The rates of non-medical prescription drug use in the United States (U.S.) have increased dramatically in the last two decades, leading to a more than 300% increase in deaths from overdose, surpassing motor vehicle accidents as the leading cause of injury deaths. In rural areas, deaths from unintentional overdose have increased by more than 250% since 1999 while urban deaths have increased at a fraction of this rate. The objective of this research was to test the hypothesis that cultural, economic, and environmental factors prevalent in rural America affect the rate of substance use disorder (SUD) in that population, and that diagnosis of these disorders across rural and urban populations may not be generalizable due to these same effects. This study applies measurement invariance analysis and factor analysis techniques: item response theory (IRT), multiple indicators, multiple causes (MIMIC), and latent class analysis (LCA), to the DSM-IV abuse and dependency diagnosis instrument. The sample used for the study was a population of adult past-year illicit drug users living in a rural or urban area drawn from the 2011-2012 National Survey on Drug Use and Health data files (N = 3,369| analyses 1 and 2; N = 12,140| analysis 3). Results of the IRT and MIMIC analyses indicated no significant variance in DSM item function across rural and urban sub-groups; however, several socio-demographic variables including age, race, income, and gender were associated with bias in the instrument. Latent class structures differed across the sub-groups in quality and number, with the rural sample fitting a 3-class structure and the urban fitting 6-class model. Overall the rural class structure exhibited less diversity and lower prevalence of SUD in multiple drug categories (e.g. cocaine, hallucinogens, and stimulants). This result suggests underlying elements affecting SUD patterns in the two populations. These findings inform the development of surveillance instruments, clinical services, and public health programming tailored to specific communities.

The purpose of this study was to build upon the existing MIRT equating literature by introducing a full multidimensional item response theory (MIRT) observed score equating method for mixed-format exams because no such methods currently exist. At this time, the MIRT equating literature is limited to full MIRT observed score equating methods for multiple-choice only exams and Bifactor observed score equating methods for mixed-format exams. Given the high frequency with which mixed-format exams are used and the accumulating evidence that some tests are not purely unidimensional, it was important to present a full MIRT equating method for mixed-format tests. The performance of the full MIRT observed score method was compared with the traditional equipercentile method, and unidimensional IRT (UIRT) observed score method, and Bifactor observed score method. With the Bifactor methods, group-specific factors were defined according to item format or content subdomain. With the full MIRT methods, two- and four-dimensional models were included and correlations between latent abilities were freely estimated or set to zero. All equating procedures were carried out using three end-of-course exams: Chemistry, Spanish Language, and English Language and Composition. For all subjects, two separate datasets were created using pseudo-groups in order to have two separate equating criteria. The specific equating criteria that served as baselines for comparisons with all other methods were the theoretical Identity and the traditional equipercentile procedures. Several important conclusions were made. In general, the multidimensional methods were found to perform better for datasets that evidenced more multidimensionality, whereas unidimensional methods worked better for unidimensional datasets. In addition, the scale on which scores are reported influenced the comparative conclusions made among the studied methods. For performance classifications, which are most important to examinees, there typically were not large discrepancies among the UIRT, Bifactor, and full MIRT methods. However, this study was limited by its sole reliance on real data which was not very multidimensional and for which the true equating relationship was not known. Therefore, plans for improvements, including the addition of a simulation study to introduce a variety of dimensional data structures, are also discussed.

