The Birmingham relationship continuity measure:the development and evaluation of a measure of the perceived continuity of spousal relationships in dementia

Background: Qualitative research has suggested that spousal carers of someone with dementia differ in terms of whether they perceive their relationship with that person as continuous with the premorbid relationship or as radically different, and that a perception of continuity may be associated with more person-centered care and the experience of fewer of the negative emotions associated with caring. The aim of the study was to develop and evaluate a quantitative measure of the extent to which spousal carers perceive the relationship to be continuous. Methods: An initial pool of 42 questionnaire items was generated on the basis of the qualitative research about relationship continuity. These were completed by 51 spousal carers and item analysis was used to reduce the pool to 23 items. The retained items, comprising five subscales, were then administered to a second sample of 84 spousal carers, and the questionnaire's reliability, discriminative power, and validity were evaluated. Results: The questionnaire showed good reliability: Cronbach's α for the full scale was 0.947, and test-retest reliability was 0.932. Ferguson's δ was 0.987, indicating good discriminative power. Evidence of construct validity was provided by predicted patterns of subscale correlations with the Closeness and Conflict Scale and the Marwit-Meuser Caregiver Grief Inventory. Conclusion: Initial psychometric evaluation of the measure was encouraging. The measure provides a quantitative means of investigating ideas from qualitative research about the role of relationship continuity in influencing how spousal carers provide care and how they react emotionally to their caring role. © 2012 International Psychogeriatric Association.

Modelling in the evaluation of a manufacturing strategy

This thesis describes research that has developed the principles of a modelling tool for the analytical evaluation of a manufacturing strategy. The appropriate process of manufacturing strategy formulation is based on mental synthesis with formal planning processes supporting this role. Inherent to such processes is a stage where the effects of alternative strategies on the performance of a manufacturing system must be evaluated so that a choice of preferred strategy can be made. Invariably this evaluation is carried out by practitioners applying mechanisms of judgement, bargaining and analysis. Ibis thesis makes a significant and original contribution to the provision of analytical support for practitioners in this role. The research programme commences by defining the requirements of analytical strategy evaluation from the perspective of practitioners. A broad taxonomy of models has been used to identify a set of potentially suitable techniques for the strategy evaluation task. Then, where possible, unsuitable modelling techniques have been identified on the basis of evidence in the literature and discarded from this set. The remaining modelling techniques have been critically appraised by testing representative contemporary modelling tools in an industrially based experimentation programme. The results show that individual modelling techniques exhibit various limitations in the strategy evaluation role, though some combinations do appear to provide the necessary functionality. On the basis of this comprehensive and in-depth knowledge a modelling tool ' has been specifically designed for this task. Further experimental testing has then been conducted to verify the principles of this modelling tool. Ibis research has bridged the fields of manufacturing strategy formulation and manufacturing systems modelling and makes two contributions to knowledge. Firstly, a comprehensive and in-depth platform of knowledge has been established about modelling techniques in manufacturing strategy evaluation. Secondly, the principles of a tool that supports this role have been formed and verified.

Modelling in the evaluation of a manufacturing strategy

This thesis describes research that has developed the principles of a modelling tool for the analytical evaluation of a manufacturing strategy. The appropriate process of manufacturing strategy formulation is based on mental synthesis with formal planning processes supporting this role. Inherent to such processes is a stage where the effects of alternative strategies on the performance of a manufacturing system must be evaluated so that a choice of preferred strategy can be made. Invariably this evaluation is carried out by practitioners applying mechanisms of judgement, bargaining and analysis. Ibis thesis makes a significant and original contribution to the provision of analytical support for practitioners in this role. The research programme commences by defining the requirements of analytical strategy evaluation from the perspective of practitioners. A broad taxonomy of models has been used to identify a set of potentially suitable techniques for the strategy evaluation task. Then, where possible, unsuitable modelling techniques have been identified on the basis of evidence in the literature and discarded from this set. The remaining modelling techniques have been critically appraised by testing representative contemporary modelling tools in an industrially based experimentation programme. The results show that individual modelling techniques exhibit various limitations in the strategy evaluation role, though some combinations do appear to provide the necessary functionality. On the basis of this comprehensive and in-depth knowledge a modelling tool ' has been specifically designed for this task. Further experimental testing has then been conducted to verify the principles of this modelling tool. Ibis research has bridged the fields of manufacturing strategy formulation and manufacturing systems modelling and makes two contributions to knowledge. Firstly, a comprehensive and in-depth platform of knowledge has been established about modelling techniques in manufacturing strategy evaluation. Secondly, the principles of a tool that supports this role have been formed and verified.

