Medication -related adverse events in older people with dementia:causes and possible solutions

This submission for a PhD by previously published work is based upon six publications in peer reviewed journals, reflecting a 9-year research programme. My research has shown, in a coherent and original way, the difficulty in treating people with dementia with safe and effective medication whilst providing research-founded guidance to develop mechanisms to optimise medication choice and minimise iatrogenic events. A wide range of methods, including systematic reviews, meta-analysis, randomised controlled trials (RCTs), quantitative research and mixed methods were used to generate the data, which supported the exploration of three themes. The first theme, to understand the incidence and causes of medication errors in dementia services, identified that people with dementia may be more susceptible to medication-related iatrogenic disease partly due to inherent disease-related characteristics. One particular area of concern is the use of anti-psychotics to treat the Behavioural and Psychological Symptoms of Dementia (BPSD). The second and third themes, respectively, investigated a novel pharmacological and health services intervention to limit anti-psychotic usage. The second phase found that whilst the glutamate receptor blocker memantine showed some promise, further research was clearly required. The third phase found that anti-psychotic usage in dementia may be higher than official figures suggest and that medication review linking primary and secondary care can limit such usage. My work has been widely cited, reflecting a substantial contribution to the field, in terms of our understanding of the causes of, and possible solutions to limit, medication-related adverse events in people with dementia. More importantly, this work has already informed clinical practice, patients, carers and policy makers by its demonstrable impact on health policy. In particular my research has identified key lines of enquiry for future work and for the development of my own personal research programme to reduce the risk associated with medication in this vulnerable population.

Mere equities and third parties in leasehold law

Examines the concept of a "mere equity" in the context of the Land Registration Act 2002 s.116(b). Considers, by reference to case law, the nature and status of a mere equity and equities coming within the category of equitable rights binding third parties, including a landlord's right to rectification of a lease, the right to set aside a lease and a tenant's right to relief against forfeiture of a lease. Comments on the extent to which s.116(b) requires a mere equity to be more than just procedural and to be an equitable proprietary right capable of binding successors in title.

„Mennyit ér” a fenntarthatóság? – Esettanulmány az externális hatások mérésére azok internalizálására (What is sustainability worth? – A case study of measuring and internalizing negative environmental effects of logistics operation)

A fenntarthatóság központi kérdés a gazdálkodástudományban, ezen belül a logisztikában, hiszen a környezetre rótt szennyezésben e vállalati működési területnek is jelentős a szerepe. A szerzők dolgozata egy konkrét hazai esettanulmány segítségével vizsgálja a kérdéskört. Azt elemzik, vajon egy, az Európai Unióban is új kamiontípus (az ún. EuroCombi) alkalmazása a logisztikai folyamatokban milyen externális hatásokkal jár. Elemzésükben kísérletet tesznek ezeknek az externális hatásoknak a pénzben kifejezett mérésére. Azért fontos mindez, mert e mérés és számszerűsítés nélkül lehetetlen ezeknek a hatásoknak az internalizálása, vagyis belsővé tétele. Így mérés nélkül sem az érintett vállalatok tulajdonosai, sem azok belső döntéshozói, de a külső szabályozó szereplők sem tudják bevonni e hatásokat gazdasági döntéseikbe. Ez a mérés nem egyszerű feladat, de nem is lehetetlen. Mindenképpen alapját, előfeltételét képezi azonban annak, hogy ilyen jellegű döntéseknél az érintettek a társadalmi, környezeti érdekeket is érvényesíteni tudják. ____ Sustainability is a key issue today both for practitioners and researchers. This is true especially for logisticians. Logistics is a function that has a significant CO2 emission and also destructs transportation infrastructure that burden our environment. The article is focusing on these issues with the help of a Hungarian case study. It analysis the effect of applying a new, long and heavy type of truck, called EuroCombi. It presents a methodology usable for measuring these negative external effects in Forint. Without proper measurement internalization of costs these externalities generate is impossible. As it will be presented in details, such a measurement is although not very easy but achievable.

