Context. Agile methods address the challenges of an unpredictable world by relying on “people and their creativity rather than on processes”, accelerate delivery of software and considered as a reaction to plan-based or traditional methods. Distributed software development helps to access a pool of skilled personnel, completion of tasks around the clock and more. Incorporating of agile methods in distributed software development could help to solve some problems of distributed software development such as lack of communication and its dependencies, close collaboration and so on. Objectives. In this study we investigate the proposed benefits of pair programming, an XP development technique used by agile, and its effects on performance and social practices in distributed software development. Methods. Systematic literature review and an experiment are utilized to fulfill the objectives of this study. In the systematic review a sub-set of the research articles are selected relevant to the subject of this study from the electronic sources including, ACM Digital Library, IEEE, Xplore, EiVillage (Compendx, Inspec), Science Direct and ISI Web of Science. Experiment is conducted to investigate the pair programming effects on performance and social practices. Results. Many proposed benefits of pair programming in existing literature are identified and reported in both collocated and distributed settings. Pair programming is reported as an effective software development technique as well as a pedagogical tool. Experimental results showed that pair programming also effects performance in distributed software development, and positively impacts the social practices (human or social factors). Conclusions. There are many benefits of pair programming reported in collocated settings and less in distributed software development. Pair programming impacts the performance and social practices positively. However, we also conclude that the effective use of pair programming in distributed software development will yield the concrete results as well as the programmers’ pairs should be trained, experienced and well motivated for an effective use of pair programming and to overcome the challenges of distributed software development.

Requirements traceability provides support for many software engineering activities like impact analysis, requirements validation and regression testing. In addition requirements traceability is the recognized component of many software process improvement initiatives. Requirements traceability also helps to control and manage evolution of a software system. This thesis presents a systematic review and a framework for requirements traceability. The systematic review is aimed at presenting fair evaluation of research concerning requirements traceability over the period 1997 – 2007. The systematic review aims at identifying probable gaps in research about requirements traceability and opens new horizons to explore. Moreover, two companies have been interviewed to understand the practice of requirements traceability in industry. After the analysis of industrial interviews these companies have been classified into two categories of traceability users. These categories are high-end traceability users and low-end traceability users. Based on the analysis of systematic review results and industrial interviews, this thesis presents a framework for requirements traceability called ‘Three Level Framework for Requirements Traceability (TLFRT)’. This framework is composed of three levels. The level 0 of this framework focuses on pre-RS traceability where as level 1 and level 2 focuses on post-RS traceability. The level 1 provide traceability for the functional requirements, where as level 2 provide traceability for non-functional requirements. TLFRT provides guidelines to a process that can be tailored to fit the needs of the high-end traceability users and low-end traceability users as well. This framework has been statically validated in two companies. The validation of TLFRT in industry resulted in compilation of lessons learned, which ensures that this theoretical framework could also be used in real industrial environment. The results of the research presented in this thesis are aimed at supporting requirements traceability by taking its current issues/challenges into account. / 0046(0)707381947

Objectives: The thesis comprises two parts. Firstly, a systematic review (SR) systematically examined meta-analytic studies assessing the prevalence of sexual abuse in childhood. A meta-analysis sought to systematically identify and synthesise data from studies providing prevalence estimates of contact and non-contact child sexual abuse (CSA) as self-reported by adolescents within the past 10 years. Methods: Consistent with Cochrane Collaboration guidelines, the systemic review adopted a comprehensive search of electronic databases and additional sources, including communication with authors working in the field, and the use of ancestry and descendency approaches between February 2013 and March 2014. The meta-analysis also adopted an equally systematic search conducted from March 2013 to June 2014. Assessment of quality and risk of bias were conducted on the included studies using PRISMA criteria and STROBE guidelines. Results: The systematic review identified six meta-analytic studies for review. The quality of studies and the range of definitional and methodological factors studied varied; results sections were well covered, whereas, quality and risk of bias within studies were generally poorly addressed. Prevalence estimates varied considerably and high heterogeneity was consistent across all analyses. Nine population studies measuring prevalence of contact and non-contact CSA were included in the meta-analysis. Meta-analyses were conducted overall and across male and female populations. Prevalence estimates varied considerably across studies, with contact CSA ranging from 2% to 39.8% and overall non-contact CSA, estimates ranged from 1% to 24.6%. Substantial heterogeneity was present across all analyses and therefore findings should be interpreted with caution. Nevertheless, the findings were thought-provoking and most likely due to differences in definitions of CSA and inconsistent use of validated instruments. Conclusions: Child sexual abuse is an international problem which is highly pervasive across all societies and populations studied. Females consistently report higher rates of CSA than males, and some Asian countries, namely China, produce relatively lower CSA estimates, even controlling for a wide range of methodological factors and study characteristics. The considerable heterogeneity was apparent both between and within studies and it appears likely based on the current findings, and in the context of previous research, that there are a wide range of methodological and socio-demographic factors which moderate CSA prevalence estimates. More specifically, the lack of a universally recognised definition of CSA proves especially problematic for researchers. The issue is further complicated by use of non-standardised instruments and inconsistent reporting and dissemination of findings. There is a need for future epidemiological studies to adhere to universal guidelines using standard definitions, standardisation of instruments and standardisation of reporting and dissemination to facilitate development of health policies, resource allocation and prevention initiatives for clinical and social services.

