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Aktualumas: Profesinio mokymo teikėjas: vykdo profesinio mokymo įstaigos vadybinės ir pedagoginės veiklos vidinį vertinimą; atsako už profesinio mokymo kokybę. Darbo tikslas: Išanalizuoti mokymo kokybės profesinėje mokykloje sampratą ir realijas. Darbo uždaviniai:  Išstudijuoti, pedagoginę, psichologinę, sociologinę literatūrą bei įvairius dokumentus, nagrinėjančius švietimo įstaigos vertinimo nuostatų teorinę bazę.  Ištirti mokytojų nuostatas vertinant profesinio parengimo kokybę.  Atskleisti mokinių įsivertinimą profesinio pasirengimo kokybės požiūriu.  Nustatyti darbdavių požiūrį į profesinio parengimo kokybę.  Aptarti respondentų grupių vertinimų dermę, diagnozuojant profesinį pasirengimą praktinei veiklai. Tyrimo objektas: Profesinio mokymo kokybė. Išvados (1):  Studijuota įvairi pedagoginė, psichologinė, sociologinė literatūra profesinio rengimo klausimu leidžia teigti, kad mokymo procese prioritetine užduotimi įvardijama mokymo kokybė. Teisiniai dokumentai taip pat skiria ypatingą vietą profesinio mokymo kokybei.  Pažymėtina, kad vieningo mokslininkų požiūrio į kokybės vertinimą nėra.  Skirtingas įmones atstovaujantys darbdaviai, vertindami profesinio rengimo kokybę, vieningai įvardija tas pačias pagrindines problemas: pasirengimo praktinei veiklai stoką, mokinių iniciatyvumo ir atsakingumo stoką.  Darbdaviai pažymi materialinės bazės stiprinimo būtinybę, bendradarbiavimo ryšių plėtojimą. Išvados (2):  Reikšminga tai, kad dauguma darbdavių... [toliau žr. visą tekstą] / The study object is professional schools quality of teaching. Study task is to analyze the conception and the reality of teaching quality in a professional school. The study consists three parts. Theoretical aspects of educational institution assessment are analyzed in the first part of this study. The point of professional school audit context is revealed in the second part. The empirical results of the study are presented in the third part. The conclusions follow that professional study quality depends on many factors: economical status of the country, adequate material basis of education institution, qualification of pedagogy, organization of teaching and a contingent of students. There is no unique and reliable system underlying the professional studying quality in Lithuania. The result of this study let us state that the main valuators of studying quality are employers. Study data show that employers are wanly ranking the professional preparedness of their trainees than the trainees themselves. The quality analysis shows that statistically reliable relation between evaluation of professional preparedness level or teaching quality and that dementias like motivation, success during the practice, also education institution system of knowledge evaluation. Study results indicate that mostly pupils agree with the statement that their professional preparedness depend only on their own effort. Future specialists ought to overprice their knowledge and skills, that is, they lack... [to full text]

Diagnostic testing is essential to distinguish non-diseased individuals from diseased individuals. The sensitivity and specificity are two important indices for the diagnostic accuracy of continuous-scale diagnostic tests. If we want to compare the effectiveness of two tests, it is of interest to construct a confidence interval for the difference of the two sensitivities at a fixed level of specificity. In this thesis, we propose two empirical likelihood based confidence intervals (HBELI and HBELII) for the difference of two sensitivities at a predetermined specificity level. Simulation studies show that when correlation between the two test results exists, HBELI and HBELII intervals perform better than the existing bootstrap based BCa, BTI and BTII intervals due to shorter interval lengths. However, when there is no correlation, BCa, BTI and BTII intervals outperform HBELI and HBELII intervals due to better coverage probability in most simulation settings.

