High Grade Serous Carcinoma is the most aggressive tubal/ovarian histotype. The Rb pathway, which functions to preserve cell cycle regulation and genomic stability, is frequently deregulated in HGSC. The aim of this study was to identify non-redundant mechanisms of Rb pathway deregulation with clinical relevance. Immunohistochemistry analysis of P16 and RB1 expression identified a P16 homogeneous/RB1+ subgroup with the shortest recurrence free survival, while P16 heterogeneous/RB1+ and P16 homogenous/RB1- subgroups showed longer recurrence free survival. These P16/RB1 categories were shared between precursor lesions and the associated HGSC. Characterization of the Rb pathway in the three subgroups revealed CCNE1 amplification and highest protein expression in the P16 homogeneous/RB1+, high cyclin D1 protein expression in P16 heterogeneous/RB1+, and E2F3 amplification and highest Ki67 protein expression in P16 homogeneous/RB1- subgroup. Rb pathway deregulation is common in HGSC, occurs early in tumor development, and results from multiple non-redundant mechanisms that correlate with clinical outcome.

Aim: To develop an outcome measure to identify “responders” for patients who had a clinically important improvement in lupus disease activity with treatment. Methods: The outcome measure derived was based on the commonly used disease activity measure SLEDAI-2K which documents findings over the previous 10 days. Since patients in drug trials are followed at monthly intervals it was necessary to validate SLEDAI-2K 30 days against SLEDAI-2K 10 days. Two prospective studies were accomplished for this purpose. SLEDAI-2K 30 days was used to develop the new responder index, SLEDAI-2K Responder Index-50 (SRI-50). The SRI-50 data retrieval form was developed to standardize the documentation of the descriptors. The construct validity of SRI-50 was prospectively evaluated against an external construct. The reliability of SRI-50 was tested in a multi-centre study. A retrospective analysis over 10 years was used to further validate SRI-50. SRI-50 ability to enhance the SLE Responder Index (SRI) in detecting “responders” was evaluated. The performance of SRI-50 was investigated against SLEDAI-2K and SRI over 12 months. Results: SLEDAI-2K 30 days was validated to describe disease activity over the previous 30 days. The responder index to SLEDAI-2K, SRI-50 was developed including the SRI-50 Definitions and SRI-50 Data Retrieval Forms. The initial validation of SRI-50 confirmed its construct validity to identify ≥ 50 % improvement. SRI-50 is reliable and can be used by both rheumatologists and trainees. The retrospective analysis confirmed that SRI-50 is valid in identifying ≥ 50 % improvement in an efficient time. SRI-50 enhances the performance of SRI and identifies more “responders” than SLEDAI-2K and SRI at 6 and 12 months. Conclusions: SRI-50, is a valid and reliable responder index to identify patients with partial, ≥50% improvement in disease activity in an efficient time. SRI-50 can be used as an independent outcome measure of improvement in patients with SLE.

Aim: To develop an outcome measure to identify “responders” for patients who had a clinically important improvement in lupus disease activity with treatment. Methods: The outcome measure derived was based on the commonly used disease activity measure SLEDAI-2K which documents findings over the previous 10 days. Since patients in drug trials are followed at monthly intervals it was necessary to validate SLEDAI-2K 30 days against SLEDAI-2K 10 days. Two prospective studies were accomplished for this purpose. SLEDAI-2K 30 days was used to develop the new responder index, SLEDAI-2K Responder Index-50 (SRI-50). The SRI-50 data retrieval form was developed to standardize the documentation of the descriptors. The construct validity of SRI-50 was prospectively evaluated against an external construct. The reliability of SRI-50 was tested in a multi-centre study. A retrospective analysis over 10 years was used to further validate SRI-50. SRI-50 ability to enhance the SLE Responder Index (SRI) in detecting “responders” was evaluated. The performance of SRI-50 was investigated against SLEDAI-2K and SRI over 12 months. Results: SLEDAI-2K 30 days was validated to describe disease activity over the previous 30 days. The responder index to SLEDAI-2K, SRI-50 was developed including the SRI-50 Definitions and SRI-50 Data Retrieval Forms. The initial validation of SRI-50 confirmed its construct validity to identify ≥ 50 % improvement. SRI-50 is reliable and can be used by both rheumatologists and trainees. The retrospective analysis confirmed that SRI-50 is valid in identifying ≥ 50 % improvement in an efficient time. SRI-50 enhances the performance of SRI and identifies more “responders” than SLEDAI-2K and SRI at 6 and 12 months. Conclusions: SRI-50, is a valid and reliable responder index to identify patients with partial, ≥50% improvement in disease activity in an efficient time. SRI-50 can be used as an independent outcome measure of improvement in patients with SLE.

