The purpose of this study was to examine the relationship between teacher religiosity and teacher self-efficacy. The present study builds upon previous research which has shown purposeful work in everyday living fosters intrinsic motivation, religious orientation affects daily living, and teacher self-efficacy beliefs predict student achievement. Religiosity and self-efficacy data were gathered from public school teachers from a suburban school district in North Texas and from private Christian schools in Western Washington. The Age Universal I-E scale (a measure of religious orientation intended to capture how one lives out his/her religiosity), Teachers' Sense of Efficacy Scale, and a teacher characteristic form were used to collect data. In a multiple regression analysis, independent variables included teacher age, gender, grade level taught, experience level, campus type (public or private religious), and teacher religious orientation (intrinsic or extrinsic); the dependent variable was the score for teacher self-efficacy. The regression analysis resulted in an equation that explained only slightly more than 9% of the variance in the score for teacher self-efficacy. Three significant variables were identified--grade level taught, teacher age, and intrinsic religious orientation. Teacher age and teacher intrinsic religious orientation were the two most important contributors according to a comparison of beta weights. Intrinsic religious orientation contributed to the equation, but it acted as a suppressor variable in the study, having little predictive value by itself but contributing to the predictive value of the model. Based on the data collected, recommendations for future research and suggestions for field application are offered.

L’altération de l’état nutritionnel est une complication fréquente dans la maladie cancéreuse, et ses conséquences sur le pronostic de la maladie, sur la prise en charge thérapeutique et sur la qualité de vie ne sont probablement pas à négliger. En pratique courante, il n’est pas facile de procéder de manière systématique à une évaluation nutritionnelle complète. L’objectif de ce travail est d’une part de mesurer l’importance de la perte de poids chez des patients traités pour un cancer et d’autre part d’identifier les facteurs prédictifs qui pourraient être utiles aux soignants pour les aider à repérer les patients à risque. Ce travail rapporte les résultats de 2 études indépendantes : la première étude a été réalisée à partir de 2 enquêtes transversales menées chez des patients traités pour un cancer, toutes localisations et tous stades confondus à Saint-Etienne et à Clermont-Ferrand. Près d’un tiers des patients avaient perdu plus de 10% de leur poids habituel depuis le début de la maladie. Le profil des patients à risque identifié était : Homme, Localisation de la tumeur au niveau digestif ou ORL, Traitement par chimiothérapie programmé, Syndrome dépressif et Niveau socio-économique bas. Dans cette étude nous avons mis en évidence une association significative entre la perte de poids et la qualité de vie globale. La deuxième étude a été réalisée à partir des données d’un essai de chimioprévention mené chez des patients traités par radiothérapie pour un cancer ORL de stade précoce au Québec. Cinq facteurs prédictifs de perte de poids ont été identifiés : Localisation de la tumeur au niveau du larynx sus-glottique, de la cavité buccale, de l’oropharynx et de l’hypopharynx, Poids élevé en début de radiothérapie, Tumeurs de stade II, Dypshagie ou odynophagie, Capacités fonctionnelles altérées. Ces éléments simples peuvent représenter un outil d’aide au repérage des patients à risque de dénutrition qui nécessiteraient une intervention nutritionnelle préventive précoce / Modification of the nutritional status is a frequent complication in patients with cancer, and its consequences on the pronotic of the disease, on the therapeutic management and on quality of life are probably not negligible. In routine practice, it’s not always easy to process at systematics nutritional assessments. The objective of this work is firstly to measure the importance of weight loss in cancer patients and secondly to identify predictors that might be useful to identifying patients at risk. We report the results of two independent studies : the first study was conducted from 2 cross- sectional surveys conducted in cancer patients, all sites and all stages combined, in the Institut de Cancérologie de la Loire at Saint-Etienne and The Centre Jean Perrin at Clermont-Ferrand. Nearly a third of patients had lost more than 10% of their usual weight since the beginning of the disease. The profile of patients at risk were identified : Male, Location of the tumor in the digestive or ENT, Scheduled chemotherapy, Depressive syndrome and Low socio- economic statut. In this study we demonstrated a significant association between weight loss and overall quality of life. The second study was conducted as part as a chemoprevention trial in patients treated with radiotherapy for early stage head and neck cancer in Quebec. Five predictors of weight loss have been identified : Location of the tumor at the supraglottic larynx, the oral cavity oropharynx and hypopharynx, High weight in the beginning of radiotherapy, Stage II, Dypshagia or odynophagia, Functional capacity impairments. These simple elements can be a tool for tracking patients at risk of malnutrition which require intervention early preventive nutrition

