The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295).

BACKGROUND: Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success. OBJECTIVES: We describe the design of a 'translational' study that examines the implementation, impact, sustainability, and cost of an evidence-based nurse-delivered tailored behavioral self-management intervention to improve BP control as it moves from a research context to healthcare delivery. The study addresses four specific aims: assess the implementation of an evidence-based behavioral self-management intervention to improve BP levels; evaluate the clinical impact of the intervention as it is implemented; assess organizational factors associated with the sustainability of the intervention; and assess the cost of implementing and sustaining the intervention. METHODS: The project involves three geographically diverse VA intervention facilities and nine control sites. We first conduct an evaluation of barriers and facilitators for implementing the intervention at intervention sites. We examine the impact of the intervention by comparing 12-month pre/post changes in BP control between patients in intervention sites versus patients in the matched control sites. Next, we examine the sustainability of the intervention and organizational factors facilitating or hindering the sustained implementation. Finally, we examine the costs of intervention implementation. Key outcomes are acceptability and costs of the program, as well as changes in BP. Outcomes will be assessed using mixed methods (e.g., qualitative analyses--pattern matching; quantitative methods--linear mixed models). DISCUSSION: The study results will provide information about the challenges and costs to implement and sustain the intervention, and what clinical impact can be expected.

Computational Journalism: from Answering Question to Questioning Answers and Raising Good Questions

Our media is saturated with claims of ``facts'' made from data. Database research has in the past focused on how to answer queries, but has not devoted much attention to discerning more subtle qualities of the resulting claims, e.g., is a claim ``cherry-picking''? This paper proposes a Query Response Surface (QRS) based framework that models claims based on structured data as parameterized queries. A key insight is that we can learn a lot about a claim by perturbing its parameters and seeing how its conclusion changes. This framework lets us formulate and tackle practical fact-checking tasks --- reverse-engineering vague claims, and countering questionable claims --- as computational problems. Within the QRS based framework, we take one step further, and propose a problem along with efficient algorithms for finding high-quality claims of a given form from data, i.e. raising good questions, in the first place. This is achieved to using a limited number of high-valued claims to represent high-valued regions of the QRS. Besides the general purpose high-quality claim finding problem, lead-finding can be tailored towards specific claim quality measures, also defined within the QRS framework. An example of uniqueness-based lead-finding is presented for ``one-of-the-few'' claims, landing in interpretable high-quality claims, and an adjustable mechanism for ranking objects, e.g. NBA players, based on what claims can be made for them. Finally, we study the use of visualization as a powerful way of conveying results of a large number of claims. An efficient two stage sampling algorithm is proposed for generating input of 2d scatter plot with heatmap, evalutaing a limited amount of data, while preserving the two essential visual features, namely outliers and clusters. For all the problems, we present real-world examples and experiments that demonstrate the power of our model, efficiency of our algorithms, and usefulness of their results.

A lysimeter experimental study and numerical characterisation of the leaching of incinerator bottom ash waste

Incinerator bottom ash (IBA) is a residual produced from incinerating municipal solid waste. In the past, IBA presented a big waste disposal problem; however, various recycling approaches have been adopted in recent years to mitigate this problem, as well as to provide a useful alternative to using primary aggregate resources. The use of IBA as an alternative to conventional aggregates in different civil engineering construction applications helps to conserve premium grade aggregate supplies; however, when IBA is in contact with water in the field, as a consequence of precipitation events or changes in water table, elements, such as salts and heavy metals, may be released to the soil and ground water. In this work, IBA waste was mixed with limestone aggregate to produce a blend with acceptable mechanical properties and minimum environmental risks for use as road foundation. The study focused on evaluating potential environmental impacts of some constituents, including sulphate, chloride, sodium, copper, zinc and lead in IBA blends using a lysimeter as a large scale leaching tool. Moreover, a specific scenario simulating field conditions was adopted in the lysimeter to assess the potential impact of changing conditions, such as IBA content in the blend, liquid to solid ratio (L/S) and pH value, on long-term release of heavy metals and salts. Then, numerical modelling was used to predict the release of the aforementioned constituents from IBA based on initial measurement of intrinsic material properties and the kinetic desorption process concept. Experimental results showed that zinc and lead were released in very low concentrations but sodium and sulphate were in high concentrations. The control limestone only blend also demonstrated low release concentrations of constituents in comparison to IBA blends, where constituent concentrations increased with increase in IBA content. Experimental results were compared with numerical results obtained using a non-equilibrium desorption model. Good agreement was found between the two sets of data. 

