Assessment of water and sanitation infrastructure at primary schools in Rakai District, Uganda

“Addressing water problems will help improve sanitation.” This relationship identified by a primary school teacher in Rakai District, Uganda, was a key component in understanding how water and sanitation technologies interact and how identified successes, challenges, and improvements would enhance schools’ water and sanitation condition. In this study, researchers and Ugandan counterparts visited 49 primary schools in Rakai District to assess the existing water and sanitation infrastructure of government and private schools. Researchers were specifically interested in learning which technologies were being used and why they were working or not. Through the development of a unique water and sanitation assessment tool, schools have been placed in to four relationship quadrants to rate existing water and latrine use standards. Recommendations including improved rainwater use and sanitation through composting have been offered to schools sampled.

Is the conditioned pain modulation paradigm reliable? A test-retest assessment using the nociceptive withdrawal reflex.

The aim of this study was to determine the reliability of the conditioned pain modulation (CPM) paradigm assessed by an objective electrophysiological method, the nociceptive withdrawal reflex (NWR), and psychophysical measures, using hypothetical sample sizes for future studies as analytical goals. Thirty-four healthy volunteers participated in two identical experimental sessions, separated by 1 to 3 weeks. In each session, the cold pressor test (CPT) was used to induce CPM, and the NWR thresholds, electrical pain detection thresholds and pain intensity ratings after suprathreshold electrical stimulation were assessed before and during CPT. CPM was consistently detected by all methods, and the electrophysiological measures did not introduce additional variation to the assessment. In particular, 99% of the trials resulted in higher NWR thresholds during CPT, with an average increase of 3.4 mA (p<0.001). Similarly, 96% of the trials resulted in higher electrical pain detection thresholds during CPT, with an average increase of 2.2 mA (p<0.001). Pain intensity ratings after suprathreshold electrical stimulation were reduced during CPT in 84% of the trials, displaying an average decrease of 1.5 points in a numeric rating scale (p<0.001). Under these experimental conditions, CPM reliability was acceptable for all assessment methods in terms of sample sizes for potential experiments. The presented results are encouraging with regards to the use of the CPM as an assessment tool in experimental and clinical pain. Trial registration: Clinical Trials.gov NCT01636440.

Assessment of markers of medication literacy in a US-Mexico border community

Each year an estimated 180,000 people in the United States (U.S.) die as a result of medication errors, now considered a major public health problem. If a patient cannot correctly act on information related to medication use or "Medication Literacy" there is an increased potential for error. Medication use issues are unique on the US-Mexico border because they include high rates of herbal products and medication products from Mexico as well as issues related to the preferred language (English or Spanish) of the patient. To evaluate the medication literacy in a US-Mexico border community, this retrospective study evaluates 180 subjects representing four diverse economic segments of a metropolitan US-Mexico Border community who have taken a Medication Literacy Assessment. The assessment tool has been created to understand how patients interpret medication information for prescription, over-the-counter, herbal, and Mexican medication product use, and how they problem-solve medication questions. The Medication Literacy Assessment tool specifically assesses document literacy (e.g., prescription labels), prose literacy (e.g., patient leaflets), numeracy (e.g., calculations and measurements) as well as qualitative data related to medication use practices. The main hypothesis of this study is that the ability to interpret and use medications will vary based on education, language (Spanish or English), and recruitment sites (economically diverse communities). The results will provide information to better characterize medication use in a primarily Hispanic population on the US-Mexico border and may be used to influence policy decisions regarding prescription and over-the-counter product information.^

Propuesta metodológica para la identificación de medidas de adaptación al cambio climático en sistemas de recursos hídricos

