A randomized crossover study to compare efavirenz and etravirine treatment.

BACKGROUND: Efavirenz (EFV) causes neuropsychiatric side-effects and an unfavourable blood lipid profile. We investigated the effect of replacing EFV with etravirine (ETR) on patient preference, sleep, anxiety and lipid levels. METHOD: Study participants did not complain of side-effects, had tolerated EFV for at least 3 months, with less than 50 copies/ml HIV-RNA. After randomization, the ETR-first group started with ETR (400 mg daily) [DOSAGE ERROR CORRECTED] with EFV-placebo and the EFV-first group with EFV with ETR-placebo. After 6 weeks, both groups switched to the alternate regimen. Nucleoside reverse transcriptase inhibitors were continued without any change. The primary end point was patient preference for the first or the second regimen, assessed after 12 weeks. RESULTS: Fifty-eight patients were enrolled with a median CD4 cell count of 589 cells/μl and the duration of previous EFV therapy was 3.9 years. Fifty-five patients completed the study. When asked about treatment preference after 12 weeks, 16 preferred EFV and 22 preferred ETR, whereas 17 did not express a preference (P = NS). Patients who continued EFV during the first phase of the trial preferred EFV (15/21, 71%), whereas patients who started with ETR were more likely to prefer ETR (n = 16/17, 94%). This order effect was strongly significant (P < 0.0001). Quality of sleep, depression, anxiety and stress scores did not differ significantly between groups. Median plasma cholesterol levels decreased by 0.7 mmol (29 mg/100 ml) after replacing EFV with ETR (P < 0.002). CONCLUSION: After substitution of EFV by ETR, patients did not express a significant preference for ETR. There was no measurable effect on neuropsychiatric symptoms and sleep. Cholesterol decreased.

A Prospective Multicenter SPOG 2003 FN Study of Microbiologically Defined Infections in Pediatric Cancer Patients with Fever and Neutropenia.

BACKGROUND: Fever and neutropenia (FN) often complicate anticancer treatment and can be caused by potentially fatal infections. Knowledge of pathogen distribution is paramount for optimal patient management. METHODS: Microbiologically defined infections (MDI) in pediatric cancer patients presenting with FN by nonmyeloablative chemotherapy enrolled in a prospective multi-center study were analyzed. Effectiveness of empiric antibiotic therapy in FN episodes with bacteremia was assessed taking into consideration recently published treatment guidelines for pediatric patients with FN. RESULTS: MDI were identified in a minority (22%) of pediatric cancer patients with FN. In patients with, compared to without MDI, fever (median, 5 [IQR 3-8] vs. 2 [IQR1-3] days, p < 0.001) and hospitalization (10 [6-14] vs. 5 [3-8] days, p < 0.001) lasted longer, transfer to the intensive care unit was more likely (13 of 95 [14%] vs. 7 of 346 [2.0%], p < 0.001), and antibiotics were given longer (10 [7-14] vs. 5 [4-7], p < 0.001). Empiric antibiotic therapy in FN episodes with bacteremia was highly effective if not only intrinsic and reported antimicrobial susceptibilities were considered but the purposeful omission of coverage for coagulase negative staphylococci and enterococci was also taken into account (81% [95%CI 68 - 90] vs. 96.6% [95%CI 87 - 99.4], p = 0.004) CONCLUSIONS: MDI were identified in a minority of FN episodes but they significantly affected management and the clinical course of pediatric cancer patients. Compliance with published guidelines was associated with effectiveness of empiric antibiotic therapy in FN episodes with bacteremia.

A Statistical Analysis of Iowa Premature Concrete Pavement Deterioration, Supplementary Study, HR-1063, 1997

This supplementary project has been undertaken as an effort to continue work previously completed in the Pooled Fund Study of Premature Concrete Pavement Deterioration. As such, it shares the objective of "Identifying the variables that are present in those pavements exhibiting premature deterioration," by collecting additional data and performing statistical analysis of those data. The approach and philosophy of this work are identical to that followed in the above project, and the Pooled Fund Study Final Report provides a detailed description of this process. This project has involved the collection of data for additional sites in the state of Iowa. These sites have then been added to sites collected in the original study, and statistical analysis has been performed on the entire set. It is hoped that this will have two major effects. First, using data from only one state allows for the analysis of a larger set of independent variables with a greater degree of commonality than was possible in the multi-state study, since the data are not limited by state to state differences in data collection and retention. Second, more data on additional sites will increase the degrees of freedom in the model and hopefully add confidence to the results.

