When children are diagnosed with developmental delays, their parents may experience psychological turmoil similar to that experienced by suicidal individuals. We sought to identify adaptive characteristics that may or may not be present in parents of children with developmental delays. Forty-nine children, with disabilities ranging from mild to severe, and their parents, were administered the Reasons for Living Inventory. No significant differences were revealed between men and women, or between individuals in 1-parent versus 2-parent households. The experience of having a disabled child may help to strengthen adaptive characteristics and, possibly, reduce the risk of suicide.

OBJECTIVE: To investigate the cross-cultural validity of international Dutch-English comparisons when using the Dutch Rivermead Mobility Index (RMI), and the intra-test reliability and construct validity of the Dutch RMI. METHODS: Cross-cultural validity was studied in a combined data-set of Dutch and English patients undergoing rehabilitation after stroke, who were assessed with the Dutch version of the RMI and the original English RMI, respectively. Mokken scale analysis was used to investigate unidimensionality, monotone homogeneity model fit, and differential item functioning between the Dutch and the English RMI. Intra-test reliability and construct validity were studied in the Dutch patients by calculating the reliability coefficient and correlating the Dutch RMI and the Dutch Barthel Index. RESULTS: The RMI was completed for Dutch (n = 200) and English (n = 420) patients after stroke. The unidimensionality and monotone homogeneity model fit of the RMI were excellent: combined Dutch-English data-set (coefficient H = 0.91); Dutch data-set (coefficient H = 0.93); English data-set (coefficient H = 0.89). No differential item functioning was found between the Dutch and the English RMI. The intra-test reliability of the Dutch RMI was excellent (coefficient rho = 0.97). In a sub-sample of patients (n = 91), the Dutch RMI correlated strongly with the Dutch Barthel Index (Spearman's correlation coefficient rho = 0.84). CONCLUSION: The Dutch RMI allows valid international Dutch-English comparisons, and has excellent intra-test reliability and construct validity.

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The purpose of this study is to show principles of TAT card pull are applicable to object relations theory, and card pull effects are greater in subjects with greater impairments. Stories of physically abused and control child and adolescent subjects were evaluated on object relations scales of the SCORS (Westen et al., 1985). Scores varied systematically as a function of card stimulus characteristics. Analysis of scales assessing internalization of self supported stimulus inhibition interpretation while scales measuring views of others or individual affective experiences advanced stimulus pull explanation. Abused individuals' response patterns were similar to controls except on CR. Results of this study may increase TAT utility for evaluating object relations functioning by guiding card selection.

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Da Prüfungen und Tests häufig dazu dienen, den Zugang zu Bildungsprogrammen zu steuern und die Grundlage zur Abschlussvergabe am Ende von Bildungsprogrammen bilden, ist ihre Fairness und Validität von größter Bedeutung. Ein kontrovers diskutierter Aspekt standardisierter Tests ist die Verwendung von Zeitlimits. Unabhängig davon ob eine Testadministration Zeitdruck hervorrufen soll oder nicht, sollten Testentwickler:innen in die Lage versetzt werden, den Zeitdruck einer Testadministrationen explizit gestalten zu können. Zu diesem Zweck schlägt van der Linden (2011a, 2011b) einen Ansatz zur Kontrolle des Zeitdrucks von Tests in der automatisierten Testhefterstellung (ATA) unter Verwendung von Mixed Integer Linear Programming und eines lognormalen Antwortzeitmodells vor. Dabei hat der Ansatz von van der Linden jedoch eine zentrale Limitation: Er ist auf das zwei-parametrische lognormale Antwortzeitmodell beschränkt, das gleiche Geschwindigkeits-Sensitivitäten (d.h. Faktorladungen) für alle Items annimmt. Diese Arbeit zeigt, dass ansonsten parallele Testhefte mit unterschiedlichen Geschwindigkeits-Sensitivitäten für bestimmte Testteilnehmende unfair sind. Darüber hinaus wird eine Erweiterung des van der Linden-Ansatzes vorgestellt, die unterschiedliche Geschwindigkeits-Sensitivitäten von Items in ATA berücksichtigt. Weiter wird diskutiert, wie Testhefte mit identischen, aber unterschiedlich angeordneten Items zu Fairness-Problemen aufgrund von Item-Positionseffekten führen können und wie dies verhindert werden kann. Die vorliegende Arbeit enthält zusätzlich Anleitungen zur Verwendung des R-Pakets eatATA für ATA und zur Verwendung von Stan und rstan für Bayesianische hierarchische Antwortzeitmodellierung. Abschließend werden Alternativen, praktische Implikationen und Grenzen der vorgeschlagenen Ansätze diskutiert und Vorschläge für zukünftige Forschungsthemen gemacht. / As examinations and assessments are often used to control access to educational programs and to assess successful participation in an educational program, their fairness and validity is of great importance. A controversially discussed aspect of standardized tests is setting time limits on tests and how this practice can result in test speededness. Regardless of whether a test should be speeded or not, being able to deliberately control the speededness of tests is desirable. For this purpose, van der Linden (2011a, 2011b) proposed an approach to control the speededness of tests in automated test assembly (ATA) using mixed integer linear programming and a lognormal response time model. However, the approach by van der Linden (2011a, 2011b) has an important limitation, in that it is restricted to the two-parameter lognormal response time model which assumes equal speed sensitivities (i.e., factor loadings) across items. This thesis demonstrates that otherwise parallel test forms with differential speed sensitivities are indeed unfair for specific test-takers. Furthermore, an extension of the van der Linden approach is introduced, which incorporates speed sensitivities in ATA. Additionally, test speededness can undermine the fairness of a test if identical but differently ordered test forms are used. To prevent that the score of test-takers depends on whether easy or difficult items are located at the end of a test form, it is proposed that the same, most time intensive items should be placed at the end of all test forms. The thesis also provides introductions and tutorials on using the R package eatATA for ATA and using Stan and rstan for Bayesian hierarchical response time modeling. Finally, the thesis discusses alternatives, practical implications, and limitations of the proposed approaches and provides an outlook on future related research topics.

