Social-emotional learning (SEL) measures assessing social-emotional learning and character development across a broad array of constructs have been developed but lack construct validity. Determining the efficacy of educational interventions requires structurally valid measures which are generalizable across settings, gender, and time. Utilizing recent factor analytic methods, the present study extends validity literature for SEL measures by investigating the structural validity and generalizability of the Social-Emotional and Character Development Scale (SECDS) with a large sample of children from schools in Belize (n = 1877, ages 8 to13). The SECDS exhibited structural and generalizability evidence of construct validity when examined under exploratory structural equation modeling (ESEM). While a higher order confirmatory factor structure with six secondary factors provided acceptable fit, the ESEM six-factor structure provided both substantive and methodological advantages. The ESEM structural model situates the SECDS into the larger body of SEL literature while also exhibiting generalizability evidence over both gender and time.

Rationale: Delirium is a serious, morbid condition affecting 2.6 million older Americans annually. A major problem plaguing delirium research is difficulty in identification, given a plethora of existing tools. The lack of consensus on key features and approaches has stymied progress in delirium research. The goal of this project was to use advanced measurement methods to improve delirium’s identification. Aims and Findings: (1) Determine the 4 most commonly used and well-validated instruments for delirium identification. Through a rigorous systematic review, I identified the Confusion Assessment Method (CAM), Delirium Observation Screening Scale (DOSS), Delirium Rating Scale-Revised-98 (DRS-R-98), and Memorial Delirium Assessment Scale (MDAS). (2) Harmonize the 4 instruments to generate a delirium item bank (DEL-IB), a dataset containing items and estimates of their population level parameters. In a secondary analysis of 3 datasets, I equated instruments on a common metric and created crosswalks. (3) Explore applications of the harmonized item bank through several approaches. First, identifying different cut-points that will optimize: (a) balanced high accuracy (Youden’s J-Statistic), (b) screening (sensitivity), and (c) confirmation of diagnosis (specificity) in identification of delirium. Second, comparing performance characteristics of example forms developed from the DEL-IB. Impact: The knowledge gained includes harmonization of 4 instruments for identification of delirium, with crosswalks on a common metric. This will pave the way for combining studies, such as meta-analyses of new treatments, essential for developing guidelines and advancing clinical care. Additionally, the DEL-IB will facilitate creating big datasets, such as for omics studies to advance pathophysiologic understanding of delirium.

L’expérience d’un cancer à l’enfance peut entraîner différents impacts physiques, neurologiques et émotionnels, autant à court terme qu’à long terme. Les survivants d’une leucémie lymphoblastique aigüe (LLA) sont une population vulnérable à la détresse émotionnelle, qui peut perdurer et même s’aggraver avec le temps. Malheureusement, les outils de repérage de la détresse émotionnelle utilisés en clinique, tel que le Thermomètre de Détresse (TD), génèrent un niveau élevé d’erreurs. L’objectif de cette thèse est d’étudier la détresse émotionnelle des survivants d’une LLA pédiatrique, en étudiant la caractérisation et la détection de cette détresse, ainsi que les facteurs explicatifs de cette détresse. La présente thèse est composée de quatre articles. Le premier article a pour objectif de caractériser un niveau de détresse émotionnelle élevé, mesuré par le Thermomètre de Détresse (TD), au sein de 202 survivants de LLA pédiatrique. Les résultats montrent qu’une cotation élevée au TD est associée à l’affectivité négative chez les enfants et les adultes, et à l’anxiété chez les adultes. Également, un niveau de détresse faible est associé à l’affectivité positive chez les adultes. Après avoir davantage défini les particularités de la détresse émotionnelle des survivants de LLA pédiatrique, nous souhaitions étudier le repérage de cette détresse. Le second article a comme objectif d’identifier une stratégie de repérage de la détresse émotionnelle en deux étapes, en utilisant le TD comme première étape et une question sur les émotions (peur, tristesse, inquiétude, colère, fatigue) comme deuxième étape. L’étude a été effectuée auprès de 255 survivants de LLA pédiatrique. Cette étude montre qu’une stratégie en deux étapes (TD combiné à la question sur la tristesse ou à celle sur l’inquiétude) repère plus efficacement les survivants ne rapportant pas de détresse ainsi que les survivants rapportant une détresse élevée, comparativement à l’utilisation du TD seul au seuil 4, pour le repérage de la détresse anxio-dépressive (dépression et/ou anxiété). Après avoir répondu à l’objectif de détection de la détresse, nous souhaitions étudier les facteurs explicatifs d’une détresse élevée. En nous basant sur les appuis de la