Psychometric Structure of a Comprehensive Objective Structured Clinical Examination: A Factor Analytic Approach

ERIC Educational Resources Information Center

Volkan, Kevin; Simon, Steven R.; Baker, Harley; Todres, I. David

2004-01-01

Problem Statement and Background: While the psychometric properties of Objective Structured Clinical Examinations (OSCEs) have been studied, their latent structures have not been well characterized. This study examines a factor analytic model of a comprehensive OSCE and addresses implications for measurement of clinical performance. Methods: An…

Computer assisted Objective structured clinical examination versus Objective structured clinical examination in assessment of Dermatology undergraduate students.

PubMed

Chaudhary, Richa; Grover, Chander; Bhattacharya, S N; Sharma, Arun

2017-01-01

The assessment of dermatology undergraduates is being done through computer assisted objective structured clinical examination at our institution for the last 4 years. We attempted to compare objective structured clinical examination (OSCE) and computer assisted objective structured clinical examination (CA-OSCE) as assessment tools. To assess the relative effectiveness of CA-OSCE and OSCE as assessment tools for undergraduate dermatology trainees. Students underwent CA-OSCE as well as OSCE-based evaluation of equal weightage as an end of posting assessment. The attendance as well as the marks in both the examination formats were meticulously recorded and statistically analyzed using SPSS version 20.0. Intercooled Stata V9.0 was used to assess the reliability and internal consistency of the examinations conducted. Feedback from both students and examiners was also recorded. The mean attendance for the study group was 77% ± 12.0%. The average score on CA- OSCE and OSCE was 47.4% ± 19.8% and 53.5% ± 18%, respectively. These scores showed a mutually positive correlation, with Spearman's coefficient being 0.593. Spearman's rank correlation coefficient between attendance scores and assessment score was 0.485 for OSCE and 0.451 for CA-OSCE. The Cronbach's alpha coefficient for all the tests ranged from 0.76 to 0.87 indicating high reliability. The comparison was based on a single batch of 139 students. Such an evaluation on more students in larger number of batches over successive years could help throw more light on the subject. Computer assisted objective structured clinical examination was found to be a valid, reliable and effective format for dermatology assessment, being rated as the preferred format by examiners.

Ability of College Students to Simulate ADHD on Objective Measures of Attention

ERIC Educational Resources Information Center

Booksh, Randee Lee; Pella, Russell D.; Singh, Ashvind N.; Gouvier, William Drew

2010-01-01

Objective: The authors examined the ability of college students to simulate ADHD symptoms on objective and self-report measures and the relationship between knowledge of ADHD and ability to simulate ADHD. Method: Undergraduate students were assigned to a control or a simulated ADHD malingering condition and compared with a clinical AD/HD group.…

A metadata schema for data objects in clinical research.

PubMed

Canham, Steve; Ohmann, Christian

2016-11-24

A large number of stakeholders have accepted the need for greater transparency in clinical research and, in the context of various initiatives and systems, have developed a diverse and expanding number of repositories for storing the data and documents created by clinical studies (collectively known as data objects). To make the best use of such resources, we assert that it is also necessary for stakeholders to agree and deploy a simple, consistent metadata scheme. The relevant data objects and their likely storage are described, and the requirements for metadata to support data sharing in clinical research are identified. Issues concerning persistent identifiers, for both studies and data objects, are explored. A scheme is proposed that is based on the DataCite standard, with extensions to cover the needs of clinical researchers, specifically to provide (a) study identification data, including links to clinical trial registries; (b) data object characteristics and identifiers; and (c) data covering location, ownership and access to the data object. The components of the metadata scheme are described. The metadata schema is proposed as a natural extension of a widely agreed standard to fill a gap not tackled by other standards related to clinical research (e.g., Clinical Data Interchange Standards Consortium, Biomedical Research Integrated Domain Group). The proposal could be integrated with, but is not dependent on, other moves to better structure data in clinical research.

Improving Objective Measures of Mobility.

ERIC Educational Resources Information Center

Dodds, Allan G.; And Others

1983-01-01

The article examines shortcomings in existing objective measures of mobility for blind persons in the light of evaluative experiences and demonstrates improvements in reliability, together with a new technique for tracking pavement position. It refutes the idea that it is not possible to measure improvement in performance objectively. (Author/CL)

Vectra DA for the objective measurement of disease activity in patients with rheumatoid arthritis.

PubMed

Segurado, O G; Sasso, E H

2014-01-01

Quantitative and regular assessment of disease activity in rheumatoid arthritis (RA) is required to achieve treatment targets such as remission and to optimize clinical outcomes. To assess inflammation accurately, predict joint damage and monitor treatment response, a measure of disease activity in RA should reflect the pathological processes resulting in irreversible joint damage and functional disability. The Vectra DA blood test is an objective measure of disease activity for patients with RA. Vectra DA provides an accurate, reproducible score on a scale of 1 to 100 based on the concentrations of 12 biomarkers that reflect the pathophysiologic diversity of RA. The analytical validity, clinical validity, and clinical utility of Vectra DA have been evaluated for patients with RA in registries and prospective and retrospective clinical studies. As a biomarker-based instrument for assessing disease activity in RA, the Vectra DA test can help monitor therapeutic response to methotrexate and biologic agents and assess clinically challenging situations, such as when clinical measures are confounded by non-inflammatory pain from fibromyalgia. Vectra DA scores correlate with imaging of joint inflammation and are predictive for radiographic progression, with high Vectra DA scores being associated with more frequent and severe progression and low scores being predictive for non-progression. In summary, the Vectra DA score is an objective measure of RA disease activity that quantifies inflammatory status. By predicting risk for joint damage more effectively than conventional clinical and laboratory measures, it has the potential to complement these measures and optimise clinical decision making.

Assessing ADHD symptoms in children and adults: evaluating the role of objective measures.

PubMed

Emser, Theresa S; Johnston, Blair A; Steele, J Douglas; Kooij, Sandra; Thorell, Lisa; Christiansen, Hanna

2018-05-18

Diagnostic guidelines recommend using a variety of methods to assess and diagnose ADHD. Applying subjective measures always incorporates risks such as informant biases or large differences between ratings obtained from diverse sources. Furthermore, it has been demonstrated that ratings and tests seem to assess somewhat different constructs. The use of objective measures might thus yield valuable information for diagnosing ADHD. This study aims at evaluating the role of objective measures when trying to distinguish between individuals with ADHD and controls. Our sample consisted of children (n = 60) and adults (n = 76) diagnosed with ADHD and matched controls who completed self- and observer ratings as well as objective tasks. Diagnosis was primarily based on clinical interviews. A popular pattern recognition approach, support vector machines, was used to predict the diagnosis. We observed relatively high accuracy of 79% (adults) and 78% (children) applying solely objective measures. Predicting an ADHD diagnosis using both subjective and objective measures exceeded the accuracy of objective measures for both adults (89.5%) and children (86.7%), with the subjective variables proving to be the most relevant. We argue that objective measures are more robust against rater bias and errors inherent in subjective measures and may be more replicable. Considering the high accuracy of objective measures only, we found in our study, we think that they should be incorporated in diagnostic procedures for assessing ADHD.

The Relationship Between Levels of Fidelity in Simulation, Traditional Clinical Experiences and Objectives.

PubMed

Gore, Teresa

2017-06-15

The purpose of this study was to explore the relationship of baccalaureate nursing students' (BSN) perceived learning effectiveness using the Clinical Learning Environments Comparison Survey of different levels of fidelity simulation and traditional clinical experiences. A convenience sample of 103 first semester BSN enrolled in a fundamental/assessment clinical course and 155 fifth semester BSN enrolled in a leadership clinical course participated in this study. A descriptive correlational design was used for this cross-sectional study to evaluate students' perceptions after a simulation experience and the completion of the traditional clinical experiences. The subscales measured were communication, nursing leadership, and teaching-learning dyad. No statistical differences were noted based on the learning objectives. The communication subscale showed a tendency toward preference for traditional clinical experiences in meeting students perceived learning for communication. For student perceived learning effectiveness, faculty should determine the appropriate level of fidelity in simulation based on the learning objectives.

A Taxonomy of Object-Oriented Measures Modeling the Object-Oriented Space

NASA Technical Reports Server (NTRS)

Neal, Ralph D.; Weistroffer, H. Roland; Coppins, Richard J.

1997-01-01

In order to control the quality of software and the software development process, it is important to understand the measurement of software. A first step toward a better comprehension of software measurement is the categorization of software measures by some meaningful taxonomy. The most worthwhile taxonomy would capture the fundamental nature of the object-oriented (O-O) space. The principal characteristics of object-oriented software offer a starting point for such a categorization of measures. This paper introduces a taxonomy of measures based upon fourteen characteristics of object-oriented software gathered from the literature. This taxonomy allows us to easily see gaps or redundancies in the existing O-O measures. The taxonomy also clearly differentiates among taxa so that there is no ambiguity as to the taxon to which a measure belongs. The taxonomy has been populated with measures taken from the literature.

A Taxonomy of Object-Oriented Measures Modeling the Object Oriented Space

NASA Technical Reports Server (NTRS)

Neal, Ralph D.; Weistroffer, H. Roland; Coppins, Richard J.

1997-01-01

In order to control the quality of software and the software development process, it is important to understand the measurement of software. A first step toward a better comprehension of software measurement is the categorization of software measures by some meaningful taxonomy. The most worthwhile taxonomy would capture the fundamental nature of the object-oriented (O-O) space. The principal characteristics of object-oriented software offer a starting point for such a categorization of measures. This paper introduces a taxonomy of measures based upon fourteen characteristics of object-oriented software gathered from the literature. This taxonomy allows us to easily see gaps or redundancies in the existing O-O measures. The taxonomy also clearly differentiates among taxa so that there is no ambiguity as to the taxon to which a measure belongs. The taxonomy has been populated with measures taken from the literature.

Use of ultrasound measurement of the inferior vena cava diameter as an objective tool in the assessment of children with clinical dehydration.

PubMed

Chen, Lei; Kim, Yunie; Santucci, Karen A

2007-10-01

Bedside ultrasonography (US) measurement of the inferior vena cava (IVC) and aorta (Ao) may be useful in objectively assessing children with dehydration. The objectives of this study were 1) to compare the IVC and Ao diameters (IVC/Ao) ratio of dehydrated children with controls and 2) to compare the IVC/Ao ratio before and after intravenous (i.v.) rehydration in children with dehydration. This prospective observational study was performed in an urban pediatric emergency department. Children between 6 months and 16 years of age with clinical evidence of dehydration were enrolled. Bedside US measurements of the IVC and Ao were taken before and immediately after i.v. fluids were administered. An age-, gender-, and weight-matched control without dehydration was enrolled for each subject. The IVC/Ao ratios of subjects and controls were compared using Wilcoxon signed rank test, as were the ratios before and after i.v. hydration for each subject. Thirty-six pairs of subjects and matched controls were enrolled. The IVC/Ao ratios in the subjects were lower as compared with controls (mean of 0.75 vs. 1.01), with a mean difference of 0.26 (95% confidence interval = 0.18 to 0.35). In subjects, the IVC/Ao ratios were significantly lower before i.v. hydration (mean of 0.75 vs. 1.09), with a mean difference of 0.34 (95% confidence interval = 0.29 to 0.39). As measured by bedside US measurement, the IVC/Ao ratio is lower in children clinically assessed to be dehydrated. Furthermore, it increases with administration of i.v. fluid boluses.

[Clinical competence evaluation using the Objective Structured Clinical Examination (OSCE) in medical internship at UNAM].

PubMed

Trejo Mejía, Juan Andrés; Martínez González, Adrián; Méndez Ramírez, Ignacio; Morales López, Sara; Ruiz Pérez, Leobardo C; Sánchez Mendiola, Melchor

2014-01-01

The Objective Structured Clinical Examination (OSCE) is a widely used measurement tool to assess clinical competence in the health sciences. There is little published evidence of its use in Mexican medical schools. To assess clinical competence in medical students with an OSCE, before and after the Medical Internship. Prospective cohort study, pre- post-test research design. The assessed population was medical students at UNAM Faculty of Medicine in Mexico in their Internship year. The instrument was an 18-stations OSCE, three stations per academic area of the Internship curriculum. We assessed the clinical competence of 278 students in a pretest OSCE when starting the Internship year, and tested them 10 months later with an equivalent post-test OSCE. The sample of students was 30.4% of the total Internship population. Test reliability with Cronbach's alpha was 0.62 in the pre-test and 0.64 in the post-test. The global mean score in the pretest OSCE was 55.6 ± 6.6 and in the post-test 63.2 ± 5.7 (p < 0.001), with a Cohen's d of 1.2. The clinical competence of medical students measured with an OSCE is higher after the medical internship year. This difference suggests that the internship can influence the development of clinical competence in medical students.

Disability and Fatigue Can Be Objectively Measured in Multiple Sclerosis

PubMed Central

Motta, Caterina; Palermo, Eduardo; Studer, Valeria; Germanotta, Marco; Germani, Giorgio; Centonze, Diego; Cappa, Paolo

2016-01-01

Background The available clinical outcome measures of disability in multiple sclerosis are not adequately responsive or sensitive. Objective To investigate the feasibility of inertial sensor-based gait analysis in multiple sclerosis. Methods A cross-sectional study of 80 multiple sclerosis patients and 50 healthy controls was performed. Lower-limb kinematics was evaluated by using a commercially available magnetic inertial measurement unit system. Mean and standard deviation of range of motion (mROM, sROM) for each joint of lower limbs were calculated in one minute walking test. A motor performance index (E) defined as the sum of sROMs was proposed. Results We established two novel observer-independent measures of disability. Hip mROM was extremely sensitive in measuring lower limb motor impairment, being correlated with muscle strength and also altered in patients without clinically detectable disability. On the other hand, E index discriminated patients according to disability, being altered only in patients with moderate and severe disability, regardless of walking speed. It was strongly correlated with fatigue and patient-perceived health status. Conclusions Inertial sensor-based gait analysis is feasible and can detect clinical and subclinical disability in multiple sclerosis. PMID:26863109

Objective, domain-specific HER2 measurement in uterine and ovarian serous carcinomas and its clinical significance.