Broadening the term augmented testing to include a combination of multiple measures to assess examinee performance on a single construct, the issues of IRT item parameter and proficiency estimates were investigated. The intent of this dissertation is to determine if different IRT calibration designs result in differences to item and proficiency parameter estimates and to understand the nature of those differences. Examinees were sampled from a testing program in which each examinee was administered three mathematics assessments measuring a broad mathematics domain at the high school level. This sample of examinees was used to perform a real data analysis to investigate the item and proficiency estimates. A simulation study was also conducted based upon the real data. The factors investigated for the real data study included three IRT calibration designs and two IRT models. The calibration designs included: separately calibrating each assessment, calibrating all assessments in one joint calibration, and separately calibrating items in three distinct content areas. Joint calibration refers to the use of IRT methodology to calibrate two or more tests, which have been administered to a single group, together so as to place all of the items on a common scale. The two IRT models were the one- and three-parameter logistic model. Also investigated were five proficiency estimators: maximum likelihood estimates, expected a posteriori, maximum a posteriori, summed-score EAP, and test characteristic curve estimates. The simulation study included the same calibration designs and IRT models but the data were simulated with varying levels of correlations among the proficiencies to determine the affect upon the item parameter estimates. The main findings indicate that item parameter and proficiency estimates are affected by the IRT calibration design. The discrimination parameter estimates of the three-parameter model were larger when calibrated under the joint calibration design for one assessment but not for the other two. Noting that equal item discrimination is an assumption of the 1-PL model, this finding raises questions as to the degree of model fit when the 1-PL model is used. Items on a second assessment had lower difficulty parameters in the joint calibration design while the item parameter estimates of the other two assessments were higher. Differences in proficiency estimates between calibration designs were also discovered, which were found to result in examinees being inconsistently classified into performance categories. Differences were observed in regards to the choice of IRT model. Finally, as the level of correlation among proficiencies increased in the simulation data, the differences observed in the item parameter estimates were decreased. Based upon the findings, IRT item parameter estimates resulting from differing calibrations designs should not be used interchangeably. Practitioners who use item pools should base the pool refreshment calibration design upon the one used to originally create the pool. Limitations to this study include the use of a single dataset consisting of high school examinees in only one subject area, thus the degree of generalization regarding research findings to other content areas of grade levels should be made with caution.

The purpose of this research was to develop observed score and true score equating procedures to be used in conjunction with the Multidimensional Item Response Theory (MIRT) framework. Currently, MIRT scale linking procedures exist to place item parameter estimates and ability estimates on the same scale after separate calibrations are conducted. These procedures account for indeterminacies in (1) translation, (2) dilation, (3) rotation, and (4) correlation. However, no procedures currently exist to equate number correct scores after parameter estimates are placed on the same scale. This research sought to fill this void in the current psychometric literature. Three equating procedures--two observed score procedures and one true score procedure--were created and described in detail. One observed score procedure was presented as a direct extension of unidimensional IRT observed score equating, and is referred to as the "Full MIRT Observed Score Equating Procedure." The true score procedure and the second observed score procedure incorporated the statistical definition of the "direction of best measurement" in an attempt to equate exams using unidimensional IRT (UIRT) equating principles. These procedures are referred to as the "Unidimensional Approximation of MIRT True Score Equating Procedure" and the "Unidimensional Approximation of MIRT Observed Score Equating Procedure," respectively. Three exams within the Iowa Test of Educational Development (ITED) Form A and Form B batteries were used to conduct UIRT observed score and true score equating, MIRT observed score and true score equating, and equipercentile equating. The equipercentile equating procedure was conducted for the purpose of comparison since this procedure does not explicitly violate the IRT assumption of unidimensionality. Results indicated that the MIRT equating procedures performed more similarly to the equipercentile equating procedure than the UIRT equating procedures, presumably due to the violation of the unidimensionality assumption under the UIRT equating procedures. Future studies are expected to address how the MIRT procedures perform under varying levels of multidimensionality (weak, moderate, strong), varying frameworks of dimensionality (simple structure vs. complex structure), and number of dimensions, among other conditions.