Esta tesis realiza una contribución metodológica en el estudio de medidas de adaptación potencialmente adecuadas a largo plazo, donde los sistemas de recursos hídricos experimentan fuertes presiones debido a los efectos del cambio climático. Esta metodología integra el análisis físico del sistema, basándose en el uso de indicadores que valoran el comportamiento de éste, y el análisis económico mediante el uso del valor del agua. El procedimiento metodológico inicia con la construcción de un conjunto de escenarios futuros, que capturan por un lado las características de variabilidad de las aportaciones de diversos modelos climáticos y, por otro, las características hidrológicas de la zona de estudio. Las zonas de estudio seleccionadas fueron las cuencas del Guadalquivir, Duero y Ebro y se utilizaron como datos observados las series de escorrentía en régimen natural estimadas por el modelo SIMPA que está calibrado en la totalidad del territorio español. Estas series observadas corresponden al periodo 1961-1990. Los escenarios futuros construidos representan el periodo 2071-2100. La identificación de medidas de adaptación se apoyó en el uso de indicadores que sean capaces de caracterizar el comportamiento de un sistema de recursos hídricos frente a los efectos del cambio climático. Para ello se seleccionaron los indicadores de calidad de servicio (I1) y de confiabilidad de la demanda (I2) propuestos por Martin-Carrasco et al. (2012). Estos indicadores valoran el comportamiento de un sistema mediante la identificación de los problemas de escasez de agua que presente, y requieren para su cuantificación el uso de un modelo de optimización. Para este estudio se ha trabajado con el modelo de optimización OPTIGES. La determinación de estos indicadores fue realizada para análisis a corto plazo donde los efectos del cambio climático no son de relevancia, por lo que fue necesario analizar su capacidad para ser usados en sistemas afectados por dichos efectos. Para este análisis se seleccionaron tres cuencas españolas: Guadalquivir, Duero y Ebro, determinándose que I2 no es adecuado para este tipo de escenarios. Por ello se propuso un nuevo indicador “Indicador de calidad de servicio bajo cambio climático” (I2p) que mantiene los mismos criterios de valoración que I2 pero que responde mejor bajo fuertes reducciones de aportaciones producto del cambio climático. La metodología propuesta para la identificación de medidas de adaptación se basa en un proceso iterativo en el cual se van afectando diversos elementos que conforman el esquema del sistema bajo acciones de gestión previamente identificadas, hasta llegar a un comportamiento óptimo dado por el gestor. Las mejoras de estas afectaciones son cuantificadas mediante los indicadores I1 e I2p, y de este conjunto de valores se selecciona la que se acerca más al comportamiento óptimo. Debido a la extensa cantidad de información manejada en este análisis, se desarrolló una herramienta de cálculo automatizada en Matlab. El proceso seguido por esta herramienta es: (i) Ejecución del modelo OPTIGES para las diferentes modificaciones por acciones de gestión; (ii) Cálculo de los valores de I1 e I2p para cada una de estas afectaciones; y (iii) Selección de la mejor opción. Este proceso se repite hasta llegar al comportamiento óptimo buscado, permitiendo la identificación de las medidas de adaptación mas adecuadas. La aplicación de la metodología para la identificación de medidas de adaptación se realizó en la cuenca del Guadalquivir, por ser de las tres cuencas analizadas bajo los indicadores I1 e I2p la que presenta los problemas más serios de escasez de agua. Para la identificación de medidas de adaptación se analizaron dos acciones de gestión: 1) incremento de los volúmenes de regulación y 2) reducción de las demandas de riego, primero bajo la valoración del comportamiento físico del sistema (análisis de sensibilidad) permitiendo identificar que la primera acción de gestión no genera cambios importantes en el comportamiento del sistema, que si se presentan bajo la segunda acción. Posteriormente, con la acción que genera cambios importantes en el comportamiento del sistema (segunda acción) se identificaron las medidas de adaptación más adecuadas, mediante el análisis físico y económico del sistema. Se concluyó que en la cuenca del Guadalquivir, la acción de reducción de las demandas de riego permite minimizar e incluso eliminar los problemas de escasez de agua que se presentarían a futuro bajo diferentes proyecciones hidrológicas, aunque estas mejoras implicarían fuertes reducciones en dichas demandas. Siendo las demandas más afectadas aquellas ubicadas en cabecera de cuenca. Los criterios para la