PubMed

Carvajal-Hausdorf, Daniel E; Schalper, Kurt A; Bai, Yalai; Black, Jonathan; Santin, Alessandro D; Rimm, David L

2017-04-01

HER2 overexpression/amplification is identified in up to 40% of uterine serous carcinomas (USC) and 10% of ovarian serous carcinomas (OSC). However, clinical trials using various HER2-targeted agents failed to show significant responses. FDA-approved HER2 assays target only the protein's intracellular domain (ICD) and not the extracellular domain (ECD). Previous quantitative studies in breast cancer by our group have shown that ICD of HER2 is expressed in some cases that do not express the HER2 ECD. We measured HER2 ICD and ECD in USC and OSC samples, and determined their relationship with clinico-pathologic characteristics and survival. We measured HER2 ICD and ECD levels in 2 cohorts of USC and OSC comprising 102 and 175 patients, respectively. HER2 antibodies targeting ICD (CB11) and ECD (SP3) were validated and standardized using the AQUA® method of quantitative immunofluorescence (QIF) and a previously reported HER2 standardization tissue microarray (TMA). Objective, population-based cut-points were used to stratify patients according to HER2 ICD/ECD status. In USC, 8% of patients with high HER2 ICD had low ECD levels (6/75 patients). In OSC, 42% of patients with high HER2 ICD had low ECD levels (29/69 patients). HER2 ICD/ECD status in USC and OSC was not significantly associated with major clinico-pathological features or survival. Using objective, domain-specific HER2 measurement, 8% of USC and 42% of OSC patients with high HER2 ICD levels do not show uniform overexpression of the ECD. This may be related to the presence of p95 HER2, an oncogenic fragment generated by full protein cleavage or alternative initiation of translation. These observations raise the possibility that USC/OSCs expressing low ECD despite being HER2-positive by ICD measurement, may benefit from therapies directed against the intracellular domain (e.g. lapatinib or afatinib) alone or in combination with extracellular domain-directed drugs (e.g. trastuzumab, pertuzumab, T-DM1

Light sensors for objective light measurement in ambulatory polysomnography.

PubMed

Schembri, Rachel; Spong, Jo; Peters, Allison; Rochford, Peter; Wilksch, Philip; O'Donoghue, Fergal J; Greenwood, Kenneth M; Barnes, Maree; Kennedy, Gerard A; Berlowitz, David J

2017-01-01

Ambulatory polysomnography (PSG) does not commonly include an objective measure of light to determine the time of lights off (Loff), and thus cannot be used to calculate important indices such as sleep onset latency and sleep efficiency. This study examined the technical specifications and appropriateness of a prototype light sensor (LS) for use in ambulatory Compumedics Somte PSG.Two studies were conducted. The first examined the light measurement characteristics of the LS when used with a portable PSG device, specifically recording trace range, linearity, sensitivity, and stability. This involved the LS being exposed to varying incandescent and fluorescent light levels in a light controlled room. Secondly, the LS was trialled in 24 home and 12 hospital ambulatory PSGs to investigate whether light levels in home and hospital settings were within the recording range of the LS, and to quantify the typical light intensity reduction at the time of Loff. A preliminary exploration of clinical utility was also conducted. Linearity between LS voltage and lux was demonstrated, and the LS trace was stable over 14 hours of recording. The observed maximum voltage output of the LS/PSG device was 250 mV, corresponding to a maximum recording range of 350 lux and 523 lux for incandescent and fluorescent light respectively. At the time of Loff, light levels were within the recording range of the LS, and on average dropped by 72 lux (9-245) in the home and 76 lux (4-348) in the hospital setting. Results suggest that clinical utility was greatest in hospital settings where patients are less mobile. The LS was a simple and effective objective marker of light level in portable PSG, which can be used to identify Loff in ambulatory PSG. This allows measurement of additional sleep indices and support with clinical decisions.

Item Dependency in an Objective Structured Clinical Examination

ERIC Educational Resources Information Center

Iramaneerat, Cherdsak; Myford, Carol M.; Yudkowsky, Rachel

2006-01-01

An Objective Structured Clinical Examination (OSCE) is an assessment approach employed in medical education, in which residents rotate through multiple stations of standardized clinical tasks to evaluate their clinical competence. Because items used to evaluate residents' performance in each OSCE station are linked to the same task and are rated…

Wearable sensors objectively measure gait parameters in Parkinson’s disease

PubMed Central

Marxreiter, Franz; Gossler, Julia; Kohl, Zacharias; Reinfelder, Samuel; Gassner, Heiko; Aminian, Kamiar; Eskofier, Bjoern M.; Winkler, Jürgen; Klucken, Jochen

2017-01-01

Distinct gait characteristics like short steps and shuffling gait are prototypical signs commonly observed in Parkinson’s disease. Routinely assessed by observation through clinicians, gait is rated as part of categorical clinical scores. There is an increasing need to provide quantitative measurements of gait, e.g. to provide detailed information about disease progression. Recently, we developed a wearable sensor-based gait analysis system as diagnostic tool that objectively assesses gait parameter in Parkinson’s disease without the need of having a specialized gait laboratory. This system consists of inertial sensor units attached laterally to both shoes. The computed target of measures are spatiotemporal gait parameters including stride length and time, stance phase time, heel-strike and toe-off angle, toe clearance, and inter-stride variation from gait sequences. To translate this prototype into medical care, we conducted a cross-sectional study including 190 Parkinson’s disease patients and 101 age-matched controls and measured gait characteristics during a 4x10 meter walk at the subjects’ preferred speed. To determine intraindividual changes in gait, we monitored the gait characteristics of 63 patients longitudinally. Cross-sectional analysis revealed distinct spatiotemporal gait parameter differences reflecting typical Parkinson’s disease gait characteristics including short steps, shuffling gait, and postural instability specific for different disease stages and levels of motor impairment. The longitudinal analysis revealed that gait parameters were sensitive to changes by mirroring the progressive nature of Parkinson’s disease and corresponded to physician ratings. Taken together, we successfully show that wearable sensor-based gait analysis reaches clinical applicability providing a high biomechanical resolution for gait impairment in Parkinson’s disease. These data demonstrate the feasibility and applicability of objective wearable sensor

DATA QUALITY OBJECTIVES AND MEASUREMENT QUALITY OBJECTIVES FOR RESEARCH PROJECTS

EPA Science Inventory

The paper provides assistance with systematic planning using measurement quality objectives to those working on research projects. These performance criteria are more familiar to researchers than data quality objectives because they are more closely associated with the measuremen...

[Comparison study on subjective and objective measurements of the accommodative convergence to accommodation ratio].

PubMed

Xu, Jing-jing; Xu, Dan; Huang, Tao; Jiang, Jian; Lü, Fan

2012-05-01

To detect the accommodative convergence to accommodation (AC/A) ratios measured respectively by objective and subjective methods. The differences and its relative factors were explored. Forty young volunteers were measured by eye tracker to get the amount of convergence when fixating at the target at 100 cm, 50 cm, 33 cm and 25 cm and were measured by infrared auto-refractor to get corresponding accommodative responses. AC/A ratio based on these two measurements were compared with the calculated and the gradient AC/A ratio from Von Graefe tests. Mean value of stimulated AC/A ratio measured by eye tracker was higher than the calculated and gradient AC/A ratio by Von Graefe method (P = 0.003, 0.001). There are statistic correlation (r = 0.871, P = 0.000) and difference (P = 0.000) between stimulated AC/A ratio and response AC/A ratios both measured by eye tracker, and the difference trends to be greater with the higher AC/A ratio. The objective AC/A ratio is usually higher than the clinical subjective measurement because of more proximal effect. The response AC/A ratio measured objectively may reveal realistically the mutual effect and relationship between accommodation and convergence and it seems to be more credible to be the monitor parameter on progression of myopia in clinics.

Objectively measuring pain using facial expression: is the technology finally ready?

PubMed

Dawes, Thomas Richard; Eden-Green, Ben; Rosten, Claire; Giles, Julian; Governo, Ricardo; Marcelline, Francesca; Nduka, Charles

2018-03-01

Currently, clinicians observe pain-related behaviors and use patient self-report measures in order to determine pain severity. This paper reviews the evidence when facial expression is used as a measure of pain. We review the literature reporting the relevance of facial expression as a diagnostic measure, which facial movements are indicative of pain, and whether such movements can be reliably used to measure pain. We conclude that although the technology for objective pain measurement is not yet ready for use in clinical settings, the potential benefits to patients in improved pain management, combined with the advances being made in sensor technology and artificial intelligence, provide opportunities for research and innovation.

Rasch analysis of three dry eye questionnaires and correlates with objective clinical tests.

PubMed

McAlinden, Colm; Gao, Rongrong; Wang, Qinmei; Zhu, Senmiao; Yang, Jing; Yu, Ayong; Bron, Anthony J; Huang, Jinhai

2017-04-01

To assess the psychometric properties of Chinese versions of the Ocular Comfort Index (OCI), Ocular Surface Disease Index (OSDI) and McMonnies questionnaires. Further, to assess the correlation between questionnaire scores and objective dry eye disease (DED) clinical tests. Translated versions of the OCI, OSDI and McMonnies questionnaires were completed in a random order by 238 participants with DED. Objective clinical tests included visual acuity (VA), fluorescein tear film break-up time (TBUT), corneal fluorescein staining, Schirmer I testing and meibomian gland grading. Rasch analysis was used to assess questionnaire psychometrics and spearman rank for correlations. For the OCI, the person separation was 2.31, item infit and outfit statistics ranged from 0.74-1.14 and 0.75-1.32, respectively, and targeting 1.54 logits. For the OSDI, person separation was 0.94. None of the three subscales provided valid measurements based on Rasch analysis. For the McMonnies questionnaire, person separation was 1.17, item infit and outfit statistics ranged from 0.7 to 1.21 and 0.51-3.49, respectively. There were weak correlations between questionnaire scores and clinical tests. There were weak correlations between OSDI scores and VA, fluorescein TBUT, Schirmer I testing and corneal fluorescein staining. There were weak correlations between McMonnies scores and VA, fluorescein TBUT, Schirmer I testing, and corneal fluorescein staining and meibomian gland grading. The OCI questionnaire was the only questionnaire that provided valid measurement on the basis of Rasch analysis, although slight multidimensionality was found. There were weak correlations between OCI scores and fluorescein TBUT, Schirmer I testing, and corneal fluorescein staining. Due to this paradoxical disconnect between symptoms and signs and the repeatability of tests, the use of both subjective and objective markers in the clinical management of patients or as endpoints in clinical trials would appear prudent

Objectivity in psychosocial measurement: what, why, how.

PubMed

Fisher, W P

2000-01-01

This article raises and tries to answer questions concerning what objectivity in psychosocial measurement is, why it is important, and how it can be achieved. Following in the tradition of the Socratic art of maiuetics, objectivity is characterized by the separation of meaning from the geometric, metaphoric, or numeric figure carrying it, allowing an ideal and abstract entity to take on a life of its own. Examples of objective entities start from anything teachable and learnable, but for the purposes of measurement, the meter, gram, volt, and liter are paradigmatic because of their generalizability across observers, instruments, laboratories, samples, applications, etc. Objectivity is important because it is only through it that distinct conceptual entities are meaningfully distinguished. Seen from another angle, objectivity is important because it defines the conditions of the possibility of shared meaning and community. Full objectivity in psychosocial measurement can be achieved only by attending to both its methodological and its social aspects. The methodological aspect has recently achieved some notice in psychosocial measurement, especially in the form of Rasch's probabilistic conjoint models. Objectivity's social aspect has only recently been noticed by historians of science, and has not yet been systematically incorporated in any psychosocial science. An approach to achieving full objectivity in psychosocial measurement is adapted from the ASTM Standard Practice for Conducting an Interlaboratory Study to Determine the Precision of a Test Method (ASTM Committee E-11 on Statistical Methods, 1992).

Learning Clinical Procedures Through Internet Digital Objects: Experience of Undergraduate Students Across Clinical Faculties

PubMed Central

Li, Tse Yan; Wong, Kin; Tse, Christine Shuk Kwan; Chan, Ying Yee

2015-01-01

Background Various digital learning objects (DLOs) are available via the World Wide Web, showing the flow of clinical procedures. It is unclear to what extent these freely accessible Internet DLOs facilitate or hamper students’ acquisition of clinical competence. Objective This study aimed to understand the experience of undergraduate students across clinical disciplines—medicine, dentistry, and nursing—in using openly accessible Internet DLOs, and to investigate the role of Internet DLOs in facilitating their clinical learning. Methods Mid-year and final-year groups were selected from each undergraduate clinical degree program of the University of Hong Kong—Bachelor of Medicine and Bachelor of Surgery (MBBS), Bachelor of Dental Surgery (BDS), and Bachelor of Nursing (BNurs). All students were invited to complete a questionnaire on their personal and educational backgrounds, and their experiences and views on using Internet DLOs in learning clinical procedures. The questionnaire design was informed by the findings of six focus groups. Results Among 439 respondents, 97.5% (428/439) learned a variety of clinical procedures through Internet DLOs. Most nursing students (107/122, 87.7%) learned preventive measures through Internet DLOs, with a lower percentage of medical students (99/215, 46.0%) and dental students (43/96, 45%) having learned them this way (both P<.001). Three-quarters (341/439, 77.7%) of students accessed DLOs through public search engines, whereas 93.2% (409/439) accessed them by watching YouTube videos. Students often shared DLOs with classmates (277/435, 63.7%), but rarely discussed them with teachers (54/436, 12.4%). The accuracy, usefulness, and importance of Internet DLOs were rated as 6.85 (SD 1.48), 7.27 (SD 1.53), and 7.13 (SD 1.72), respectively, out of a high score of 10. Conclusions Self-exploration of DLOs in the unrestricted Internet environment is extremely common among current e-generation learners and was regarded by students

Use of an Objective Structured Clinical Examination in Clinical Nurse Specialist Education.

