Fragestellung und Zielsetzung: Ausgehend von dem Ziel, kommunikative Fähigkeiten von Studierenden der Humanmedizin objektiv zu messen, sollte in dieser Studie untersucht werden, ob eine ins Deutsche übersetzte Kurzversion des „Calgary-Cambridge Observation Guide for the Medical Interview“ (CCOG) von Kurtz und Silverman (1996) valide und reliabel ist und sich damit die Kommunikationsfähigkeit von Studierenden der Medizin bewerten lässt. Methode: Eine Auswahl von Ärzten, wissenschaftlichen Mitarbeitern und Studierenden des klinischen Studienabschnittes evaluierten im Abstand von mindestens drei Monaten fünf Anamnese-Videos mittels der ins Deutsche übersetzten „CCOG-Kurzversion“. Die Videos bestanden aus je einem Gespräch zwischen einem Studierenden des ersten klinischen Semesters in der Rolle des Arztes bzw. einer approbierten Ärztin und einem Schauspielpatienten – in unterschiedlicher Kommunikationsqualität. Die Auswertung erfolgte deskriptiv nach folgenden Kriterien: Bewertungszeitpunkt, Geschlecht bzw. Gruppe der Rater, Qualität der Videogespräche. Darüberhinaus wurden eine explorative und eine konfirmatorische Faktorenanalyse berechnet und die Retest-Reliabilität (Intra-Rater-Reliabilität) sowie die Intra-Class-Correlation (Inter-Rater-Reliabilität) bestimmt. Ergebnisse: 30 Rater beteiligten sich an der Studie, davon drei als sog. „Goldstan-dard“. Die Gesamtbewertung aller fünf Anamnese-Videos zeigte eine geringfügige Verbesserung in der Notenvergabe beim zweiten Bewertungszeitpunkt. In der Benotung waren professionelle Rater generell etwas strenger als Laien, Ärzte etwas strenger als Studierende und weibliche Rater etwas strenger als männliche. „Gold-standard“ und übrige Rater unterschieden sich bei einzelnen Items bis zu 1,6 Notenpunkten (z.B. beim Item „verbale/nonverbale Unterstützung des Patienten“). In der Originalversion enthält der CCOG 28 Items, die in sechs Skalen (mit jeweils 3 bis 7 Items) zusammengefasst sind. Diese Struktur ließ sich in der hier gerechneten Faktorenanalyse nur bedingt abbilden. Gemäß Eigenvalue > 1 genügten 5 Faktoren zur Abbildung bzw. Aufteilung der Items. Darüber hinaus zeigte sich eine andere Skalenzuordnung als im Original und über die Hälfte der Items (15/28) lud auf demselben Faktor. Auch die Inter-Rater-Übereinstimmung in der Beantwortung einzelner Items war nicht optimal (ICC-Range: 0,05 bis 0,57). Schlussfolgerungen: Die CCOG-Kurzversion zeigte relativ gute Übereinstimmun-gen bei der Retest-Reliabilität. Schwierigkeiten zeigten sich bei der Benotung einiger Items im Vergleich zwischen dem „Goldstandard“ und den übrigen Ratern. Die Skalen-Struktur der Items und die Inter-Rater-Reliabilität sind nur bedingt akzeptabel. Vielleicht hätte eine dreistufige Bewertungsskala oder eine homogene Rater-Gruppe oder auch eine bessere Schulung das Ergebnis der ICC verbessert. Es sollten einige Items gestrichen, sprachlich trennschärfer formuliert oder anders zusammengefasst, neue Items hinzugefügt und Skalen neu strukturiert werden.