reducción de las demandas se encuentran en función de las productividades y garantías con las que son atendidas dichas demandas. This thesis makes a methodological contribution to the study of potentially suitable adaptation measures in the long term, where water resource systems undergo strong pressure due to the effects of climate change. This methodology integrates the physical analysis of the system, by the use of indicators which assess its behavior, and the economic analysis by the use of the value of water. The methodological procedure begins with the building of a set of future scenarios that capture, by one hand, the characteristics and variability of the streamflow of various climate models and, on the other hand, the hydrological characteristics of the study area. The study areas chosen were the Guadalquivir, Ebro and Duero basins, and as observed data where used runoff series in natural regimen estimated by the SIMPA model, which is calibrated in the whole Spanish territory. The observed series are for the 1961-1990 period. The future scenarios built represent the 2071-2100 periods. The identification of adaptation measures relied on the use of indicators that were able of characterize the behavior of one water resource system facing the effects of climate change. Because of that, the Demand Satisfaction Index (I1) and the Demand Reliability Index (I2) proposed by Martin-Carrasco et al. (2012) were selected. These indicators assess the behavior of a system by identifying the water scarcity problems that it presents, and require in order to be quantified the use of one optimization model. For this study the OPTIGES optimization model has been used. The determination of the indicators was made for the short-term analysis where the climates change effect are not relevant, so it was necessary to analyze their capability to be used in systems affected by those these. For this analysis three Spanish basins were selected: Guadalquivir, Duero and Ebro. It was determined that the indicator I2 is not suitable for this type of scenario. It was proposed a new indicator called “Demand Reliability Index under climate change” (I2p), which keeps the same assessment criteria than I2, but responsive under heavy reductions of streamflow due to climate change. The proposed methodology for identifying adaptation measures is based on an iterative process, in which the different elements of the system´s schema are affected by previously defined management actions, until reach an optimal behavior given by the manager. The improvements of affectations are measured by indicators I1 e I2p, and from this set of values it is selected the affectation that is closer to the optimal behavior. Due to the large amount of information managed in this analysis, it was developed an automatic calculation tool in Matlab. The process followed by this tool is: Firstly, it executes the OPTIGES model for the different modifications by management actions; secondly, it calculates the values of I1 e I2p for each of these affectations; and finally it chooses the best option. This process is performed for the different iterations that are required until reach the optimal behavior, allowing to identify the most appropriate adaptation measured. The application of the methodology for the identification of adaptation measures was conducted in the Guadalquivir basin, due to this was from the three basins analyzed under the indicators I1 e I2p, which presents the most serious problems of water scarcity. For the identification of adaptation measures there were analyzed two management actions: 1) To increase the regulation volumes, and 2) to reduce the irrigation demands, first under the assessment of the physical behavior of the system (sensibility analysis), allowing to identify that the first management action does not generate significant changes in the system´s behavior, which there are present under the second management action. Afterwards, with the management action that generates significant changes in the system´s behavior (second management action), there were identified the most adequate adaptation measures, through the physical and economic analysis of the system. It was concluded that in the Guadalquivir basin, the action of reduction of irrigation demands allows to minimize or even eliminate the water scarcity problems that could exist in the future under different hydrologic projections, although this improvements should involve strong reductions of the irrigation demands. Being the most affected demands those located in basins head. The criteria for reducing the demands are based on the productivities and reliabilities with which such demands are meet.