PubMed

Cuevas, Heather E; Timmerman, Gayle M

2016-01-01

Helping patients maximize their potential using expert coaching to facilitate lifestyle change is an important practice area for clinical nurse specialists (CNSs). The purpose is to determine the usefulness of objective structured clinical examinations (OSCEs) for evaluating CNS students' coaching competencies in the context of facilitating lifestyle change. Despite the use of OSCEs to assess competencies in clinical skills (eg, performance of procedures, decision making), its potential for evaluating coaching competencies for lifestyle change has not been demonstrated. We developed 4 OSCEs dealing with coaching patients in exercise, weight loss, stress reduction, or nonpharmacologic management of hyperlipidemia. Evaluation criteria included (1) approach to the patient, (2) information gathering, (3) motivational interviewing, and (4) management (medical and behavioral strategies). Student performance ranged from highly organized with proficient coaching skills to disorganized and focused solely on clinical management and prescriptive communication. Student responses were positive. Objective structured clinical examinations were highly useful for evaluating CNS students' coaching competencies for lifestyle change. Using OSCEs early in the semester to provide students feedback on their performance and again at the end to determine improvement optimizes use of this teaching strategy.

Object strength--an accurate measure for small objects that is insensitive to partial volume effects.

PubMed

Tofts, P S; Silver, N C; Barker, G J; Gass, A

2005-07-01

There are currently four problems in characterising small nonuniform lesions or other objects in Magnetic Resonance images where partial volume effects are significant. Object size is over- or under-estimated; boundaries are often not reproducible; mean object value cannot be measured; and fuzzy borders cannot be accommodated. A new measure, Object Strength, is proposed. This is the sum of all abnormal intensities, above a uniform background value. For a uniform object, this is simply the product of the increase in intensity and the size of the object. Biologically, this could be at least as relevant as existing measures of size or mean intensity. We hypothesise that Object Strength will perform better than traditional area measurements in characterising small objects. In a pilot study, the reproducibility of object strength measurements was investigated using MR images of small multiple sclerosis (MS) lesions. In addition, accuracy was investigated using artificial lesions of known volume (0.3-6.2 ml) and realistic appearance. Reproducibility approached that of area measurements (in 33/90 lesion reports the difference between repeats was less than for area measurements). Total lesion volume was accurate to 0.2%. In conclusion, Object Strength has potential for improved characterisation of small lesions and objects in imaging and possibly spectroscopy.

Does lumbar dorsal ramus syndrome have an objective clinical basis?

PubMed

Annaswamy, Thiru M; Bierner, Samuel M; Doppalapudi, Hima

2013-12-01

Degenerative processes can cause chronic low back pain that occasionally creates impingement of the lumbar dorsal rami, resulting in a clinical syndrome previously described as lumbar dorsal ramus syndrome (LDRS). To evaluate the clinical basis of LDRS by comparing pain, disability, and objective measures of pathophysiology in 3 groups of subjects defined by needle electromyography examination (NEE) findings. Prospective group cohort study with retrospective chart review. Veterans Affairs medical center outpatient clinic. Subjects who had undergone lower limb NEE and lumbar magnetic resonance imaging. A total of 71 subjects' records that met the study criteria were retrospectively reviewed for interventional spine procedures performed and to measure the lumbosacral paraspinal cross-sectional area (PSP CSA); 28 of the 71 subjects underwent further clinical assessment. One-way analysis of variance was performed to evaluate group differences. In the retrospective arm: (1) PSP CSAs measured at 4 lower lumbar disk levels (average of 3 consecutive slices/level) bilaterally and overall left and right lumbar average PSP CSA and (2) the frequency and type of interventional spine procedures performed. In the prospective arm: (1) temporal changes of NEE abnormalities, (2) pain measured using the Visual Analog Scale, (3) Pain Disability Questionnaire responses, and (4) Short Form-36 scores. The right L5 CSA was significantly greater in the group with mechanical low back pain compared with the group with lumbar radicular syndrome (F = 3.3; P < .05). No significant group differences were noted in the number of spine procedures performed. No significant differences in pain or disability scores were found among the groups. NEE findings improved over time predominantly in the LDRS group. LDRS is a diagnosis with identifiable NEE (lumbar multifidus denervation) findings and magnetic resonance imaging findings that may include lower lumbar paraspinal atrophy. NEE (paraspinal

Using connected objects in clinical research.

PubMed

Dhainaut, Jean-François; Huot, Laure; Pomar, Valérie Bouchara; Dubray, Claude

2018-02-01

Connected objects (CO), whether medical devices or not, are used in clinical research for data collection, a specific activity (communication, diagnosis, effector, etc.), or several functions combined. Their validation should be based on three approaches: technical and clinical reliability, data protection and cybersecurity. Consequently, the round table recommends that the typology of COs, their uses and limitations, be known and shared by all, particularly for implementing precise specifications. COs are used in clinical research during observational studies (assessment of the device itself or data collection), randomized studies, where only one group has a CO (assessment of its impact on patient follow-up or management), or randomized studies where both groups have a CO, which is then used as a tool to help with assessment. The benefits of using COs in clinical research includes: improved collection and quality of data, compliance of patients and pharmacovigilance, easier implementation of e-cohorts and a better representative balance of patients. The societal limits and risks identified relate to the sometimes intrusive nature of certain collected parameters and the possible misuse of data. The round table recommends the following on this last point: anticipation, by securing transmission methods, the qualification of data hosts, and assessment of the object's vulnerability. For this, a risk analysis appears necessary for each project. It is also necessary to accurately document the data flow, in order to inform both patients and healthcare professionals and to ensure adequate security. Anticipating regulatory changes and involving users starting from the study design stage are also recommended. Copyright © 2018 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

Subjective versus objective measures of tic severity in Tourette syndrome - The influence of environment.

PubMed

Barnea, Meirav; Benaroya-Milshtein, Noa; Gilboa-Sechtman, Eva; Woods, Douglas W; Piacentini, John; Fennig, Silvana; Apter, Alan; Steinberg, Tamar

2016-08-30

The objective of this study was to examine the influence of environmental challenges on tic expression by subjective and objective measures. The study group consisted of 41 children aged 6-18 years (M=10.15, SD=2.73) with a primary diagnosis of Tourette syndrome. Subjective measures included the Functional Assessment Interview developed for this study and three standard validated instruments. The objective measure was a video-recording of the patients in five daily-life situations: watching television, doing homework, being alone, receiving attention when ticcing, and talking to a stranger. In addition, the effect of premonitory urges on assessment of tic expression was evaluated. The associations between the subjective and objective measures of tic expression were moderate to low. A significantly higher number of tics were observed in the television situation, and a significantly lower number in the alone situation, compared to the other situations. Higher levels of premonitory urge were associated with greater awareness of objectively measured tic expression. In conclusion, tic expression is significantly influenced by the environment. Subjective measures of tic expression may be misleading. These results have implications for refining the clinical assessment of tics, improving research methodology, and developing new therapeutic strategies. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Neurology objective structured clinical examination reliability using generalizability theory

PubMed Central

Park, Yoon Soo; Lukas, Rimas V.; Brorson, James R.

2015-01-01

Objectives: This study examines factors affecting reliability, or consistency of assessment scores, from an objective structured clinical examination (OSCE) in neurology through generalizability theory (G theory). Methods: Data include assessments from a multistation OSCE taken by 194 medical students at the completion of a neurology clerkship. Facets evaluated in this study include cases, domains, and items. Domains refer to areas of skill (or constructs) that the OSCE measures. G theory is used to estimate variance components associated with each facet, derive reliability, and project the number of cases required to obtain a reliable (consistent, precise) score. Results: Reliability using G theory is moderate (Φ coefficient = 0.61, G coefficient = 0.64). Performance is similar across cases but differs by the particular domain, such that the majority of variance is attributed to the domain. Projections in reliability estimates reveal that students need to participate in 3 OSCE cases in order to increase reliability beyond the 0.70 threshold. Conclusions: This novel use of G theory in evaluating an OSCE in neurology provides meaningful measurement characteristics of the assessment. Differing from prior work in other medical specialties, the cases students were randomly assigned did not influence their OSCE score; rather, scores varied in expected fashion by domain assessed. PMID:26432851

Reliability of a single objective measure in assessing sleepiness.

PubMed

Sunwoo, Bernie Y; Jackson, Nicholas; Maislin, Greg; Gurubhagavatula, Indira; George, Charles F; Pack, Allan I

2012-01-01

To evaluate reliability of single objective tests in assessing sleepiness. Subjects who completed polysomnography underwent a 4-nap multiple sleep latency test (MSLT) the following day. Prior to each nap opportunity on MSLT, subjects performed the psychomotor vigilance test (PVT) and divided attention driving task (DADT). Results of single versus multiple test administrations were compared using the intraclass correlation coefficient (ICC) and adjusted for test administration order effects to explore time of day effects. Measures were explored as continuous and binary (i.e., impaired or not impaired). Community-based sample evaluated at a tertiary, university-based sleep center. 372 adult commercial vehicle operators oversampled for increased obstructive sleep apnea risk. N/A. AS CONTINUOUS MEASURES, ICC WERE AS FOLLOWS: MSLT 0.45, PVT median response time 0.69, PVT number of lapses 0.51, 10-min DADT tracking error 0.87, 20-min DADT tracking error 0.90. Based on binary outcomes, ICC were: MSLT 0.63, PVT number of lapses 0.85, 10-min DADT 0.95, 20-min DADT 0.96. Statistically significant time of day effects were seen in both the MSLT and PVT but not the DADT. Correlation between ESS and different objective tests was strongest for MSLT, range [-0.270 to -0.195] and persisted across all time points. Single DADT and PVT administrations are reliable measures of sleepiness. A single MSLT administration can reasonably discriminate individuals with MSL < 8 minutes. These results support the use of a single administration of some objective tests of sleepiness when performed under controlled conditions in routine clinical care.

Assessing MSW Students' Integrated Behavioral Health Skills Using an Objective Structured Clinical Examination

ERIC Educational Resources Information Center

Sampson, McClain; Parrish, Danielle E.; Washburn, Micki

2018-01-01

Within the last decade, there has been a significant shift in the field of social work toward competency-based education. This article details the use of the Objective Structured Clinical Examination (OSCE) Adapted for Social Work Performance Rating Scale. We used the measure to evaluate specific practice competencies among students (n = 33)…

Issues Related to Measuring and Interpreting Objectively Measured Sedentary Behavior Data

ERIC Educational Resources Information Center

Janssen, Xanne; Cliff, Dylan P.

2015-01-01

The use of objective measures of sedentary behavior has increased over the past decade; however, as is the case for objectively measured physical activity, methodological decisions before and after data collection are likely to influence the outcomes. The aim of this article is to review the evidence on different methodological decisions made by…

APPLICATION OF DATA QUALITY OBJECTIVES AND MEASUREMENT QUALITY OBJECTIVES TO RESEARCH PROJECTS

EPA Science Inventory

The paper assists systematic planning for research projects. It presents planning concepts in terms that have some utility for researchers. For example, measurement quality objectives are more familiar to researchers than data quality objectives because these quality criteria are...

TAKING THE PULSE OF PROLONGED EXPOSURE THERAPY: PHYSIOLOGICAL REACTIVITY TO TRAUMA IMAGERY AS AN OBJECTIVE MEASURE OF TREATMENT RESPONSE.

PubMed

Wangelin, Bethany C; Tuerk, Peter W

2015-12-01

Physiological reactivity to trauma-related cues is a primary symptom of PTSD and can be assessed objectively using script-driven imagery paradigms. However, subjective self-reported symptom measures are the most common outcome indices utilized in PTSD treatment trials and clinic settings. We examined physiological reactivity during a short trauma imagery task as an objective index of response to PTSD treatment, optimized for use in routine clinical care settings. Participants were 35 male combat veterans receiving prolonged exposure (PE) therapy in a Veterans Affairs outpatient clinic. In addition to traditional subjective self-reported and clinician-rated symptom measures, patients also completed a script-driven imagery task in which heart rate (HR) and skin conductance (SC) were recorded at three assessment points across treatment. We examined changes in subjective symptom measures and objective trauma-specific physiological reactivity over the course of PE, and investigated the association between pretreatment physiological reactivity and treatment response. Patients who completed PE showed significantly diminished HR and SC reactivity to trauma imagery across therapy. Additionally, individuals showing greater trauma-specific HR reactivity at pretreatment showed greater reductions in subjectively reported PTSD symptoms at posttreatment. Findings support the utility of physiological reactivity during trauma imagery as an objective outcome measure that has the potential to be incorporated into evidence-based PTSD treatment in routine clinical settings, or prospective studies related to the individualization of care at pretreatment. © 2015 Wiley Periodicals, Inc.

Measuring systems of hard to get objects: problems with analysis of measurement results

NASA Astrophysics Data System (ADS)

Gilewska, Grazyna

2005-02-01

The problem accessibility of metrological parameters features of objects appeared in many measurements. Especially if it is biological object which parameters very often determined on the basis of indirect research. Accidental component predominate in forming of measurement results with very limited access to measurement objects. Every measuring process has a lot of conditions limiting its abilities to any way processing (e.g. increase number of measurement repetition to decrease random limiting error). It may be temporal, financial limitations, or in case of biological object, small volume of sample, influence measuring tool and observers on object, or whether fatigue effects e.g. at patient. It's taken listing difficulties into consideration author worked out and checked practical application of methods outlying observation reduction and next innovative methods of elimination measured data with excess variance to decrease of mean standard deviation of measured data, with limited aomunt of data and accepted level of confidence. Elaborated methods wee verified on the basis of measurement results of knee-joint width space got from radiographs. Measurements were carried out by indirectly method on the digital images of radiographs. Results of examination confirmed legitimacy to using of elaborated methodology and measurement procedures. Such methodology has special importance when standard scientific ways didn't bring expectations effects.

Objective and quantitative equilibriometric evaluation of individual locomotor behaviour in schizophrenia: Translational and clinical implications.