A comparison of the academic performance of students with General Educational Development credentials and high school diplomas at a selected community college

This study compared the performance of students who earned GED credentials in Florida with that of graduates of Florida high schools, when members of both groups enrolled for the first time in fall 1992 at an urban multicultural community college in south Florida. GED's and HSD's were matched on gender, race, age range, placement levels, and enrollment in college preparatory courses (reading, English, mathematics). The paired samples t-test compared course grades, first semester GPA, and total college GPA for the groups and subgroups of matched students at a probability level of .05. The McNemar test compared how many students in each group and subgroup re-enrolled for a second and third term, or ever; how many were placed on special academic status during their college enrollment; and how many graduated within 16 semesters. Differences between groups were found only for placement on probation—with HSD's on probation in significantly higher proportion than GED's. ^ Additional findings among subgroups revealed that male and Caucasian HSD subjects earned higher math grades than their GED counterparts. Male HSD's were more likely than male GED's to return to the college at some point after the first term. However, male HSD's were placed on probation in greater proportion than the GED's with whom they were matched. ^ Female GED's earned higher English grades and higher first semester and cumulative GPA's and returned to the college in greater proportion than their HSD counterparts. Black GED's earned higher first-semester GPA's, re-enrolled in terms 2 and 3 and graduated from the college in higher percentages than Black HSD's. Black HSD's were placed on probation in higher proportion than Black GED's. Lastly, greater percentages of HSD than GED subjects in the lowest age range (16–19) were placed on probation. ^ Results connected to the performance of Black GED subjects are likely to have been affected by the fact that 50% of Black study subjects had been born in Jamaica. The place of the GED in the constellation of methods for earning credit by examination is explored, future implications are discussed, and further study is recommended. ^

Consistency and accuracy in memory: Effects of schema-typicality, retention interval and question-format

This study examined the effect of schemas on consistency and accuracy of memory across interviews, providing theoretical hypotheses explaining why inconsistencies may occur. The design manipulated schema-typicality of items (schema-typical and atypical), question format (free-recall, cued-recall and recognition) and retention interval (immediate/2 week and 2 week/4 week). Consistency, accuracy and experiential quality of memory were measured. ^ All independent variables affected accuracy and experiential quality of memory while question format was the only variable affecting consistency. These results challenge the commonly held notion in the legal arena that consistency is a proxy for accuracy. The study also demonstrates that other variables, such as item-typicality and retention interval have different effects on consistency and accuracy in memory. ^

Prenatal augmented auditory stimulation and visual system development: Effects of timing on intersensory organization

This study investigated the effects of augmented prenatal auditory stimulation on postnatal visual responsivity and neural organization in bobwhite quail (Colinus virginianus). I delivered conspecific embryonic vocalizations before, during, or after the development of a multisensory, midbrain audiovisual area, the optic tectum. Postnatal simultaneous choice tests revealed that hatchlings receiving augmented auditory stimulation during optic tectum development as embryos failed to show species-typical visual preferences for a conspecific maternal hen 72 hours after hatching. Auditory simultaneous choice tests showed no hatchlings had deficits in auditory function in any of the groups, indicating deficits were specific to visual function. ZENK protein expression confirmed differences in the amount of neural plasticity in multiple neuroanatomical regions of birds receiving stimulation during optic tecturn development, compared to unmanipulated birds. The results of these experiments support the notion that the timing of augmented prenatal auditory stimulation relative to optic tectum development can impact postnatal perceptual organization in an enduring way.^

Jury decision making and the Story Model: How do deliberation style and evidence order influence the story that juries create?

This study investigated the utility of the Story Model for decision making at the jury level by examining the influence of evidence order and deliberation style on story consistency and guilt. Participants were shown a video-taped trial stimulus and then provided case perceptions including a guilt judgment and a narrative about what occurred during the incident. Participants then deliberated for approximately thirty minutes using either an evidence-driven or verdict-driven deliberation style before again providing case perceptions, including a guilt determination, a narrative about what happened during the incident, and an evidence recognition test. Multi-level regression analyses revealed that evidence order, deliberation style and sample interacted to influence both story consistency measures and guilt. Among students, participants in the verdict-driven deliberation condition formed more consistent pro-prosecution stories when the prosecution presented their case in story-order, while participants in the evidence-driven deliberation condition formed more consistent pro-prosecution stories when the defense's case was presented in story-order. Findings were the opposite among community members, with participants in the verdict-driven deliberation condition forming more consistent pro-prosecution stories when the defense's case was presented in story-order, and participants in the evidence-driven deliberation condition forming more consistent pro-prosecution stories when the prosecution's case was presented in story-order. Additionally several story consistency measures influenced guilt decisions. Thus there is some support for the hypothesis that story consistency mediates the influence of evidence order and deliberation style on guilt decisions.

