No description available.

Introduction Asthma is a common and heterogeneous disease in primary care. Asthma phenotypes are recognisable clusters of for example clinical characteristics. Current asthma symptoms and previous exacerbations are used to assess the level of asthma control. Asthma control is used clinically to plan follow-up strategies. Aim The aim of this study is to examine if an data-driven algorithm based on sex and age of onset can categorize an asthma population at a primary care center into three phenotypes with different risk of disease. To investigate if the results can be generalized by comparing to an epidemiological survey in Sweden. Secondary aims are to investigate if these phenotypes predict the level of follow-up and which factors influence asthma control. Methods In this cross-sectional study, 335 participants from one primary care site and 1442 participants from an epidemiological study were compared on sex, age, medical treatment, respiratory allergy, smoking, asthma symptoms and exacerbations. Logistic regression analyses focusing on factors affecting asthma control were performed in a consolidated dataset. Results An adult asthma population can easily be categorized according to the data-driven algorithm. However, these phenotypes do not predict follow-up strategies. Clinical follow-up based on level of asthma control, did not differ between the phenotypes. There were statistically significant differences between the phenotypes regarding respiratory allergy and smoking. In the logistic regression, smoking has the highest odds for poor asthma control. Conclusion The clinical use of the data-driven phenotypes were limited. Follow-up strategies are probably best based on traditional clinical outcomes like asthma control.

Syftet med studien var att undersöka patientupplevelsen vid behandling med sömnapnéskena hos patienter med diagnosen obstruktiv sömnapné utförda i allmän tandvårdspraxis. Studien genomfördes som en tvärsnittsundersökning i en av de större regionerna i Sverige, region Skåne. Undersökningen var retrospektiv i sin design och bestod av en enkät sänd till de patienter med en verifierad obstruktiv sömnapné som fått sin odontologiska behandling som ett led i sjukdomsbehandling. Behandlingen skulle ha pågått minst 6 månader. Enkäten skickades ut till 1148 patienter, varav 738 svarade (64 %). Enkäten bestod av 70 frågor och påståenden inom olika domäner som: allmänhälsa/livsstil, användning av sömnapnéskena, symtomförändringar, sömnrelaterade upplevelseförändringar, vårdbemötande, utvärdering av behandling, värde av behandling, förändringar i livssituation och dagsömnighet.Behandling med sömnapnéskena gav symtomlindring vid obstruktiv sömnapné för majoriteten av patienterna. Livskvalitet, somatiska och kognitiva symtom förändrades signifikant positivt för patienterna som använde sin behandling frekvent. Dagtröttheten reducerades för majoriteten av de behandlade patienterna. Nöjdhet med behandlingen och att rekommendera liknande behandling för en vän var hög.Behandling av obstruktiv sömnapné med intra-oral apparatur utförd i allmän praxis lindrade tillståndet och dess konsekvenser enligt patientens egenbedömning. / The purpose of this study was to investigate the patient’s experiences in treatment of obstructive sleep apnoea with a mandibular advancement oral appliance conducted in general dental practice. The study was conducted to study a cross-section of patients in one of the major regions of Sweden, region Scania. The study was retrospective in its design and consisted of a postal questionnaire to 1148 patients with a treatment period of more than 6 months. The questionnaire comprised 70 questions and assertions in various domains: general health/ lifestyle, use of oral appliance, changes in symptoms, sleep-related experience changes, evaluation of treatment, value of treatment, changes in life situation and daytime sleepiness. The responder rate was 64%. Treatment with oral appliance gave relief of symptoms in the majority of patients with obstructive sleep apnoea. Quality of life, somatic and cognitive symptoms changed significant positively in patients who used the treatment frequent. The daytime sleepiness was reduced for the majority of the treated patients. The satisfaction with the treatment and the will to recommend a similar treatment for a friend was high. Treatment of obstructive sleep apnoea with an oral appliance performed in general dental practice relieved the condition and its consequences according to the patient's own judgement.