PubMed

Haralanov, Svetlozar; Haralanova, Evelina; Milushev, Emil; Shkodrova, Diana; Claussen, Claus-Frenz

2018-04-17

Psychiatry is the only medical specialty that lacks clinically applicable biomarkers for objective evaluation of the existing pathology at a single-patient level. On the basis of an original translational equilibriometric method for evaluation of movement patterns, we have introduced in the everyday clinical practice of psychiatry an easy-to-perform computerized objective quantification of the individual locomotor behaviour during execution of the Unterberger stepping test. For the last 20 years, we have gradually collected a large database of more than 1000 schizophrenic patients, their relatives, and matched psychiatric, neurological, and healthy controls via cross-sectional and longitudinal investigations. Comparative analyses revealed transdiagnostic locomotor similarities among schizophrenic patients, high-risk schizotaxic individuals, and neurological patients with multiple sclerosis and cerebellar ataxia, thus suggesting common underlying brain mechanisms. In parallel, intradiagnostic dissimilarities were revealed, which allow to separate out subclinical locomotor subgroups within the diagnostic categories. Prototypical qualitative (dysmetric and ataxic) locomotor abnormalities in schizophrenic patients were differentiated from 2 atypical quantitative ones, manifested as either hypolocomotion or hyperlocomotion. Theoretical analyses suggested that these 3 subtypes of locomotor abnormalities could be conceived as objectively measurable biomarkers of 3 schizophrenic subgroups with dissimilar brain mechanisms, which require different treatment strategies. Analogies with the prominent role of locomotor measures in some well-known animal models of mental disorders advocate for a promising objective translational research in the so far over-subjective field of psychiatry. Distinctions among prototypical, atypical, and diagnostic biomarkers, as well as between neuromotor and psychomotor locomotor abnormalities, are discussed. Conclusions are drawn about the

An Improved Suite of Object Oriented Software Measures

NASA Technical Reports Server (NTRS)

Neal, Ralph D.; Weistroffer, H. Roland; Coppins, Richard J.

1997-01-01

In the pursuit of ever increasing productivity, the need to be able to measure specific aspects of software is generally agreed upon. As object oriented programming languages are becoming more and more widely used, metrics specifically designed for object oriented software are required. In recent years there has been an explosion of new, object oriented software metrics proposed in the literature. Unfortunately, many or most of these proposed metrics have not been validated to measure what they claim to measure. In fact, an analysis of many of these metrics shows that they do not satisfy basic properties of measurement theory, and thus their application has to be suspect. In this paper ten improved metrics are proposed and are validated using measurement theory.

Evaluation of Clinical and Communication Skills of Pharmacy Students and Pharmacists with an Objective Structured Clinical Examination.

PubMed

Urteaga, Elizabeth M; Attridge, Rebecca L; Tovar, John M; Witte, Amy P

2015-10-25

Objective. To evaluate how effectively pharmacy students and practicing pharmacists communicate and apply knowledge to simulations of commonly encountered patient scenarios using an objective structured clinical examination (OSCE). Design. Second-, third-, and fourth-year pharmacy students completed an OSCE as part of their required courses in 2012 and 2013. All students in both years completed identical OSCE cases. Licensed pharmacists were recruited to complete the OSCE and serve as controls in 2012. A survey assessed student perception and acceptance of the OSCE as well as student confidence in performance. Assessment. Licensed pharmacists had significantly higher clinical and communication skills scores than did pharmacy students. Student progression in communication and clinical skills improved significantly over time. Survey results indicated that students felt the OSCE was well-structured and assessed clinical skills taught in pharmacy school; 86% of students felt confident they could provide these skills. Conclusion. Objective structured clinical examinations can evaluate clinical competence and communication skills among professional students. Implementation of OSCEs may be an effective tool for assessment of the Center for the Advancement of Pharmacy Education domains.

First ultraviolet reflectance measurements of several Kuiper Belt objects, Kuiper Belt object satellites, and new ultraviolet measurements of A Centaur

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stern, S. A.; Schindhelm, E.; Cunningham, N. J., E-mail: astern@swri.edu

We observed the 2600-3200 Å (hereafter, mid-UV) reflectance of two Kuiper Belt Objects (KBOs), two KBO satellites, and a Centaur, using the Hubble Space Telescope (HST) Cosmic Origins Spectrograph (COS). Other than measurements of the Pluto system, these constitute the first UV measurements obtained of KBOs, and KBO satellites, and new HST UV measurements of the Centaur 2060 Chiron. We find significant differences among these objects, constrain the sizes and densities of Haumea's satellites, and report the detection of a possible spectral absorption band in Haumea's spectrum near 3050 Å. Comparisons of these objects to previously published UV reflectance measurementsmore » of Pluto and Charon are also made here.« less

The objective impact of clinical peer review on hospital quality and safety.

PubMed

Edwards, Marc T

2011-01-01

Despite its importance, the objective impact of clinical peer review on the quality and safety of care has not been studied. Data from 296 acute care hospitals show that peer review program and related organizational factors can explain up to 18% of the variation in standardized measures of quality and patient safety. The majority of programs rely on an outmoded and dysfunctional process model. Adoption of best practices informed by the continuing study of peer review program effectiveness has the potential to significantly improve patient outcomes.

Objective measures of prospective memory do not correlate with subjective complaints in schizophrenia.

PubMed

Chan, Raymond C K; Wang, Ya; Ma, Zheng; Hong, Xiao-hong; Yuan, Yanbo; Yu, Xin; Li, Zhanjiang; Shum, David; Gong, Qi-yong

2008-08-01

While a number of studies have shown that individuals with schizophrenia are impaired on various types of prospective memory, few studies have examined the relationship between subjective and objective measures of this construct in this clinical group. The purpose of the current study was to explore the relationship between computer-based prospective memory tasks and the corresponding subjective complaints in patients with schizophrenia, individuals with schizotypal personality features, and healthy volunteers. The findings showed that patients with schizophrenia demonstrated significantly poorer performance in all domains of memory function except visual memory than individuals with schizotypal personality disorder and healthy controls. More importantly, there was a significant interaction effect of prospective memory type and group. Although patients with schizophrenia were found to show significantly poorer performance on computer-based measures of prospective memory than controls, their level of subjective complaint was not found to be significantly higher. While subjective complaints of prospective memory were found to associate significantly with self-reported executive dysfunctions, significant relationships were not found between these complaints and performance on a computer-based task of prospective memory and other objective measures of memory. Taken together, these findings suggest that subjective and objective measures of prospective memory are two distinct domains that might need to be assessed and addressed separately.

Learning Clinical Procedures Through Internet Digital Objects: Experience of Undergraduate Students Across Clinical Faculties.

PubMed

Li, Tse Yan; Gao, Xiaoli; Wong, Kin; Tse, Christine Shuk Kwan; Chan, Ying Yee

2015-04-14

Various digital learning objects (DLOs) are available via the World Wide Web, showing the flow of clinical procedures. It is unclear to what extent these freely accessible Internet DLOs facilitate or hamper students' acquisition of clinical competence. This study aimed to understand the experience of undergraduate students across clinical disciplines-medicine, dentistry, and nursing-in using openly accessible Internet DLOs, and to investigate the role of Internet DLOs in facilitating their clinical learning. Mid-year and final-year groups were selected from each undergraduate clinical degree program of the University of Hong Kong-Bachelor of Medicine and Bachelor of Surgery (MBBS), Bachelor of Dental Surgery (BDS), and Bachelor of Nursing (BNurs). All students were invited to complete a questionnaire on their personal and educational backgrounds, and their experiences and views on using Internet DLOs in learning clinical procedures. The questionnaire design was informed by the findings of six focus groups. Among 439 respondents, 97.5% (428/439) learned a variety of clinical procedures through Internet DLOs. Most nursing students (107/122, 87.7%) learned preventive measures through Internet DLOs, with a lower percentage of medical students (99/215, 46.0%) and dental students (43/96, 45%) having learned them this way (both P<.001). Three-quarters (341/439, 77.7%) of students accessed DLOs through public search engines, whereas 93.2% (409/439) accessed them by watching YouTube videos. Students often shared DLOs with classmates (277/435, 63.7%), but rarely discussed them with teachers (54/436, 12.4%). The accuracy, usefulness, and importance of Internet DLOs were rated as 6.85 (SD 1.48), 7.27 (SD 1.53), and 7.13 (SD 1.72), respectively, out of a high score of 10. Self-exploration of DLOs in the unrestricted Internet environment is extremely common among current e-generation learners and was regarded by students across clinical faculties as an important supplement to

Planning and the "Measurable Objective."

ERIC Educational Resources Information Center

Miller, Ronald H.

1973-01-01

Accountability is being required of all America's institutions of higher education. Gallaudet College, an institution for the deaf in Washington, D.C., feels it has found a solution to the accountability problem in the use of "measurable objectives" in its program planning. The first phase from January 1 through June 30, 1972 of…

Clinical Application Of The Direct Measurement Of Human Shape

NASA Astrophysics Data System (ADS)

Anderson, J.; Vincent, R.; Marks, P.; English, M. J.

1980-07-01

A system is described for the recording and measurement of human body shape by a series of circular ultrasound scans. Computer manipulation of the echo data provides a graphic display of body contour, and a measurement of total body surface area and volume. The theoretical resolution for distance measurements using this device is 2.5 mm, a figure achieved in practical calibration experiments using a metal test object. Measurements from the body surface, although less precise, are sufficiently accurate and reproducible to enable useful clinical information to be obtained, particularly in recording the morphological changes associated with obesity and malnutrition.

The Assignment of Scale to Object-Oriented Software Measures

NASA Technical Reports Server (NTRS)

Neal, Ralph D.; Weistroffer, H. Roland; Coppins, Richard J.

1997-01-01

In order to improve productivity (and quality), measurement of specific aspects of software has become imperative. As object oriented programming languages have become more widely used, metrics designed specifically for object-oriented software are required. Recently a large number of new metrics for object- oriented software has appeared in the literature. Unfortunately, many of these proposed metrics have not been validated to measure what they purport to measure. In this paper fifty (50) of these metrics are analyzed.

Exploring Patient Activation in the Clinic: Measurement from Three Perspectives

ERIC Educational Resources Information Center

Ledford, Christy J. W.; Ledford, Christopher C.; Childress, Marc A.

2013-01-01

Objective. To further conceptualize and operationalize patient activation (PA), using measures from patient, physician, and researcher perspectives. Data Source/Study Setting. Multimethod observation in 2010 within a family medicine clinic. Study Design. Part of an intervention with 130 patients with type 2 diabetes, this observational study…

Use of Portable Digital Devices to Analyze Autonomic Stress Response in Psychology Objective Structured Clinical Examination.

PubMed

Beltrán-Velasco, Ana Isabel; Bellido-Esteban, Alberto; Ruisoto-Palomera, Pablo; Clemente-Suárez, Vicente Javier

2018-01-12

The aim of the present study was to explore changes in the autonomic stress response of Psychology students in a Psychology Objective Structured Clinical Examination (OSCE) and their relationship with OSCE performance. Variables of autonomic modulation by the analysis of heart rate variability in temporal, frequency and non-linear domains, subjective perception of distress strait and academic performance were measured before and after the two different evaluations that composed the OSCE. A psychology objective structured clinical examination composed by two different evaluation scenarios produced a large anxiety anticipatory response, a habituation response in the first of the evaluation scenarios and a in the entire evaluation, and a no habituation response in the second evaluation scenario. Autonomic modulation parameters do not correlate with academic performance of students.

If You're Not Measuring, You're Guessing: The Advent of Objective Concussion Assessments.

PubMed

Broglio, Steven P; Guskiewicz, Kevin M; Norwig, John

2017-03-01

Sport-related concussion remains one of the most complex injuries presented to sports medicine professionals. Although the injury has been recognized since ancient times, the concussion-assessment process has seen significant advances over the last 30 years. This review outlines the addition of objective measures to the clinical evaluation of the concussed athlete, beginning in the 1980s and continuing through the modern age. International and domestic organizations now describe standardized symptom reports, neurostatus and neurocognitive-function evaluations, and postural-control measures as standards of medical care, a significant shift from a short time ago. Despite this progression, much about the injury remains unknown, including new clinical and research-based assessment techniques and how the injury may influence the athlete's cognitive health over the long term.

Significance of Objective Structured Clinical Examinations to Plastic Surgery Residency Training.

PubMed

Simmons, Brian J; Zoghbi, Yasmina; Askari, Morad; Birnbach, David J; Shekhter, Ilya; Thaller, Seth R

2017-09-01

Objective structured clinical examinations (OSCEs) have proven to be a powerful tool. They possess more than a 30-year track record in assessing the competency of medical students, residents, and fellows. Objective structured clinical examinations have been used successfully in a variety of medical specialties, including surgery. They have recently found their way into the subspecialty of plastic surgery. This article uses a systematic review of the available literature on OSCEs and their recent use in plastic surgery. It incorporates survey results assessing program directors' views on the use of OSCEs. Approximately 40% of programs surveyed use OSCEs to assess the Accreditation Council for Graduate Medical Education core competencies. We found that 40% use OSCEs to evaluate specific plastic surgery milestones. Objective structured clinical examinations are usually performed annually. They cost anywhere between $100 and more than $1000 per resident. Four milestones giving residents the most difficulties on OSCEs were congenital anomalies, noncancer breast surgery, breast reconstruction, and practice-based learning and improvement. It was determined that challenges with milestones were due to lack of adequate general knowledge and surgical ward patient care, as well as deficits in professionalism and system-based problems. Programs were able to remediate weakness found by OSCEs using a variety of methods. Objective structured clinical examinations offer a unique tool to objectively assess the proficiency of residents in key areas of the Accreditation Council for Graduate Medical Education core competencies. In addition, they can be used to assess the specific milestones that plastic surgery residents must meet. This allows programs to identify and improve identified areas of weakness.

A Fuzzy Description Logic with Automatic Object Membership Measurement

NASA Astrophysics Data System (ADS)

Cai, Yi; Leung, Ho-Fung

In this paper, we propose a fuzzy description logic named f om -DL by combining the classical view in cognitive psychology and fuzzy set theory. A formal mechanism used to determine object memberships automatically in concepts is also proposed, which is lacked in previous work fuzzy description logics. In this mechanism, object membership is based on the defining properties of concept definition and properties in object description. Moreover, while previous works cannot express the qualitative measurements of an object possessing a property, we introduce two kinds of properties named N-property and L-property, which are quantitative measurements and qualitative measurements of an object possessing a property respectively. The subsumption and implication of concepts and properties are also explored in our work. We believe that it is useful to the Semantic Web community for reasoning the fuzzy membership of objects for concepts in fuzzy ontologies.

