The spectrum of acute pancreatitis (AP) affects between 4.9 and 73.4 patients out of 100,000 worldwide annually (Tenner, Baillie, DeWitt, & Vege, 2013). AP uses the Atlanta classification system to establish a diagnosis of mild, moderate, or severe. The American College of Gastroenterology (ACG) has established comprehensive clinical practice guidelines (CPG) for the management of AP, the most recent version published in 2013 (Tenner et al., 2013). There have been similar CPGs published internationally that integrate current evidence-based research into recommendations for practice. These guidelines along with the ACG's guidelines recommend initiating a diet for mild acute pancreatitis patients due to research findings of improved patient outcomes (i.e. reduced length of hospital stay, decreased rate of infections, and reduced mortality) (Horibe et al., 2015; Lariño-Noia et al., 2014). There is an international awareness of the need for increased CPG nutrition recommendation compliance in the practice setting as many studies have found providers prefer to keep patients nil per os (NPO) and do not adhere to CPGs (Andersson, Andrén-Sandberg, Nilsson, & Andersson, 2012; Greenberg et al., 2016; Sun et al., 2013). The purpose of this doctor of nursing practice (DNP) project is to assess providers' current nutrition therapy practice and knowledge of the ACG’s CPG nutrition recommendations for mild AP patients. The researcher conducted the assessment with a hospitalist practice at Banner University Medical Center in Phoenix, Arizona. The results of the project contribute to the current body of research on national adherence to CPGs for AP and act as a needs assessment for future projects where a nutrition protocol order set may be established. The investigation of nutrition therapy for AP patients seeks to improve and standardize the care this patient population receives while in the acute care setting.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Department of Chiropractic and Somatology, Durban University of Technology, Durban, South Africa, 2016. / Background Chiropractic is practiced in over 100 countries and is considered to be the fastest growing health care profession internationally. Several studies investigating the practice characteristics of chiropractors have been conducted in selected countries, however, as far as is known, no study has been conducted where chiropractors from countries across the globe are assessed for their practice characteristics in order to determine if regional differences exist. Gaining insight into chiropractic practice and its influencing factors, relating to both the profession itself and the chiropractor can enable organisations such as the World Federation of Chiropractic to have a greater understanding of how chiropractors are currently practicing and how the profession is being utilised by the public. Improved insight into the profession provides a baseline description for the public and other health care practitioners to fully comprehend what chiropractors can offer to the health care system. Aim: The aim of this study was to determine the demographic profile and practice characteristics of chiropractic delegates attending the World Federation of Chiropractic’s 12th Biennial Congress 2013. Method A pre-validated questionnaire and letter of information and consent was distributed to all registered chiropractic delegates (N = 406) attending the World Federation of Chiropractic Congress in Durban, Kwa-Zulu Natal 2013. The questionnaire was part of the delegate packages and they self-selected to participate. Due to a low response rate at the congress, the questionnaire was made available electronically on Survey Monkey®, for six weeks after the congress. Questions relevant to this study were coded, reduced where necessary and utilised for data analysis with IBM SPSS Version 21. Descriptive data was then summarised and presented using tables and graphs. The study was approved by the Durban University of Technology’s Institutional Research Ethics committee. Results: The response rate was 34.72%, with 52.5% being female, mean age was 42 (SD ± 13years, and all seven geographical regions were represented. The majority of respondents were from Africa (51.1%), followed by North America (22.7%) then Europe (14.2%). South Africa (48.6%) was the most represented country. Respondents held either a Master’s degree in Chiropractic (51.8%) or a Doctor of Chiropractic (DC) degree (48.2%). The mean years since graduating as a chiropractor was 15.7 years (SD ± 3.6). The majority of respondents (71.2%) engaged in full-time clinical practice, for between 5 to 15 years (39.8%) with 51.4% purporting to have an evidence based philosophical approach to practice. The majority (72.5%) viewed the role of a chiropractor in the health care system as a primary health care practitioner with a focused scope of practice. The majority of respondents (n = 52) personally treated 50 patients or less per week, with approximately one third of the respondents (n = 34) having high volume practices (>100 patients weekly). The respondents favoured being one of two chiropractors (36.9%) in a practice setting followed by sole practices (31.6%). The top chiropractic technique utilised was the diversified technique (74.5%) followed by extremity adjusting (68.8%). Various adjunctive, active and passive, axillary techniques were utilised in the daily management of patients. The patient demographics were majority female (55.7%), older than 30 years of age (66.7%) and Caucasian (77%), complaining of head, neck, mid-back and low back pain, which was mostly acute in nature. Trends suggested that females were more likely to select an evidence-based philosophical orientation than males. Females were more likely to delegate adjunctive therapies to non-chiropractic assistants (p = 0.029), and favoured sending patients to a physical therapist (p = 0.018), whereas males were more likely to refer to nutritionists and paediatricians (p = 0.030 and p = 0.038, respectively). Females were less likely to utilise mobilisation techniques (p = 0.008), massage therapy (p = 0.018) and nutritional counselling (p = 0.032). In terms of age, those selecting an evidence-based approach were significantly older than those who adopted a mixer approach to practicing (p = 0.002). The mean age of the respondents, irrespective of the region, was not significantly associated with the number of patients treated per week (p = 0.377) or the hours worked per week (p = 0.474). Trends show that the number of years spent in practice differed among the regions with North American chiropractors spending more years in practice than those from Europe and Australasia. The respondents from South Africa spent fewer years in practice (15 years or less) than respondents from Asia, Australasia, Europe and North America. Geographic region was not significantly associated with practice setting (p = 0.182). The only chief complaint that differed between regions was patients presenting with headaches accompanied by neck pain (p = 0.007), where Asian and North American respondents reported seeing less patients than their colleagues from other regions. Trends suggested that the respondents who attained a Masters of Technology in Chiropractic were more inclined to select a mixer orientation whereas those with a DC qualification selected an evidence-based philosophical approach. Conclusion: The WFC congress provided a platform to successfully determine the demographic profile and practice characteristics of chiropractors from various regions. Similar demographics were evident, with males no longer showing dominance within the profession. Chiropractors adopting an evidence-based and mixer philosophical orientation are synonymous in the role that they play in the health care system and display similarities in chiropractic practice and patient management. Investigating chiropractors who adopt a straight philosophical approach would be beneficial as it will allow for better comparison of demographics and practice characteristics. It is evident that selected demographics do influence how one would opt to practice, with regional differences showing that the chiropractic profession in South Africa is still relatively young. / M

