Com a expansão da Educação a Distância (EaD) no Brasil, nos últimos anos, avaliações são fundamentais para mensurar o seu desempenho. Contudo, a qualidade é muitas vezes questionada e possivelmente uma das causas é a falta de confiabilidade e validade dos instrumentos utilizados. Desta forma, o objetivo deste estudo foi criar uma arquitetura de orientação para a construção de instrumentos de avaliação de Programas de Educação a Distância com evidências de confiabilidade e validade. A investigação é uma pesquisa descritiva e explicativa, que congrega os enfoques qualitativo e quantitativo e é sustentada por um arcabouço teórico e metodológico. Além disso, parte do pressuposto de um sistema integrado, cuja natureza cíclica do método confere dinamicidade e flexibilidade, sobretudo em ações que lastreiam qualidade ao produto final. Para isso, propõe-se um conjunto de elementos que podem ser utilizados como referência para a construção de diferentes instrumentos de avaliação. A partir da arquitetura de orientação desenvolvida criou-se um plano de assessment, o qual foi aplicado em um caso específico. Os resultados demonstram que a arquitetura é viável e tem capacidade de atender diferentes modelos e contextos de EaD, de forma que qualquer tipo de Instituição de Ensino pode utilizá-la para a construção de seus instrumentos avaliativos (assessment) de Educação a Distância. Conclui-se, portanto, que a arquitetura de orientação integra componentes de confiabilidade e validade, o que assegura uma tomada de decisão segura e precisa. / With the expansion of Distance Education (DE) in Brazil in recent years, assessments are crucial to measure its performance. However, its quality has been frequently questioned and one of the reasons may be the lack of reliability and validity in the tools used for it. Therefore, the objective of this study was to create an architecture to guide the construction of assessment tools for Distance Education Programs, with evidences of reliability and validity. The investigation is a descriptive and explanatory research, which brings together the qualitative and quantitative approaches and is underpinned by a theoretical and methodological framework. Moreover, it is based on an integrated system whose methods cyclical nature allows dynamicity and flexibility, mainly in actions that assure quality to the final product. Hence, it proposes a a set of elements that can be used as reference for the construction of different assessment instruments. From the architectural guidance designed to create an assessment plan, which was applied in a particular case. The results show that the architecture is feasible and has the capacity to suit different contexts and models of distance education, so that any type of Education Institution can use it for building their evaluative instruments (assessment) of Distance Education. Therefore, it is concluded that the Architecture Guidance integrates components of reliability and validity, which assure a precise and trustworthy decision taking.

Esse trabalho teve como objetivo principal avaliar a estimação da imagem corporal por meio de dois métodos diferentes, entre mulheres eutróficas e com excesso de peso. A amostra foi composta por 80 mulheres adultas, com idades entre 20 e 50 anos, sendo que 40 delas pertenciam ao grupo Eutrofia e 40, ao grupo Excesso de Peso, de acordo com a classificação do IMC. As participantes foram recrutadas nas dependências do Campus de Ribeirão Preto da USP, sendo que as mulheres com sobrepeso e obesidade estavam inscritas no Programa de Reeducação Alimentar da USP (PRAUSP). Para avaliação perceptiva da imagem corporal foram utilizados dois instrumentos: o programa Body Size Distortion, a partir do método Adaptive Probit Estimation (APE), e a Escala de Figuras de Silhuetas para adultos brasileiros (EFS). Foram coletados também dados sociodemográficos e aplicados instrumentos para mensuração da insatisfação com a imagem corporal, EFS, e sintomas depressivos, BDI. A coleta de dados foi feita em uma sala do Laboratório de Nutrição e Comportamento, na FFCLRP mediante aprovação do projeto pelo Comitê de Ética em Pesquisa desta instituição. Os resultados demonstraram que o IMC, sozinho, não prediz diferenças na acurácia da estimação entre os dois grupos amostrais, para ambas as metodologias utilizadas. A insatisfação foi apontada como importante variável interveniente, sendo mais preponderante do que o IMC na mediação dos valores de estimação, quando avaliada pela EFS. Apesar da correlação entre os valores dos dois instrumentos não evidenciar associação significativa, observa-se que as duas medidas estabeleceram, algumas vezes, associações