BACKGROUND. The study of patient reported outcomes (PROs) has seen an exponential increase in recent years. In order to be useful in practice, PRO questionnaires should be evaluated for validity, reliability, and responsiveness. Responsiveness, which assesses a questionnaire’s ability to capture changes in quality of life (QOL) when they occur, has not formally been evaluated in hemophilia-specific questionnaires. PRIMARY OBJECTIVE. To evaluate the responsiveness of the Patient Reported Outcomes, Burdens, and Experiences (PROBE) questionnaire in individuals living with hemophilia A or B following events of interest. SECONDARY OBJECTIVES. To evaluate the responsiveness of PROBE over periods in which no events occur. To explore the use of regression analysis in aiding interpretability. To assess the presence of response shift in the study population. METHODS. Participants will be asked to complete PROBE, as well as questions indicating changes in QOL, following a bleed or surgical intervention, and every 6 months. Responses will be evaluated using anchor-based and distribution-based approaches. OUTCOMES. Minimally important differences (MIDs) and minimally detectable changes (MDCs) will be calculated, graphically represented, and compared to determine a single or small range of MID values. STUDY IMPLICATIONS. Understanding responsiveness will provide increased interpretability of PROBE scores. Using an MID value, one can be confident that a change in PROBE score greater than the MID is beyond measurement error and indicates a change in QOL. This will allow for the use of PROBE in future research trials of drug effectiveness and can offer patients’ perspectives on their changes in QOL when switching to novel therapies. In addition, physicians may be able to use PROBE as a method of tracking and better understanding changes in their patients’ health statuses in the clinical setting. / Thesis / Master of Science (MSc) / This project hopes to identify the responsiveness of the Patient Reported Outcomes, Burdens, and Experiences (PROBE) Questionnaire. The responsiveness of a questionnaire is its ability to detect a change in health status when one has occurred. In order to measure whether PROBE can detect these changes, participants living with hemophilia A or B will be asked to fill out the questionnaire, as well as a few questions aimed at determining if their quality of life has changed, after they have a bleed or a surgery, as well as after 6 months. Collecting this information will help us understand how much the PROBE score needs to change in order for patients to consider a small but important change in health to have occurred. This will help with interpreting the PROBE score, which could then be used in research or in hemophilia clinics across Canada.

För att organisationer skall anses vara uppdaterade och relevanta är förändring en nödvändighet. Förändringsarbetets framgång är främst beroende av de processer som uppföljs och åtgärder som vidtas vid implementeringen. Denna studie undersöker den psykosociala arbetsmiljön vid ett förändringsarbete vid en offentlig kulturverksamhet med hjälp av Kotters åttastegsmodell. Syftet är att undersöka lyfta medarbetarnas perspektiv på hur den psykosociala arbetsmiljön påverkas under en organisationsförändring. Enligt tidigare forskning är de främsta faktorerna för ett framgångsrikt förändringsarbete tydlig kommunikation kring implementeringen och organisationsledarens intresse för medarbetarnas motivation, samt att organisatoriskt lyssnande kan användas som verktyg för att öka engagemanget gentemot förändringen. Studien har en abduktiv grund och genomförandet av denna studie har involverat en datainsamling genom en enkät utformad från dimensionerna Relation och Ledarskap samt Socialt Kapital i det standardiserade enkätverktyget COPSOQ med en tillhörande öppen kvalitativ fråga. I studien deltog 53 medarbetare från den offentliga kulturverksamheten, resultatet visar på bristfällig kommunikation och delaktighet. Genom studien kan man dra slutsatser kring att förändringsarbetet vid den offentliga kulturverksamheten inte följer Kotters åttastegsmodell och att medarbetarna inte upplever sig få delta i förändringen, detta kan påverka den psykosociala arbetsmiljön negativt för medarbetarna. / For organizations to be considered up-to-date and relevant, change is a necessity. The success of the change work is primarily dependent on the processes that are followed up and measures that are taken during the implementation. This study examines the psychosocial work environment during change work at a public cultural activity using Kotter's eight-step model. The purpose is to examine the employees' perspective on how the psychosocial work environment is affected during an organizational change. According to previous research, the main factors for successful change work are clear communication about the implementation and the organizational leader's interest in employee motivation, and that organizational listening can be used as a tool to increase commitment to the change. The study has an abductive basis and the implementation of this study has involved data collection through a survey designed from the dimensions Relationship and Leadership as well as Social Capital in the standardized survey tool COPSOQ with an associated open qualitative question. 53 employees from public cultural activities participated in the study, the results show insufficient communication and participation. Through the study, it can be concluded that the change work at the public cultural activities does not follow Kotter's eight-step model and that the employees do not feel they can participate in the change, this can affect the psychosocial work environment negatively for the employees.

