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2017

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Articles 13441 - 13470 of 14527

Full-Text Articles in Medicine and Health Sciences

Publc Hospital Conversions: A Question Of Social Capital?, Antionette Smith Epps Jan 2017

Publc Hospital Conversions: A Question Of Social Capital?, Antionette Smith Epps

All ETDs from UAB

ABSTRACT Between 1975 and 2015, the number of public hospitals decreased by 43%, from 1761 to 1003. Public hospitals have undergone changes in ownership status, structural and/or governance conversions and closures. Reasons for these changes are varied and numerous, however, many studies identify financial difficulties as a major reason that decision-makers consider an ownership change. Some public hospitals persist despite exhibiting financial issues. Therefore, there may be other factors contributing to the persistence of some public hospitals. This paper examines the potential role of social capital or community engagement and cohesion as a factor in determining if a public hospital …

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Home Healthcare And Performance: Development And Application Of A Typology For Home Health Agencies, Ronique Nechelle Evans Jan 2017

Home Healthcare And Performance: Development And Application Of A Typology For Home Health Agencies, Ronique Nechelle Evans

All ETDs from UAB

This three-paper dissertation sought to examine the existence of strategic groups in the home health industry, the application of Porter’s generic strategies (cost leader, differentiator, “stuck-in-the-middle” and both cost leader/differentiator) in identifying these groups, and the association of group membership with agency performance. The findings of this study will provide researchers and managers with a highlight of the current strategic makeup of the home health industry and its relationship with quality and financial performance. The results of this dissertation provide some evidence that strategic groups do exist in the home health industry and can be described along the basis of …

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The Effectiveness Of Clinical Integration: The Relationship Between Evidence-Based Clinical Processes, In-Network Utilization And Clinical, Service And Efficiency Outcomes, Patrick D. Falvey Jan 2017

The Effectiveness Of Clinical Integration: The Relationship Between Evidence-Based Clinical Processes, In-Network Utilization And Clinical, Service And Efficiency Outcomes, Patrick D. Falvey

All ETDs from UAB

THE EFFECTIVENESS OF CLINICAL INTEGRATION: THE RELATIONSHIP BETWEEN EVIDENCE-BASED CLINICAL PROCESSES, IN-NETWORK UTILIZATION AND CLINICAL, SERVICE AND EFFICIENCY OUTCOMES PATRICK D. FALVEY EXECUTIVE DOCTORAL PROGRAM – SCHOOL OF HEALTH PROFESSIONS ABSTRACT The evolving U.S. health care system continues to steer healthcare organizations and integrated healthcare delivery networks (IDNs) to function as population health networks and ACOs. Policymakers, payers, health care leaders and consumer groups are advocating that IDNs clinically integrate processes and structures under the assumption that they will improve the clinical outcomes for a population, reduce the health care spend, and enhance the patient experience. Relatively little research has …

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Identification And Exploration Of The Information Needs And Information-Seeking Behaviors Of Medical-Surgical Nurses During Patient Care, Carrie Lee Gardner Jan 2017

Identification And Exploration Of The Information Needs And Information-Seeking Behaviors Of Medical-Surgical Nurses During Patient Care, Carrie Lee Gardner

All ETDs from UAB

Errors during the course of clinical practice are common and can lead to adverse events in hospitalized patients. Insufficient information and lack of clinician knowledge can serve as major contributing factors to the incidence of errors that occur during patient care. Nurses at the bedside need immediate access to patient specific information, at the point of care, and in an easily accessible format. There is a need for better understanding of the information needs and information-seeking behaviors of medical-surgical nurses. The purpose of this mixed-methods study was to explore the information-seeking behaviors of nurses when delivering patient care on medical-surgical …

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Immunoregulation During Acute And Chronic Exposure To Aspergillus Fumigatus, Jaleesa M. Garth Jan 2017

Immunoregulation During Acute And Chronic Exposure To Aspergillus Fumigatus, Jaleesa M. Garth

All ETDs from UAB

A. fumigatus is one of the most common fungal isolates with clinical disorders ranging from mild to severe. The development of Aspergillus-induced allergic and invasive fungal infections is a major health concern in several patient populations. IL-1 family members have been shown to play critical roles in host defense against A. fumigatus. IL-33, an IL-1 family member widely study in allergic and inflammatory diseases, was induced upon acute exposure to A. fumigatus. IL-33 receptor knockout mice, (Il1rl1-/-), demonstrated lower lung fungal burden in the presence of enhanced IL-1α, IL-1β, IL-6, IL-17A, IL-22, and PGE2 production. Administration of IL-33 to normal …

