This research aims at revising the Victim Scale of the School Bullying Scales to examine bullying behaviors with high frequency and high severity. Participants were 1611 secondary school students in Kaohsiung. The Rasch Rating Scale Model was employed to analyze the collected data. Results showed that the revised Victim Scale fit well, exhibiting good evidence of the construct validity. Male students considered that victimized behaviors with high frequency and high severity were ¡§friendship being breached,¡¨ ¡§belongings being taken without permission,¡¨ ¡§goods being breached,¡¨ ¡§being tattled,¡¨ ¡§being hit or kicked,¡¨ and ¡§being neglected intentionally. Female students revealed different patterns of bullying behavior, while female students regard ¡§friendship being breached,¡¨ ¡§being crowded out of a group,¡¨ ¡§being isolation,¡¨ ¡§belongings being taken without permission,¡¨ ¡§being tattled,¡¨ ¡§being criticized online,¡¨ ¡§being neglected intentionally¡¨ and ¡§others kept silent to me on purpose¡¨ as victimized behaviors with high frequency and high severity. Finally, the implications for school bullying intervention and prevention were discussed. Keywords: school bullying, Rasch measurement, multidimensional Rasch analysis, DIF

Background: Growing numbers of patients with cancer are surviving following treatment with pelvic radiotherapy. Eighty per cent will experience acute gastrointestinal (GI) toxicity during treatment and 50% will subsequently have a change in their bowel habit which will affect their quality of life. The main project in this thesis aims to determine whether delivery of a gastrointestinal bundle of care will decrease GI acute toxicity and late effects of pelvic chemoradiotherapy. Additional work in the thesis evaluated the newer technique of Volumetric Modulated Arc Therapy (VMAT) which delivers decreased dose to the organs at risk on planning scans. We aimed to determine outcomes of this technique in terms of patient-reported acute toxicity and late effects. There is no internationally accepted patient reported outcome measure to capture this toxicity data and this issue was addressed using Rasch analysis in a third project. Methods: A randomised controlled trial was performed. Patients who were scheduled to undergo potentially curative chemoradiotherapy for cervix and bladder cancers were recruited and randomised. The treatment group received dietetic input and if they developed lower GI symptoms they underwent investigations and treatment for bile acid malabsorption, small bowel bacterial overgrowth and lactose intolerance. The control group received standard care. Patients who were to undergo VMAT to treat gynaecological malignancy completed patient-reported outcomes at baseline, end of treatment and one year. The rates of patient-reported toxicity were compared with those of a historical cohort and were correlated with the volume of small bowel which was irradiated. Thirdly the technique of Rasch analysis was used to evaluate the Common Terminology Criteria for Adverse Events derived patient reported outcome to measure pelvic toxicity of gynaecological cancer treatments. Results: It was feasible and acceptable to deliver a GI care bundle to patients undergoing chemotherapy and pelvic radiotherapy. All patients' data were available for analysis for the primary outcome and 29 patients' data were available at the 1 year time point. GI toxicity at 6 weeks was predicted by the trial group, suggesting that the intervention benefited the patients in terms of GI toxicity at 6 weeks. It is not yet clear whether this benefit is maintained at the 1 year time point. The frequencies of acute and late GI toxicity reported by patients undergoing VMAT were similar to that of a historical cohort who received conformal therapy. There was not a strong association between the volume of small bowel which was irradiated and the toxicity which was reported suggesting that other factors are involved in the development of toxicity. Rasch analysis of the pelvic symptom questionnaire demonstrated the main issue to be response dependency. When this was accounted for by grouping items into sub-tests the questionnaire could be made to be unidimensional and showed high reliability in a symptomatic population. Conclusion: GI intervention holds promise as a measure to reduce the acute toxicity and late effects of pelvic radiotherapy. Although newer radiotherapy techniques appear to decrease the dose delivered to the small bowel this does not translate to a reduction in patient-reported toxicity. The measurement of toxicity is complex and patient-reported outcome measures should be developed with techniques such as Rasch analysis to ensure meaningful data is available to guide further developments to reduce GI toxicity secondary to pelvic radiotherapy.