Beginning with a brief historical analysis of how the education system came to be and an analysis of culture, themes came forth demonstrating the White Anglo-Saxon Protestant (WASP) roots of education no longer align with the diversity of society. Parental engagement in education has been veered as a pillar of overall success; however, it was consistently view through a nonculturally responsive lens and geared toward early childhood and elementary education, leaving out high school as an equally important facet of a child’s development. Synthesizing the themes of cultural responsiveness, parental engagement, and positive relationships, a culturally responsive guide emerges to create a starting point for public high schools to serve their uniquely diverse populations in creation and promotion of parental engagement.

The purpose of this study was to identify middle level leaders' perceptions of their responsiveness to students' developmental needs and their support of staff and structures related to meeting those needs. This study also sought a broader understanding of how transition programs aligned with the developmental needs of young adolescents. A mixed-methods approach was used to address the study's research questions. Participants in the study included middle school principals and assistant principals in two Virginia school divisions. Participants completed an online questionnaire reporting their self-perceptions about their responsiveness to their students' developmental needs and their support of staff and structures related to meeting those needs. Participants rated their responsiveness to their students' developmental needs as fairly often and their responsiveness to supporting staff and structures related to those needs as falling between frequently, if not always, and fairly often. Middle school leaders also shared how their schools' transition programs aligned to their students' developmental needs in focus group interviews. Participants identified that young adolescents need additional emotional, social-emotional and organizational support during the transition to middle school. They also shared the need and desire for training to best serve young adolescents. Overall, the findings aligned with existing research underscoring the critical role middle level leaders play in meeting the developmental needs of young adolescents when transitioning to middle school. This study provided implications for middle level and school division leaders and principal prep programs to emphasize strategic, on-going, and collaborative learning opportunities to prepare middle level leaders. / Doctor of Education / The purpose of this mixed method study was to identify middle level leaders' perceptions of their responsiveness to students' developmental needs and their support of staff and structures related to meeting those needs. This study also sought a broader understanding of how schools' transition programs aligned with the developmental needs of young adolescents. Middle school principals and assistant principals from two Virginia school divisions shared their levels of responsiveness to the needs of their students and how their school sites' programs aligned with their students' needs. Middle level leaders rated their responsiveness to their students' developmental needs as fairly often and rated their responsiveness to supporting the staff and structures related to those needs as falling between frequently, if not always, and fairly often. Middle level leaders identified that during the transition to middle school, young adolescents need additional emotional, social-emotional and organizational support. They also shared the need and desire for additional training and development to best serve young adolescents. Overall, the findings aligned with existing research underscoring the critical role of the middle level leader in meeting the developmental needs of young adolescents, particularly during the transition to middle school. This study provided implications for middle level and division leaders and principal prep programs to emphasize strategic, on-going, and collaborative learning opportunities to prepare middle level leaders.

Family support programs serve vulnerable families by providing various forms of support, such as education, health services, financial assistance, and referrals to community resources. A major feature of evaluation involves assessing program effectiveness and learning from evaluation findings (Mertens and Wilson, 2012). Collaboration and cultural responsiveness are important topics in evaluation which remain largely distinct in the literature. However, evaluation capacity building provides a context for exploring possible intersections. Data about seven programs were collected via semi-structured interviews and document analysis. This study revealed that the program leaders feel that their programs are unique, complex, and misunderstood. The findings also suggest that program leaders believe that evaluation is important for program improvement and funding. Although participants did not anticipate evaluation capacity building and did not readily express a desire to develop their own evaluation skills, participants from all seven programs enthusiastically expressed interest in evaluation capacity building once explained. Although participants did not discuss cultural responsiveness as it relates to race, they expressed a need to overcome a community culture of reluctance to participate in programs and aversion to educational pursuits. Given the programs' shared population of interest, similar outcomes, and common challenges, evaluation capacity building in a group setting may give Roanoke family support program leaders the evaluation knowledge, skills, and peer support to engage in program evaluation that is both collaborative and culturally responsive. / Master of Science in Life Sciences