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Reducing Acute Cardiovascular Hospitalizations With A Weight Management Program (Reach), Laura A. Graham Jan 2017

Reducing Acute Cardiovascular Hospitalizations With A Weight Management Program (Reach), Laura A. Graham

All ETDs from UAB

Reducing cardiovascular (CVD) risk factors such as obesity through lifestyle and behavioral interventions like weight management programs should result in better cardiovascular health. However, there is conflicting evidence on the effectiveness of these interventions in reducing long-term CVD outcomes such as acute myocardial infarction or stroke. This reflects an important gap in our understanding about factors affecting recruitment and engagement in these programs and how these factors relate to improvement in long-term cardiovascular health. To address this gap, we will use a retrospective study with up to 11 years of follow up data from the nation’s largest health care system-associated …

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Evaluating The Genotype Phenotype Correlations In Cleidocranial Dysplasia, Stephen Lamar Greene Jan 2017

Evaluating The Genotype Phenotype Correlations In Cleidocranial Dysplasia, Stephen Lamar Greene

All ETDs from UAB

Cleidocranial dysplasia (CCD, OMIM 119600) is a rare (1 in 1,000,000) human autosomal dominant skeletal disorder with unique craniofacial and dental features caused by mutations the gene coding for transcription factor RUNX2. RUNX2 is a key master regulator of osteoblast differentiation, chondrocyte maturation and tooth formation. CCD is commonly diagnosed based on bone defects with ~90% of cases presenting with supernumerary teeth or a “third dentition”. Mouse Runx2 null models (Runx2+/-), although having similar CCD skeletal defects, do not mimic the human dental phenotype of supernumerary teeth. Instead, Runx2-/- mouse have arrested tooth formation at the cap stage. Furthermore, based …

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Transcriptional Dysregulation In Interneurons Causes Altered Modulation Of Hippocampal Synaptic Transmission And Circuit Function By The Dopamine System, Lillian J. Brady Jan 2017

Transcriptional Dysregulation In Interneurons Causes Altered Modulation Of Hippocampal Synaptic Transmission And Circuit Function By The Dopamine System, Lillian J. Brady

All ETDs from UAB

Genetic deletion of the transcriptional coactivator PGC-1α leads to transcriptional dysregulation in interneurons, and transcriptional dysregulation in interneurons lead to changes in hippocampal synaptic transmission and circuit function. Hippocampal circuit activity and synaptic transmission alterations have implications for symptoms of cognitive impairment in neurological disorders like schizophrenia. Modulation of dopamine receptor activity through pharmacologic application of haloperidol and the specific dopamine D4 receptor antagonist L-745,870 in PGC-1α-/- mice leads to altered effects on inhibitory/excitatory synaptic transmission balance, circuit function, and innate hippocampal dependent nesting behavior. These are key aspects underlying hippocampus dependent cognitive impairment. Specifically, bath application of haloperidol restores …

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Autism Spectrum Disorders And Social-Ecological Models: Understanding How Context Drives Prevalence, Anne Elizabeth Brisendine Jan 2017

Autism Spectrum Disorders And Social-Ecological Models: Understanding How Context Drives Prevalence, Anne Elizabeth Brisendine

All ETDs from UAB

Background: While there has been significant work done to explore disparities in autism spectrum disorder (ASD) diagnoses with respect to individual characteristics, little work has been done to examine the overall system and structure of the environment in which ASD identification is made and how it is related to diagnosis and services. The purpose of this study is to better understand the social-ecological factors that impact ASD diagnoses at the population level. Methods: In the first aim of this dissertation, a tailored social ecological model was developed and examined across variables in the 2011/12 National Survey of Children’s Health. In …

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Immunobiology Of The Mucosal Response To Helicobacter Pylori In Children, Kyle Brawner Jan 2017

Immunobiology Of The Mucosal Response To Helicobacter Pylori In Children, Kyle Brawner