Introdução - O estudo do conhecimento nutricional, das motivações para as escolhas alimentares e da qualidade da dieta traz informações importantes para o controle das crescentes prevalências de excesso de peso e doenças crônicas. Apesar da eficiência das estratégias de controle depender de uma escala de boa qualidade, se desconhece a precisão das escalas existentes ou estas não estão em acordo com recomendações vigentes. Objetivo - Desenvolver escalas para avaliar o conhecimento nutricional, a motivação de saúde para escolhas alimentares e a qualidade da dieta com aplicação da Teoria de Resposta ao Item (TRI). Métodos - Para desenvolver as escalas de conhecimento nutricional (NKTS) e motivação de saúde para as escolhas alimentares (SOFIE) foram utilizados questionários já existentes e utilizados no estudo HELENA, uma investigação multicêntrica da União Europeia: Nutritional Knowledge Test (NKT) e Food Choices and Preferences (FCP). Para desenvolver a escala de qualidade da dieta (ESQUADA) foi desenvolvido um questionário, baseado no Guia Alimentar para a População Brasileira e cuja relevância e compreensão foram estudadas a partir das sugestões de nutricionistas, em grupos focais, e adolescentes e jovens adultos brasileiros, em um questionário online. Para cada escala, a dimensionalidade dos itens foi estudada separadamente pela análise fatorial exploratória. A TRI foi aplicada para identificar os itens com melhor discriminação da informação de interesse, bem como localizá-los nos diferentes níveis do continuum e calcular os escores dos indivíduos. Foi verificada a associação entre os escores de NKTS e SOFIE com consumo de alimentos e biomarcadores nutricionais, avaliados no estudo HELENA. Para construir as escalas foram utilizados BILOG-MG versão 3, GGUM 2004 e o R. As sugestões dos nutricionistas foram analisadas no MAXQDA versão 12. As sugestões dos adolescentes e jovens adultos e a caracterização das escalas foram realizadas no Microsoft Office Excel versão 2013. O estudo das associações foi realizado no Stata versão 14. Resultados - A análise fatorial e a TRI indicaram que onze itens do NKT e dezesseis itens do FCP avaliam adequadamente o conhecimento nutricional e a motivação de saúde para as escolhas alimentares, compondo, respectivamente, NKTS e SOFIE. NKTS identifica indivíduos com conhecimento nutricional básico, adequado e avançado. SOFIE classifica indivíduos com baixa, indiferente e alta motivação de saúde para as escolhas alimentares. Os escores de NKTS e SOFIE associaram positivamente com marcadores de alimentação saudável. Em relação à ESQUADA, os nutricionistas consideraram os itens relevantes para avaliar a qualidade da dieta, mas indicaram a necessidade de alterar a escrita de alguns, bem como de suas alternativas de resposta. Todos os itens foram facilmente compreendidos por adolescentes e adultos jovens. A análise fatorial e a TRI reteram 25 itens para a ESQUADA, possibilitando identificar cinco níveis de qualidade da dieta. Conclusão - NKTS, SOFIE e ESQUADA, respectivamente, apresentaram medidas acuradas do conhecimento nutricional, das motivações de saúde para as escolhas alimentares e da qualidade da dieta, permitindo caracterizar seus diferentes níveis. Outros estudos podem analisar a relação entre ESQUADA e marcadores de consumo alimentar, bem como selecionar as escalas desenvolvidas para avaliação em outras populações. / Introduction - The study of the nutritional knowledge, the motivations to food choices, and the diet quality provides important information to control the increasing prevalences of overweight and chronic diseases. Although the effectiveness of the control strategies depends on a good quality scale, the accuracy of existing scales is unknown or these scales are not in line with current recommendations. Objective - This thesis aimed to develop scales to evaluate the nutritional knowledge, health motivation influencing food choices, and diet quality using the IRT analysis. Methods - Due to develop the scales of the nutritional knowledge (NKTS) and health motivation to food choices (SOFIE), questionnaires already used in the HELENA study, a European multicenter research, were used: Nutritional Knowlwdge Test (NKT) and Food Choices and Preferences (FCP). Due to develop the scale of diet quality (ESQUADA), a questionnaire, based on the Food Guide for the Brazilian Population, was created. The relevance and laypersons\' comprehension of this questionnaire were studied based on the suggestions from: nutritionists using focus groups\' discussions and Brazilian adolescents and young adults using an online questionnaire. The dimensionality of the items was analysed separately using the exploratory factor analysis for each scale. The IRT analysis was applied to identify the items with the best discrimination of the information of interest, as well as to locate them at the different levels of the continuum and to calculate the IRT scores. The association between IRT scores, food consumption and nutritional biomarkers was analyzed around NKTS and SOFIE. The softwares BILOG-MG version 3, GGUM 2004, and R were used to construct the scales. The nutritionists\' suggestions were analyzed in MAXQDA version 12. The laypersons\' suggestions and the characterization of each scale level were performed in Microsoft Office Excel version 2013. The study of association was performed in Stata version 14. Results - Factor analysis and IRT analysis indicated that eleven items from NKT and sixteen items from FCP adequately evaluate the nutritional knowledge and health motivation influencing food choices and compose NKTS and SOFIE, respectively. NKTS identifies individuals with basic, adequate, and advanced nutritional knowledge. SOFIE classifies individuals with low, indifferent, and high health motivation influencing food choices. The scores from NKTS and SOFIE were positively associated with healthy food markers. Regarding the ESQUADA, the nutritionists considered the items relevant to assess the quality of diet. However, they indicated the need to change the writing of some items as well as their response options. Adolescents and young adults easily understood all items. The factor analysis and IRT analysis retained 25 items in ESQUADA, possibiting to identify five levels of diet quality. Conclusion - NKTS, SOFIE, and ESQUADA, respectively, presented accurate measures of nutritional knowledge, health motivation to food choices, and quality of diet, allowing the characterization of their different levels. Other studies may analyze the relationship between ESQUADA and food consumption, as well as select the developed scales to evaluate these latent traits in other populations.