Magister Educationis - MEd / In this study I explored grade 9 learners’ perceptions after the implementation of “intentional teaching”. The research question is: “What are the perceptions of grade 9 learners of the teaching they experience in mathematics?” Conceptually the study is situated in “learners’ perceptions” of teaching with “intentional teaching” as the context. The design used was a survey where learners had to complete a questionnaire, adapted from the Students Evaluating Accomplished Teaching-Mathematics (SEAT-M) instrument. Learners from two grade 9 classes, taught by me, participated. Rasch analysis was used to analyse the data. It was found that learners ranked “the teacher’s ability to encourage them to place a high value on mathematics” the highest. “The teacher’s ability to challenge learners to think through and solve problems, either by themselves or together as a group” was ranked the lowest. It is recommended that all role-players and teachers develop skills of authentic pedagogical dialogue to promote dynamic learning in mathematics classrooms. http://

During the 1980’s the non-profit organisation RAND Corporation conducted the two-year Medical Outcomes Study with the goal of creating a comprehensive medical questionnaire. The resulting 116-item questionnaire measures health related quality of life (HRQoL) topics such as physical, mental and general health. The questionnaire is available as a free resource on their web page. SF-36, which contains 36 of these questions, is distributed for a fee by the US company Quality Metric Inc. The company has translated the questionnaire into several languages, including Swedish, and has also taken license for the translations. Registercentrum sydost has made a new Swedish translation of the same questions as in the SF-36. This survey is called RAND-36 and is license free. Because Quality Metric Inc has taken license for its Swedish translation, the surveys are similar but not identical. This study aims to compare the aforementioned HRQoL-instruments to determine whether it is possible to replace the licensed questionnaire SF-36 with the license free RAND-36. The distribution of items with response options according ordinal scale were compared with Mann-Whitney U-test. The test yielded a significant difference for eight items in the measure PF(physical functioning), MH(mental health), VT (vitality) and GH (general health perceptions). The distribution of items with response options according dichotomous scale were compared with X2-test. The test yielded significant difference for an item in the measure RE (emotional role functioning). The reliability of questionnaire was compared with ordinal alpha. In the selection the reliability between MH and VT is equivalent. The biggest difference between the surveys is the measure RP (physical role functioning) where the RAND-36 meets the requirement that the measure can be used for reliable conclusions on the individual level, which is a condition that SF-36 can’t met. The probability of entering an answer, given the respondent's ability, was compared with Rasch analysis. Wald's test gave DIF between most items within the measures PF, MH, VT and GH.

Thesis advisor: June A. Horowitz / Agitation is a distressing set of behaviors frequently observed in emergency department psychiatry patients. Key to developing and evaluating treatment strategies aimed at decreasing and preventing agitation is the availability of a reliable, valid instrument to measure behaviors representative of agitation. Currently, an agitation rating instrument appropriate for use in the emergency setting does not exist and clinicians are left without standard language for communicating about the phenomenon. The Agitation Severity Scale was developed to fill this void using facilitated focus groups to generate an initial item pool. Beginning evidence of content validity was established through a survey of clinical providers and a panel of content experts. The objectives of this methodological study were to: (a) develop an observation-based rating scale to assess the continuum of behaviors known as agitation in adult emergency department patients, and (b) to evaluate the psychometric properties of the newly developed instrument. Psychometric evaluation was conducted using a sample of 270 emergency department psychiatric patients. A 17-item instrument with a standardized Cronbach's alpha coefficient of 0.91 resulted, providing evidence of a high degree of internal consistency reliability. Principle components analysis revealed a 4-component solution accounting for 69% of observed variance. Internal consistency reliability ranged from 0.71 to 0.91 for the scale components. Equivalence reliability was established through the evaluation of Agitation Severity Scores assigned by independent evaluators, <italic> r </italic>= 0.99, &kappa = 0.98. Construct validity was established through comparison of mean scores for subjects in the highest and lowest scoring quartiles. A statistically significant difference in scores was noted when comparing these groups, <italic> t </italic> = -17.688, df = 155, <italic> p </italic> < 0.001. Convergent validity was evaluated by testing the association between Agitation Severity Scores and scores obtained using a well-established instrument, the Overt Agitation Severity Scale. Pearson's correlation coefficient for the associations between the scores ranged from 0.91 to 0.93, indicating a strong, positive relationship between the scores. Finally, the Rasch measurement model was employed to further evaluate the functioning of the instrument. In sum, the Agitation Severity Scale was found to be reliable and valid when used to measure agitation in the emergency setting. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