com as mesmas variáveis. No entanto, apesar da maior sensibilidade do método APE, fornecendo valores de medida em frações decimais, a EFS foi associada com as variáveis do estudo em maior frequência e significância, confirmando sua validade. Em relação ao APE, foram também verificadas associações entre o componente sensorial (LD) e não sensorial (PIS), sobretudo no grupo excesso de peso. / This study aimed to evaluate the body image estimation through two different methods, among women with normal weight and overweight. The sample consisted of 80 adult women, aged between 20 and 50 years. The distribution of the sample was: 40 women composed the Normal Weight group and 40 was the Overweight group, according to BMI classification. Participants were recruited on the premises of the Campus of Ribeirão Preto, USP, and the overweight and obese women were enrolled in the Programa de Reeducação Alimentar (PRAUSP). Two instruments were used for assessment of perceptual body image: the Body Size Distortion program from the Adaptive Probit Estimation method (APE), and Figure Rating Scale for Brazilian adults (FRS). There were also collected sociodemographic data and there were applied tools for measurement of body image dissatisfaction, FRS, and depressive symptoms, BDI. Data collection was done in a room of the Laboratory of Nutrition and Behavior, in FFCLRP upon project approval by the Ethics Committee in Research of the institution. Results demonstrated that BMI alone does not predict differences in the accuracy of estimation between the two sample groups, for both methodologies. Dissatisfaction was identified as an important intervening variable and it was more prevalent than BMI in mediating the estimation values, measured by the FRS. Despite the correlation between the two instruments values did not show any significant association, it was observed that sometimes the two measures established association with the same variables. However, despite the higher sensitivity of the method APE, which provides measurement values in decimal fractions, the FRS was associated with study variables at higher frequency and significance, thus confirming its validity. Regarding the APE, there were also found associations between the sensory (LD) and non-sensory (PIS) components especially in the overweight group.

O objetivo desta pesquisa foi aplicar ao Protocolo de Avaliação de Habilidades Linguístico- Pragmáticas de Gerber & Gurland (1989) em falantes de português brasileiro, descrevendo o comportamento linguístico exibido pelos participantes da amostra, e verificando se o desempenho dos voluntários pode ser influenciado por fatores de estilo, trajetória de vida e saúde, relatados em situação interacional a partir da aplicação de um questionário. Este protocolo avalia a ocorrência de quebras conversacionais de fundo linguístico ou pragmático e as estratégias de reparação dessas quebras, em interações dialógicas entre pacientes afásicos e interlocutores não afásicos, a partir da perspectiva do interlocutor, e possui poucos estudos na nossa população falante de português brasileiro. Partindo de uma perspectiva de língua enquanto função cognitiva do cérebro investigou-se se fatores de estilo, trajetória de vida e saúde por poderem afetar a cognição humana também afetariam o desempenho dos participantes. Foram realizadas e analisadas 66 entrevistas gravadas de participantes não afásicos com idade entre 18 e 75 anos de idade, distribuídos em três grupos etários, falantes de português brasileiro, com ensino fundamental completo como escolaridade mínima. As entrevistas foram guiadas por um Questionário de Informações Básicas elaborado pela autora a partir do Modelo STAC-R de Reuter-Lorenz & Park (2014) sobre fatores protetivos e depletivos à cognição humana. As análises de entrevistas que consideravam participantes sem vantagens e/ou desvantagens linguísticas/cognitivas mostraram que as quebras linguísticas apresentaram a seguinte ocorrência: quebras fonológicas mín.: 0, máx.: 3 vezes, quebras por problemas de recuperação lexical, mín.: 0, máx.: 1 vez e quebras por problemas semânticos, mín.: 0, máx.: 1 vez. Com relação às quebras pragmáticas, observou-se o seguinte padrão de ocorrência: por problemas de pressuposição/referência, mín.: 0, máx.: 4, problemas de mudança de turno, mín.: 0, máx.: 1, e no caso de quebras por manutenção de tópico não foram registradas ocorrências nas análises com a presença dos filtros de vantagem/desvantagem. O número de quebras detectadas sem discriminação do tipo de quebra foi mín.: 0, máx.: 5. A utilização de estratégias de reparação do indivíduo na análise em participantes sem vantagens/desvantagens