Este estudo foi realizado com os seguintes objetivos: identificar a frequência e os preditores de disfagia em pacientes com Acidente Vascular Cerebral (AVC); avaliar o impacto da disfagia quanto aos desfechos dependência funcional e óbito em três meses após o AVC; e validar o teste de rastreio para disfagia Toronto Bedside Swallowing Screening Test (TOR-BSST©) em pacientes com AVC de um hospital público no Brasil. Participaram do estudo pacientes admitidos na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) e incluídos no Registro de Acidente Vascular Encefálico (REAVER) no período de abril de 2015 a setembro de 2016, maiores de 18 anos, com diagnóstico de AVC agudo (<10 dias entre o AVC e a admissão hospitalar) confirmado por exames de neuroimagem. Foram excluídos pacientes com ataque isquêmico transitório, hemorragia subaracnóidea, trombose venosa cerebral, ictus antigo, AVC hemorrágico de causa secundária ou aqueles que não concordaram em participar do estudo. As características demográficas e clínicas foram coletadas de forma prospectiva pelos coordenadores de pesquisa do REAVER. A deglutição foi avaliada na primeira semana da admissão hospitalar à beira do leito, por três fonoaudiólogas, com um protocolo de avaliação clínica utilizando as consistências pastosa e líquida. Os pacientes foram avaliados com o teste TORBSST© e com a videofluoroscopia após a alta hospitalar. A escala modificada de Rankin, o Índice de Barthel e a Medida de Independência Funcional (MIF) foram utilizados para avaliar os desfechos funcionais de três meses após o AVC. No período do estudo foram admitidos 831 pacientes com AVC, sendo que 353 pacientes foram excluídos de acordo com os critérios de inclusão e exclusão. Dos pacientes elegíveis, 53 foram removidos das análises por receberem alta antes da avaliação da deglutição, portanto, foram incluídos 425 pacientes. Dentre os pacientes incluídos, 28,2% não apresentaram condições para avaliação clínica da deglutição e foram considerados no grupo de disfagia presumida. Desta forma, foram examinados com avaliação clínica da deglutição 305 pacientes, sendo que 45,2% foram diagnosticados com disfagia. Idade (p=0,017), história médica conhecida de apneia obstrutiva do sono (p=0,003) e gravidade do AVC na admissão hospitalar (p<0,001) se associaram independentemente com disfagia. Os pacientes disfágicos apresentaram maior tempo de internação (p=0,001), maior frequência de reabilitação (p<0,001) e uso de sonda para alimentação (p<0,001) dentro de três meses após o AVC. A presença de disfagia detectada na avaliação clínica da deglutição foi independentemente associada com dependência funcional ou óbito em três meses após o AVC (p<0,001). O teste TORBSST© apresentou sensibilidade de 85% para detectar disfagia comparado a videofluoroscopia, e concordância moderada entre os avaliadores (K=0,44). Portanto, neste estudo, disfagia foi diagnosticada em quase metade dos pacientes (45,2%). Idade, história médica conhecida de apneia obstrutiva do sono e gravidade do AVC foram preditores de disfagia, sendo esta independentemente associada com morte ou dependência funcional em três meses após o AVC. O teste de rastreio para disfagia TOR-BSST© apresentou alta sensibilidade para detectar disfagia em pacientes com AVC comparado ao padrão ouro. / This study was carried out with the following objectives: to identify the frequency and the predictors of dysphagia in stroke patients; to assess the impact of dysphagia on outcomes functional dependence and death at three months post-stroke; and to validate the Toronto Bedside Swallowing Screening Test (TOR-BSST©) screening test in stroke patients from a public hospital in Brazil. All consecutive eligible patients newly admitted to the Emergency Unit of the Hospital Clinics of School of Medicine of Ribeirao Preto - University of São Paulo (HCFMRP-USP) and captured by REAVER (an institution based prospective registry for stroke patients) between April 2015 and September 2016 were approached and consented. Eligible patients were those that met the following criteria: age>18 years and medical diagnosis of acute stroke (<10 days between stroke and hospital admission) confirmed from neuroimage exams. Patients with transient ischemic attack, subarachnoid hemorrhage, cerebral venous thrombosis, not acute stroke, hemorrhagic stroke with secondary cause or those who did not agree to participate in the study were excluded. The demographic and clinical characteristics were prospectively collected by REAVER research coordinators. Swallowing was evaluated by three Speech and Language Pathologists in the first week of hospital admission at the bedside with clinical assessment using paste and liquid consistency. Patients were assessed with TOR-BSST© and with videofluoroscopy after discharge from hospital. Modified Rankin scale, Barthel Index and Functional Independence Measure (FIM) were used to assess functional outcomes three months after stroke. In the period of the study, 831 stroke patients were admitted, 353 patients were excluded according to the inclusion and exclusion criteria. Of the eligible patients, 53 were removed because they were discharged before clinical assessment of swallowing, therefore 425 patients were included in this study. Among the included patients, 28.2% did not present conditions for clinical swallowing assessment and were considered in the presumed dysphagia group. Thus, 305 patients were examined with clinical swallowing assessment and 45.2% of them had dysphagia. Age (p=0.017), known medical history of obstructive sleep apnea (p=0.003) and stroke severity at hospital admission (p<0.001) were independently associated with dysphagia. Dysphagic patients had longer length of stay (p=0.001), higher frequency of rehabilitation (p<0.001) and higher frequency of use of tube feeding (p<0.001) within three months after stroke. The presence of dysphagia detected in clinical swallowing assessment was independently associated with functional dependence or death within three months after stroke (p<0.001). The TORBSST© showed sensitivity of 85% to detect dysphagia compared to videofluoroscopy and moderate agreement among the screeners (K=0.44). Therefore, in this study, dysphagia was diagnosed in almost half of the patients (45.2%). Age, known medical history of obstructive sleep apnea and stroke severity were predictors of dysphagia, which was independently associated with death or functional dependence at three months post-stroke. The TOR-BSST© presented high sensitivity to detect dysphagia in stroke patients compared to the gold standard.

