings indicated that teachers find the flipped classroom beneficial to build student relationships but requires a significant amount of time to develop. Mixed student reactions revealed benefits of a flipped classroom as a successful learning tool for current and future endeavors for college or career preparation.