With more than 10% of all high school age students taking classes at a continuation school at some point in their high school career, this normally forgotten alternative learning environment is one that serves many of our most historically marginalized student groups: Black, Latinx, those with learning differences, and English Learners (Ruiz de Velasco et al., 2012). Leadership in schools is the difference-maker in student learning efficacy (Wahlstrom et al., 2010; Whitaker, 2020). This qualitative study was situated on the theoretical framework created by Madhlangobe and Gordon (2012), Culturally Responsive Leadership (CRL). The aim of this study was to build a professional profile of effective continuation school principals to help guide current practitioners, aid district leadership in identifying candidates best suited to lead their continuation schools, and how to train future leaders. Data was collected via interviews with nine principals of model continuation schools, the highest honor such a school can receive from the California Department of Education (2022a). Data showed that the study participants embodied many of the tenets set forth in CRL, but were not as strong in specific modeling and fostering cultural responsiveness in others. As described earlier, the opportunities for professional growth and collaboration across schools and principals is not well developed statewide. This area for growth is one of the most substantial opportunities the continuation school community has to improve professional practices and improve learning outcomes for all students across the state of California.

Research has validated the contribution of information sharing to performance improvement. It has also suggested that flexibility is a highly important competitive priority for those companies where demand is volatile. Several studies argue that flexibility has been recognized as a key enabler for supply chain responsiveness. However, the impact of information sharing on supplier flexibility is still unexplored, especially for the companies that operate in agile business environments such as in the automotive industry where flexibility is a strategic requirement to manage demand uncertainty. In agile supply chains, such as in the automotive industry, information sharing can play an important role in responding to demand variability. In such settings, the demand volumes generally fluctuate, and hence create production-scheduling problems for the upstream suppliers such as first-tier suppliers. Interestingly, the impact of demand fluctuations on suppliers is higher than that of Original Equipment Manufacturers (OEMs). The aim of this doctoral thesis is to investigate the role of information sharing between OEMs and first-tier suppliers, in enhancing supplier flexibility. Particularly, the research focuses on exploring the relationship between sharing demand schedules and inventory data, and volume and delivery flexibility. The questions on whether information sharing between OEMs and first-tier suppliers affect supplier flexibility remain unanswered. The following research questions have emerged:  RQ1: How does information sharing between OEMs and first-tier suppliers affect the latter's responsiveness to fluctuating demand? RQ2: What is the relationship between information sharing of OEMsʼ demand forecasts and inventory data, and suppliers’ volume and delivery flexibility? RQ3: What factors should OEMs consider to improve the sharing of demand forecasts with suppliers? The empirical part of this thesis comprises three individual studies that constitute the empirical foundations of the research problem. Each study analyzes one research question using its own methodological approach. Hence, different research methods for collecting and analyzing data were used to address the research questions. Applying different research methods is deemed advantageous because it allows for methodological rigorousness in this doctoral thesis. This thesis contributes to the body of knowledge in three dimensions—theory, method, and context. First, it contributes to the academic field of operations and supply chain management by developing a model to explain how information sharing could affect suppliers’ delivery performance. The model provides a measurement scale to measure the level of information sharing between OEMs and suppliers, and its impact on suppliers’ delivery flexibility. Second, this thesis contributes to the methods by using state-of-the-art techniques, which is partial least squares structural equation modeling (PLS-SEM) including consistent PLS, and applying advanced concepts to empirically test the proposed model. Third, this thesis has a managerial contribution to examine the concept of information sharing and flexibility at the supplier level. Investigating the problem at the supplier level may enable managers to improve short-term decisions, such as production scheduling decisions, internal production, and inventory processes, and evaluate collaboration practices with OEMs. This doctoral thesis is organized in a monograph format comprising five chapters: Introduction, Literature review, Methodology, Empirics, and Conclusion. As an outcome, several scientific articles have emerged from this thesis and have been submitted for consideration for publication in peer-reviewed journals and international conferences in the field of operations and supply chain management. These articles are listed and appended at the end of this dissertation. / <p>QC 20160302</p>

