This study evaluated the efficacy of the From Survivor to Thriver program, an interactive, online therapist-facilitated cognitive-behavioral program for rape-related PTSD. Eighty-seven college women with rape-related PTSD were randomized to complete the interactive program (n = 46) or a psycho-educational self-help website (n = 41). Both programs led to large reductions in interview-assessed PTSD at post-treatment (interactive d = 2.22, psycho-educational d = 1.10), which were maintained at three month follow-up. Both also led to medium- to large-sized reductions in self-reported depressive and general anxiety symptoms. Follow-up analyses supported that the therapist-facilitated interactive program led to superior outcomes among those with higher pre-treatment PTSD whereas the psycho-educational self-help website led to superior outcomes for individuals with lower pre-treatment PTSD. Future research should examine the efficacy and effectiveness of online interventions for rape-related PTSD including whether treatment intensity matching could be utilized to maximize outcomes and therapist resource efficiency.

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Background and objectives: Prediction models are useful tools in clinical practise by providing predictive estimates of outcome probabilities to aid in decision making. As biomedical research advances, concerns have been raised regarding combined effectiveness (benefit) and safety (harm) outcomes in a prediction model, while typically different prediction models only focus on predictions of separate outcomes. A second issue is that, evidence also reveals poor predictive accuracy in different populations and settings for some prediction models, requiring model calibration or redevelopment. A third issue in data analyses is whether the treatment effect estimates could be influenced by competing risk bias. If other events preclude the outcomes of interest, these events would compete with the outcomes and thus fundamentally change the probability of the outcomes of interest. Failure to recognize the existence of competing risk or to account for it may result in misleading conclusions in health research. Therefore in this thesis, we explored three methodological issues in prediction models and data analyses by: (1) developing and externally validating a prediction model for patients’ individual combined benefit and harm outcomes (stroke with no major bleeding, major bleeding with no stroke, neither event, or both stroke and major bleeding) with and without warfarin therapy for atrial fibrillation; (2) constructing a prediction model for hospital mortality in medical-surgical critically ill patients; and (3) performing a competing risk analysis to assess the efficacy of the low molecular weight heparin dalteparin versus unfractionated heparin in venous thromboembolism in medical-surgical critically ill patients. Methods: Project 1: Using the Kaiser Permanente Colorado (KPCO) anticoagulation management cohort in the Denver-Boulder metropolitan area of Colorado in the United States to include patients with AF who were and were not prescribed warfarin therapy, we used a new approach to build a prediction model of individual combined benefit and harm outcomes related to warfarin therapy (stroke with no major bleeding, major bleeding with no stroke, neither event, or both stroke and major bleeding) in patients with AF. We utilized a polytomous logistic regression (PLR) model to identify risk factors and then construct the new prediction model. Model performances and validation were evaluated systematically in the study. Project 2: We used data from a multicenter randomized controlled trial named Prophylaxis for Thromboembolism in Critical Care Trial (PROTECT) to develop a new prediction model for hospital mortality in critically ill medical-surgical patients receiving heparin thromboprophylaxis. We first identified risk factors independent of APACHE (Acute Physiology and Chronic Health Evaluation) II score for hospital mortality, and then combined the identified risk factors and APACHE II score to build the new prediction model. Model performances were compared between the new prediction model and the APACHE II score. Project 3: We re-analyzed the data from PROTECT to perform a sensitivity analysis based on a competing risk analysis to investigate the efficacy of dalteparin versus unfractionated heparin in preventing venous thromboembolism in medical-surgical critically ill patients, taking all-cause death as a competing risk for venous thromboembolism. Results from the competing risk analysis were compared with findings from the cause-specific analysis. Results and Conclusions: Project 1: The PLR model could simultaneously predict risk of individual combined benefit and harm outcomes in patients with and without warfarin therapy for AF. The prediction model was a good fit, had acceptable discrimination and calibration, and was internally and externally validated. Should this approach be validated in other patient populations, it has potential advantages over existing risk stratification approaches. Project 2: The new model combining other risk factors and APACHE II score was a good fit, well calibrated and internally validated. However, the discriminative ability of the prediction model was not satisfactory. Compared with the APACHE II score alone, the new prediction model increased data collection, was more complex but did not substantially improve discriminative ability. Project 3: The competing risk analysis yielded no significant effect of dalteparin compared with unfractionated heparin on proximal leg deep vein thromboses, but a lower risk of pulmonary embolism in critically ill medical-surgical patients. Findings from the competing risk analysis were similar to results from the cause-specific analysis. / Thesis / Doctor of Philosophy (PhD)

The current study examined the impact of education about rape myths and sexual consent law on the guilt and responsibility assessment of mock jurors in a hypothetical rape trial. Juror education had no effect on any of the measures and did not vary with alcohol consumption. In regards to alcohol, mock jurors always assigned more guilt to the defendant if the complainant was sober, regardless of his alcohol consumption. Mock jurors consistently found the defendant guilty when both were sober. Complainants were assessed more responsibility when both the complainant and defendant were sober and when they were both intoxicated. More responsibility was attributed to the complainant when she was intoxicated and the defendant was sober. The complainant was assessed the least responsibility when she was sober and the defendant was intoxicated. Findings suggest that educating mock jurors about rape myths does not have an effect on ratings of defendant guilt.

The objective of this study was to develop soy concept foods with potential marketability in the food industry for health conscious consumers. Fourteen commercial soy protein isolate samples were obtained from various processors. The flavor profiles of the soy protein isolates were evaluated by five expert panelists. The three soy protein isolate samples with the most acceptable flavor profiles were utilized for further analysis and the development of soy concept foods including cranberry nut soy pudding, two bean soy dip and a soy based meal replacer. Based on consumer acceptability studies, it appears that two bean soy dip may have the most potential for success in the food industry. Although, no differences (P>0.05) existed in acceptability among soy protein products in any of the soy concept foods, ISP may have the most potential for utilization in the development of new products since numerical values were slightly higher when this soy protein was incorporated into the various concept foods.

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Discrete Trial Teaching (DTT) is a teaching method that involves fast-paced trials designed to teach basic skills by breaking them into smaller components, typically conducted in a one-on-one setting. Treatment integrity has proven to be of great importance in DTT, with skill acquisition occurring at higher rates when treatment integrity is high. While research has shown that verbal and written feedback are effective in training staff to conduct DTT, there is still a need for research on the use of individualized interventions based on performance assessments. This study used a multiple-probe across participants design, and demonstrated that a one-on-one session including interventions such as feedback, practice, treatment integrity checklists, and/or antecedent interventions is an effective method for increasing treatment integrity and implementation of DTT. The three participants that took part in the individualized interventions all displayed increases in proficiency of delivering DTT trials. / Applied Behavioral Analysis