The influence of neurocognitive impairment, alcohol and other drug (AOD) use, and psychosocial factors on antiretroviral treatment adherence, service utilization and viral load among HIV-seropositive adults

Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) can be affected by problems of neurocognitive (NC) impairment, stress, alcohol and other drug (AOD) abuse, and other barriers. The aims of this research were to: (1) examine factors associated with NC impairment, (2) explore relationships between psychosocial variables with ART adherence and viral load (VL), and (3) evaluate the efficacy of an evidence-based intervention in improving ART adherence, increasing service utilization, and decreasing VL. The first study (n=370) was cross sectional and used structural equation modeling to test whether AOD use, years living with HIV, and time from HIV diagnosis to seeking care were associated with poorer NC functioning. The second study (n=246) used similar methods to test the hypothesis that stress, barriers to adherence, NC impairment, poor social support, and AOD use were related to lower VL mediated by ART adherence. The third study (n=243) evaluated an evidence-based, eight-session program to improve ART adherence, reduce VL, and increase service utilization in a randomized controlled trial. Study participants were PLWH living in South Florida, 18 to 60 years old, with a history of alcohol abuse enrolled from January 2009 through November 2012. Secondary analysis of available data showed: (1) scores on interference with executive functioning increased by 0.32 for each day of marijuana use and 1.18 for each year living with HIV, but no association was found between alcohol use and NC functioning; (2) each barrier to adherence was associated with a 10% decrease in adherence to ART and a 0.42 unit increase in VL (log10) and the relationship between barriers and VL was partially mediated by ART adherence; (3) participants in the evidence-based program were more likely than the comparison group to report an undetectable VL (OR=2.25, p<0.01) at 6 months, but not 3 months, post-intervention. Psychosocial factors affect VL, but ART adherence is essential in achieving an undetectable VL in PLWH.

The effect of reciprocal mapping on high-risk sixth-grade students' social studies achievement

Reading deficits in students in Grades 4 to 12 are evident in American schools. Informational text is particularly difficult for students. This quasi-experimental study (N=138) investigated sixth-grade students' achievement in social studies using the Reciprocal Mapping instructional routine, compared to sixth-grade students' achievement taught with a traditional approach. The Reciprocal Mapping instructional routine incorporated explicit instruction in text structure using graphic organizers. Students created their own graphic organizers and used them to write about social studies content. The comparison group used a traditional approach, students' reading the textbook and answering questions. Students for this study included sixth-graders in the seven sixth-grade classrooms in two public schools in a small, rural south Florida school district. A focus of this study was to determine the helpfulness of the intervention for at-risk readers. To determine students considered to be at-risk, the researcher used data from the reading portion of the Florida Comprehensive Assessment Test (FCAT), 2011-2012, that considers Level 1 and 2 as at-risk readers. The quasi-experimental study used a pretest-posttest control group design, with students assigned to treatment groups by class. Two teachers at the two rural sites were trained on the Reciprocal Mapping instructional routine and taught students in both the experimental and control groups for an equivalent amount of time over a 5-week period. Results of the 3 x 2 factorial ANCOVA found a significant positive difference favoring the experimental group's social studies achievement as compared to that of the comparison group as measured by the pre/post unit test from the social studies series (McGraw-Hill, 2013), when controlling for initial differences in students' reading FCAT scores. Interactions for high-risk struggling readers were investigated using the significance level p < .05. Due to no significant interaction the main effects of treatment were interpreted. The pretest was used as a covariate and the multivariate analysis was found to be significant. Therefore, analysis of covariance was run on each of the dependent variable as a follow-up. Reciprocal Mapping was found to be significant in posttest scores, independent of gender and level of risk, and while holding the pretest scores constant. Findings showed there was a significant difference in the performance of the high-risk reading students taught with the Reciprocal Mapping intervention who scored statistically better than students in the control group. Further study findings showed that teacher fidelity of implementation of the treatment had a statistically significant relationship in predicting posttest scores when controlling for pretest scores. Study results indicated that improving students' use of text structure through the Reciprocal Mapping instructional routine positively supported sixth-grade students' social studies achievement.

