Background: Endothelial dysfunction (ED) is one of the earliest subclinical indicators of impaired cardiovascular health and several non-invasive tools have been developed to evaluate vascular function, including strain gauge plethysmography (SGP), brachial artery flow-mediated dilation (FMD) via ultrasound, and peripheral artery tonometry (PAT). While these tools have extensively been studied during a resting condition, the responses following acute exercise are not as well characterized. Purpose: The purpose of this study was to compare the pre- and post-exercise vascular function values obtained with SGP, FMD, and PAT. Relationships among the primary outcome variables obtained with each assessment tool were also evaluated. Methods: Vascular function was assessed in 17 sedentary, apparently healthy male subjects (24±4 yrs; 24.5±3.2 kg/m2) at rest and following an acute submaximal exercise bout with SGP, FMD, and PAT. Results: During rest, post-occlusion reactive hyperemia resulted in significant (p<0.05) increases in forearm blood flow (FBF; 2.13±1.03 vs 6.35 ± 2.90 mL/min/100 mL tissue) and area under the curve (AUC; 226.77 ± 111.20 vs 588.22 ±283.33 mL/min/100 mL) as determined by SGP. Brachial artery diameter (BAD) as assessed with FMD was increased by 5.3% (p<0.05). Resting reactive hyperemia index (RHI) as assessed by PAT was observed to be 1.73±0.34. Significant exercise-induced increases (p<0.05) were observed in baseline and post-occlusion FBF and baseline AUC values utilizing SGP. Additionally, FMD baseline blood velocity was significantly increased (91.8±11.1 vs 108.0±17.1 cm/sec, p<0.05) and the PAT augmentation index (AI) was significantly more negative (-8.8 ±9.4 vs -18.9±8.4%, p<0.05) after exercise. There were no significant correlations observed among the primary outcome measures obtained from each assessment technique. There was, however, a moderate correlation between pre-exercise vascular reactivity as assessed by SGP and change in blood velocity as assessed by FMD (r= 0.566, p= 0.035). Conclusions: The addition of an exercise stress to vascular function assessment may offer greater insight into the health of the vasculature. This initial study was undertaken to further evaluate the pre- to post-exercise responses obtained using three commonly employed vascular function assessment techniques in healthy individuals. Additional research as to the value of the addition of an exercise stress to vascular function assessment in individuals with traditional cardiovascular disease risk factors or known cardiovascular disease is warranted.

Thesis (Ed.M.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / This study was the initial research conducted to ascertain the validity of a prevocational behavior checklist. The instrument under investigation was developed at the South Shore Rehabilitation Center in Quincy, Massachusetts. The Center's assessment instrument entitled, 466 Behaviors Necessary to Function Successfully as a Sheltered Worker, was used for assessing the skills of 60 severely retarded subjects enrolled in the Center's prevocational program. The major purpose of this study was to identify which of the 466 behaviors comprising the checklist contributed highly discriminating information. Test scores from 60 severely retarded adults were collected and processed in two phases of the study. Phase I included the analysis of the distribution of scores, elimination of behaviors that did not discriminate between 5 percent or less of the sample. In Phase II of this study, the investigator statistically analyzed behavior-to-Specific Skill Area correlations. If the analysis resulted in a correlation coefficient of less than +.5, the behavior was dropped from the checklist. This procedure was completed in four consecutive series. Thus, the investigator guaranteed that the remaining items were providing reliable information about the related Specific Skill Areas. Phase I of this study resulted in the elimination of 218 behaviors from the checklist and further calculations. Only 248 behaviors discriminated differences between more than 5 percent of the sample. Of the 248 behaviors, 144 behaviors met the +.5 criterion in Phase II. The investigator concluded that 114 behaviors comprising 25 Specific Skill Areas on the assessment instrument were contributing discriminating information. Recommendations were made to continue research of the prevocational behavior checklist. The recommended research would contribute to validating the instrument, producing an effective method of assessing vocational skills of severely retarded adults. / 2031-01-02