All ETDs from UAB

Helicobacter pylori colonizes the stomach of approximately one half of the world’s population. However, the vast majority of infected persons remain asymptomatic. The degree of H. pylori-induced gastric inflammation depends on a complex interaction of several factors. In this dissertation, we focus on age as a determinant of gastritis severity. Children are known to respond to H. pylori infection with a stronger T regulatory cell profile compared with infected adults, yet the reason remains unknown. The influence of the microbiota on, and the communication among, cells of the innate immune system shape the nature of the adaptive immune response to …

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Nadph Oxidase-Derived Superoxide Production During Coxsackie B Virus Infection Fuels Macrophage Activation To Accelerate Type 1 Diabetes, Ashley R. Burg Jan 2017

Nadph Oxidase-Derived Superoxide Production During Coxsackie B Virus Infection Fuels Macrophage Activation To Accelerate Type 1 Diabetes, Ashley R. Burg

All ETDs from UAB

Type 1 diabetes (T1D) is a chronic inflammatory autoimmune disease in which autoreactive T cells selectively destroy insulin-producing pancreatic β-cells. While genetic predisposition underlies susceptibility, environmental factors are proposed to play the important role of triggering the activation of autoimmunity in T1D individuals. Viral infections, particularly by Coxsackie B viruses, are highly suspected as a precipitating event. However, the exact molecular mechanism for how viral infections elicit β-cell-specific autoimmunity remains unclear. Rodent models of virus-induced T1D suggest it is through bystander activation, during which innate antiviral responses to pancreas-tropic viral infections create an inflammatory milieu that breaks the peripheral tolerance …

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A Comparison Between Number And Letter Acuities Among Patients, Sarah Berry Jan 2017

A Comparison Between Number And Letter Acuities Among Patients, Sarah Berry

All ETDs from UAB

ABSTRACT Purpose: Previous studies have shown that there is an association between visual acuity and Alzheimers’ disease. Untreated visual problems may contribute to cognitive impairment and more progressive cognitive decline. This study investigates the association of chart design, specifically comparing charts using letters versus numbers, to accuracy and repeatability among patients with dementia. Methods: 23 English-speaking subjects diagnosed with moderate to advanced levels of dementia were recruited from two local Birmingham nursing homes. Visual acuities were measured in a randomly selected eye and timed from six different charts: Back-illuminated ETDRS chart with letters, Back-illuminated ETDRS chart with numbers, HOTV cards …

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Interplay Of The Circadian Clock And Growth Hormone Signaling In The Heart, Ryan Darrell Berry Jan 2017

Interplay Of The Circadian Clock And Growth Hormone Signaling In The Heart, Ryan Darrell Berry

All ETDs from UAB

Growth hormone (GH) signaling plays a critical role in postnatal development and the details of its release, regulation, and influence on the development of a number of organs has been well studied. GH is released from the anterior pituitary in a pulsatile fashion with pulse amplitude being greater at night than during the day in a number of species, including humans. Once in circulation, GH binds to the GH receptor (GHR) on target tissues throughout the body altering gene expression and stimulating the local production of insulin-like growth factor 1 (IGF-1). IGF-1 primarily acts in an autocrine and paracrine fashion. …

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Increasing The Accessibility Of A Falls Prevention Intervention For Community-Dwelling Older Adults With Low Vision, Sarah Blaylock Jan 2017

Increasing The Accessibility Of A Falls Prevention Intervention For Community-Dwelling Older Adults With Low Vision, Sarah Blaylock

All ETDs from UAB

Falls remain a costly problem as a leading cause of injuries and fatalities for individuals over the age of 65. Older adults with low vision, or non-correctable visual impairment, are estimated to be two times more likely to fall than those without vision loss. There appear to be limited falls prevention interventions available for older adults that have been tested on or designed specifically for individuals with visual impairment. The goals of this dissertation were to learn more about the availability of visually accessible falls prevention interventions and to develop an intervention that can be used with veterans receiving services …

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Contribution Of Distinct Interneuron Subclasses To Cortical Network Activity, Andrew Scott Bohannon Jan 2017

Contribution Of Distinct Interneuron Subclasses To Cortical Network Activity, Andrew Scott Bohannon

All ETDs from UAB

The excitatory glutamatergic output of the cerebral neocortex is tightly regulated by the release of the inhibitory neurotransmitter GABA from cortical interneurons (INs). Once viewed as a largely homogenous population, recent studies have revealed that cortical INs display a diverse range of biochemical, anatomical and physiological properties. In this work we sought to determine if differences in the physiology and connectivity patterns of identified cortical IN populations enable them to differentially contribute to network activity. Specifically, we investigated the contribution of discrete L2/3 IN groups to the generation of aberrant cortical synchrony, and the influence of HCN channels on information …

