Chronic low back pain (CLBP) is a challenging problem in Nova Scotia and is a leading cause of disability and a contributor to high health related costs to the system. The primary objective of this thesis is to develop and test a methodology for the creation of an electronic standardized assessment tool for chronic conditions such as CLBP using a triangulation method. The methodology involves evidence-based, expert and explicit clinical knowledge in the development of the tool. The outcome of this research is the development of a methodology model for the generation of electronic standardized assessment form for CLBP with 30 predictive factors. Experts evaluated the form for its use and usefulness, usability, and standardized terminologies. Intra-Class Correlation (ICC) and Cronbach’s alpha were used to measure inter-rater reliabilities among experts. The results were in the fair and moderate levels of agreement due to the limitation in sample size and the variation of disciplines among participants.

In the first essay, I document sample-specific and time period-specific style returns in two distinct sets of U.S. equities: Fama and French style portfolios and the S&P 1500 style indexes. The value and size effects are apparent in the Fama and French portfolios. Only the size effect is evident in the S&P data. In general, the Fama and French style returns are greater than those of the S&P 1500 styles. Style returns tend to be time-varying and exhibit momentum over a variety of formation period-holding period horizons. In the second essay, I utilize a bootstrap procedure to test for the presence of styleswitchers - as defined in Barberis and Shleifer (2003). I document style winner and loser continuations. There are some periods when no matter which particular style won (lost) in the past, it is more likely to continue winning (losing) in the future. I also test some Barberis and Shleifer (2003) propositions regarding style momentum. One proposition holds that Sharpe ratios from style-level momentum strategies should be at least as large as asset-level momentum Sharpe ratios. While many style momentum strategies generate significant returns, the implied Sharpe ratios are lower than those reported for asset-level momentum strategies. The Barberis and Shleifer (2003) model also suggests that style momentum could be time-varying. I condition style momentum returns on January, lagged market state, lagged monetary policy changes and lagged changes in relative dispersion and find significant conditional style-level momentum. In the third essay, I identify and test explanatory factors that potentially predict style momentum returns. Several macroeconomic, relative dispersion, market related and volatility related factors are associated with future short-term style momentum returns. Interactions of many of these variables with market and monetary state indicator variables are significant in the regressions as well.

BACKGROUND: Identifying factors related to migraine onset is essential to effective treatment because it would allow patients to take prophylactic measures to reduce the likelihood of migraine occurrence. The experience of intense emotions is a potential factor affecting migraine onset. This study aimed to explore the relationship between day-to-day experience of emotions (specifically the intensity of sadness, happiness, anxiety/stress, and interpersonal stress) and migraine onset. METHODS: Thirty adult women with episodic migraine were recruited to engage in a 12-week monitoring period that involved wearing a Fitbit and answering daily questionnaires by mobile app. The daily questionnaires asked about headache occurrence and triggers, emotional intensity, and sleep. A series of linear regressions were carried out to understand the overall relationship between emotional intensity and the onset of migraine over the 12-week period. In addition, mixed effects models were used to explore the temporal relationship between participants’ reported emotional intensity on a given day and migraine occurrence the next day. RESULTS: The linear regressions for migraine occurrence and headache occurrence as a function of emotional intensity were not significant. However, mixed effects models showed that emotion intensity and migraine onset were significantly associated for happiness (estimate = -0.081; p = .027), anxiety/stress (estimate = 0.060; p = .040), and interpersonal stress (estimate = 0.12; p = .0017) but not sadness (estimate = 0.025; p = .46). CONCLUSIONS: Findings suggest that high levels of anxiety/stress and interpersonal stress predict onset of migraine the next day. Similarly, low levels of happiness predict onset of migraine the next day. However, these relationships are no longer significant when emotional intensity is averaged over the 12-week monitoring period. Taken together, these findings support the need for longitudinal research evaluating the temporal relationship between emotion and migraine occurrence, particularly because important relationships may be lost with cross-sectional studies. Furthermore, these findings point to the potential role of strong negative emotions and the absence of positive emotions in producing migraine.