A methodological evaluation and predictive in silico investigation into the multi-functionality of arginine in directly compressed tablets

The acceleration of solid dosage form product development can be facilitated by the inclusion of excipients that exhibit poly-/multi-functionality with reduction of the time invested in multiple excipient optimisations. Because active pharmaceutical ingredients (APIs) and tablet excipients present diverse densification behaviours upon compaction, the involvement of these different powders during compaction makes the compaction process very complicated. The aim of this study was to assess the macrometric characteristics and distribution of surface charges of two powders: indomethacin (IND) and arginine (ARG); and evaluate their impact on the densification properties of the two powders. Response surface modelling (RSM) was employed to predict the effect of two independent variables; Compression pressure (F) and ARG percentage (R) in binary mixtures on the properties of resultant tablets. The study looked at three responses namely; porosity (P), tensile strength (S) and disintegration time (T). Micrometric studies showed that IND had a higher charge density (net charge to mass ratio) when compared to ARG; nonetheless, ARG demonstrated good compaction properties with high plasticity (Y=28.01MPa). Therefore, ARG as filler to IND tablets was associated with better mechanical properties of the tablets (tablet tensile strength (σ) increased from 0.2±0.05N/mm2 to 2.85±0.36N/mm2 upon adding ARG at molar ratio of 8:1 to IND). Moreover, tablets' disintegration time was shortened to reach few seconds in some of the formulations. RSM revealed tablet porosity to be affected by both compression pressure and ARG ratio for IND/ARG physical mixtures (PMs). Conversely, the tensile strength (σ) and disintegration time (T) for the PMs were influenced by the compression pressure, ARG ratio and their interactive term (FR); and a strong correlation was observed between the experimental results and the predicted data for tablet porosity. This work provides clear evidence of the multi-functionality of ARG as filler, binder and disintegrant for directly compressed tablets.

A holistic multi evidence approach to study the fragmentation behaviour of crystalline mannitol

Mannitol is an essential excipient employed in orally disintegrating tablets due to its high palatability. However its fundamental disadvantage is its fragmentation during direct compression, producing mechanically weak tablets. The primary aim of this study was to assess the fracture behaviour of crystalline mannitol in relation to the energy input during direct compression, utilising ball milling as the method of energy input, whilst assessing tablet characteristics of post-milled powders. Results indicated that crystalline mannitol fractured at the hydrophilic (011) plane, as observed through SEM, alongside a reduction in dispersive surface energy. Disintegration times of post-milled tablets were reduced due to the exposure of the hydrophilic plane, whilst more robust tablets were produced. This was shown through higher tablet hardness and increased plastic deformation profiles of the post-milled powders, as observed with a lower yield pressure through an out-of-die Heckel analysis. Evaluation of crystal state using x-ray diffraction/differential scanning calorimetry showed that mannitol predominantly retained the β-polymorph; however x-ray diffraction provided a novel method to calculate energy input into the powders during ball milling. It can be concluded that particle size reduction is a pragmatic strategy to overcome the current limitation of mannitol fragmentation and provide improvements in tablet properties.

