Dissertations / Theses on the topic 'Outcomes assessment'

This study examined the impact therapeutic assessment (TA) had on participants recruited from the UNT Psychology Clinic's waiting list. Using a pretest-posttest design, participants completed measures prior to and following their assessment. UNT Psychology Clinic archive data was used to compare this sample to clients who received traditional information gathering assessments with implicit measures, those receiving assessments relying on only self-report measures, and those who did not receive an assessment before beginning psychotherapy. The findings of this study vary based on the criteria being examined. Due to the small sample in the experimental group, no statistical significance was found through null hypothesis testing. However, the TA group's scores on the Outcome Questionnaire – 45 (OQ) and the Working Alliance Inventory (WAI) indicated better outcomes than those without a TA, with large effect sizes. Furthermore, those who received a TA were more likely than those without a TA to score below the clinically significant cutoff levels on the OQ. The study raises issues for consideration in what is deemed "effective" in therapeutic efficacy research.

Given the conflicting research results on the effectiveness of whole-school reform models (Nunnery, 1998; Stringfield & Herman, 1997; American Institutes for Research, 1999; U.S. Department of Education, 2004), there is a need to focus on the evaluation procedures of whole-school reform organizations. Because the ultimate goal is to improve school performance, it should also be a goal of each whole-school reform organization to design a comprehensive data collection system to evaluate each school’s performance. A comprehensive reporting system was developed for a school reform organization, the Accelerated Schools Project (ASP). Using the steps of the research and development process recommended by Borg and Gall (1989), this study: (a) developed a theoretical framework for the reporting system, (b) identified data that should be collected in the reporting system, (c) performed a field test with an expert panel of educational professionals, (d) developed a preliminary form of the reporting system, (e) performed a main field test with principals and coaches in the ASP network, (f) reported field test results, (g) revised the preliminary reporting system, (h) developed a website for the reporting system, and (i) provided recommendations for the completion, dissemination and implementation of the system in accelerated schools across the nation. This study has important implications for both the ASP community and for the entire whole-school reform community. For the ASP community, the reporting system could be used: (a) to collect data in all accelerated schools across the nation (b) as a longitudinal database of information to monitor data on each ASP school, and (c) to generate school summary reports on ASP schools. These data will assist researchers in measuring the effectiveness of the ASP model on student achievement and other important variables. For the whole-school reform community, the method used in this study could be replicated in other school reform organizations to develop a comprehensive reporting system. By providing consistent data for school reform organizations to evaluate the impact of their models on students and schools, educational researchers will be better equipped to understand each model’s impact, and thus will better understand the diverse research results on school reform effectiveness.

Few studies have systematically evaluated whether preferences can reliably be identified using brief procedures. Typically, studies have used brief procedures to select potential reinforcers for use in intervention procedures. A total of 17 food and leisure paired-choice preference assessments were administered to 10 subjects in order to evaluate the extent to which the results of a brief (i.e., single-session) assessment correspond with those from more extended procedures (i.e., 5 sessions). Eleven out of the 17 brief and extended assessments identified the same stimulus as the most preferred (highest rank). Outcomes suggest that a brief assessment can be useful when a single, potent reinforcing stimulus is desired, and an extended assessment should be conducted when a larger number of preferred stimuli is desired.

Thesis (PhD (Education Policy Studies))--University of Stellenbosch, 2009
ENGLISH ABSTRACT: The core question that is addressed in this dissertation is: “How can we think differently about education in order to transcend the predicament that outcomes-based assessment poses for teachers and the practice of teaching?” This question is addressed against the background of my own narrative and experience in education in South Africa and in dialogue with the ideas of a number of contemporary philosophers. I assume an internal link between the outcomes-based discourse and its attendant assessment system. I argue that although outcomes-based education is proclaimed to be a progressive pedagogy, an alternative argument can be made that characterises it as an old behaviourist, management theory, overlain by a new policy technology called performativity. Thereafter, I engage critically with outcomes-based assessment as a prime example of performativity. In the next step I explore the ways in which outcomes-based assessment poses a predicament to teachers and to the practice of teaching. I then construct an alternative view of education that, in my opinion, provides a way to transcend the predicament that outcomes-based assessment poses for teachers and the practice of teaching. I also compare my alternative view of education with a new notion of education as therapy and standing in need of therapy, which is also presented as an alternative to instrumental approaches to education. Thereafter I consider the implications of my alternative view of education for teachers and assessment. I consider potential critiques against my argument at various stages in this dissertation. In the final chapter, I anticipate five more potential critiques against the argument developed in this dissertation and give initial responses to these. At the end of this dissertation I extend an invitation to deliberation in the spirit of my alternative view of education.
AFRIKAANSE OPSOMMING: Die kernvraag wat in hierdie proefskrif aan bod kom, is: “Hoe kan ons anders dink oor onderwys sodat die penarie wat uitkomsgebaseerde assessering vir onderwysers en die onderwyspraktyk meebring, oorkom kan word? Die vraag word beredeneer teen die agtergrond van my eie narratief en ervaring in onderwys in Suid-Afrika en in dialoog met die idees van ’n aantal kontemporêre filosowe. Ek veronderstel ’n interne skakel tussen die uitkomsgebaseerde diskoers en die verbandhoudende assesseringstelsel. Ek voer aan dat hoewel uitkomsgebaseerde onderwys as ’n progressiewe pedagogie voorgehou word, ’n alternatiewe argument gemaak kan word wat dit as ’n ou, behavioristiese bestuursteorie beskryf, wat oordek is met ’n nuwe beleidstegnologie genaamd performatiwiteit. Daarna gaan ek krities om met uitkomsgebaseerde assessering as ’n primêre voorbeeld van performatiwiteit. In die volgende stap verken ek die maniere waarop uitkomsgebaseerde assessering ’n penarie vir onderwysers en die onderwyspraktyk voorhou. Ek ontwikkel dan ’n alternatiewe beskouing van opvoeding wat, na my mening, ’n manier verskaf om die penarie wat assessering vir onderwysers en die onderwyspraktyk veroorsaak, te oorkom. Ek vergelyk ook my alternatiewe beskouing van onderwys met ’n nuwe konsep van onderwys as terapie en as behoeftig aan terapie, wat ook as ’n alternatief vir instrumentele benaderings tot onderwys aangebied word. Daarna oorweeg ek die implikasies van my alternatiewe beskouing van onderwys vir onderwysers en assessering. Ek oorweeg op verskillende stadiums in hierdie proefskrif potensiële punte van kritiek teen my argument. In die laaste hoofstuk antisipeer ek vyf bykomende potensiële punte van kritiek teen die argument wat in hierdie proefskrif ontwikkel is en gee aanvanklike reaksies daarop. Teen die einde van hierdie proefskrif rig ek ’n uitnodiging tot beraadslaging in die gees van my alternatiewe beskouing van opvoeding.

The need continues within the field of organizational behavior management for empirically valid and feasible interventions to assist organizations with producing desirable changes in the work behavior of employees. The present study sought to determine the utility of a procedure to identify preferred stimulus among employees and the effects of implementation of the preferred stimulus on employee performance. Baseline data was collected on the productivity of employees. Then, a preference assessment was administered to employees. The results of the preference assessment yielded a commonly preferred stimulus which was then implemented to test for an effect on employee task completion. Results indicated moderate increases in employee performance and support the use of preference assessments to identify effective reinforcers for employees.

A private, nonprofit university in Mexico invested millions of U.S. dollars in a strategic initiative to build and operate technology-knowledge transfer parks (TKTP) with the mission of supporting the development of Mexican society's entrepreneurial capabilities. The university, however, lacked an assessment policy for gauging the effectiveness of the TKTP initiative. The purpose of this study was to explore stakeholder values about TKTP effectiveness in order to inform future assessment of TKTPs. The triple helix conceptual framework of collaboration between universities, business and industry, and government informed the design of this study. The central question for this study sought to clarify what stakeholders perceive to make TKTPs effective. The study employed stratified random sampling and cross-sectional stakeholder survey data (N = 129). Data analysis included descriptive statistics to present common themes about TKTP stakeholder values, as well as ANOVA to discern significant differences in TKTP valuations between the stakeholder groups. A key finding was that stakeholder groups lack enough information to assess whether the university achieved its original objectives by using the TKTP initiative. Other findings revealed that the stakeholder groups agreed on several criteria for TKTP assessment. A policy recommendation for TKTP assessment, based on the research findings, is provided as part of the project component of this study. This project study supports positive social change by encouraging the region's transformation into a more entrepreneurial, innovative, and knowledge-based economy through continued but more accountable use of TKTPs in Mexico.