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Racial Disparities In The Maintenance Of Healthy Lifestyles And Their Effect On Cumulative Blood Pressure Burden And Left Ventricular Mass In African Americans And Whites: Data From The Coronary Artery Risk Development In Young Adults (Cardia) Study, John N. Booth Jan 2017

Racial Disparities In The Maintenance Of Healthy Lifestyles And Their Effect On Cumulative Blood Pressure Burden And Left Ventricular Mass In African Americans And Whites: Data From The Coronary Artery Risk Development In Young Adults (Cardia) Study, John N. Booth

All ETDs from UAB

The prevalence of healthy behaviors associated with optimal blood pressure (BP) levels and reduced risk for target-organ damage and cardiovascular disease (CVD) is lower in blacks compared with whites. Randomized controlled trials provide evidence that if healthy behaviors are maintained over the lifespan, including normal body weight, moderate physical activity, limited alcohol intake, limited sodium intake, adequate potassium intake and a rich diet of fruits and vegetables and low in high-fat dairy and saturated and total fat, then high BP may be preventable. The goal of this dissertation was to assess racial differences in the maintenance of healthy behaviors and …

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Optimizing The Non-Ablative Conditioning Regimen For Bone Marrow Transplantation Using A Murine Model Of Sickle Cell Disease, Divya Devadasan Jan 2017

Optimizing The Non-Ablative Conditioning Regimen For Bone Marrow Transplantation Using A Murine Model Of Sickle Cell Disease, Divya Devadasan

All ETDs from UAB

In this dissertation, we sought to determine if a sub-myeloablative conditioning regimen followed by bone marrow transplantation/hematopoietic stem cell transplantation (HSCT) using syngeneic donor cells could facilitate donor chimerism using a clinically relevant mouse model of sickle cell disease (SCD). This pre-clinical study determined the feasibility of using sub-myeloablative conditioning in the context of autologous HSCT. The prospect of using less-intense conditioning is particularly appealing in the era of modern gene-editing technologies since its extension to use in humans will allow for HSCT to be less toxic and hence be applicable in all patients. We showed that using a sub-myeloablative …

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Effect Of Antihypertensive Drugs On Left Ventricular Traits In Africam American, Anh N. Do Jan 2017

Effect Of Antihypertensive Drugs On Left Ventricular Traits In Africam American, Anh N. Do

All ETDs from UAB

The purpose of this dissertation is to evaluate the association of antihypertensive treatment as well genomic variants with left ventricular (LV) hypertrophy (LVH) -related traits among African Americans (AAs) in five cross-sectional epidemiology cohorts from the United States. AAs especially those with hypertension, are overburdened by left ventricular (LV) hypertrophy (LVH) compared to other ethnic groups. LVH is associated with increased risk for cardiovascular morbidity and mortality. Antihypertensive treatments have been found to improve LVH and related echocardiographic measures (i.e. LV traits) among hypertensive patients. However, the effect of antihypertensive treatments on LVH and related traits in AAs has not …

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Practical Neurology Linked To The Curriculum: An Online Resource, Dilraj Sokhi, Alice Brockington, Christine Lo Jan 2017

Practical Neurology Linked To The Curriculum: An Online Resource, Dilraj Sokhi, Alice Brockington, Christine Lo

Internal Medicine, East Africa

Navigating the online galaxy for up-to-date evidence-based knowledge in clinical neurology can be a challenge. Practical Neurology is a noted and popular online clinical resource,1 which according to its website is "…practical in the sense of being useful for everyone who sees neurological patients and who want to keep up to date, and safe, in managing them." As UK-based neurology trainees, we have been fortunate to have automatic access to Practical Neurology during our training. We found that the articles adequately covered most elements in our syllabus and were ideal reference material for our department. This accords with the …

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O-Acetyltransferase Functionality Mediates Pneumococcal Capsular Diversity, Brady Spencer Jan 2017

O-Acetyltransferase Functionality Mediates Pneumococcal Capsular Diversity, Brady Spencer

