The aim of this dissertation is to examine the implementation of the Addiction Severity Index (ASI) in social services and how it affects the encounter between the clients and their social workers. As structured interviews are unusual in social service based addiction care there is concern that they will have negative consequences on the relation between the social workers and their clients. The first study therefore investigates the clients’ acceptance of the ASI. The results show that 95 % of the clients accepted the ASI and that 85% viewed it in positive terms. Approximately 8% reported feeling violated by one question without this having any negative effect on the relation to the social workers or confidence in the social services. The results did not give empirical support for negative effects of the ASI. In the second study a comparison was made between a group that had participated in an assessment session using the ASI and a group with which the ASI had not been used. The results show that there is no difference in perception of “the alliance” or “negative experiences” with or without the ASI, but that the clients’ feeling of “own competence” is lower when the ASI is employed. The question of whether the reduced feeling of own competence among the clients is an expression of greater realism and reduced denial or only the negative effect of increased helplessness on the clients’ self-esteem can not be resolved in this study. In the third study, based on the same groups participating in the second study, the social workers were also asked to judge how the clients experienced such assessment sessions. The results show that the social workers’ assessment of the clients’ experiences differed from the clients’ own experiences regarding the “alliance” and “clients’ own feelings of competence”. However, the social workers made a correct assessment of the clients’ “negative experiences” of the sessions. The two different forms of session, with or without the ASI, did not influence the social workers’ assessment of the clients’ perceptions. The fourth study presents the results of a national questionnaire completed by 555 members of staff in social services, the prison service, and addiction services. The results show that supervisors and bosses take an increasingly greater responsibility for ASI training and that opportunities for using the ASI varied according to the place of work. Differences can probably be explained by different services being in different phases of implementation at the time of the study. The ASI has primarily been used in direct client work and only to a minor extent for follow-ups and evaluation. The number of ASI interviews carried out is small especially for those trained prior to 1999.

Road safety is a serious societal concern in Riyadh city, Kingdom of Saudi Arabia. Because of the negative impact of traffic crashes which cause losses in the form of deaths, injuries and property damage, in addition to the pain and social tragedy affecting families of the victims, it is important for transport policy makers to reduce their impact and increase safety standards by reducing the severity and frequency of crashes in the city of Riyadh. It is therefore important to fully understand the relationship between traffic crash severity and frequency and their contributing factors so to establish effective safety policies which can be implemented to enhance road safety in Riyadh city. Data used in previous research have only consisted of basic information as there was unavailability of suitable and accurate data in Riyadh and there are very few studies that have undertaken as small area-wide crash analysis in Riyadh using appropriate statistical models. Therefore safety policies are not based on rigorous analyses to identify factors affecting both the severity and the frequency of traffic crashes. This research aims to explore the relationship between traffic crash severity and frequency and their contributing factors by using statistical models and a GIS approach. The analysis is based on the data obtained over a period of five years, namely AH 1425, 1426, 1427, 1428, and 1429 (roughly equivalent to 2004, 2005, 2006, 2007, and 2008). Injury crash severity data were classified into three categories: fatal, serious injury and slight injury. A series of statistical models were employed to investigate the factors that affect both crash severity (i.e. ordered logit and mixed logit models) and area-wide crash frequency (i.e. classical Poisson and negative binomial models). Because of a severe underreporting problem on the slight injury crashes, binary and mixed binary logistic regression models were also estimated for two categories of severity: fatal and serious crashes. The mixed binary logit model and the negative binomial model are found to be the best models for crash severity and crash frequency analyses respectively. The model estimation results suggest that the statistically significant factors in crash severity are the age and nationality of the driver who is at fault, the time period from 16.00 to 19.59, excessive speed, road surface and lighting conditions, number of vehicles involved and number of casualties. Older drivers are associated with a higher probability of having a fatal crash, and, as expected, excessive speeds were consistently associated with fatal crashes in all models. In the area-level crash frequency models, population, percentage of illiterate people, income per capita and income per adult were found to be positively associated with the frequency of both fatal and serious injury crashes whereas all types of land use such as percentages of residential use, transport utilities, and educational use in all models were found to be negatively associated with the frequency of occurrence of crashes. Results suggest that safety strategies aimed at reducing the severity and frequency of traffic crashes in Riyadh city should take into account the structure of the resident population and greater emphasis should be put on native residents and older age groups. Tougher enforcement should be introduced to tackle the issue of excessive speed. This thesis contributes to knowledge in terms of examining and identifying a range of factors affecting traffic crash severity and frequency in Riyadh city.