Clinical simulation as a boundary object in design of health IT-systems.

PubMed

Rasmussen, Stine Loft; Jensen, Sanne; Lyng, Karen Marie

2013-01-01

Healthcare organizations are very complex, holding numerous stakeholders with various approaches and goals towards the design of health IT-systems. Some of these differences may be approached by applying the concept of boundary objects in a participatory IT-design process. Traditionally clinical simulation provides the opportunity to evaluate the design and the usage of clinical IT-systems without endangering the patients and interrupting clinical work. In this paper we present how clinical simulation additionally holds the potential to function as a boundary object in the design process. The case points out that clinical simulation provides an opportunity for discussions and mutual learning among the various stakeholders involved in design of standardized electronic clinical documentation templates. The paper presents and discusses the use of clinical simulation in the translation, transfer and transformation of knowledge between various stakeholders in a large healthcare organization.

Subjective and objective measurements of postoperative pain in cats.

PubMed

Cambridge, A J; Tobias, K M; Newberry, R C; Sarkar, D K

2000-09-01

To evaluate the ability of various subjective and objective measurements to determine the presence and degree of postoperative pain in cats. Randomized controlled prospective clinical study. 18 healthy client-owned cats. Cats were randomly assigned to 3 groups of 6: control, tenectomy, and onychectomy. Jugular catheters were placed the day prior to surgery. All surgeries were performed by the same surgeon, and all observations were made by the same blinded trained observer. One hour prior to surgery and at assigned intervals for 36 hours after surgery, heart rate, respiratory rate, and rectal temperature were measured. Scores were assigned for 3 interaction responses, including response to palpation, by use of simple descriptive scales, and to 2 pain assessments by use of visual analogue scales. Blood was collected to measure plasma beta-endorphin and cortisol concentrations. Butorphanol was administered to all cats before surgery and to any cat subjectively assessed to be experiencing pain after surgery. Only visual analogue scale scores and response to palpation scores differed significantly between control and surgical groups. Determination of the presence of pain in cats can be made on the basis of observation and interaction by a trained observer. Physiologic measurements, including plasma cortisol and beta-endorphin concentrations, did not differentiate between control cats and cats that underwent surgery.

Objective and automated measurement of dynamic vision functions

NASA Technical Reports Server (NTRS)

Flom, M. C.; Adams, A. J.

1976-01-01

A phoria stimulus array and electro-oculographic (EOG) arrangements for measuring motor and sensory responses of subjects subjected to stress or drug conditions are described, along with experimental procedures. Heterophoria (as oculomotor function) and glare recovery time (time required for photochemical and neural recovery after exposure to a flash stimulus) are measured, in research aimed at developing automated objective measurement of dynamic vision functions. Onset of involuntary optokinetic nystagmus in subjects attempting to track moving stripes (while viewing through head-mounted binocular eyepieces) after exposure to glare serves as an objective measure of glare recovery time.

The Skin Cancer Objective Structured Clinical Examination (SCOSCE): A multi-institutional collaboration to develop and validate a clinical skills assessment for melanoma.

PubMed

Garg, Amit; Biello, Katie; Hoot, Joyce W; Reddy, Shalini B; Wilson, Lindsay; George, Paul; Robinson-Bostom, Leslie; Belazarian, Leah; Domingues, Erik; Powers, Jennifer; Jacob, Reza; Powers, Michael; Besen, Justin; Geller, Alan C

2015-12-01

Assessing medical students on core skills related to melanoma detection is challenging in the absence of a well-developed instrument. We sought to develop an objective structured clinical examination for the detection and evaluation of melanoma among medical students. This was a prospective cohort analysis of student and objective rater agreement on performance of clinical skills and assessment of differences in performance across 3 schools. Kappa coefficients indicated excellent agreement for 3 of 5 core skills including commenting on the presence of the moulage (k = 0.87, 95% confidence interval 0.77-0.96), obtaining a history for the moulage (k = 0.84, 95% confidence interval 0.74-0.94), and making a clinical impression (k = 0.80, 95% confidence interval 0.68-0.92). There were no differences in performance across schools with respect to 3 of 5 core skills: commenting on the presence of the moulage (P = .15), initiating a history (P = .53), and managing the suspicious lesion (P value range .07-.17). Overall, 54.2% and 44.7% of students commented on the presence of the moulage and achieved maximum performance of core skills, respectively, with no difference in performance across schools. Limitations include overall sample size of students and schools. The Skin Cancer Objective Structured Clinical Examination represents a potentially important instrument to measure students' performance on the optimal step-by-step evaluation of a melanoma. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Management by Objectives: A Program of Measured Performance.

ERIC Educational Resources Information Center

Block, Philip

1980-01-01

Management by objectives (MBO) is defined and an MBO program adapted for clinic services of a college of podiatric medicine is presented. Major steps with specific examples for goal setting, action planning, self-control, and periodic review are outlined. (Author/MLW)

The Associations Between Clerkship Objective Structured Clinical Examination (OSCE) Grades and Subsequent Performance.

PubMed

Dong, Ting; Zahn, Christopher; Saguil, Aaron; Swygert, Kimberly A; Yoon, Michelle; Servey, Jessica; Durning, Steven

2017-01-01

Construct: We investigated the extent of the associations between medical students' clinical competency measured by performance in Objective Structured Clinical Examinations (OSCE) during Obstetrics/Gynecology and Family Medicine clerkships and later performance in both undergraduate and graduate medical education. There is a relative dearth of studies on the correlations between undergraduate OSCE scores and future exam performance within either undergraduate or graduate medical education and almost none on linking these simulated encounters to eventual patient care. Of the research studies that do correlate clerkship OSCE scores with future performance, these often have a small sample size and/or include only 1 clerkship. Students in USU graduating classes of 2007 through 2011 participated in the study. We investigated correlations between clerkship OSCE grades with United States Medical Licensing Examination Step 2 Clinical Knowledge, Clinical Skills, and Step 3 Exams scores as well as Postgraduate Year 1 program director's evaluation scores on Medical Expertise and Professionalism. We also conducted contingency table analysis to examine the associations between poor performance on clerkship OSCEs with failing Step 3 and receiving poor program director ratings. The correlation coefficients were weak between the clerkship OSCE grades and the outcomes. The strongest correlations existed between the clerkship OSCE grades and the Step 2 CS Integrated Clinical Encounter component score, Step 2 Clinical Skills, and Step 3 scores. Contingency table associations between poor performances on both clerkships OSCEs and poor Postgraduate Year 1 Program Director ratings were significant. The results of this study provide additional but limited validity evidence for the use of OSCEs during clinical clerkships given their associations with subsequent performance measures.

Modeling the Object-Oriented Space Through Validated Measures

NASA Technical Reports Server (NTRS)

Neal, Ralph D.

1996-01-01

In order to truly understand software and the software development process, software measurement must be better understood. A beginning step toward a better understanding of software measurement is the categorization of the measurements by some meaningful taxonomy. The most meaningful taxonomy would capture the basic nature of the subject oriented (O-O) space. The interesting characteristics of object oriented software offer a starting point for such a categorization of measures. A taxonomy has been developed based on fourteen characteristics of object-oriented software gathered from the literature This taxonomy allows us to easily see gaps and redundancies in the O-O measures. The taxonomy also clearly differentiates among taxa so that there is no ambiguity as to the taxon to which a measure belongs. The taxonomy has been populated with thirty-two measures that have been validated in the narrow sense of Fenton, using measurement theory with Zuse's augmentation.

Effects of Objective 3-Dimensional Measures of Facial Shape and Symmetry on Perceptions of Facial Attractiveness.

PubMed

Hatch, Cory D; Wehby, George L; Nidey, Nichole L; Moreno Uribe, Lina M

2017-09-01

Meeting patient desires for enhanced facial esthetics requires that providers have standardized and objective methods to measure esthetics. The authors evaluated the effects of objective 3-dimensional (3D) facial shape and asymmetry measurements derived from 3D facial images on perceptions of facial attractiveness. The 3D facial images of 313 adults in Iowa were digitized with 32 landmarks, and objective 3D facial measurements capturing symmetric and asymmetric components of shape variation, centroid size, and fluctuating asymmetry were obtained from the 3D coordinate data using geo-morphometric analyses. Frontal and profile images of study participants were rated for facial attractiveness by 10 volunteers (5 women and 5 men) on a 5-point Likert scale and a visual analog scale. Multivariate regression was used to identify the effects of the objective 3D facial measurements on attractiveness ratings. Several objective 3D facial measurements had marked effects on attractiveness ratings. Shorter facial heights with protrusive chins, midface retrusion, faces with protrusive noses and thin lips, flat mandibular planes with deep labiomental folds, any cants of the lip commissures and floor of the nose, larger faces overall, and increased fluctuating asymmetry were rated as significantly (P < .001) less attractive. Perceptions of facial attractiveness can be explained by specific 3D measurements of facial shapes and fluctuating asymmetry, which have important implications for clinical practice and research. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Objective and Subjective Measures of Simultaneous vs Sequential Bilateral Cochlear Implants in Adults: A Randomized Clinical Trial.

PubMed

Kraaijenga, Véronique J C; Ramakers, Geerte G J; Smulders, Yvette E; van Zon, Alice; Stegeman, Inge; Smit, Adriana L; Stokroos, Robert J; Hendrice, Nadia; Free, Rolien H; Maat, Bert; Frijns, Johan H M; Briaire, Jeroen J; Mylanus, E A M; Huinck, Wendy J; Van Zanten, Gijsbert A; Grolman, Wilko

2017-09-01

To date, no randomized clinical trial on the comparison between simultaneous and sequential bilateral cochlear implants (BiCIs) has been performed. To investigate the hearing capabilities and the self-reported benefits of simultaneous BiCIs compared with those of sequential BiCIs. A multicenter randomized clinical trial was conducted between January 12, 2010, and September 2, 2012, at 5 tertiary referral centers among 40 participants eligible for BiCIs. Main inclusion criteria were postlingual severe to profound hearing loss, age 18 to 70 years, and a maximum duration of 10 years without hearing aid use in both ears. Data analysis was conducted from May 24 to June 12, 2016. The simultaneous BiCI group received 2 cochlear implants during 1 surgical procedure. The sequential BiCI group received 2 cochlear implants with an interval of 2 years between implants. First, the results 1 year after receiving simultaneous BiCIs were compared with the results 1 year after receiving sequential BiCIs. Second, the results of 3 years of follow-up for both groups were compared separately. The primary outcome measure was speech intelligibility in noise from straight ahead. Secondary outcome measures were speech intelligibility in noise from spatially separated sources, speech intelligibility in silence, localization capabilities, and self-reported benefits assessed with various hearing and quality of life questionnaires. Nineteen participants were randomized to receive simultaneous BiCIs (11 women and 8 men; median age, 52 years [interquartile range, 36-63 years]), and another 19 participants were randomized to undergo sequential BiCIs (8 women and 11 men; median age, 54 years [interquartile range, 43-64 years]). Three patients did not receive a second cochlear implant and were unavailable for follow-up. Comparable results were found 1 year after simultaneous or sequential BiCIs for speech intelligibility in noise from straight ahead (difference, 0.9 dB [95% CI, -3.1 to 4.4 dB]) and

Speckle correlation method used to measure object's in-plane velocity.

PubMed

Smíd, Petr; Horváth, Pavel; Hrabovský, Miroslav

2007-06-20

We present a measurement of an object's in-plane velocity in one direction by the use of the speckle correlation method. Numerical correlations of speckle patterns recorded periodically during motion of the object under investigation give information used to evaluate the object's in-plane velocity. The proposed optical setup uses a detection plane in the image field and enables one to detect the object's velocity within the interval (10-150) microm x s(-1). Simulation analysis shows a way of controlling the measuring range. The presented theory, simulation analysis, and setup are verified through an experiment of measurement of the velocity profile of an object.

Measuring Workload Demand of Informatics Systems with the Clinical Case Demand Index

PubMed Central

Iyengar, M. Sriram; Rogith, Deevakar; Florez-Arango, Jose F

2017-01-01

Introduction: The increasing use of Health Information Technology (HIT) can add substantially to workload on clinical providers. Current methods for assessing workload do not take into account the nature of clinical cases and the use of HIT tools while solving them. Methods: The Clinical Case Demand Index (CCDI), consisting of a summary score and visual representation, was developed to meet this need. Consistency with current perceived workload measures was evaluated in a Randomized Control Trial of a mobile health system. Results: CCDI is significantly correlated with existing workload measures and inversely related to provider performance. Discussion: CCDI combines subjective and objective characteristics of clinical cases along with cognitive and clinical dimensions. Applications include evaluation of HIT tools, clinician scheduling, medical education. Conclusion: CCDI supports comparative effectiveness research of HIT tools. In addition, CCDI could have numerous applications including training, clinical trials, design of clinical workflows, and others. PMID:29854166

Clinical skills development in student-run free clinic volunteers: a multi-trait, multi-measure study.

PubMed

Nakamura, Mio; Altshuler, David; Chadwell, Margit; Binienda, Juliann

2014-12-12

At Wayne State University School of Medicine (WSU SOM), the Robert R. Frank Student Run Free Clinic (SRFC) is one place preclinical students can gain clinical experience. There have been no published studies to date measuring the impact of student-run free clinic (SRFC) volunteerism on clinical skills development in preclinical medical students. Surveys were given to first year medical students at WSU SOM at the beginning and end of Year 1 to assess perception of clinical skills, including self-confidence, self-reflection, and professionalism. Scores of the Year 1 Objective Structured Clinical Exam (OSCE) were compared between SRFC volunteers and non-volunteers. There were a total of 206 (68.2%) and 80 (26.5%) survey responses at the beginning and end of Year 1, respectively. Of the 80 students, 31 (38.7%) volunteered at SRFC during Year 1. Statistically significant differences were found between time points in self-confidence (p < 0.001) in both groups. When looking at self-confidence in skills pertaining to SRFC, the difference between groups was statistically significant (p = 0.032) at both time points. A total of 302 students participated in the Year 1 OSCE, 27 (9%) of which were SRFC volunteers. No statistically significant differences were found between groups for mean score (p = 0.888) and established level of rapport (p = 0.394). While this study indicated no significant differences in clinical skills in students who volunteer at the SRFC, it is a first step in attempting to measure clinical skill development outside of the structured medical school setting. The findings lend themselves to development of research designs, clinical surveys, and future studies to measure the impact of clinical volunteer opportunities on clinical skills development in future physicians.