Childhood anxiety disorders are often considered gateway disorders: having an anxiety disorder in youth is associated with a higher likelihood of developing a related psychological disorder in adulthood. Successfully treating youth with anxiety disorders may reduce the likelihood of subsequent anxiety, depressive, and substance use disorders later in life. This study evaluates follow-up outcomes associated with treatment for childhood anxiety by comparing successfully and unsuccessfully treated participants 16 years after the completion of treatment. A sample of 66 youth (ages 7 to 14 at time of initial study treatment, ages 18 to 32 at present follow-up) who had been diagnosed with an anxiety disorder and randomized to treatment in a randomized clinical trial on average 16.24 (SD = 3.56) years prior participated in the present follow-up evaluation that included self-report measures and a diagnostic interview conducted to assess anxiety, depression, and substance misuse. Results indicate that, relative to those who respond successfully to CBT intervention for an anxiety disorder in childhood, those who were less responsive to CBT for childhood anxiety had higher rates of panic disorder, alcohol dependence, and drug abuse in adulthood. The present study is the first to assess the 16-year follow-up effects of CBT treatment for an anxiety disorder in youth on anxiety, depression, and substance abuse through the period of young adulthood when these disorders are often seen. / Psychology

The way in which a school division addresses the problem of an unsatisfactory teacher varies. A school division may choose to tolerate the problem, dismiss the teacher, or provide assistance to foster the development of the skills needed to meet minimum performance standards. The design of teacher assistance programs varies in the type of personnel who provide remediation and the extent to which events in the program are documented. This study describes the status of teacher assistance programs that were operational in Virginia during the 1988-89 school year. A survey instrument was distributed to each school division in the Commonwealth of Virginia. First, all of the existing programs were identified. Each program was classified by degree of formality: informal, semi-formal, and formal. Each program was further classified by the type of staff utilized: school-based and central office-based staff. Secondly, the categories were developed into a model of teacher assistance programs for comparison. / Ed. D.

In an attempt to evaluate the impact of vocational education programming on post-release performance, a study was conducted to gather follow-up data on students who were released from the Department of Correctional Education School at Natural Bridge Juvenile Correctional Center (NBJCC) during the 1993 and 1994 calendar years. The population for this descriptive study consisted of 167 males age 17 to 21. Data were successfully collected on 137 members of the population. Findings from the study were as follows: 1. Nearly half of the total study group were employed. 2. Approximately one fourth of the total study group continued their education. 3. Students who earned a vocational education certificate of completion were more likely to be employed than students who earned a lesser vocational certificate of credit or no vocational certificate at all. 4. Students who earned a vocational certificate of completion and a General Education Development (GED) certificate were more likely to be employed than all other NBJCC students. 5. Less than half of all vocational program completors were employed in a field related to their vocational training. 6. Nearly half of all vocational program completors were employed in food service. (Not a field of vocational training at NBJCC) Based on the findings and conclusions in this study, recommendations for policy practice and research in vocational education are provided. / Master of Science

Experiential learning theory stresses the importance of adequate preparation and reflection surrounding concrete experiences. This study explores the relationship between preparation and follow-up classroom experiences and the outcomes of environmental education (EE) field trips, including environmental literacy, 21st century skills, positive youth development, satisfaction, and self-reported behavior change. Surveys with both students and their school teachers who attended over 300 EE programs reveal that both pre-trip preparation, especially concerning logistics, and post-trip follow up, related to the subject matter of the field trip, were significantly related to more positive student outcomes. The authors recommend both schools and organizations take into consideration how they can work together to create more holistic learning experiences. / Master of Science / Environmental and science education in the form of school field trips have the capability of to enhance student learning, increase motivation to do well in school, and develop skills such as thinking critically and collaborating with peers. Learning theory illuminates the importance of in-school preparation and reflection surrounding field trips. We wanted to discover what happens in the classroom before and after these field trips that contribute to creating truly valuable educational experiences. Student and teacher surveys from over 300 field trip programs highlight the importance of preparing students both logistically and with the educational content, as well as following-up after the field trip by reviewing and utilizing newly gained knowledge and skills. We recommend schools and field trip providers, such as parks, zoos and nature centers, collaborate to create more holistic science learning experiences.

The main campus of Virginia Polytechnic Institute and State University (Virginia Tech) has a current parking inventory of approximately 14,310 parking spaces in 88 surface lots. Of the available parking spaces 92% are designated for the use of Virginia Tech students, faculty and staff members. The share of visitor usage of these parking spaces is approximately 2%. The objective of this thesis is to evaluate the current visitor parking system and develop techniques to enhance the parking facility operations. The current visitor parking demand is determined by conducting a field evaluation of the visitor parking in five parking lots. Personal and follow-up interviews were conducted with university visitors to determine their satisfaction levels with the existing parking facilities. While the survey results demonstrated that 52% of visitors rated the parking services to be good or very good, the study also showed that approximately 28% of the visitors did not know the location of the most convenient parking lot to access their destination and almost 6% were not satisfied with the parking services offered by Virginia Tech. Apart from this, about 32% of the visitors had to visit at least 2 parking lots before finding a parking space. These figures clearly demonstrate a need for a better management of the parking lots to serve the visitors in an efficient way. In an attempt to enhance the visitor parking system a web-based interactive framework is proposed. This framework identifies the best possible parking lot(s) for a selected destination considering various factors like - distance of the parking lot to the destination and typical occupancy of the parking lot at specific times of the day and other relevant factors. The web-based interactive system is designed to provide the visitor with two or more choices for the parking in order to arrive at their desired destination. / Master of Science