In this study, we capture the moderating effect of aggressive driving behavior while assessing the influence of a comprehensive set of variables on injury severity. In doing so, we are able to account for the indirect effects of variables on injury severity through their influence on aggressive driving behavior, as well as the direct effect of variables on injury severity. The methodology used in this study to accommodate the moderating effect of aggressive driving behavior takes the form of two models – one for aggressive driving and another for injury severity. These are appropriately linked to obtain the indirect and direct effects of variables. The data for estimation is obtained from the National Motor Vehicle Crash Causation Study (NMVCCS). From an empirical standpoint, we consider a fine age categorization until 20 years of age when examining age effects on aggressive driving behavior and injury severity. There are several important results from the empirical analysis. Young drivers (especially novice drivers between 16-17 years of age), drivers who are not wearing seat belt, under the influence of alcohol, not having a valid license, and driving a pickup are found to be most likely to behave aggressively. Situational, vehicle, and roadway factors such as young drivers traveling with young passengers, young drivers driving an SUV or a pick-up truck, driving during the morning rush hour, and driving on roads with high speed limits are also found to trigger aggressive driving behavior. In terms of vehicle occupants, the safest situation from a driver injury standpoint is when there are 2 or more passengers in the vehicle, at least one of whom is above the age of 20 years. These and many other results are discussed, along with implications of the result for graduated driving licensing (GDL) programs. / text

Bean pod mottle virus (BPMV), a member of the genus Comovirus in the family Comoviridae, is widespread in the major soybean-growing areas in the United States. Soybean yield losses of 10-40% have been reported as a consequence of BPMV infection. The complete nucleotide sequences of two strains, K-Ha1 and K-Ho1, were determined. Field isolates of BPMV were classified into two distinct subgroups (I and II) based on slot blot hybridization and sequence analyses. Full-length cDNA clones from which infectious transcripts can be produced were constructed for strains K-G7, K-Ho1 and K-Ha1. Whereas strains K-Ha1 and K-G7 induced mild or moderate symptoms in infected soybean plants, strain K-Ho1 produced very severe symptoms. Symptom severity was mapped to RNA1. Chimeric RNA1 constructs were generated by exchanging full or partial coding regions of the five RNA1-encoded mature proteins between the full-length cDNA clones of the three RNA1s and the resultant transcripts were inoculated onto soybean. The results showed that the coding regions of the protease co-factor (Co-pro) and the putative helicase (Hel) are determinants of symptom severity. Although symptom severity correlated well with accumulation of viral RNA, neither the Co-pro nor Hel protein could be demonstrated as a suppressor of RNA silencing. Furthermore, separate expression of the Co-pro or Hel proteins from a PVX vector induced necrosis on the inoculated leaves of Nicotiana benthamiana. Characterization of BPMV K-Ho1 indicated that it is a diploid reassortant, containing two distinct types of RNA1s and one type of RNA2. Examination of field isolates from various locations in the United States and Canada revealed that diploid reassortants are of frequent occurrence in natural populations of BPMV. The vary severe symptoms induced by BPMV K-Ho1 can be mimicked by inoculation of plants with a mixture of RNA1 transcripts from two distinct strain subgroups and RNA2 transcript from either subgroup. Plants inoculated with a mixture of transcripts containing two types of RNA1 from the same strain subgroup did not produce very severe symptoms. These are due to interactions between two distinct types of RNA1s. At present, no soybean cultivars with resistance to BPMV are commercially available. Therefore, the feasibility of cross protection as an alternative disease management strategy was studied. Two mild strains of BPMV (K-Da1 and K-Ha1), belonging to subgroup II, were tested for their ability to protect infected plants against a severe strain (K-Ho1). Inoculation of the soybean cultivar Essex on the primary leaves with either of the two mild strains conferred complete protection against challenge inoculation with the severe strain K-Ho1, regardless of the timing of challenge inoculation. Cross-protection was evident regardless of whether virions or BPMV-RNA were used as inocula. Cross protection was independent of the soybean cultivar used and method of virus inoculation, sap-inoculation or by the bean leaf beetle, vector of BPMV. Protection was complete and durable.