Physicians' and nurses' expectations and objections toward a clinical ethics committee.

PubMed

Jansky, Maximiliane; Marx, Gabriella; Nauck, Friedemann; Alt-Epping, Bernd

2013-11-01

The study aimed to explore the subjective need of healthcare professionals for ethics consultation, their experience with ethical conflicts, and expectations and objections toward a Clinical Ethics Committee. Staff at a university hospital took part in a survey (January to June 2010) using a questionnaire with open and closed questions. Descriptive data for physicians and nurses (response rate = 13.5%, n = 101) are presented. Physicians and nurses reported similar high frequencies of ethical conflicts but rated the relevance of ethical issues differently. Nurses stated ethical issues as less important to physicians than to themselves. Ethical conflicts were mostly discussed with staff from one's own profession. Respondents predominantly expected the Clinical Ethics Committee to provide competent support. Mostly, nurses feared it might have no influence on clinical practice. Findings suggest that experiences of ethical conflicts might reflect interprofessional communication patterns. Expectations and objections against Clinical Ethics Committees were multifaceted, and should be overcome by providing sufficient information. The Clinical Ethics Committee needs to take different perspectives of professions into account.

Clinical characteristics and objective living conditions in relation to quality of life among community-based individuals of schizophrenia in Hong Kong.

PubMed

Yeung, Frederick Ka Ching; Chan, Sunny Ho Wan

2006-11-01

Quality of life (QOL) has gained importance as an outcome measure for people with schizophrenia living in the community following deinstitutionalization. This study aims at exploring the effects of clinical characteristics and objective living conditions on QOL. In this study, 201 community-based individuals with schizophrenia were recruited from five different types of objective living conditions comprising long stay care home, halfway house, supported hostel/housing, living with family, and living alone. Clinical characteristics including cognitive abilities, symptom levels, and community/social functioning were assessed by the Allen Cognitive Level Screen, the Scales for the Assessment of Negative Symptoms and Positive Symptoms, and the Chinese version of the Multnomah Community Ability Scale respectively. The outcome measure of QOL was measured by the Chinese version of the WHO Quality of Life Measure. Analysis of covariance showed significant differences in community/social functioning, cognitive abilities, and negative symptoms; but not in QOL under different objective living conditions. Further simultaneous multiple regressions found out that community/social functioning was the robust significant predictor of QOL. Yet caution should be noted in making the conclusion with the objective living condition of long stay care home, as it provides a protective element for the perseverance of QOL.

Objectives | Office of Cancer Clinical Proteomics Research

Cancer.gov

The overall objective of CPTAC is to systematically identify proteins that derive from alterations in cancer genomes and related biological processes, in order to understand the molecular basis of cancer that is not fully elucidated or not possible through genomics and to accelerate the translation of molecular findings into the clinic.  This is to be achieved through enhancing our understanding of cancer genome biology by adding a complementary functional layer of protein biology (a “proteogenome” approach) that refines/prioritizes driver genes, enhances understanding of pathogenesis

Evaluation of perceived and actual competency in a family medicine objective structured clinical examination

PubMed Central

Graves, Lisa; Lalla, Leonora; Young, Meredith

2017-01-01

Abstract Objective To examine the relationship between objective assessment of performance and self-rated competence immediately before and after participation in a required summative family medicine clerkship objective structured clinical examination (OSCE). Design Learners rated their competence (on a 7-point Likert scale) before and after an OSCE along 3 dimensions: general, specific, and professional competencies relevant to family medicine. Setting McGill University in Montreal, Que. Participants All 168 third-year clinical clerks completing their mandatory family medicine rotation in 2010 to 2011 were invited to participate. Main outcome measures Self-ratings of competence and objective performance scores were compared, and were examined to determine if OSCEs could be a “corrective” tool for self-rating perceived competence (ie, if the experience of undergoing an assessment might assist learners in recalibrating their understanding of their own performance). Results A total of 140 (83%) of the third-year clinical clerks participated. Participating in an OSCE decreased learners’ ratings of perceived competence (pre-OSCE score = 4.9, post-OSCE score = 4.7; F1,3192 = 4.2; P < .05). Learners’ mean self-rated competence for all categories of behaviour (before and after) showed no relationship to OSCE performance (r < 0.12 and P > .08 for all), nor did ratings of station-relevant competence (before and after) (r < 0.19 and P > .09 for all). Ratings of competence before and after the OSCE were correlated for individual students (r > 0.40 and P < .001 for all). Conclusion After the OSCE, students’ self-ratings of perceived competence had decreased, and these ratings had little relationship to actual performance, regardless of the specificity of the rated competency. Discordance between perceived and actual competence is neither novel nor unique to family medicine. However, this discordance is an important consideration for the development of competency

Using Clinical Data Standards to Measure Quality: A New Approach.

PubMed

D'Amore, John D; Li, Chun; McCrary, Laura; Niloff, Jonathan M; Sittig, Dean F; McCoy, Allison B; Wright, Adam

2018-04-01

 Value-based payment for care requires the consistent, objective calculation of care quality. Previous initiatives to calculate ambulatory quality measures have relied on billing data or individual electronic health records (EHRs) to calculate and report performance. New methods for quality measure calculation promoted by federal regulations allow qualified clinical data registries to report quality outcomes based on data aggregated across facilities and EHRs using interoperability standards.  This research evaluates the use of clinical document interchange standards as the basis for quality measurement.  Using data on 1,100 patients from 11 ambulatory care facilities and 5 different EHRs, challenges to quality measurement are identified and addressed for 17 certified quality measures.  Iterative solutions were identified for 14 measures that improved patient inclusion and measure calculation accuracy. Findings validate this approach to improving measure accuracy while maintaining measure certification.  Organizations that report care quality should be aware of how identified issues affect quality measure selection and calculation. Quality measure authors should consider increasing real-world validation and the consistency of measure logic in respect to issues identified in this research. Schattauer GmbH Stuttgart.

Objective Sepsis Surveillance Using Electronic Clinical Data

PubMed Central

Rhee, Chanu; Kadri, Sameer; Huang, Susan S.; Murphy, Michael V.; Li, Lingling; Platt, Richard; Klompas, Michael

2016-01-01

OBJECTIVE To compare the accuracy of surveillance of severe sepsis using electronic health record clinical data vs claims and to compare incidence and mortality trends using both methods. DESIGN We created an electronic health record–based surveillance definition for severe sepsis using clinical indicators of infection (blood culture and antibiotic orders) and concurrent organ dysfunction (vasopressors, mechanical ventilation, and/or abnormal laboratory values). We reviewed 1,000 randomly selected medical charts to characterize the definition’s accuracy and stability over time compared with a claims-based definition requiring infection and organ dysfunction codes. We compared incidence and mortality trends from 2003–2012 using both methods. SETTING Two US academic hospitals. PATIENTS Adult inpatients. RESULTS The electronic health record–based clinical surveillance definition had stable and high sensitivity over time (77% in 2003–2009 vs 80% in 2012, P=.58) whereas the sensitivity of claims increased (52% in 2003–2009 vs 67% in 2012, P=.02). Positive predictive values for claims and clinical surveillance definitions were comparable (55% vs 53%, P=.65) and stable over time. From 2003 to 2012, severe sepsis incidence imputed from claims rose by 72% (95% CI, 57%–88%) and absolute mortality declined by 5.4% (95% CI, 4.6%–6.7%). In contrast, incidence using the clinical surveillance definition increased by 7.7% (95% CI, −1.1% to 17%) and mortality declined by 1.7% (95% CI, 1.1%–2.3%). CONCLUSIONS Sepsis surveillance using clinical data is more sensitive and more stable over time compared with claims and can be done electronically. This may enable more reliable estimates of sepsis burden and trends. PMID:26526737

Learning object correspondences with the observed transport shape measure.

PubMed

Pitiot, Alain; Delingette, Hervé; Toga, Arthur W; Thompson, Paul M

2003-07-01

We propose a learning method which introduces explicit knowledge to the object correspondence problem. Our approach uses an a priori learning set to compute a dense correspondence field between two objects, where the characteristics of the field bear close resemblance to those in the learning set. We introduce a new local shape measure we call the "observed transport measure", whose properties make it particularly amenable to the matching problem. From the values of our measure obtained at every point of the objects to be matched, we compute a distance matrix which embeds the correspondence problem in a highly expressive and redundant construct and facilitates its manipulation. We present two learning strategies that rely on the distance matrix and discuss their applications to the matching of a variety of 1-D, 2-D and 3-D objects, including the corpus callosum and ventricular surfaces.

Situational awareness within objective structured clinical examination stations in undergraduate medical training - a literature search.

PubMed

Fischer, Markus A; Kennedy, Kieran M; Durning, Steven; Schijven, Marlies P; Ker, Jean; O'Connor, Paul; Doherty, Eva; Kropmans, Thomas J B

2017-12-21

Medical students may not be able to identify the essential elements of situational awareness (SA) necessary for clinical reasoning. Recent studies suggest that students have little insight into cognitive processing and SA in clinical scenarios. Objective Structured Clinical Examinations (OSCEs) could be used to assess certain elements of situational awareness. The purpose of this paper is to review the literature with a view to identifying whether levels of SA based on Endsley's model can be assessed utilising OSCEs during undergraduate medical training. A systematic search was performed pertaining to SA and OSCEs, to identify studies published between January 1975 (first paper describing an OSCE) and February 2017, in peer reviewed international journals published in English. PUBMED, EMBASE, PsycINFO Ovid and SCOPUS were searched for papers that described the assessment of SA using OSCEs among undergraduate medical students. Key search terms included "objective structured clinical examination", "objective structured clinical assessment" or "OSCE" and "non-technical skills", "sense-making", "clinical reasoning", "perception", "comprehension", "projection", "situation awareness", "situational awareness" and "situation assessment". Boolean operators (AND, OR) were used as conjunctions to narrow the search strategy, resulting in the limitation of papers relevant to the research interest. Areas of interest were elements of SA that can be assessed by these examinations. The initial search of the literature retrieved 1127 publications. Upon removal of duplicates and papers relating to nursing, paramedical disciplines, pharmacy and veterinary education by title, abstract or full text, 11 articles were eligible for inclusion as related to the assessment of elements of SA in undergraduate medical students. Review of the literature suggests that whole-task OSCEs enable the evaluation of SA associated with clinical reasoning skills. If they address the levels of SA, these

Neurology objective structured clinical examination reliability using generalizability theory.

PubMed

Blood, Angela D; Park, Yoon Soo; Lukas, Rimas V; Brorson, James R

2015-11-03

This study examines factors affecting reliability, or consistency of assessment scores, from an objective structured clinical examination (OSCE) in neurology through generalizability theory (G theory). Data include assessments from a multistation OSCE taken by 194 medical students at the completion of a neurology clerkship. Facets evaluated in this study include cases, domains, and items. Domains refer to areas of skill (or constructs) that the OSCE measures. G theory is used to estimate variance components associated with each facet, derive reliability, and project the number of cases required to obtain a reliable (consistent, precise) score. Reliability using G theory is moderate (Φ coefficient = 0.61, G coefficient = 0.64). Performance is similar across cases but differs by the particular domain, such that the majority of variance is attributed to the domain. Projections in reliability estimates reveal that students need to participate in 3 OSCE cases in order to increase reliability beyond the 0.70 threshold. This novel use of G theory in evaluating an OSCE in neurology provides meaningful measurement characteristics of the assessment. Differing from prior work in other medical specialties, the cases students were randomly assigned did not influence their OSCE score; rather, scores varied in expected fashion by domain assessed. © 2015 American Academy of Neurology.

Medical Student Use of Objectives in Basic Science and Clinical Instruction.

ERIC Educational Resources Information Center

And Others; Mast, Terrill A.

1980-01-01

A study that investigated the long-term use of instructional objectives by medical students taking basic science and clinical courses is reported. Focus is on the extent and manner in which the objectives were used and factors that influenced their use. Students reported heavier usage earlier in the curriculum. (Author/JMD)

Evaluating an Objective Structured Clinical Examination (OSCE) Adapted for Social Work

ERIC Educational Resources Information Center

Bogo, Marion; Regehr, Cheryl; Katz, Ellen; Logie, Carmen; Tufford, Lea; Litvack, Andrea

2012-01-01

Objectives: To evaluate an objective structured clinical examination (OSCE) adapted for social work in a lab course and examine the degree to which it predicts competence in the practicum. Method: 125 Masters students participated in a one-scenario OSCE and wrote responses to standardized reflection questions. OSCE performance and reflections were…

Contributions to Objective Measurement and Evaluation of Trainee Competency.

ERIC Educational Resources Information Center

Moonan, William J.

The purpose of this paper is to lay a basis for and discuss the components of a system, called COMET, designed to objectively measure and evaluate the competency of trainees in military training enterprises. COMET is an acronym for "Computerized Objective Measurement and Evaluation of Trainees." These goals will be accomplished by: (a)…

Construct Validity of an Objective Structured Clinical Examination (OSCE) in Psychiatry: Associations with the Clinical Skills Examination and Other Indicators

ERIC Educational Resources Information Center

Park, Robin S.; Chibnall, John T.; Blaskiewicz, Robert J.; Furman, Gail E.; Powell, Jill K.; Mohr, Clinton J.

2004-01-01

Objective: The construct validity of checklist and global process scores for an objective structured clinical examination (OSCE) in psychiatry was assessed. Multiple regression analysis was used to predict psychiatry OSCE scores from the clinical skills examination, an obstetrics/gynecology (OB/GYN) OSCE, and the National Board of Medical…

Photogrammetric Measurements of Heritage Objects

NASA Astrophysics Data System (ADS)

Tumeliene, E.; Nareiko, V.; Suziedelyte Visockiene, J.

