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Additional file 1.

This thesis was scanned from the print manuscript for digital preservation and is copyright the author. Researchers can access this thesis by asking their local university, institution or public library to make a request on their behalf. Monash staff and postgraduate students can use the link in the References field.

BackgroundEarly hospital readmission for patients with cirrhosis continues to challenge the healthcare system. Risk stratification may help tailor resources, but existing models were designed using small, single-institution cohorts or had modest performance.AimsWe leveraged a large clinical database from the Department of Veterans Affairs (VA) to design a readmission risk model for patients hospitalized with cirrhosis. Additionally, we analyzed potentially modifiable or unexplored readmission risk factors.MethodsA national VA retrospective cohort of patients with a history of cirrhosis hospitalized for any reason from January 1, 2006, to November 30, 2013, was developed from 123 centers. Using 174 candidate variables within demographics, laboratory results, vital signs, medications, diagnoses and procedures, and healthcare utilization, we built a 47-variable penalized logistic regression model with the outcome of all-cause 30-day readmission. We excluded patients who left against medical advice, transferred to a non-VA facility, or if the hospital length of stay was greater than 30days. We evaluated calibration and discrimination across variable volume and compared the performance to recalibrated preexisting risk models for readmission.ResultsWe analyzed 67,749 patients and 179,298 index hospitalizations. The 30-day readmission rate was 23%. Ascites was the most common cirrhosis-related cause of index hospitalization and readmission. The AUC of the model was 0.670 compared to existing models (0.649, 0.566, 0.577). The Brier score of 0.165 showed good calibration.ConclusionOur model achieved better discrimination and calibration compared to existing models, even after local recalibration. Assessment of calibration by variable parsimony revealed performance improvements for increasing variable inclusion well beyond those detectable for discrimination.

Perceptions about marijuana are changing across the United States. As more states alter its legal standing, medically and/or recreationally, perceptions of its risks of harm are likely to continue to decrease. College students and young adults represent a significant population with viewpoints that are seen as driving this cultural and attitudinal shift. Millions of individuals living in the United States report using marijuana making it the most commonly used illicit substance. Treatment admissions for marijuana use disorders are still proportionately high compared to the other substances. Similarly, marijuana was the most commonly reported secondary substance among treatment admissions aged 18 to 30. This study reports results on college students’ drug use histories and perceptions of utility and harm. Respondents endorsed a variety of ideas supporting and refuting the notion that marijuana was harmful. Findings, including ideas and rationales for and against marijuana use among college students, and implications for counselors, researchers and prevention professionals are presented.

Additional file 1. Further details about the simulations, parameter settings and results in table format.

Characteristics of the selected single nucleotide polymorphisms (SNPs) in the CLOCK gene (DOCX 17 kb)

Table S1. Characteristics of the selected single nucleotide polymorphisms (SNPs) in the ADIPOQ gene. Table S2. Association between ADIPOQ SNPs and adiponectin serum levels in men and women from the Jackson Heart Study cohort. Table S3. Association between ADIPOQ SNPs and BMI in normal weight and overweight or obese men and women from the Jackson Heart Study cohort. (DOCX 28Â kb)

This thesis focuses on a vulnerable group of people with asthma that have to date been ignored in the literature i.e. individuals with intellectual disability (ID) who use inhalers. Based on their cognitive, and sometimes physical and sensory impairments, people with ID are a subgroup of people with asthma who potentially have special needs, require additional support and are at increased risk of inhaler misuse. Through a multifaceted exploration into several aspects of their care, their environment and their specific needs, strategies to assist people with asthma who also have ID are identified. Key research areas considered are the health care context of individuals with ID and respiratory illness, the perceptions of their caregivers around asthma medication management and the knowledge and skills of individuals with ID regarding asthma medication self-management, including inhaler technique mastery. A qualitative examination of the inhaler technique training is triangulated with established quantitative techniques to give the first insights into how individuals with mild levels of ID actually use their inhalers. Finally the thesis examines the knowledge and skills of healthcare providers caring for an “at risk” population, including individuals with ID. Future research directions are outlined, and respiratory care recommendations are proposed.

The relationship between mental health and public health has been debated for decades. But when services are delivered through publically funded mental health clinics, it clearly becomes a public health endeavor. One of the latest trends in mental health service delivery is the recovery concept. Developed in the 1990’s, the recovery concept represents a paradigm shift where successful treatment is defined by self-awareness, self-care, and self-fulfillment. Furthermore, patients are encouraged to assess their own progress in the recovery process. There are currently nine unique assessment tools to measure recovery progress, including the Mental Health Recovery Measure (MHRM), which was used in this study. The current study followed the implementation of the recovery model in the DeKalb Community Service Board (DeKalb CSB). DeKalb CSB has 12 locations that serve 10,000 patients with mental illness, substance abuse, and developmental disabilities each year. Only patients with primary diagnoses of mental health or substance abuse disorders were considered for this study. Implementation of the MHRM began in December 2008 and included all DeKalb CSB patients, however only new DeKalb CSB patients were considered for this study. During 13 months of data collection 960 clients completed 2 assessments and 196 completed 3 assessments. A new consumer is defined as someone who has just completed the intake process and has no record of previous service at DeKalb CSB. The current study examined trends in MHRM data in the DeKalb CSB population; and offered recommendations for future implementation.