littérature, nous souhaitions étudier particulièrement l’association entre les traitements de corticostéroïdes et la détresse émotionnelle. Le troisième article est une revue de littérature qui vise à synthétiser les résultats sur l’association entre la présence d’une détresse émotionnelle élevée rapportée par les patients ou les survivants de LLA pédiatrique, et la dose cumulative de corticostéroïdes reçue durant les traitements. Les résultats de cette étude ne permettent pas d’identifier une association significative entre les différentes dimensions de la détresse émotionnelle (émotions, comportements, neurocognitions, fatigue/sommeil) et la dose cumulative de corticostéroïdes reçue durant les traitements. Toutefois, cette revue de littérature a permis d’identifier des recommandations pour améliorer l’information divulguée dans les études, afin de faciliter la synthèse des résultats de la littérature. Finalement, afin d’étudier de manière empirique les différents facteurs reliés aux traitements de radiothérapie, de chimiothérapie et de corticothérapie, associés à la détresse émotionnelle, nous avons effectué la quatrième étude. Le quatrième article est une étude empirique sur les facteurs explicatifs de la détresse émotionnelle de 212 survivants d’une LLA pédiatrique. Les résultats de cette étude montrent qu’il n’y a pas d’association entre les variables reliées aux traitements de radiothérapie, de chimiothérapie et de corticothérapie, et la détresse anxio-dépressive. La présente thèse a permis d’apporter un éclairage sur la caractérisation et la détection de la détresse émotionnelle des survivants d’une LLA pédiatrique. Les résultats prometteurs de l’efficacité d’une stratégie de repérage de la détresse en deux étapes génèrent des implications cliniques importantes et novatrices pour les cliniques de cancérologie. Des recherches ultérieures sur l’amélioration du repérage de la détresse, ainsi que sur l’identification des facteurs explicatifs de cette détresse, autant chez les patients que chez les survivants des différents types de cancers pédiatriques, sont nécessaires afin de mieux comprendre, prévenir et traiter cette détresse émotionnelle élevée, rapportée par le groupe de survivants les plus vulnérables. / Pediatric cancer is associated with different physical, neurological, and emotional short- and long-term adverse effects. Survivors of childhood acute lymphoblastic leukemia (ALL) are vulnerable to emotional distress, which could persist or increase over time. Unfortunately, the existing routine screening tools of emotional distress, such as the Distress Thermometer (DT) generate high rates of errors. The aim of this thesis is to study emotional distress among childhood ALL survivors. We studied the description and the screening of emotional distress, and the identification of predictive factors of distress. This thesis is composed of four articles. The objective of the first article is to describe the characteristics of a high level of emotional distress measured by the DT, among 202 childhood ALL survivors. The results suggest that a high level of distress on the DT is associated with negative affectivity among children and adults, and with anxiety among adults. Also, a low level of distress is associated with positive affectivity among adults. After defining emotional distress’s characteristics among pediatric ALL survivors, we wanted to study emotional distress’ screening. The objective of the second article is to study the efficacy of a two-step strategy, combining the DT at step one, and one question on emotions (fear, sadness, concerns, anger, fatigue) at step two. The study is conducted among 255 childhood ALL survivors. The results show that a two-step strategy (DT combined with emotional question of sadness or concerns) is more effective than the DT used alone at the cut point 4, to screen mixed anxious-depressive distress (depression and/or anxiety). After responding to the objective of distress’ screening, we wanted to study the predictive factors associated to emotional distress. Based on the literature support, we desired to study the association between corticosteroids ALL treatments and emotional distress. The third article is a literature review. The aim of this review is to synthesize the literature results on the association between presence of elevated emotional distress among childhood ALL patients and survivors, and the cumulative doses of corticosteroids received during ALL treatments. The results do not suggest association between cumulative doses of corticosteroids and any domains of emotional distress (emotions, behaviours, neurocognitions, and fatigue/sleep). However, this review has allowed us to identify recommendations for future studies, to improve the synthesis of research results. Finally, we wanted to empirically study the different treatment related factors (radiotherapy, chemotherapy, corticotherapy) associated to emotional distress. The fourth study is an empirical study on predictive factors of emotional distress among 212 childhood ALL survivors. The results show that there is no association between treatment related variables (radiotherapy, chemotherapy and corticotherapy) and mixed anxious-depressive distress. This thesis has allowed to different contributions on the characterization and the screening of emotional distress among childhood ALL survivors. The results are promising. The efficacy of the screening two-step strategy for emotional distress. These results have significant and innovative clinical implications. Future researches are needed to improve the screening of emotional distress and the identification of predictive factors, both in patients and survivors of the different childhood cancer types. More experimental researches are needed to understand high level of emotional distress among patients and survivors of childhood cancer, and to prevent and treat this distress.