Science, technology, engineering and mathematics (STEM) skills are globally valued. In United Kingdom, serious concerns have long been raised over the apparently insufficient number of young people studying science and maths beyond compulsory education. A range of STEM schemes have been introduced and sustained for over a decade now to raise attainment and improve attitudes of students in school towards pursuing STEM subjects and careers. These schemes call for huge investments of time, money, and resources. Over the same period, government reports have pointed out the pressing need for large scale evaluations to understand what works in public policy including education. This is important for accountability and to achieve better results by building on the best schemes for similar or reduced investments. Increasing and widening participation in STEM are clearly priorities for UK’s education policy. However, in the absence of proper evaluations the impact of spending on STEM schemes on raising attainment or improving participation remains unclear. Addressing this gap in literature, using official datasets in the form of National Pupil Database (NPD), this project evaluates the impact of STEM enrichment and enhancement activities on all pupils, disadvantaged pupils and schools with a large share of such pupils. A part of this research project tries to understand the reasons linked to underachievement of disadvantaged pupils in school science and maths through a systematic review. To ensure comparability across evaluations, the public sector guidance for evaluation issued by the National STEM Centre was followed. Using a prospective longitudinal (2007-2014) research design, a 1000 intervention secondary schools and 80,000 students exposed to STEM interventions were followed-up from the beginning of key stage-3 to A-levels. The study uses various deprivation measures such as eligibility for free school meals (FSM), speaking English as an additional language (EAL) and ethnic minority status. The outcome measures considered are school GCSE performances in science and maths, individual pupil attainment in GCSE science and maths, and continued post-16 participation in STEM subjects. Correlation-regression approaches are used and a range of effect sizes have been calculated to estimate the impact. Results show overall science and maths results have improved for schools, students and disadvantaged pupils (since 2007). However, this success cannot be attributed to STEM enrichment and enhancement activities, because the improvements are not peculiar to schools known to have been involved in STEM interventions. Synthesising 771 research reports, the systematic review concludes that a range of individual, social, family and school related factors interact to hold back a child from realising their full academic potential. Recommendations from this evaluation research project should be of particular interest to policy makers, schools, educators, STEM activity providers and anybody working towards improvement of the learning trajectories of disadvantaged students.

In South Africa today, the challenge is to redress past inequalities and to transform the higher education system. This transformation of the higher education system is necessary in order to serve a new social order. The introduction of outcomes-based education and training requires a new approach to education, including the process of assessment. An outcomes-based approach to education and training focuses on continuous assessment through the use of a range of assessment methods. The Ministry of Education tasked the National Department of Education to embark on a review of their academic programmes. This review has been in response to register programmes on the National Qualifications Framework. This review has also been part of an attempt to improve the quality of qualifications. In most learning organisations, assessment and learning have always been closely related. If assessment has not simply been seen as the end point in learning but has been an important component in the design of the learning process itself, this statement will be severely tested by the movement towards an outcomes model for education and training. The primary aim of the study was to develop a conceptual model for the management of the impleme tation of a continuous assessment plan in a university of technology by means of aliterature study and an empirical investigation. Currently, information regarding the conceptualisation of this topic is inadequate and vague. If the nature of the complexities involved in the management and implementation of CASS at universities of technology are known, a conceptualised model can be developed for the effective management of the implementation thereof. The implementation of an integrated model of assessment requires the creation of an enabling environment in which the model can be implemented. This study has found that this is not true for many universities of technology, as: • programme design still rests on subjects that are not aimed at outcome-based models; • administrative systems are not designed to accommodate the recording of continuous assessments; • students, lecturers and other stakeholders have not undergone the necessary training regarding the change in paradigm from content-based to outcomebased education; and • policy regarding modularisation and continuous assessment has not yet been defined and implemented. The study serves to present a useable model for the management of the implementation of continuous assessment at universities of technology. The study is based on a balanced opinion as the experiences of both lecturers and students were investigated by means of structured questionnaires. The findings were verified by means of a focus group interview with administrative staff involved with continuous assessment. The model that was developed is a usable model as it was subjected to a number of verification tests.
Thesis (Ph.D. (Teaching and Learning))--North-West University, Vaal Triangle Campus, 2008.

Since its inception, the Outcomes-Based Education (OBE) curriculum in South Africa has caused much confusion and frustration among teachers, especially with regard to the implementation of Outcomes- Based Assessment (OBA). From the onset of the implementation of OBE in South Africa, teachers were confronted with unfamiliar challenges with regard to teaching, learning and assessment. Most teachers experienced these challenges as very stressful, because they were inadequately prepared for the didactical paradigm shift. This resulted in a general degree of negativity and resistance towards OBE amongst teachers. In particular, there seemed to be much confusion and frustration about the workload and administrative burden that OBA imposed on teachers. In the light of the afore-mentioned, the researcher wished to determine how the teachers from the North- West Province experience the OBA of Physical Sciences in the Further Education and Training (FET) Band. In order to achieve the aim and objectives of the research, a literature study as well as an empirical investigation was undertaken. The literature study focused on OBA, OBE, and the National Policy Document on the teaching, learning and assessment of Physical Sciences in the FET Band. For the purposes of the empirical investigation, quantitative and qualitative data were collected by means of a questionnaire that was distributed among a sample of teachers who taught Physical Sciences in the FET Band schools in the North-West Province. The data were quantitatively and qualitatively analyzed and on the basis of the findings the following conclusions were drawn: • Although most participants indicated that they received training in OBA and were in possession of the relevant National Curriculum Statement (NCS) documents, some of their responses indicated a lack of practical implementation skills. It also transpired that some of the participants experienced a lack of resources and inadequate support from subject advisors in implementing OBA. • Participants experienced the following obstacles with regard to the assessment of Physical Sciences in the FET Band: - inadequate training to conduct practical work; - a complicated and confusing NCS document that does not contain clear guidelines; - an overloaded curriculum; and - limited resources, time constraints, overcrowded classrooms and an overloaded curriculum make practical work and experimentation very difficult. On the basis of the findings emanating from the research, a model for the implementation of OBA of Physical Sciences in the FET Band was proposed to close the gap between the theory and assessment practice.
Thesis (PhD (Natural Science Education))--North-West University, Potchefstroom Campus, 2013.

While descriptive assessment outcomes show limited correspondence with experimental analysis outcomes, they are still often used in the treatment of problem behavior. The most effective way of treating problem behavior is by manipulating its controlling variables; however, if descriptive analyses are not depicting accurate environment-behavior relations, then treatments based off of descriptive analysis results have a higher chance of failing. The current study looks to replicate and extend the literature on utility descriptive assessments by analyzing three different data analysis methods. Three children with a diagnosis of autism were exposed to two types of experimental analyses. Following experimental analyses, descriptive assessments were completed and analyzed to determine correlations between the behavior and environmental events. The results from the three investigated data analysis methods were then compared to the outcomes of the experimental analyses.

