School reform programs focus on making educational changes; however, research on interventions past the funded implementation phase to determine what was sustained is rarely done (Beery, Senter, Cheadle, Greenwald, Pearson, et al., 2005). This study adds to the research on sustainability by determining what instructional practices, if any, of the Teaching SMART[reg] professional development program that was implemented from 2005-2008 in elementary schools with teachers in grades third through eighth were continued, discontinued, or adapted five years post-implementation (in 2013). Specifically, this study sought to answer the following questions: What do teachers who participated in Teaching SMART[reg] and district administrators share about the sustainability of Teaching SMART[reg] practices in 2013? What teaching strategies do teachers who participated in the program (2005-2008) use in their science classrooms five years post-implementation (2013)? What perceptions about the roles of females in science, technology, engineering, and mathematics (STEM) do teachers who participated in the program (2005-2008) have five years later (2013)? And, What classroom management techniques do the teachers who participated in the program (2005-2008) use five years post implementation (2013)? A mixed method approach was used to answer these questions. Quantitative teacher survey data from 23 teachers who participated in 2008 and 2013 were analyzed in SAS v. 9.3. Descriptive statistics were reported and paired t-tests were conducted to determine mean differences by survey factors identified from an exploratory factor analysis, principal axis factoring, and parallel analysis conducted with teacher survey baseline data (2005). Individual teacher change scores (2008 and 2013) for identified factors were computed using the Reliable Change Index statistic. Qualitative data consisted of interviews with two district administrators and three teachers who responded to the survey in both years (2008 and 2013). Additionally, a classroom observation was conducted with one of the interviewed teachers in 2013. Qualitative analyses were conducted following the constant comparative method and were facilitated by ATLAS.ti v. 6.2, a qualitative analysis software program. Qualitative findings identified themes at the district level that influenced teachers' use of Teaching SMART[reg] strategies. All the themes were classified as obstacles to sustainability: economic downturn, turnover of teachers and lack of hiring, new reform policies, such as Race to the Top, Student Success Act, Common Core State Standards, and mandated blocks of time for specific content. Results from the survey data showed no statistically significant difference through time in perceived instructional practices except for a perceived decrease in the use of hands-on instructional activities from 2008 to 2013. Analyses conducted at the individual teacher level found change scores were statistically significant for a few teachers, but overall, teachers reported similarly on the teacher survey at both time points. This sustainability study revealed the lack of facilitating factors to support the continuation of reform practices; however, teachers identified strategies to continue to implement some of the reform practices through time in spite of a number of system-wide obstacles. This sustainability study adds to the literature by documenting obstacles to sustainability in this specific context, which overlap with what is known in the literature. Additionally, the strategies teachers identified to overcome some of the obstacles to implement reform practices and the recommendations by district level administrators add to the literature on how stakeholders may support sustainability of reform through time.

Individuals with dyslexia have an unexpected difficulty learning to read. This difficulty produces other effects, such as poor reading attitudes, meaning many choose not to read. Reading is a valuable source of information and entertainment, therefore individuals with dyslexia require better reading support. This study attempted to develop an intervention to improve reading attitudes using video self-modelling (VSM). VSM involves individuals watching carefully created videos of themselves correctly performing target behaviours. During this 1 month intervention, 14 participants (13 male and 1 female) aged 9-14 who had dyslexia were asked to watch a weekly video of themselves silently reading one of four types of material: academic digital, academic print, recreational digital or recreational print. The participants’ reading attitudes and ability were measured before and after the intervention using the Survey of Adolescent Reading Attitudes and the Wide Range Achievement Test–Fourth Edition, respectively. Their reading habits and affect while reading (as a proxy measure of reading attitudes) were monitored during the intervention using a daily reading diary. This study did not detect any systematic or reliable changes in reading habits, affect while reading, reading attitudes and reading skills. This may have been due to limitations in the procedure, or it is possible that VSM cannot affect attitudes and that reading attitudes alone do not have a strong influence on ability. Consequently, future research should use VSM to help individuals with dyslexia by focusing on specific reading skills, such as phonological awareness.

