Fibromyalgia (FMS) goes undiagnosed in as many as 3 out of 4 people who have the disease. Primary care providers (PCPs) are the first to evaluate patients; therefore, PCPs need to be able to recognize FMS, implement initial treatment, and refer for further consultation. The Fibromyalgia Diagnostic Screening Tool (FDST), a validated instrument to identify FMS, can improve the speed and accuracy of FMS diagnosis. The purpose of this project was to familiarize PCPS with the FDST, evaluate their receptiveness to the tool, and train them in its use. The Leventhal, Diefenbach, and Levanthal, common sense model of illness provided the theoretical framework to guide this quality improvement project. A 45-minute in-service and accompanying reference manual was given to 4 participating PCPs, along with a demographic questionnaire asking about their age, race, gender, marital status, and years in practice. Following the in-service, a 10-question self-completed questionnaire consisting of a combination of open-ended and nominal scale yes/no questions, was administered. A thematic analysis revealed 2 primary barriers for diagnosis without the FDST: lengthy screening time and trouble differentiating FMS from a patient's other conditions. In response to one of the yes/no questions, the participants all replied that the in-service on FDST was helpful in diagnosing FMS. Implications for social change include improved diagnosis with a diagnostic screening instrument, improved quality of health care, and cost effectiveness at the system level for chronic disease prevention and management. This project demonstrates in a localized primary care setting that the FDST may offers PCPs a reliable method to diagnose FMS.

The prevalence of chronic Lyme disease (CLD) remains relatively unknown in Connecticut because there is not an agreement on what CLD is and how it should be diagnosed in addition to which pathological agent causes CLD. The aim of this quantitative study was to assess whether there were significant differences between two groups of primary care physicians (PCP) working in Connecticut from two different points in time regarding their knowledge in the diagnosis, treatment, and management of CLD. A knowledge, attitude, and practice model was used as the underlying theoretical framework for this study. A random cross-sectional survey was mailed out to the 1,726 PCPs found in the list of certified medical doctors in Connecticut of 2015. One hundred and forty-five PCPs responses (11.9% response rate) were received and compared to responses from previous data (a 2010 study) of 285 PCPs (39.1% response rate) from the list of certified medical doctors in 2006. The PCP estimated mean number of patients diagnosed and treated for CLD was not significantly different between 2006 and 2015. However, a significantly higher number of PCPs in 2015 reported knowing Lyme disease (LD) symptoms but not feeling comfortable diagnosing LD (χ� = 536.83, p < 0.001), and significantly more PCPs in 2015 reported knowing LD symptoms and feeling comfortable diagnosing CLD (χ� = 265.41, p < 0.001). This study can promote social change by encouraging Connecticut PCPs to recognize CLD as a diagnosis to enable the development of registries and case-control assessments. The findings of this study may also inspire future studies.

There were several purposes to this case study using a convergent parallel mixed method design. The first purpose was to explore how one exemplary high school science teacher (EST) and her selected supporting administrator rated the importance of particular elements of science instruction. The second purpose was to describe how an EST explained her practices of fostering success for her students. The third purpose was to identify the administrator’s practices that supported the EST as described by both educator participants. Data for this study were collected through two researcher-developed instruments, interviews, and documents. The EST completed the Questionnaire of Exemplary Science Teachers (QEST), and the administrator completed the Questionnaire for Administrator Perception of Exemplary Science Teachers (QAPEST). The researcher also conducted an interview with each participant and analyzed documents (i.e., lesson plans, students’ course grades, and Biology Subject Area Testing Program results). The EST examined data to provide context to the case study. Results of the study revealed that both the EST and administrator understood and closely agreed on the importance of science and in the methods of planning and teachingscience. Results also indicated that students taught by the EST were successful in a science program. The EST used a combination of specifying objectives, diagnosing and evaluating student learners in science instruction, planning of science instruction, and delivering of science instruction to assist her students in becoming successful. Results also revealed that the EST and the administrator believed that building strong personal relationships with the students motivated students to want to succeed even more for the EST. Finally, results indicated that unwavering, generative administrative support was helpful in supporting the teacher’s exemplary instruction.