apresentou a seguinte ocorrência: estratégia de reconhecimento, mín.: 0, máx.: 1, repetições:, mín.: 0, máx.: 3, paráfrase, mín.: 0, máx.: 1, adição de informação, mín.: 0, máx.: 3, revisão sintáticosemântica: mín.: 0, máx.: 2. As estratégias de reparação do indivíduo ocorreram no mínimo 0 e no máximo 7 vezes, em situações de ocorrência de quebra. Os resultados também mostraram que apenas a presença de problemas neurológicos foi estatisticamente significante para a ocorrência de quebras linguísticas e para o total de quebras detectadas na amostra. Esse resultado está dentro do esperado pois o protocolo foi elaborado para avaliação de afasia, que é um problema neurológico que afeta a linguagem especificamente. Entretanto, os problemas relatados pelos participantes não incluíam afasia, foram pontuais e bastante anteriores ao momento da entrevista na maior parte das vezes. Concluiu-se, portanto, que o protocolo é um bom instrumento de avaliação individual, sensível à presença de problemas neurológicos em nossa população também. Sugerimos que o protocolo seja utilizado de forma complementar a outros tipos de instrumentos de avaliação de linguagem, por ser específico para a avaliação da comunicação dialógica. / The aim of this research was to apply the Assessment Protocol of Pragmatic -Linguistic Skills of Gerber & Gurland (1989) in Brazilian Portuguese speakers, describing the linguistic behavior exhibited by the sample participants, and checking if the protocol performance could be influenced by lifestyle, life course and health factors reported in an interactional situation from the application of a questionnaire. This protocol evaluates the occurrence of linguistic or pragmatic conversational breakdowns and the strategies for repairing these breakdowns, in dialogic interactions between aphasic patients and non-aphasic interlocutors, from the perspective of the interlocutor, and has few studies in our Brazilian Portuguese speakers population. Based on a perspective of language as a cognitive function of the brain, we investigated whether factors related to lifestyle, life course and health because they could affect human cognition would also affect participants\' performance. Were carried out and analyzed, 66 recorded interviews with non - aphasic participants aged 18 to 75 years old, divided into three age groups, monolingual or bilingual speakers of Brazilian Portuguese, with complete primary education1 as minimum education. The interviews were guided by a Basic Information Questionnaire elaborated by the author based on the STAC-R Model of Reuter-Lorenz & Park (2014) on protective and depletive factors to human cognition. The interviews analysis that considered participants without linguistic/cognitive advantages and/or disadvantages showed that linguistic breakdowns presented the following occurrence: phonological breakdowns, min.: 0, max.:3 times, word retrieval breakdowns, min.: 0, max.: 1, and syntactic-semantic breakdowns, min.: 0, max.: 1. Within relation to pragmatic breakdowns, it was observed the following occurrence pattern: for pressupostional/referencial problems: min.: 0, max.: 4, turntaking problems, min.: 0, max.: 1 and in the case of topic maintenance breakdowns, it was not registered occurrences in the analysis. The number of breakdowns without discrimination of the type of the breakdown was min.: 0, max.: 5. The client repair strategies used in the analysis of participants without advantages/disadvantages presented the following occurrence: acknowledgment strategy, min.: 0, max.: 1, repetition, min.: 0, max.: 3, paraphrase, min.: 0, max.: 1, adding information, min.: 0, max.: 3, semantic-syntactic revision, min.: 0, max.: 2. The client repair strategies occurred in a minimum 0 and in a maximum 7 times in breakdown situations. The results also showed that only the presence of neurological problems was statistically significant for the occurrence of linguistc breakdowns and for the total number of breakdowns detected in the sample. This result is within the expected range, since the protocol was designed to evaluate aphasia, which is a neurological problem that affects language specifically. The problems reported by the participants did not include aphasia and were punctual and well before the moment of the interview most of the time. Therefore, it was concluded that the protocol is a good instrument for individual assessment, also sensitive to the presence of neurological problems in our population. We suggest that the protocol should be used in a complementary way to other types of language assessment tools, inasmuch it is specific for the evaluation of dialogic communication.