The relationship between scaffolding metacognitive strategies identified through dialogue journals and second graders' reading comprehension, science achievement, and metacognition using expository text

Poor informational reading and writing skills in early grades and the need to provide students more experience with informational text have been identified by research as areas of concern. Wilkinson and Son (2011) support future research in dialogic approaches to investigate the impact dialogic teaching has on comprehension. This study (N = 39) examined the gains in reading comprehension, science achievement, and metacognitive functioning of individual second grade students interacting with instructors using dialogue journals alongside their textbook. The 38 week study consisted of two instructional phases, and three assessment points. After a period of oral metacognitive strategies, one class formed the treatment group (n=17), consisting of two teachers following the co-teaching method, and two classes formed the comparison group ( n=22). The dialogue journal intervention for the treatment group embraced the transactional theory of instruction through the use of dialogic interaction between teachers and students. Students took notes on the assigned lesson after an oral discussion. Teachers responded to students' entries with scaffolding using reading strategies (prior knowledge, skim, slow down, mental integration, and diagrams) modeled after Schraw's (1998) strategy evaluation matrix, to enhance students' comprehension. The comparison group utilized text-based, teacher-led whole group discussion. Data were collected using different measures: (a) Florida Assessments for Instruction in Reading (FAIR) Broad Diagnostic Inventory; (b) Scott Foresman end of chapter tests; (c) Metacomprehension Strategy Index (Schmitt, 1990); and (d) researcher-made metacognitive scaffolding rubric. Statistical analyses were performed using paired sample t-tests, regression analysis of covariance, and two way analysis of covariance. Findings from the study revealed that experimental participants performed significantly better on the linear combination of reading comprehension, science achievement, and metacognitive function, than their comparison group counterparts while controlling for pretest scores. Overall, results from the study established that teacher scaffolding using metacognitive strategies can potentially develop students' reading comprehension, science achievement, and metacognitive awareness. This suggests that early childhood students gain from the integration of reading and writing when using authentic materials (science textbooks) in science classrooms. A replication of this study with more students across more schools, and different grade levels would improve the generalizability of these results.

The effects of trained teachers' integration of dialogic reading discourse on Hispanic English Language Learners' literacy skills in kindergarten

This quasi-experimental Analysis of Covariance (ANCOVA) study explored whether the vocabulary and reading comprehension mean scores of Hispanic Kindergarten ELs whose teachers were trained to utilize Dialogic Reading (DR) discourse were higher than the mean scores of Hispanic ELs in kindergarten whose teachers were not trained to utilize DR discourse strategies. Sixty-three self-identified Hispanic, English Language Kindergarten students and four teachers participated in the study. The teachers were randomly assigned to either the experimental group (DR trained) or control group by drawing names from a hat. Student assignment to experimental versus comparison group was based on the teacher's assignment to either the experimental or comparison group. Thirty-one were assigned to the control group and 32 to the experimental group. The teachers were instructed to read the story to a group of six students (maximum) at a time, utilizing the DR discourse strategies they had been trained to implement. Subjects were read a story each week during the 8-week duration of the study. Teachers in the experimental group collaboratively selected 10 words each week from the Read Together Talk Together (RTTT) instructional stories that were utilized for vocabulary instruction. A test of homogeneity was conducted to evaluate whether the variance among the dependent variables was the same across the groups. An Analyses of Covariance (ANCOVA) was applied to analyze students' vocabulary and comprehension mean scores in the experimental group and the comparison group. The results of the study demonstrated a significant increase in the vocabulary and reading comprehension mean scores for the students whose teachers had been trained in DR discourse strategies. When comparing the two groups, the results revealed a statistically significant difference (p < 0.05). In conclusion, this study was conducted to explore how DR discourse may be an effective technique to teach literacy skills. The findings of this study showed that vocabulary knowledge and reading comprehension of Hispanic ELs were positively affected by the teachers' inclusion of dialogue during storybook reading. Its outcomes accentuated the need for teachers to provide assistance to ELs as they develop vocabulary knowledge and reading comprehension skills.

The use of visualization, onset-and-rime, story read-alouds, and discussion to improve diverse first graders' vocabulary and comprehension

It has long been known that vocabulary is essential in the development of reading. Because vocabulary leading to increased comprehension is important, it necessary to determine strategies for ensuring that the best methods of teaching vocabulary are used to help students make gains in vocabulary leading to reading comprehension. According to the National Reading Panel, multiple strategies that involve active engagement on the part of the student are more effective than the use of just one strategy. The purpose of this study was to determine if students' use of visualization, student-generated pictures of onset-and-rime-patterned vocabulary, and story read-alouds with discussion, would enable diverse first-grade students to increase their vocabulary and comprehension. In addition, this study examined the effect of the multimodal framework of strategies on English learners (ELs). This quasi-experimental study (N=69) was conducted in four first-grade classrooms in a low socio-economic school. Two treatment classes used a multimodal framework of strategies to learn weekly vocabulary words and comprehension. Two comparison classrooms used the traditional method of teaching weekly vocabulary and comprehension. Data sources included Florida Assessments for Instruction in Reading (FAIR), comprehension and vocabulary scores, and weekly MacMillan/McGraw Hill Treasures basal comprehension questions and onset-and-rime vocabulary questions. This research determined that the treatment had an effect in adjusted FAIR comprehension means by group, with the treatment group (adj M = 5.14) significantly higher than the comparison group ( adj M = -8.26) on post scores. However, the treatment means did not increase from pre to post, but the comparison means significantly decreased from pre to post as the materials became more challenging. For the FAIR vocabulary, there was a significant difference by group with the comparison adjusted post mean higher than the treatment's, although both groups significantly increased from pre to post. However, the FAIR vocabulary posttest was not part of the Treasures vocabulary, which was taught using the multimodal framework of strategies. The Treasures vocabulary scores were not significantly different by group on the assessment across the weeks, although the treatment means were higher than those of the comparison group. Continued research is needed in the area of vocabulary and comprehension instructional methods in order to determine strategies to increase diverse, urban students' performance.