BACKGROUND: Surgical treatment of Insular gliomas is technically challenging and may lead to high postoperative morbidity. However, previous research has proven that maximal safe resection is critical for maintaining quality of life as well as enhancing overall and progression-free survival. Insular gliomas are currently resected through either a transsylvian or transcortical approach. However, there is no objective evidence to aid surgical management to maximize safe resection rates. OBJECTIVES: To define an optimal treatment strategy for the neurosurgical management of insular gliomas using a sequential research protocol. Phase A1- Design a custom embalming formula for preserving native brain features in cadavers to optimize the validity and clinical applicability of laboratory-based operative research. A2- Design a laboratory method to obtain objective data to assess -and compare- neurosurgical techniques in cadavers. Phase B- Define an optimal surgical technique for the management of each insular glioma of the Berger-Sanai classification system using our surgical simulation method in cadavers. Phase C- Validate the existing anatomical classification of insular gliomas to predict extent of resection (extent of resection) and anticipate neurological morbidity. METHODS: We aimed to provide sound objective evidence to the surgical management of insular gliomas through a multidisciplinary, sequential method including basic laboratory research, neurosurgical simulation using cadavers and a prospective clinical study. We first developed a customized embalming formula to create a neurosurgical simulation method that best resembles life surgery (a). We then used this optimized surgical simulation method to objectively determine and quantify the best surgical approach (transsylvian vs transcortical) for each type of insular tumor according to the Berger-Sanai insular glioma classification (b). Finally, we carried out a prospective clinical study to assess the predictability of the Berger-Sanai insular glioma classification regarding extent of resection and patient outcomes (c). RESULTS: We designed an embalming solution that dramatically improved validity and applicability of research using neurosurgical simulation in cadavers. Our formula optimizes resemblance to life surgery (lower retraction pressure and greater retraction area) compared to the gold standard (formaldehyde). Our embalming method preserved specimens for significantly longer use than un-embalmed cadavers, which allows for complex research designs (such as Phase B of this work). We described cutting-edge surgical simulation techniques to objectivize surgical techniques in the laboratory. Our surgical simulation experiments show that the transcortical approach performs better than the transsylvian approach on all parameters for zones I and IV. On Zones II and III, cortical mapping and specific anatomical features may make the transsylvian approach more favorable. Our prospective clinical study showed that the Berger-Sanai insular glioma classification is a reliable tool to predict extent of resection (highest on zone I, IV) and postoperative complications (lowest on zone II and IV) following surgical treatment. CLINICAL AND SCIENTIFIC IMPACT: Overall, this work improved the field of neurosurgical simulation research by providing a detailed description of cadaver preparation (including public disclosure of the embalming chemical formula) and methodology to carry objective measurements to compare surgical techniques. For the first time, we provided objective data to aid the neurosurgeon in choosing the best surgical approach to maximize resection rates of insular gliomas tailored to the Berger-Sanai insular glioma classification. Finally, we validated the Berger-Sanai insular glioma classification as a tool to anticipate resection rates and postoperative neurological complications. As a whole, this work will substantially impact management of insular gliomas and patient informed decisions.
En la present tesis doctoral es presenten els resultats de sis anys d’investigació del doctorand sobre els gliomes que afecten el lòbul de l'Insula. La present tesis doctoral es divideix en tres parts en les que es desenvolupa un programa seqüencial dirigit a la investigació i optimització del tractament quirúrgic de les lesions de la Insula (amb especial atenció als gliomes cerebrals d’alt grau). En primer lloc es desenvolupa un treball de laboratori per al disseny d’una metodologia òptima per a la simulació quirúrgica d’abordatges Neuroquirúrgics intracerebrals en un model cadavèric. Es descriuen els mètodes i estratègies per al disseny de la composició química del líquid de embalsamament que el cervell humà així com la metodologia per avaluar objectivament l’esmentada fórmula química i el mètode de embalsamament. Es descriu la superioritat del mètode desenvolupat respecte de l’estàndard de preparació de cadàvers però simulació quirúrgica i es discuteixen els avantatges principals del mètode dissenyat respecte la investigació referent a la tècnica neuroquirúrgica. Aquests són, en breu, la millora substancial d’elastança cerebral que permet la retracció del teixit cerebral de forma similar a la cirurgía en ésser humà viu, la disminució de l’exposició del personal de recerca a components carcinogènics com el formaldehid, la superioritat en la preservació del material cadavèric respecte el teixit no embalsamat, etc. L’esmentada metodologia és la base per la segona fase de la present tesi doctoral. En segon lloc es desenvolupa un projecte d’investigació sobre la tècnica quirúrgica per la ressecció de lesions del lòbul de l'Insula, amb especial atenció als gliomes insulars. Prenent el mètode de simulació neuroquirúrgica desenvolupat a la primera fase d’aquesta tesi, es comparen les dues tècniques principals per l’accés a la Insula: l’abordatge Transilvià i l’abordatge Transcortical. Es descriuen els perfils quirúrgics d’ambdues tècniques quirúrgiques respecte a l’accés a cada una de les parts de la Insula (anterior superior, posterior superior, posterior inferior, i anterior inferior). Es descriu, per primera vegada, la tècnica quirúrgica més favorable per cada part de la Insula i s’introdueixen conceptes claus per la decisió preoperatòria. En termes generals l’abordatge transilvià demostra superioritat en tumors que afecten la part anterior de la Insula, mentre que l’abordatge transcortical és superior en tumors de la part posterior. En tercer lloc s’estudien els resultats clínics de les tècniques quirúrgiques estudiades en un model de simulació descrit a la fase anterior, per mitjà de la revisió retrospectiva de casos clínics en els quals es varen realitzar cirurgies de glioma insular. L’esmentada investigació retrospectiva es va desenvolupar a University of California San Francisco, Califòrnia, USA (Centre de notable prestigi vers la cirurgia de gliomes insulars), així com a Barrow Neurological Institute, Arizona, USA (centre de prestigi mundial en microneurocirurgia). En aquesta última fase es resumeixen els resultats de laboratori així com l’experiència clínica desenvolupats en aquest treball de tesis doctoral per proveir les bases sòlides per la decisió clínica i tècnica vers el tractament de pacients que pateixen de glioma insular. Específicament, s’estableix que el grau de resecció quirúrgica determina la supervivència del pacient amb glioma insular. Així doncs és important identificar l’abordatge quirúrgic (transsilvià o transcortical) que permet arribar als nivells de resecció quirúrgica superior al 80% del volum del tumor, per optimitzar el resultats clínics tot mantenint la funció cerebral.

Data on the three?dimensional (3?D) morphology of normal faces and facial deformities as well as objective techniques for evaluating postoperative changes are currently unavailable. With the advent of stereophotography and cone?beam CT (CBCT), it is possible to acquire 3?D images of soft and hard tissues of the maxillofacial complex. A series of studies were conducted aimed at 1) establishing 3?D facial anthropometric norms for Hong Kong young adults, 2) determining 3?D facial anthropometric features in skeletal Class II and III deformities, 3) characterizing the oropharyngeal space in Class II and III skeletal deformities, 4) exploring clinical applications of 3?D colour maps, 5) establishing a non?invasive technique for estimating serial volume changes and 6) creating virtual craniofacial models by fusing 3?D photographs and CBCT images. Study 1: A stereophotographic system was used to capture 3?D images of 103 Hong Kong Chinese young adults with normal balanced faces. An anthropometric analysis protocol with linear, angular and proportional measurements was developed to establish a normative database and quantify dysmorphology. The Hong Kong Chinese norms were distinct from Caucasians, especially with regard to ocular and nasal measurements. Facial height and nasolabial measurements differed significantly between Hong Kong males and females. Study 2: Anthropometric analyses of 3?D facial images from 41 skeletal Class II and 43 Class III subjects were performed. The Class II subjects had increased lower facial height compared with Class III, who had longer total facial heights and narrower faces. While Class II deformity primarily resulted from mandibular deficiency with a normal maxilla, Class III presented as combined midfacial hypoplasia and mandibular hyperplasia. Study 3: Anthropometric characteristics of the oropharygeal space in skeletal Class II and III were evaluated using 62 CBCT scans. The retroglossal (RG) and retropalatal (RP) volumes and average cross sectional areas were significantly larger in Class III than Class II skeletal deformity. The RP compartment was larger but less uniform than the RG compartment in both Classes. Study 4: 3?D photographs or CBCT images acquired at two different time points were superimposed using a common unaffected area. 3?D colour maps were generated depicting distance differences between superimposed images in a graphical format. These maps were used as an objective tool for treatment planning and assessing outcomes after orthognathic surgery, bimaxillary distraction and facial trauma. Study 5: 3?D photogrammetry was employed for planning soft tissue expansion (STE) and transplantation of a vascularised scapular flap in hemifacial microsomia. This technique facilitated the identification of extent and degree of tissue deficiency, selection of the appropriate tissue expander, monitoring volumetric changes during STE and estimation of the free flap dimensions. Study 6: 3?D facial photographs and CBCT scans of 29 subjects were merged to create virtual craniofacial models with natural surface texture. Accuracy was assessed with 3?D colour maps and Root Mean Square (RMS) error. The CBCT and 3?D photographic data were integrated while minimizing average RMS error to 0.441mm. These virtual composite craniofacial models permitted concurrent 3?D assessment of bone and soft tissue.
published_or_final_version
Dentistry
Doctoral
Doctor of Philosophy

The present study examined the emotional responses of 112 dyads of same-sex friends in early and middle childhood as they competed against each other on 3 identical games, enabling each child in the pair to experience 3 outcome conditions: winning, losing, and tying. Emotional reactions were videotaped and rated for degree of enjoyment and discomfort. In addition, following the 3 games, children were individually interviewed and asked to report their levels of happiness regarding winning, losing, and tying. The social context of a dyad is more closely associated with female social interaction which tends to be egalitarian. It was hypothesized that boys' well-documented greater comfort with competition relative to girls would be attenuated in the context of a dyad. Results indicated that boys showed more comfort and enjoyment throughout the competitive process than did girls. However, both boys and girls showed equal levels of comfort and enjoyment for the win and tie outcomes, indicating boys, like girls, were also concerned with doing the same as their friend. A developmental difference was also seen as the children in middle childhood reported less happiness than the kindergarten children when they experienced the win outcome. The results are discussed in terms of the necessity of considering the social context in which competition occurs when investigating gender differences in competition.