Qualitative research has suggested that spousal carers of someone with dementia differ in terms of whether they perceive their relationship with that person as continuous with the premorbid relationship or as radically different, and that a perception of continuity may be associated with more person-centered care and the experience of fewer of the negative emotions associated with caring. The aim of the study was to develop and evaluate a quantitative measure of the extent to which spousal carers perceive the relationship to be continuous. METHODS: An initial pool of 42 questionnaire items was generated on the basis of the qualitative research about relationship continuity. These were completed by 51 spousal carers and item analysis was used to reduce the pool to 23 items. The retained items, comprising five subscales, were then administered to a second sample of 84 spousal carers, and the questionnaire's reliability, discriminative power, and validity were evaluated. RESULTS: The questionnaire showed good reliability: Cronbach's alpha for the full scale was 0.947, and test-retest reliability was 0.932. Ferguson's delta was 0.987, indicating good discriminative power. Evidence of construct validity was provided by predicted patterns of subscale correlations with the Closeness and Conflict Scale and the Marwit-Meuser Caregiver Grief Inventory. CONCLUSION: Initial psychometric evaluation of the measure was encouraging. The measure provides a quantitative means of investigating ideas from qualitative research about the role of relationship continuity in influencing how spousal carers provide care and how they react emotionally to their caring role.

Patients have the potential to provide a rich source of information on both organisational aspects of safety and patient safety incidents. This project aims to develop two patient safety interventions to promote organisational learning about safety - a patient measure of organisational safety (PMOS), and a patient incident reporting tool (PIRT) - to help the NHS prevent patient safety incidents by learning more about when and why they occur. METHODS: To develop the PMOS 1) literature will be reviewed to identify similar measures and key contributory factors to error; 2) four patient focus groups will ascertain practicality and feasibility; 3) 25 patient interviews will elicit approximately 60 items across 10 domains; 4) 10 patient and clinician interviews will test acceptability and understanding. Qualitative data will be analysed using thematic content analysis.To develop the PIRT 1) individual and then combined patient and clinician focus groups will provide guidance for the development of three potential reporting tools; 2) nine wards across three hospital directorates will pilot each of the tools for three months. The best performing tool will be identified from the frequency, volume and quality of reports. The validity of both measures will be tested. 300 patients will be asked to complete the PMOS and PIRT during their stay in hospital. A sub-sample (N = 50) will complete the PMOS again one week later. Health professionals in participating wards will also be asked to complete the AHRQ safety culture questionnaire. Case notes for all patients will be reviewed. The psychometric properties of the PMOS will be assessed and a final valid and reliable version developed. Concurrent validity for the PIRT will be assessed by comparing reported incidents with those identified from case note review and the existing staff reporting scheme. In a subsequent study these tools will be used to provide information to wards/units about their priorities for patient safety. A patient panel will provide steering to the research. DISCUSSION: The PMOS and PIRT aim to provide a reliable means of eliciting patient views about patient safety. Both interventions are likely to have relevance and practical utility for all NHS hospital trusts.