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / The objective of this research is to assess the psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC) in order to contribute to the literature identifying validated resilience measures in low-resource settings where individuals face significant adversity. This cross-sectional study included 789 adolescent mothers who delivered at a maternity hospital in Lima, Peru. The Spanish version of the 10-item CD-RISC was used to measure resilience. Internal consistency and construct validity were assessed by evaluating individual item characteristics as well as the association of CD-RISC score with symptoms of depression, anxiety and sleep disturbance. Exploratory factor analysis (EFA) was performed to test the factorial structure of the CD-RISC. The CD-RISC was found to have good internal consistency (Cronbach’s alpha = 0.85). CD-RISC scores were positively associated with school attendance, financial hardship, and history of childhood abuse; scores were negatively associated with household dysfunction, depression, anxiety and poor sleep quality. The results of the EFA showed that the CD-RISC contained a two-factor solution, which accounted for 46% of the variance. Overall, these findings suggest that the Spanish-language version of the CD-RISC-10 is an adequate measure of resilience in this population. Further research is needed to incorporate culturally-specific constructs into resilience measures. / National Institutes of Health / Revisión por pares

BACKGROUND: Of the 22 known measures of nicotine dependence (ND), none capture the overall disease severity of physical dependence alone. Instead, they capture constructs related to dependence, such as perceived risk, psychological addiction, smoker motivations, or smoking related behaviors, but none of the measures include only physical withdrawal symptoms to capture physical dependence on nicotine. AIM: To develop a range of nicotine dependence measures that capture physical dependence on nicotine. METHODS: The final measures were developed in a cross-sectional study conducted in three phases: 1) candidate item development through literature review and cognitive interviews, 2) developing and pre-testing the survey, and 3) survey administration and psychometric evaluation to validate three distinct measures. The final survey was conducted at four health clinics and three high schools. Psychometric tests used to select the final measure items included inter-item correlations, sensitivity analyses done by subgroup, item-total correlations, convergent validity tests, and confirmatory factor analysis. The final measures were evaluated using confirmatory factor analysis (CFA), internal reliability, total score distributions, and convergent validity correlations. Relative validity analyses were also conducted using a ratio of F-Statistics to compare the ability of each new measure to differentiate dependent smokers as compared previous measures. RESULTS: The final sample included 275 smokers ranging from 14 to 76 years old (mean=30.9, SD=16.2), who smoked an average of 11.5 cigarettes per day (range=0-50, SD=9.4). The sample was 86.5% white and 57.5% male. The three new measures developed included: 1) the 4-item Withdrawal-Induced Craving Scale (WICS) used to capture severity of craving, the most common physical withdrawal symptom; 2) the 12- item Nicotine Withdrawal Symptom Checklist (NWSC), which measures both overall disease severity and the severity of a comprehensive list of individual physical withdrawal symptoms including withdrawal-induced craving, anger, anxiety, depression, headache, insomnia, loss of focus, restlessness, and stress; and 3) the 6-item brief NWSC (NWSC-b), a short measure which only captures overall disease severity. All of the new measures exhibited a unidimensional factor structure loading highly on a single factor (thought to be physical dependence). They also correlated highly (over 0.6) and significantly (p<0.001) to a battery of convergent validity indices including four widely used nicotine dependence measures: Hooked on Nicotine Checklist (HONC), the Autonomy Over Tobacco Scale (AUTOS), the Fagerström Test for Nicotine Dependence (FTND), and self-rated addiction. CONCLUSION: The WICS, NWSC, and NWSC-b provide three distinct validated tools that can be used by researchers, clinicians, and educators to track the progression of physical dependence on nicotine across a range of smoking behaviors and histories.