To identify those with kidney disease early and thus facilitate earlier instigation of disease-progression slowing treatments, new definitions of chronic kidney disease (CKD) were introduced in 2002 (KDOQI). After this, the worldwide introduction of estimated glomerular filtration rate (eGFR) reporting (2006 onwards), also facilitated more widespread identification of those with CKD. Prognosis in those with CKD identified in this way was not known and the numbers with CKD appeared higher than originally expected. This thesis aimed to improve understanding of outcomes in those who met the definition of chronic kidney disease and facilitate better directed care. Data-linkage of several healthcare datasets including to laboratory, morbidity and mortality healthcare data for individuals in the Grampian region with measures of renal function in 2003 allowed those aims to be addressed. Patterns in the testing of kidney function over time were also described. Mortality and RRT initiation during the GLOMMS-I cohort's 6.5 years of follow-up were described, as were variables that were associated with these outcomes. Other measures of decline of kidney function over time (progression), were explored and compared to the ultimate measure of progression - the initiation of RRT. Various models to predict outcomes (RRT initiation, mortality and survival) were explored. Measures of model performance including discrimination, calibration, goodness of model fit and predictive performance were described. Overall the aim of this thesis was met - to improve the understanding of the prognosis of those currently labelled with chronic kidney disease. The work in this thesis has also provided the necessary information to plan and start a much wider population based study of outcome in those both with and without CKD (GLOMMS-II).

This program evaluation study focused on the outcomes of a Math program for elementary level students. This mixed-methods study explored the relationship between the implementation of the Investigations Math program and teachers' perceptions of its impacts. The program theory that guided this study stated that teachers who were provided time and resources to examine best practice Math curricula and instructional methods would: adopt and implement a holistic Math program that updated the curriculum; create positive changes in teacher content and pedagogical knowledge; meet the needs of all students, at all proficiency levels; result in a consistent scope and sequence; and lead to improved student achievement. The findings did not fully support the program theory but did inform the school of study of the positive outcomes that the adoption of the Investigations program enhanced teachers' perceptions of: alignment of the curriculum with Common Core Standards for Mathematical Practice; their capabilities as leaders of the inquiry process within the classroom setting; facilitating a Math program with consistency in concepts, student experiences, and assessment; improved students' consistency of good thinking; and increased number sense, perseverance in solving problems, and use of appropriate tools to construct viable arguments. However, analysis of the ERB-CTP4 math achievement test scores revealed negligible changes in the overall mean student performance as a result of the implementation of the Investigations program. Weaknesses in the assessment materials of Investigations also required a supplemental curriculum to be adopted in parts.

The aim of this thesis was to establish the long-term outcomes of the Oxford medial Unicompartmental Knee Arthroplasty (OUKA), define patient selection criteria and to develop and externally validate an evidence based method of patient selection for this procedure. In the hands of the developer surgeons, outcomes following medial OUKA were found to be good with an implant survival of 94% (95%CI 92 to 96) at ten-years and 91% (95%CI 83 to 98) at fifteen-years. Across the published literature, however, variation in outcomes was observed with a meta-analysis of published series of OUKA finding estimates of ten-year survival ranging from 57% to 100%, mean 88% (95%CI 85 to 90). It was identified that both increased surgical caseload (volume) and increased surgical usage (proportion of primary knee arthroplasty that are OUKA), a surrogate marker of indications, were associated with improved outcomes. Surgical usage, however, was more important, with good results following OUKA seen with high surgical usage, representing broad indications, independent of the surgical volume. This finding, coupled with differences in patient demographics and failure mechanisms between usage groups, highlighted that differences in indications for OUKA may explain the variability in outcomes observed. One reason surgeons may have a low usage is if they apply previously recommended patient factor contraindications based on age (<60 years), weight (&GE;82kg) and activity level (high activity). When disease factors are standardised, however, it was found that patients with these previously reported contraindications often actually did better than those without, and outcomes of knees implanted where all these factors were present were as good as where none were present. Therefore, the decision to proceed with OUKA should be based on the pathoanatomy of disease. Optimal candidates for OUKA should have full-thickness cartilage loss, with bone on bone arthritis, in the medial compartment, as knees with partial thickness cartilage loss were found to have worse functional outcomes and almost three-times the reoperation rate, predominantly for unexplained pain. Provided there was full-thickness preserved cartilage laterally and functionally normal ligaments, the presence of lateral osteophytes and the macroscopic status of the anterior cruciate ligament was not found to influence outcomes, nor did the presence of patellofemoral joint disease (with the exception of lateral facet disease with bone loss and grooving) or anterior knee pain. The pathoanatomy of disease can be identified radiologically, however, standing knee radiograph were found to perform poorly. To identify medial compartment full-thickness cartilage loss either a varus stress radiograph or fixed flexion radiograph, both at 20° flexion and aligned to the joint surface, were identified as the optimum views. To confirm preserved lateral compartment full-thickness cartilage a valgus stress radiograph at 20° flexion, aligned to the joint surface, was identified as the most appropriate technique. As stress radiographs are time and resource consuming, a novel stress device was developed in line with the IDEAL-D framework and validated against the gold standard of manual, clinician performed stress radiographs, as well as independently tested in clinical practice. Finally, to simplify patient selection, an atlas based Decision Aid, combined with a structured radiographic assessment, was developed and externally validated with an accuracy of over 90% at identifying suitability for OUKA. The routine use of this approach would be expected to standardise patient selection and ultimately translate into improved long-term outcomes.

Occupational Exposure Limits (OELs) are used as an important regulatory instrument to protect workers’ health from adverse effects of chemical exposures. The main objective of this thesis is to study risk assessment practices in the setting of OEL in order to produce knowledge that will help improve the consistency and transparency of OELs. For the purpose of paper I a database of OELs for a total of 1341 substances was compiled. Of these, only 25 substances have OELs from all 18 included organisations while more than one third of the substances are only regulated by one organisation alone. The average level of OELs differs substantially between organisations; the US OSHA exposure limits are (on average) nearly 40 % higher than those of Poland. In paper II six EU member states’ OELs are compared to the European Commission’s OELs. Also within Europe there is a large difference concerning the average level of OELs (35%). The average level of lists tends to decrease over time, although there are exceptions to this. There are also indications that the exposure limits of EU member states are converging towards the European Commission’s OELs. The work presented in paper III identifies steps in the risk assessment that could account for the large differences in OELs for 14 different substances. Differences in the identification of the critical effect could explain the different level of the OELs for half of the substances. But the age of the data review could not account for all the differences in data selection, only one fifth of the documents referred to all available key studies. Also the evaluation of the key studies varied significantly. The aim of paper IV was to investigate how the Scientific Committee on Occupational Exposure Limits (SCOEL) of the European Commission uses assessment factors when proposing health-based indicative OELs. For only one third of the investigated OELs were explicit assessment factors given. On average the safety margin of the recommendations was 2.1 higher when an explicit assessment factor had been used. It is recommended that the SCOEL develop and adhere to a more articulate framework on the use of assessment factors. Paper V focuses on the Derived No-Effect Levels (DNELs) which are to be calculated under the new European Union REACH legislation. It is a comparison of the safety margins of 88 SCOEL recommendations with those of the corresponding worker-DNELs, derived according to the default approach as described in the REACH guidance document. Overall, the REACH safety margins were approximately six times higher than those derived from the SCOEL documentations but varied widely with REACH/SCOEL safety margin ratios ranging by two orders of magnitude, from 0.3 to 58.
QC 20110215

This study explored whether the Child and Adolescent Functional Assessment Scale (CAFAS) scores of children in the care of Family and Children's Services of Renfrew County might predict foster placement outcomes. A file review was completed for 268 children, all of whom had at least one set of CAFAS scores completed, to obtain data regarding the number and types of placements they experienced. Placement categories were ranked -- in order from best alternate care option to least-desired -- by 11 agency employees. These rankings were used to calculate total weighted placements for each child as a measure of the child's foster placement experience. In regression analyses, including age, gender, and reasons for placement, CAFAS scores were found to be the most significant predictor of the number and nature of placements experienced by a child. This relationship suggests that there might be value in using CAFAS as a placement matching tool in a child welfare setting.