Doctor of Philosophy / Department of Human Nutrition / Craig A. Harms / The overall aim of this dissertation was to ascertain the influences of lifestyle factors on airway health in children and young adults. In Study 1 (Chapter 2) the effect of a high-fat meal on airway inflammation and hyper-responsiveness was examined. Results revealed a post-prandial increase (p<0.05) in total cholesterol (~4%), triglycerides (~93%), and exhaled nitric oxide (a marker of airway inflammation, ~19%) two-hours following a high-fat meal (74.2±4.1g fat). These novel findings suggest that a high-fat meal may contribute to impaired airway function. In study 2 (Chapter 3) we assessed the role of body fat and physical activity (PA) on airway health in prepubescent children. This study revealed that children with higher-body-fat levels (>21%), who were not meeting current PA recommendations, experienced greater (p<0.05) amounts of post-exercise airway narrowing (FEV1, forced expiratory volume in 1-second, ~11%), as compared to children with lower-body-fat (<21%), who were meeting PA guidelines. These findings suggest that elevated adiposity and low PA levels may place children at risk for development of asthma and asthma-like symptoms. In study 3 (Chapter 4), based on study 2 results, we assessed the impact of 8 weeks of high-intensity interval training on airway health in children who were not meeting PA guidelines. We determined that high-intensity training significantly increased V02max (~24%), and decreased total cholesterol (~11%) and LDL cholesterol (~35%). Additionally, we found improvements (p<0.05) in ∆FEV1 both post-exercise (pre: -7.6±2.2%, post: -1.3±1.8%) and post-eucapnic voluntary hyperventilation (pre: -6.7±2.2%, post: -1.4±1.5%) with training. Further, Lower-body-fat and higher V02max subjects experienced significantly greater improvement in ∆FEV1 following training than higher-body-fat and lower V02max subjects (r=-0.80, r=0.73, respectively). These results suggest that in children, high-intensity training can ameliorate the negative health consequences of inactivity. However, increased body fat, and low V02max levels may constrain these improvements. This series of studies underscores the importance of dietary habits, body composition, and PA for airway health in children and young adults. These findings may be useful in determining policies and practices impacting children’s health, and could facilitate protocol development for prevention of asthma-like symptoms.

Attempts to assess psychological stress rely heavily upon subjective techniques which measure changes in perceived mental loading and situational awareness (Hart and Staveland 1988, Reid and Nygren 1988, Lemyre and Tessier 2003, 1998). Although quantitative methodologies do exist, for example monitoring changes in the cardiopulmonary system (Gelfand et al. 2004, Harada et al. 2006), such parameters are subject to influence by factors other than stress. Psychological stress is known to influence the effectiveness of the innate immune system, leading to an increased risk of infection and immune-related disease (Dhabhar et al. 1996, Boscarino et al. 1999, Altemus et al. 2006). Leukocytes, primarily neutrophils have been identified as an essential component of this mechanism - periods of increased psychological stress have been shown to stimulate neutrophils to release reactive oxygen species into surrounding healthy tissues (Mian et al. 2003). The exact biochemical pathways by which this occurs have not yet been fully elucidated. However, this mechanism has become the basis for a novel in vitro technique (McLaren et al. 2003) which has the potential and sensitivity to rapidly quantify and discriminate between changes in psychological stress, resulting from exposure to short-term low-level everyday life-stressors. Aims The overall aim of this research was to further explore the relationship between short-term psychological stress and altered immune responsiveness. Leukocyte coping capacity (LCC) is a luminol-dependent chemiluminescent technique for the assay of reactive oxygen species production in whole blood samples. The feasibility of applying this test as an objective, quantitative, diagnostic measure of altered mental workload (mental stress), in the assessment of ergonomics within automotive research and development was examined. Methods Leukocyte activity was determined from whole blood, using a luminol-dependent, in vitro, chemiluminescent technique referred to as Leukocyte Coping Capacity (LCC). 2 The technique measures reactive oxygen species production following phorbol 12-myristate 13-acetate (PMA) stimulation. Subjective psychological measures, including likert scales and the NASA task load index were employed to assess perceived stress and altered mental workload. Other traditional physiological parameters including heart rate, systolic and diastolic blood pressure and core body temperature were also measured. The ability of each parameter to detect and discriminate between related short-term stressors was investigated, and results were correlated with post-test changes in leukocyte activity. To investigate the mechanism of stress induced leukocyte activation, standard ELISA was used to assess post-stressor plasma concentration changes in nine mediators including Adrenaline, Noradrenaline, Cortisol, E-Selectin, L-Selectin, Interleukin-1β, Interleukin-6, Endothelin-1, and Tumour Necrosis Factor-α. All 5 studies involved the use of mental stressors that were associated with either driving or the ergonomics of driving. Participants were moderately fit and healthy, aged between 20 and 65 years. Study one assessed the ability of the LCC technique to objectively discriminate between two closely related stressors (performing a simple manoeuvre in two different vehicles). Study two investigated leukocyte sensitivity, by testing whether a quantifiable response was elicited following exposure to a low-level stressor lasting seconds. The third study was used to explore the mechanism of leukocyte activation following short-term low-level stress. In addition to testing the viability of leukocyte responsiveness as an objective quantitative ergonomic assay for use within the motor industry, study four investigated how the magnitude of leukocyte responsiveness changed following repeated exposure to the same stressor. The final study used leukocyte reactivity to investigate how mental loading was affected during the interaction with three different motor vehicle control interfaces, whilst simultaneously maintaining lane discipline within a simulated driving environment.