Yes / Aims: There is a clear association between alcohol use and offending behaviour and significant police time is spent on alcohol-related incidents. This study aimed to test the feasibility of a trial of screening and brief intervention in police custody suites to reduce heavy drinking and re-offending behaviour. Short summary: We achieved target recruitment and high brief intervention delivery if this occurred immediately after screening. Low rates of return for counselling and retention at follow-up were challenges for a definitive trial. Conversely, high consent rates for access to police data suggested at least some outcomes could be measured remotely. Methods: A three-armed pilot Cluster Randomised Controlled Trial with an embedded qualitative interview-based process evaluation to explore acceptability issues in six police custody suites (north east and south west of the UK). Interventions included: 1. Screening only (Controls), 2. 10 min Brief Advice 3. Brief Advice plus 20 min of brief Counselling. Results: Of 3330 arrestees approached: 2228 were eligible for screening (67%) and 720 consented (32%); 386 (54%) scored 8+ on AUDIT; and 205 (53%) were enroled (79 controls, 65 brief advice and 61 brief counselling). Follow-up rates at 6 and 12 months were 29% and 26%, respectively. However, routinely collected re-offending data were obtained for 193 (94%) participants. Indices of deprivation data were calculated for 184 (90%) participants; 37.6% of these resided in the 20% most deprived areas of UK. Qualitative data showed that all arrestees reported awareness that participation was voluntary, that the trial was separate from police work, and the majority said trial procedures were acceptable. Conclusion: Despite hitting target recruitment and same-day brief intervention delivery, a future trial of alcohol screening and brief intervention in a police custody setting would only be feasible if routinely collected re-offending and health data were used for outcome measurement. / NIHR School for Public Health Research (SPHR) (SPHR-SWP-ALC-WP2). Fuse is a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Funding for Fuse from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, under the auspices of the UKCRC, is gratefully acknowledged.

Improved definition of risk factors for equine colic is necessary to develop effective interventions to reduce colic incidence. A one-year prospective study was conducted to estimate colic incidence and to identify risk factors. Farms with greater than 20 horses were randomly selected from two adjacent counties of Virginia and Maryland. Management information was recorded by questionnaire for 31 farms with 1427 horses. Owners kept calendars to record occurrence of specified events. Colic was reported by the owner when a horse exhibited signs of abdominal pain. The incidence of colic was 10.6 colic cases per 100 horse-years, based on 104 cases per 983.5 horse-years. Twenty-five deaths occurred from all causes, the proportional mortality rate of colic was 7/25 (28%). Risk factors were analyzed by logistic regression at the farm-level and the horse-level with farm as a random effects variable. No farm-level variables were significant. Significant horse variables were: age 2-10 years, odds ratio (OR)=2.8 (95% confidence interval, 1.2-6.5); previous colic, OR=3.6(1.9-6.8); changes in concentrate feeding during the year, OR=3.6(1.6-5.4); more than one change in hay feeding during the year, OR=2.1(1.2-3.8); feeding high levels of concentrate (>2.5 kg/day dry matter, OR=4.8(1.4-16), >5 kg/day dry matter, OR=6.3(1.8-22)); and vaccination with monocytic ehrlichiosis vaccine during the study, OR=2.0(1.8-22). Feeding whole grain with or without other concentrates had less risk than diets without whole grain included. Variables related to concentrate feeding frequency or concentrate type could be substituted for the concentrate level variable. A nested analysis examined risk for the time period following an event. The odds ratio was determined for the proportion of cases with an event within 14 days prior to the colic-date, relative to the proportion of horses without colic with an event within 14 days of a date chosen at random from the observation time. Weather events were analyzed for the three days before the colic or assigned date. Foaling was analyzed for three time periods: before, 0-60 and 60-150 days post-foaling. Significant events were recent vaccination, OR=3.31(1.9-6.0); recent transport, OR=3.3(1.2-5.5); 60-150 days post-foaling, OR=5.9(1.8-13); and recent fever, OR=20(2.5-169). Snow on the day of the colic, OR=2.8(1.0-7) and humidity <50% the day before the colic OR=1.6(1.0-2.9) were marginally significant. / Ph. D.