Doctor of Philosophy
Introduction Cachexia is characterised by a marked weight loss and the presence of anorexia, anaemia, and asthenia. Although cachexia is often associated with the presence and growth of tumour and observed in solid tumours of the upper gastrointestinal tract, its presence is not unique to cancer and is often also present in most chronic, end-stage diseases processes. The loss of body fat, altered lipid metabolism, increase in the resting energy expenditure, and the increased loss of body protein the degree of which is associated with poor survival, are all hallmarks of this detrimental disease. The clinical aspects and consequences of cachexia can simply be summarised as morbidity, debilitating conditions, and mortality. The conditions such as loss of muscle mass, impaired muscle function, fatigue, reduced activity and functional capacity by themselves are enough to severely and significantly affect the patients’ QL. Although different interventional procedures and therapies are available for the treatment of cachexia and its symptoms, effective methods to evaluate their benefits and outcomes have not been tested or investigated. It was, therefore, the aim of this project to use body composition analysis as a clinical tool and evaluate the effectiveness and outcome of interventional and therapeutic procedures in three groups of patients with cancer. Methods Three patient groups were investigated: 1) patients with pancreatic cancer undergoing Whipple’s Procedure, 2) patients with pancreatic cancer undergoing cancer chemotherapy and receiving either EPA or placebo, and 3) patients with malignant mesothelioma undergoing cancer chemotherapy plus thalidomide or thalidomide alone. Body composition analysis techniques were used to assess the changes in TBN, TBF, TBK, and TBW. In addition, the body composition parameters together with clinical measures were also used to determine parameters influencing survival. The malignant mesothelioma patients were randomised into patients who received gemcitabine / cisplatin plus thalidomide and those who received thalidomide alone. The pancreatic cancer patients undergoing chemotherapy were randomised into the group who were receiving EPA and those who were receiving placebo. In addition, these patients were also investigated on the basis of their disease extent where they were separated into two groups of metastatic and locally advanced. Unpaired T-Test and ANOVA were used to determine differences between groups. Kaplan-Meier analysis and Cox’s Regression were used to assess survival in all three patient cohorts. The Whipple’s Procedure patients were separated into those who received a Clear Margin and those who received an Unclear Margin during their resection. Results 1) In the pancreatic cancer patients undergoing Whipple’s Procedure, compared to the base-line, there were highly significant changes in Weight (p=0.006), BMI (p=0.005), and FM (p=0.007) followed by significant changes in %BFat (p=0.016), TBK/Ht (p=0.021), LBM (By TBK) (p=0.023), LBM (Van Loan) (p=0.034), and LBM (Segal) (p=0.038) at the 14 week time-point. At the 26 weeks post-operative time point, the only significant changes were in the FM (p=0.012), %BFat (p=0.003), and BMI (p=0.027) parameters. There was also a deviation between the two groups in their TBN, LBM and TBW content observable in a long-term setting and fat content in the relatively shorter-term. Although the Unclear Margin group had lower body composition values, both groups seem to begin to gradually “equalise” around the 14 weeks post-operative time-point. The survival analysis results for the Whipple’s Procedure patients demonstrated that Margin Status (p=0.001), Fat Mass (p=0.003) and Age (p=0.081) were significant and could influence survival. 2) When the second cohort pancreatic cancer patients undergoing chemotherapy were analysed, they were initially separated according to the extent of their disease The results of the analyses of body composition changes between measurement time-points for the each group separately, suggested that the patients with locally advanced disease maintain their Weight, FM, and TBN but are more likely to have a lower TBW by the end of the four month of chemotherapy. However, the patients with metastatic pancreatic cancer maintain their TBW but are more likely to have a decreased fat compartment and a higher FFM. The QL analysis showed that the metastatic group are performing “worse” than the locally advanced group especially in term of their Dyspnoea, Nausea & Vomiting, and Sexuality. In addition, the Karnofsky score showed that the metastatic group are not performing as well as the locally advanced group. Furthermore, for the metastatic group there was an increase in the patients’ pain with a decline in mood and general performance as well as increase in gastrointestinal symptoms. Pain Card scores also showed a general increase for the metastatic group and a general decrease for the locally advanced group. When the pancreatic cancer patients undergoing chemotherapy were separated according to whether they received EPA or placebo, the results demonstrated that firstly, due to the fact that the patients were well randomised, the two groups commenced the trial with similar and statistically non-significantly different body composition parameters. Secondly, the two groups were also found to be statistically not different at their corresponding measurement time-points. And thirdly, the patients receiving placebo compared to those receiving EPA lost more Weight, and FM but less TBW throughout the trial. The TBK/Ht (p=0.044), TBK (p=0.042), and LBM (By TBK) (p=0.042), however, showed statistically significant differences where in all three parameters the EPA showed an increase compared to the base-line (pre-chemotherapy). Results of the survival analysis demonstrated that the use of EPA in this group of pancreatic cancer patients did not provide any benefit. In fact, as it was shown in the Kaplan-Meier plot, the group of patients receiving the EPA had a “worse” survival than the group receiving the placebo. The QL results showed that placebo group improved in their functional scales, but increased their Altered Bowel Habit scores with an increase in the perception of pain and decrease in relief from pain. The EPA group, however, showed a decrease in the Loss of Appetite, Dyspnoea, Pain, Pancreatic Pain, and Fatigue, and improvements in Role Functioning and Sexuality. 3) Results of the malignant mesothelioma patients demonstrated that both study arms show similar weight changes. In addition, body composition measurements indicated that the gemcitabine / cisplatin chemotherapy plus thalidomide group had a greater TBN loss and a greater TBW gain than the thalidomide-alone group. This loss of TBN and gain in TBW looked to be “concealed” in the weight. The results of the survival analysis carried out on the mesothelioma patient group suggested that haemoglobin levels (p=0.001), Age (p=0.007), and NI (p=0.008) are the parameters that can influence the survival of patients with malignant mesothelioma undergoing chemotherapy. Conclusions 1) The trend in body composition changes in the Whipple’s Procedure group showed that, although both groups may start with non-significantly different body composition, they tended to grow closer around the 14 week point indicating that the Clear Margin group may lose more than Unclear Margin group. The implications of these findings, therefore, were that once the most appropriate surgical procedure is performed, an adjuvant therapy regimen (such as chemotherapy) at around 14 weeks may have the most impact on the patient’s overall treatment outcome. 2) When the pancreatic cancer patients were separated by the extent of their disease, the results lead to the conclusion that the patients with locally advanced disease maintain their Weight, FM, and TBN but are more likely to have a lower TBW by the end of the four month of chemotherapy. However, the patients with metastatic pancreatic cancer maintain their TBW but are more likely to have a decreased fat compartment and a higher FFM. The QL analysis concluded that the results may point to a worsening and/or progressing disease which is consistent with classic metastatic disease aetiology. From the results of the pancreatic cancer patients undergoing cancer chemotherapy it was concluded that the use of EPA in this group of pancreatic cancer patients undergoing cancer chemotherapy with gemcitabine results in a non-significant reduction in weight loss, FM loss, and TBW gain with a statistically significant increase in FFM. The results of the survival analysis was, however, contradictory suggesting that patients receiving EPA may have a worse survival than the placebo group. The QL analysis here concluded that that EPA does improve the QL of this group of pancreatic cancer patients. 3) From the malignant mesothelioma group it was concluded that provided that the overall anti-cancer potential of gemcitabine / cisplatin plus thalidomide is comparable with that of thalidomide-alone, then by looking purely from the body composition angle one may be able to suggest the use of thalidomide alone in the treatment of malignant mesothelioma in this group of patients. From the results of the survival analysis, the fact that the Study Arm parameter did not reach statistical significance could indicate that survival in these patients is not affected by the presence or absence of chemotherapy with gemcitabine and cisplatin. The body composition techniques were used here as a tool to monitor changes in various body composition parameters to assess the outcomes, including survival, of the administration of different therapies and interventional procedures in these three groups of cancer patients. For these purposes, these techniques were demonstrated to be an effective and invaluable tool.