Background: The Institute of Medicine and numerous other healthcare organizations have identified the severe shortage of underrepresented minority healthcare professionals graduating into the workforce, and have called for a radical transformation of healthcare educational programs to make them more welcoming and supportive of underrepresented minority students. Purpose: The purpose of the study was to develop a reliable and valid measure of faculty response patterns to the needs of underrepresented minority nursing students. Theory: Yoder’s patterns of faculty interaction formed the conceptual basis for the development of this instrument. Methods: A mixed-method approach was used to develop this instrument. The first phase (item development phase) consisted of work with underrepresented minority nurse and faculty focus groups, individual interviews, and content experts to develop items. During the second phase of this study, psychometric evaluation of 134 survey responses from nursing faculty in the Northeast was conducted. Results: A 10-item scale was developed that measured faculty engagement with underrepresented minority nursing students. The Cronbach alpha for the EFURMS scale was .81. Principle component factor analysis with varimax rotation revealed a 3 factor solution that explained 66% of the variance in engagement with underrepresented minority students. The Cronbach alpha for the 3 factors ranged from .72-.78. The EFURM scale did not demonstrate ceiling or floor effects, or social desirability bias. More positive scores (higher EFURMS Scores) were associated with older faculty who had been teaching longer and had more experience teaching underrepresented minority students. Conclusion and Implications: The results of this study provide preliminary evidence for the reliability (internal consistency) and validity (content, criterion-related, and construct validity) of the 10-item EFURMS Scale. Further testing is needed to test the usefulness of this scale with wider samples of nursing faculty. With further development, the EFURMS Scale could be used to evaluate faculty readiness to engage with underrepresented minority students, and with studies to test the efficacy of interventions designed to improve faculty engagement with underrepresented minority students. A major finding of this study was the significance of age, years teaching, and experience teaching underrepresented minority students with EFURMS Scores suggesting that younger or less experienced faculty could benefit from mentoring by more seasoned faculty who have greater experience teaching underrepresented minority students.

Indiana University-Purdue University Indianapolis (IUPUI) / Despite outstanding employment opportunities and high demand to address the global nursing shortage, men who consider becoming nurses are less likely to enroll in and to graduate from nursing programs. Many barriers that men commonly encounter during nursing education have been found in the literature; however, there is a lack of theoretically based research that examines factors that help men succeed as they study nursing. Based on a conceptual model derived from O’Lynn’s construct of male friendliness in nursing education and Frankl’s theory of will to meaning and purpose in life, this study examined facilitators for men during nursing education. This was accomplished through the development and psychometric testing of the Survey of Facilitators for Men (SFM) in a sample of 145 men in nursing. Strong evidence of reliability and validity was provided for the SFM consisting of three subscales (Internal facilitators, External Connections facilitators, and Institutional facilitators). Internal facilitators consist of intrapersonal strengths, experiences, and motivators. External Connections facilitators are interpersonal connections that emerge from relationships that men develop. Institutional facilitators involve structural or organizational aspects of institutions that ease barriers. Testing provided satisfactory evidence of internal consistency (α = .85) and test-retest reliability (intraclass coefficient = .72; confidence interval = 0.57–0.83). Dimensionality of three facilitator subscales was supported by Principle Axis Factoring with Varimax rotation and satisfactory factor loadings (.49–.72). Support for the conceptual model was provided using multiple regressions explaining 17% of the variance in purpose in life [F(4, 140) = 6.99, p < .001], 13% of the variance in GPA [F(6, 114) = 2.88, p < .01], and 49% of the variance in perception of nursing success [F(9, 128) = 13.42, p < .001]. Purpose in life was associated with Internal facilitators and comfortable income, GPA was associated with External Connections facilitators and age at BSN, while perception of nursing success was associated with purpose in life, holding an MSN, having a comfortable income, and having children. Future research is warranted to determine the usefulness of the SFM in designing strategies to recruit and retain men in nursing programs.