Rapid detection of health-care-associated bloodstream infection in critical care using multipathogen real-time polymerase chain reaction technology: a diagnostic accuracy study and systematic review

Background: There is growing interest in the potential utility of real-time polymerase chain reaction (PCR) in diagnosing bloodstream infection by detecting pathogen deoxyribonucleic acid (DNA) in blood samples within a few hours. SeptiFast (Roche Diagnostics GmBH, Mannheim, Germany) is a multipathogen probe-based system targeting ribosomal DNA sequences of bacteria and fungi. It detects and identifies the commonest pathogens causing bloodstream infection. As background to this study, we report a systematic review of Phase III diagnostic accuracy studies of SeptiFast, which reveals uncertainty about its likely clinical utility based on widespread evidence of deficiencies in study design and reporting with a high risk of bias. 

Objective: Determine the accuracy of SeptiFast real-time PCR for the detection of health-care-associated bloodstream infection, against standard microbiological culture. 

Design: Prospective multicentre Phase III clinical diagnostic accuracy study using the standards for the reporting of diagnostic accuracy studies criteria. 

Setting: Critical care departments within NHS hospitals in the north-west of England. 

Participants: Adult patients requiring blood culture (BC) when developing new signs of systemic inflammation. 

Main outcome measures: SeptiFast real-time PCR results at species/genus level compared with microbiological culture in association with independent adjudication of infection. Metrics of diagnostic accuracy were derived including sensitivity, specificity, likelihood ratios and predictive values, with their 95% confidence intervals (CIs). Latent class analysis was used to explore the diagnostic performance of culture as a reference standard. 

Results: Of 1006 new patient episodes of systemic inflammation in 853 patients, 922 (92%) met the inclusion criteria and provided sufficient information for analysis. Index test assay failure occurred on 69 (7%) occasions. Adult patients had been exposed to a median of 8 days (interquartile range 4–16 days) of hospital care, had high levels of organ support activities and recent antibiotic exposure. SeptiFast real-time PCR, when compared with culture-proven bloodstream infection at species/genus level, had better specificity (85.8%, 95% CI 83.3% to 88.1%) than sensitivity (50%, 95% CI 39.1% to 60.8%). When compared with pooled diagnostic metrics derived from our systematic review, our clinical study revealed lower test accuracy of SeptiFast real-time PCR, mainly as a result of low diagnostic sensitivity. There was a low prevalence of BC-proven pathogens in these patients (9.2%, 95% CI 7.4% to 11.2%) such that the post-test probabilities of both a positive (26.3%, 95% CI 19.8% to 33.7%) and a negative SeptiFast test (5.6%, 95% CI 4.1% to 7.4%) indicate the potential limitations of this technology in the diagnosis of bloodstream infection. However, latent class analysis indicates that BC has a low sensitivity, questioning its relevance as a reference test in this setting. Using this analysis approach, the sensitivity of the SeptiFast test was low but also appeared significantly better than BC. Blood samples identified as positive by either culture or SeptiFast real-time PCR were associated with a high probability (> 95%) of infection, indicating higher diagnostic rule-in utility than was apparent using conventional analyses of diagnostic accuracy. 

Conclusion: SeptiFast real-time PCR on blood samples may have rapid rule-in utility for the diagnosis of health-care-associated bloodstream infection but the lack of sensitivity is a significant limiting factor. Innovations aimed at improved diagnostic sensitivity of real-time PCR in this setting are urgently required. Future work recommendations include technology developments to improve the efficiency of pathogen DNA extraction and the capacity to detect a much broader range of pathogens and drug resistance genes and the application of new statistical approaches able to more reliably assess test performance in situation where the reference standard (e.g. blood culture in the setting of high antimicrobial use) is prone to error.

Combinations of Prompt and Target Response Modalities and Their Impact on Emergent Relations and Teaching Efficiency.

In the present study, native Spanish speakers were taught a small English vocabulary (Spanish-to-English intraverbals). Four different training conditions were created by combining textual and echoic prompts with written and vocal target responses. The efficiency of each training condition was examined by analysing emergent relations (i.e., tacts) and the total number of sessions required to reach mastery under each training condition. All combinations of prompt-response modalities generated increases in correct responding on tests for emergent relations but when target responses were written, mastery criterion was reached faster. Results are discussed in terms of efficiency for emergent relations and recommendations for future directions are provided.