All ETDs from UAB

Streptococcus pneumoniae (pneumococcus) is an important human pathogen that asymptomatically colonizes the nasopharynx but can disseminate opportunistically to cause diseases such as otitis media, pneumonia, septicemia, or meningitis. The pneumo-coccal capsular polysaccharide is necessary to prevent opsonophagocytosis as nonencap-sulated pneumococci are largely avirulent. Currently, 98 antigenically distinct capsule types (serotypes) have been identified, which vary in virulence. O-acetylation, a subtle capsular modification, contributes to pneumococcal capsular diversity and modulates capsular physicochemical properties and interaction with innate or vaccine immunity. Replacement serotypes (and future vaccine types) 33F and 15B have O-acetylated capsules due to membrane-bound O-acetyltransferases (MOATs). We hypothesize that future …

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Diabetes Risk In Women: Pschosocial And Lifestyle Determinants, Sarah Katherine Sweatt Jan 2017

Diabetes Risk In Women: Pschosocial And Lifestyle Determinants, Sarah Katherine Sweatt

All ETDs from UAB

Type 2 diabetes (T2D) is a major public health concern. Physical inactivity, poor diet, and psychosocial distress have emerged as factors contributing to T2D. Women may be uniquely affected by these factors as obesity, physical inactivity, and the prevalence of psychosocial distress are higher in women. Additionally, polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women and increases the risk of both T2D and psychosocial distress. However, the relationship between physical activity (PA), psychosocial distress, and metabolic health is not fully understood, particularly in at risk populations such as minorities and women with PCOS. Therefore, the goal …

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The Role Of Adipocytes And Osteocytes In Multiple Myeloma Progression, Timothy Nathan Trotter Jan 2017

The Role Of Adipocytes And Osteocytes In Multiple Myeloma Progression, Timothy Nathan Trotter

All ETDs from UAB

Multiple myeloma (MM) is a hematological malignancy of plasma cells that is intrinsically tied to the bone marrow (BM). Many cells in the BM microenvironment have been studied in MM, yet there is still much progress to be made. Recent work has revealed two new potential cellular targets in MM: adipocytes and osteocytes. Both are endocrine cells and secrete many molecules that regulate other cells proximally and systemically. Our lab previously showed that MM cells shift osteoblast precursor cells towards adipogenesis through soluble molecules alone. Recent findings also revealed that osteocyte apoptosis is enhanced in MM patients compared to healthy …

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Statistical Tests For Confounding, Falynn Cartmill Turley Jan 2017

Statistical Tests For Confounding, Falynn Cartmill Turley

All ETDs from UAB

The use of propensity score methods have increased tremendously in the last several years. Propensity scores are used as a tool to correct the effects of confounding that can result in biased estimates of treatment effects. However, there is more than one method that employs propensity scores, and there is no guide in choosing the optimal method, in terms of Type I error and statistical power. This research aims to assess these attributes through a complex simulation study of a five variable model. The results of the simulations indicate performance of a particular propensity score method is dependent

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Acute And Chronic Regulation Of Skeletal Muscle Mitochondrial Function, Jonathan Lund Warren Jan 2017

Acute And Chronic Regulation Of Skeletal Muscle Mitochondrial Function, Jonathan Lund Warren

All ETDs from UAB

Obesity and type 2 diabetes (T2D) represent a growing global burden on healthcare and financial resources. One hypothesis for the onset and exacerbation of these diseases is related to the role of mitochondria as the end users of products of the metabolism of the nutrients we consume and in mediating the oxidative state of the body through the production of reactive oxygen species (ROS). In order to meet the demands of a metabolic challenge and prevent excessive ROS production, there appear to be adaptations to mitochondrial physiology and morphology that can occur and we hypothesize that the ability of the …

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Comparative Analysis Of New Techniques For Hearing Conservation Program Selection, Laura Hurst Jan 2017

Comparative Analysis Of New Techniques For Hearing Conservation Program Selection, Laura Hurst

All ETDs from UAB

Hazardous noise is a widespread problem in industry and recreation. Noise induced hearing loss is one of the most frequently reported occupational health claims worldwide. While there has been much research on noise, its effects, and how to prevent hearing loss in industry, there is limited research available to help quantify the difference that monitoring noise at a lower threshold might create in the measured exposure estimate. Additionally, the studies involving the use of different noise monitoring settings do not attempt to explain how the results might change the outcomes when using data and statistical techniques to classify similar exposure …