Concept maps provide a way to assess how well students have developed an organized understanding of how the concepts taught in a unit are interrelated and fit together. However, concept maps are challenging to score because of the idiosyncratic ways in which students organize their knowledge (McClure, Sonak, & Suen, 1999). The construct a map or C-mapping" task has been shown to capture students' organized understanding. This "C-mapping" task involves giving students a list of concepts and asking them to produce a map showing how these concepts are interrelated. The purpose of this study was twofold: (a) to determine to what extent the use of the restricted C-mapping technique coupled with the threefold scoring rubric produced reliable ratings of students conceptual understanding from two examinations, and (b) to project how the reliability of the mean ratings for individual students would likely vary as a function of the average number of raters and rating occasions from two examinations. Nearly three-fourths (73%) of the variability in the ratings for one exam and (43 %) of the variability for the other exam were due to dependable differences in the students' understanding detected by the raters. The rater inconsistencies were higher for one exam and somewhat lower for the other exam. The person-to-rater interaction was relatively small for one exam and somewhat higher for the other exam. The rater-by-occasion variance components were zero for both exams. The unexplained variance accounted for 19% on one exam and 14% on the other. The size of the reliability coefficient of student concept map scores varied across the two examinations. A reliability of .95 and .93 for relative and absolute decision was obtained for one exam. A reliability of .88 and .78. for absolute and relative decision was obtained for the other exam. Increasing the number of raters from one to two on one rating occasion would yield a greater increase in the reliability of the ratings at a lower cost than increasing the number of rating occasions. The same pattern holds for both exams.

INTRODUCTION: Despite evidence showing that tinnitus can have a detrimental impact on significant others (SOs), no standardized self-reported measure is currently available that specifically assesses the presence of third-party disability for tinnitus. The aim of this study was to develop and assess the psychometric properties of a newly developed self-reported measure for SOs of tinnitus and assess how scores could be meaningfully interpreted. METHODS: The research consisted of two phases. During Phase I, the Consequences of Tinnitus on Significant Others Questionnaire (CTSOQ) was developed using the The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. Phase II included the assessment of psychometric properties of the CTSOQ including the construct validity, internal consistency, interpretability, and responsiveness. Pairs of 194 individuals with tinnitus and their SOs completed a series of online questionnaires. SOs completed the CTSOQ measure while individuals with tinnitus completed measures related to tinnitus distress, anxiety, depression, insomnia, and quality of life. RESULTS: A 25 item CTSOQ was developed using a formative model. The questionnaire validation process indicated good psychometric properties with an internal consistency of 0.93 and inter-item correlation of 0.60. Support was found for the construct and discriminative validity of the measure. Floor and ceiling effects were negligible. Scores can be meaningfully interpreted to indicate mild, significant, or severe effect of tinnitus on SOs. The questionnaire was also found to be responsive to treatment-related changes. CONCLUSIONS: The CTSOQ was found to have sufficient measurement properties suggesting that it is a suitable measure of third-party disability for SOs of individuals with tinnitus. Further research should be initiated to measure face validity and what scores reflect clinically meaningful change.

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.