Purpose: To retrospectively assess the incidence and predictive factors for self-correction of ectopic eruption of maxillary permanent first molars (EE) and the prevailing attitudes amongst surveyed specialists regarding intervention in cases of EE. Methods: Charts of patients diagnosed with EE were assessed for predictive clinical and radiographic factors. An online survey was sent to pediatric dentists and orthodontists. Results: The rate of self-correction was 71%. One third of self-corrections occurred after age 9. Increased amount of impaction (r(43)=0.59, p<.001) and degree of resorption (r(57)=0.41, p=.001) were positively correlated with irreversibility. Orthodontists estimated the spontaneous self-correction rate to be lower (t(1178)=19.2, p<.001) than pediatric dentists. Conclusions: One third of self-corrections occurred after 9 years of age and delaying treatment of EE may be a viable option when uncertain of the outcome. Reliable predictive factors of irreversibility of EE were identified. Differences exist between pediatric dentists and orthodontists regarding management of EE.

Purpose: To retrospectively assess the incidence and predictive factors for self-correction of ectopic eruption of maxillary permanent first molars (EE) and the prevailing attitudes amongst surveyed specialists regarding intervention in cases of EE. Methods: Charts of patients diagnosed with EE were assessed for predictive clinical and radiographic factors. An online survey was sent to pediatric dentists and orthodontists. Results: The rate of self-correction was 71%. One third of self-corrections occurred after age 9. Increased amount of impaction (r(43)=0.59, p<.001) and degree of resorption (r(57)=0.41, p=.001) were positively correlated with irreversibility. Orthodontists estimated the spontaneous self-correction rate to be lower (t(1178)=19.2, p<.001) than pediatric dentists. Conclusions: One third of self-corrections occurred after 9 years of age and delaying treatment of EE may be a viable option when uncertain of the outcome. Reliable predictive factors of irreversibility of EE were identified. Differences exist between pediatric dentists and orthodontists regarding management of EE.

