DM is a serious and complex public health problem in the U.S. The CDC (2013) estimated that 25.8 million people, or 8.3% of the U.S. population, were suffering from DM in 2011. DM can significantly affect patient’s quality of life. Additionally, DM places a significant economic burden on the U.S. healthcare system. Over the past two decades, DMPs have emerged as a promising intervention to improve health outcomes for patients suffering from chronic conditions, such as DM, and to bend the cost curve. DMP’s aim is to improve communication and follow-up so that patients can better manage their chronic condition(s) to avoid costly hospital stays and emergency room visits (Fireman, Bartlett, & Selby, 2004). The Georgia region of Kaiser Permanente (KPGA) is a fully integrated health system that serves 260,000 members at 28 medical offices along with two specialty offices in the metropolitan Atlanta area. The Center for Care Partnership, the population care division of KPGA, administers a chronic disease management program (DMP), Healthy Solutions (HS). HS exists to improve and maintain the health of chronically ill KPGA members, including patients diagnosed with diabetes mellitus (DM), by providing health coaches via telephone who counsel members on their specific chronic disease and aid members in starting or maintaining a physician approved self-care management plan. In order to determine the impact HS has on KPGA members with DM, an evaluation plan was created to evaluate the impact HS has on members’ glycated hemoglobin (A1C), blood pressure, and emergency department (ED) utilization. This capstone thoroughly details the proposed evaluation plan created for HS by using Robert Milstein and Scott Wetterhall’s six-step framework for program evaluation. Additionally, further evaluation questions are suggested and discussed in order to provide a more complete picture of program performance to stakeholders.

Optimal pharmacotherapy requires an understanding of the dose-exposure (pharmacokinetics or PK) to response (pharmacodynamic or PD) relationship. Little is known about the influence of obesity on this dynamic system as PK studies in obesity have been largely descriptive rather than explanatory. This has led to a paucity of dosing guidelines for the obese, and arbitrary dose selection in the clinic. There is a need to quantify the impact of obesity on drug clearance (CL) to ensure that exposure is matched across patients of different body compositions, thereby improving therapeutic outcomes and minimising adverse events. The global aim of this thesis was to use prior published data and new clinical trial data to understand how body composition impacts upon drug CL and renal function, and to determine how clinical study design influences the identification of these relationships. Chapter 2 of this thesis determined if conventional body size descriptors that have been used to scale drug doses to body size were appropriate. In the clinical setting, a body size descriptor commonly used for determining dose requirements is total body weight (WT), based on the assumption that physiological function and PK parameters vary according to body size. However, dosing algorithms based on WT might be unsuitable for the obese due to their altered body composition which, if inaccurate, could ultimately lead to overdoses. Alternative body size descriptors such as body surface area and ideal body weight have been used, but are limited when extrapolated to obese patients as they do not take into account the covariates required to describe differences in body composition between individuals. In contrast, it was demonstrated that lean body weight (LBW), as derived by Janmahasatian et al, had the potential to scale CL across a wide range of body compositions. This literature review and systematic analysis of previously published obesity data led to the proposal of a hypothesis that body composition is sufficient to explain the influence of obesity on drug CL and that dosing for obese patients should be based on LBW. When conducting clinical studies, the selection of an appropriate body size descriptor for scaling doses across individuals of different body compositions can be aided by a study design that allows for the identification of parameter-covariate relationships which are transportable to the obese. Chapter 3 of this thesis quantified the probability of identifying these parameter-covariate relationships as a function of differing study designs. Demographics were generated using a multivariate lognormal covariate distribution with truncation at different WT limits under both a non-stratified and stratified design. PK data were simulated from a 1-compartment, first order input, first order elimination model with LBW as the covariate on CL, termed the ‘True Model’. The ‘False Model’ had WT as the covariate on CL. Both models were fitted to the simulated data and the preferred model was selected based on the difference in objective function values. Each design was evaluated under differing magnitudes of random effects, as well as under a D-optimal sparse sampling scheme. It was shown under a simulation platform that the use of stratification and a wide covariate range enhanced the probability of selecting the true covariate from two competing covariate models. The aforementioned findings regarding LBW and stratification were used to design a new clinical study investigating the influence of obesity on renal drug elimination pathways. This work forms Chapters 4 and 5 of this thesis. Non-obese and obese healthy volunteers were recruited using a study design stratified for LBW. These subjects were administered a combination of four renal markers for the simultaneous assessment of various renal processes. One of the renal markers was para-aminohippuric acid (PAH), which provides an estimation of renal plasma flow (RPF). A population PK model was developed for PAH, which revealed that body size alone was insufficient to explain variability in RPF across healthy individuals of a large range of body compositions, although LBW emerged as the preferred covariate (p=0.053) among the body size descriptors tested. This weak covariate effect was in contrast with prior research supporting the use of LBW in normalising the effect of obesity on glomerular filtration rate (GFR), implying that body composition could play a greater role in influencing GFR than RPF. This thesis has applied new methods to the design of drug CL studies in obesity, and offered results and future directions to maximise the information gained from such clinical studies. A better understanding of alterations in PK and physiological function arising from changes in body composition should aid in optimising dose adjustments for obese patients, which is of great importance given the increasing prevalence of obesity in today’s society.