A joint approach to treating dental phobia:a re-evaluation of a collaboration between community dental services and specialist psychotherapy services ten years on

Objective To audit the records of a group of patients who had previously benefited from cognitive behavioural therapy (CBT) for dental phobia.Aim To ascertain if they had returned to the use of intravenous (IV) sedation to facilitate dental treatment. Ten years ago these patients were routinely requiring IV sedation to facilitate dental treatment due to severe dental phobia.Method Sixty patients entered the original pilot project. Of those, 30 were offered CBT and 21 attended. Twenty of those patients (95.2%) were subsequently able to have dental treatment without IV sedation. In this follow-up study the electronic records of 19 of the 20 patients who had originally been successful with CBT were re-audited. Our purpose was to see if there was any record of subsequent IV sedation administration in the intervening ten years.Results Of the 19 successful CBT patients available to follow-up, 100% had not received IV sedation since the study ten years ago. This may suggest the initial benefit of CBT has endured over the ten-year period.Conclusion This study indicates that the use of CBT for patients with dental phobia proves beneficial not only in the initial treatment but that the benefits may endure over time. This results in a significant reduction in health risks to the patient from repeated IV sedation. It may also translate into significant financial savings for dental care providers. Our evidence for CBT as treatment for dental phobia suggests dental services should be implementing this approach now rather than pursuing further research. © 2011 Macmillan Publishers Limited. All rights reserved.

The Long-Term impact of Business Support? - Exploring the Role of Evaluation Timing using Micro Data

The original contribution of this work is threefold. Firstly, this thesis develops a critical perspective on current evaluation practice of business support, with focus on the timing of evaluation. The general time frame applied for business support policy evaluation is limited to one to two, seldom three years post intervention. This is despite calls for long-term impact studies by various authors, concerned about time lags before effects are fully realised. This desire for long-term evaluation opposes the requirements by policy-makers and funders, seeking quick results. Also, current ‘best practice’ frameworks do not refer to timing or its implications, and data availability affects the ability to undertake long-term evaluation. Secondly, this thesis provides methodological value for follow-up and similar studies by using data linking of scheme-beneficiary data with official performance datasets. Thus data availability problems are avoided through the use of secondary data. Thirdly, this thesis builds the evidence, through the application of a longitudinal impact study of small business support in England, covering seven years of post intervention data. This illustrates the variability of results for different evaluation periods, and the value in using multiple years of data for a robust understanding of support impact. For survival, impact of assistance is found to be immediate, but limited. Concerning growth, significant impact centres on a two to three year period post intervention for the linear selection and quantile regression models – positive for employment and turnover, negative for productivity. Attribution of impact may present a problem for subsequent periods. The results clearly support the argument for the use of longitudinal data and analysis, and a greater appreciation by evaluators of the factor time. This analysis recommends a time frame of four to five years post intervention for soft business support evaluation.

The long-term impact of business support? - Exploring the role of evaluation timing using micro data

The original contribution of this work is threefold. Firstly, this thesis develops a critical perspective on current evaluation practice of business support, with focus on the timing of evaluation. The general time frame applied for business support policy evaluation is limited to one to two, seldom three years post intervention. This is despite calls for long-term impact studies by various authors, concerned about time lags before effects are fully realised. This desire for long-term evaluation opposes the requirements by policy-makers and funders, seeking quick results. Also, current ‘best practice’ frameworks do not refer to timing or its implications, and data availability affects the ability to undertake long-term evaluation. Secondly, this thesis provides methodological value for follow-up and similar studies by using data linking of scheme-beneficiary data with official performance datasets. Thus data availability problems are avoided through the use of secondary data. Thirdly, this thesis builds the evidence, through the application of a longitudinal impact study of small business support in England, covering seven years of post intervention data. This illustrates the variability of results for different evaluation periods, and the value in using multiple years of data for a robust understanding of support impact. For survival, impact of assistance is found to be immediate, but limited. Concerning growth, significant impact centres on a two to three year period post intervention for the linear selection and quantile regression models – positive for employment and turnover, negative for productivity. Attribution of impact may present a problem for subsequent periods. The results clearly support the argument for the use of longitudinal data and analysis, and a greater appreciation by evaluators of the factor time. This analysis recommends a time frame of four to five years post intervention for soft business support evaluation.