Stress is associated with poor mental health, specifically anxiety and depression, and stress and mental health problems are predictors of substance dependence and relapse. Social characteristics, such as racial/ethnic minority status, female gender, and low socioeconomic status, are often associated with increased psychological distress and substance use disorders. Pearlin’s social stress theory postulates that this association is due to increased exposure to stress and subsequent experiences of distress related to social disadvantage and decreased access to resources for coping with stress. This project uses a social stress theoretical perspective to examine predictors of substance use after treatment entry and follow-up addiction severity in a large sample of Kentucky substance abuse treatment participants (N = 1123). A conceptual model is tested to determine if social characteristics along with psychological distress, perceived stress, and economic hardship are predictors of substance use and follow-up addiction severity. In addition, since recovery support, efficacy, and self-control have been previously identified as mediators in the stress and relapse processes these factors were included as mediators in the model tested. The conceptual model was tested with three outcome variables, substance use between baseline and 12-month follow-up, follow-up alcohol addiction severity, and follow-up drug addiction severity. Bivariate and multivariate analyses, including logistic regression and ordinary least squares regression, were used to test conceptual models with the full sample and also with a subsample with baseline substance use indicative of potential substance dependence. Findings indicated that significance of predictors varied depending on outcome variable, although recovery support, efficacy, and self-control were significant predictors of all three dependent variables. Findings for each outcome variable are discussed, as well as limitations of the present study, implications for social work practice, and implications for future research.

The Rodeo-Chediski Wildfire the largest in Arizona's history at the time of burning damaged and disrupted ecosystems resources and functioning in a largely mosaic pattern throughout the ponderosa pine (Pinus Ponderosa) forests exposed to the burn. Impacts of this wildfire on ecosystems resources and functioning were studied from shortly after the cessation of the wildfire in late summer of 2002 through the spring of 2007 on two previously instrumented watersheds located on sandstone derived soils within the burn. One watershed was burned by a high severity (stand-replacing fire), while the other watershed burned in a low severity (stand-modifying) fire. This dissertation focuses on the effects fire severity had on watersheds resources and functioning in terms of the tree overstories, herbaceous understories, large and small mammals, avifauna, hydrologic functioning, soil water repellency, hillslope soil movement, and fuel loadings. The results of these studies indicated the cumulative impacts incurred to ecosystem resources, hydrologic functioning, and flammable fuels were much greater on the watershed exposed to the high severity (stand-replacing) fire. It is anticipated that the overall ecological and hydrologic function on the watershed burned by a high severity will not approach pre-fire conditions for many years. The watershed burned at a low severity, however, was approaching pre-fire conditions nearly five years after fire and is expected to be recovered within the next few years.

This study investigated the association between the severity of Tourette Syndrome (TS) and comorbid tendencies (Attention Deficit Hyperactivity Disorder (ADHD), Obsessive-Compulsive Disorder (OCD), and rage), maternal differential treatment, fairness evaluation of maternal differential treatment, and communication with both sibling and family relationships. Fifty-five mothers and healthy siblings of individuals with Tourette Syndrome participated in the study. The parents provided information regarding family demographics and the severity of Tourette Syndrome and comorbid tendencies, and the healthy siblings completed the sibling and family relationship questionnaires. The questionnaires were posted on a secure website, where the parents and healthy siblings could complete the online measures via internet connections. <br /><br /> The study revealed several important findings. The results showed significant associations between the severity of Tourette Syndrome and comorbid OCD, ADHD and rage tendencies thus suggesting that studying Tourette Syndrome without considering comorbidity would be unrealistic. Additionally, communication regarding Tourette Syndrome between the healthy siblings and their parents played an important role with respect to sibling and family relationships. Communication between the healthy siblings and their parents predicted more warmth between the healthy siblings and their sibling with Tourette Syndrome as well as more family cohesion and adaptability as reported by the healthy siblings. Communication had a significant moderating effect on both severity of Tourette Syndrome and healthy siblings' fairness evaluation of maternal differential treatment in predicting family relationships. When the sibling had less severe Tourette Syndrome, the healthy siblings reported more family adaptability when they had more communication with their parents, and reported less family adaptability when they had less communication with their parents. The results also indicated that when healthy siblings perceived their maternal differential treatment to be unfair, they reported more family cohesion when they had more communication with their parents, and reported less family cohesion when they had less communication with their parents. The study did not support the negative impact of maternal differential treatment on sibling relationships; however, the results confirmed the previous findings regarding the moderating effect of fairness evaluation on maternal differential treatment in predicting sibling relationships. When the sibling with Tourette Syndrome was favored, the healthy siblings reported more sibling warmth when they perceived the favouritism (maternal differential treatment) to be fair. Furthermore, the results showed that healthy siblings' perceptions of maternal differential treatment could predict cohesion and adaptability in the family. The more the healthy siblings reported being treated differently by their mothers, the less cohesion and adaptability they reported in their families. <br /><br /> The present study supported previous studies in finding that sibling conflict decreased with age. The results also highlighted the role of age in moderating the effects of communication and maternal differential treatment in predicting sibling conflict. When healthy siblings had more communication with their parents they reported more conflict with their sibling with Tourette Syndrome when they were younger, and reported less sibling conflict with their sibling with Tourette Syndrome when they were older. Furthermore, when healthy siblings were favored by their mothers, they reported more conflict with their sibling with Tourette Syndrome when they were younger than when they were older, thereby emphasizing the importance of developmental differences in dynamics between the siblings. The significant contributions of the study include underlining the importance of communication, the relationship between Tourette Syndrome and comorbid conditions, and healthy siblings' perceptions of sibling and family relationships.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Motor vehicle accidents involving pedestrians are some of the most common and lethal forms of injury for children in the United States. Among younger children, a common mechanism of action for severe trauma is when a vehicle runs over the child in a forward or backward motion at low speed resulting in a blunt crush injury. This typically occurs in non‐traffic settings including driveways, sidewalks, and roadways. Such incidents have been referred to in many different ways in the literature but for the purposes of this paper will be referred to as low speed vehicle run‐overs. This is a retrospective chart review carried out at Phoenix Children’s Hospital in affiliation with the University of Arizona College of Medicine‐Phoenix that categorizes and examines the injuries sustained by patients involved in low speed vehicle runovers occurring between December 2007 and August 2013. Fifty‐five pediatric patients were included with a median age of 24 months and 6 of these patients were fatally injured. Internal injuries were common overall and significantly more common in children ≤24months. Over half of the cohort sustained fractures, with a 24% incidence of skull fractures. All fatalities were the result of traumatic brain injury. Twenty percent of victims required operative intervention. It was concluded that the severity of these types of incidents varies from minimal to life threatening and best care requires close and thorough evaluation by the trauma and emergency department teams.