This research focused on how child protection practitioners in the Department of Child Safety, Queensland used the Structured Decision Making (SDM) tools in their practice with children and families. SDM is a set of tools designed to assist practitioners with their decision making, promote consistency in practice and target the children most in need of a service. This research focused on how practitioners used four of the SDM tools in the intake and investigation stages of a case: the Screening Criteria (used to assess which cases should be accepted for investigation), the Response Priority Tool (used to assess the urgency with which an investigation should commence), the Safety Assessment Tool (used to assess whether a Safety Plan needs to be developed or a child needs to be removed from parental care) and the Family Risk Evaluation Tool (used to assign levels of risk to cases and assist in decision making about further Departmental intervention). More broadly, the research aimed to address a gap in the literature about how child protection practitioners use risk assessment tools in their practice with children and families. / Theoretically the research drew from ethnomethodology to explore the ‘unstated conditions’ (Garfinkel, 1967) in relation to how the tools were used by practitioners. Methods for data collection were drawn from ethnography and involved three months fieldwork at six Child Safety Service Centres in Queensland during 2007/08. The fieldwork involved observing the practice of practitioners in intake and investigation teams at the different offices, interviews with 46 practitioners and audits of 51 case files. / A significant finding of the research was that practitioners were not using the tools in the way that they were intended to be used by their designers (primarily to assist decision making). Rather the tools were considered as tools that met organisational requirements for accountability and consistency. The ‘unstated conditions’ that emerged from the research provide not only description about how the tools were used, but also explanation about why the tools were used in certain ways. These explanations provide insights which have implications more generally for the future development and implementation of tools to assist practitioners with assessment and decision making.

Automatic assessment tools are increasingly utilized in undergraduate programming courses to evaluate software solutions, streamlining the grading process for both students and professors. In spite of their benefits of speed and convenience, such online systems for providing instant feedback have the tendency to draw attention to performance-based outcomes while failing to reliably recognize the effort and hard work a student puts into a solution. For the many struggling students who are new to programming, this type of objective feedback can be discouraging and may decrease their motivation to stay engaged towards success. To address this issue, this paper explores strategies for more effectively recognizing student progress on programming assignments and identifying small tasks for students to complete that will steer them in the right direction. Further, this paper will discuss a gamification approach for adding ``Daily Missions" to Web-CAT, the Web-based Center for Automated Testing. From an evaluation of results gathered from student experiences with this latest version of Web-CAT at Virginia Tech, this paper will highlight the valuable potential gamification has in boosting student engagement in computer science learning. / Master of Science / In college computer science courses today, many students submit their assignments and receive instant feedback through online websites. Although they streamline the grading process for both students and professors, these systems have the tendency to draw attention to performance-based outcomes while failing to reliably recognize the effort and hard work a student puts into a solution. For the many struggling students who are new to programming, this type of objective feedback can be discouraging and may decrease their motivation to stay engaged towards success. To address this issue, this paper explores strategies for more effectively recognizing student progress on programming assignments and identifying small tasks for students to complete that will steer them in the right direction. One strategy in particular is called gamification, which refers to giving game-like attributes to a non-game system. This paper will discuss a gamification approach for adding “Daily Missions” to WebCAT, the Web-based Center for Automated Testing. From an evaluation of results gathered from student experiences with this latest version of Web-CAT at Virginia Tech, this paper will highlight the valuable potential gamification has in boosting student engagement in computer science learning.