Malmö högskolaLärarutbildningenSkolutveckling och ledarskapMagisterkurs i specialpedagogikHöstterminen 2008Borgfors, S. (2008). Att få diagnosen dyslexi först under gymnasietiden: tio ungdomars verklighet - en kritisk betraktelse. Skolutveckling och ledarskap, Specialpedagogisk magisterutbildning, Malmö högskola.Följande kvalitativa studie, med abduktiv ansats och reflexiv metod som vetenskapsfilosofisk grund, är resultatet av intervjuer med tio ungdomar som har fått diagnos dyslexi först under sin gymnasietid. Syftet var att utröna om diagnostiseringsprocessen och dyslexidiagnosen i sig hade haft någon betydelse för informanternas självbild, studiesituation och studieresultat. Intervjuerna reflekterade också betydelsen av omgivningens förhållningssätt till informanternas svårigheter, såväl före som efter diagnos. Den enskilda skolans och lärarens utövande av makt, bl.a. genom hur styrdokumentens riktlinjer för elever med särskilda behov tolkas, är av största vikt för den enskilda elevens möjligheter till kunskaps- och färdighetsutveckling. Vid jämförelser mellan intervjuerna och tidigare forskning synliggjordes betydelsen av såväl samhällsövergripande som individ- och klassrumscentrerade normativa mönster och brist på kunskap kring dyslexi, med risker för därpå följande stigmatiseringsprocesser. Studiens resultat visar att diagnostiseringen har haft en positiv inverkan på informanternas självbild, studiesituation och studieresultat. Studien visar också att informanterna är rädda för omgivningens okunskap och fördomar. Resultaten motsäger att diagnostisering i sig är stigmatiserande, men ger belägg för att omgivningens attityder till och värderingar av läs- och skrivsvårigheter kan vara det. Fortbildning av skolledare och pedagogisk personal i läs- och skrivutveckling/-problematik framstår som ytterst angelägen.Nyckelord: diagnostisering, dyslexi, fortbildning, kunskap, makt, normer, självbild, stigmatisering, värderingar, åtgärder Susanne Borgfors Handledare: Ingrid Sandén Examinator: Lena Lang / Malmö UniversitySchool of Education, School Development and LeadershipMasters Programme in Special Needs EducationAutumn Term 2008Borgfors, S. (2008). Getting the Diagnosis of Dyslexia only during Upper Secondary School: the Reality of Ten Adolescents – a Critical Study. School Development and Leadership, Masters Programme in Special Needs Education, Malmö University.This qualitative study, performed with an abductive and reflexive method, is the result of interviews with ten adolescents who have received the diagnosis of dyslexia during their time at upper secondary school. The fundamental aim of the study was to examine if the process of diagnosing, and the diagnosis of dyslexia in itself, have affected the informants’ regard of self, study situation and study results. The interviews reflected the significance of attitudes among adults and peers, concerning the informants’ reading and writing difficulties, both before and after the diagnosis. To enable the students’ development of cognition and proficiency, it is of great importance how schools and teachers wield their power when interpreting the principles in the steering documents regarding special education needs. When comparing the interviews with results of earlier research, the lack of knowledge about dyslexia, the importance of normative patterns, attitudes and values in society, the classroom and the individual, with the following risks of stigmatization processes, became evident.The results of the study indicate that the process of diagnosing and the diagnosis itself have had positive consequences for the informants’ concept of self, study situation and study results. The study results also show that the informants fear the ignorance and prejudice of adults and peers. The results suggest that a diagnosis of dyslexia in itself is not stigmatizing to the individual, but confirm that the attitudes and values of others can be so. Continuing professional development of school leaders and teachers regarding reading and writing development/difficulties is of the utmost importance.Keywords: continuing professional development, diagnosing, dyslexia, knowledge, measures, norms, power, self, stigmatization, valuesSusanne Borgfors Tutor: Ingrid Sandén Examiner: Lena Lang

