This thesis considers an approach to evaluate the effectiveness of risk communications for prescription drugs by performing interrupted time series analysis of prescription drug volumes prior to and after the risk communication date. The paper presents methods for detecting change in the presence of autocorrelation and techniques to reduce bias in estimation. Statistical results and data plots are presented for 63 data series. Size and power of the statistical techniques are considered, and a correspondence analysis between these statistical techniques and a small group of physicians is performed. The methods considered in this thesis correspond weakly with physician sentiment, and exhibit inflated type I errors in the presence of significant autocorrelation.

This thesis considers an approach to evaluate the effectiveness of risk communications for prescription drugs by performing interrupted time series analysis of prescription drug volumes prior to and after the risk communication date. The paper presents methods for detecting change in the presence of autocorrelation and techniques to reduce bias in estimation. Statistical results and data plots are presented for 63 data series. Size and power of the statistical techniques are considered, and a correspondence analysis between these statistical techniques and a small group of physicians is performed. The methods considered in this thesis correspond weakly with physician sentiment, and exhibit inflated type I errors in the presence of significant autocorrelation.

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Non-compliance with (tuberculosis) TB treatment is a problem at the Nyanga Clinic in the Western Cape Province. Non-compliance is defined as when a patient interrupted TB treatment for more than two months consecutively, at any time during the treatment period. The aim of the study was to explore the patient experiences and perceptions of non-compliance regarding their TB treatment. The following research question was posed by the researcher as a guide for this study: “What are the patient experiences and perceptions of non-compliance with TB treatment?” The objectives of this study were to determine the: - patients’ experiences and perceptions of non-compliance with TB treatment - non-compliant patients’ knowledge regarding TB - reasons why patients are not compliant with TB treatment. A qualitative, explorative, descriptive and contextual design was applied. The target population included the 354 non-compliant with TB treatment patients from March 2010 until May 2011. A purposive, non-random sampling technique was used to select participants for the study. Every tenth participant who, according to the TB register, was colour-coded as non-compliant with TB treatment, was selected for interviewing until data saturation should occurred. A sample of fourteen (14) participants was realised. A semi-structured interview schedule was developed based on the objectives of the study, which was validated by experts in nursing and approved by the Human Resources Ethics Committee of the Faculty of Health Sciences of the University of Stellenbosch. Data was collected personally by the researcher. Informed written consent was obtained from the participants. One patient who was not included in the main study was selected at random to pre-test the semi-structured interview. The pilot study revealed no pitfalls. Trustworthiness of the research was enhanced by adhering to the principles of credibility, confirmability, transferability and dependability. Credibility was ensured by member checking, data saturation, triangulation and involvement of an experienced research supervisor. Confirmability was enhanced through member checking and the leaving of an audit trail. Transferability through keeping an intensive description of all the processes and dependability by using an interview schedule and by submitting the transcribed tape-recorded data and field notes to the research supervisor for verification. The quantitative data was summarised in a table format to enhance clarity and facilitate a rapid overview of the results. The qualitative data was analysed manually with the findings coded and divided into subthemes and themes. Four themes emerged, namely: health system, client-related, social-economic and therapy factors. These themes identified the