A Study of role conflict, role ambiguity, locus of control, job satisfaction and participation in decision making among front-line vocational service workers for mentally retarded adults

This study was an investigation of individual and organizational factors, as perceived by front-line vocational service workers from Adult Rehabilitation Centres (ARC Industries) for mentally retarded adults. The specific variables which were measured included role conflict/role ambiguity (role factors), internal/external locus of control (individual differences), job satisfaction with work and supervision (job attitudes) and participation in deci~ion making (organizational factor). The exploration of these constructs was conducted by means of self-report questionnaires which were completed by sixty-nine out of a total of ninety front-line employees. The surveys were distributed in booklet form to nine distinct rehabilitation facilities from St. Catharines, West Lincoln, Greater Niagara, Port Colborne, WeIland, Fort Erie, Hamilton, Guelph and Brantford. The survey data was evaluated by the statisti.cal Package for the Social Sciences (SPSS) which used the Pearson Product Moment Correlation procedure and a compar~son of means test. A comparison of correlation coefficients test was also conducted. This statistical procedure was calculated mathematically. The results obtained from the statistical evaluation confirmed the prediction that self-reported measures of participation in decision making and satisfaction (work and supervision) would be negatively correlated with role conflict and role ambiguity. As well, the speculation that perceived satisfaction (work and supervision) would be positively correlated with participation in decision making was empirically supported. Internal and external locus of control did not contribute to a significant difference in r~sponses to role perceptions (conflict and ambiguity) , satisfaction (work and supervision) or the correlational relationship between participation in decision making and satisfaction (work and supervision). Overall, the findings from this study substantiated the importance of examining employee perceptions in the workplace and the interrelationships among individual and organizational variables. This research was considered a contribution to the general area of occupational stress and to the study of individuals in work organizations.

Creativity and the working artist/teacher : the relationships

The purpose of this qualitative study was to understand the relationships between creativity and the working artist/teacher employed by an art college. The topic emerged from my job as an instructor at The Ontario College of Art which was used as the primary data resource and provided the highest caliber of professionals to chose from. Existent data were used to facilitate the study generated by the research of Cawelti, Rappaport, and Wood (1992). The data were generated by a group of 5 faculty members from The University of Northern Iowa, recognized for their expertise in the arts (a painter, a poet, a sculptor, a novelist, and a photographer). They were asked to respond to the following statement: "In as much detail as you like, list the things that you did, thought, or felt the last time you created an artistic product. II Cawelti, Rappaport, and Wood (1992) produced three models of the creative process, each building on the previous, with the resultant third,being in my opinion, an excellent illustration (text/visual) of the creative process. Model three (Appendix D) presented a "multi-dimensional view of the creative process: time, space, observatility, and consciousnessll (p. 90). Model three utilized a visual mapping device along the bottom of the page linked to text segments above. Both the visual and the text were interrelated so that they harmonized into a comprehensive "picture." The parti'cipants of this qualitative study were asked to consider model three from their professional perspective as artist/teachers. The interpretive sciences directed the methodology. The hermeneutic circle of continuous reflection from the whole to the part and back to the whole was an important aspect of the data analyses. Four members of the Foundation Department at The Ontario College of Art were the key participants. A series of conversational interviews was the primary source of data collection, this was augmented by observation, fie,ldnotes, and follow up telephone interviews. Transcripts of interviews were returned to participants for reflection and the telephone was used to discuss any additional -points raised. Analysis consisted of coding and organizing data according to emerging themes. These themes formed the basis for the narrative stories. The text of the narrative stories were given back to each participant for further comment. Revisions were made until both the researcher and the participants felt that the stories reflected reality. The resultant whole was critiqued from the researcher's perspective. The significance of this study was discussed as it pertains to the working artist/teacher and areas in need of further study are pointed out.

Sentence combining and thinking : a study of adult ESL learners

Thesis (M.Ed.)--Brock University, 2003.

The association of faculty's teaching philosophy and teaching behaviour, and critical thinking and self- direction in learning

The intent in this study was to investigate in what ways teachers· beliefs about education and teaching are expressed in the specific teaching behaviours they employ, and whether teaching behaviours, as perceived by their students, are correlated with students· critical thinking and self-directed learning. To this end the relationships studied were: among faCUlty members· philosophy of teaching, locus of control orientation, psychological type, and observed teaching behaviour; and among students· psychological type, perceptions of teaching behaviour, self-directed learning readiness, and critical thinking. The overall purpose of the study was to investigate whether the implicit goals of higher education, critical thinking and self-direction, were actually accounted for in the university classroom. The research was set within the context of path-goal theory, adapted from the leadership literature. Within this framework, Mezirow·s work on transformative learning, including the influences of Habermas· writings, was integrated to develop a theoretical perspective upon which to base the research methodology. Both qualitative and quantitative methodologies were incorporated. Four faCUlty and a total of 142 students participated in the study. Philosophy of teaching was described through faCUlty interviews and completion of a repertory grid. Faculty completed a descriptive locus of control scale, and a psychological type test. Observations of their teaching behaviour were conducted. Students completed a Teaching Behaviour Assessment Scale, the Self-Directed Learning Readiness Scale, a psychological type test, and the Watson-Glaser Critical Thinking Appraisal. A small sample of students were interviewed. Follow-up discussions with faculty were used to validate the interview, observation, teaching behaviour, and repertory grid data. Results indicated that some discrepancies existed between faculty's espoused philosophy of teaching and their observed teaching behaviour. Instructors' teaching behaviour, however, was a function of their personal theory of practice. Relationships were found between perceived teaching behaviour and students· self-directed learning and critical thinking, but these varied across situations, as would be predicted from path-goal theory. Psychological type of students and instructor also accounted for some of the variability in the relationships studied. Student psychological type could be shown as a partial predictor of self-directed learning readiness. The results were discussed in terms of theory development and implications for further research and practice.

