Serial peak expiratory flow measurements (PEF) are recommended as an initial investigation in the confirmation of occupational asthma. Plotting measurements in Oasys gives reproducible results and can be used by non-experts. I report a new analysis, the area between curves (ABC) score, which gives 72% sensitivity and 100% specificity using a cut off of 15 L/min/h. Two-hourly measurements of PEF require 8 work days and 3 rest days for sensitive and specific analysis. Serial PEF records with long periods off work (≥ 4 consecutive days) show improved sensitivity from 73% to 80%, implying that 7 more workers in every 100 would be diagnosed. In a comparison of forced expiratory volume in one second (FEV1) to PEF, PEF was more sensitive to diurnal changes than FEV1, although FEV1 was more reproducible. Exhaled breath nitric oxide (FENO) showed similar ABC scores between those with normal and raised FENO. FENO was significantly correlated to methacholine reactivity. In shift workers, mean ABC scores were increased on morning shifts compared to nights, but the cut off of 15 L/min/h would be applicable across all shift types. The ABC score is a new robust method of confirming occupational asthma requiring shorter records than the Oasys score.

Smokers attend preferentially to smoking-related cues in the environment, known as attentional bias. Evidence suggests that attentional bias is related to craving and relapse. Attentional retraining (AR) procedures have been used in laboratory studies to modify attentional bias and processes related to drug use, but investigations on the clinical value of AR in addiction are scarce. This thesis reports on two randomised controlled trials investigating the efficacy of AR with modified visual probe tasks in smokers. The first study explored the effects of varying the length of AR on attentional bias, craving, mood and withdrawal in current smokers. No retraining effects were observed after either a short, medium or long block of AR. The second study explored the efficacy of AR on attentional bias and smoking cessation outcomes in treatment-seeking smokers. While AR procedures were feasible to deliver within smoking cessation clinics, the intervention did not significantly reduce attentional bias, craving, withdrawal symptoms or the likelihood of relapse. These results and the literature in general show that there is no clear association between attentional bias and craving and relapse. Current AR procedures are not effective in smokers and should not be used in smoking cessation treatments, as they currently stand.

In 2008, The American College of Cardiology/American Heart Association/Heart Rhythm Society issued revised guidelines for automatic implantable cardioverter-defibrillators (AICD). We hypothesized that these guidelines have influenced AICD implantation rates.

archives@tulane.edu / Research has shown that populations with mental illness tend to have higher rates of obesity, diabetes, and other chronic conditions. This can be due in part to the medication treatment as anti-psychotic and anti-depressant medications have been shown to be major contributors to elevated rates of obesity, diabetes, dyslipidemia, and metabolic disorders that have the potential to lead to cardiovascular disease. Existing literature has identified many barriers that contribute to low preventive care utilization and screenings for metabolic risk factors. Consequently, national policy initiatives, such as the 2010 Affordable Care Act’s (ACA) Medicaid expansion, have aimed to improve access to care impacting adults with mental illness and expand coverage for more preventive and mental health services. Thus, this project: (1) examined longitudinal trends in diabetes preventive screenings and healthcare utilization associated with the 2016 Louisiana Medicaid expansion for a traditionally enrolled Severe Mentally Ill (SMI) Medicaid insured population, (2) assessed differences in racial and other socio-demographic characteristics associated with receiving diabetes preventive care and utilizing health care services amongst a traditionally enrolled SMI Medicaid insured population, and (3) assessed if Medicaid expansion was associated with better access to care and increased utilization of preventive care for diabetes-related complications in adults with diabetes and depression. To address these aims, adults ages 18 to 64 were analyzed through two data sources. The first is Louisiana Medicaid claims data; a longitudinal assessment of screening rates over a five-year period was used in an interrupted time series analysis to look at the change in screening rates for preventive care services and health care utilization before and after expansion for adults with SMI. Next, we used multivariable logit regression modeling, to examine the likelihood of receiving preventive care and utilizing health care services based on sociodemographic characteristics. Results from these analyses showed there was a total of 53,926 adults with a diagnosed SMI who had continuous enrollment in Medicaid between January 1st, 2014 – December 31st, 2018. Medicaid expansion was associated with significant increases in ED utilization and average inpatient length of stay for traditionally enrolled SMI adults. Racial differences in the likelihood of going to the ED were also apparent as blacks were more likely to go to the ED and for reasons that could have been prevented. For the third aim, data were extracted from the Behavioral Risk Factor Surveillance System survey for the years 2010 to 2017 for all adults with a self-reported diagnoses of depression and diabetes by a health professional. A retrospective cross-sectional study design using difference-in-differences analysis assessed relationship between Medicaid expansion and access to care and preventive care utilization for Medicaid eligible respondents in expansion states, compared to Medicaid eligible respondents in non-expansion states. Medicaid expansion significantly increased insurance coverage and the likelihood of having a personal doctor for eligible respondents in expansion states. / 1 / Alisha Monnette

<p>The change in course recently taken by the Swedish Armed Forces results in an increased use of equipment, and thereby increased requirements of preventive maintenance. This paper aims to examine the current responsibilities for preventive maintenance in an army unit. The intended effect of this examination is to disclose possible flaws, and to help make routines for preventive maintenance more effective.</p><p>The questions asked in this paper are;</p><ul><li>Who, in an army unit, is responsible for the routine maintenance?</li><li>When is this responsibility valid?</li><li>What demands does the technical service have on responsibilities for the routine maintenance?</li><li>How are these demands met?</li><li>How ought to be responsible for the routine maintenance?</li></ul><p>To answer these questions the author has chosen to use a descriptive method to show the current facts. A theorizing method is chosen to, from described facts, clarify the demands of the technical service on routine maintenance. A comparing method is chosen to compare responsibilities and the different responsibility-posts.</p><p>This paper presents the following conclusions;</p><ul><li>Much of the current literature, concerning the subject, is in dire need of being synchronised and updated.</li><li>Routines for how the supply-responsibility is to be most effectively distributed in the unit ought to be established.</li><li>The user ought to be given more responsibility to choose what routine maintenance should be carried out.</li></ul>