impeding factors regarding the non-compliance with TB treatment. The main conclusion is that there is a need to educate the community regarding the lengthy duration of the TB treatment, its side-effects, its curability and the spread of the infection as well as the consequences of inadequate treatment to empower the community at large about the disease. The National Department of Health framework of contributing to non-compliance with TB treatment was used as the conceptual framework for this study. The researcher applied the problem-solving approach of Faye Glen Abdellah’s theory. According to this theory it is anticipated that by solving the problems or needs of patients, through appropriate and organised health strategies the client will be moved towards ultimate health. / AFRIKAANSE OPSOMMING: Onderbreking van tuberkulose (TB) behandeling is ’n probleem by die Nyanga-kliniek in die Wes-Kaap Provinsie. Onderbreking kan gedefinieer word wanneer’n pasiënt vir twee of drie opeenvolgende maande TB behandeling onderbreek het (Jaggarajamma, Sudha, Chandrasekaran, Nirupa, Thomas, Santha, Muniyandi & Narayanan, 2007:131). Die doel van die studie is om die pasiënte se ervaringe en persepsies betreffende die onderbreking in TB behandeling te ondersoek. Die navorser het die volgende navorsingsvraag as riglyn vir hierdie studie gestel: “Wat is die pasiënte se ervaringe en persepsies wat TB-behandeling onderbreek het?” Die doelwitte van die studie was om te bepaal wat die: - pasiëntervaringe en persepsies is wat TB-behandeling onderbreek - kennis van pasiënte is wat TB-behandeling onderbreek - redes is waarom pasiënte TB-behandeling onderbreek. ’n Kwalitatiewe navorsingsontwerp met’n ondersoekende, beskrywende en kontekstuele benadering is aangewend. ’n Doelbewuste, lukrake steekproef is gebruik om deelnemers te selekteer. ‘n Steekproef van veertien (14) deelnemers uit ’n totale populasie van 354 hetrealiseer en sluit pasiënte in wat behandeling onderbreek het vanaf Maart 2010 tot en met Mei 2011. ’n Semi-gestruktureerde onderhoudsgids is ontwerp, gebaseer op die doelwitte van die studie en gevalideer deur kundiges in verpleegkunde en die Etiese Komitee van die Fakulteit van Gesondheidswetenskappe aan die Universiteit van Stellenbosch. Die data is persoonlik deur die navorser ingesamel. Ingeligte skriftelike toestemming is van die deelnemers verkry. Een deelnemer wat nie ingesluit is by die hoofstudie nie, is lukraak gekies om die semi-gestruktureerde onderhoud te toets. Die loodsondersoek het geen tekortkominge aangedui nie. Betroubaarheid van die studie is verseker deur die beginsels van objektiwiteit, bevestiging, veralgemening en neutraliteit te verseker. Getranskribeerde data is gekontroleer met die deelnemers, volledige beskrywings van alle prosesse is bygehou, ’n onderhoudsgids is gebruik om te verseker dat vir al die deelnemers dieselfde vrae gevra word, en ’n ervare navorsing toesighouers was deurgaans teenwoordig wat alle data gevalideer het. Kwantitatiewe data is in ’n tabel opgesom ten einde goeie oorsig te bied. Kwalitatiewe data-analise is met die hand gedoen. Die data wat uit die analise na vore gekom het, is geënkodeer en in subtemas en temasgekategoriseer. Die vier temas wat hieruit voortspruit, is faktore betreffende die gesondheidsorgsisteem, kliënte, sosio-ekonomiese en terapie-verwante faktore. Die navorser het n geskrewe verslag saamgestel betreffende die weergawe van die data-analise ten einde te verseker dat belangrike data nie verlore gaan. Die belangrikste bevindinge van die studie dui daarop dat die gemeenskap ’n behoefte aan opleiding het betreffende die onderbreking in TB behandeling, die langdurige tydperk van behandeling, newe-effekte van die medikasie, geneesbaarheid daarvan, hoe die siekte versprei en die gevolge betreffende onvoldoende medikasie ten einde die gemeenskap te bemagtig betreffende die siekte. Die raamwerk van die Nasionale Departement van Gesondheid (2009:45) betreffende die faktore wat bydra tot onderbreking in TB-behandeling is gebruik as konseptuele raamwerk vir die studie. Faye Abdellah se teorie (George, 2002:173-1830)verduidelik verpleging as ’n omvattende diens wat insluit: identifisering van die pasiënt se verplegingsprobleme, die besluit van ’n toepaslike plan van aksie, sowel as die voortgesette sorg betreffende die individu se totale behoeftes.