Abstract Introduction Most countries including Australia are experiencing an ageing of their population, with an increasing proportion of frail older persons requiring hospitalisation from acute illness. The aging process places the older person at risk of geriatric syndromes, such as falling, dependency in performance of Activities of Daily Living and instrumental Activities of Daily Living, confusion, bladder and bowel incontinence. New or deteriorating geriatric syndromes are a frequent occurrence among hospitalized older patients. Hospital associated factors associated with these outcomes include complications of medical therapies; polypharmacy and excessive bed rest. Few studies have been conducted into factors predicting risk of negative outcomes in older patients admitted to medical units of acute care teaching hospitals. If available, a screening tool with few predictive factors, able to be administered close to the time of admission could be used to identify patients at lower and higher risk. It is imperative that such a tool is developed empirically and tested for its accuracy in identifying patients at high risk. Aims of the research The first aim was to identify the proportion of patients aged ≥ 70 years, admitted to acute care medical units that experienced a negative outcome. These outcomes included falls during hospitalisation, presence of new or a significant decline in existing pressure ulcers, significant decline in independently performing Activities of Daily Living (ADLs), requiring increased care needs at discharge, readmission to hospital with 28 days of the index hospitalisation, bladder and bowel incontinence, and delirium. The second aim was to identify factors predicting the risk of two of these negative outcomes: requiring a higher level of care at discharge, and experiencing a decline in independently performing ADLs. Based on the predictive factors, two screening tools to identify patients at risk were developed and validated. Method A prospective cohort study of 413 acute general medical patients, aged ≥ 70 years and consecutively admitted to an acute care metropolitan 700-bed teaching hospital was conducted. Consenting patients expected to remain in hospital for more than 48 hours were included. Patients were excluded if they were admitted to intensive or coronary care units, admitted for terminal care only or were transferred from a general medical to another unit within 24 hours of admission to the ward. Trained research nurses assessed patients and used the interRAI Acute Care instrument to collect information on candidate predictive variables and negative outcomes. Patients were assessed within 36 hours of admission and at discharge to obtain information on predictive variables and negative outcomes. Patients were also followed daily to identify any instances of transient negative outcomes during hospitalisation and at 28 days following discharge to identify any instances of readmission to hospital. The 413 cases were randomly split into 309 cases in the development cohort and 104 cases in validation cohort. Logistic regression models were used to identify the predictive factors independently associated with two negative outcomes, requiring a higher level of care at discharge and experiencing a decline in independently performing ADLs. Findings At least one negative outcome was experienced by 53% of the development and 63% of the validation cohort. The most common negative outcomes experienced were: delirium (27%; 23%), a significant decline in ADLs (19%, 22%), requiring a higher level of care at discharge (16%, 16%), and readmission to hospital within 28 days of discharge (17%, 28%) in the development and validation cohorts respectively. The logistic regression analysis identified four independent factors associated with requiring higher levels of care at discharge: ‘short term memory problems’ (OR 4.21, 95% CI 1.79, 9.89; p=0.001); ‘dependence in toilet use’ (OR 3.51, 95% CI 1.14, 10.84; p=0.029); ‘dependence in hygiene’ (OR 2.76, 95% CI 1.16, 6.56; p=0.021), and ‘use of community services prior to admission’ (OR 2.41, 95% CI 1.12, 5.16; p= 0.024). A screening tool developed to assess patients at lower and higher risk had a sensitivity, specificity, positive predicted value (PPV) and negative predictive value (NPV) of 77.27%, 73.66%, 36.56% and 94.29% respectively. Reasonable accuracy was evident when tested in the validation sample. Sensitivity, specificity, PPV and NPV were 60%, 76.32%, 33.33% and 90.63% respectively. Predictive factors associated with a significant decline in ADLs were: ‘history of falling’(OR 2.21, 95% CI 1.12, 4.36; p= 0.023), ‘no interest in things enjoyed normally’ (OR 4.30, 95% CI 1.92, 9.64; p=0.000), ‘dependence in management of finances’ (OR 3.93, 95% CI 1.63, 9.48; p =0.002) and ‘hearing problems’ (OR 2.38, 95% CI 1.05, 5.39; p =0.038). The screening tool had sensitivity, specificity, PPV and NPV in the development cohort of 74.55%, 69.13%, 36.6% and 92% respectively and 45%, 65.79%, 25.7% and 82% respectively in the validation sample. Conclusion The tools require further validation in larger samples in diverse settings. Future research should focus on developing a screening tool that could predict risk of a number of negative outcomes to enhance the provision of quality patient care.

Predictive and prognostic factors in gastric cancer Šmíd D. Surgical clinic of University Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University in Prague. Introduction: Gastric cancer is one of malignant diseases which have the worst prognosis. Unfortunately, there are most patients with advanced-stage disease who have to be treated in a palliative way. Patients suffered from the same type of tumor, being at the same stage of disease and treated with the same chemotherapy have various rates of survival, which can be caused by diverse expression of selected genes impacting on the mechanism of cytostatic effects. The determination of these genes or microRNAs which regulate these genes could be used as a predictive factor for prediction of effects of administered chemotherapy. The determination of some microRNAs, or in the combination with suitable plasmatic factors, could be used as a prognostic factor for patients with gastric cancer. It is also possible to use this combination for early diagnosis of cancerogenesis Object: The aim is to verify the possibility to use expression of selected genes and some microRNAs in tumor tissue as a prognostic factor or a predictor for therapeutic effects of chemotherapy in patients with gastric cancer. Methodology: We retrospectively evaluated the group...