The purpose of this thesis was to investigate the psychometric properties and clinical utility of the Functional Mobility Scale (FMS) for children with cerebral palsy (CP). The FMS quantifies mobility according to the need for assistive devices in different environmental settings. Initially a systematic review was conducted on the psychometric properties and clinical utility of existing evaluative outcome measures that assessed activity limitation in children with CP. Good to excellent reliability was found for all tools. In contrast, the validity and responsiveness of many tools required further investigation. The FMS was the only tool to quantify activity with different assistive devices for a range of environmental settings. A key objective of this thesis was to investigate the reliability, construct, concurrent and discriminative validity, as well as the responsiveness to change of the FMS. (For complete abstract open document)

Thesis (Ph.D.)--Virginia Commonwealth University, 2010. / Prepared for: Dept. of Epidemiology and Community Health. Title from resource description page. Includes bibliographical references.

Thesis (Ph. D. in Psychology)--Vanderbilt University, Dec. 2006. / Title from title screen. Includes bibliographical references.

Increasingly patients are surviving admission to intensive care units (ICUs) with life-threatening, critical illness. This has led to a growing interest in longer-term patient outcomes, including their psychological health. This thesis consists of two discrete sections: 1) a systematic review of research that evaluated emotional outcomes between 3 and 12 months post-ICU discharge, and 2) a longitudinal cohort study of emotional sequelae among adults with Type 1 diabetes during and following admission for diabetic ketoacidosis (DKA). The systematic review identified seven studies that met inclusion criteria, and highlighted weaknesses in the existing literature. From the available evidence there appears to be elevated rates of clinically significant depression (11%), anxiety (15%) and post-traumatic stress disorder (PTSD) symptoms (23%) 3 months after discharge, and these remain high 9 months later (12%; 18%, and 27%, respectively). The prospective study of DKA admissions indicated substantial rates of clinically relevant depression (25%); anxiety (37.5%), and PTSD symptoms (37.5%) prior to discharge. However, 3 months later the rates of depression and PTSD had substantially attenuated (both 8.3%) although rates of anxiety (37.5%) remained higher than that found in the general population (7%) and the local Type 1 diabetes clinical community (11.9%). Those admitted with DKA had significantly poorer HbA1c compared to the overall Type 1 clinic population (10.9% vs. 8.9%; p < 0.0001), which indicates substantial difficulties in self managing their condition. It appears that psychological problems are elevated over time following ICU discharge. PTSD is notably high and enduring in general ICU survivors, whereas was observed to fall away in the DKA sample. Anxiety seems to be elevated and this persists over time following DKA; this is pertinent given the dearth of research on the role of anxiety in the efforts of people with type 1 diabetes to manage their condition. As far as the authors’ are aware, this is the first study tracking emotional outcomes post DKA discharge. There are clearly significant psychological issues that will likely impact on staff efforts to provide ward-based care aimed at improving post-discharge diabetes control, and on the future efforts of those admitted for DKA to self-manage a complex condition. A greater awareness of the psychological issues affecting people with type 1 diabetes who experience DKA is an important first step. More specifically, a better understanding among health professionals about the ways emotional distress can impact on self-management is needed, as well as a greater understanding of how best to communicate information and educational material in light of possible information processing deficits (which may be a result of emotional distress). Larger, multi-centre, higher quality studies are required in both general ICU settings and looking at specific disease complications (such as DKA). Psychological screening for ICU survivors and implementation of a care pathway to allow access to services post-ICU may be a useful development.