Recent advances in the fundamental theories in cryobiology using thermodynamic principles have created new opportunities for innovative methodologies in cryobiology. This thesis tested the hypothesis that calculated indicators of the two-factor hypothesis of cryoinjury, depending on cellular osmotic properties, will describe outcomes of cryobiological experiments. In addition, this thesis demonstrated that knowledge gained from improved descriptions of cellular osmotic parameters allows better understanding of cryoinjury and cryoprotection. The main objective of this thesis was to develop approaches using simulations that can be applied to development of cryopreservation procedures for cell types of interest for therapies. In order for this approach to be successful, a method to more accurately describe the osmotic solution properties of the cell (i.e. osmolality as a function of molality for the cytoplasm) was developed. Also, in-depth examination into the correlation between predictions of the two types of cryoinjury and measured post-thaw biological outcomes was required. The work presented in this thesis has shown that simulations, based on cell-specific osmotic characteristics, and coupled with interrupted cooling procedures can be used to determine conditions that minimize the two identified damaging factors in cryopreservation. Based on results from this research, both intracellular supercooling and osmolality, as indicators of intracellular ice formation and solution effects injury, respectively, should be calculated when attempting to compare simulations with biological experimentation. This thesis has also shown a novel method of obtaining the solution properties (i.e. osmolality as a function of molality) of the cytoplasm of living cells using equilibrium cell volume measurements. Using these newly calculated parameters, this research also demonstrated the magnitude of error introduced by making dilute solution assumptions of the solution properties in cellular responses to low temperatures, including simulations of interrupted freezing procedures. Overall, the research work presented in this thesis has extended the approach to cryopreservation to include the properties of the cell and the physical conditions of the freezing environment, which was only possible through the linkage between biological experimentation and simulations.

An increasing number of newcomer English language learners (ELLs) in Canadian high schools are from refugee backgrounds, have a history of interrupted formal schooling (IFS), and do not have alphabetic and numerical literacy skills in their first language (MacKay & Tavares, 2005; Yau, 1995). While ELLs with IFS pose challenges for Canadian high schools and teachers, the struggles faced by these learners to integrate and succeed in their new educational environments are far more complex. This study aimed to gain insight into how two teachers are attempting to support the academic, linguistic and social integration of ELLs with IFS. Through classroom observations, interviews and document analysis, I examined the envisioned, enacted and experienced stages of two Manitoba high school programs that were created specifically for ELLs from refugee backgrounds who have disrupted or limited formal schooling and are at high risk of academic failure. The findings from this study revealed how teacher agency and divisional as well as administrative input significantly alter current and future learning opportunities for ELLs with IFS. The unique circumstances of each school’s Intensive Newcomer Support classrooms, i.e. student population, support services, teaching practices and administrative decisions, were found to impact the design and delivery of each school’s program and thus the experiences of the students. This study identifies how two teachers in Winnipeg, Manitoba, Canada, attempted to provide a meaningful and relevant education for their ELL with IFS students. It is the researcher’s hope and intent that this study will inform educational policy, teacher education and educational development initiatives both in Canada and in the various international contexts that serve refugees.

An increasing number of newcomer English language learners (ELLs) in Canadian high schools are from refugee backgrounds, have a history of interrupted formal schooling (IFS), and do not have alphabetic and numerical literacy skills in their first language (MacKay & Tavares, 2005; Yau, 1995). While ELLs with IFS pose challenges for Canadian high schools and teachers, the struggles faced by these learners to integrate and succeed in their new educational environments are far more complex. This study aimed to gain insight into how two teachers are attempting to support the academic, linguistic and social integration of ELLs with IFS. Through classroom observations, interviews and document analysis, I examined the envisioned, enacted and experienced stages of two Manitoba high school programs that were created specifically for ELLs from refugee backgrounds who have disrupted or limited formal schooling and are at high risk of academic failure. The findings from this study revealed how teacher agency and divisional as well as administrative input significantly alter current and future learning opportunities for ELLs with IFS. The unique circumstances of each school’s Intensive Newcomer Support classrooms, i.e. student population, support services, teaching practices and administrative decisions, were found to impact the design and delivery of each school’s program and thus the experiences of the students. This study identifies how two teachers in Winnipeg, Manitoba, Canada, attempted to provide a meaningful and relevant education for their ELL with IFS students. It is the researcher’s hope and intent that this study will inform educational policy, teacher education and educational development initiatives both in Canada and in the various international contexts that serve refugees.

No description available.