Hepatitis C Virus (HCV) is an infection that can have grave consequences when left untreated. Hepatitis C can be easily eradicated with direct acting antiviral therapy. People who inject drugs (PWID) and inmates are among those with the highest incidence of HCV. However, cure rates among this population remains low. This is, in part, related to an interruption in the HCV care cascade such that only 30% of PWID are linked to care and only 8% of those receive treatment. Inadequate screening and failure to be linked to HCV care remain the largest impediments to treatment success. There is limited research on barriers and facilitators to primary care, where screening may take place, and linkage to HCV care among PWID. Few studies have evaluated vulnerable populations such as those living in rural communities or inmates. The purpose of this dissertation was to develop a broader understanding of barriers and facilitators to healthcare utilization among PWID at the primary care and specialist levels (linkage to care). Three manuscripts addressed important gaps in knowledge. The first was a review of the literature to describe the state of science on linkage to care among PWID. All but one reviewed study recruited from countries with universal healthcare, urban areas, and opioid substitution facilities. The review of the literature revealed that little is known about the barriers/facilitators to linkage to HCV care faced by rural-dwelling PWID from countries without universal healthcare. The second manuscript is a study to determine whether predictors of linkage to care identified in urban-dwelling PWID from countries with universal healthcare predicted seeking HCV care among PWID living in rural Appalachia. Data were obtained from a subsample of 63 HCV positive PWID who recently used opioids, were between the ages of 18-35 years, and lived in one of five rural counties in Kentucky. Logistic regression revealed that recent injection drug use was the only predictor of seeking HCV care. However, remote use of opioid substitution therapy and no transportation issues approached clinical significance. Although not evaluated in our second manuscript, seeing a primary care provider (PCP) is associated with an increased likelihood of being linked to care and higher rates of screening/diagnosis. Among rural dwelling PWID, there are subpopulations that may face unique barriers to linkage to care. One sub-population that may be particularly vulnerable are female PWID who are incarcerated. Therefore, the purpose of the third study was to determine predictors of primary care use using data from 302 female inmates from rural Appalachia with a history of injecting drugs. Age, insurance issues, and health problems that interfere with responsibilities were predictors of PCP use. In this dissertation, I have addressed important gaps in the literature by determining barriers and facilitators to seeking HCV care and primary care use among PWID from rural Kentucky. Additional studies are needed using a larger sample of rural PWID to confirm our findings. In addition, further studies should evaluate system and provider level barriers to linkage to care and PCP use among rural PWID.