Malmö högskolaLärarutbildningenSkolutveckling och ledarskapMagisterkurs i specialpedagogikHöstterminen 2008Borgfors, S. (2008). Att få diagnosen dyslexi först under gymnasietiden: tio ungdomars verklighet - en kritisk betraktelse. (Getting the Diagnosis of Dyslexia only during Upper Secondary School: the Reality of Ten Adolescents – a Critical Study.) Skolutveckling och ledarskap, Specialpedagogisk magisterutbildning, Malmö högskola.Följande kvalitativa studie, med abduktiv ansats och reflexiv metod som vetenskapsfilosofisk grund, är resultatet av intervjuer med tio ungdomar som har fått diagnos dyslexi först under sin gymnasietid. Syftet var att utröna om diagnostiseringsprocessen och dyslexidiagnosen i sig hade haft någon betydelse för informanternas självbild, studiesituation och studieresultat. Intervjuerna reflekterade också betydelsen av omgivningens förhållningssätt till informanternas svårigheter, såväl före som efter diagnos. Den enskilda skolans och lärarens utövande av makt, bl.a. genom hur styrdokumentens riktlinjer för elever med särskilda behov tolkas, är av största vikt för den enskilda elevens möjligheter till kunskaps- och färdighetsutveckling. Vid jämförelser mellan intervjuerna och tidigare forskning synliggjordes betydelsen av såväl samhällsövergripande som individ- och klassrumscentrerade normativa mönster och brist på kunskap kring dyslexi, med risker för därpå följande stigmatiseringsprocesser. Studiens resultat visar att diagnostiseringen har haft en positiv inverkan på informanternas självbild, studiesituation och studieresultat. Studien visar också att informanterna är rädda för omgivningens okunskap och fördomar. Resultaten motsäger att diagnostisering i sig är stigmatiserande, men ger belägg för att omgivningens attityder till och värderingar av läs- och skrivsvårigheter kan vara det. Fortbildning av skolledare och pedagogisk personal i läs- och skrivutveckling/-problematik framstår som ytterst angelägen.Nyckelord: diagnostisering, dyslexi, fortbildning, kunskap, makt, normer, självbild, stigmatisering, värderingar, åtgärder Susanne Borgfors Handledare: Ingrid Sandén Examinator: Lena Lang / Malmö UniversitySchool of Education, School Development and LeadershipMasters Programme in Special Needs EducationAutumn Term 2008Borgfors, S. (2008). Getting the Diagnosis of Dyslexia only during Upper Secondary School: the Reality of Ten Adolescents – a Critical Study. School Development and Leadership, Masters Programme in Special Needs Education, Malmö University.This qualitative study, performed with an abductive and reflexive method, is the result of interviews with ten adolescents who have received the diagnosis of dyslexia during their time at upper secondary school. The fundamental aim of the study was to examine if the process of diagnosing, and the diagnosis of dyslexia in itself, have affected the informants’ regard of self, study situation and study results. The interviews reflected the significance of attitudes among adults and peers, concerning the informants’ reading and writing difficulties, both before and after the diagnosis. To enable the students’ development of cognition and proficiency, it is of great importance how schools and teachers wield their power when interpreting the principles in the steering documents regarding special education needs. When comparing the interviews with results of earlier research, the lack of knowledge about dyslexia, the importance of normative patterns, attitudes and values in society, the classroom and the individual, with the following risks of stigmatization processes, became evident.The results of the study indicate that the process of diagnosing and the diagnosis itself have had positive consequences for the informants’ concept of self, study situation and study results. The study results also show that the informants fear the ignorance and prejudice of adults and peers. The results suggest that a diagnosis of dyslexia in itself is not stigmatizing to the individual, but confirm that the attitudes and values of others can be so. Continuing professional development of school leaders and teachers regarding reading and writing development/difficulties is of the utmost importance.Keywords: continuing professional development, diagnosing, dyslexia, knowledge, measures, norms, power, self, stigmatization, valuesSusanne Borgfors Tutor: Ingrid Sandén Examiner: Lena Lang

Rheumatoid Arthritis (RA) is a disease in which the body has "turned on itself", with its immune system attacking mobility. In RA, an immune mechanism attacks and destroys the joints and limits mobility, in some circumstances to the point of needing replacement of joints. The aim of this research is the development of a less costly, widely accessible, passive sensing technology that provides a quantitative assessment of RA and that monitors the therapeutic effectiveness on joint-debilitating diseases. The proposed solution relies on a quantitative evaluation of human gestures. Such a quantitative assessment supports the comparison between the motion capabilities of a patient and that of a healthy person, using a kinematic model of the human skeleton. Criteria for the classification of severity were established, and tables were generated to classify the levels of severity as a function of the measurements extracted from processed videos of a subject performing predefined movements. This research project, while contributing a new tool to the process of classification of RA level of severity, opens the way for using widely accessible digital imaging for diagnosing and monitoring the evolution of the illness. Replacing MRI or HRUS with a cheaper and more accessible technology would have a major impact on health care services. From the clinical point of view, the proposed techniques based on digital images processing combined with a monitoring approach based on infrared images that was previously developed may provide a utility of care for patients with RA, as well as an alternative and automated approach for early detection of RA and active inflammation at a critical time.

Rheumatoid Arthritis (RA) is a disease in which the body has "turned on itself", with its immune system attacking mobility. In RA, an immune mechanism attacks and destroys the joints and limits mobility, in some circumstances to the point of needing replacement of joints. The aim of this research is the development of a less costly, widely accessible, passive sensing technology that provides a quantitative assessment of RA and that monitors the therapeutic effectiveness on joint-debilitating diseases. The proposed solution relies on a quantitative evaluation of human gestures. Such a quantitative assessment supports the comparison between the motion capabilities of a patient and that of a healthy person, using a kinematic model of the human skeleton. Criteria for the classification of severity were established, and tables were generated to classify the levels of severity as a function of the measurements extracted from processed videos of a subject performing predefined movements. This research project, while contributing a new tool to the process of classification of RA level of severity, opens the way for using widely accessible digital imaging for diagnosing and monitoring the evolution of the illness. Replacing MRI or HRUS with a cheaper and more accessible technology would have a major impact on health care services. From the clinical point of view, the proposed techniques based on digital images processing combined with a monitoring approach based on infrared images that was previously developed may provide a utility of care for patients with RA, as well as an alternative and automated approach for early detection of RA and active inflammation at a critical time.