Osteoporosis is a common health problem and it is increasing in prevalence due to the increase in the aging population. The interest to treat osteoporosis has increased in recent years, due to availability of screening modalities, advances in medications that may prevent osteoporotic fractures. Many studies have showed the high medical and economic burden of the disease on the patients, their caregivers and on the health system. Clinical practice guidelines for management of osteoporosis varied nationally and internationally, and the adherence of physicians to guidelines were always reported as suboptimal, though most studies were for after fragility fracture care gap and vert few looked at the primary screening to identify patients at risk before the occurrence of fractures. This thesis is composed of two manuscripts research project assessing the development and impact of screening for osteoporosis guidelines. The first chapter is an overview of osteoporosis, definition, risk factors, diagnosis and treatment. A follow up discussion of the literature on adherence of physicians to the osteoporosis guidelines, which ends up with the rational for this thesis. The first paper is a systematic review to identify guidelines for screening for osteoporosis from 2002-2016 (Chapter 2). We assessed the quality of these guidelines using the AGREE II and IOM standards, compared between the two tools, and assessed if the quality has changed over time. We extracted recommendations in key areas with summary of the systems that were used to assign the level of evidence and strength of recommendations. We found that the quality of guidelines has varied greatly between different countries with no significant change over time. The recommendations and systems for level of evidence were variable and all this may create confusion to clinicians. In the second paper, we used an interrupted time series design to assess the effect of three clinical practice guidelines for screening for osteoporosis in Ontario on the baseline bone mineral density (BMD) testing for older adults 65 years of age and above using administrative data by ICES from 1998-2006. All three guidelines recommend baseline BMD testing for this age population. In addition, we analyzed the pattern of repeated testing in accordance with the latest guideline. We have found low rates of baseline BMD testing with a decreasing pattern of testing. The last guideline in 2010 had gradually increased the trend of BMD testing, though it was a very small change. Stratified analyses by sex showed that the decrease in the total BMD testing is due to decrease in the testing for female population while there is an increasing trend of BMD testing in male population. CPG by Osteoporosis Canada in 2010 caused an immediate reduction in the BMD testing for female, yet, over a period of time, the guideline increased the BMD testing. For male population; the 2002 CPG had immediately increased the BMD testing, while over time this trend has decreased. Despite the low baseline BMD testing by physicians, there is an over use of repeated BMD testing in the low risk population, especially the annual and the 2 yearly BMD repeats. In conclusion: This research project found a varied quality of guideline development and reporting of guidelines for osteoporosis screening, and no improvement in the quality over time (2002-2016). Several systems were used to assign the level of evidence and strength of recommendations with conflicting recommendations between different health organizations in the same country such as in Canada. Many tools are available to appraise the quality of guidelines, however, comparing between two tools (AGREE II & IOM standards) showed that they may give conflicting results for guidelines quality. There is no effect of guidelines for screening for osteoporosis on the ordering of BMD testing to screen adults 65 years and above living in Ontario between 1998- 2016. A small increase the rate of baseline BMD testing followed the release of the 2010 guideline. For male population the 2002 guideline showed an evident immediate and gradual effect over time on the rate of baseline BMD testing ordering for male population. Despite the low baseline BMD testing rates for adults 65 years and above, there is an unnecessary repeated BMD testing for low risk population in Ontario between 2011-2016 which is not in compliance to the latest guideline for screening for osteoporosis.

Background: The abrupt transition of a signal from off to on and vice versa typically produces spectral splatter that can mask other signals that are spectrally removed from the nominal signal frequency. Both the Miller and Licklider (1950) and Cherry (1953) studies of interrupted speech and alternated speech, respectively, acknowledged the generation of extraneous noise by the rapid on and off characteristics of their unshaped signals but noted for slower interruption rates (e.g., 10 interruptions per second); the masking effects were minimal. Recent studies of interrupted speech have avoided this issue by shaping the rise-fall times with a digital algorithm (e.g., Jin and Nelson, 2010; Wang and Humes, 2010). A second variable in the interrupted speech paradigm is the temporal location or placement of the interruptions (i.e., where in the waveform the interruptions occur). Here the issue is this: what parts of an utterance are necessary to enable intelligibility (e.g., Fogerty and Kewley-Port, 2009)? Interruptions may or may not disturb these necessary cues. Purpose: Here is the prompting question: do shaped and unshaped rise-fall characteristics of the on-segments of interrupted speech produce the same or different recognition performances? A second question arises: are recognition performances on complementary halves of an interrupted signal the same or different? Research Design: This study used a mixed-model design with two within-subject variables (unshaped and shaped rise-fall characteristic, complementary halves) and one between-subjects variable (listener group). Study Sample: A total of 12 young listeners (age range: 19-29 yr) with normal hearing and 12 older listeners (age range: 53-80 yr) with hearing loss for pure tones participated. Data Collection and Analysis: A total of 95 consonant-vowel nucleus-consonant words were interrupted (10 interruptions per second; 50% duty cycle) by parsing alternate 50 msec segments to separate files, which provided complementary temporal halves of the target word referenced to word onset; the first on-segment of the 0 msec condition started at word onset, whereas the first on-segment of the 50 msec condition started 50 msec after word onset. The interruption routine either applied no shaping of the 4 msec rise-fall times or a cos2 shape. Each listener received 25 practice words then a unique randomization of 280 interrupted words (70 words, 2 rise-fall shapes, and 2 interrupt onset conditions). Results: The listeners with normal hearing performed 8-16% better on the various comparable conditions than did the older listeners with hearing loss. The mean performance differences between shaped and unshaped rise-fall characteristics ranged from <1-3% and were not significant. Performance was significantly 10-17% better on the 0 msec condition than on the 50 msec condition. There was no significant interaction between the two main variables, rise-fall shape, and onset time of the interruptions. Conclusions: The rise-fall shape of the onset and offset of the on-segment of the interruption cycle does not affect recognition performance of words. The location of the interruptions in a word can have a significant effect on recognition performance.