Current accreditation preparation methods at many universities are time consuming and tedious. This is because cost prohibits many programs from purchasing commercial assessment applications. Creating an accreditation system that utilizes readily available and internally produced software reduces the time burden and cost of an accreditation process. This work presents software applications and operating procedures for a system that integrates a high granularity database to record assessment test results and student work exhibits. Database records are linked to course and program educational outcomes. The database includes fields that link student work exhibits to outcomes using a standardized filename code. This work combines a testing application, assessment database, electronic student portfolio, and standardized File Name Generator into a cohesive assessment system. This work resulted in three applications; an updated tester application, a File Name Generator, and a hyperlinked database. The applications were used in a pilot program to collect data and produce reports showing percentage scores for each outcome.

In our society, American citizens expect public policies to result in programs that address social problems in ways that are both efficient and effective. In order to judge if these two values are being achieved, public programs are often scrutinized through program monitoring and evaluation. Evaluation of public programs often is a responsibility delegated to local-level managers. The resulting discretion has to be balanced with the need for accountability that is also inherent in public programs. Evaluation is often difficult because outcomes are not readily measurable due to the complexity of the problems faced in the public setting. The Upward Bound program provides an example of this. Upward Bound provides services to students from low-income families and those in which neither parent holds a bachelor’s degree in order to increase the rate at which participants complete secondary education and enroll in and graduate from postsecondary institutions. Upward Bound is implemented and evaluated based upon specifications decided upon at the local level. This discretion granted to local level managers has resulted in wide variations in the way the program is being evaluated. This presents a problem for evaluation and has resulted in inconclusive results as to the success of the program. One way to correct this problem is to try and gain a clear understanding of how the evaluation outcome measures are being chosen for Upward Bound. My study accomplished this task.

Thesis (M.ED.) --University of Limpopo, 2006 / South Africa chose an Outcomes-Based Education approach to underpin the new education system called Curriculum 2005, which was later reviewed to become the Revised National Curriculum Statement. This became policy and it was delivered to schools for educators to apply in their learning programmes work schedules and lesson plans. This study focuses on the lesson plan as a tool to be used by individual educators. Although the other curriculum development steps cannot be ignored, the empirical study of this investigation will be on lesson planning. The empirical study investigates the problems experienced by educators in planning Social Sciences lessons and uses them as tools to achieve the learning outcomes at senior Phase level. In order to find possible solutions to problems experienced by educators in the Department of Education, the following questions were constructed for investigation: • What is the structure of a lesson plan in the Social Sciences learning area? • How have educators changed their ways of planning lessons from the old to the new system? • What are the problems experienced by educators in the planning and use of Social Sciences lessons? The above questions guided this study to yield the following results: • The majority of educators does not know and understand how to plan by using learning outcomes in the lesson plan structure. It is not only with learning outcomes but even the use of other elements of a lesson plan structure makes planning difficult for educators. • Most educators are resistant to change from the old to the new ways of planning lessons. In some cases, educators start by implementing the curriculum without a well written, structured lesson plan because of delays in the delivery of policy documents to schools, workshops which do not address classroom issues but emphasize the design features without relating them to the Social Sciences learning area specifics. ii • The majority of educators experience problems in planning Social Sciences lessons because they were not trained in the revised National Curriculum Statement, because of being in excess. They are not taken for training and are frequently not enthusiastic to implement what they have learnt from Outcomes- Based Education workshops in the classroom because they fear failure due to a lack of managerial intervention for support, guidance and follow-ups. The recommendations of this study were guided by the findings of the empirical results.