Le diagnostic précoce des troubles envahissants du développement (TED) amène plusieurs bénéfices pour les familles, dont une plus grande efficacité des interventions et une meilleure mobilisation des parents (Rogers, 2001). Toutefois, l'évaluation diagnostique des TED est un acte complexe. Bien que les parents remarquent souvent des anomalies dans le développement de leur enfant avant l'âge de deux ans, le diagnostic de TED est généralement posé vers six ans (Howlin et Moore, 1997). L'annonce du diagnostic représente également une partie capitale du processus puisqu'elle peut avoir des effets sur le niveau d'anxiété des parents (Wasserman, Inuit, Barriatua, Carter et Lippincott, 1984), l'acceptation du diagnostic (Woolley, Stein, Forrest et Baum, 1989) ainsi que la relation parent-enfant (Bouchard, Pelchat, Boudreault et Lalonde-Graton, 1994). Plusieurs recommandations ont été formulées à cet effet afin de répondre aux besoins des familles. Alors que des études ont été effectuées dans diverses régions de monde pour illustrer le vécu des familles, à notre connaissance, aucune recherche portant sur le processus d'évaluation québécois n'a fait l'objet de publication. Pour combler cette lacune, un questionnaire portant sur le processus d'évaluation et l'annonce du diagnostic de TED a été construit et validé auprès de cinq experts dans le domaine. Quatre-vingt-huit familles d'enfants ayant un TED ont été recrutées à l'aide d'une lettre de sollicitation distribuée par l'intermédiaire de centres de réadaptation et d'associations de parents ayant accepté de participer à l'étude. Au total, 92 questionnaires concernant 81 personnes ayant un diagnostic de trouble autistique ou de trouble envahissant du développement non spécifié et 11 personnes ayant reçu un diagnostic de syndrome d'Asperger ont été remplis. Les résultats de cette recherche font l'objet de deux articles. Le premier concerne le processus d'évaluation diagnostique. Le but de cet article est d'illustrer le cheminement de familles québécoises dont l'enfant a reçu un diagnostic de TED dans les dernières années, à partir de leurs premières préoccupations jusqu'au diagnostic officiel. Pour ce faire, des questions touchant les préoccupations parentales relativement au développement de l'enfant ainsi que les détails des consultations effectuées par la famille pour obtenir un diagnostic ont été utilisées. Les résultats révèlent que les premières préoccupations quant au développement surviennent en moyenne à l'âge de 2,4 ans, alors que le diagnostic est obtenu à l'âge de 5,8 ans. En moyenne, 4,5 consultations professionnelles sont nécessaires afin d'obtenir un diagnostic officiel. Le processus menant au diagnostic de syndrome d'Asperger est significativement plus long que celui conduisant au diagnostic de trouble autistique et de TED-NS. Les données de cette recherche sont similaires à celles obtenues dans d'autres études. Les résultats concernant les pratiques d'annonce du diagnostic sont présentés dans un deuxième article ayant pour but de décrire les modalités entourant cet événement et d'évaluer la satisfaction des parents. La partie du questionnaire qui concerne l'annonce comprend quatre sections portant sur l'organisation générale lors de l'annonce du diagnostic, l'attitude des professionnels, les informations reçues ainsi que la satisfaction générale des parents. Bien que trois famiIles québécoises sur quatre affirment être satisfaites du déroulement de l'annonce du diagnostic, plusieurs des recommandations de la littérature scientifique ne sont pas respectées. Des délais moyens de plus de cinq mois pour obtenir une consultation ont été relevés. Une des lacunes les plus importantes des pratiques utilisées semble être la quantité d'informations fournies aux familles lors de ces rencontres. En somme, cette recherche exploratoire a permis d'obtenir un premier portrait de l'annonce du diagnostic des TED au Québec. En comparant les pratiques utilisées au Québec avec celles qui sont préconisées dans la littérature, et à la lumière des commentaires des parents, il a été possible, en conclusion de cet essai, de formuler différentes recommandations. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Trouble envahissant du développement, Autisme, Syndrome d'Asperger, Évaluation, Diagnostic, Québec.

Examination of functional brain anatomy is a crucial step in the process of surgical removal of many brain tumors. Functional magnetic resonance imaging (fMRI) is a promising technology capable of mapping brain function non-invasively. To be successfully applied to presurgical mapping, there are questions of diagnostic accuracy that remain to be addressed. One of the greatest difficulties in implementing fMRI is the need to define an activation threshold for producing functional maps. There is as of yet no consensus on the best approach to this problem, and a priori statistical approaches are generally considered insufficient because they are not specific to individual patient data. Additionally, low signal to noise and sensitivity to magnetic susceptibility effects combine to make the production of activation maps technically demanding. This contributes to a wide range of estimates of reproducibility and validity for fMRI, as the results are sensitive to changes in acquisition and processing strategies. Test-retest fMRI imaging at the individual level, and receiver operator characteristic (ROC) analysis of the results can address both of these concerns simultaneously. In this work, it is shown that the area under the ROC curve (AUC) can be used as an indicator of reproducibility, and that this is dependent on the image thresholds used. Production of AUC profiles can thus be used to optimize the selection of individual thresholds on the basis of detecting stable activation patterns, rather than a priori significance levels. The ROC analysis framework developed provides a powerful tool for simultaneous control of protocol reproducibility and data driven threshold selection, at the individual level. This tool can be used to guide optimal acquisition and processing strategies, and as part of a quality assurance program for implementing presurgical fMRI.