2017-12-01

Cultural heritage is an invaluable example of human culture and creativity. The majority of them can become unstable or can be destroyed due to a combination of human and natural disturbances. In order to restore, preserve, and systematize data about architectural heritage objects, it is necessary to have geodetic, photogrammetric measurements of such data and to constantly monitor condition of the objects. The data of immovable cultural objects for many years are stored in photogrammetric data archives. Such archives have Germany, Lithuania, England and other countries. The article gives a brief introduction of the history of data archives formation and presents a photogrammetric and modern methods of modelling the spatial geometric properties of objects currently used to reveal immovable cultural properties and to evaluate geometric sizes. The pilot work was done with the Concept Capture simulation program that was developed by the Bentley company with photos of the Blessed Virgin Mary painting in Pivašiūnai of Trakai district. A shot from the ground with 12.4 MP resolution Pentax K-x camera was done using lenses with different focal lengths. The painting of the Blessed Virgin Mary is coordinated by 4 reference geodesic points and therefore after the modelling work it was possible to evaluate the accuracy of the created model. Based on the results of the spatial (3D) model, photo shooting and modelling recommendations are presented, the advantages of the new technology are distinguished.

ASUPT Automated Objective Performance Measurement System.

ERIC Educational Resources Information Center

Waag, Wayne L.; And Others

To realize its full research potential, a need exists for the development of an automated objective pilot performance evaluation system for use in the Advanced Simulation in Undergraduate Pilot Training (ASUPT) facility. The present report documents the approach taken for the development of performance measures and also presents data collected…

[Patients' perspective and economic variables as objectives in clinical trials: added value to clinical parameters].

PubMed

Bovaira-García, M J; Soler-Company, E

2012-01-01

Patient-reported outcome (PRO) measures complement traditional biomedical outcome measures. The purpose of this study was to evaluate the use of PRO measures including health-related quality of life (HRQoL) questionnaires as a measurement of efficacy and the frequency of inclusion of economic variables related to direct and indirect costs in the design of clinical trials and phase IV observational studies. Moreover, for the trials quality score were measured, and if there were any relationship between the quality study design score and the PRO inclusion. Retrospective observational study of the clinical trials and phase IV observational studies approved by a Clinical Research Ethics Committee (2008-2010). We gathered data concerning general aspects including medical specialty, pathology, methodological quality based on Jadad scale (0-5), inclusion of PRO and economic variables. For clinical trials including HRQoL measurements, we analysed the type of questionnaire in use. Where there were no HRQoL measurements, we analysed if their inclusion would have been proper or not. A total of 70 protocols (59 CTs and 11 phase IV observational studies) were analysed; 37 (52.8%) included PRO measures, and 3 protocols (4.3%) used them as a primary endpoint. Data analysis by therapeutic area showed that PRO measures were most commonly studied in the fields of endocrinology, neurology, digestive diseases, and cardiology. The average quality score for the trials was 2.8. The trials with more PRO inclusion in their end points had a significantly higher quality score. Only 13 (22%) clinical trials and 2 (18.2%) phase IV observational studies included economic variables. The emergence of economic variables in clinical trials and phase IV observational studies evaluated was low, however, more than half of the revised protocols have included PRO measures, reflecting the importance of these parameters in the assessment of the effectiveness of drug treatments, although its use is still

Objective measures of situation awareness in a simulated medical environment

PubMed Central

Wright, M; Taekman, J; Endsley, M

2004-01-01

One major limitation in the use of human patient simulators is a lack of objective, validated measures of human performance. Objective measures are necessary if simulators are to be used to evaluate the skills and training of medical practitioners and teams or to evaluate the impact of new processes or equipment design on overall system performance. Situation awareness (SA) refers to a person's perception and understanding of their dynamic environment. This awareness and comprehension is critical in making correct decisions that ultimately lead to correct actions in medical care settings. An objective measure of SA may be more sensitive and diagnostic than traditional performance measures. This paper reviews a theory of SA and discusses the methods required for developing an objective measure of SA within the context of a simulated medical environment. Analysis and interpretation of SA data for both individual and team performance in health care are also presented. PMID:15465958

Do Clinical Clerks Provide Candidates with Adequate Formative Assessment during Objective Structured Clinical Examinations?

ERIC Educational Resources Information Center

Reiter, Harold I.; Rosenfeld, Jack; Nandagopal, Kiruthiga; Eva, Kevin W.

2004-01-01

Context: Various research studies have examined the question of whether expert or non-expert raters, faculty or students, evaluators or standardized patients, give more reliable and valid summative assessments of performance on Objective Structured Clinical Examinations (OSCEs). Less studied has been the question of whether or not non-faculty…

Measurements Conducted on an Unknown Object Labeled Pu-239

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hoteling, Nathan

Measurements were carried out on 12 November 2013 to determine whether Pu-239 was present on an object discovered in a plastic bag with label “Pu-­239 6 uCi.” Following initial survey measurements to verify that the object was not leaking or contaminated, spectra were collected with a High Purity Germanium (HPGe) detector with object positioned in two different configurations. Analysis of the spectra did not yield any direct evidence of Pu-­239. From the measured spectra, minimum detectable activity (MDA) was determined to be approximately 2 uCi for the gamma-­ray measurements. Although there was no direct evidence of Pu-239, a peak atmore » 60 keV characteristic of Am-­241 decay was observed. Since it is very likely that Am-­241 would be present in aged plutonium samples, this was interpreted as indirect evidence for the presence of plutonium on the object. Analysis of this peak led to an estimated Pu-­239 activity of 0.02–0.04 uCi, or <1x10 -6 grams.« less

Tissue tonometry is a simple, objective measure for pliability of burn scar: is it reliable?

PubMed

Lye, Ian; Edgar, Dale W; Wood, Fiona M; Carroll, Sara

2006-01-01

Objective measurement of burn scar response to treatment is important to facilitate individual patient care, research, and service development. This work examines the validity and reliability of the tonometer as a means of quantifying scar pliability. Ten burn survivors were recruited into the study. Triplicate measures were taken for each of four scar and one normal skin point. The pliability score from the Vancouver Scar Scale also was used as a comparison. The tonometer demonstrated a high degree of reliability (intraclass correlation coefficients 0.91-0.94). It also was shown to provide a valid measure of pliability by quantifying decreased tissue deformation for scar (2.04 +/- 0.45 mm) compared with normal tissue (3.02 +/- 0.92 mm; t = 4.28, P = .004) and a moderate correlation with Vancouver Scar Scale scores. The tissue tonometer provides a repeatable, objective index of burn scar pliability. Using the methods described, it is a simple, clinically useful technique for monitoring an individual's scar.

Measuring the Speed of Newborn Object Recognition in Controlled Visual Worlds

ERIC Educational Resources Information Center

Wood, Justin N.; Wood, Samantha M. W.

2017-01-01

How long does it take for a newborn to recognize an object? Adults can recognize objects rapidly, but measuring object recognition speed in newborns has not previously been possible. Here we introduce an automated controlled-rearing method for measuring the speed of newborn object recognition in controlled visual worlds. We raised newborn chicks…

Brief Analysis of Application of Objective Structured Clinical Examination (OSCE) in Graduation Exams of Clinical Medical Students

ERIC Educational Resources Information Center

Du, Yihua; Yu, Ke; Li, Xiaohong; Wang, Feng; Wang, Tingting

2011-01-01

This article gives a brief introduction to the Objective Structured Clinical Examination (OSCE) and analyzes developmental progress of OSCE at both home and abroad and standardized patients' application in OSCE. Also, this article expounds application of OSCE in graduation exam of clinical medical students. Finally, this article summarizes…

Flipping the Objective Structured Clinical Examination: A Teaching Innovation in Graduate Nursing Education.

PubMed

Day, Cristi; Barker, Connie; Bell, Eva; Sefcik, Elizabeth; Flournoy, Deborah

Objective evaluation of distance-based family nurse practitioner (FNP) students can be challenging. One FNP program piloted a teaching innovation, the video-enhanced objective structured clinical examination (VE-OSCE) or "flip" of the traditional face-to-face OSCE, to assess student clinical performance in a controlled online environment using a teleconferencing platform. This project sought to assess the VE-OSCE design, implementation, and ability to identify FNP student learning needs.

Objectively measured sedentary time and academic achievement in schoolchildren.

PubMed

Lopes, Luís; Santos, Rute; Mota, Jorge; Pereira, Beatriz; Lopes, Vítor

2017-03-01

This study aimed to evaluate the relationship between objectively measured total sedentary time and academic achievement (AA) in Portuguese children. The sample comprised of 213 children (51.6% girls) aged 9.46 ± 0.43 years, from the north of Portugal. Sedentary time was measured with accelerometry, and AA was assessed using the Portuguese Language and Mathematics National Exams results. Multilevel linear regression models were fitted to assess regression coefficients predicting AA. The results showed that objectively measured total sedentary time was not associated with AA, after adjusting for potential confounders.

Acoustic Measurement Of Periodic Motion Of Levitated Object

NASA Technical Reports Server (NTRS)

Watkins, John L.; Barmatz, Martin B.

1992-01-01

Some internal vibrations, oscillations in position, and rotations of acoustically levitated object measured by use of microphone already installed in typical levitation chamber for tuning chamber to resonance and monitoring operation. Levitating acoustic signal modulated by object motion of lower frequency. Amplitude modulation detected and analyzed spectrally to determine amplitudes and frequencies of motions.

Correlation between the reason for referral, clinical, and objective assessment of the risk for dysphagia.

PubMed

Mancopes, Renata; Gonçalves, Bruna Franciele da Trindade; Costa, Cintia Conceição; Favero, Talita Cristina; Drozdz, Daniela Rejane Constantino; Bilheri, Diego Fernando Dorneles; Schumacher, Stéfani Fernanda

2014-01-01

To correlate the reason for referral to speech therapy service at a university hospital with the results of clinical and objective assessment of risk for dysphagia. This is a cross-sectional, observational, retrospective analytical and quantitative study. The data were gathered from the database, and the information used was the reason for referral to speech therapy service, results of clinical assessment of the risk for dysphagia, and also from swallowing videofluoroscopy. There was a mean difference between the variables of the reason for the referral, results of the clinical and objective swallowing assessments, and scale of penetration/aspiration, although the values were not statistically significant. Statistically significant correlation was observed between clinical and objective assessments and the penetration scale, with the largest occurring between the results of objective assessment and penetration scale. There was a correlation between clinical and objective assessments of swallowing and mean difference between the variables of the reason for the referral with their respective assessment. This shows the importance of the association between the data of patient's history and results of clinical evaluation and complementary tests, such as videofluoroscopy, for correct identification of the swallowing disorders, being important to combine the use of severity scales of penetration/aspiration for diagnosis.

Effects of basic clinical skills training on objective structured clinical examination performance.

PubMed

Jünger, Jana; Schäfer, Sybille; Roth, Christiane; Schellberg, Dieter; Friedman Ben-David, Miriam; Nikendei, Christoph

2005-10-01

The aim of curriculum reform in medical education is to improve students' clinical and communication skills. However, there are contradicting results regarding the effectiveness of such reforms. A study of internal medicine students was carried out using a static group design. The experimental group consisted of 77 students participating in 7 sessions of communication training, 7 sessions of skills-laboratory training and 7 sessions of bedside-teaching, each lasting 1.5 hours. The control group of 66 students from the traditional curriculum participated in equally as many sessions but was offered only bedside teaching. Students' cognitive and practical skills performance was assessed using Multiple Choice Question (MCQ) testing and an objective structured clinical examination (OSCE), delivered by examiners blind to group membership. The experimental group performed significantly better on the OSCE than did the control group (P < 0.01), whereas the groups did not differ on the MCQ test (P < 0.15). This indicates that specific training in communication and basic clinical skills enabled students to perform better in an OSCE, whereas its effects on knowledge did not differ from those of the traditional curriculum. Curriculum reform promoting communication and basic clinical skills are effective and lead to an improved performance in history taking and physical examination skills.

Effect of ethnicity on performance in a final objective structured clinical examination: qualitative and quantitative study

PubMed Central

Wass, Val; Roberts, Celia; Hoogenboom, Ron; Jones, Roger; Van der Vleuten, Cees

2003-01-01

Objective To assess the effect of ethnicity on student performance in stations assessing communication skills within an objective structured clinical examination. Design Quantitative and qualitative study. Setting A final UK clinical examination consisting of a two day objective structured clinical examination with 22 stations. Participants 82 students from ethnic minorities and 97 white students. Main outcome measures Mean scores for stations (quantitative) and observations made using discourse analysis on selected communication stations (qualitative). Results Mean performance of students from ethnic minorities was significantly lower than that of white students for stations assessing communication skills on days 1 (67.0% (SD 6.8%) and 72.3% (7.6%); P=0.001) and 2 (65.2% (6.6%) and 69.5% (6.3%); P=0.003). No examples of overt discrimination were found in 309 video recordings. Transcriptions showed subtle differences in communication styles in some students from ethnic minorities who performed poorly. Examiners' assumptions about what is good communication may have contributed to differences in grading. Conclusions There was no evidence of explicit discrimination between students from ethnic minorities and white students in the objective structured clinical examination. A small group of male students from ethnic minorities used particularly poorly rated communicative styles, and some subtle problems in assessing communication skills may have introduced bias. Tests need to reflect issues of diversity to ensure that students from ethnic minorities are not disadvantaged. What is already known on this topicUK medical schools are concerned that students from ethnic minorities may perform less well than white students in examinationsIt is important to understand whether our examination system disadvantages themWhat this study addsMean performance of students from ethnic minorities was significantly lower than that of white students in a final year objective structured

Reliability analysis of the objective structured clinical examination using generalizability theory.

PubMed

Trejo-Mejía, Juan Andrés; Sánchez-Mendiola, Melchor; Méndez-Ramírez, Ignacio; Martínez-González, Adrián

2016-01-01

The objective structured clinical examination (OSCE) is a widely used method for assessing clinical competence in health sciences education. Studies using this method have shown evidence of validity and reliability. There are no published studies of OSCE reliability measurement with generalizability theory (G-theory) in Latin America. The aims of this study were to assess the reliability of an OSCE in medical students using G-theory and explore its usefulness for quality improvement. An observational cross-sectional study was conducted at National Autonomous University of Mexico (UNAM) Faculty of Medicine in Mexico City. A total of 278 fifth-year medical students were assessed with an 18-station OSCE in a summative end-of-career final examination. There were four exam versions. G-theory with a crossover random effects design was used to identify the main sources of variance. Examiners, standardized patients, and cases were considered as a single facet of analysis. The exam was applied to 278 medical students. The OSCE had a generalizability coefficient of 0.93. The major components of variance were stations, students, and residual error. The sites and the versions of the tests had minimum variance. Our study achieved a G coefficient similar to that found in other reports, which is acceptable for summative tests. G-theory allows the estimation of the magnitude of multiple sources of error and helps decision makers to determine the number of stations, test versions, and examiners needed to obtain reliable measurements.