Made available in DSpace on 2016-08-12T19:15:26Z (GMT). No. of bitstreams: 1 RobertoPS_TESE.pdf: 1647938 bytes, checksum: dc34992c335e50d26416144e8fb502c1 (MD5) Previous issue date: 2013-11-29 / This study aims to determine the appropriate size of field plots for field experimentation with sunflower. An experiment was conducted in randomized complete blocks design with 14 cultivars of sunflower and 10 replications. The field plots consisted of four rows of six-meter long rows, spaced 0.7 m and 0.3 m between plants, with a total area of 16.8 m2. The useful area of the plot (7.56 m2), consisting of the two central rows, was divided into 12 basic units, each one consisting of three plants in the row (0.63 m2). The production of sunflower grains obtained in basic units was grouped in order to form portions of seven kinds of five different predefined sizes. The appropriate size of the experimental plot was estimated by the following methods: a) Intraclass correlation coefficient b) Maximum modified curvature c) Segmented linear model with plateau and d) Hatheway (1961). Were also estimated the soil heterogeneity coefficient (b) and the detectable difference among treatments (d). There was a reduction in the coefficient of variation with increasing the size of the plot. The soil of the experiment showed high heterogeneity ( = 1.0585). They were estimated by the methods of the intraclass correlation coefficient, maximum modified curvature and segmented linear model with plateau, respectively, the optimal plot sizes corresponding to 2.52, 3.74 and 2.48 m2. The maximum modified curvature method presented estimate of the optimum plot size more appropriate, together with the detectable difference between means of cultivars to accurately assess the yield of sunflower grain. The plot of 3.74 m2 of useful area was considered appropriate to assess the yield of sunflower grains and it was smaller than the size generally used in researches with sunflower. Though the Hatheway method (1961), they were estimated several very aplicable plot sizes. Considering all the cultivars for the same difference to be detected among means of cultivars, the use of a portion of smaller size with the largest number of replicates required less experimental area than the larger plots with a fewer number of replications / O objetivo desse trabalho foi determinar o tamanho adequado de parcela para experimentação de campo com girassol. Foi realizado um experimento no delineamento em blocos completos casualizados com 14 cultivares de girassol e 10 repetições. As parcelas foram constituídas de quatro fileiras de seis metros de comprimento, espaçadas de 0,7 m e entre plantas de 0,3 m, com área total de 16,8 m2. A área útil da parcela (7,56 m2), composta das duas fileiras centrais, foi dividida em 12 unidades básicas, cada uma constituída de três plantas na fileira (0,63 m2). A produção de grãos do girassol obtida nas unidades básicas foi agrupada de modo a formar sete tipos de parcelas de cinco tamanhos diferentes pré-estabelecidos. O tamanho adequado da parcela experimental foi estimado por meio dos seguintes métodos: a) Coeficiente de correlação intraclasse; b) Máxima curvatura modificado; c) Modelo linear segmentado com platô e d) Hatheway (1961). Estimaram-se também o coeficiente de heterogeneidade do solo (b) e a diferença detectável entre tratamentos (d). Ocorreu redução do coeficiente de variação com o aumento do tamanho da parcela. O solo do experimento apresentou alta heterogeneidade ( = 1,0585). Foram estimados pelos métodos do coeficiente de correlação intraclasse, máxima curvatura modificado e modelo linear segmentado com platô, respectivamente, os tamanhos ótimos de parcela correspondentes a 2,52, 3,74 e 2,48 m2. O método da máxima curvatura modificado apresentou estimativa do tamanho ótimo da parcela mais adequado, aliado à diferença detectável entre médias de cultivares para avaliar com precisão o rendimento de grãos do girassol. Parcela 3,74 m2 de área útil foi considerada adequada para avaliação do rendimento de grãos do girassol e foi menor que o tamanho geralmente usado nas pesquisas com o girassol. Pelo método de Hatheway (1961) estimaram-se diversos tamanhos de parcelas, muitos aplicáveis. Considerando todas as cultivares, para uma mesma diferença a ser detectada entre médias de cultivares, a utilização de parcela de menor tamanho com maior número de repetições requereu menos área experimental do que parcelas maiores com menor número de repetições