Der implantierbare Kardioverter-Defibrillator gehört zu der Behandlung von herzinsuffizienten Patienten. In dieser Arbeit wird eine Risikostratifizierung anhand der vorliegenden Grunderkrankung analysiert. Untersucht wurden 330 konsekutive Patienten mit ischämischer oder nicht-ischämischer dilatativer Kardiomyopathie, die zwischen 2009 und 2011 einen ICD erhalten haben. Im Rahmen des Follow-up von 19 ± 9 Monaten erlitten 29 % der Patienten adäquate ICD-Therapien. Als signifikante Risikofaktoren für adäquate Therapien waren die sekundärprophylaktische Implantation bei ICM-Patienten und die Präsenz von Vorhofflimmern bei DCM-Patienten zu beobachten. Die leitliniengerechte CRT-Implantation zeigte eine prophylaktische Wirkung bei ICM-Patienten.

Broadly defined political ideology: Liberalism, Conservatism and Right-wing authoritarianism - often percieved as identical, are concepts dominantly used by researchers as descriptors of two distinct groups of people. However, this ideological understanding stems from overly generalized conclusions of current research: Empirically defined Social and Economic dimension of ideology is better described by two negatively correlated factors than one broad conservatism factor. Social and Economic conservatism and Authoritarianism are rather distinct concepts with specific personality and demographic correlates. Social and Economic ideology is - in part contrary to expectations - mostly predicted by Openness to Experience, Extraversion and Emotional stability. Economic conservatism differs from other ideological dimensions being mostly predicted by Income and Education. Social conservatism differs from Authoritarianism being predicted by Age. Moreover, in contrast with Authoritarianism, Economic and Social conservatism are both connected to unique opposite interactions of Income and Openness to Experience. Keywords Social and economic ideological dimensions, Authoritarianism, Personality predictors

Background: Although bariatric surgery is the most effective treatment for severe obesity, a subgroup of patients shows insufficient postbariatric outcomes. Differences may at least in part result from heterogeneous patient profiles regarding reactive and regulative temperament, emotion dysregulation, and disinhibited eating. This study aims to subtype patients based on these aspects before and two years after bariatric surgery and tests the predictive value of identified subtypes for health-related outcomes three years after surgery.