An international validation study of the EORTC brain cancer module (EORTC QLQ-BN20) for assessing health-related quality of life and symptoms in brain cancer patients.

Aims: The psychometric properties of the EORTC QLQ-BN20, a brain cancer-specific HRQOL questionnaire, have been previously determined in an English-speaking sample of patients. This study examined the validity and reliability of the questionnaire in a multi-national, multi-lingual study. Methods: QLQ-BN20 data were selected from two completed phase III EORTC/NCIC clinical trials in brain cancer (N=891), including 12 languages. Experimental treatments were surgery followed by radiotherapy (RT) and adjuvant PCV chemotherapy or surgery followed by concomitant RT plus temozolomide (TMZ) chemotherapy and adjuvant TMZ chemotherapy. Standard treatment consisted of surgery and postoperative RT alone. The psychometrics of the QLQ-BN20 were examined by means of multi-trait scaling analyses, reliability estimation, known groups validity testing, and responsiveness analysis. Results: All QLQ-BN20 items correlated more strongly with their own scale (r>0.70) than with other QLQ-BN20 scales. Internal consistency reliability coefficients were high (all alpha0.70). Known-groups comparisons yielded positive results, with the QLQ-BN20 distinguishing between patients with differing levels of performance status and mental functioning. Responsiveness of the questionnaire to changes over time was acceptable. Conclusion: The QLQ-BN20 demonstrates adequate psychometric properties and can be recommended for use in conjunction with the QLQ-C30 in assessing the HRQOL of brain cancer patients in international studies.

Using digital RNA counting and flow cytometry to compare mRNA with protein expression in acute leukemias.

BACKGROUND: The diagnosis of malignant hematologic diseases has become increasingly complex during the last decade. It is based on the interpretation of results from different laboratory analyses, which range from microscopy to gene expression profiling. Recently, a method for the analysis of RNA phenotypes has been developed, the nCounter technology (Nanostring® Technologies), which allows for simultaneous quantification of hundreds of RNA molecules in biological samples. We evaluated this technique in a Swiss multi-center study on eighty-six samples from acute leukemia patients. METHODS: mRNA and protein profiles were established for normal peripheral blood and bone marrow samples. Signal intensities of the various tested antigens with surface expression were similar to those found in previously performed Affymetrix microarray analyses. Acute leukemia samples were analyzed for a set of twenty-two validated antigens and the Pearson Correlation Coefficient for nCounter and flow cytometry results was calculated. RESULTS: Highly significant values between 0.40 and 0.97 were found for the twenty-two antigens tested. A second correlation analysis performed on a per sample basis resulted in concordant results between flow cytometry and nCounter in 44-100% of the antigens tested (mean = 76%), depending on the number of blasts present in a sample, the homogeneity of the blast population, and the type of leukemia (AML or ALL). CONCLUSIONS: The nCounter technology allows for fast and easy depiction of a mRNA profile from hematologic samples. This technology has the potential to become a valuable tool for the diagnosis of acute leukemias, in addition to multi-color flow cytometry.

Paediatric end-of-life care needs in Switzerland: current practices, and perspectives from parents and professionals. A study protocol.

AIM: To present a protocol for a multi-phase study about the current practice of end-of-life care in paediatric settings in Switzerland. BACKGROUND: In Switzerland, paediatric palliative care is usually provided by teams, who may not necessarily have specific training. There is a lack of systematic data about specific aspects of care at the end of a child's life, such as symptom management, involvement of parents in decision-making and family-centred care and experiences and needs of parents, and perspectives of healthcare professionals. DESIGN: This retrospective nationwide multicentre study, Paediatric End-of-LIfe CAre Needs in Switzerland (PELICAN), combines quantitative and qualitative methods of enquiry. METHODS: The PELICAN study consists of three observational parts, PELICAN I describes practices of end-of-life care (defined as the last 4 weeks of life) in the hospital and home care setting of children (0-18 years) who died in the years 2011-2012 due to a cardiac, neurological or oncological disease, or who died in the neonatal period. PELICAN II assesses the experiences and needs of parents during the end-of-life phase of their child. PELICAN III focuses on healthcare professionals and explores their perspectives concerning the provision of end-of-life care. CONCLUSION: This first study across Switzerland will provide comprehensive insight into the current end-of-life care in children with distinct diagnoses and the perspectives of affected parents and health professionals. The results may facilitate the development and implementation of programmes for end-of-life care in children across Switzerland, building on real experiences and needs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01983852.