Differential item functioning (DIF) and differential distractor functioning (DDF) are methods used to screen for item bias (Camilli && Shepard, 1994; Penfield, 2008). Using an applied empirical example, this mixed-methods study examined the congruency and relationship of DIF and DDF methods in screening multiple-choice items. Data for Study I were drawn from item responses of 271 female and 236 male low-income children on a preschool science assessment. Item analyses employed a common statistical approach of the Mantel-Haenszel log-odds ratio (MH-LOR) to detect DIF in dichotomously scored items (Holland & Thayer, 1988), and extended the approach to identify DDF (Penfield, 2008). Findings demonstrated that the using MH-LOR to detect DIF and DDF supported the theoretical relationship that the magnitude and form of DIF and are dependent on the DDF effects, and demonstrated the advantages of studying DIF and DDF in multiple-choice items. A total of 4 items with DIF and DDF and 5 items with only DDF were detected. Study II incorporated an item content review, an important but often overlooked and under-published step of DIF and DDF studies (Camilli & Shepard). Interviews with 25 female and 22 male low-income preschool children and an expert review helped to interpret the DIF and DDF results and their comparison, and determined that a content review process of studied items can reveal reasons for potential item bias that are often congruent with the statistical results. Patterns emerged and are discussed in detail. The quantitative and qualitative analyses were conducted in an applied framework of examining the validity of the preschool science assessment scores for evaluating science programs serving low-income children, however, the techniques can be generalized for use with measures across various disciplines of research.

This study had three purposes: (1) to identify differential item functioning (DIF) on the PPVT-III (Forms A & B) using a partial correlation method, (2) to find a consistent pattern in items identified as underestimating ability in each ethnic minority group, and (3) to compare findings from an expert judgment method and a partial correlation method. Hispanic, African American, and white subjects for the study were provided by American Guidance Service (AGS) from the standardization sample of the PPVT-III; English language learners (ELL) of Mexican descent were recruited from school districts in Central and South Texas. Content raters were all self-selected volunteers, each had advanced degrees, a career in education, and no special expertise of ELL or ethnic minorities. Two groups of teachers participated as judges for this study. The "expert" group was selected because of their special knowledge of ELL students of Mexican descent. The control group was all regular education teachers with limited exposure to ELL. Using the partial correlation method, DIF was detected within each group comparison. In all cases except with the ELL on form A of the PPVT-III, there were no significant differences in numbers of items found to have significant positive correlations versus significant negative correlations. On form A, the ELL group comparison indicated more items with negative correlation than positive correlation [χ2 (1) = 5.538; p=.019]. Among the items flagged as underestimating ability of the ELL group, no consistent trend could be detected. Also, it was found that none of the expert judges could adequately predict those items that would underestimate ability for the ELL group, despite expertise. Discussion includes possible consequences of item placement and recommendations regarding further research and use of the PPVT-III.