Studiens syfte var att undersöka om läsning med stöd av en hund påverkade avkodningsförmågan och motivation till läsning hos elever som hade svårigheter med att automatisera sin läsning. Under sex veckor, fyra dagar i veckan, lästränade sex elever intensivt genom att läsa läslistor samt läsa högt ur en bok. Tre elever läste med en hund och tre elever läste utan hund men för övrigt var lästillfällena upplagda på samma sätt. Single study design användes som metod, med pre-, posttest samt testning under träningens gång. Resultatet visade positiva resultat på avkodning men hundens påverkan gick inte att mäta. Resultatet gick inte heller att generalisera eftersom urvalet av elever var för få, inte valdes ut slumpmässigt och hade olika utgångsläge. Eleverna som läste med en hund som stöd hade högre avkodningsförmåga initialt jämfört med eleverna som lästränade utan hund.Resultatet gällande motivationen visade små positiva förändringar på individnivå.

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Randomized controlled trials (RCTs) are the hallmark of evidence-based medicine and form the basis for translating research data into clinical practice. This review summarizes commonly applied designs and quality indicators of RCTs to provide guidance in interpreting and critically evaluating clinical research data. It further reflects on the principle of equipoise and its practical applicability to clinical science with an emphasis on critical care and neurological research. We performed a review of educational material, review articles, methodological studies, and published clinical trials using the databases MEDLINE, PubMed, and ClinicalTrials.gov. The most relevant recommendations regarding design, conduction, and reporting of RCTs may include the following: 1) clinically relevant end points should be defined a priori, and an unbiased analysis and report of the study results should be warranted, 2) both significant and nonsignificant results should be objectively reported and published, 3) structured study design and performance as indicated in the Consolidated Standards of Reporting Trials statement should be employed as well as registration in a public trial database, 4) potential conflicts of interest and funding sources should be disclaimed in study report or publication, and 5) in the comparison of experimental treatment with standard care, preplanned interim analyses during an ongoing RCT can aid in maintaining clinical equipoise by assessing benefit, harm, or futility, thus allowing decision on continuation or termination of the trial.