Submitted by Cléa Mara Barradas (maraclea@hotmail.com) on 2010-11-16T22:00:28Z No. of bitstreams: 1 Josué_Laguardia _Tese.pdf: 1697668 bytes, checksum: 1a2aa02f38853a11704c27fdcfecfc5d (MD5) / Made available in DSpace on 2010-11-16T22:00:28Z (GMT). No. of bitstreams: 1 Josué_Laguardia _Tese.pdf: 1697668 bytes, checksum: 1a2aa02f38853a11704c27fdcfecfc5d (MD5) Previous issue date: 2007-09 / O uso crescente das tecnologias de informação e comunicação e da internet na constituição de ambientes virtuais de aprendizagem profissional implica em desafios às instituições de ensino frente às altas taxas de evasão registradas na educação a distância. O delineamento das ações que aumentem a retenção nos cursos on-line depende do conhecimento acerca dos fatores que influenciam a evasão dos alunos nesses ambientes. Desse modo, tomando o curso de aperfeiçoamento on-line “Processos de Gestão e Tecnologias de Informação em Saúde” da Escola Nacional de Saúde Pública – ENSP/FIOCRUZ como objeto de estudo, procedeu-se à investigação dos fatores preditores da evasão neste ambiente. As respostas de 201 alunos, coletadas em três questionários que abordaram aspectos sócio-demográficos, situação no trabalho, condições de estudo, habilidades e abordagens de estudo e lócus de controle dos alunos, constituíram a base de dados para as análises de validação e multivariada. A validação da versão resumida do inventário de abordagens e habilidades de estudo de estudantes (ASSIST) segundo a teoria da resposta aos itens mostrou que os itens das escalas de abordagem de estudo estratégica e superficial apresentaram variabilidade na informação ao longo de toda a distribuição do traço latente. As análises fatorial e de correspondência do ASSIST apontaram não confirmaram a estrutura em três fatores ou um padrão de distribuição das categorias compatível com o referido em outros estudos. Quanto à escala de lócus de controle interno-externo de Rotter, não foi identificado um padrão com um único fator que confirmasse o aspecto unidimensional da escala, nem tampouco os dois ou três fatores descritos na literatura. A inclusão em um modelo de sobrevida das escalas de abordagem de estudo reduzidas, selecionadas a partir dos resultados da análise da resposta ao item, mostrou que a discordância com as afirmações da abordagem de estudo superficial e a idade superior a 41 anos tem um efeito protetor para o abandono, juntamente com o tempo de uso do computador. Os achados desse estudo destacam a importância de se aprofundar as investigações relacionadas ao papel que desempenham as variáveis relacionadas às abordagens de estudo e às habilidades e percepções no uso do computador e da internet na permanência dos alunos em cursos on-line. / The growing use of information and communication technologies and the internet in professional virtual learning environments implies challenges to teaching institutions facing high rates of dropout registered in distance education. The drawing of actions to elevate retention in on-line courses depends on knowledge about factors that influence student dropout in those environments. Ttaking the lato sensu on-line course “Processos de Gestão e Tecnologias de Informação em Saúde” at Escola Nacional de Saúde Pública – ENSP/FIOCRUZ as the object of this study, it was investigated the predictive factors of dropout. The answers of 201 students collected in three questionnaires about socio-demographic and study conditions, job situation, skills and approaches to study and locus of control of the students formed the database for validation ands multivariate analysis. The validation of the short version of Approaches and Study Skills Inventory for Students (ASSIST) under item response theory analysis showed that strategic and superficial scales items had information variability along the latent trait distribution. The factor and correspondence analysis of the ASSIST did not confirmed the three factor structure or categories distribution pattern compatible with other studies. In the investigation of Rotter´s internal-external locus of control scale, it was not identified a pattern with one single factor that confirmed the unidimensional aspect of the scale or two or three factors described in the literature. In multivariated analysis, the inclusion in a survival model of resumed approaches of study scales, selected from the results of item response analysis, showed that the discordance with the statements of superficial approach and age above 41 years had a protector effect in dropout, along with time of computer use. The findings of this study highlight the importance of deepening the investigations related to the role that study approaches and computers use skills and perceptions have on the student retention in on-line courses.