Background There are more than 300,000 persons in the U.S. living with transfemoral amputation (TFA). Persons with TFA use a knee prosthesis for gait and mobility. Presently, the C-Leg microprocessor knee prosthesis is the standard of care. C-Leg has significantly improved safety and cost efficacy and has created modest gains in gait efficiency. Recently, a new prosthesis has introduced a new sensor array and processor that reportedly improves knee motion, stair function and standing stability. Early claims of the reported functional benefits of the new Genium knee (formerly X2) have not been validated in a rigorous clinical trial. Therefore, the purpose of this project was to determine if the Genium knee improves safety, function and quality of life compared to the current standard of care (C-Leg). Methods The study is a randomized AB crossover with a control group. Subjects must have used (and still be using) a C-Leg for a minimum of 1yr prior to enrollment. Inclusion criteria beyond this are unilateral transfemoral or knee disarticulation amputation for any etiology, community level ambulation (Medicare level 3 or above), independent ambulation and ability to independently provide written, informed consent. Once enrolled subjects utilize their same socket but receive a study foot (Trias or Axtion). Subjects are randomly assigned to either stay with their C-Leg or be fit with a Genium knee. Subjects accommodate and test (A phase) then crossover to the other knee condition and repeat the testing (B phase). A follow up phase of the study beyond the B phase is ongoing to study longer term preference. For AB assessment, three domains were assessed: Safety, function and quality of life. For safety, the PEQ-A survey of stumbles and falls, posturography (Biodex SD limits of stability and postural stability tests), 4 square step test and 2 minute ramp stand test were completed. For function, a series of timed walking tests, the amputee mobility predictor, kinematic gait assessment and physical functional performance-10 tests were conducted. For quality of life, the socioemotional and situational satisfaction domains of the population specific and validated PEQ (prosthesis evaluation questionnaire) were completed. Results Safety: Posturographic assessment revealed impairment between transfemoral amputees and non-amputees. Stumbles and semi-controlled falls decreased with Genium but were not significantly different. Four square step testing was significantly (p 0.05) improved from 12.2s(3.3) to 11.1s(3.4) for the C-Leg and Genium respectively. Function: Kinematic asymmetry was minimally different between knee conditions. The AMP mean(SD) scores while subjects used C-Leg was 40.8(3.6; 33-45) and 43.3(2.6) [p<0.001]. PFP scores (cumulative), upper body function and endurance scores were improved with Genium compared with C-Leg at 9.1%(p=0.03), 8.7%(0.01) and 10.3%(0.04) respectively. Quality of Life: For quality of life, situational satisfaction favored Genium (p<0.001) which included subject's satisfaction with gait, training and quality of life in general. Conclusion C-Leg and Genium promote static weight bearing beyond asymmetric values reported in the literature. In terms of limits of stability, TFA's are clearly impaired, primarily over the amputated side posteriorly however the Genium seems to enable posterior compensations that coincide with multi-directional stepping improvements. Anteriorly, the C-Leg's toe triggering requirements seem to improve limits of stability but come at the cost of discomfort on ramp ascent. With regard to safety, it seems that both knee systems represent good options for the community ambulating TFA. The largest improvements with Genium were in the activities of daily living assessment; predominantly balance and upper body function. It seems that the combination of multi-direction stepping with starts and stops and stair ascent are key areas of improvement. In conclusion, the sensor array in the Genium knee prosthesis promotes improved function in activities of daily living. Specifically improved in this context were balance, endurance, multi-directional stepping, stair ascent and upper limb function in highly active transfemoral amputees.

Licensing and reimbursement decisions on health technologies should be ideally based on randomised controlled trials (RCTs) that report final patient relevant outcomes, such as overall survival or health-related quality of life. However, biomarkers and intermediate endpoints are often used in clinical trials as surrogate outcomes, i.e., as substitutes for final patient-relevant outcomes. Surrogate outcomes may occur faster or may be easier to assess than final outcomes. Nevertheless, relying on surrogate outcomes evidence alone has been shown to lead to inadequate conclusions about the value of new treatments. This PhD thesis by publication explores key issues related to the use of surrogate outcomes in health technology assessment, particularly in the field of oncology. The specific aims of the four component papers are: I. To quantify and compare the treatment effect of RCTs reporting surrogate outcomes versus RCTs using final patient-relevant primary outcomes across a range of diseases; 11. To review the statistical methods used in meta-analyses for validating surrogate endpoints in a specific disease area (i.e., advanced solid tumours) and assess the available level of evidence against current standardised frameworks for surrogate evaluation; Ill. To assess the within-trial surrogate-to-finaI outcome relationship in advanced colorectal cancer, according to different methods and depending on several trial characteristics; IV. To illustrate the use of surrogate end points in a real HTA process (i.e., the technology appraisa l of imatinib, nilotinib and dasatinib as first-line treatment in chronic myeloid leukemia at the National Institute for Health and Care Excellence). In publication I, clinical trials reporting surrogate primary outcomes were found to be more likely to report larger treatment effects (by up to 47%) than clinical trials reporting final patient-relevant outcomes. The review of statistical methods in publication 11 shows that the level of evidence for the use of surrogate outcomes in advanced solid tumours to date is generally poor according to common evaluation tools. In publication IV, I confirm the findings from publication I: the treatment effect observed on the surrogate endpoint appears always to be larger than that observed on the final endpoint, by 3% to 45%. In 4 publication IV, using the case study of chronic myeloid leukemia, the validation of two surrogate outcomes was performed and their link with long-term effectiveness and cost-effectiveness was built for three treatments under comparison. A final overall discussion section brings together the findings of these four publications and identifies practical recommendations and future research implications.

The poor learner outcomes in the TIMSS assessment, the SACMEQ assessment, and the Grade 9 ANAs led to this study being conducted. The purpose of the study was to explore whether Grade 9 mathematics teachers’ teaching can improve learner outcomes. This study therefore investigated the literature regarding mathematics teachers’ classroom practices with an emphasis on teachers’ Pedagogical Content Knowledge (PCK), Pedagogical Content Knowledge and Skills (PCK&S), and how these teachers used assessment outcomes to inform their teaching of mathematics. In developing learners’ conceptual understanding and higher-order thinking skills, mathematics teachers not only need subject matter knowledge, but also PCK and the skill to implement their planning efficiently during instruction. The conceptual framework for this study is based on Gess-Newsome’s (in Berry et al., 2015) Model of Teachers’ Professional Knowledge and Skills. Based on this, PCK was examined in the planning and executing of topic-specific instruction and as a skill when teaching this content to the learners for enhanced learner outcomes. The research approach was qualitative and the research design was a case study. Two Grade 9 mathematics teachers from one school were selected through purposive sampling. The data were collected using a baseline test, three classroom observations, one semi-structured interview and a formative test. Both teachers used Direct Instruction in all their lessons, but proficiently used various representations when explaining the work, and integrated the topic into other mathematical topics and real-life scenarios. The teachers admitted that they did not usually make use of baseline tests to inform their teaching due to time constraints, but found it valuable during this endeavour. The findings from the two tests showed many learners still have the same misconceptions regarding the concepts of surface area, volume and capacity; continued to make the same typical mistakes in finding formulae for surface area and volume; and still found it difficult to convert between the SI units. There was, however, significant improvement in learner outcomes, but the positive outcomes regarding all typical mistakes and learner difficulties were still below 46%.
Dissertation (MEd)--University of Pretoria, 2017.
Science, Mathematics and Technology Education
MEd
Unrestricted