The change in course recently taken by the Swedish Armed Forces results in an increased use of equipment, and thereby increased requirements of preventive maintenance. This paper aims to examine the current responsibilities for preventive maintenance in an army unit. The intended effect of this examination is to disclose possible flaws, and to help make routines for preventive maintenance more effective. The questions asked in this paper are; Who, in an army unit, is responsible for the routine maintenance? When is this responsibility valid? What demands does the technical service have on responsibilities for the routine maintenance? How are these demands met? How ought to be responsible for the routine maintenance? To answer these questions the author has chosen to use a descriptive method to show the current facts. A theorizing method is chosen to, from described facts, clarify the demands of the technical service on routine maintenance. A comparing method is chosen to compare responsibilities and the different responsibility-posts. This paper presents the following conclusions; Much of the current literature, concerning the subject, is in dire need of being synchronised and updated. Routines for how the supply-responsibility is to be most effectively distributed in the unit ought to be established. The user ought to be given more responsibility to choose what routine maintenance should be carried out.

A power system is normally composed of a large number of generators and transmission lines that are connected through switching stations and substations. The quality and availability of power supply to the customer is highly dependent on the performance of the station equipment. Research shows that station related outages can have considerable impact on the composite system reliability. The individual station components, the station configurations and the terminal connection topologies are important factors in bulk system reliability evaluation. The major components in a station are circuit breakers, bus bars and transformers and these elements are periodically removed from service in order to conduct preventive maintenance. The removal of equipment for maintenance creates a change in the station configuration and a more vulnerable system. The failure of a related major component during a station preventive maintenance outage can result in a system disturbance and customer load loss. The bulk of the existing infrastructure of most electric power systems has been installed over the last 30 to 50 years. Aging failures of system components are a growing issue in modern electric power systems. Station related preventive maintenance outages and aging failures are important factors that affect the system reliability. This thesis examines the reliability implications of station related outages, including maintenance outages and aging outages in basic station configurations using two practical test systems. Models and techniques are created to incorporate these outages in composite system reliability evaluation. The techniques presented and the quantitative analyses illustrated in this thesis provide valuable information for a wide range of system planning, design, reinforcement and maintenance applications, including design and modification of power stations and station maintenance planning.

The absence of consistent and correct usage of condoms increases the risk of STI's and HIV/AIDS. However, most studies done to date across the nation indicate a low usage of condoms among college students. In fall of 2004, the National College Health Assessment was administered to a random sample of students at a state comprehensive university in south central Kentucky. Findings revealed that among the sexually active students, approximately half never used condoms during vaginal intercourse. Further among students engaging in anal sex, an alarmingly high proportion --95%- reported never using condom during this act. These findings along with differences noted in various subgroups (gender, Greek Status, housing, class standing) and other risk behaviors (alcohol, illicit drug use) will be presented and discussed.

Adolescent obesity is an important public health issue, and one important factor that contributes to the problem is overeating, eating more than required for homeostasis. Appetitive behaviors such as overeating may in part be the result of poor control of impulsive behavior. This study investigated the relationship between impulsivity factors and snacking habits. The Youth/Adolescent Food Frequency Questionnaire (YAQ) and the Barratt Impulsivity Scale (BIS) were completed by 198 Southern California high school students (56% female; age M=15.8, SD=0.9). Four subscales were calculated from responses on the YAQ and included the frequency of consuming sweetened drinks, sweet snacks, salty snacks, and fresh fruits. Multiple regression was used to determine the association of the YAQ subscales with the six first-order impulsivity factors in the BIS after adjusting for age, gender, and SES (mother and father education). Self-control impulsivity was positively associated with salty snack consumption. Both sweet snacks and drinks had a positive correlation with cognitive complexity. Finally, perseverance had a positive association with sweet snacks. Fruit consumption had no association with impulsivity levels. This is the first study of which we are aware that examined the association between snacking behaviors and the first-order factors for impulsivity in the BIS. It is beneficial to understand the processes behind snacking decisions so we can intervene to help adolescents make better food choices. Snacking is likely to be under the control of the adolescent compared, for example, to meals prepared at home by a parent or guardian. As a result, targeting snacking habits with interventions among adolescents may be an effective approach to reducing obesity.

A power system is normally composed of a large number of generators and transmission lines that are connected through switching stations and substations. The quality and availability of power supply to the customer is highly dependent on the performance of the station equipment. Research shows that station related outages can have considerable impact on the composite system reliability. The individual station components, the station configurations and the terminal connection topologies are important factors in bulk system reliability evaluation. The major components in a station are circuit breakers, bus bars and transformers and these elements are periodically removed from service in order to conduct preventive maintenance. The removal of equipment for maintenance creates a change in the station configuration and a more vulnerable system. The failure of a related major component during a station preventive maintenance outage can result in a system disturbance and customer load loss. The bulk of the existing infrastructure of most electric power systems has been installed over the last 30 to 50 years. Aging failures of system components are a growing issue in modern electric power systems. Station related preventive maintenance outages and aging failures are important factors that affect the system reliability. This thesis examines the reliability implications of station related outages, including maintenance outages and aging outages in basic station configurations using two practical test systems. Models and techniques are created to incorporate these outages in composite system reliability evaluation. The techniques presented and the quantitative analyses illustrated in this thesis provide valuable information for a wide range of system planning, design, reinforcement and maintenance applications, including design and modification of power stations and station maintenance planning.