Det förekommer skillnader i hälsa mellan olika grupper i samhället. Skillnaderna kan ge negativa hälsokonsekvenser för de enskilda individerna och för samhället. Många unga, invandrare, personer med beroendeproblematik, bidragsberoende och personer med diagnoser står idag utanför arbetsmarknaden och löper större risk att hamna i utanförskap. Individer som står långt ifrån arbetsmarknaden kan leda till negativa konsekvenser för hälsan som påverkar en individs livssituation. Att arbeta är en central del av individers liv som ger en känsla av sammanhang och meningsfullhet. Studiens syfte är undersöka kommunanställdas erfarenhet av att arbeta med utanförskap. För att besvara studiens syfte användes en kvalitativ metod. Semistrukturerade intervjuer har genomförts med fem kommunanställda som arbetar med utanförskap i en kommun i Mellansverige. Det insamlade materialet har analyserats genom en manifest innehållsanalys. Resultatet visar att samverkan mellan olika aktörer underlättar kommunanställdas möjlighet att ge socialt stöd till individer som befinner sig i utanförskap. Att ge socialt stöd ansågs också vara viktigt i arbete med utanförskap eftersom utsatta människor kan sakna det. Deltagarna i studien har belyst att individer som har socialt sammanhang påverkar deras delaktighet i samhället. Att uppleva sammanhang kan skapa en meningsfullhet för utsatta individer som befinner sig i utanförskap. En rimlig slutsats av resultatet är att de kommunanställda arbetar med att öka det sociala sammanhanget bland utsatta personer som söker hjälp och kan hjälpa dem med att öka det sociala stödet. Deltagarna belyste även att deras arbete med att motverka utanförskap lyckas med hjälp av deras samverkan med aktörer och myndigheter. / There are differences in health between different groups in society. The differences can cause negative consequences for individuals and for the society. Young adults, immigrants, people with addiction problems, contributions dependent, people with diagnoses are currently outside the labor market who are more likely to end up in social exclusion. Individuals who are far from the labor market can affect their life situation, which usually has negative consequences. Work today is a central part of individuals lives that’s gives a sense of context and meaningfulness. The aim of the study is to analyse communal employees experience of work with exclusion. To answer the study’s purpose, a qualitative method was used, and semi-structured interviews were conducted with five communal employees who work with people in social exclusion in a communal in the middle of Sweden. The collected material has been analysed through a manifest content analysis. The results show that collaboration between different actors facilitates their ability to provide social support to individuals who are in exclusion. Social support was considered important in work with exclusion because it leads to positive factors. The communal employees highlighted that social context among vulnerable individuals is something that affects them to take part in the society and experience meaningfulness. A reasonable conclusion from the result is that communal employees work to increase the social context among vulnerable people who seek help thereby increasing social support. The participants have highlighted that their work with people is in social exclusion succeeds with the help of their collaboration with actors and authorities.

This dissertation serves as a report on the qualitative exploration of best practices in animal-assisted therapy (AAT) with children. The aim of the study was to explore and describe best practices in the field of AAT with children in the Western Cape. The research made use of the case study design, which offered the researcher the opportunity to interact with a small number of individuals and look for patterns in the research participants’ words and experiences. Four participants, who were trained mental health professionals and had offered AAT to children, were selected to participate in the research. A literature review of animal-assisted therapy and best practice provided a theoretical basis for the research. The history of AAT, the uses and benefits of AAT and the animals incorporated in AAT were explored. The term “best practice” and its application in mental health and AAT were also discussed. The verbatim transcriptions of the audiotaped data were analysed and interpreted using Interpretative Phenomenological Analysis (IPA) and an AAT conceptual framework (brought about by the literature review). Themes were developed from the empirical data and substantiated by the literature review. Five main themes emerged as a result of the analysis. The first theme, Training of the animal-assisted therapist, focused on both the mental health training and the AAT training of the therapist. The second theme, Training of animals incorporated in animal-assisted therapy, revealed the importance of training the animal to be included in AAT. The third theme, Different client populations in animal-assisted therapy, looked at which populations should be included, excluded or included and carefully managed during AAT. The fourth theme, Ethical considerations in animal-assisted therapy, revealed the importance of considering both the child’s and the animal’s welfare. The fifth theme, Regulation of animal-assisted therapy, gave a more in-depth description of the current regulation of AAT in the Western Cape and provided suggestions for the regulation of AAT. Based on the findings of the five themes, recommendations were made for best practice in AAT with children in the Western Cape. / Thesis (MA (Psychology))--North-West University, Potchefstroom Campus, 2013.

This dissertation serves as a report on the qualitative exploration of best practices in animal-assisted therapy (AAT) with children. The aim of the study was to explore and describe best practices in the field of AAT with children in the Western Cape. The research made use of the case study design, which offered the researcher the opportunity to interact with a small number of individuals and look for patterns in the research participants’ words and experiences. Four participants, who were trained mental health professionals and had offered AAT to children, were selected to participate in the research. A literature review of animal-assisted therapy and best practice provided a theoretical basis for the research. The history of AAT, the uses and benefits of AAT and the animals incorporated in AAT were explored. The term “best practice” and its application in mental health and AAT were also discussed. The verbatim transcriptions of the audiotaped data were analysed and interpreted using Interpretative Phenomenological Analysis (IPA) and an AAT conceptual framework (brought about by the literature review). Themes were developed from the empirical data and substantiated by the literature review. Five main themes emerged as a result of the analysis. The first theme, Training of the animal-assisted therapist, focused on both the mental health training and the AAT training of the therapist. The second theme, Training of animals incorporated in animal-assisted therapy, revealed the importance of training the animal to be included in AAT. The third theme, Different client populations in animal-assisted therapy, looked at which populations should be included, excluded or included and carefully managed during AAT. The fourth theme, Ethical considerations in animal-assisted therapy, revealed the importance of considering both the child’s and the animal’s welfare. The fifth theme, Regulation of animal-assisted therapy, gave a more in-depth description of the current regulation of AAT in the Western Cape and provided suggestions for the regulation of AAT. Based on the findings of the five themes, recommendations were made for best practice in AAT with children in the Western Cape. / Thesis (MA (Psychology))--North-West University, Potchefstroom Campus, 2013.