Made available in DSpace on 2016-08-12T19:18:46Z (GMT). No. of bitstreams: 1 RobertoPS_TESE.pdf: 1647938 bytes, checksum: dc34992c335e50d26416144e8fb502c1 (MD5) Previous issue date: 2013-11-29 / This study aims to determine the appropriate size of field plots for field experimentation with sunflower. An experiment was conducted in randomized complete blocks design with 14 cultivars of sunflower and 10 replications. The field plots consisted of four rows of six-meter long rows, spaced 0.7 m and 0.3 m between plants, with a total area of 16.8 m2. The useful area of the plot (7.56 m2), consisting of the two central rows, was divided into 12 basic units, each one consisting of three plants in the row (0.63 m2). The production of sunflower grains obtained in basic units was grouped in order to form portions of seven kinds of five different predefined sizes. The appropriate size of the experimental plot was estimated by the following methods: a) Intraclass correlation coefficient b) Maximum modified curvature c) Segmented linear model with plateau and d) Hatheway (1961). Were also estimated the soil heterogeneity coefficient (b) and the detectable difference among treatments (d). There was a reduction in the coefficient of variation with increasing the size of the plot. The soil of the experiment showed high heterogeneity ( = 1.0585). They were estimated by the methods of the intraclass correlation coefficient, maximum modified curvature and segmented linear model with plateau, respectively, the optimal plot sizes corresponding to 2.52, 3.74 and 2.48 m2. The maximum modified curvature method presented estimate of the optimum plot size more appropriate, together with the detectable difference between means of cultivars to accurately assess the yield of sunflower grain. The plot of 3.74 m2 of useful area was considered appropriate to assess the yield of sunflower grains and it was smaller than the size generally used in researches with sunflower. Though the Hatheway method (1961), they were estimated several very aplicable plot sizes. Considering all the cultivars for the same difference to be detected among means of cultivars, the use of a portion of smaller size with the largest number of replicates required less experimental area than the larger plots with a fewer number of replications / O objetivo desse trabalho foi determinar o tamanho adequado de parcela para experimentação de campo com girassol. Foi realizado um experimento no delineamento em blocos completos casualizados com 14 cultivares de girassol e 10 repetições. As parcelas foram constituídas de quatro fileiras de seis metros de comprimento, espaçadas de 0,7 m e entre plantas de 0,3 m, com área total de 16,8 m2. A área útil da parcela (7,56 m2), composta das duas fileiras centrais, foi dividida em 12 unidades básicas, cada uma constituída de três plantas na fileira (0,63 m2). A produção de grãos do girassol obtida nas unidades básicas foi agrupada de modo a formar sete tipos de parcelas de cinco tamanhos diferentes pré-estabelecidos. O tamanho adequado da parcela experimental foi estimado por meio dos seguintes métodos: a) Coeficiente de correlação intraclasse; b) Máxima curvatura modificado; c) Modelo linear segmentado com platô e d) Hatheway (1961). Estimaram-se também o coeficiente de heterogeneidade do solo (b) e a diferença detectável entre tratamentos (d). Ocorreu redução do coeficiente de variação com o aumento do tamanho da parcela. O solo do experimento apresentou alta heterogeneidade ( = 1,0585). Foram estimados pelos métodos do coeficiente de correlação intraclasse, máxima curvatura modificado e modelo linear segmentado com platô, respectivamente, os tamanhos ótimos de parcela correspondentes a 2,52, 3,74 e 2,48 m2. O método da máxima curvatura modificado apresentou estimativa do tamanho ótimo da parcela mais adequado, aliado à diferença detectável entre médias de cultivares para avaliar com precisão o rendimento de grãos do girassol. Parcela 3,74 m2 de área útil foi considerada adequada para avaliação do rendimento de grãos do girassol e foi menor que o tamanho geralmente usado nas pesquisas com o girassol. Pelo método de Hatheway (1961) estimaram-se diversos tamanhos de parcelas, muitos aplicáveis. Considerando todas as cultivares, para uma mesma diferença a ser detectada entre médias de cultivares, a utilização de parcela de menor tamanho com maior número de repetições requereu menos área experimental do que parcelas maiores com menor número de repetições

abstract: Through a two study simulation design with different design conditions (sample size at level 1 (L1) was set to 3, level 2 (L2) sample size ranged from 10 to 75, level 3 (L3) sample size ranged from 30 to 150, intraclass correlation (ICC) ranging from 0.10 to 0.50, model complexity ranging from one predictor to three predictors), this study intends to provide general guidelines about adequate sample sizes at three levels under varying ICC conditions for a viable three level HLM analysis (e.g., reasonably unbiased and accurate parameter estimates). In this study, the data generating parameters for the were obtained using a large-scale longitudinal data set from North Carolina, provided by the National Center on Assessment and Accountability for Special Education (NCAASE). I discuss ranges of sample sizes that are inadequate or adequate for convergence, absolute bias, relative bias, root