In most epidemiological studies, one in every five children and adolescents are said to display Emotional and Behavioural Difficulties (EDB), with greater risk of school and wider social exclusion (Brauner & Stephens 2006; Costello, Egger & Angold 2005). Although no formal statistics are currently available with regards EBD in Brunei, there was a formal report stating that quite a number of young people are now being referred to professionals for assistance and support for EBD. There is currently no assessment tool for EBD in Brunei and no ‘Brunei Malay’ translation for most of the Western design measures. Although some of these measures have Malay translations, it was formally back-to-back translated among professionals from Malaysia, who are known to speak slightly different standard Malay language than those Malays who reside in Brunei. Despite the differences in some technical language, Malays in Brunei and Malaysia share a very similar culture and geography. The aim of this study was twofold, to explore the responses of parents, teachers and adolescents in Brunei using the translation of the Western designed assessment tool for EBD as well as to determine how useful the original subscales of those measures are in reporting problems associated with EBD in Brunei Darussalam, a Malay speaking country based in the South East Asian region. A single phase cross sectional survey of 11-16 year-old adolescents attending mainstream public (i.e. government) schools in Brunei was carried out. Responses of parents and teachers were measured using the Strength and Difficulties Questionnaires (SDQ) and a subsample of the participants received a second copy of Child Behaviour Checklist (CBCL) and Teacher Report Form (TRF) of Achenbach measures. Responses from adolescents were measured using the Youth Self Report (YSR) of Achenbach measure. In total, responses were obtained from 396 parent version SDQ and 92 parent version of CBCL; 329 teacher version of SDQ and 71 teacher version of TRF; and 282 adolescent Youth Self Report (YSR) were obtained for analyses. Results indicated that there are some differences in the three different groups of respondents in Brunei in relation to the identification of EBD and that this differed somewhat from Western population studies. It is suggested that this may be due to differences in interpreting behavioural norms and that this might be linked to cultural differences. It was found that the YSR did not produce factor structure like that of the original study and this might indicate necessary refinement to ensure better fit as revealed by the psychometric analyses. Teachers’ responses to the SDQ items were more similar to those of teachers in other evaluation of the SDQ, whilst parents differed more in their responses when compared to those of Western respondents. Despite the clear differences in their responses when describing EBD using these Western measures, exploration of other statistical tests offered some possible reasons for continuing using the measures to report the prevalence of the problems. Previous studies have also highlighted some critical insights into the use of the measures in other cultures, which are discussed in the finding of this study. Some age and gender differences also appeared in responses, and there were a tendency for parents and adolescents in Brunei to report higher Total Difficulties Score (TDS) among girls than boys. The cut-off scores that were adjusted based on the criteria advocated by the founder of these measures indicated slight differences in the level of point describing the clinical range. This again served to highlight the possible cultural behavioural expectation that varies from one country to another. This exploratory study suggests that reporting a prevalence rate of a given culture using a measure that was designed elsewhere might pose risk of wrongly describing problems of a particular nature without investigating the way in which it has been understood by the respondent. The study stresses that it is important to understand cultural determinants of respondents when reporting EBD of adolescents and points out the necessity of planning and networking across social context to meet young people mental health needs.

Does the lead industry have a future, in the face of the developing environmental challenge? This thesis addresses this question and concludes, it should have for the foreseeable future, providing it adopts the changes detailed. These changes are posited within a framework, which consists of a strategy, approaches and tools. The changes are both technical and philosophical. They are technical, in the sense that the tools and approaches provide practical means whereby the environmental `risks' may be identified, assessed and managed. They are philosophical, because they set out and identify the features of a new conceptual paradigm, whose basis is in the concept of the `risk society'. The paradigm is significantly more holistic, multi-dimensional, inherently flexible, and is intended to be reflexive. Adoption of the elements of the framework, will facilitate a more effective establishment, and management of environmental `risk' credentials, which will help encourage better environmental decision making. Hence, it will facilitate, the balancing of resource consumption and environmental impact costs, versus social and economic benefits, in an improved manner. The modelling approaches, and selected inventory and environmental impact assessment tools, enclosed within this thesis, have been designed to facilitate the development of, and to function within, the new paradigm. These have been developed for BRM and MIM case studies, and function at the site-specific and the cradle-to-gate scales. The former consider the company site of Britannia Refined Metals (BRM) Ltd., where refining to produce primary and secondary refined lead products takes place, whilst the latter consider the life-cycle of the refined primary lead products of MIM Ltd. The modelling approaches have also been designed so, that they may be re-aggregated into models able to operate at many different scales, as required. The framework, and its elements, are applicable for all industries facing similar challenges.

This thesis explores Neighbourhood and Building Environmental Assessment Tools’ (NBEATs’) function as assessment tools and decision support, and their relation to environment, architecture and architects. This is done by analysing, testing, and discussing a number of NBEATs (LEED-NC, Code for Sustainable Homes, EcoEffect, LEED-ND, BREEAM-C, and ENSLIC-tool), their manuals and use. Moreover, professionals’ (architects’) self-rated opinions regarding use and knowledge of NBEATs and environmental aspects are surveyed. Similarities and differences in NBEATs are found regarding: content, structure, weighting and indicators used. Indicators distinguished as procedure, performance and feature are used to varying extents to assess social, environmental and technical aspects. NBEATs relation to environmental sustainability has limitations due to: non-transparency, tradable indicators, relative measures, low criteria levels, limited life cycle perspective, and exclusion of relevant environmental aspects, such as embedded toxic substances, nutrient cycles, land use change, and ecosystem services. Ratings and architecture are influenced by NBEATs in varying ways. Higher criteria levels would probably increase their impact on architecture. Thus more research regarding NBEATs and links to architectural design, theory and practice is welcomed. There is limited use of NBEATs as decision support in early design phases such as in architectural competitions. Architects rate the importance of environmental aspects high, but few rate their skill in handling environmental aspects high. This calls for increasing knowledge and know-how of environmental strategies and solutions among architects and adaptation of NBEATs to early design processes. The values NBEATs reflect and the values we want them to create is also important. To support ‘environmental’ architecture, an increased socio-eco-technological system perspective is put forward, and other measures besides NBEATs are needed. / <p>QC 20160926</p>