För att anhöriga och personer med afasi ska kunna etablera en fungerande vardag harkunskap om och förståelse för afasi visat sig viktig. I tidigare studier har anhöriga tillpersoner med afasi visat sig sakna relevant kunskap om och förståelse för afasi som debehöver för att etablera en fungerande vardag. Logopediska insatser som är riktadedirekt till anhöriga är relativt ovanliga i Sverige. Syftet med denna studie är att utifråndata från litteratur och intervjuer utforma frågor, så kallade item, som på ett tillförlitligtsätt kan mäta kunskap om och förståelse för afasi hos anhöriga till personer med afasi.Tre fokusgrupper bestående av anhöriga till personer med afasi, personer med afasi ochlogopeder användes för insamlande av intervjudata. Intervjudatan analyserades genomkvalitativ innehållsanalys. Från analysen framställdes sju kategorier med tillhörandeunderkategorier. Kategorierna låg till grund för utformningen av item. Sammanlagt har140 stycken item utformats. Dessa item var av två typer; item bestående av en 6-gradigLikert-skala och item av typen Multiple Choice. Vidare indelades item beroende påvilka svar som kan erhållas . Item med önskvärda svar( typ A) och situations- ochindividberoende item (typ B) som syftar till att ligga till grund för samtal mellananhörig till person med afasi och logoped.. De kategorier och item som studienresulterat i uppvisar samstämmighet med tidigare studier som fokuserat på anhöriga tillpersoner med afasi. Samstämmigheten tyder på att de item som inkluderas i ett framtidaformulär har möjlighet att kunna mäta av kunskap och förståelse hos anhöriga tillpersoner med afasi. För att framtagna item ska kunna resultera i det tilltänkta formuläretkrävs ytterligare validering, reliabilitetstestning och urval. / Previous studies have shown that significant others to persons with aphasia are in needof increased knowledge and understanding of aphasia. The knowledge andunderstanding for aphasia has shown to be crucial to significant others in terms ofpsychosocial well-being and to be able to establish a satisfying everyday life. PresentSpeech-language pathologist services in Sweden tend to have limited involvement ofsignificant others to persons with aphasia. This study aims to design a number ofquestions, items, which will be able to measure the knowledge and understanding ofaphasia for significant others of persons with aphasia. The items result from literaturestudies and semi-structured interviews with significant others to persons with aphasia,persons with aphasia and speech-language pathologists. Transcripts from interviews areanalyzed through content analysis. The study results in 140 items presented in sevencategories, each with a number of sub-categories. Two types of items are designed:items in the form of a 6-point Likert Scale and items in the form of Multiple Choice.The items are also divided depending on whether the answer is knowledgde-based (typeA) or to be used as material for discussion (type B). The categories and items from thisstudy are consistent with previous research. To transform the items into a completequestionnaire, further validation, testing of reliability and selection is needed.

Increased product proliferation and global competition are forcing companies within the supply chain to adopt new strategies. Postponement is an effective strategy that allows companies to be agile and cost effective in dealing with the dynamics of global supply chains. Postponement centres around delaying activities in the supply chain until real information about the market is available, which reduces the complexity and uncertainty of dealing with a proliferation of products. A two-echelon divergent supply chain entailing a central production facility and N retailers facing stochastic demand is studied within the inventory-distribution system. A periodic review order-up-to strategy is incorporated at all echelons. Unique to the study, five different systems are created and the effectiveness of several postponement strategies (form and transshipment) under various operational settings are compared. The importance of postponement under an integrated supply chain context and its contribution to various sector implementations are also discussed. Simulation is used to analyze the performance of the systems especially with respect to cost, order lead time and the effectiveness of transshipment policies. The study is unique in determining factors that favour one system implementation over another and distinguishing sector requirements that support postponement. In the study, postponement is found to be an effective strategy in dealing with managing item variety, demand uncertainty and differences in review periods in the two echelon supply chain for different experimental settings.

When an exam is administered across dual platforms, such as paper-and-pencil and computer-based testing simultaneously, individual items may become more or less difficult in the computer version (CBT) as compared to the paper-and-pencil (P&P) version, possibly resulting in a shift in the overall difficulty of the test (Mazzeo & Harvey, 1988). Using 38,955 examinees' response data across five forms of the National Nurse Aide Assessment Program (NNAAP) administered in both the CBT and P&P mode, three methods of differential item functioning (DIF) detection were used to detect item DIF across platforms. The three methods were Mantel-Haenszel (MH), Logistic Regression (LR), and the 1-Parameter Logistic Model (1-PL). These methods were compared to determine if they detect DIF equally in all items on the NNAAP forms. Data were reported by agreement of methods, that is, an item flagged by multiple DIF methods. A kappa statistic was calculated to provide an index of agreement bet ween paired methods of the LR, MH, and the 1-PL based on the inferential tests. Finally, in order to determine what, if any, impact these DIF items may have on the test as a whole, the test characteristic curves for each test form and examinee group were displayed. Results indicated that items behaved differently and the examinee's odds of answering an item correctly were influenced by the test mode administration for several items ranging from 23% of the items on Forms W and Z (MH) to 38% of the items on Form X (1-PL) with an average of 29%. The test characteristic curves for each test form were examined by examinee group and it was concluded that the impact of the DIF items on the test was not consequential. Each of the three methods detected items exhibiting DIF in each test form (ranging from 14 items to 23 items). The Kappa statistic demonstrated a strong degree of agreement between paired methods of analysis for each test form and each DIF method pairing (reporting good to excell ent agreement in all pairings). Findings indicated that while items did exhibit DIF, there was no substantial impact at the test level.