Evaluation of low vision services on the quality of life of individuals with age-related macular degeneration

Background: Age-related macular degeneration (ARMD) is a major cause of irreversible visual loss in the elderly and a significant threat to their quality of life. Although low vision services often improve the functional outcomes of individuals with macular disease, it remains unclear whether or not they have any impact on quality of life. The principal aim of this study was to determine the effect of a hospital-based low vision clinic on the quality of life of individuals with ARMD. Methods: Forty patients with ARMD attended the low vision clinic at Milton Keynes University Hospital. Quality of life was measured with the vision-specific Low Vision Quality of Life (LVQOL) questionnaire and the general health EuroQol (EQ-5D-5L) questionnaire. Measures were completed at baseline (time zero, T0), and at three- (T3) and six-month (T6) follow-up visits. Results: The near visual acuity of individuals attending the low vision clinic for the first time improved significantly between visits T0 and T3 (p=0.005), reflecting the practiced use of their newly-dispensed low vision aids. As expected, there was no significant change in near acuity over this time period for existing patients. For both new and existing patients, a significant increase in LVQOL score was evident between visits T0 and T3, with a further significant improvement between T3 and T6. Similarly, there was a significant decrease in EQ-5D-5L questionnaire scores between visits T0 and T6. Conclusions: The higher LVQOL scores obtained at the end of the study period (T6) provide evidence that low vision services at Milton Keynes University Hospital served to improve patient quality of life. The reduction in EQ-5D-5L scores over the same time period suggests that low vision services also provide for an improvement in general health-related quality of life. Impact: The findings support the cause of low vision services to improve not only the vision and functional outcomes of individuals with macular disease but also their quality of life. Moreover, the findings suggest that a more efficient allocation of resources at low vision clinics may be possible through the standardisation of patient follow-up frequency.

Evaluation of contact and non-contact trapping efficiencies of human scent chemical profiles and their stabilities under different environmental conditions

Establishing an association between the scent a perpetrator left at a crime scene to the odor of the suspect of that crime is the basis for the use of human scent identification evidence in a court of law. Law enforcement agencies gather evidence through the collection of scent from the objects that a perpetrator may have handled during the execution of the criminal act. The collected scent evidence is consequently presented to the canines for identification line-up procedures with the apprehended suspects. Presently, canine scent identification is admitted as expert witness testimony, however, the accurate behavior of the dogs and the scent collection methods used are often challenged by the court system. The primary focus of this research project entailed an evaluation of contact and non-contact scent collection techniques with an emphasis on the optimization of collection materials of different fiber chemistries to evaluate the chemical odor profiles obtained using varying environment conditions to provide a better scientific understanding of human scent as a discriminative tool in the identification of suspects. The collection of hand odor from female and male subjects through both contact and non-contact sampling approaches yielded new insights into the types of VOCs collected when different materials are utilized, which had never been instrumentally performed. Furthermore, the collected scent mass was shown to be obtained in the highest amounts for both gender hand odor samples on cotton sorbent materials. Compared to non-contact sampling, the contact sampling methods yielded a higher number of volatiles, an enhancement of up to 3 times, as well as a higher scent mass than non-contact methods by more than an order of magnitude. The evaluation of the STU-100 as a non-contact methodology highlighted strong instrumental drawbacks that need to be targeted for enhanced scientific validation of current field practices. These results demonstrated that an individual's human scent components vary considerably depending on the method used to collect scent from the same body region. This study demonstrated the importance of collection medium selection as well as the collection method employed in providing a reproducible human scent sample that can be used to differentiate individuals.

Disaster Risk Management Disparity in the Caribbean: Evidence from Barbados, Dominican Republic, Jamaica and Trinidad and Tobago