Trust in inter-organizational relationships

Trust in inter-organizational collaborative relationships has attracted substantial research interest among academics and practitioners. Previous studies have concentrated on the benefits of trust to business outcomes and economic performance, as it is considered to be a source of competitive advantage. Despite this increased level of interest, there is no consensus, much less overall agreement, about how it should be conceptualized or about the number of dimensions it incorporates. On the inter-organizational level there is an obvious challenge in defining both the trusting party and the objects of trust. Thus, the notion of trust as an under-theorized and poorly understood phenomenon still holds. Hence, the motivation of this study was fuelled by the need to increase our knowledge and understanding of the role and nature of trust in inter-organizational collaborative relationships. It is posited that there is a call for more understanding about its antecedents and consequences, as well as about the very concept in inter-organizational collaborative relationships. The study is divided into two parts. The first part gives a general overview, and the second part comprises four research publications. Both qualitative and quantitative research methodology is utilized. A multi-method research design was used because it provides different levels of data and different perspectives on the phenomenon. The results of this study reveal that trust incorporates three dimensions on both the individual and the organizational level: capability, goodwill, and self-reference. Trust develops from the reputation and behavior of the trusted party. It appears from this study that trust is clearly directed towards both individual boundary spanners and the counterpart company itself – i.e. not only to one or the other. The trusting party, on the other hand, is always an individual, and not the organization per se. Trust increases collaboration benefits and lowers collaboration drawbacks, thus having a positive effect on relationship performance. The major contribution of this study lies in uncovering the critical points and drawbacks in prior research and thereby in responding to the highlighted challenges. The way in which these challenges were addressed offers contributions to three major issues in the emerging theory of trust in the inter-organizational context: firstly, this study clarifies the trustor-trustee discussion; secondly, it conceptualizes trust as existing on both individual and organizational levels; and thirdly, it provides more information about the antecedents of trust and the ways in which it affects relationship performance.

Intercultural bridges in teenagers' theatrical events : performing self and constructing cultural identity through a creative drama process

The overriding aim of this drama educational case study is to deepen the understanding of meaning making in a creative intercultural youth theatre process and to examine it in the context of the 10th European Children's TheatreEncounter. The research task is to give a theoretical description of some key features of a creative drama process as the basis for theory about meaning makingin physical theatre. The first task is to illuminate the culture-historical connections of the multilayered practice of the EDERED-association. The second taskis to analyse and interpret theatrical meaning making. The ethnographical research site is regarded as a theatrical event. The analysis of the theatrical eventis divided into four segments: cultural contexts, contextual theatricality, theatrical playing and playing culture. These segments are connected with four research questions: What are the cultural contexts of a creative drama process? How can the organisation of the Encounter, genres, aesthetic codes and perception ofcodes be seen to influence the lived experiences of the participants? What are some of the key phases and characteristics in a creative practice? What kind of cultural learning can be interpreted from the performance texts? The interpretative question concerns identity and community (re)construction. How are the categories, `community´ and `child´ constructed in the Encounter culture? In this drama educational case study the research material (transcribed interviews, coded questionnaire answers, participant drawings, videotaped process text and performance texts) are examined in a multi-method analysis in the meta-theoretical framework of Dewey's naturalistic pragmatism. A three-dimensional research interest through a combination of lived experiences, social contexts and cultural-aesthetical practices compared with drama-educational practices required the methodological project of cultural studies. Furthermore, the critical interpretation of cultural texts is divided into three levels of analyses which are called description, structural analysis and theoretical interpretation. Dialogic validity (truthfulness, self-reflexivity and polyvocality) is combined with contextual validity (sensitivity to social context and awareness of historicity) and with deconstructive validity (awareness of the social discourses). My research suggests that itis possible, by means of physical theatre, to construct symbolic worlds where questions about intercultural identity and multilingual community are examined and where provisional answers are constructed in social interaction.

Resa i röstens landskap : en narrativ studie av hur lärare blir professionella röstanvändare