mean squared error (RMSE), and coverage of individual parameter estimates. The current study, with the help of a detailed two-part simulation design for various sample sizes, model complexity and ICCs, provides various options of adequate sample sizes under different conditions. This study emphasizes that adequate sample sizes at either L1, L2, and L3 can be adjusted according to different interests in parameter estimates, different ranges of acceptable absolute bias, relative bias, root mean squared error, and coverage. Under different model complexity and varying ICC conditions, this study aims to help researchers identify L1, L2, and L3 sample size or both as the source of variation in absolute bias, relative bias, RMSE, or coverage proportions for a certain parameter estimate. This assists researchers in making better decisions for selecting adequate sample sizes in a three-level HLM analysis. A limitation of the study was the use of only a single distribution for the dependent and explanatory variables, different types of distributions and their effects might result in different sample size recommendations. / Dissertation/Thesis / Doctoral Dissertation Educational Psychology 2016

The evaluation of shoulder abduction and flexion strength is important in the rehabilitation after rotator cuff tear. The purpose of this work is to assess the intra and inter-rater reliability of measurement data from an isokinetic dynamometer used to evaluate shoulder abduction and flexion strength, with the aim to identify sources of measurement errors and suggest improvements. The measurement data was collected by a research group at Karolinska Institute and contained load and torque data from thirteen healthy subjects in the ages of 25 to 87 years. The measurements were carried out on two occasions, one week apart. Systematic differences between occasions are analyzed using the Shapiro Wilk test, the paired t-test, and Wilcoxon signed rank test. The agreement of the measurements is analyzed quantitatively using the coefficient of variation and the Bland Altman plot, and quantitively, using the intraclass correlation coefficient. A significant systematic difference in shoulder abduction and flexion load measurements was found, and the recommendation to prevent this is that components should be calibrated in a standardized way. The measurements showed varying reliability within and between measurement occasions and that after familiarization with the isokinetic dynamometer, repeatability improved. The findings indicate a need of a standardized protocol for patient education and placement. Measurements from the position sensor contributed to more random torque values. To improve the repeatability in measurements from the position sensor, axis of rotation should be kept aligned. An increasing variability in measurements with increasing load and torque was found. The recommendation is to use a preload for patients using more force in the movement, to make sure a preset speed is not exceeded, which contributes to more reliable measurements. / Utvärderingen av axelabduktion och flexionsstyrka är viktig i rehabiliteringen efter skada i axelleden. Syftet med det här arbetet är att bedöma intra- och interbedömartillförlitligheten hos mätdata från en isokinetisk dynamometer som används för att utvärdera axelabduktion och flexionsstyrka, med syftet att identifiera källor till mätfel och föreslå förbättringar. Mätdatat samlades in av en forskargrupp vid Karolinska Institutet och innehöll belastnings- och vridmomentdata från tretton friska försökspersoner i åldrarna 25 till 87 år. Mätningarna utfördes vid två tillfällen med en veckas mellanrum. Systematiska skillnader mellan tillfällena analyseras med Shapiro Wilk-testet, det parade t-testet och Wilcoxon signed rank test. Mätningarnas överensstämmelse analyseras kvantitativt med hjälp av variationskoefficienten och Bland Altman-diagrammet, samt kvalitativt med hjälp av intraklasskorrelationskoefficienten. En signifikant systematisk skillnad i axelabduktion och flexionsbelastningsmätningar hittades, och rekommendationen för att förhindra detta är att komponenter bör kalibreras på ett standardiserat sätt. Mätningarna visade på en varierande tillförlitlighet inom och mellan mättillfällen och att efter bekantskap med den isokinetiska dynamometern, förbättrades repeterbarheten. Slutsatserna indikerar ett behov av ett standardiserat protokoll för patientutbildning och placering. Mätningar från positionssensorn bidrog till mer slumpmässiga vridmomentvärden. För att förbättra repeterbarheten i mätningar från positionssensorn bör rotationsaxeln hållas i linje. En ökande variation mellan mättillfällen med ökande belastning och vridmoment hittades. Rekommendationen är att använda en förspänning för patienter som använder mer kraft i rörelsen, för att säkerställa att en förinställd hastighet inte överskrids, vilket bidrar till mer tillförlitliga mätningar.