Face, content, and construct validity of the EndoViS training system for objective assessment of psychomotor skills of laparoscopic surgeons

Background The aim of this study is to present face, content, and constructs validity of the endoscopic orthogonal video system (EndoViS) training system and determines its efficiency as a training and objective assessment tool of the surgeons’ psychomotor skills. Methods Thirty-five surgeons and medical students participated in this study: 11 medical students, 19 residents, and 5 experts. All participants performed four basic skill tasks using conventional laparoscopic instruments and EndoViS training system. Subsequently, participants filled out a questionnaire regarding the design, realism, overall functionality, and its capabilities to train hand–eye coordination and depth perception, rated on a 5-point Likert scale. Motion data of the instruments were obtained by means of two webcams built into a laparoscopic physical trainer. To identify the surgical instruments in the images, colored markers were placed in each instrument. Thirteen motion-related metrics were used to assess laparoscopic performance of the participants. Statistical analysis of performance was made between novice, intermediate, and expert groups. Internal consistency of all metrics was analyzed with Cronbach’s α test. Results Overall scores about features of the EndoViS system were positives. Participants agreed with the usefulness of tasks and the training capacities of EndoViS system (score >4). Results presented significant differences in the execution of three skill tasks performed by participants. Seven metrics showed construct validity for assessment of performance with high consistency levels. Conclusions EndoViS training system has been successfully validated. Results showed that EndoViS was able to differentiate between participants of varying laparoscopic experience. This simulator is a useful and effective tool to objectively assess laparoscopic psychomotor skills of the surgeons.

Assessment of Competences in the Physical Chemistry Area: Use of the Department Teaching Portfolio

Competences have become a standard learning outcome in present university education within the European Higher Education Area (EHEA). In this regard, updated tools for their assessment have turned out essential in this new teaching-learning paradigm. Among them, one of the most promising tools is the “learner´s portfolio”, which is based on the gathering and evaluation of a range of evidences from the student, which provides a wider and more realistic view of his/her competence acquisition. Its appropriate use as a formative (continuous) assessment instrument allows a deeper appraisal of student´s learning, provided it does not end up as another summative (final) evaluation tool. In this contribution we propose the use of the portfolio as a unifying assessment tool within a university department (Physical Chemistry), exemplifying how the portfolio could yield both personalized student reports and averaged area reports on competence acquisition. A proposed stepwise protocol is given to organize the individual competence reports and estimate the global competence level following a bottom-up approach (i.e. ranging from the class group, subject, grade, and academic course).

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.

Screening for physical activity in family practice - Evaluation of two brief assessment tools

Background: Physical activity (PA) is relevant to the prevention and management of many health conditions in family practice. There is a need for an efficient, reliable, and valid assessment tool to identify patients in need of PA interventions. Methods: Twenty-eight family physicians in three Australian cities assessed the PA of their adult patients during 2004 using either a two- (2Q) or three-question (3Q) assessment. This was administered again approximately 3 days later to evaluate test-retest reliability. Concurrent validity was evaluated by measuring agreement with the Active Australia Questionnaire, and criterion validity by comparison with 7-day Computer Science Applications, Inc. (CSA) accelerometer counts. Results: A total of 509 patients participated, with 428 (84%) completing a repeat assessment, and 415 (82%) accelerometer monitoring. The brief assessments had moderate test-retest reliability (2Q k = 58.0%, 95% confidence interval [CI] = 47.2-68.8%; 3Q k = 55.6%, 95% CI = 43.8-67.4%); fair to moderate concurrent validity (2Q k = 46.7%, 95% CI = 35.657.9%; 3Q k = 38.7%, 95% CI = 26.4-51.1%); and poor to fair criterion validity (2Q k = 18.2%, 95% CI = 3.9-32.6%; 3Q k = 24.3%, 95% CI = 11.6-36.9%) for identifying patients as sufficiently active. A four-level scale of PA derived from the PA assessments was significantly correlated with accelerometer minutes (2Q rho = 0.39, 95% CI = 0.28-0.49; 3Q rho = 0.31, 95% CI = 0.18-0.43). Physicians reported that the assessments took I to 2 minutes to complete. Conclusions: Both PA assessments were feasible to use in family practice, and were suitable for identifying the least active patients. The 2Q assessment was preferred by clinicians and may be most appropriate for dissemination.