Yes / We aimed to co-produce and validate an accessible, evidence-based questionnaire measuring 'living well' with dementia that reflects the experience of people with mild-to-moderate dementia. Nine people with dementia formed a co-production group. An initial series of workshops generated the format of the questionnaire and a longlist of items. Preliminary testing with 53 IDEAL cohort participants yielded a shortlist of items. These were tested with 136 IDEAL cohort participants during a further round of data collection and assessed for reliability and validity. The co-production group contributed to decisions throughout and agreed the final version. An initial list of 230 items was reduced to 41 for initial testing, 12 for full testing, and 10 for the final version. The 10-item version had good internal consistency and test-retest reliability, and a single factor structure. Analyses showed significant large positive correlations with scores on measures of quality of life, well-being, and satisfaction with life, and expected patterns of association including a significant large negative association with depression scores and no association with cognitive test scores. The co-produced My Life Questionnaire is an accessible and valid measure of 'living well' with dementia suitable for use in a range of contexts. / This work was supported by the Economic and Social Research Council, National Institute for Health and Care Research (ES/L001853/2), and Alzheimer’s Society (348, AS-PR2-16-001).

There is very little in the literature about the sensitivity of norm-referenced tests to growth of diverse groups of test takers, particularly low-achieving test takers, who operate at the lowest 15 percentile of their peers. To bridge the knowledge gap, this study examined the sensitivity to growth of norm-referenced achievement tests. The purpose of the study is to determine the sensitivity of norm-referenced test to the growth of low-achieving students in prekindergarten through 12th grade. Four analysis were performed to test eight identified norm-referenced test for their sensitivity to the growth of students who perform at approximately the 15th percentile or below of their grade peers. Results of the analyses suggested that two of the eight tests are adequate for use with low-achieving students within a norm period. The other six tests showed lack of precision and appeared not to be suitable for measuring progress of low -achieving students.

Neuropsychological impairment following cardiopulmonary bypass (CPB) remains a serious consequence of otherwise successful surgery. The incidence of neuropsychological decline is poorly understood due to varied measurement intervals, and perhaps more importantly the use of unreliable detection and classification methods. The reported incidence varies considerably, ranging anywhere from 30% to 90% of subjects. While the nature of this impairment has not been fully elucidated, recent evidence suggests that microembolism during surgery may be the principal causative agent of postoperative cerebral dysfunction. The work described in this thesis investigates one possible source of microembolism leading to postoperative decline, namely thromboembolism arising from excessive activation of the haemostatic mechanism. Crucial to the accurate detection of significant decline in individual patients, this work also focuses on the development and use of meaningful criteria to be used when describing change in neuropsychological performance measures. The strong haemostatic activation during CPB is controlled by heparin anticoagulation. The clinical performance of the Hepcon heparin-monitoring instrument was compared to the activated clotting time (ACT), which is used in most cardiac centres. An analysis of samples from 42 elective coronary artery bypass grafting (CABG) patients shows that the ACT does not detect the significant decline in heparin concentration seen upon connection to CPB, in comparison to the Hepcon. The Hepcon appears to be in satisfactory agreement with laboratory anti-Xa analysis of heparin concentration, with the mean difference for the Hepcon at -0.46 U/ml, and the limits of agreement +/- 1.12 U/ml. Further analysis shows that that for 95% of cases, the Hepcon will give values that are between 0.53 and 1.27 times the value for anti-Xa. The loss of relationship between ACT and heparin concentration was further investigated by converting ACT values to heparin concentration. The results provide data on the degree of prolongation in ACT times brought about by factors associated with CPB. A methodology is presented by which users can adjust for the loss of relationship between ACT and heparin. This work also demonstrates that under normal usage of the ACT, the user may obtain values up to 3 times appropriate for the plasma heparin concentration. The computer-administered neuropsychological testing tool (the MicroCog) was validated using 40 age-matched control subjects. Using a two-week interval, the summary score correlation coefficients ranged from .49 to .84, with all scores demonstrating significant practice effects. Also presented are retest normative data that may be used to determine significant change in a homogeneous sample using both reliable change and regression models of analysis. The performance of four different models of change analysis was then analysed using data from the clinical group. The regression technique of analysis was shown to be the most useful prediction model as it provides correction for both practice effects and regression toward the mean in each individual. A novel statistical rationale is presented for the choice of criteria in the identification of patients that may be defined as overall impaired when using a battery of test scores. When using one-tailed prediction models for decline, the binomial distribution of scores was shown to be a useful descriptive statistic providing an estimate of change due to chance. When applied to a suitable selection of scores that minimise shared variance, a value +/- 20% of test scores used was demonstrated to be a rational cut-off for an individual to be classified as impaired. Using this methodology, 32.7% of patients were identified as significantly deteriorated in neuropsychological test function immediately prior to discharge from hospital. Patient age was shown to be a significant predictor of neuropsychological decline following CPB. No significant relationship was identified between thrombin generation and neuropsychological change scores, however problems with patient recruitment and retention limited the statistical power of this study. An intriguing relationship with heparin concentration was noted that might warrant further investigation. This work highlights the complex nature of post-bypass neuropsychological dysfunction and the complexities in assessing decline. The regression-based model was shown to be highly useful in the analysis of data from a suitably validated neuropsychological testing tool. The argument that no suitable criterion exists for the identification of patients as overall impaired has been challenged with the development of a rational cut-off based on the likely distribution of change scores across a series. The work presented here confirms the need for standardised testing methods based on sound statistical criteria. This work also highlights the problems associated with current methods for monitoring anticoagulation therapy during bypass surgery. Methodology is presented that allows adjustment of ACT results to account for CPB-induced prolongation of clotting times. Current techniques for heparin monitoring overestimate heparin levels on bypass by up to threefold, which may predispose to subclinical coagulation and increased delivery of protamine.