Bakgrund: Ett av sjuksköterskans ansvarsområden är omvårdnaden för nutrition till äldre i särskilt eller ordinärt boende. Flera studier visar att det råder risk för undernäring bland äldre vilket bland annat orsakas av bristande födointag, sämre munstatus, flertal mediciner. För att utreda nutritionstatus hos de äldre kan sjuksköterskan eller annan hälso- och sjukvårdspersonal använda ett bedömningsinstrument. För att de äldre ska bibehålla god nutritionsstatus bör bland annat ett välfungerande samarbete mellan olika professioner finnas. Syfte: Var att undersöka hur sjuksköterskan bedömer, åtgärdar och följer upp nutritionsstatus hos äldre i särskilt och ordinärt boende. Metod: Studien är en tvärsnittsstudie som redovisas med beskrivande statisstik. Populationen var sjuksköterskor som arbetade mot särskilt och ordinärt boend. Enkäter lämnades ut till 112 sjuksköterskor varav 65 besvarades.   Resultat: Studien visade att få av respondenterna var specialist mot distrikt eller äldresköterska. Det förekom bristfälligt utbildning inom nutrition, och en stor andel av sjuksköterskorna beskrev att chefen inte arbetar tillräckligt avseende nutritionsfrågor. Bedömningsinstumentet MNA användes i de flesta fall. Det saknades rutiner för överrapportering av risken för undernäring. Samarbete mellan sjuksköteskorna i studien och dietist ansågs vara litet. Slutsats: Det finns ett behov av att hälso- och sjukvårdspersonal erbjuds utbildning i ämnet nutrition. Det framkommer att det finns ett behov av mer stöd ifrån organisationen vad gäller bland annat rutiner för överrapportering mellan olika vårdinstanser vid risk för undernäring. För att behålla god nutritionstatus hos de äldre är det viktigt med ett gott samarbete mellan de olika professionerna. / Abstract   Background: One of the nurse's responsibilities include the care of nutrition for older people in special or regular housing. Several studies show that there is a risk of malnutrition among older people, due to for example, lack of food intake, poor oral status, multiple medications. To investigate the nutritional status in older people, nurses or other health professionals should use an assessment instrument. In order to maintain good nutritional status among older people, a well-functioning cooperation between different professions is necessary. Aim: Was to investigate how the nurse assesses, addresses and monitors the nutritional status of older people living in particular and ordinary housing. Method: The study is cross-sectional and is reported by descriptive statistics. The population was nurses who worked in special and regular housing. Questionnaires were sent to 112 nurses of which 65 were answered. Results: The study showed that few of the respondents were district nurses. There was inadequate training in nutrition, and a large proportion of the nurses described that their managers did not work enough with nutrition issues. The assessment instrument MNA is used in most cases. Lack of procedures regarding reporting of risk of malnutrition was described. Cooperation between nurses and dietitians was considered small by respondents. Conclusion: There is a need of education in nutrition for health care professionals.  There is a need for more support from the organization such as procedures/guidelines of how risk of malnutrition should be reported between different care institutions. To maintain good nutritional status in older people  it is important to have a good cooperation between various professional categories.