The purpose of this study was to evaluate the methods currently available to measure the functional outcomes of physiotherapy treatment for low back problems. As a preliminary step, all extant questionnaires were located and evaluated against practical criteria to determine their likely utility in clinical practice. This process identified a large number of questionnaires, however, only six back-specific questionnaires fulfilled the practical criteria for clinical application. Four of these questionnaires were selected for further evaluation along with a generic health status assessment instrument, the SF-36 Health Survey. Current recommendations suggest that a low-back specific and a generic questionnaire are required for comprehensive assessment of the impact of low back problems. The four back-specific questionnaires selected were the Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire and the Waddell Disability Index. An evaluation of the literature on the clinimetric properties of these questionnaires revealed that little information was available for the Quebec and Waddell questionnaires and no information was available for any of the questionnaires for a clinical population of people with low back pain seeking physiotherapy treatment in an Australian setting. The primary aim of the research was identify which, if any, of the questionnaires should be recommended for measuring outcomes of physiotherapy treatment for low back pain. Consecutive ambulatory (non-admitted) patients presenting for physiotherapy treatment at three public hospital physiotherapy outpatient departments, three community health services, and four private practices were invited to enter the study. Patients were included if they were seeking treatment for a low back problem, were aged 18 or over, and could read and write English. Subjects completed the questionnaires on two occasions six-weeks apart. One hundred and forty subjects returned the first set of questionnaires, and 106 the second set. The mean age of the sample at pre-test was 51 (SD 17) and ranged from 18 to 89 years. Sixty-six percent were female, 41% were employed and 12% were receiving compensation for their back problem. Duration of the back complaint was more than six weeks for 56% of subjects, and 60% reported five or more previous episodes or continuous pain. Referred pain in the buttock thigh or leg was reported by 70% of subjects. The first aim was to compare the questionnaires for acceptability and comprehensibility. Data quality was high for all the questionnaires (less than 5% missing data). As expected, subjects found the more complex SF-36 Health Survey more difficult to complete than three of the low-back questionnaires. However, less than 10% of subjects found any of the questionnaires more than a little difficult to complete. The next aim was to explore the internal structure and inter-relationships of the low-back questionnaires and the three physical scales of the SF-36 Health Survey (Physical Functioning, Role-Physical and Bodily Pain). Analysis of item-item correlation, item-total correlation and Cronbach�s alpha confirmed that all scales were internally consistent. Factor analysis confirmed item homogeneity (unidimensionality) of all questionnaires except the Roland-Morris Disability Questionnaire. The questionnaires were significantly intercorrelated, but correlations exceeded .70 only for the Oswestry, Quebec and Waddell questionnaires. The next aim of the research was to compare test-retest reliability of the questionnaires. The Oswestry, Quebec and SF-36 Physical Functioning scale had sufficient reliability and scale width for clinical application. Despite previous reports of high reliability, the Roland-Morris scale was significantly less reliable than several of the other questionnaires. This indicates the importance of establishing the measurement properties of a test in the population or setting in which it will be used. The Waddell Disability Index, and the SF-36 Role-Physical and Bodily Pain scales had insufficient scale width to be useful in clinical practice. More than 15% of respondents had an initial score on these scales that would not allow change to be detected with 90% confidence. The next aim of the research was to compare the responsiveness of the questionnaires. None of the questionnaires was consistently identified as more or less responsive than the others although two methods (effect size and Liang�s standardized response mean) suggested the SF-36 Bodily Pain scale was more responsive than some other questionnaires. A secondary aim of this section was to evaluate the validity of the many available responsiveness indices and a novel �reliable change� method. A �known groups� strategy was used to determine whether the responsiveness index could discriminate between the low-back relevant questionnaires and the SF-36 General Health scale, the scores of which did not change across the retest period. With the exception of the novel �reliable change� method the responsiveness indices were all found to be valid indicators of responsiveness. Guyatt�s Responsiveness Index, effect size and Liang�s standardized response mean discriminated at 95% confidence between the reference scale and all the low-back questionnaires. The standardized response mean, t-test, correlation and ROC methods discriminated between the reference scale and five or six of the seven other questionnaires. Guyatt�s index was recommended as the best of the criterion-based methods, and the effect size the best of the distribution-based methods. The three questionnaires identified as having sufficient reliability and scale width, the Oswestry, Quebec and SF-36 Physical Functioning scale, were next analysed for data fit to a Rasch model. All three questionnaires had good data fit and item function was not affected by time, age, gender or whether or not subjects reported avoiding bending. The final aim of this research was to identify by Rasch analysis items to supplement the SF-36 Physical Functioning scale. The new scale, named the Low-Back SF-36 Physical Functioning18, showed comparable reliability and responsiveness to the SF-36 Physical Functioning scale. Further research is required to establish the measurement properties of the Low-Back SF-36 Physical Functioning18 scale in an independent sample. However, it has the potential to improve the clinical measurement of function by providing clinicians with a single measurement tool for comprehensive assessment of patients with low back pain.

The purpose of this study was to evaluate the methods currently available to measure the functional outcomes of physiotherapy treatment for low back problems. As a preliminary step, all extant questionnaires were located and evaluated against practical criteria to determine their likely utility in clinical practice. This process identified a large number of questionnaires, however, only six back-specific questionnaires fulfilled the practical criteria for clinical application. Four of these questionnaires were selected for further evaluation along with a generic health status assessment instrument, the SF-36 Health Survey. Current recommendations suggest that a low-back specific and a generic questionnaire are required for comprehensive assessment of the impact of low back problems. The four back-specific questionnaires selected were the Oswestry Disability Questionnaire, the Quebec Back Pain Disability Scale, the Roland-Morris Disability Questionnaire and the Waddell Disability Index. An evaluation of the literature on the clinimetric properties of these questionnaires revealed that little information was available for the Quebec and Waddell questionnaires and no information was available for any of the questionnaires for a clinical population of people with low back pain seeking physiotherapy treatment in an Australian setting. The primary aim of the research was identify which, if any, of the questionnaires should be recommended for measuring outcomes of physiotherapy treatment for low back pain. Consecutive ambulatory (non-admitted) patients presenting for physiotherapy treatment at three public hospital physiotherapy outpatient departments, three community health services, and four private practices were invited to enter the study. Patients were included if they were seeking treatment for a low back problem, were aged 18 or over, and could read and write English. Subjects completed the questionnaires on two occasions six-weeks apart. One hundred and forty subjects returned the first set of questionnaires, and 106 the second set. The mean age of the sample at pre-test was 51 (SD 17) and ranged from 18 to 89 years. Sixty-six percent were female, 41% were employed and 12% were receiving compensation for their back problem. Duration of the back complaint was more than six weeks for 56% of subjects, and 60% reported five or more previous episodes or continuous pain. Referred pain in the buttock thigh or leg was reported by 70% of subjects. The first aim was to compare the questionnaires for acceptability and comprehensibility. Data quality was high for all the questionnaires (less than 5% missing data). As expected, subjects found the more complex SF-36 Health Survey more difficult to complete than three of the low-back questionnaires. However, less than 10% of subjects found any of the questionnaires more than a little difficult to complete. The next aim was to explore the internal structure and inter-relationships of the low-back questionnaires and the three physical scales of the SF-36 Health Survey (Physical Functioning, Role-Physical and Bodily Pain). Analysis of item-item correlation, item-total correlation and Cronbach�s alpha confirmed that all scales were internally consistent. Factor analysis confirmed item homogeneity (unidimensionality) of all questionnaires except the Roland-Morris Disability Questionnaire. The questionnaires were significantly intercorrelated, but correlations