This study on risk and disaster management capacities of four Caribbean countries: Barbados, the Dominican Republic, Jamaica, and Trinidad and Tobago, examines three main dimensions: 1) the impact of natural disasters from 1900 to 2010 (number of events, number of people killed, total number affected, and damage in US$); 2) institutional assessments of disaster risk management disparity; and 3) the 2010 Inter-American Bank for Development (IADB) Disaster Risk and Risk Management indicators for the countries under study. The results show high consistency among the different sources examined, pointing out the need to extend the IADB measurements to the rest of the Caribbean countries. Indexes and indicators constitute a comparison measure vis-à-vis existing benchmarks in order to anticipate a capacity to deal with adverse events and their consequences; however, the indexes and indicators could only be tested against the occurrence of a real event. Therefore, the need exists to establish a sustainable and comprehensive evaluation system after important disasters to assess a country‘s performance, verify the indicators, and gain feedback on measurement systems and methodologies. There is diversity in emergency and preparedness for disasters in the four countries under study. The nature of the event (hurricanes, earthquakes, floods, and seismic activity), especially its frequency and the intensity of the damage experienced, is related to how each has designed its risk and disaster management policies and programs to face natural disasters. Vulnerabilities to disaster risks have been increasing, among other factors, because of uncontrolled urbanization, demographic density and poverty increase, social and economic marginalization, and lack of building code enforcement. The four countries under study have shown improvements in risk management capabilities, yet they are far from being completed prepared. Barbados‘ risk management performance is superior, in comparison, to the majority of the countries of the region. However, is still far in achieving high performance levels and sustainability in risk management, primarily when it has the highest gap between potential macroeconomic and financial losses and the ability to face them. The Dominican Republic has shown steady risk performance up to 2008, but two remaining areas for improvement are hazard monitoring and early warning systems. Jamaica has made uneven advances between 1990 and 2008, requiring significant improvements to achieve high performance levels and sustainability in risk management, as well as macroeconomic mitigation infrastructure. Trinidad and Tobago has the lowest risk management score of the 15 countries in the Latin American and Caribbean region as assessed by the IADB study in 2010, yet it has experienced an important vulnerability reduction. In sum, the results confirmed the high disaster risk management disparity in the Caribbean region.

An evaluation of functional impairment among children with anxiety disorders

Despite a considerable progress in developing and testing psychosocial treatments to reduce youth anxiety disorders, much remains to learn about the relation between anxiety symptom reduction and change in youth functional impairment. The specific aims of this dissertation thus were to examine: (1) the relation between different levels of anxiety and youth functional impairment ratings; (2) incremental validity of the Children Global Assessment Scale (CGAS); (3) the mediating role of anxiety symptom reduction on youth functional impairment ratings; (4) the directionality of change between anxiety symptom reduction and youth functional impairment; (5) the moderating effects of youth age, sex, and ethnicity on the mediated relation between youth anxiety symptom reduction and change in functional impairment; and (6) an agreement (or lack thereof) between youths and their parents in their views of change in youth functional impairment vis-à-vis anxiety symptom reduction. ^ The results were analyzed using archival data set acquired from 183 youths and their mothers. Research questions were tested using SPSS and structural equation modeling techniques in Mplus. ^ The results supported the efficacy of psychosocial treatments to reduce the severity of youth anxiety symptoms and its associated functional impairment. Moreover, the results revealed that at posttreatment, youths who scored either low or medium on anxiety levels scored significantly lower on impairment, than youths who scored high on anxiety levels. Incremental validity of the CGAS was also revealed across all assessment points and informants in my sample. In addition, the results indicated the mediating role of anxiety symptom reduction with respect to change in youth functional impairment at posttest, regardless of the youth’s age, sex, and ethnicity. No significant findings were observed with regard to the bidirectionality and an informant disagreement vis-à-vis the relation between anxiety symptom reduction and change in functional impairment. ^ The study’s main contributions and potential implications on theoretical, empirical, and clinical levels are further discussed. The emphasis is on the need to enhance existing evidence-based treatments and develop innovative treatment models that will not only reduce youth’s symptoms (such anxiety) but also evoke genuine and palpable improvements in lives of youths and their families.^

Disater Risk Management Disparity in the Caribbean: Evidence from Barbados, Dominican Republic, Jamaica and Trinidad and Tobago