Antalet sjukskrivningar till följd av stressrelaterade sjukdomar har ökat kraftigt för vårdpersonal. Därtill saknas det evidens för internetbaserade interventioner mot stressrelaterad ohälsa för vårdpersonal. Syftet var att undersöka och utvärdera en internetbaserad kognitiv beteendeterapi-intervention (iKBT) avseende graden av samvetsstress, arbetsrelaterad stress samt självmedkänsla hos vårdpersonal. Enkäter bestående av Stress of Conscience Questionnaire (SCQ), Copenhagen Psychosocial Questionnaire version II (COPSOQ II) och Self-Compassion Scale (SCS) besvarades av deltagarna (N = 8), samtliga var kvinnor mellan 27 – 53 år. Resultaten analyserades med PEM och RCI på individnivå och T-test på gruppnivå. RCI-analysen visade begränsade resultat för SCQ, blandade resultat för COPSOQ II och övervägande positiva resultat för SCS. Analysen på gruppnivå visade en signifikant minskning i Sömnbesvär (p = .032) och Self-Judgment (p = .021) samt signifikant ökning i Self-Kindness (p = .016). Studien behöver replikeras i framtida studier med ett större antal deltagare och en studiedesign som är metodologiskt robust. / The amount of sick leave due to stress-related illnesses has increased significantly for healthcare staff. In addition, there is a lack of evidence for internet-based interventions for stress-related illness for healthcare staff. The aim was to examine and evaluate an internet-based Cognitive Behavioral Therapy (iCBT) intervention regarding the degree of stress of conscience, work-related stress and self-compassion among healthcare staff. Questionnaires consisting of Stress of Conscience Questionnaire (SCQ), Copenhagen Psychosocial Questionnaire version II (COPSOQ II) and Self-Compassion Scale (SCS) were answered by the participants (N = 8), all were women between 27 - 53 years. The results were analyzed with PEM and RCI at the individual level and T-tests at group level. The RCI analysis showed limited results for SCQ, mixed results for COPSOQ II and predominantly positive results for SCS. The analysis at group level showed a significant decrease in Sleep Disorders (p = .032) and Self-Judgment (p = .021) as well as a significant increase in Self-Kindness (p = .016). The study needs to be replicated in future studies with a larger number of participants and a study design that is more methodologically robust.

Despite well-established diagnostic measures and measures of specific dimensions of eating disorder symptomatology, little work has been done to develop a brief, comprehensive, and valid measure for assessing change in eating disorder symptoms. Further, empirically-supported change indices to assess treatment progression and outcome have not yet been developed. The Change in Eating Disorder Symptoms Scale (CHEDS) is a new comprehensive measure designed to assess progress and change during treatment in persons with diagnoses on the eating disorder spectrum. Previous studies have demonstrated the subscale structure, reliability, and validity of the CHEDS. This study determined clinically significant change criteria for the CHEDS to complement the studies that have supported the CHEDS as a reliable and valid measure of eating disorder symptomatology. The CHEDS was also compared to a life functioning scale, the Clinical Impairment Assessment. A reliable change index (RCI) was developed, which generated an inferential statistic that estimates the magnitude of change in a score necessary for a change score to be considered statistically reliable. A cutscore was also developed, which differentiates between functional and dysfunctional populations, between eating disordered clinical subjects and non-clinical subjects. Trajectories were identified using hierarchical linear modeling methods for use in conjunction with clinical significance criteria to aid in the tracking of symptoms during treatment, treatment decision-making, and tailoring treatment according to expected and observed progress. The clinical significance change criteria were then applied to the clinical sample to determine change patterns descriptive of recovered, reliable improvement, deterioration, and no change. Finally, a scoring program with clinical significance change criteria and trajectory analyses for total and subscale scores was developed.