O objetivo desta pesquisa foi aplicar ao Protocolo de Avaliação de Habilidades Linguístico- Pragmáticas de Gerber & Gurland (1989) em falantes de português brasileiro, descrevendo o comportamento linguístico exibido pelos participantes da amostra, e verificando se o desempenho dos voluntários pode ser influenciado por fatores de estilo, trajetória de vida e saúde, relatados em situação interacional a partir da aplicação de um questionário. Este protocolo avalia a ocorrência de quebras conversacionais de fundo linguístico ou pragmático e as estratégias de reparação dessas quebras, em interações dialógicas entre pacientes afásicos e interlocutores não afásicos, a partir da perspectiva do interlocutor, e possui poucos estudos na nossa população falante de português brasileiro. Partindo de uma perspectiva de língua enquanto função cognitiva do cérebro investigou-se se fatores de estilo, trajetória de vida e saúde por poderem afetar a cognição humana também afetariam o desempenho dos participantes. Foram realizadas e analisadas 66 entrevistas gravadas de participantes não afásicos com idade entre 18 e 75 anos de idade, distribuídos em três grupos etários, falantes de português brasileiro, com ensino fundamental completo como escolaridade mínima. As entrevistas foram guiadas por um Questionário de Informações Básicas elaborado pela autora a partir do Modelo STAC-R de Reuter-Lorenz & Park (2014) sobre fatores protetivos e depletivos à cognição humana. As análises de entrevistas que consideravam participantes sem vantagens e/ou desvantagens linguísticas/cognitivas mostraram que as quebras linguísticas apresentaram a seguinte ocorrência: quebras fonológicas mín.: 0, máx.: 3 vezes, quebras por problemas de recuperação lexical, mín.: 0, máx.: 1 vez e quebras por problemas semânticos, mín.: 0, máx.: 1 vez. Com relação às quebras pragmáticas, observou-se o seguinte padrão de ocorrência: por problemas de pressuposição/referência, mín.: 0, máx.: 4, problemas de mudança de turno, mín.: 0, máx.: 1, e no caso de quebras por manutenção de tópico não foram registradas ocorrências nas análises com a presença dos filtros de vantagem/desvantagem. O número de quebras detectadas sem discriminação do tipo de quebra foi mín.: 0, máx.: 5. A utilização de estratégias de reparação do indivíduo na análise em participantes sem vantagens/desvantagens apresentou a seguinte ocorrência: estratégia de reconhecimento, mín.: 0, máx.: 1, repetições:, mín.: 0, máx.: 3, paráfrase, mín.: 0, máx.: 1, adição de informação, mín.: 0, máx.: 3, revisão sintáticosemântica: mín.: 0, máx.: 2. As estratégias de reparação do indivíduo ocorreram no mínimo 0 e no máximo 7 vezes, em situações de ocorrência de quebra. Os resultados também mostraram que apenas a presença de problemas neurológicos foi estatisticamente significante para a ocorrência de quebras linguísticas e para o total de quebras detectadas na amostra. Esse resultado está dentro do esperado pois o protocolo foi elaborado para avaliação de afasia, que é um problema neurológico que afeta a linguagem especificamente. Entretanto, os problemas relatados pelos participantes não incluíam afasia, foram pontuais e bastante anteriores ao momento da entrevista na maior parte das vezes. Concluiu-se, portanto, que o protocolo é um bom instrumento de avaliação individual, sensível à presença de problemas neurológicos em nossa população também. Sugerimos que o protocolo seja utilizado de forma complementar a outros tipos de instrumentos de avaliação de linguagem, por ser específico para a avaliação da comunicação dialógica. / The aim of this research was to apply the Assessment Protocol of Pragmatic -Linguistic Skills of Gerber & Gurland (1989) in Brazilian Portuguese speakers, describing the linguistic behavior exhibited by the sample participants, and checking if the protocol performance could be influenced by lifestyle, life course and health factors reported in an interactional situation from the application of a questionnaire. This protocol evaluates the occurrence of linguistic or pragmatic conversational breakdowns and the strategies for repairing these breakdowns, in dialogic interactions between aphasic patients and non-aphasic interlocutors, from the perspective of the interlocutor, and has few studies in our Brazilian Portuguese speakers population. Based on a perspective of language as a cognitive function of the brain, we investigated whether factors related to lifestyle, life course and health because they could affect human cognition would also affect participants\' performance. Were carried out and analyzed, 66 recorded interviews with non - aphasic participants aged 18 to 75 years old, divided into three age groups, monolingual or bilingual speakers of Brazilian Portuguese, with complete primary education1 as minimum education. The interviews