This study on risk and disaster management capacities of four Caribbean countries: Barbados, the Dominican Republic, Jamaica, and Trinidad and Tobago, examines three main dimensions: 1) the impact of natural disasters from 1900 to 2010 (number of events, number of people killed, total number affected, and damage in US$); 2) institutional assessments of disaster risk management disparity; and 3) the 2010 Inter-American Bank for Development (IADB) Disaster Risk and Risk Management indicators for the countries under study. The results show high consistency among the different sources examined, pointing out the need to extend the IADB measurements to the rest of the Caribbean countries. Indexes and indicators constitute a comparison measure vis-à-vis existing benchmarks in order to anticipate a capacity to deal with adverse events and their consequences; however, the indexes and indicators could only be tested against the occurrence of a real event. Therefore, the need exists to establish a sustainable and comprehensive evaluation system after important disasters to assess a country’s performance, verify the indicators, and gain feedback on measurement systems and methodologies. There is diversity in emergency and preparedness for disasters in the four countries under study. The nature of the event (hurricanes, earthquakes, floods, and seismic activity), especially its frequency and the intensity of the damage experienced, is related to how each has designed its risk and disaster management policies and programs to face natural disasters. Vulnerabilities to disaster risks have been increasing, among other factors, because of uncontrolled urbanization, demographic density and poverty increase, social and economic marginalization, and lack of building code enforcement. The four countries under study have shown improvements in risk management capabilities, yet they are far from being completed prepared. Barbados’ risk management performance is superior, in comparison, to the majority of the countries of the region. However, is still far in achieving high performance levels and sustainability in risk management, primarily when it has the highest gap between potential macroeconomic and financial losses and the ability to face them. The Dominican Republic has shown steady risk performance up to 2008, but two remaining areas for improvement are hazard monitoring and early warning systems. Jamaica has made uneven advances between 1990 and 2008, requiring significant improvements to achieve high performance levels and sustainability in risk management, as well as macroeconomic mitigation infrastructure. Trinidad and Tobago has the lowest risk management score of the 15 countries in the Latin American and Caribbean region as assessed by the IADB study in 2010, yet it has experienced an important vulnerability reduction. In sum, the results confirmed the high disaster risk management disparity in the Caribbean region.

Evaluation of the evidential value of the elemental composition of glass, ink and paper by laser-based microspectrochemical methods

Elemental analysis can become an important piece of evidence to assist the solution of a case. The work presented in this dissertation aims to evaluate the evidential value of the elemental composition of three particular matrices: ink, paper and glass. In the first part of this study, the analytical performance of LIBS and LA-ICP-MS methods was evaluated for paper, writing inks and printing inks. A total of 350 ink specimens were examined including black and blue gel inks, ballpoint inks, inkjets and toners originating from several manufacturing sources and/or batches. The paper collection set consisted of over 200 paper specimens originating from 20 different paper sources produced by 10 different plants. Micro-homogeneity studies show smaller variation of elemental compositions within a single source (i.e., sheet, pen or cartridge) than the observed variation between different sources (i.e., brands, types, batches). Significant and detectable differences in the elemental profile of the inks and paper were observed between samples originating from different sources (discrimination of 87–100% of samples, depending on the sample set under investigation and the method applied). These results support the use of elemental analysis, using LA-ICP-MS and LIBS, for the examination of documents and provide additional discrimination to the currently used techniques in document examination. In the second part of this study, a direct comparison between four analytical methods (µ-XRF, solution-ICP-MS, LA-ICP-MS and LIBS) was conducted for glass analyses using interlaboratory studies. The data provided by 21 participants were used to assess the performance of the analytical methods in associating glass samples from the same source and differentiating different sources, as well as the use of different match criteria (confidence interval (±6s, ±5s, ±4s, ±3s, ±2s), modified confidence interval, t-test (sequential univariate, p=0.05 and p=0.01), t-test with Bonferroni correction (for multivariate comparisons), range overlap, and Hotelling's T2 tests. Error rates (Type 1 and Type 2) are reported for the use of each of these match criteria and depend on the heterogeneity of the glass sources, the repeatability between analytical measurements, and the number of elements that were measured. The study provided recommendations for analytical performance-based parameters for µ-XRF and LA-ICP-MS as well as the best performing match criteria for both analytical techniques, which can be applied now by forensic glass examiners.

Team Evaluation: Solutions for Hotel Management and Productivity

Employee performance appraisal systems are controversial, especially when accomplished by a single rater. The authors, who have had experience with team evaluation systems, present evidence from that experience for over- coming obstacles to moving to a "less-biased" system of rating employees.