The theme of this thesis is the learning process that occurs when teachers become professional voice users. The aim is to explore what it (really) means to become a professional voice user in a teaching profession; thereby developing an understanding of how future education in this field can be arranged so as to both effectively prevent vocal problems and to develop oral didactical competence among teachers. The ambition is to describe, interpret, and understand the learning process through a combination of emic and ethic research perspectives. The theoretical frame of reference reflects the cross disciplinary character of the thesis. Voice problems are common among both student teachers and inservice teachers and adversely affect professional competence, identity and quality of life. Additionally, vocal problems are proven to have a negative impact on pupils´ learning. The individual elements of learning are explored in the light of experiential learning theory and transformative learning theory. The social elements of learning are explored in relation to the theory of situated learning. In addition, theories of teacher professionalisation in terms of competence and identity are outlined. The empirical study has a longitudinal and multi method character. It is anchored in a phenomenological hermeneutical tradition, more specifically in narrative inquiry. The point of departure is the learning experiences of ten student teachers, who attended a ten week long course on voice production as part of their teacher training at Åbo Akademi University, in the autumn of 2002 and the spring of 2003. Four interviews in the form of conversations were conducted with each participant. These were crystallised with a process diary, a Swedish Voice Handicap Index, a voice observation, and a video observation. A fifth interview was conducted with each participant five years post teacher training, in the spring of 2008. Participant observation was also conducted throughout the course. The research materials have been analysed and interpreted narratively using a phenomenological hermeneutical method. The results are presented descriptively as individual narratives, which are reflected in logopedic research materials. Learning is here understood as emergent awareness. This is followed by a meta narrative concerning learning as experiences in the four dimensions body, thought, feeling, and relation. Finally, interpretation is expressed with respect to the theory of relational education. Learning is here understood as a movement in the field between the actual and the possible voice. It is also viewed as fundamentally rooted in inter-human relationships, in moments of presence and coexistence. As a tentative answer to the call for an existential space for learning in order to be a professional voice user, I suggest the concept of a learning refuge as a locus for a learning process built on trust, mutuality and openness.

Service innovation development and knowledge integration practices - a comparative case study on KIBS sector

Academic research on services and innovations on services has significantly grown during recent years. So far research concerning management of knowledge intensive work on service development activities is very limited. The objective of this study was to examine knowledge integration practices that support service innovation development and to the best of knowledge such studies have not been previously published in academic literature. In the theoretical part of the study a review of state‐of‐the‐art literature was conducted, research gap was indicated and a framework for analysis was built. In the empirical part an explorative comparative multi‐case study was carried out in KIBS sector. Four companies were selected and four service development projects were inspected. The service development activities and knowledge integration practices were identified. The cases were carefully compared and results formed. The empirical results indicated that service innovation development is partly linear and partly incremental flow of activities where knowledge integration practices have important role supporting the planning and execution of tasks. Knowledge integration practices supporting planning and workshops are close interaction, interpretation, project planning and sequencing of work tasks. The identified knowledge integration practices supporting building service solution were careful role and competence management, routines and common knowledge. The main implication is that to manage knowledge intensive service innovation development a firm should carefully develop and choose relevant knowledge integration practices to support the service development activities.

Children at psychiatric risk and their families in Bucharest, in the context of 25 years of changes after December 89’ Romanian Revolution

The aim of the present dissertation was to capture a picture of child and adolescent mental health in Romania, in the context of almost 25 years of changes following the Romanian Revolution of December ’89. A three-part study was carried out in order to provide consistent answers to the pre-defined objectives: to appraise the development of child and adolescent mental health services in Romania (Part I), to explore the characteristics of clinically-referred patients in a Romanian child and adolescent psychiatry department (Part II), to examine the children’s mental health state and its connections with family functioning and associated risk factors (Part III). A multi-method research approach was used, comprising one qualitative analysis and two quantitative research studies. Part I consisted of a comparative qualitative analysis of the answers given by 10 mental health professionals at a 12-questions open ended interview about the current situation in child and adolescent mental health in Romania, on three topics: changes, challenges, solutions. Part II involved a descriptive quantitative analysis of certain variables (e.g. age, gender, primary diagnosis, co-morbidities, time of hospitalization) conducted on the patients who had been admitted to the Child and Adolescent Psychiatry Department at “Prof. Dr. Alexandru Obregia” Psychiatry Hospital, Bucharest in 1991 and in 2013. Part III was conducted on 342 subjects enrolled in two clinical groups and one school group, this study being performed through a cross-sectional analysis on multi-informant child and adolescent mental health problems and competencies (CBCL, YSR, SDQ P, SDQ SR) and their interrelation with household information (HQ) and family functioning (FAD). Outlining the results it can be stated that: 1) The CAMH System in Romania is definitely set on the path of reorganization, including a higher involvement of beneficiaries and of the community. 2) The characteristics of the admitted patients have changed significantly during the last almost 25 years since `89 December Revolution, under the influence of word wide trends in child psychiatry and of administrative aspects of the mental health network in Romania. 3) The rates of main diagnoses and co-morbidities confirm the reports in literature, with Autism Spectrum Disorder being the most frequent childhood psychiatric disorders in this study. 4) The children’s mental health problems in the psychiatry group are comparable to those reported for other clinical populations. 5) Significant score differences were observed according to various household features and also meaningful associations between a child’s clinical status and different aspects of family functioning. The Romanian Child and Adolescent Psychiatry has started to adopt the norms and standards of the European Union. In the 25 years that have elapsed after the 1989 Revolution, many changes have occurred in Romanian CAMH, but many unresolved issues have also risen. Therefore, the major contribution of this thesis is that it provides a coherent and updated overview of the present-day situation from three different perspectives- those of mental healthcare professionals, the one observed in clinical patients and the one reported by children’s families.

