Constructing the Vulvar Pain Assessment Questionnaire Inventory

The goals of this program of research were to examine the link between self-reported vulvar pain and clinical diagnoses, and to create a user-friendly assessment tool to aid in that process. These goals were undertaken through a series of four empirical studies (Chapters 2-6): one archival study, two online studies, and one study conducted in a Women’s Health clinic. In Chapter 2, the link between self-report and clinical diagnosis was confirmed by extracting data from multiple studies conducted in the Sexual Health Research Laboratory over the course of several years. We demonstrated the accuracy of diagnosis based on multiple factors, and explored the varied gynecological presentation of different diagnostic groups. Chapter 3 was based on an online study designed to create the Vulvar Pain Assessment Questionnaire (VPAQ) inventory. Following the construct validation approach, a large pool of potential items was created to capture a broad selection of vulvar pain symptoms. Nearly 300 participants completed the entire item pool, and a series of factor analyses were utilized to narrow down the items and create scales/subscales. Relationships were computed among subscales and validated scales to establish convergent and discriminant validity. Chapters 4 and 5 were conducted in the Department of Obstetrics & Gynecology at Oregon Health & Science University. The brief screening version of the VPAQ was employed with patients of the Program in Vulvar Health at the Center for Women’s Health. The accuracy and usefulness of the VPAQscreen was determined from the perspective of patients as well as their health care providers, and the treatment-seeking experiences of patients was explored. Finally, a second online study was conducted to confirm the factor structure, internal consistency, and test-retest reliability of the VPAQ inventory. The results presented in these chapters confirm the link between targeted questions and accurate diagnoses, and provide a guideline that is useful and accessible for providers and patients.

Performance and Assessment of Rehabilitated Steel Culverts

This thesis explores the effects of rehabilitation on the structural performance of corrugated steel culverts. A full-scale laboratory experiment investigated the effects of grouted slip-liners on the performance of two buried circular corrugated steel culverts. One culvert was slip-lined and grouted using low strength grout, while the other was slip-lined and grouted using high strength grout. The performances of the culverts were measured before and after rehabilitation under service loads using single wheel pair loading at 0.45m of cover. Then, the rehabilitated culverts were loaded to their ultimate limit states. Results showed that the low and high strength grouted slip-liners provided strength well beyond requirements, with the low strength specimen failing at a load 2.4 times the fully factored service load, while the high strength specimen did not reach an ultimate limit state before bearing failure of the soil stopped testing. Results also showed that the low strength specimen behaved rigidly under service loads and flexibly under higher loads, while the high strength specimen behaved rigidly under all loads. A second full-scale experiment investigated the effect of a paved invert rehabilitation procedure on the performance of a deteriorated horizontal ellipse culvert. The performance of the culvert before and after rehabilitation was examined under service loads using tandem axle loading at 0.45m of cover. The rehabilitated culvert was then loaded up to its ultimate limit state. The culvert failed due to the formation of a plastic hinge at the West shoulder, while the paved invert cracked at the invert. Results showed that the rehabilitation increased the structural performance of the culvert, increasing the system stiffness and reducing average strains and local bending at critical locations in the culvert under service loads. A sustainability rating tool specifically for the evaluation of deteriorated culvert replacement or rehabilitation projects was also developed. A module for an existing tool, called GoldSET, was created and tested using two case studies, each comparing the replacement of a culvert using a traditional open-cut method with two trenchless rehabilitation techniques. In each case, the analyses showed that the trenchless techniques were the better alternatives in terms of sustainability.