Background: The use of the Dynamic Appraisal of Situational Aggression (DASA) in acute psychiatric settings to identify aggressive and/or violent patients upon admission. Objective: Determining nurses' perception of the usefulness of the Dynamic Assessment of Situational Aggression (DASA) in a psychiatric emergency room setting. Theoretical Background: Langley, Nolan, Nolan and Provost’s (2009) Model for Improvement, which incorporates Deming’s Plan-Do-Study-Act (PDSA) cycle, was utilized as the theoretical framework to guide this DNP project. Setting: An adult psychiatric emergency room in urban Phoenix, Arizona. Measurement: A six-item survey questionnaire measured on a five-point Likert scale ranging from "Strongly Disagree" (1) to "Strongly Agree" (5) describes and measures nurses' perception on the usefulness of the DASA. An additional question explored the influence of static nursing factors (gender, years of experience, level of education, years at the facility), on nurses' perception of the usefulness of the DASA. Results: Overall, nurses (90%) of the study participants perceived the DASA to be effective in identifying aggressive violent patients and 70% of the participants would like to continue to use the DASA. Static nursing factors showed no difference in nurses' perception of usefulness. Limitations: Further exploration in similar settings such as regular emergency departments and psychiatric emergency and crisis settings are recommended. In this study only nursing perception was explored. Analysis of the validity of the DASA tool in the psychiatric emergency room setting in addition to nursing perceptions would be more beneficial in determining the DASA’s true usefulness. Conclusion: The results of this DNP project demonstrate that nurses at the SAUPC perceive the DASA to be a useful addition to their admission assessment. Overall nursing response was positive and the SAUPC seclusion and restraint committee recommended incorporating the DASA into the triage nursing admission assessment.

abstract: Late preterm infants (LPIs), born between 34 and 37 weeks gestation, are at risk for a myriad of health conditions related to neuro-muscular and physiologic immaturity. However, relative stability allow many of these infants to avoid care in specialty nurseries and discharge home with their mothers after birth. Due to underlying immaturity, feeding difficulty is the most common issue LPIs experience, resulting in early breastfeeding cessation, increased risk for secondary diagnoses, and hospital readmission. The purpose of this study was to assess early breastfeeding behavior of LPIs, including testing inter-rater reliability of an assessment tool and the feeding patterns of infants over time. An extensive review of breastfeeding assessment tools resulted in the selection of the Premature Infant Breastfeeding Behavior Scale (PIBBS) based on its reliability and validity in the preterm infant population. A convenience sample of LPI dyads was recruited and used to conduct inter-rater reliability testing of PIBBS. A longitudinal one-group non-experimental study was used for observational follow-up. A strong statistical agreement of PIBBS scores occurred between mothers and a healthcare professional (Cohen’s kappa values of items ranged from .776 to 1.000, p = <.001). Participants continued using the PIBBS tool after hospital discharge until their infants expected due dates (40 weeks adjusted age). T-test analyses were conducted to examine changes in scores over time indicating increase in item scores (p = .003 - .193). PIBBS appears to be a valid and reliable tool to assess breastfeeding among LPI dyads. Incorporation of PIBBS into a comprehensive plan of care could better support and protect breastfeeding among the LPI population. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2018

When working on United States Green Building Council’s (USGBC) Leadership in Energy and Environmental Design LEED projects, architects, designers, and engineers involved in a sustainable design project often require information and tools beyond energy simulation software. They may require resources (tools) to support their decisions and to assess the risk involved in decision making. This research has presented a framework that links building performance assessment tools with the LEED rating system. It aims at bridging a gap between Architects, engineers, contractors, facility managers and LEED professionals. This work provides information about performance tools that can be used for different phases during design, construction and operation of a LEED rated building. A simple logic of the transitive property of equality i.e. if a = b, b = c then a = c was used to link the LEED credits requiring decision support with the tools that have capabilities to achieve it. This research presents a 3-dimensional matrix of "Right tool for right job at right time" by linking LEED credits, software tools and phases of building design, construction and operation. Overall the findings of the research demonstrated that the framework developed can be used for achieving 21 percent of total possible LEED 3.0 credits by providing about 36 percent of total possible points.