Reverse total shoulder arthroplasty (RTSA) alleviates pain and restores function to patients with cuff tear arthropathies or massive rotator cuff tears. The procedure uses a semi-constrained prosthesis to reverse the orientation of the glenohumeral joint, thereby altering the biomechanics of the deltoid and allowing it to restore shoulder function in the presence of an irreparably damaged rotator cuff. However, there are complications that can impact long-term success of RTSA. Adaptations to the design and placement of the prosthesis have been investigated to address these complications and this has led medical device manufacturers to develop divergent implants. This divergence, as well as previous literature regarding RTSA biomechanics, suggest that a configuration that optimises reverse shoulder functional outcomes has yet to be determined and that it can be obtained by combining multiple modifications. A biomechanical assessment framework was established to characterise reverse shoulder function and the effect of modifying prosthesis configuration. It utilised the Newcastle Shoulder Model (NSM) and a custom-made impingement detection algorithm to simulate seven standardised motions that either elevated or rotated the humerus. Four outcome measures (deltoid elongation, deltoid moment arm, joint stability and impingement-free range of motion) were evaluated for each motion. The framework took anatomical variability into consideration by performing the simulations using a subject-specific reverse shoulder cohort. Further, 36 modified configurations of the prosthesis (based on offsets to the placement of glenosphere, humeral tray and greater tuberosity) were evaluated. The effect of each of these modifiable parameters on the outcome measures was characterised as beneficial, detrimental, or negligible, in comparison to a default prosthesis configuration. Seven of the most beneficial parameters were then selected for combination and evaluated using the assessment framework. Due to an antagonistic relationship between the outcome measures, and differing functional requirements of the motions, none of the configurations were able to simultaneously maximise all outcome measures. Rather, the optimised configuration (which inferiorly translated the glenosphere and posteromedially translated the humeral tray) provided balanced, moderate improvements to majority of the outcome measures. Overall, the deltoid did not excessively elongate, and deltoid moment arms, joint stability, and impingement-free range of motion improved by 17.9%, 57.1%, and 32.1%, respectively compared to the default configuration. Subsequently, comparisons between the effect of the default and optimised configurations on muscle fatigue and micromotion at the bone-implant interface were made. Muscle fatigue was assessed by adapting the NSM, and micromotion was assessed through a finite element analysis of a subset of the reverse shoulder cohort. The optimised configuration had a beneficial impact on the time to initiate muscle fatigue by decreasing the force required by the middle deltoid to initially elevate the humerus, and it had no appreciable effect on micromotion. In summary, an optimised RTSA configuration has been presented in this thesis. For a rotator cuff deficient reverse shoulder, the proposed configuration provided balanced, moderate improvements to majority of the functional outcomes. Additionally, the configuration was able to mitigate the effect of muscle fatigue and did not affect micromotion. Future studies should look to experimentally validate these findings, determine their clinical significance, and enhance both the assessment techniques and framework.

Class of 2005 Abstract
Objective: The purpose of this study was to explore whether current meta-analyses on exercise interventions assess adherence and/or compliance of the studies included in the meta-analyses and to determine if subject adherence had any effect on outcomes of the analyses. Methods: Data was collected through a search of the MEDLINE database using the key words exercise, adherence, compliance, clinical trials, and meta-analysis. Data on study title, author, number of studies screened, number in meta-analysis, range of sample sizes, total number of subjects, primary intervention, primary outcome, how study quality was assessed, how adherence was assessed, whether adherence was used as a control variable, and did adherence affect the outcome was recorded on a paper and pencil data extraction form. Data was analyzed by constructing a table describing the meta-analyses and calculating the number and percent of analyses that included adherence. The table allowed for the evaluation of the strength and methodology of each piece of literature with respect to acknowledging adherence as a significant variable in the strength and legitimacy of each analysis. Results: Nineteen meta-analyses met our search criteria and were evaluated. Five of the nineteen meta-analyses (26 percent) described a method for assessing adherence. It was found that none of these used adherence as a control variable. Four of the nineteen meta-analyses did not assess the quality of the studies contained within the analysis. One of these meta-analyses suggested that adherence may have confounded outcomes, but did not provide any data to address their concerns. Conclusions: In meta-analyses, adherence is unlikely to be addressed. Current meta-analyses frequently lack methods for assessing adherence, and do not use adherence as a control variable. Whether adherence to exercise regimens affects outcomes cannot be determined from current meta-analyses.

One of the most common running related injuries and leading cause of lateral knee pain in recreational runners is iliotibial band syndrome (ITBS). The popularity of recreational running and rate of running related injuries are increasing. This study’s goals were to evaluate the effects of three different exercises programs in reducing ITBS symptoms and determine if the experimental exercise group program provides a new progressive rehab intervention for ITBS management. This study consisted of volunteer female distance runners age 19-45 with ITBS—with a 10-mile per week average running distance during a three-month period. After recording age, gender, injured leg, pain, body weight, and height the participants were split into three treatment groups: i) an experimental exercise group, ii) a conventional exercise group, and iii) a stretching group. Outcomes measured were the Y Balance test (YBT), single leg mini squats (SLMS), dynamometer readings (DN), lower extremity functional scale (LEFS), and numeric pain rating scale (NPRS). The YBT, SLMS and LEFS were taken at weeks 0 and 8, hip strength DN measurements were taken biweekly and the NPRS was taken weekly for 8-weeks. Hypothetically the experimental exercise group should exhibit similar or greater improvements in ITBS symptoms compared to current researched programs for hip strength and stretching. A two-way factorial, repeated measures, analysis of variance (ANOVA) model examined the effects each exercise program had on the outcome measures for between and within group’s differences. Statistical significance within the experimental group was determined for the composite YBT and DN measurements for injured and non-injured leg, injured leg for the posterior medial reach for the YBT, LEFS questionnaire, NPRS during running activity and the SLMS. Statistical significance was determined between the stretching and experimental exercise groups. The stretching group exhibited statistically significant YBT anterior reach for the injured/non-injured leg and the LEFS questionnaire. Although there were no statistical differences found for the experimental exercises group, it consistently showed improvements in outcome measures and never scored less than the other two groups.
Kinesiology, School of
Graduate

Class of 2013 Abstract
Specific Aims: The purpose of this study was to assess the clinical and economic predictors associated with rural emergency department visits in stroke patients. Methods: The current research was a retrospective, observational, cohort study. Multivariate regression was used to assess data from the Agency for Healthcare Research and Quality (AHRQ) 2009 Nationwide Emergency Department Sample (NEDS). Inclusion criteria were at least 18 years of age and rural ED admission with principle diagnoses of stroke. Main Results: Significant results for risks included: Intubation for increased mortality (OR = 17.432, p = 0.001), increased length of stay (IRR = 1.643, p = 0.018) and increased charges (exp β = 2.289, p = < 0.001); myocardial infarction for increased mortality (OR = 1.969, p = 0.006), decreased charges (exp β = 0.862, p = 0.013) and decreased length of stay (IRR = 0.853, p = 0.001); moderate to severe liver disease for increased mortality (OR = 62.691, p = 0.001) and reduced length of stay (IRR = 0.517, p = 0.025); congestive heart failure for increased mortality (OR 1.978, p = 0.003) and increased charges (exp β = 1.118, p = 0.039); non-specific cancer (OR = 2.447, p = 0.017) and metastatic cancer (OR = 4.799, p = 0.016) for mortality; hemiplegia/paraplegia for increased charges (exp β = 1.173, p = < 0.001). Conclusion: The current study found a better understanding of national estimates of burden of illness to further define clinical decision rules for stroke in rural emergency departments.

Outcomes of Standards-based Portfolios for Elementary Teacher Candidates by Christie McIntyre Documentation of outcomes associated with teacher education portfolios and the quality of the reflections contained within the portfolios is sparse. This collective case study (Stake, 1995) of six teacher candidates enrolled in an elementary teacher education program at a large mid-western university explores the outcomes of developing a portfolio based on state standards. The first question of this study focuses on the outcomes of the portfolio process for the teacher candidate; the second question is an investigation of the critical events that facilitate the outcomes associated with the teacher portfolio. Zeichner and Wray’s (2001) critical dimensions of a portfolio process are used as a framework for understanding current research and the data from these portfolios. The third question addresses the nature and quality of reflections that accompany portfolios using Sparks-Langer, Simmons, Pasch, Colton, and Starko’s (1990) Framework for Pedagogical Thinking. In this qualitative study, Glasser and Strauss’(1967) constant comparative method is used to analyze data within and among the six cases. Data sources include electronic-portfolios, observations of portfolio seminars, and interviews with teacher candidates, cooperating teachers, and center coordinators. Credibility and dependability is based on prolonged engagement, triangulation, a comprehensive member check, and an auditor check. A “reflexive journal” (Lincoln & Guba, 1985, p. 327) is used to increase the overall trustworthiness. Historical theories of reflection by Dewey (1933) and Schön (1987) are considered during the final analysis. The study identifies four outcomes of this portfolio process for the teacher candidate: it increased their understanding of standards; supported the organization and articulation of their thoughts; encouraged them to reflect; and provided a snapshot of their professional growth. Three additional critical dimensions support the portfolio outcomes: the rationale guidelines, the assessment process, and the entire portfolio process.