The aim of this thesis was to explore the relationships between the constructs of self-compassion (SC), self-esteem (SE) and recovery in psychosis. It is presented to the reader as three separate papers. 1) A systematic literature review exploring the relationships between SE and the positive symptoms of psychosis, 2) an empirical study investigating SC, SE, recovery in psychosis and positive psychotic symptoms and 3) a critical appraisal and personal reflection of the processes involved in conducting the research. Paper one presents a systematic review of the existing literature that explores the relationships between SE and the positive symptoms of psychosis. Thirty-four articles were identified which met the strict criteria. The evidence was mixed and much of it inconclusive. There was some support for the relationship between SE and delusions, in particular paranoia. The evidence for hallucinations was much less conclusive. Recommendations for future research were suggested as were potential clinical implications which arose from the review. The empirical study presented in paper two explores the relationships between SE, SC and recovery in psychosis, and aimed to assess whether SC was a unique predictor of recovery in psychosis, over and above the impact of SE (using cross-sectional and longitudinal analysis). Further exploratory analysis was conducted to ascertain whether specific positive symptoms of psychosis were related to SC and SE. At baseline, the results indicated that SC did not contribute unique variance in recovery from psychosis over and above that attributable to SE. Longitudinally, SC at baseline was not related to recovery at follow up. Exploratory analysis revealed levels of SE and SC were significantly different in groups who had a presence or absence hallucinations, but not delusions. Methodological strengths and limitations, clinical implications and ideas for future research discussed. Paper three provides the reader with a critical reflection of the processes involved in the undertaking of the two papers presented. Implications for clinical practice are discussed as well as directions for future research.

Objective: This work consisted of three research projects bridged by their focus on a multivariate assessment of executive functions in research and practice: (a) a systematic review and re-analysis of latent variable studies on executive function test batteries, (b) a confirmatory factor analysis (CFA) of the Delis-Kaplan Executive Function System (D-KEFS), the most commonly administered executive function test battery in clinical practice, and (c) the derivation of multivariate base rates for the D-KEFS, offering a psychometric resource with direct applications to clinical practice. Method: Systematic review. The systematic review identified 45 eligible samples (N=9,498 participants, mean age range: 3.01-74.40 years-old) and 21 correlation matrices eligible for re-analysis, comparing seven competing models including the most commonly evaluated factors: updating/working memory, inhibition, and shifting. Model results were summarized based on the mean percent accepted (i.e., mean rate at which models both properly converged and met fit thresholds: CFI≥.90/RMSEA≤.08). CFA. Using adults from the D-KEFS normative sample (N=425; 20-49 years-old), eight alternative measurement models were evaluated for a subset of D-KEFS tests. Factors from the accepted measurement model predicted three tests measuring constructs less often evaluated in the executive function literature: abstraction, reasoning, and problem solving. Base rates. The frequency of low scores occurring among the D-KEFS normative sample (N=1,050; 16-89 years-old) was calculated for the full D-KEFS and two brief batteries using stratifications for age, education, and intelligence. Results: Systematic review. The most often accepted models varied by age (preschool=one/two-factor; school-age=two/three-factor; adolescent/adult=three/nested-factor; older adult=two/three-factor), and most frequently included updating/working memory, inhibition, and shifting factors. The nested-factor and three-factor models were accepted most often and at similar rates among adult samples: 33-34% and 25-32%, respectively. No model was accepted most often for child/adolescent samples, but those with shifting differentiated garnered less support. CFA. A three-factor model including inhibition, shifting, and fluency fit the data well (CFI=0.938; RMSEA=0.047), although a two-factor model merging shifting/fluency fit similarly well (CFI=0.929; RMSEA=0.048). A bifactor model fit best (CFI=0.977; RMSEA=0.032), but rarely converged. Shifting best predicted tests of reasoning, abstraction, and problem solving (p<0.05; R2=0.246-0.408). Base rates. Low scores, based on commonly used clinical cutoffs, occurred frequently among healthy adults. For a three-test, four-test, and full D-KEFS battery, 62.8%, 71.8%, and 82.6% obtained ≥1 score(s) ≤16th percentile, respectively, and 36.1%, 42.0%, 50.7%, obtained ≥1 score(s) ≤5th percentile, respectively. The frequency of low scores increased with lower intelligence and fewer years of education. Discussion: The systematic review effort did not identify a definitive model of executive functions for either adults or children/adolescents, demonstrating the continued need to re-evaluate the conceptualization and measurement of this construct in future research. The D-KEFS CFA offers some evidence of clinical measures capturing theoretical constructs, but is not directly translatable into clinical practice; while the multivariate base rates are useful to clinicians, but do not bridge theory and assessment. This research reaffirms the elusive nature of executive functions in both research and clinical spheres, and represents a step forward in an enduring scientific process towards a true understanding of this mysterious construct. / Graduate / 2018-07-24

Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease that has a highly variable disease course. Three biologic agents, adalimumab, etanercept, and infliximab, have been developed for the treatment of AS. We conducted three studies: 1) an exploratory analysis of a year-long longitudinal dataset to gain insight into the variability of disease activity, physical function, and well-being and to explore the relationship between these outcome measures; 2) a systematic review of the available evidence for the efficacy of biologic treatment; 3) a systematic review of potential adverse effects of this treatment. We found that repeated measures of disease activity, function and well-being fluctuate considerably between patients, with complex patterns occurring over time within patients. There was mostly high quality evidence that these biologics are efficacious against placebo. We did not find evidence of an increase in serious adverse events or serious infections from short-term randomized controlled trials.

Background: Postpartum depression (PPD) is a complex mental health disorder that affects women during their childbearing years. It is a serious medical condition that occurs in approximately 13–20% of women after birth and has an adverse effect on both the mother and the infant. Certain dietary deficiencies in a pregnant or postnatal woman’s diet may cause postnatal depression. It is unclear whether Omega-3 polyunsaturated fatty acids (n-3 PUFAs) are effective for treating or preventing PPD. Objectives: To assess the best available evidence to date regarding the effect of n-3 PUFAs on the etiology, prevention and treatment of postnatal depression. Methods: A systematic review and narrative synthesis was conducted in order to address the gaps in knowledge. For the systematic review, a broad search of electronic databases of published quantitative literature was conducted. Quality appraisal was performed using the tools produced by the effective public health practice project (EPHPP). The narrative synthesis consists of four elements: 1) developing a theory; 2) developing a preliminary synthesis; 3) exploring relationships in the data; 4) assessing the robustness of the synthesis. Results: Out of 181 potential articles, a total of 17 studies met the inclusion criteria. The overwhelming majority of the studies found that n-3 PUFAs had no association with PPD evaluations versus only few ones observed a beneficial effect of n-3 PUFAs supplementation on depressive symptoms. Significant heterogeneity was observed among included studies which can be explained by dissimilar study designs, differences in study duration, time period of measurement and number of participants, and in varied dosages and types of supplemental n-3 PUFAs. Conclusions: Overall, This systematic review and narrative synthesis failed to find a significant positive association between n-3 PUFAs intake and PPD. However further investigation of the specific molecular mechanisms underlying the function of n-3 PUFAs in the brain and the factors related to the pathophysiological nature of depression is warranted.