Phonics instruction using pseudowords for success in phonetic decoding

This study examined a Pseudoword Phonics Curriculum to determine if this form of instruction would increase students’ decoding skills compared to typical real-word phonics instruction. In typical phonics instruction, children learn to decode familiar words which allow them to draw on their prior knowledge of how to pronounce the word and may detract from learning decoding skills. By using pseudowords during phonics instruction, students may learn more decoding skills because they are unfamiliar with the “words” and therefore cannot draw on memory for how to pronounce the word. It was hypothesized that students who learn phonics with pseudowords will learn more decoding skills and perform higher on a real-word assessment compared to students who learn phonics with real words. ^ Students from two kindergarten classes participated in this study. An author-created word decoding assessment was used to determine the students’ ability to decode words. The study was broken into three phases, each lasting one month. During Phase 1, both groups received phonics instruction using real words, which allowed for the exploration of baseline student growth trajectories and potential teacher effects. During Phase 2, the experimental group received pseudoword phonics instruction while the control group continued real-word phonics instruction. During Phase 3, both groups were taught with real-word phonics instruction. Students were assessed on their decoding skills before and after each phase. ^ Results from multiple regression and multi-level model analyses revealed a greater increase in decoding skills during the second and third phases of the study for students who received the pseudoword phonics instruction compared to students who received the real-word phonics instruction. This suggests that pseudoword phonics instruction improves decoding skills quicker than real-word phonics instruction. This also suggests that teaching decoding with pseudowords for one month can continue to improve decoding skills when children return to real-word phonics instruction. Teacher feedback suggests that confidence with reading increased for students who learned with pseudowords because they were less intimidated by the approach and viewed pseudoword phonics as a game that involved reading “silly” words. Implications of these results, limitations of this study, and areas for future research are discussed. ^

Large scale data processing using MapReduce

As massive data sets become increasingly available, people are facing the problem of how to effectively process and understand these data. Traditional sequential computing models are giving way to parallel and distributed computing models, such as MapReduce, both due to the large size of the data sets and their high dimensionality. This dissertation, as in the same direction of other researches that are based on MapReduce, tries to develop effective techniques and applications using MapReduce that can help people solve large-scale problems. Three different problems are tackled in the dissertation. The first one deals with processing terabytes of raster data in a spatial data management system. Aerial imagery files are broken into tiles to enable data parallel computation. The second and third problems deal with dimension reduction techniques that can be used to handle data sets of high dimensionality. Three variants of the nonnegative matrix factorization technique are scaled up to factorize matrices of dimensions in the order of millions in MapReduce based on different matrix multiplication implementations. Two algorithms, which compute CANDECOMP/PARAFAC and Tucker tensor decompositions respectively, are parallelized in MapReduce based on carefully partitioning the data and arranging the computation to maximize data locality and parallelism.

A longitudinal exploration of the relationship between oral reading fluency and reading comprehension achievement among a sample of diverse young learners

Exploring the relationship between early oral reading fluency ability and reading comprehension achievement among an ethnically and racially diverse sample of young learners from low-income families, attending elementary school within a large public school district in southeast Florida is the purpose of this longitudinal study. Although many studies have been conducted to address the relationship between oral reading fluency ability and reading comprehension achievement, most of the existing research failed either to disaggregate the data by demographic subgroups or secure a large enough sample of students to adequately represent the diverse subgroups. The research questions that guided this study were: (a) To what extent does early oral reading fluency ability measured in first, second, or third grade correlate with reading comprehension achievement in third grade? (b) To what extent does the relationship of early oral reading fluency ability and reading comprehension achievement vary by demographic subgroup membership (i.e., gender, race/ethnicity, socioeconomic status) among a diverse sample of students? A predictive research design using archived secondary data was employed in this nonexperimental quantitative methods study of 1,663 third grade students who attended a cohort of 25 Reading First funded schools. The data analyzed derived from the Dynamic Indicators of Basic Early Literacy Skills Oral Reading Fluency (DIBELS ORF) measure administered in first, second, and third grades and the Florida Comprehensive Assessment Test of the Sunshine State Standards (FCAT-SSS) Reading administered in third grade. Linear regression analyses between each of the oral reading fluency and reading comprehension measures produced significant positive correlations. Hierarchical regression analyses supported the predictive potential of all three oral reading fluency ability measures toward reading comprehension achievement, with the first grade oral reading fluency ability measure explaining the most significant variance in third grade reading comprehension achievement. Male students produced significant overall differences in variance when compared to female students as did the Other student subgroup (i.e., Asian, Multiracial, and Native American) when compared to Black, White, and Hispanic students. No significant differences in variance were produced between students from low and moderate socioeconomic families. These findings are vital toward adding to the literature of diverse young learners.