Staff training packages combining instructions, modeling, practice, and feedback have been shown to be effective in demonstrating skills to work in early intensive behavioral intervention, but maintenance and generalization of the skills trained are often not addressed. Establishing a community of practice, in which staff members continue to learn and develop new skill sets from one another through shared experiences and information, may lead to the endurance and maintenance of desired staff behavior over time. The purpose of the current study is to evaluate the effects of a behaviorally designed community of practice on staff use of socially embedded consequences. The effects of the training procedure were evaluated using a concurrent multiple baseline design across two sites (7 staff members). The results suggest that the behaviorally planned community of practice was effective in reinforcing and maintaining staff use of socially embedded consequences for at least 5 to 9 weeks. Additionally, the number of learning opportunities provided by the staff and social engagement between staff and child increased.

The implementation of evidence-based practices has great potential to improve the quality of children’s services; however, with a large variety of available practices, it can be challenging to select targets for quality improvement in community-based treatment. This study used a method called relevance mapping to identify how thoroughly evidence-based programs could cover a specific population of children seeking services at a large public agency and identify practice elements relevant to these clients. A therapist survey was used to examine current practice at the agency. Eight therapists at the agency reported on their practice delivery for 141 clients. Results from relevance mapping and therapist surveys were combined to create practice profiles for two predominant diagnostic categories seen at the agency: substance use and depression. These practice profiles were used to identify three areas of interest for agency quality improvement with regard to practice element delivery: Agency Strengths, Opportunities, and Weaknesses. Results demonstrate a potential blueprint for tailoring specific feedback to an agency for use in quality improvement efforts.

Creating immersive performance design using mycorrhizalstructure methodology and iceberg theory in circusperformance settingsWhat is immersive performance design and what role does ithave in a performance-based setting and frame? Does it holdthe possibility and capability of challenging the frame in whichwe normally perform?The focus of my research is to explore the boundaries of howwe approach devising performance with particular attentionto the relationships in space and the proximity of objects andparticipants within this. I am to create a performance-basedmilieu in which spectators, practitioners, the space andobjects are in symbiosis. A space of symbiosis where no oneperson has a different status from the other, but a space thatallows for people holding different roles. The performer andthe audience, the object and the body. My definition ofsymbiosis draws inspiration from the mycorrhizae funginetwork as a starting point for me to mould a methodologyadapted to a performative setting. To this milieu I incorporateother factors and concepts, such as the role of text, thedialogue of the still and quiet and how our senses-experienceaffect our perception. I attempt to weave these concerns intomy circus practices

Study Objective: Drug-related problems (DRPs) are associated with increased rates of infection, rejection, and graft loss in kidney transplant recipients. This study aimed to develop a model to predict which patients are at highest risk of DRPs to streamline pharmacists’ workflow in a chronic kidney transplant clinic. Design: Prospective observational study. Setting: Chronic kidney transplant clinic at a large, tertiary care, academic hospital. Patients: Two hundred thirty-seven adults seen in the kidney transplant clinic between September 16, 2015, and November 30, 2015, who were at least 90 days posttransplantation at the time of their clinic visit. Measurements and Main Results: Prospective data detailing DRPs and a survey assessing baseline characteristics and patient-related outcomes were used to generate a predictive model to identify patients at risk of having six or more DRPs; the cutoff of six DRPs provided a threshold for identifying a subset of high-risk patients on whom the transplant pharmacists could focus their efforts. DRPs were categorized as nonadherence, overdosing or underdosing, duplication of therapy, preventable adverse drug reaction, missing medication, erroneous medication, conflicting provider information, undermonitoring or lack of monitoring, and wrong medication received. In total, 865 unique DRPs were identified, and the most common were erroneous medication, missing medication, and nonadherence, accounting for 38%, 21%, and 16% of the DRPs, respectively. A nine-variable model with a sensitivity of 62.5% and specificity of 66.7% (area under the receiver operating characteristic curve of 0.720) was developed to identify patients at risk of having six or more DRPs. The model included the following variables: age, Medicaid for prescription insurance, current employment status, medication affordability, difficulty or lack of difficulty obtaining medications from the pharmacy, negative impact of medications on quality of life, medication nonadherence, poor rating of current health status, and moderate or poor medication understanding. Conclusion: These results demonstrated that a straightforward, 5-minute survey completed by renal transplant recipients prior to their clinic visit may be capable of effectively determining those at risk of having six or more DRPs, potentially allowing use as a screening tool for transplant pharmacists’ workflow prioritization. External validation is needed before this tool can be used in the outpatient setting.