A case study investigation of the learning needs of the Niagara grape and wine community

The Niagara Grape and Wine Community (NGWC) is an industry that has undergone rapid change and expansion as a result of changes in governmental regulations and consumer preferences. As a result of these changes, the demands of the wine industry workforce have changed to reflect the need to implement new strategies and practices to remain viable and competitive. The influx of people into the community with little or no prior practical experience in grape growing (viticulture) or winemaking (oenology) has created a need for additional training and learning opportunities to meet workforce needs. This case study investigated the learning needs of the members of this community and how these needs are currently being met. The barriers to, and the opportunities for, members acquiring new knowledge and developing skills were also explored. Participants were those involved in all levels of the industry and sectors (viticulture, processing, and retail), and their views on needs and suggestions for programs of study were collected. Through cross analyses of sectors, areas of common and unique interest were identified as well as formats for delivery. A common fundamental component was identified by all sectors - any program must have a significant applied component or demonstration of proficiency and should utilize members as peer instructors, mentors, and collaborators to generate a larger shared collective of knowledge. Through the review of learning organizations, learning communities, communities of practices, and learning networks, the principles for the development of a Grape and Wine Learning Network to meet the learning needs of the NGWC outside of formal institutional or academic programs were developed. The roles and actions of members to make such a network successful are suggested.

Teaching persons with intellectual disabilities and limited receptive and expressive communication how to recognize and assert their human rights

Persons with intellectual disabilities (ID) are far more likely to be abused than the general population, but there is little research on teaching people with ID about their rights. The goal of this study was to teach four participants with ID and limited communication abilities about their human rights by training them on specific rights topics. The training program included icebreaker activities, instruction on rights concepts, watching and answering questions about videotaped scenarios of rights restrictions, watching and answering questions about role pl ay scenarios of rights restrictions, and responding to brief, low risk in situ rights restrictions imposed by the researchers. Participant performance did not improve significantly or consistently from baseline to training on the questions asked about the videotaped or the role play scenarios, but two of three participants demonstrated defmite improvements in responding to in situ rights restrictions.

An effective course of study for teaching hearing-impaired children TTY/TDD skills

This paper includes a course of study for teaching hearing impaired children about the use of TTY/TDD.

An effective course of study for teaching hearing-impaired children TTY/TDD skills

This paper includes a course of study for teaching hearing impaired children about the use of TTY/TDD.

Adapted Physical Education teachers and teaching knowledge

In the 1980's, there was a suggestion of including the Adapted Physical Education discipline in the Physical Education Graduation Course. In this perspective, starting from the Adapted Physical Education teacher's routine, the aim of this research was to verify what these teachers know and how they manage to plan, elaborate and apply their knowledge with their students with educational special needs. It's an exploring study that had in its interview and silabus analisis technics the source of its data. Among its most important results, it showed teaching, experimental and pedagogical knowledge as part of Physical Education and Adapted Physical Education, in the arrangement, building and knowledge apliance.

Economic evaluation of nile tilapia juvenile production, feed with commercial ration and with primary production come from organic and inorganic fertilization

Study objective was to evaluate economically a Nile tilapia juvenile production, employing different feeding techniques. Tilapia fingerlings of 8g were stocked at 5 fish m-2 stocking in 50 and 150 m2 ponds, during 75 days. Treatments were: inorganic fertilization (P205 and N); organic fertilization (poultry manure) and commercial ration (32% CP). Water quality results were considered adequate for fish rearing. In juvenile production there were significant differences among treatments for individual final weight, medians were: for inorganic fertilization 12.92g (13.35g in 50 m2 and 12.49g in 150 m2); for organic fertilization 30.55g (33.69g in 50 m2 and 27.40g in 150 m2) and for commercial ration 51.23g (52.90g in 50 m2 and 50.15g in 150 m2). Survival rate ranged from 63 to 71%, with no statistic difference. Commercial ration was effective to bigger juvenile production, with a better market value. Costs considered in economic analyses were tilapia fingerlings, fertilizer, ration, labor and installation depreciation. Obtained information showed that juvenile production in 50 m2 ponds is not viable economically and, in 150 m2, production is viable only when commercial ration is used.