The mechanism of how physical education teacher education (PETE) students learn to teach physical education (PE) has been considered as a missing link in a comprehensive curriculum of PETE research. Previous studies found that the PETE students’ acculturation phase has a big impact on the students’ beliefs towards teaching PE as it is referred to as Occupational Socialization Theory (OST). The purpose of this study was to explore how PETE students learn to teach PE based on their experiences being taught PE and coached in a sport and their reflections on their emerging practices whilst taking a course EPHE 452 – Strategies for teaching games, a culminating course in their physical and health education teachable area. The study used two qualitative research methods, autoethnography and participant observation ethnography, within a case study design methodology. Data collection included the case studies’ interviews of three PETE students and the EPHE 452 course observation throughout COVID-19 pandemic in Spring semester in 2021. The findings showed that PETE students carried beliefs from their acculturation phase to their professional phase, while the teacher education program has a positive impact on the PETE students’ beliefs towards teaching PE. Four organizing course themes with sub-themes emerged; insights on the impact of COVID-19 pandemic on the course becoming a mediating theme. Several effective methods were used to develop PETE students’ abilities to teach PE, such as the online resources, group discussions, the practicum experience and the reading of articles. The COVID-19 pandemic created opportunities and challenges among PETE students who took EPHE 452 course in Spring Semester in 2021 that have led to a rethinking and redevelopment of the EPHE 452 course. / Graduate

L’augmentation des capacités des systèmes de télécommunications optiques passe par le développement des dispositifs optoélectroniques innovants et des technologies clés à hautes performances. Ces dispositifs sont sujets à une forte intégration des composants et les technologies déployées mettent en œuvre des fonctions complexes (PDM – QPSK, PDM – 16 QAM, etc.). Il est donc nécessaire avant toute réalisation d’étudier le comportement électromagnétique de ces composants afin d’envisager des performances en haute fréquence et une bonne intégrité du signal contenant l’information dans la chaîne de transmission. Ainsi à travers une modélisation EM – circuit le comportement global d’un modulateur à plusieurs niveaux de phase, basé sur la déplétion de porteurs dans une jonction PN, est étudié et analysé. Le modulateur est dans un premier temps représenté par un modèle prenant en compte la jonction. Cette dernière est modélisée par sa résistance et sa capacité équivalentes. Ensuite le packaging du modulateur avec son circuit d’entrée pour les signaux RF et son circuit de sortie pour l’adaptation de charges en sortie est réalisé et optimisé. Une modélisation EM a également permis de concevoir le circuit d’entrée d’un multiplexeur intégré à un Convertisseur Numérique – Analogique 3 bits, destiné à mettre œuvre une modulation PDM – 64 QAM dans un système optique. Les résultats obtenus respectent les spécifications industrielles et permettent de d’envisager le fonctionnement en haute fréquence des dispositifs intégrés. / The increase of the capacities of optical telecommunications systems goes through the development of innovative optoelectronics devices and key technologies with high performances. These devices are subjects to high components integration and the deployed technologies implement complex functions (PDM - QPSK, PDM - 16 QAM etc.). Therefore, it is necessary before any realization to study the electromagnetic behavior of these components in order to predict good performances at high frequency and signal integrity in the transmission chain. Thus, through an EM - circuit modeling, the overall behavior of an electro-optical multilevel modulator based on carrier depletion in a PN junction has been studied and analyzed. The modulator is firstly represented by a model taking in account the junction. The junction is modeled by her equivalents resistance and capacity. Subsequently, the packaging of the modulator with the input and out circuit is realized and optimized. The EM modeling has also helped to design the input circuit of an integrated multiplexer to a 3 bits digital - analog converter for an optical system. The obtained results meet the industry specifications and allow predicting good performances in high frequency for the integrated devices.