The impact of looping of fourth grade students on their reading achievement

This study examines the effects of looping (staying with the same teacher for two grade levels) on the reading achievement of fourth graders within a large, urban, multicultural school. Looping was expected to have a positive effect on reading achievement and reading qualities. Additional benefits, such as its effect on anxiety levels and self-concept were also assumed to accrue from looping. A causal-comparative design was employed. Four existing classrooms consisting of eighty-one fourth grade students comprised the treatment and comparison groups. The two "looping" treatment groups consisted of students who had the same teacher for their third and fourth grade school years. The remaining two classes comprised the comparison groups. Pre- and post-tests for reading achievement total scores and subscores for main idea and comparisons were obtained using the Florida Comprehensive Assessment Test (FCAT). Assessments were also obtained from the State-Trait Anxiety Inventory for Children, modified to reflect reading, and the Self- Perception Profile for Children. The difference in pre- and post-test FCAT scores were analyzed via a four group simple ANOVA to examine the effects of the looping model on reading achievement and reading qualities. Similar simple ANOVAs were performed to investigate the relationship of looping to anxiety and self-concept. The findings led to the conclusion that looping was significantly related to improvement in reading achievement and reading qualities. In addition, the hypothesized relationship of lower anxiety in the looping group compared to the comparison group was supported. There were no significant effects on self-concept for any of the comparisons. The study clearly demonstrated the positive effects of looping, on total reading achievement scores, on reading qualities of fourth grade students who participated in looping classes and on differences in students' anxiety. Looping did not have an effect on general self-concept. The results demonstrate the effects of looping on teaching methods. In looping practice teachers have the advantage of knowing their students and the students' readiness and can make adaptations of teaching methods accordingly. From the students' perspective, the looped students do not have to adapt to a new teacher and thus, experience lower anxiety.

The impact of standards-based practices in mathematics on the achievement of low-performing students

This study examined standards-based mathematics reform initiatives to determine if they would improve student achievement on the part of low-performing students. New curricula, the Carnegie Learning Cognitive Tutor®, were provided for algebra and geometry students. The new instructional strategy relied on both the teacher-led instruction and the use of computers to differentiate instruction for individual students. Mathematics teachers received ongoing professional development to help them implement the new curricula. In addition, teachers were provided with ongoing support to assist them with the transformation of the learning environments for students using standards-based practices. This quasi-experimental (nonrandomized) study involved teachers in two matched urban high schools. Analyses (ANCOVAs) revealed that the experimental group with an appropriately implemented program had significantly higher learning gains than the comparison group as determined by the students' 2007 mathematics Developmental Scale Score (DSS). In addition, the experimental group's adjusted mean for the second interim mathematics assessment was significantly higher than the comparison group's mean. The findings support the idea that if the traditional curriculum is replaced with standards-based curriculum, and the curriculum is implemented as intended, low-performing students may make significant learning gains. With respect to the teaching practices as observed with the Classroom Observation Protocol (COP), t-tests were conducted on four constructs. The results for both the algebra and geometry teachers on the constructs were not significant. The COP indicated that teachers in both the experimental and comparison groups used traditional instruction strategies in their classrooms. The analyses of covariance (ANCOVA) on the use of technology revealed no significant main effects for computer use.