Sedan år 1998 har det i Nollvisionens fotspår startats ett utvecklingsprogram i Sverige som syftar till att omvandla gamla 13 meters landsvägar och motortrafikleder till mötesfria. Implementeringen var tänkt att påtagligt reducera antalet mötes- och omkörningsolyckor samt singelolyckor med svåra konsekvenser i form av svårt skadade och dödade utan att försämra trafiksäkerheten i övrigt. Syftet med denna studie är att göra en effektmätning av de mötesfria vägarnas införande i Karlstadsregionen samt att göra en sammanställning av de olycksrisker mötesfria vägar omfattas av. Frågeställningarna som används i studien är: - Har det blivit säkrare på vägarna sedan implementeringen av mötesfria vägar i Karlstadsregionen? - Hur sker olyckor på mötesfria vägar inom Karlstadsregionen?  För att beskriva hur olyckor sker på mötesfria vägar inom Karlstadsregionen har en deskriptiv analys tillämpats som grundats på de beskrivningar av händelseförlopp som dokumenterats i STRADA och CORE, mellan åren 2010-2013. För att avgöra huruvida vägarna blivit säkrare sedan implementering tillämpades en segmenterad linjär regressionsanalys där antalet personskadeolyckor studerats, tre år innan och tre år efter ombyggnad för respektive vägavsnitt. Singel- och upphinnandeolyckor var de dominerande olyckstyperna på mötesfria vägar i Karlstadsregionen mellan åren 2010-2013 då de sammanlagt stod för 72,3% av samtliga olyckor som medfört skada. Vid kategoriseringen av huvudorsak till olycka framgick det att 42% av alla olyckor kan spåras till brister i samspel mellan trafikanter och väderförhållanden bedömdes i 24,1% av fallen vara huvudorsak till olycka. Den statistiska analysen var inte signifikant, men gav indikation på att vägarna blivit säkrare sedan implementering då trenden för samtliga skadade minskat. / In the footsteps of Vision Zero, a development program in Sweden was initiated in 1998. The program aimed to increase road safety on existing 13-meter roads and express roads by implementing median barriers. The purpose of this study is to measure the impact of the transformed roadways in the Karlstad region and to examine the different types of accident risks the roadways are covered by. The research questions used are: - Has the implementation of median barriers in the Karlstad region contributed to safer roads? - How do accidents occur on roads with median barriers? To describe how accidents occur on roads with median barriers in Karlstad region a descriptive analysis was made by the description of event that is documented in STRADA and CORE, between the years 2010-2013. To determine whether the roads became safer after implementation a segmented linear regression analysis was applied. Accidents resulting in injury were examined, three years before and three years after reconstruction for each road section. Single-vehicle accidents and rear-end collisions were the dominating accident types on roadways with median barriers in the Karlstad region between the years 2010-2013. They together accounted for 72,3% of all accidents that resulted in injury. When the main cause of accident was examined, it emerged that 42% of all accidents could be traced to deficiencies in the interaction between road users. Weather conditions were estimated to be the main cause of accident in 24,1% of all the studied cases. The statistical analysis was not significant, but indicated that the roads became safer after the implementation since the observed trend for all types of injured decreased.