Social capital, HIV risk behavior and substance use among recent Latino immigrants in South Florida

Social capital, or social cohesion or group connectedness, can influence both HIV risk behavior and substance use. Because recent immigrants undergo a change in environment, one of the consequences can be a change in social capital. There may be an association among changes in social capital, and HIV risk behavior and substance use post immigration. The dissertation focused on the interface of these three variables among recent Latino immigrants (RLIs) in South Florida. The first manuscript is a systematic review of social capital and HIV risk behavior, and served as a partial background for the second and third manuscripts. Twelve papers with a measure of social capital as an independent variable and HIV risk as the dependent variable were included in the analysis. Eleven studies measured social capital at the individual level, and one study measured social capital at the group level. HIV risk was influenced by social capital, but the type of influence was dependent on the type of social capital and on the study population. Cognitive social capital, or levels of collective action, was protective against HIV in both men and women. The role of structural social capital, or levels of civic engagement/group participation, on HIV risk was dependent on the type of structural social capital and varied by gender. Microfinance programs and functional group participation were protective for women, while dysfunctional group participation and peer-level support may have increased HIV risk among men. The second manuscript was an original study assessing changes in social capital and HIV risk behavior pre to post immigration among RLIs in South Florida (n=527). HIV risk behavior was assessed through the frequency of vaginal-penile condom use, and the number of sexual partners. It was a longitudinal study using secondary data analysis to assess changes in social capital and HIV risk behavior pre immigration to two years post immigration, and to determine if there was a relationship between the two variables. There was an 8% decrease in total social capital (p < .05). Reporting of 'Never use' of condoms in the past 90 days increased in all subcategories (p < .05). Single men had a decrease in number of sexual partners (p < .05). Lower social capital measured on the dimension of 'friend and other' was marginally associated with fewer sexual partners. The third manuscript was another original study looking at the association between social capital and substance use among RLIs in South Florida (n=527). Substance use with measured by frequency of hazardous alcoholic drinking, and illicit drug use. It was a longitudinal study of social capital and substance-use from pre to two years post immigration. Post-immigration, social capital, hazardous drinking and illicit drug use decreased (p<.001). After adjusting for time, compared to males, females were less likely to engage in hazardous drinking (OR=.31, p<.001), and less likely to engage in illicit drug use (OR=.67, p=.01). Documentation status was a moderator between social capital and illicit drug use. 'Business' and 'Agency' social capital were associated with changes in illicit drug use for documented immigrants. After adjusting for gender and marital status, on average, documented immigrants with a one-unit increase in 'business' social capital were 1.2 times more likely to engage in illicit drug use (p<.01), and documented immigrants with one-unit increase in 'agency' social capital were 38% less likely to engage in illicit drug use (p<.01). 'Friend and other' social capital was associated with a decrease in illicit drug use among undocumented immigrants. After adjusting for gender and marital status, on average, undocumented immigrants with a one-unit increase in 'friend and other' social capital were 45% less likely to engage in hazardous drinking and 44% less likely to use illicit drugs (p<.01, p<.05). Studying these three domains is relevant because HIV continues to be a public health issue, particularly in Miami-Dade County, which is ranked among other U.S. regions with high rates of HIV/AIDS prevalence. Substance use is associated with HIV risk behavior; in most studies, increased substance use is associated with increased chances of HIV risk behavior. Immigration, which is the hypothesized catalyst for the change in social capital, has an impact on the dynamic of a society. Greater immigration can be burdensome on the host country's societal resources; however immigrants are also potentially a source of additional skilled labor for the workforce. Therefore, successful adaption of immigrants can have a positive influence on receiving communities. With Florida being a major receiver of immigrants to the U.S, this dissertation attempts to address an important public health issue for South Florida and the U.S. at large.

Pollination, Herbivory, and Habitat Fragmentation: Their Effects on the Reproductive Fitness of Angadenia berteroi, a Native Perennial Plant of the South Florida Pine Rocklands

Angadenia berteroi is a tropical perennial subshrub of the pine rocklands with large yellow flowers that set very few fruits. My dissertation seeks to elucidate the factors that affect the reproductive fitness of Angadenia berteroi a native species of the south Florida pine rocklands. I provide novel information on the pollination biology of this native species. I also assess the effects of herbivory on growth and the reproductive success of A. berteroi. Finally, I elucidate how habitat fragmentation and quality are correlated with reproductive fitness of this native perennial plant. Using a novel experimental approach, I determined the most effective pollinator group. I used nylon fishing line of widths corresponding to proboscis diameter of the major groups of visitors to examine pollen removal and deposition. In the field, I estimated visitation frequency and efficacy of each pollinator type. Using potted plants, I exposed flowers to single visit from different types of pollinators to measure fruit set. I performed artificial defoliation with scissors on plants growing in the greenhouse to assess the effects of defoliation before flowering as well as during flowering. Additionally, I used structural equation modelling (SEM) to elucidate how A. berteroi reproductive fitness was affected by habitat fragmentation and quality. My experiments provide evidence that Angadenia berteroi is specialized for bee pollination; though butterflies, skippers and others also visit its flowers, A. berteroi is exclusively pollinated by two native bees of the South Florida pine rocklands . This research also demonstrated that herbivory by the oleander moth may have direct and indirect effects on Angadenia berteroi growth and reproductive success. The SEM results suggested that habitat quality (litter depth and subcanopy cover) may favor reproduction in native species of the South Florida pine rocklands that are properly maintained by periodic fires and exotic control. Insights from this threatened and charismatic species may provide impetus to properly manage remaining pine rocklands in South Florida for this and other endemic understory species.