<p> Considerable controversy exists about how motor skills come to be represented in memory as a product of practice. One line of research advocates specificity effects, whereby skills are considered highly specific to the conditions under which they are learned. An alternative view suggests that motor control is flexible and non-specific; that motor skills are represented in a more general manner, whereby the representation is an abstraction of the products ofpractice. Although experimental findings exist that support both specificity and generality of motor skills, such evidence has emerged from very different experimental conditions and paradigms, making direct comparisons difficult. An important and interesting question then is what would happen if both specificity and generality effects could be documented within a single paradigm? And what could be said about motor control theory if such effects co-exist? </p> <p> The possibility that a single memory representation may be developed for an entire class of skills (i.e., generality), but that performance of one member of that class may be distinguished from the rest (i.e., showing specificity effects) was examined. The basketball set shot (characterized by the feet remaining planted on the floor during execution) performed by highly-skilled players represents such a class of skills. Skilled performers have massive numbers of practice attempts of the set shot, however taken predominantly at 15-ft. (free-throws from the foul-line), with only minimal practice at other locations (in front of and behind the foul-line or at different angles to the basket). The six experiments presented here examined the nature of learned memory representation of the basketball set shot in highly skilled players. </p> <p> In an initial series of experiments, skilled basketball players were required to perform a series of shots from several target locations spanning 9-to 21-ft. in line with the basket, including the foul-line at 15-ft. This task was completed using two different types of basketball shots (set shots; Experiments 1and2,jump shots; Experiment 3). Results revealed that set shot performance at the 15-ft. location was significantly better than predicted by a regression equation based on the performance at the other locations in Experiment 1 and replicated in Experiment 2. However, the superior performance at the foul line was not found in novice players (Experiment 2b) or when individuals performed jump shots (in Experiment 3). Instead, performance was accurately predicted by the regression equation. We suggested that a massive amount of practice accrued over many years of basketball shooting establishes the free throw as an especial skill -one that represents a highly specific capability among the general class of set-shot skills. </p> <p> In a follow-up series of experiments, we examined potential mechanisms underlying the emergence of the especial free throw skill with an attempt to reconcile our findings with theories of motor control. In Experiments 4 and 5 two possible explanations for the specificity effect were examined: the visual-context hypothesis (unique visual context including the visual distance and visual angle to the basket) vs. the learned-parameters hypothesis (over learned specifications for the parameterizations of the set shot at 15 ft). In Experiment 4, skilled players performed set shots from the foul line (15 ft) and locations that were equidistant (15ft) but at different angles to the basket (15°, 30°, 45° to the left and right of the foul line). Performance of the set shot at the foul line was superior to the other locations, which is consistent with our previous specificity findings. In Experiment 5, players performed set shots and jump shots at the foul line and at player-chosen "favorite" locations on the court. A double dissociation was found: performance of the set shot was superior to the jump shot at the foul line but was inferior to jump shot performance at the players' favorite locations. These results are contrary to the learned-parameters hypothesis, but consistent with the visual-context hypothesis. In our last experiment, invariance in the timing structure of set shot execution of skilled players was examined to determine if the free throw was represented by the same or a distinct generalized motor program. Results revealed that the especial free throw is not represented in memory by a separate motor program compared to other set shot skills. </p> <p> Overall, these experiments provided evidence that the free-throw is an especial skill, one which, as a result of massive amounts of practice, has a special status within a generalizable class of motor skills, and which is distinguished by its enhanced performance capability relative to the other members of the same class. The co-existence of skills represented by both specificity and generality effects have theoretical and practical implications which are discussed and warrant further investigation. </p> / Thesis / Doctor of Philosophy (PhD)

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This thesis explores integrating deload weeks into musicians' practice plans to enhance performance and prevent burnout. It investigates the concept's applicability in music practice, drawing parallels from strength training and bouldering. The thesis examines typical practice approaches, methods for measuring exertion, and considers the Sibelius Academy's practice guide as an alternative methodology. Deload week examples, tapering strategies, arguments against deloading, and the author's personalized practice plan are discussed. The thesis emphasizes the importance of integrating deload weeks to optimize musicians' performance and well-being, calling for further exploration in refining practice methodologies.