Morbidity and mortality following pelvic rami fractures in an elderly Newfoundland population

Introduction: Pelvic rami fractures in the elderly are associated with significant morbidity and mortality. Despite our rapidly aging population there is a paucity of literature dealing with fractures of the pelvic rami in this age group. The purpose of this study is report mortality rates following these injuries in the Eastern region of Newfoundland. Additionally, we aim to describe and quantify the important resultant morbidity in this vulnerable elderly population . Methods: A retrospective chart review was performed of all the pelvic fractures in individuals over the age of 60 between 2000 and 2005 in the Eastern Health region of Newfoundland and Labrador. From these patients, only those with the radiographic parameters consistent with low energy pattern pelvic ring injuries were included. Excluded from the study were those with concurrent fractures of the femur. Survival data, comorbidities, injury characteristics, hospital stay, ambulatory status, and place of residence were recorded from the chart. A surrogate control group was formulated from Statistics Canada survival data for use as a survival comparison group. Results: There were 80 fractures of the pelvis identified in patients over 60 years old from 2000-2005. Of these, 43 met our inclusion/exclusion criteria and were used in our analysis. The one and five year mortalities of these patients were 16.3% (95% CI; 7.80% to 30.3%) and 58.1% (95% CI; 43.3% to 71.6%), respectively. These were both significantly different from the point estimates from our constructed age and gender matched control group from the Statistics Canada data of 6.58% (one year mortality) and 31.3% (five year mortality). Morbidity was quantified by change in ambulatory status (independent, walker/cane assisted, wheelchair) and change in residential independence (independent, assisted living, nursing home). Post fracture, 36% of patients permanently required increased ambulatory aids and 21% of patients required a permanent increase in everyday level of care. Conclusion: This study suggests that there may be significantly increased mortality and morbidity following low energy pattern pelvic rami fractures in an elderly population compared to age and gender matched controls. In contrast to previous studies describing these injuries, there is greater homogeneity in this population with respect to age and mechanism of injury. This study generates several important hypotheses for future research and in particular highlights the need for larger prospective studies to identify factors predicting the highest risk for poor outcomes in this population.

The Effect of Authentic Literacy Experiences as Book Buddies with Hispanic Fourth Graders on Preservice Teachers’ Literacy Content Knowledge and Reading Maturity

From a sociocultural perspective, individuals learn best from contextualized experiences. In preservice teacher education, contextualized experiences include authentic literacy experiences, which include a real reader and writer and replicate real life communication. To be prepared to teach well, preservice teachers need to gain literacy content knowledge and possess reading maturity. The purpose of this study was to examine the effect of authentic literacy experiences as Book Buddies with Hispanic fourth graders on preservice teachers’ literacy content knowledge and reading maturity. The study was a pretest/posttest design conducted over 12 weeks. Preservice teacher participants, the focus of the study, were elementary education majors taking the third of four required reading courses in non-probabilistic convenience groups, 43 (n = 33 experimental, n = 10 comparison) Elementary Education majors. The Survey of Preservice Teachers’ Knowledge of Teaching and Technology (SPTKTT), specifically designed for preservice teachers majoring in elementary or early childhood education and the Reading Maturity Survey (RMS) were used in this study. Preservice teachers chose either the experimental or comparison group based on the opportunity to earn extra credit points (experimental = 30 points, comparison = 15). After exchanging introductory letters preservice teachers and Hispanic fourth graders each read four books. After reading each book preservice teachers wrote letters to their student asking higher order thinking questions. Preservice teachers received scanned copies of their student’s unedited letters via email which enabled them to see their student’s authentic answers and writing levels. A series of analyses of covariance were used to determine whether there were significant differences in the dependent variables between the experimental and comparison groups. This quasi-experimental study tested two hypotheses. Using the appropriate pretest scores as covariates for adjusting the posttest means of the subcategory Literacy Content Knowledge (LCK), of the SPTKTT and the RMS, the mean adjusted posttest scores from the experimental group and comparison group were compared. No significant differences were found on the LCK dependent variable using the .05 level of significance, which may be due to Type II error caused by the small sample size. Significant differences were found on RMS using the .05 level of significance.

An exploration of men’s experiences of undergoing active surveillance for favourable-risk prostate cancer: A mixed methods study protocol

Background
Prostate cancer is one of the most common male cancers worldwide. Active Surveillance (AS) has been developed to allow men with lower risk disease to postpone or avoid the adverse side effects associated with curative treatments until the disease progresses. Despite the medical benefits of AS, it is reported that living with untreated cancer can create a significant emotional burden for patients.

Methods/design
The aim of this study is to gain insight into the experiences of men eligible to undergo AS for favourable-risk PCa.