Phonics Instruction using Pseudowords for Success in Phonetic Decoding

This study examined a Pseudoword Phonics Curriculum to determine if this form of instruction would increase students’ decoding skills compared to typical real-word phonics instruction. In typical phonics instruction, children learn to decode familiar words which allow them to draw on their prior knowledge of how to pronounce the word and may detract from learning decoding skills. By using pseudowords during phonics instruction, students may learn more decoding skills because they are unfamiliar with the “words” and therefore cannot draw on memory for how to pronounce the word. It was hypothesized that students who learn phonics with pseudowords will learn more decoding skills and perform higher on a real-word assessment compared to students who learn phonics with real words. Students from two kindergarten classes participated in this study. An author-created word decoding assessment was used to determine the students’ ability to decode words. The study was broken into three phases, each lasting one month. During Phase 1, both groups received phonics instruction using real words, which allowed for the exploration of baseline student growth trajectories and potential teacher effects. During Phase 2, the experimental group received pseudoword phonics instruction while the control group continued real-word phonics instruction. During Phase 3, both groups were taught with real-word phonics instruction. Students were assessed on their decoding skills before and after each phase. Results from multiple regression and multi-level model analyses revealed a greater increase in decoding skills during the second and third phases of the study for students who received the pseudoword phonics instruction compared to students who received the real-word phonics instruction. This suggests that pseudoword phonics instruction improves decoding skills quicker than real-word phonics instruction. This also suggests that teaching decoding with pseudowords for one month can continue to improve decoding skills when children return to real-word phonics instruction. Teacher feedback suggests that confidence with reading increased for students who learned with pseudowords because they were less intimidated by the approach and viewed pseudoword phonics as a game that involved reading “silly” words. Implications of these results, limitations of this study, and areas for future research are discussed.

Chemical and mineral composition of rocks from the Philippine Sea

The book is devoted to geology of the Philippine Sea floor. This region is studied most extensively among other marginal seas of the Pacific Ocean. Rocks of the sedimentary and basalt layers within this sea have been studied during five legs of D/S Glomar Challenger. International geological expedition on board R/V Dmitry Mendeleev carried out according to the Project ''Ophiolites of Continents and Comparable Rocks of the Ocean Floor''obtained unique collection of rocks from the second and third layers of the ocean crust in the Philippine Sea. The book provides detailed petrographic and geochemical description of igneous and sedimentary formations from the Philippine Sea and compares them with rocks of the continental ophiolite association. An analysis of structure and history of the ocean crust formation in the region is based on all known geological information. The main periods of tectonic movement activation and nature of their manifestations within the sea are shown.

Fitting model-based psychometric functions to simultaneity and temporal-order judgment data: MATLAB and R routines

Research on temporal-order perception uses temporal-order judgment (TOJ) tasks or synchrony judgment (SJ) tasks in their binary SJ2 or ternary SJ3 variants. In all cases, two stimuli are presented with some temporal delay, and observers judge the order of presentation. Arbitrary psychometric functions are typically fitted to obtain performance measures such as sensitivity or the point of subjective simultaneity, but the parameters of these functions are uninterpretable. We describe routines in MATLAB and R that fit model-based functions whose parameters are interpretable in terms of the processes underlying temporal-order and simultaneity judgments and responses. These functions arise from an independent-channels model assuming arrival latencies with exponential distributions and a trichotomous decision space. Different routines fit data separately for SJ2, SJ3, and TOJ tasks, jointly for any two tasks, or also jointly for the three tasks (for common cases in which two or even the three tasks were used with the same stimuli and participants). Additional routines provide bootstrap p-values and confidence intervals for estimated parameters. A further routine is included that obtains performance measures from the fitted functions. An R package for Windows and source code of the MATLAB and R routines are available as Supplementary Files.