were guided by a Basic Information Questionnaire elaborated by the author based on the STAC-R Model of Reuter-Lorenz & Park (2014) on protective and depletive factors to human cognition. The interviews analysis that considered participants without linguistic/cognitive advantages and/or disadvantages showed that linguistic breakdowns presented the following occurrence: phonological breakdowns, min.: 0, max.:3 times, word retrieval breakdowns, min.: 0, max.: 1, and syntactic-semantic breakdowns, min.: 0, max.: 1. Within relation to pragmatic breakdowns, it was observed the following occurrence pattern: for pressupostional/referencial problems: min.: 0, max.: 4, turntaking problems, min.: 0, max.: 1 and in the case of topic maintenance breakdowns, it was not registered occurrences in the analysis. The number of breakdowns without discrimination of the type of the breakdown was min.: 0, max.: 5. The client repair strategies used in the analysis of participants without advantages/disadvantages presented the following occurrence: acknowledgment strategy, min.: 0, max.: 1, repetition, min.: 0, max.: 3, paraphrase, min.: 0, max.: 1, adding information, min.: 0, max.: 3, semantic-syntactic revision, min.: 0, max.: 2. The client repair strategies occurred in a minimum 0 and in a maximum 7 times in breakdown situations. The results also showed that only the presence of neurological problems was statistically significant for the occurrence of linguistc breakdowns and for the total number of breakdowns detected in the sample. This result is within the expected range, since the protocol was designed to evaluate aphasia, which is a neurological problem that affects language specifically. The problems reported by the participants did not include aphasia and were punctual and well before the moment of the interview most of the time. Therefore, it was concluded that the protocol is a good instrument for individual assessment, also sensitive to the presence of neurological problems in our population. We suggest that the protocol should be used in a complementary way to other types of language assessment tools, inasmuch it is specific for the evaluation of dialogic communication.

The present thesis was carried out in part fulfilment of the Doctorate in Clinical Psychology at the University of Edinburgh. It is presented in portfolio format, comprising of two individual papers although a total thesis abstract provides an overview of the entire thesis. The first paper is a systematic review of existing empirical research. It explores the predictive validity of risk assessment tools for imminent (short-term) violence and aggression in forensic psychiatric settings. The second paper is an empirical study exploring how frontline nursing staff both predict and emotionally cope with experiencing violence and aggression in a high-security setting. Paper one was prepared for Aggression and Violent Behavior and paper two for The International Journal of Forensic Mental Health; so, follow their respective author guidelines. Mental health, and forensic mental health nurses have been identified as being at particular risk of experiencing patient perpetrated violence and aggression (PPVA). There is relatively little research investigating how nursing staff predict and cope with more immediate, imminent inpatient violence and aggression, specifically within secure (forensic) settings. Negative outcomes of PPVA are widely accepted and demonstrated within empirical literature, including increased anxiety and stress for staff, fractures to the therapeutic relationship between patients and staff, and difficulties with staff retention and absenteeism for the organization. Due to the extensive negative outcomes associated with PPVA, a wealth of research has focused on developing the area of violence risk assessment. Despite this, there remains limited understanding regarding the utility of existing risk assessment tools for predicting and assessing violence risk over brief time frames (i.e. days to weeks). Therefore, a systematic review was conducted to explore the predictive validity of violence risk assessment tools for imminent, short-term risk in inpatient forensic psychiatric settings. Findings demonstrated that multiple tools had decent predictive validity, however quality scores were impacted by small sample sizes. The Dynamic Appraisal of Situational Aggression- Inpatient Version was the most effective tool with the highest mean quality score. The main limitations were the small number of studies assessing some of the included tools and the level of ambiguity between studies regarding the definition of imminent, short-term violence. Developing a shared understanding of what constitutes short-term risk and improving the number and quality of studies on the largely neglected tools, should