Increased profitability and efficiency by improving the Meetings & Events Category S2P-process – Case Company

The purpose of this research was to examine the most optimal way to arrange meetings and events management and source to pay –process in a global company. The research is a qualitative multi-method case study and is a commission from a global company. The theoretical framework of this research structures around two approaches. First approach focus on a purchasing strategy and management that shows the current role of procure-ment and introduce different ways to organize purchasing functions. Second approach focus on purchasing process management and improvement methods. Annual spend analyze, external and internal interviews and internal survey were done to gain compre-hensive knowledge about the current state of operations and possible solutions. Gathered data were then combined to theoretical framework in order to create optimal solution for the case company. Based on the research a source to pay –process and global policy for meeting and event category was created. The solution includes all relevant matters that are needed in order to secure efficient and profitable operations. The results show that optimal way to arrange meetings and events structures around standardized source to pay –processes, central-ized procurement, preferred supplier and clearly defined roles and responsibilities be-tween different stakeholders.

A multidimensional measurement approach and analysis of children's motivation for reading, attributional style, and reading achievement

The present study investigates the usefulness of a multi-method approach to the measurement of reading motivation and achievement. A sample of 127 elementary and middle-school children aged 10 to 14 responded to measures of motivation, attributions, and achievement both longitudinally and in a challenging reading context. Novel measures of motivation and attributions were constructed, validated, and utilized to examine the relationship between ~ motivation, attributions, and achievement over a one-year period (Study I). The impact of classroom contexts and instructional practices was also explored through a study of the influence of topic interest and challenge on motivation, attributions, and persistence (Study II), as well as through interviews with children regarding motivation and reading in the classroom (Study III). Creation and validation of novel measures of motivation and attributions supported the use of a self-report measure of motivation in situation-specific contexts, and confirmed a three-factor structure of attributions for reading performance in both hypothetical and situation-specific contexts. A one-year follow up study of children's motivation and reading achievement demonstrated declines in all components of motivation beginning at age 10 through 12, and particularly strong decreases in motivation with the transition to middle school. Past perceived competence for reading predicted current achievement after controlling for past achievement, and showed the strongest relationships with reading-related skills in both elementary and middle school. Motivation and attributions were strongly related, and children with higher motivation Fulmer III displayed more adaptive attributions for reading success and failure. In the context of a developmentally inappropriate challenging reading task, children's motivation for reading, especially in terms of perceived competence, was threatened. However, interest in the story buffered some ofthe negative impacts of challenge, sustaining children's motivation, adaptive attributions, and reading persistence. Finally, children's responses during interviews outlined several emotions, perceptions, and aspects of reading tasks and contexts that influence reading motivation and achievement. Findings revealed that children with comparable motivation and achievement profiles respond in a similar way to particular reading situations, such as excessive challenge, but also that motivation is dynamic and individualistic and can change over time and across contexts. Overall, the present study outlines the importance of motivation and adaptive attributions for reading success, and the necessity of integrating various methodologies to study the dynamic construct of achievement motivation.

Interaction and knowledge exchange among academic business librarians in Ontario

A research project submitted to the Faculty of Extension, University of Alberta in partial fulfillment of the requirements for the degree of Master of Arts in Communications and Technology in 2005.

The Transfer of Wilderness Trips to the Everyday Lives of Young People: A Case Study

There has been considerable research that investigates the outcomes, benefits, and perceptions of wilderness trip experiences. However, the transfer of learning from a wilderness trip to the everyday lives of youth trip participants, that has deliberately explored post-trip experience, is minimal. Using a qualitative multi-case study approach, methods of data collection included interviews with six youth program participants, six parents/legal guardians, and three program staff, as well as document solicitation. Reports from the participants suggested that the key content transferred to a post-wilderness trip context were interpersonal skills; life skills; and instances of personal growth. Participants applied their learning content from the wilderness trip to school; sports; community and international volunteering; work and career aspirations; family and home life; and social life contexts. Implications for adventure programming and curriculum design, instruction, and transfer are considered.