Includes bibliographical references / South Africa has a high incidence of injury-related disorders, such as traumatic brain injury (TBI) as a result of motor vehicle accidents and assault. Dysphagia is a common sequela of TBI, which may result in malnutrition or aspiration pneumonia. There is limited epidemiological data available for TBI and dysphagia in South Africa which is important for health care planning. There is also inadequate literature reporting predictive factors for dysphagia and health outcomes of patients with TBI and swallowing disorders for the South African context, which would provide management guidelines for Speech-Language Pathologists (SLPs) for patients with TBI and dysphagia. This study aims to begin to provide up-to-date information regarding the incidence of TBI and the prevalence of dysphagia in the population with TBI in Bloemfontein, South Africa. Predictive factors for dysphagia and health outcomes were also investigated in order to provide management guidelines for TBI-related dysphagia for SLPs. A prospective cohort study followed 77 participants aged 18 to 68 years (M = 33.1) with mild to severe traumatic brain injury, admitted to 2 state and 2 private hospitals in the Bloemfontein metropole, South Africa, to investigate the incidence of TBI and the prevalence of TBI-related dysphagia in the adult population in 2013. Participants were tracked from admission to hospital to discharge. Demographic and medical data was collected for each participant, including: gender, age, TBI aetiology, means of nutritional intake, respiratory status, length of hospital stay, and number of speech therapy sessions. Glasgow Coma Scale (GCS) scores at time of admission, swallowing evaluation, and discharge were noted as an indicator of TBI severity and each participant was assessed with the Mann Assessment of Swallowing Ability on admission and prior to discharge to assess the presence of dysphagia. The incidence of TBI for the Bloemfontein metropole was 353 per 100,000 people and was greater in the male than in the female population (11.83:1). The main mechanism for TBI in Bloemfontein was interpersonal violence (67.53%), followed by road traffic accidents (motor and pedestrian vehicle accidents; 23.38%). The prevalence rate for dysphagia was 32%. Twenty-eight percent of those who presented with dysphagia also aspirated. Severe TBI (GCS ≤ 8) was identified as a predictive factor for dysphagia. Participants with dysphagia had longer hospital stays (days; M = 22.04, SD = 17.67) than those with normal swallowing (M = 6.23, SD = 4.28), t(75) = 6.13, p < .001, and took significantly more days to achieve oral intake (M = 6.23, SD = 10.32) than those without dysphagia (M = .31, SD = 1.41), t(75) = 4.08, p < .001. Ventilation was associated with longer hospital stays, rs(25) = -.47, p = .02 and longer duration until achievement of oral intake, rs(22) = -.80, p < .001. Tracheotomised participants also had significantly longer hospital stays, rs(25) = -.67, p < .001, and took longer to achieve oral intake, rs(22) = -.52, p = .01. An increased period of time with a tracheostomy was also significantly associated with mortality, χ2(2, n = 11) = 6.52, p = .04. Participants with dysphagia (M = 3.84, SD = 5.44) required significantly more therapy sessions with an SLP than those without dysphagia (M = .15, SD = .64), t(75) = 4.85, p < .001, and those with low GCS scores were significantly less likely to achieve oral intake prior to discharge, rs(25) = -.45, p = .02, and had longer hospital stays than participants with mild head injuries, rs(25) = -.49, p = .01. All participants who received nutrition via nasogastric tubes returned to oral intake; however, individuals who had percutaneous endoscopic gastrostomies did not achieve oral intake prior to discharge. It is recommended that objective swallowing evaluations be conducted for patients admitted with severe TBIs, and patients with mild and moderate TBIs be screened to determine the presence of dysphagia. TBI prevention initiatives should be developed to reduce the incidence of TBI, specifically in the young adult male population.

Predictive and prognostic factors in gastric cancer Šmíd D. Surgical clinic of University Hospital in Pilsen and Faculty of Medicine in Pilsen, Charles University in Prague. Introduction: Gastric cancer is one of malignant diseases which have the worst prognosis. Unfortunately, there are most patients with advanced-stage disease who have to be treated in a palliative way. Patients suffered from the same type of tumor, being at the same stage of disease and treated with the same chemotherapy have various rates of survival, which can be caused by diverse expression of selected genes impacting on the mechanism of cytostatic effects. The determination of these genes or microRNAs which regulate these genes could be used as a predictive factor for prediction of effects of administered chemotherapy. The determination of some microRNAs, or in the combination with suitable plasmatic factors, could be used as a prognostic factor for patients with gastric cancer. It is also possible to use this combination for early diagnosis of cancerogenesis Object: The aim is to verify the possibility to use expression of selected genes and some microRNAs in tumor tissue as a prognostic factor or a predictor for therapeutic effects of chemotherapy in patients with gastric cancer. Methodology: We retrospectively evaluated the group...