therefore be research priorities. How nurses actually recognize and predict inpatient violence and aggression in forensic psychiatric settings, and how they emotionally cope with the aftermath, are poorly explored and understood processes. A social constructivist grounded theory approach was used to analyze the transcripts from 12 interviews with frontline nursing staff from an inpatient high-security setting. A model was constructed integrating nurses' beliefs and assumptions about subtypes of violence, their efforts to use observation skills in order to aid risk prediction, and their resultant emotional experiences following PPVA. Nurses emotional coping seemed to be affected by several factors relating to the culture of the organization and the accessibility of support. Seemingly, knowing the patient helped nurses to better identify underlying needs leading to violent behavior. This understanding helped nurses to implement targeted, needs-led interventions to address these unmet needs, and so reduce recurrent and cyclical violence. Recommendations are made to build upon, and utilize nursing skills in risk prediction and management, and to help better support the emotional impact of experiencing PPVA within forensic psychiatric settings.

Depression is a mental illness that requires prompt identification and treatment due to grave consequences if untreated. Depression can affect a person's level of functioning, lead to worsening health conditions, comorbid substance abuse, and suicide. Despite these facts, the current state of nursing practice includes an inadequate diagnosis of patients with depression, lack of guidelines for the use of assessment tools and diagnostic tests to identify depression, and insufficient information concerning the accuracy of depression assessment tools. This systematic literature review examined 6 depression assessment tools in regard to their accuracy as identified by specificity, sensitivity, reliability, and validity. This project also examined the pros and cons, demographics, and healthcare settings that use these depression inventory tools. This project used the Orlando nursing process theory as a theoretical framework. Based on the review of 10 articles selected, evidence showed that the Hamilton depression rating scale has the highest sensitivity (93%) and specificity (97%) rates. The implications for positive social change include the opportunity for clinicians to use the findings of this project in their selection of depression assessment tools in healthcare settings. Other researchers can use this project as a valuable resource for management of major depressive disorders.

This study set out to determine the relationship between assessment practices and teaching methods. I wanted to investigate whether making mathematical investigation assessment tasks available to elementary-school mathematics teachers would have a positive effect on their teaching. Research tells us that standardized tests influence instruction. My research explored whether a national Assessment Task Bank of mathematical investigative tasks could influence teachers.With these aims in mind, the following research questions were formulated:1. Will the teachers' use of mathematical investigation tasks for assessment purposes influence their view of mathematics?2. Will the teachers' use of mathematical investigation tasks for assessment purposes influence the way they teach, and if so, in what ways?3. Will the teachers' use of mathematical investigation tasks for assessment purposes influence the way they assess their students, and if so, in what ways?My research was divided into two parts: 1) a national study involving teachers-leaders throughout the country; and 2) an intensive study in a small Israeli community, called Sharon. The first part examined how the national courses on assessment that I conducted affected the participating teacher-leaders in terms of their concept of mathematics, their teaching methods and their assessment practices. The second part examined the same issues with regard to the mathematics coordinators in the Sharon community. In each case, I have detailed my experiences so that the reader can gain a view of all facets of the study.The research methodology adopted was based on a constructivist paradigm, sometimes referred to as a "naturalistic inquiry", utilizing ethnographic principles wherein the data collection and analysis procedures were eclectic. In the course of the five years of my research, I used many strategies of data collection - ++ / for example, unstructured participant-observations, interviews, questionnaires and content analysis of artifacts (tests and tasks written by teachers).The ideas of reform mathematics (as defined in Ch 2 of this thesis) are based on a broadened vision of mathematics with emphasis on