exceeded .70 only for the Oswestry, Quebec and Waddell questionnaires. The next aim of the research was to compare test-retest reliability of the questionnaires. The Oswestry, Quebec and SF-36 Physical Functioning scale had sufficient reliability and scale width for clinical application. Despite previous reports of high reliability, the Roland-Morris scale was significantly less reliable than several of the other questionnaires. This indicates the importance of establishing the measurement properties of a test in the population or setting in which it will be used. The Waddell Disability Index, and the SF-36 Role-Physical and Bodily Pain scales had insufficient scale width to be useful in clinical practice. More than 15% of respondents had an initial score on these scales that would not allow change to be detected with 90% confidence. The next aim of the research was to compare the responsiveness of the questionnaires. None of the questionnaires was consistently identified as more or less responsive than the others although two methods (effect size and Liang�s standardized response mean) suggested the SF-36 Bodily Pain scale was more responsive than some other questionnaires. A secondary aim of this section was to evaluate the validity of the many available responsiveness indices and a novel �reliable change� method. A �known groups� strategy was used to determine whether the responsiveness index could discriminate between the low-back relevant questionnaires and the SF-36 General Health scale, the scores of which did not change across the retest period. With the exception of the novel �reliable change� method the responsiveness indices were all found to be valid indicators of responsiveness. Guyatt�s Responsiveness Index, effect size and Liang�s standardized response mean discriminated at 95% confidence between the reference scale and all the low-back questionnaires. The standardized response mean, t-test, correlation and ROC methods discriminated between the reference scale and five or six of the seven other questionnaires. Guyatt�s index was recommended as the best of the criterion-based methods, and the effect size the best of the distribution-based methods. The three questionnaires identified as having sufficient reliability and scale width, the Oswestry, Quebec and SF-36 Physical Functioning scale, were next analysed for data fit to a Rasch model. All three questionnaires had good data fit and item function was not affected by time, age, gender or whether or not subjects reported avoiding bending. The final aim of this research was to identify by Rasch analysis items to supplement the SF-36 Physical Functioning scale. The new scale, named the Low-Back SF-36 Physical Functioning18, showed comparable reliability and responsiveness to the SF-36 Physical Functioning scale. Further research is required to establish the measurement properties of the Low-Back SF-36 Physical Functioning18 scale in an independent sample. However, it has the potential to improve the clinical measurement of function by providing clinicians with a single measurement tool for comprehensive assessment of patients with low back pain.

The aim of this study was to investigate the quality of the Annual National Assessment (ANA) Grade 6 mathematics instrument including its design, with reference to a single education district. The main question that was investigated was: To what extent does the 2012 Annual National Assessment Grade 6 mathematics assessment instrument provide meaningful information for making appropriate interpretations on district level? The conceptual framework underpinning this study was drawn from the Queensland Studies Authorities Assessment Policy document. The research comprised a secondary analysis design applying mixed methods using the scripts of 546 learners in one district from 5 schools selected to represent a range of achievement. A content analysis of the instrument was undertaken, followed by a statistical item analysis applying the Rasch measurement model. These analytical methods were utilised to determine the quality of the ANA Grade 6 mathematics instrument. Content validity, construct validity and reliability was investigated in order to evaluate inferences that were made and actions that were taken based upon the mathematics performance of learners in Grade 6 in the Gauteng North District (GND) in the year 2012. The investigation revealed that construct validity and content validity were largely achieved, as items were appropriately aligned to the 2012 ANA Grade 6 mathematics curriculum. However errors in mathematics and language formulation detracted from the validity of the instrument. In the case of some items, lack of clarity may have confused learners. As far as reliability is concerned the investigation revealed that the instrument had a reasonable person separation index, a measure of both item and person reliability. However, these conclusions are based on a relatively small sample from only one district and therefore has somewhat limited applicability but is nevertheless of educational consequence. / Dissertation (MEd)--University of Pretoria, 2017. / Science, Mathematics and Technology Education / MEd / Unrestricted

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