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Alternative Methodological Approaches For Quantifying Dental Caries And Non-Water Beverage Consumptions For The Improvement Of Caries Risk Analyses In Children, Kelsey Harris Jordan Jan 2017

Alternative Methodological Approaches For Quantifying Dental Caries And Non-Water Beverage Consumptions For The Improvement Of Caries Risk Analyses In Children, Kelsey Harris Jordan

All ETDs from UAB

Researchers assume caries progress constantly, all crowned/extracted tooth surfaces are carious, and non-water beverage consumption (NWBC) habits are similar by relying on increments, dmfs scoring, and consumption frequencies, respectively. These assumptions are likely inaccurate. The purpose of this research was to evaluate and modify the use of 1) longitudinal caries disease assessment, 2) the dmfs score and 3) NWBC variables to more accurately estimate disease and identify risk factors. To investigate, young (8-18 months at baseline), healthy, poor, rural, African American, Alabamian children were observed annually for five years. Three calibrated dentists performed oral examinations (without radiographs), calculating the number …

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Bioactive Materials: Ion Release, Flexural Strength, Secondary Caries Depth And Elemental Analysis Of Surrounding Tooth Structure, Prajakta Shreeram Kulkarni Jan 2017

Bioactive Materials: Ion Release, Flexural Strength, Secondary Caries Depth And Elemental Analysis Of Surrounding Tooth Structure, Prajakta Shreeram Kulkarni

All ETDs from UAB

ABSTRACT Objectives: Bioactive materials release calcium, phosphate, and fluoride which may increase tooth remineralization. But limited data is available demonstrating the superiority of bioactive or ion releasing materials compared to fluoride or no ion releasing materials. The aims of the present study are to measure and compare the calcium, fluoride, and phosphate ion release at different pH, flexural strength and caries protecting ability of the materials including the ion uptake of surrounding tooth structure. Methods: Activa, Cention N, Fuji LC II and Filtek Supreme Ultra were the restorative materials tested. Firstly, the fluoride and calcium release of these materials was …

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Teleexercise For People With Disabilities, Byron Lai Jan 2017

Teleexercise For People With Disabilities, Byron Lai

All ETDs from UAB

Exercise is recognized as a method of improving health and function and preventing deconditioning for adults with neurological disabilities. However, they experience a multitude of barriers that prevent them from regular participation in exercise. To address these barriers, the goal of this dissertation was to explore the use of monitoring technology as a means for delivering exercise to adults with neurological disabilities at home. This pursuit involved three studies. The first study reviewed the extant literature for current trends in exercise interventions for people with disabilities. Regarding technology, the review indicated that technology is rarely used to deliver one-on-on supervised …

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The Role Of Klotho In Adult Neurogenesis, Ann Laszczyk Jan 2017

The Role Of Klotho In Adult Neurogenesis, Ann Laszczyk

All ETDs from UAB

Klotho is an anti-aging protein that when upregulated, extends lifespan and enhances cognition. Klotho knockout mice age prematurely and die by ~8 weeks of life after developing cognitive impairment. Klotho function outside of the brain is well established but the protein’s action within the brain remains unknown. As klotho regulates peripheral stem cell populations, I sought to determine whether klotho contributes to cognition through a role in the maintenance of the adult hippocampal neurogenic niche. I examined adult mouse neurogenesis using global klotho-deficiency or global klotho overexpression models. Klotho knockout brains show reduced progenitor proliferation and granule cell production while …

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Sample Size Re-Estimation For Confirmatory Two-Stage Multi-Arm Trials With Normal And Binary Outcomes, Yan Li Jan 2017

Sample Size Re-Estimation For Confirmatory Two-Stage Multi-Arm Trials With Normal And Binary Outcomes, Yan Li

All ETDs from UAB

Multi-arm clinical trials comparing several treatments against a common control are more efficient than traditional multiple two-arm trials. Several flexible multi-arm designs which utilize the closed test procedure for strong familywise error rate control have been proposed to allow treatment selection and sample size re-estimation (SSR) at the interim analysis. Because of the interdependence among hypothesis tests for each treatment induced by the closed test procedure, SSR methods for two-arm trials are not directly applicable to multi-arm trials. Further, there is limited literature on methods for SSR in multi-arm trials. In paper 1, we derive SSR procedures based on the …

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