Falls are the number one mechanism of injury for The Trauma Center and Johnson City Medical Center (JCMC TC). JCMC TC is one of two level one trauma centers in the region and one of only six in the state. The main method for trauma prevention is outcome specific education and awareness. Injury prevention education is a critically needed area in the field of trauma and emergency care. Falls are the number one cause of injury in populations age >65. Socioeconomic status, age, gender, and race are all mitigating factors in the likelihood of greater length of stays, death in hospital, and death within one year of discharge for those who fall in a home setting. According to the CDC, people over the age of 75 are four to five times more likely than people under 75 to be admitted to a long-term care facility for more than a year. What is the relationship between patient characteristics and fall related outcomes in a level one trauma center? We looked at associations between patient demographics and associated outcomes for those admitted to the trauma center secondary to a ground level fall (GLF) in the home. Dataset: De-identified National Trauma Databank information was compiled by the JCMC Registrar for the past 8 years for the metrics: Injury Severity Score (ISS), length of stay, 48hr readmission, and disposition (home, nursing home, skilled nursing facility (SNF)).Demographic information, along with mechanism of fall, was collected for each patient. Patient age, gender, and date of injury was all used for statistical analysis and trend recognition. Statistical Analysis: Bivariate analyses included independent samples t-tests and Oneway ANOVA to find differences between groups. Results: T-test results show women are significantly more likely than men to be admit for a ground level fall (p<.001) and those with a higher ISS are more likely to have an extended stay in an inpatient setting (p<.001). One-Way ANOVA analysis of collected data shows an annual increase from 2006-2013 of trauma admissions for ground level falls (p<.01). Eight year analysis showed a two-fold increase in these admissions. Over 30% of patients admitted with a GLF are discharged to a SNF leading to higher societal costs due to Medicare reimbursement rates. Diagnosis related groups codes (DRG) dictate Medicare reimbursement rate of $14,091 per patient with an average facility cost of $14,196 per patient with no readmissions (Unplanned readmission within 180 days occurred at a rate of 8.3%). Conclusion: Fall education programs are necessary and needed in rural level one trauma centers to educate citizens on causes and methods of preventing falls in their homes. A decrease in these falls would lead to an increase in productive years of life and a reduction in strain on the hospital system.

Research suggests youth with disabilities are less likely to experience positive outcomes compared to peers without disabilities. Identification of in-school predictors of postschool success can provide teachers (e.g., special education, general education, career technical education), administrators, district-level personnel, and vocational rehabilitation counselors with information to design, evaluate, and improve transition programs. The purpose of this systematic literature review was to examine secondary transition correlational literature to identify additional evidence to support existing predictors and identify new predictors of postschool success. Results provided additional evidence for 14 existing predictors and identified three new predictors. Limitations and implications for research, policy, and practice are discussed.

Objective: To identify correlates of quality of life (QoL) measured with the Quality of Life Scale (QOLS) in participants of a multidisciplinary day hospital treatment program for fibromyalgia (FM). Methods: In this cross-sectional, observational study, “real world” data from 480 FM patients including socio-demographics, pain variables and questionnaires such as the SF-36, Beck Depression Inventory (BDI), Multiphasic Pain Inventory (MPI), SCL-90-R and others were categorized according to the components (body structure and function, activities and participation, personal factors, environmental factors) of the International Classification of Functioning (ICF). For every ICF component, a linear regression analysis with QOLS as the dependent variable was computed. A final comprehensive model was calculated on the basis of the results of the five independent analyses. Results: The following variables could be identified as main correlates for QoL in FM, explaining 56% of the variance of the QOLS (subscale/questionnaire and standardized beta in parenthesis): depression (− 0.22), pain-related interference with everyday life (− 0.19), general activity (0.13), general health perception (0.11), punishing response from others (− 0.11), work status (− 0.10), vitality (− 0.11) and cognitive difficulties (− 0.12). Pain intensity or frequency was not an independent correlate. Conclusions: More than 50% of QoL variance could be explained by distinct self-reported variables with neither pain intensity nor pain frequency playing a major role. Therefore, FM treatment should not primarily concentrate on pain but should address multiple factors within multidisciplinary therapy.