We administered the Motivation Assessment Scale (MAS) and the Questions About Behavioral Function (QABF) to five raters and compared the results with functional analysis outcomes for 12 cases in which agreement was obtained for at least four out of five raters on either anecdotal assessment. The scores for functional categories on the MAS and QABF were ranked by averaging the scores for the raters who agreed on the primary maintaining variable. Functional analysis results were ranked by examining average responding across all conditions. A comparison showed correspondence between the highest category and the highest functional analysis condition for 10 out of 11 cases for the MAS and all 10 cases for the QABF. Correspondence for the category and condition ranked second was found for 2 out of 11 cases for the MAS and 2 out of 10 cases for the QABF. The magnitude of difference between categories on the MAS/QABF did not appear to predict the amount of difference in responding in the corresponding functional analyses.

The implementation of outcomes-based education (OBE) in South African schools brought radical changes to the teaching profession. The transition to an OBE curriculum exerted a great impact on teachers' assessment practices and required a major revision of teaching and learning activities. Outcomes-based assessment (OBA) does not only require of teachers to design appropriate assessment plans, assessment programmes and assessment strategies, but it also implies that learners should be provided with expanded and 89Propriate opportunities to achieve in accordance with their abilities. Thus, it is of the utmost importance that the training of teachers should not only focus on the demands that OBA make on the learner, but specifically on what OBA expects from the teacher. The main aim of assessment is to promote teaching and learning, which implies that teachers must assess in such a way that quality information about learner performance will be produced. The teacher must record and interpret this information carefully, in order to enable professional and accountable decisions about learner performance and to give constructive feedback to learners and their parents. Easier said than done! The implementation of OBE and specifically OBA elicited serious debates and fierce criticism from a variety of sources. Since the implementation of OBE, quite a number of newspaper reports reflected the negativity of teachers, educationists and other role players towards OBE and particularly OBA. OBE and OBA have become problematic and controversial issues in South Africa. In light of the above mentioned the purpose of this study was to determine the nature, scope and causes of the problems experienced with OBA in South African schools and come forward with practical, supportive recommendations that could alleviate and/or improve the situation. In order to determine the difficulties experienced with OBA empirical, quantitative and qualitative research methods were utilised. A structured questionnaire, with closed and open items, was sent to a representative sample of South African public schools. The resultant data was qualitatively and quantitatively analysed and the following main findings emerged from the research: 1. The training that teachers receive from the education department is inadequate for the successful implementation of OBA in South African schools. 2. Teachers' knowledge of OBE, and more specifically OBA, is too superficial to implement OBA successfully. 3. The assessment practices of teachers reflect that they have not yet made the transition from traditional and conventional types of assessment to authentic OBA. Assessment is primarily used for summative purposes and not for formative purposes, as is supposed to be the case. 4. The education department do not adequately support and empower teachers for the successful implementation of OBA. In light of the research findings, recommendations were made to promote the implementation of OBA in schools.
Die implementering van uitkomsgebaseerde onderwys (UGO) in Suid-Afrikaanse skole het radikale veranderinge vir die onderwysprofessie teweeggebring. Die oorgang na 'n UGOkurrikulum het 'n diepgaande impak op onderwysers se assesseringspraktyke gehad en het grootskaalse wysigings van onderrig-en leeraktiwiteite ingehou. Uitkomsgebaseerde assessering (UGA) verlang nie net van onderwysers om toepaslike assesseringsplanne, assesseringsprogramme en assesseringstrategiee te ontwerp nie, maar ook om aan leerders uitgebreide en toepaslike geleenthede te bied om volgens hulle vermoe te presteer. Dit is dus uiters belangrik dat daar in die opleiding van onderwysers nie net gelet sal word op wat UGA van die leerder vereis nie, maar spesifiek op wat UGA van die onderwyser verwag. Die hoofdoel van assessering is om onderrig en leer te bevorder en onderwysers moet dus op so 'n wyse assesseer dat dit kwaliteitinligting oor leerderprestasie lewer. Die onderwyser moet hierdie inligting noukeurig rekordeer en interpreteer, sodat professionele en verantwoordbare besluite oor leerderprestasie geneem kan word en op 'n konstruktiewe wyse aan leerders en hulle ouers oorgedra kan word. Makliker gese as gedaan! Die implementering van UGO, en in besonder UGA, het 'n hewige debat en felle kritiek uit verskillende oorde ontlok. Talle koerantberigte het sedert die implementering van UGO die negatiwiteit van onderwysers, opvoedkundiges en ander rolspelers teenoor UGO en in die besonder UGA weerspieel. UGO en UGA het 'n problematiese en kontroversiele aangeleentheid in Suid-Afrika geword. Teen die agtergrond van bogenoemde, was die doel van hierdie ondersoek om die aard, omvang en oorsake van die UGO-assesseringsknelpunte in Suid-Afrikaanse skole te bepaal en om met praktykgerigte, hulpverlenende aanbevelings na vore te kom om die situasie te verlig en/of te verbeter. Ten einde die problematiek van UGA empiries te bepaal is daar van beide kwantitatiewe en kwalitatiewe navorsingsmetodes gebruik gemaak. 'n Gestruktureerde vraelys (met geslote en oop items) is aan 'n verteenwoordigende steekproef van Suid-Afrikaanse staatskole gestuur. Die ingesamelde data is kwalitatief en kwantitatief geanaliseer en die volgende hoofbevindinge het uit die ondersoek voortgespruit: 1. Die opleiding wat onderwysers van die onderwysdepartement ontvang, is ontoereikend vir die suksesvolle implementering van UGA in Suid-Afrikaanse skole. 2. Onderwysers se kennis van UGO, en meer spesifiek UGA, is te oppervlakkig om UGA prakties suksesvol te implementeer. 3. Die assesseringspraktyke van onderwysers weerspieel dat hulle nog nie van die tradisionele en konvensionele tipes van assessering wegbeweeg het, na outentieke UGA toe nie. Assessering word ook oorwegend vir summatiewe doeleindes aangewend en nie vir formatiewe doeleindes, so os dit veronderstel is om te gebeur nie. 4. Onderwysers word ook nie toereikend deur die onderwysdepartement ondersteun en bemagtig om UGA suksesvol te implementeer nie. Aan die hand van die bevindinge is aanbevelings, te, bevordering van UGA-implementering in skole, gemaak.
Thesis (M.Ed.)--North-West University, Potchefstroom Campus, 2010.

Published Article
This article describes a process of student learning outcomes assessment for a health sciences programme in radiography at a university in South Africa. Its purpose is to demonstrate that while the process of student learning outcomes assessment is universal, it can be used both nationally and internationally. As long as underlying premises are met, assessment needs to be considered within the context of a country's unique culture, society and history. Underlying premises include understanding the institution's mission and vision, determining that the programme's mission and vision are congruent with those of the institution, and involving faculty early in the assessment process.

This study explores the assessment practices of adult educators in Mamelodi Adult Learning Centers using a qualitative methodology. The study recognizes that assessment is an important activity within the education and training enterprise since it can be used to improve the quality of teaching as well as improve and support the learning process. The study sets out to investigate how Mamelodi adult educators conceptualize assessment
the skills levels of these educators
the nature of support and training these educators received to enhance their assessment practices
the different assessment methods employed by the adult educators to assess learners
and the educational validity and efficacy of these practices.

Guided by traditional and micro-level theories, the present study seeks to identify the relationship between race/ethnicity and risk factors in the Florida juvenile justice system. Central to this explanation is the understanding that racial biases and stereotypes have been shown to influence the decision-making of probation officers. The objectives are to examine the extent that race and risk factors influence court outcomes, in addition to the extent to which individual level risk factors influence court outcomes. The results provide insight into the relationship between the influence of racial biases and stereotypes of probation officers and juvenile risk assessment scoring.