Background: With usual supplementation practices, most children are Vitamin D Deficient (VDD) following Congenital Heart Disease (CHD) surgery and alternative regimens need consideration. Methods/Results: i) A systematic review identified 88 pediatric trials of high dose vitamin D. Studies evaluating the Institute of Medicine (IOM) Tolerable Upper Intake Level (UL) did not rapidly normalize levels, while loading therapy (≥ 40000 IU) did so within 3 days. Hypercalcemia occurred more often with doses above 400000 IU. ii) A double blind RCT was designed to determine whether pre-operative administration of the IOM UL can prevent post-operative VDD. Results after the first 30 participants completed study procedures demonstrated it was possible to recruit (1.8 patients per month) and complete study procedures (i.e. blood collection). Unfortunately few participants (45%) received more than 30 doses of study drug. Conclusion: Prevention of post-operative VDD in the majority of CHD patients will require alternatives to the IOM recommendations.

Objective Postpartum hemorrhage (PPH) is a major cause of maternal mortality world-wide; misoprostol is a relatively cheap, easily administered, and an efficient medication to be given after the delivery of the baby to prevent PPH, thus posing it as a first choice in resource-poor communities. The aim of this study is to answer questions regarding the most appropriate dose (400 µg versus 600 µg), effect of labour settings (community or clinical), and management of labour on misoprostol effectiveness and safety in preventing PPH. Methods We developed a search strategy and conducted a search within five key databases. Two reviewers screened the articles for predefined inclusion/exclusion criteria, quality, and performed data extraction. Discrepancy was dealt with by reaching consensus. In article 1, we only included randomized controlled trials, we performed a random-effects Bayesian network meta-analysis comparing 400 µg to 600 µg misoprostol over five outcomes of interest: blood loss ≥500 ml, blood loss ≥1000 ml, using additional uterotonics, shivering, and pyrexia. In article 2, we included any experimental trial, we performed a random effects model meta-analysis, pooling the incidence of PPH from each misoprostol arm. Subsequently, a meta-regression model was performed on identified potential effect-modifiers, including clinical settings and labour management. Results Of 444 identified records, 46 trials met the inclusion/exclusion criteria in article 1, and 56 trials in article 2. The odds ratio (OR) of misoprostol 400 µg vs. 600 µg for bleeding ≥ 500 ml is 0.86 [95% Credible Intervals: 0.46 − 1.54], for bleeding ≥ 1000 ml the OR is 0.83 [95% CrI 0.54 – 1.26], for additional uterotonics is 0.75 [95% CrI 0.40 – 1.40], for pyrexia and shivering an OR of 0.57 [95% CrI 0.15 – 2.18] and 0.63 [95% CrI 0.29 – 1.31] respectively. The overall incidence of PPH was 6.62 per 100 pregnancies (95%CI 4.71 per 100 – 8.53 per 100). Labour settings and other aspects of active management of labour had no statistically significant effect on the incidence of post-partum hemorrhage. Conclusion We found no difference between the administration of misoprostol 400 µg or 600 µg for the prevention of PPH and side effects of misoprostol, as well as no effect of labour settings and management of labour on misoprostol effectiveness.

Intensive Behavioural Intervention (IBI) is one of the most widely used treatments for children with an autism spectrum disorder (ASD). While IBI has been recognized as the treatment of choice for very young children with an ASD, its sensible use among school age children is a matter of dispute. The aim of this thesis was to determine the clinical effectiveness of IBI, as compared with no treatment or treatment-as-usual, for the management of cognitive functioning and adaptive skills in preschool and school age children with an ASD, as well as to examine predictors of treatment response. Peer-reviewed, English language publications were identified using MEDLINE, EMBASE, PsychINFO, CINAHL, and ERIC from 1995 to September 1, 2014. Grey literature and reference lists of published papers were also searched for relevant records. Retrieved citations were screened by two independent reviewers, and data extraction was performed by a single reviewer with verification by a second reviewer. The methodological quality and procedural fidelity of included studies was assessed by one reviewer, and a subset of included studies were pooled in a random-effects meta-analysis using the standardized mean difference (SMD) effect size. A total of 24 unique studies were selected for inclusion in this review, comprising a total of 1,816 participants. Findings revealed that IBI improves full-scale IQ (SMD ES = 0.66, 95% CI 0.46 to 0.85, p<0.00001; 13 studies) and adaptive skills (SMD ES = 0.57, 95% CI 0.33 to 0.82, p<0.00001; 12 studies) in preschool and school age children with an ASD, with seemingly higher clinical benefits in children aged under 4 years at intake. Better outcomes with IBI are predicted by children’s relatively younger age, increased cognitive and adaptive ability, as well as a milder severity of symptoms at treatment entry. Results warrant careful interpretation in light of several methodological limitations and inadequate monitoring of procedural fidelity.