Research supports interventions for high-risk juvenile offenders to reduce recidivism. Methods for assessing delinquent risk vary, however. Aggregate risk scores (i.e. number of risk factors) and specific risk profiles (i.e. types of risk factors) are both empirically supported techniques. This study compared aggregate scores versus profiles for predicting measures of criminal severity among detained adolescents (n=292). Twenty-four risk factors from the Structured Assessment of Violence Risk in Youth (SAVRY) were summed to calculate aggregate scores. Using latent class analysis (LCA), profiles were identified based on scores from the following theoretically important SAVRY risk factors: Risk Taking/Impulsivity, Anger Management Problems, Low Empathy/Remorse (CU traits), and Attention Deficit/Hyperactivity Difficulties. LCA identified one low-risk profile, plus two high-risk profiles differentiated by levels of CU traits. Aggregate scores significantly predicted four out of six criminal severity indicators, while profiles failed to predict any measures. Results support aggregate scores over profiles for assessing delinquent severity.

<p>Dengue is an important vector-borne virus that infects on the order of 400 million individuals per year. Infection with one of the virus's four serotypes (denoted DENV-1 to 4) may be silent, result in symptomatic dengue 'breakbone' fever, or develop into the more severe dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). Extensive research has therefore focused on identifying factors that influence dengue infection outcomes. It has been well-documented through epidemiological studies that DHF is most likely to result from a secondary heterologous infection, and that individuals experiencing a DENV-2 or DENV-3 infection typically are more likely to present with more severe dengue disease than those individuals experiencing a DENV-1 or DENV-4 infection. However, a mechanistic understanding of how these risk factors affect disease outcomes, and further, how the virus's ability to evolve these mechanisms will affect disease severity patterns over time, is lacking. In the second chapter of my dissertation, I formulate mechanistic mathematical models of primary and secondary dengue infections that describe how the dengue virus interacts with the immune response and the results of this interaction on the risk of developing severe dengue disease. I show that only the innate immune response is needed to reproduce characteristic features of a primary infection whereas the adaptive immune response is needed to reproduce characteristic features of a secondary dengue infection. I then add to these models a quantitative measure of disease severity that assumes immunopathology, and analyze the effectiveness of virological indicators of disease severity. In the third chapter of my dissertation, I then statistically fit these mathematical models to viral load data of dengue patients to understand the mechanisms that drive variation in viral load. I specifically consider the roles that immune status, clinical disease manifestation, and serotype may play in explaining viral load variation observed across the patients. With this analysis, I show that there is statistical support for the theory of antibody dependent enhancement in the development of severe disease in secondary dengue infections and that there is statistical support for serotype-specific differences in viral infectivity rates, with infectivity rates of DENV-2 and DENV-3 exceeding those of DENV-1. In the fourth chapter of my dissertation, I integrate these within-host models with a vector-borne epidemiological model to understand the potential for virulence evolution in dengue. Critically, I show that dengue is expected to evolve towards intermediate virulence, and that the optimal virulence of the virus depends strongly on the number of serotypes that co-circulate. Together, these dissertation chapters show that dengue viral load dynamics provide insight into the within-host mechanisms driving differences in dengue disease patterns and that these mechanisms have important implications for dengue virulence evolution.</p> / Dissertation