Background: The ability to measure health and the value of improving or declining health is crucial to the evaluation of health care interventions. Many generic and disease specific health status measures exist for use in patients with rheumatoid arthritis (RA). The Overall Status in Rheumatoid Arthritis (OSRA) measure is a new and simple measure with early evidence of construct validity. Generic health profiles with attached utility weights such as the EuroQol EQ-5D and the SF-6D (calculated from the Medical Outcome Study 36-item short-form health survey) allow the quantification of a patient's health relative to perfect health and death, and can be used to estimate quality adjusted life years (QALYs). The EQ-5D is extensively used in RA, but has potential limitations. The SF-6D appears to have potential, but needs further evaluation. The aim of this thesis was to assess the validity and responsiveness of the EQ5D, SF-6D and OSRA in UK RA patients, and compare the performance and implications of the use of the EQ-5D and SF-6D.Methods and subjects: Patient data were obtained from three sources; the Steroids in Very Early Arthritis (STIVEA) (n=256) and British Rheumatoid arthritis Outcome Study Group (BROSG) (n=466) randomised controlled trials, and the British Society for Rheumatology Biologics Register (BSRBR) (n=129). The data used included lifestyle and demographic factors, disease activity (DAS28), functional disability (HAQ), X-rays to assess erosive damage, the EQ-5D and the SF-6D. The OSRA was collected only in the BROSG trial. Visual analogue scales (VAS) of pain and fatigue were collected in BROSG and STIVEA. Construct validity was tested by correlating the EQ-5D, SF-6D and OSRA with a range of outcome measures for RA. Responsiveness to change was assessed using minimum important differences (MID), effect size (ES) and standardised response means (SRM), and compared using ratios. EQ-5D profiles placing arthritis patients in utility states 'worse than death' (negative scores) were described and assessed using linear and logistic regression. The implications of using the EQ-5D and SF-6D in economic evaluation were compared by cost-effectiveness analyses of the BROSG trial. Results: The correlation of the EQ-5D and SF-6D was moderate to high (0.67). Both measures had moderate to high correlations with disease activity, physical function, joint damage and fatigue. The OSRA Activity (OSRA-A) and Damage (OSRA-D) correlated strongly with measures of related aspects of disease. The EQ-5D, SF-6D and OSRA discriminated between known differences in health status across groups defined by social deprivation and disease activity. The EQ-5D MID was 0.04 for improvement and 0.10 for deterioration. The SF-6D MID was 0.04 in both directions. The SF-6D was more responsive to improvement (EQ-5D: SF-6D ES ratio 0.78-0.88) and the EQ-5D more responsive to deterioration (ES ratio 1.14) in health. The OSRA-A was the most sensitive disease specific measure in the BROSG trial, and the OSRA-D was more responsive than the HAQ. The factors associated with being in a 'worse than death' health state were male gender, the HAQ, SF-36 mental composite scale, pain VAS, and erythrocyte sedimentation rate (a marker of inflammation). Pain was the predominant factor and was scored at the most extreme level in every worse than death profile. The cost-effectiveness analyses (BROSG trial), found net quality adjusted life years (QALYs) were greater for the EQ-5D (0.07) than the SF-6D (0.05), but had higher variance than the SF-6D. Conclusions: The EQ-5D and SF-6D appear valid and responsive to changes in health in RA, but measure subtly different aspects of health. There are issues with both measures, and cost-effectiveness conclusions of a study could differ according to which measure was used. The EQ-5D may be more likely to demonstrate that an intervention is cost effective than the SF-6D, due to its larger mean change in response to change in health status. The OSRA is valid for use in RA and its responsiveness suggests potential for inclusion in clinical trials.