Reliability and validity of a brief physical activity assessment for use by family doctors

Objective: To evaluate the reliability and validity of a brief physical activity assessment tool suitable for doctors to use to identify inactive patients in the primary care setting. Methods: Volunteer family doctors (n = 8) screened consenting patients (n = 75) for physical activity participation using a brief physical activity assessment tool. Inter-rater reliability was assessed within one week (n = 71). Validity was assessed against an objective physical activity monitor (computer science and applications accelerometer; n = 42). Results: The brief physical activity assessment tool produced repeatable estimates of sufficient total physical activity, correctly classifying over 76% of cases (kappa 0.53, 95% confidence interval (CI) 0.33 to 0.72). The validity coefficient was reasonable (kappa 0.40, 95% CI 0.12 to 0.69), with good percentage agreement (71%). Conclusions: The brief physical activity assessment tool is a reliable instrument, with validity similar to that of more detailed self report measures of physical activity. It is a tool that can be used efficiently in routine primary healthcare services to identify insufficiently active patients who may need physical activity advice.

Achieving continuous improvement through self-assessment

In 2007 the UK Office of Government Commerce was mandated to carry out Procurement Capability Reviews (PCR) across the 16 top spending UK Government Departments. Since then, this programme has evolved into a self assessment based approach which is markedly different from the original approach. Will the move from a centre-led strategic review of procurement capability to a department-led model based on self assessment continue to strengthen and improve procurement capability across Central Civil Government? OGC is currently working with UK Government Departments to carry out their PCRs using a self-assessment tool which incorporates qualitative and quantitative measures. Results are generated based on a capability maturity model. The results are assured independently. OGC expectations are that tangible and measurable capability improvements will be realised when departments embed the self-assessment model and implement the findings as part of a continuous improvement regime. This paper is a case study, using some relevant literature to reflect on past and possible future development of the PCR self assessment scheme.

An eMathTeacher Tool for Active Learning Fleury’s Algorithm

An eMathTeacher [Sánchez-Torrubia 2007a] is an eLearning on line self assessment tool that help students to active learning math algorithms by themselves, correcting their mistakes and providing them with clues to find the right solution. The tool presented in this paper is an example of this new concept on Computer Aided Instruction (CAI) resources and has been implemented as a Java applet and designed as an auxiliary instrument for both classroom teaching and individual practicing of Fleury’s algorithm. This tool, included within a set of eMathTeacher tools, has been designed as educational complement of Graph Algorithm active learning for first course students. Its characteristics of visualization, simplicity and interactivity, make this tutorial a great value pedagogical instrument.

Apollo 13 Risk Assessment Revisited

Fault tree methodology is the most widespread risk assessment tool by which one is able to predict - in principle - the outcome of an event whenever it is reduced to simpler ones by the logic operations conjunction and disjunction according to the basics of Boolean algebra. The object of this work is to present an algorithm by which, using the corresponding computer code, one is able to predict - in practice - the outcome of an event whenever its fault tree is given in the usual form.

Signal processing of physiological signals for automated assessment of stress in computer users

The need to provide computers with the ability to distinguish the affective state of their users is a major requirement for the practical implementation of affective computing concepts. This dissertation proposes the application of signal processing methods on physiological signals to extract from them features that can be processed by learning pattern recognition systems to provide cues about a person's affective state. In particular, combining physiological information sensed from a user's left hand in a non-invasive way with the pupil diameter information from an eye-tracking system may provide a computer with an awareness of its user's affective responses in the course of human-computer interactions. In this study an integrated hardware-software setup was developed to achieve automatic assessment of the affective status of a computer user. A computer-based "Paced Stroop Test" was designed as a stimulus to elicit emotional stress in the subject during the experiment. Four signals: the Galvanic Skin Response (GSR), the Blood Volume Pulse (BVP), the Skin Temperature (ST) and the Pupil Diameter (PD), were monitored and analyzed to differentiate affective states in the user. Several signal processing techniques were applied on the collected signals to extract their most relevant features. These features were analyzed with learning classification systems, to accomplish the affective state identification. Three learning algorithms: Naïve Bayes, Decision Tree and Support Vector Machine were applied to this identification process and their levels of classification accuracy were compared. The results achieved indicate that the physiological signals monitored do, in fact, have a strong correlation with the changes in the emotional states of the experimental subjects. These results also revealed that the inclusion of pupil diameter information significantly improved the performance of the emotion recognition system. ^

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.