This study has a mixed-methods sequential explanatory design consisting of two phases: quantitative followed by qualitative. Phase 1 has a multiple point, prospective, longitudinal exploratory design. Ninety men diagnosed with favourable-risk prostate cancer will be assessed immediately post-diagnosis (baseline) and followed over a period of 12 months, in intervals of 3 month. Ninety age-matched men with no cancer diagnosis will also be recruited using peer nomination and followed up in the same 3 month intervals. Following completion of Phase 1, 10–15 AS participants who have reported both the best and worst psychological functioning will be invited to participate in semi-structured qualitative interviews. Phase 2 will facilitate further exploration of the quantitative results and obtain a richer understanding of participants’ personal interpretations of their illness and psychological wellbeing.

Discussion
To our knowledge, this is the first study to utilise early baseline measures; include a healthy comparison group; calculate sample size through power calculations; and use a mixed methods approach to gain a deeper more holistic insight into the experiences of men diagnosed with favourable-risk prostate cancer.

Fonction et structure des muscles du plancher pelvien de femmes traitées par chirurgie et radiothérapie à la suite d'un cancer de l'endomètre

Ce mémoire porte sur les propriétés fonctionnelles du plancher pelvien à la suite de traitements pour un cancer de l’endomètre. Chez les femmes, le cancer de l’endomètre est le cancer gynécologique ayant la plus forte prévalence. Les traitements oncologiques de ce cancer ont des conséquences néfastes sur la continence urinaire et il est possible que des altérations aux muscles du plancher pelvien à la suite de ces traitements puissent expliquer en partie cette problématique. Ce mémoire est composé de deux études principales. La première étude porte sur la recension des écrits liés aux impacts de la radiothérapie sur la structure anatomique et la fonction musculaire du plancher pelvien chez des adultes atteints d’un cancer pelvien. La deuxième étude compare les propriétés fonctionnelles du plancher pelvien de femmes avec incontinence urinaire à la suite d’un cancer de l’endomètre traité par chirurgie et une radiothérapie adjuvante (groupe à l’étude), à celles de femmes avec hystérectomie sans incontinence (groupe témoin). Cette étude a permis de mettre en évidence une diminution de l’ouverture maximale à l’entrée vaginale, de la longueur vaginale, de la force maximale volontaire du plancher pelvien, du taux de développement de la force dans un test de force maximale et de la coordination lors d’un test de contractions rapides. Ainsi, les deux études de ce mémoire apportent de nouvelles évidences sur les altérations des propriétés fonctionnelles du plancher pelvien à la suite de traitements pour un cancer génital.

Evaluation of Community-led Complementary Feeding and Learning Sessions

Thesis (Master's)--University of Washington, 2016-08

The Cardiovascular Pathology of Stimulant Overdose Decedents in King County, Washington

Thesis (Master's)--University of Washington, 2016-09

Effects of an in-service training program using the routines-based interview

The focus of this study is an in-service training program rooted in routines-based early intervention and designed to improve the quality of goals and objectives on individualized plans. Participants were local intervention team members and other professionals who worked closely with each team. This training program involved a small number of trainees per group, providing multiple learning experiences across time and various opportunities for self-assessment and monitoring. We investigated (a) the perceptions of the participants about the strengths and weaknesses of the training program, (b) medium-term outcomes of the training with a comparison group, (c) and variables associated with the quality of goals and objectives. This study involved training more than 200 professionals, and results support the effectiveness of the program in improving the quality of goals and objectives, showing the importance of the routines-based interview in producing that improvement.

EXPLICIT WRITTEN CORRECTIVE FEEDBACK AND LANGUAGE APTITUDE IN SLA: IMPLICATIONS FOR IMPROVEMENT OF LINGUISTIC ACCURACY

Most second language researchers agree that there is a role for corrective feedback in second language writing classes. However, many unanswered questions remain concerning which linguistic features to target and the type and amount of feedback to offer. This study examined two new pieces of writing by 151 learners of English as a Second Language (ESL), in order to investigate the effect of direct and metalinguistic written feedback on errors with the simple past tense, the present perfect tense, dropped pronouns, and pronominal duplication. This inquiry also considered the extent to which learner differences in language-analytic ability (LAA), as measured by the LLAMA F, mediated the effects of these two types of explicit written corrective feedback. Learners in the feedback groups were provided with corrective feedback on two essays, after which learners in all three groups completed two additional writing tasks to determine whether or not the provision of corrective feedback led to greater gains in accuracy compared to no feedback. Both treatment groups, direct and metalinguistic, performed better than the comparison group on new pieces of writing immediately following the treatment sessions, yet direct feedback was more durable than metalinguistic feedback for one structure, the simple past tense. Participants with greater LAA proved more likely to achieve gains in the direct feedback group than in the metalinguistic group, whereas learners with lower LAA benefited more from metalinguistic feedback. Overall, the findings of the present study confirm the results of prior studies that have found a positive role for written corrective feedback in instructed second language acquisition.