higher-order thinking. My research indicated that the use of mathematical investigation tasks helped the teachers in my study reach the awareness that mathematics, even on the elementary school level, involves generalizations, justifications and even creativity.Prior to my research, and because of my position, I was aware that Israeli teachers were concerned primarily with teaching routine procedures and that their work sheets for the most part involved single-answer exercises. My research indicated that the use of mathematical investigation tasks indeed influenced the way teachers teach. Verbalization-having the students explain "Why"-has become integral to the teaching practices of the participants in my study. Nowadays, the Israeli teachers I worked with use "authentic tasks" in their classrooms: real-life situations that involve some mathematics. Unfortunately, these tasks are not always planned properly.My research demonstrated that teachers attending my professional courses found the mathematical investigation tasks to be useful for assessment purposes, providing them with additional information about their pupils, not obtainable through conventional assessment methods. The additional criteria (I introduced) for evaluating the pupils' work aided in defining these additional areas. I found that while teachers were quite willing to use the mathematical investigation tasks to supplement the conventional tests, they were reluctant to use them as replacements.Exposure to the Assessment Task Bank influenced to a certain degree, the way the teachers in my study assessed their students. The ++ / tests of the teachers who were participants in my study now regularly include elements that were previously absent: questions requiring explanations and questions with more than one possible answer.Although the teachers of my study were increasingly using questions that required higher-order thinking, the tendency was to use the tests in a summative manner, rather than formatively. In other words, many teachers found it difficult to use test results for planning their subsequent lessons. While they were able to analyze their students' work and could report in some detail on each student's performance, they failed to understand how this should affect their teaching. Before they were exposed to the tasks they had administered tests merely in order to provide grades, whereas now the teachers were often trying to understand the students' thinking.While long-term change is still elusive, my research has demonstrated that exposure to reform mathematics through the mathematical investigative tasks of the Assessment Task Bank did have some influence on the teachers' view of mathematics, as well as their teaching and assessment practices.

Health risk assessment tools compute an individual’s risk of developing a disease. They are potentially useful in chronic disease prevention mediated by family physicians. We sought to learn family physicians’ awareness, and perspectives on the usefulness, usability and feasibility of implementation of risk assessment tools. Focus groups, discussion with key informants, and usability testing with an EMR-embedded risk assessment tool were conducted with family physicians (n=30) from academic and community-based practices. Analysis following grounded theory methodology was used to generate categories and themes. Our findings indicate that participants are aware of the implications of risk assessment calculations though very few tools are used regularly. Tool integration with EMR systems was felt to be essential in assisting tool usability, uptake and efficiency of use. Results provide insight into current risk assessment tool use and the facilitation of wider implementation of risk assessment tools in family practice settings.

Health risk assessment tools compute an individual’s risk of developing a disease. They are potentially useful in chronic disease prevention mediated by family physicians. We sought to learn family physicians’ awareness, and perspectives on the usefulness, usability and feasibility of implementation of risk assessment tools. Focus groups, discussion with key informants, and usability testing with an EMR-embedded risk assessment tool were conducted with family physicians (n=30) from academic and community-based practices. Analysis following grounded theory methodology was used to generate categories and themes. Our findings indicate that participants are aware of the implications of risk assessment calculations though very few tools are used regularly. Tool integration with EMR systems was felt to be essential in assisting tool usability, uptake and efficiency of use. Results provide insight into current risk assessment tool use and the facilitation of wider implementation of risk assessment tools in family practice settings.