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<p>The translational potential of diagnostic and prognostic platforms developed using expression microarray technology is evident. However, the majority of array-based diagnostics have yet to make their way into the clinical laboratory. Current approaches tend to focus on development of multi-gene classifiers of disease subtypes, but very few studies evaluate the translational potential of these assays. Likewise, only a handful of studies focus on development of approaches to optimize array-based tests for the ultimate goal of clinical utility. Prior to translation into the clinical setting, molecular diagnostic platforms should demonstrate a number of characteristics to ensure optimal and efficient testing and patient care. Assays should be accurate and precise, technically and biologically robust, and should take into account normal sources of biological variance that could ultimately affect test results. The overarching goal of the research presented in this dissertation is to develop methods for evaluating and optimizing the translational potential of molecular diagnostics developed using expression microarray technology.</p><p> </p><p>The first research section of this dissertation is focused on our evaluation of the impact of intratumor heterogeneity on precision in microarray-based assays in breast cancer. We conducted genome-wide expression profiling on 50 needle core biopsies from 18 breast cancer patients. Global profiles of expression were characterized using unsupervised clustering methods and variance components models. Array-based measures of estrogen (ER) and progesterone receptor (PR) status were compared to immunohistochemistry. The precision of genomic predictors of ER pathway status, recurrence risk, and sensitivity to chemotherapeutics were evaluated by interclass correlation. Results demonstrated that intratumor variation was substantially less than the total variation observed across the patient population. Nevertheless, a fraction of genes exhibited significant intratumor heterogeneity in expression. A high degree of reproducibility was observed in single gene predictors of ER (intraclass correlation coefficient (ICC)=0.94) and PR expression (ICC=0.90), and in a multi-gene predictor of ER pathway activation (ICC=0.98) with high concordance with immunohistochemistry. Substantial agreement was also observed for multi-gene signatures of cancer recurrence (ICC=0.71), and chemotherapeutic sensitivity (ICC=0.72 and 0.64). Together, these results demonstrated that intratumor heterogeneity, although present at the level of individual gene expression, does not preclude precise micro-array based predictions of tumor behavior or clinical outcome in breast cancer patients.</p><p> </p><p>Leading into the second research section, we observed that in some cancer types, certain genes behave as molecular switches and have either an "on" or "off" expression state. Specifically, we observed these molecular switch genes exist in breast cancer as robust diagnostic and prognostic markers, including ER, PR, and HER2, and define tumor subtypes associated with different treatment and patient survival. We hypothesized that clinically relevant molecular switch (bimodal) genes exist in epithelial ovarian cancer, a type of cancer with no established molecular subgroups. To test this hypothesis, we applied a bimodal discovery algorithm to a publically available ovarian cancer expression microarray dataset (GSE9891:285 tumors; 246 malignant serous (MS), 20 endometrioid (EM), 18 low malignant potential (LMP) ovarian carcinomas). Genes with robust bimodal expression were identified across all ovarian tumor types and within selected subtypes. Of these bimodal genes, 73 demonstrated differential expression between LMP vs. MS and EM, and 22 genes distinguished MS from EM. Fourteen bimodal genes had significant association with survival among MS tumors. When these genes were combined into a single survival score, the median survival for patients with a favorable versus unfavorable score was 65 versus 29 months (p<0.0001, HR=0.4221). Two independent datasets (n=53 high grade, advanced stage serous and n=119 advanced stage ovarian tumors) validated the survival score performance. Taken together, the results of this study revealed that genes with bimodal expression patterns not only define clinically relevant molecular subtypes of ovarian carcinoma, but also provide ideal targets for translation into the clinical laboratory.</p><p> </p><p>Finally, the third research section of this dissertation focuses on development of robust blood-based molecular markers of decompression stress (DS). DS is defined as the pathophysiological response to inert gas coming out of solution in the blood and tissues when a body experiences a reduction in ambient pressure. To date, there are no established molecular markers of DS. We hypothesized that comparing gene expression before and after human decompression exposures by genome-wide expression profiling would identify candidate molecular markers of DS. Peripheral blood was collected 1hr before and 2hr after 93 hyperoxic, heliox experimental dives (n=54). Control arms included samples collected 1 hour before and 2 hours after high pressure oxygen breathing (n= 9) and surface exercise (n=9), and samples collected at 7am and 5pm for time of day (n=11). Pre and post-dive expression data collected from normoxic nitrox experimental dives were utilized for independent validation. Blood samples were collected into PaxGene RNA tubes. RNA was extracted and processed for globin reduction prior to cDNA synthesis and Affymetrix U133A GeneChip hybridization. 746 genes were differentially expressed following hyperoxic, heliox decompression exposures (permutation adjusted p-value cutoff 1.0E-4). After filtering control significant genes, 726 genes remained. Pathway analysis demonstrated a significant portion of genes were associated with innate immune response (p<0.0001). A 362 multi-gene signature of significant, covariant genes was then applied to the independent dataset and demonstrated differentiation between pre and post-dive samples (p=0.0058). There was no significant correlation between signature and venous bubble grade or bottom time in the validation study. Our results showed that expression profiling of peripheral blood following decompression exposures, while controlling for experimental and normal sources of biological variance, identifies a reproducible multi-gene signature of differentially expressed genes, primarily comprising genes associated with innate immune response and independent of venous bubble grade or dive profile. </p><p> </p><p>Taken together, the research and results presented in this dissertation represent considerable advances in the development of approaches to guide microarray-based diagnostics towards the ultimate goal of clinical translation.</p> / Dissertation