Reliability analysis of the objective structured clinical examination using generalizability theory.

PubMed

Trejo-Mejía, Juan Andrés; Sánchez-Mendiola, Melchor; Méndez-Ramírez, Ignacio; Martínez-González, Adrián

2016-01-01

Background The objective structured clinical examination (OSCE) is a widely used method for assessing clinical competence in health sciences education. Studies using this method have shown evidence of validity and reliability. There are no published studies of OSCE reliability measurement with generalizability theory (G-theory) in Latin America. The aims of this study were to assess the reliability of an OSCE in medical students using G-theory and explore its usefulness for quality improvement. Methods An observational cross-sectional study was conducted at National Autonomous University of Mexico (UNAM) Faculty of Medicine in Mexico City. A total of 278 fifth-year medical students were assessed with an 18-station OSCE in a summative end-of-career final examination. There were four exam versions. G-theory with a crossover random effects design was used to identify the main sources of variance. Examiners, standardized patients, and cases were considered as a single facet of analysis. Results The exam was applied to 278 medical students. The OSCE had a generalizability coefficient of 0.93. The major components of variance were stations, students, and residual error. The sites and the versions of the tests had minimum variance. Conclusions Our study achieved a G coefficient similar to that found in other reports, which is acceptable for summative tests. G-theory allows the estimation of the magnitude of multiple sources of error and helps decision makers to determine the number of stations, test versions, and examiners needed to obtain reliable measurements.

Clinical utility of measures of breathlessness.

PubMed

Cullen, Deborah L; Rodak, Bernadette

2002-09-01

The clinical utility of measures of dyspnea has been debated in the health care community. Although breathlessness can be evaluated with various instruments, the most effective dyspnea measurement tool for patients with chronic lung disease or for measuring treatment effectiveness remains uncertain. Understanding the evidence for the validity and reliability of these instruments may provide a basis for appropriate clinical application. Evaluate instruments designed to measure breathlessness, either as single-symptom or multidimensional instruments, based on psychometrics foundations such as validity, reliability, and discriminative and evaluative properties. Classification of each dyspnea measurement instrument will recommend clinical application in terms of exercise, benchmarking patients, activities of daily living, patient outcomes, clinical trials, and responsiveness to treatment. Eleven dyspnea measurement instruments were selected. Each instrument was assessed as discriminative or evaluative and then analyzed as to its psychometric properties and purpose of design. Descriptive data from all studies were described according to their primary patient application (ie, chronic obstructive pulmonary disease, asthma, or other patient populations). The Borg Scale and the Visual Analogue Scale are applicable to exertion and thus can be applied to any cardiopulmonary patient to determine dyspnea. All other measures were determined appropriate for chronic obstructive pulmonary disease, whereas the Shortness of Breath Questionnaire can be applied to cystic fibrosis and lung transplant patients. The most appropriate utility for all instruments was measuring the effects on activities of daily living and for benchmarking patient progress. Instruments that quantify function and health-related quality of life have great utility for documenting outcomes but may be limited as to documenting treatment responsiveness in terms of clinically important changes. The dyspnea

Clinical Complexity in Medicine: A Measurement Model of Task and Patient Complexity.

PubMed

Islam, R; Weir, C; Del Fiol, G

2016-01-01

Complexity in medicine needs to be reduced to simple components in a way that is comprehensible to researchers and clinicians. Few studies in the current literature propose a measurement model that addresses both task and patient complexity in medicine. The objective of this paper is to develop an integrated approach to understand and measure clinical complexity by incorporating both task and patient complexity components focusing on the infectious disease domain. The measurement model was adapted and modified for the healthcare domain. Three clinical infectious disease teams were observed, audio-recorded and transcribed. Each team included an infectious diseases expert, one infectious diseases fellow, one physician assistant and one pharmacy resident fellow. The transcripts were parsed and the authors independently coded complexity attributes. This baseline measurement model of clinical complexity was modified in an initial set of coding processes and further validated in a consensus-based iterative process that included several meetings and email discussions by three clinical experts from diverse backgrounds from the Department of Biomedical Informatics at the University of Utah. Inter-rater reliability was calculated using Cohen's kappa. The proposed clinical complexity model consists of two separate components. The first is a clinical task complexity model with 13 clinical complexity-contributing factors and 7 dimensions. The second is the patient complexity model with 11 complexity-contributing factors and 5 dimensions. The measurement model for complexity encompassing both task and patient complexity will be a valuable resource for future researchers and industry to measure and understand complexity in healthcare.

A component-based, distributed object services architecture for a clinical workstation.

PubMed

Chueh, H C; Raila, W F; Pappas, J J; Ford, M; Zatsman, P; Tu, J; Barnett, G O

1996-01-01

Attention to an architectural framework in the development of clinical applications can promote reusability of both legacy systems as well as newly designed software. We describe one approach to an architecture for a clinical workstation application which is based on a critical middle tier of distributed object-oriented services. This tier of network-based services provides flexibility in the creation of both the user interface and the database tiers. We developed a clinical workstation for ambulatory care using this architecture, defining a number of core services including those for vocabulary, patient index, documents, charting, security, and encounter management. These services can be implemented through proprietary or more standard distributed object interfaces such as CORBA and OLE. Services are accessed over the network by a collection of user interface components which can be mixed and matched to form a variety of interface styles. These services have also been reused with several applications based on World Wide Web browser interfaces.

A component-based, distributed object services architecture for a clinical workstation.

PubMed Central

Chueh, H. C.; Raila, W. F.; Pappas, J. J.; Ford, M.; Zatsman, P.; Tu, J.; Barnett, G. O.

1996-01-01

Attention to an architectural framework in the development of clinical applications can promote reusability of both legacy systems as well as newly designed software. We describe one approach to an architecture for a clinical workstation application which is based on a critical middle tier of distributed object-oriented services. This tier of network-based services provides flexibility in the creation of both the user interface and the database tiers. We developed a clinical workstation for ambulatory care using this architecture, defining a number of core services including those for vocabulary, patient index, documents, charting, security, and encounter management. These services can be implemented through proprietary or more standard distributed object interfaces such as CORBA and OLE. Services are accessed over the network by a collection of user interface components which can be mixed and matched to form a variety of interface styles. These services have also been reused with several applications based on World Wide Web browser interfaces. PMID:8947744

Three-Dimensional Shape Measurements of Specular Objects Using Phase-Measuring Deflectometry.

PubMed

Zhang, Zonghua; Wang, Yuemin; Huang, Shujun; Liu, Yue; Chang, Caixia; Gao, Feng; Jiang, Xiangqian

2017-12-07

The fast development in the fields of integrated circuits, photovoltaics, the automobile industry, advanced manufacturing, and astronomy have led to the importance and necessity of quickly and accurately obtaining three-dimensional (3D) shape data of specular surfaces for quality control and function evaluation. Owing to the advantages of a large dynamic range, non-contact operation, full-field and fast acquisition, high accuracy, and automatic data processing, phase-measuring deflectometry (PMD, also called fringe reflection profilometry) has been widely studied and applied in many fields. Phase information coded in the reflected fringe patterns relates to the local slope and height of the measured specular objects. The 3D shape is obtained by integrating the local gradient data or directly calculating the depth data from the phase information. We present a review of the relevant techniques regarding classical PMD. The improved PMD technique is then used to measure specular objects having discontinuous and/or isolated surfaces. Some influential factors on the measured results are presented. The challenges and future research directions are discussed to further advance PMD techniques. Finally, the application fields of PMD are briefly introduced.

Three-Dimensional Shape Measurements of Specular Objects Using Phase-Measuring Deflectometry

PubMed Central

Wang, Yuemin; Huang, Shujun; Liu, Yue; Chang, Caixia; Gao, Feng; Jiang, Xiangqian

2017-01-01

The fast development in the fields of integrated circuits, photovoltaics, the automobile industry, advanced manufacturing, and astronomy have led to the importance and necessity of quickly and accurately obtaining three-dimensional (3D) shape data of specular surfaces for quality control and function evaluation. Owing to the advantages of a large dynamic range, non-contact operation, full-field and fast acquisition, high accuracy, and automatic data processing, phase-measuring deflectometry (PMD, also called fringe reflection profilometry) has been widely studied and applied in many fields. Phase information coded in the reflected fringe patterns relates to the local slope and height of the measured specular objects. The 3D shape is obtained by integrating the local gradient data or directly calculating the depth data from the phase information. We present a review of the relevant techniques regarding classical PMD. The improved PMD technique is then used to measure specular objects having discontinuous and/or isolated surfaces. Some influential factors on the measured results are presented. The challenges and future research directions are discussed to further advance PMD techniques. Finally, the application fields of PMD are briefly introduced. PMID:29215600

Twelve Tips for Organizing an Objective Structured Clinical Examination (OSCE).

ERIC Educational Resources Information Center

Harden, R. M.

1991-01-01

Suggestions for organizing the objective structured clinical examination for medical students and physicians address selection of competencies to be evaluated, number, type, and duration of examination stations, use of examiners, clarity of instructions, test administration, resource requirements, interstation signals, and recordkeeping. (MSE)

Adiponectin, Leptin and Objectively Measured Physical Activity in Adults: A Narrative Review

PubMed Central

Nurnazahiah, Ali; Lua, Pei Lin; Shahril, Mohd Razif

2016-01-01

The objective of this study was to compile and analyse existing scientific evidences reporting the effects of objectively measured physical activity on the levels of adiponectin and leptin. Articles related to the effects of objectively measured physical activity on the levels of adiponectin and leptin were searched from the Medline and PubMed databases. The search was limited to ‘objectively measured’ physical activity, and studies that did not objectively measure the physical activity were excluded. Only English articles were included in the search and review. A total of 18 articles encompassing 2,026 respondents met the inclusion criteria. The eligible articles included all forms of evidence (e.g., cross-sectional and intervention). Seventeen and 11 studies showed the effects of objectively measured physical activity on adiponectin and leptin, respectively. Five and four cross-sectional studies showed the effects of objectively measured physical activity on adiponectin and leptin, respectively. Two out of five studies showed a weak to moderate positive association between adiponectin and objectively measured physical activity, while three out of four studies showed a weak to moderate inverse association between leptin and objectively measured physical activity. For intervention studies, six out of 12 studies involving adiponectin and five out of seven studies involving leptin showed a significant effect between the proteins and objectively measured physical activity. However, a definitive conclusion could not be drawn due to several methodological flaws in the existing articles and the acute lack of additional research in this area. In conclusion, the existing evidences are encouraging but yet not compelling. Hence, further well-designed large trials are needed before the effectiveness of objectively measured physical activity in elevating adiponectin levels and in decreasing leptin levels could be strongly confirmed. PMID:28090175

Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures: a systematic review

PubMed Central

Saw, Anna E; Main, Luana C; Gastin, Paul B

2016-01-01

Background Monitoring athlete well-being is essential to guide training and to detect any progression towards negative health outcomes and associated poor performance. Objective (performance, physiological, biochemical) and subjective measures are all options for athlete monitoring. Objective We systematically reviewed objective and subjective measures of athlete well-being. Objective measures, including those taken at rest (eg, blood markers, heart rate) and during exercise (eg, oxygen consumption, heart rate response), were compared against subjective measures (eg, mood, perceived stress). All measures were also evaluated for their response to acute and chronic training load. Methods The databases Academic search complete, MEDLINE, PsycINFO, SPORTDiscus and PubMed were searched in May 2014. Fifty-six original studies reported concurrent subjective and objective measures of athlete well-being. The quality and strength of findings of each study were evaluated to determine overall levels of evidence. Results Subjective and objective measures of athlete well-being generally did not correlate. Subjective measures reflected acute and chronic training loads with superior sensitivity and consistency than objective measures. Subjective well-being was typically impaired with an acute increase in training load, and also with chronic training, while an acute decrease in training load improved subjective well-being. Summary This review provides further support for practitioners to use subjective measures to monitor changes in athlete well-being in response to training. Subjective measures may stand alone, or be incorporated into a mixed methods approach to athlete monitoring, as is current practice in many sport settings. PMID:26423706

Executive function in fibromyalgia: Comparing subjective and objective measures.

PubMed

Gelonch, Olga; Garolera, Maite; Valls, Joan; Rosselló, Lluís; Pifarré, Josep

2016-04-01

There is evidence to suggest the existence of an executive dysfunction in people diagnosed with fibromyalgia, although there are certain inconsistencies between studies. Here, we aim to compare executive performance between patients with fibromyalgia and a control group by using subjective and objective cognitive tests, analyzing the influence of patient mood on the results obtained, and studying associations between the two measures. 82 patients diagnosed with fibromyalgia and 42 healthy controls, matched by age and years of education, were assessed using the Behavioral Rating Inventory of Executive Function - Adult Version (BRIEF-A) as a subjective measure of executive functioning. A selection of objective cognitive tests were also used to measure a series of executive functions and to identify symptoms of depression and anxiety. Patients with fibromyalgia perceived greater difficulties than the control group on all of the BRIEF-A scales. However, after adjustments were made for depression and anxiety the only differences that remained were those associated with the working memory scale and the Metacognition and Global Executive Composite index. In the case of the objective cognitive tests, a significantly worse overall performance was evidenced for the fibromyalgia patients. However, this also disappeared when adjustments were made for depression and anxiety. After this adjustment, fibromyalgia patients only performed significantly worse for the interference effect in the Stroop Test. Although there were no significant associations between most of the objective cognitive tests and the BRIEF-A scales, depression and anxiety exhibited strong associations with almost all of the BRIEF-A scales and with several of the objective cognitive tests. Patients with fibromyalgia showed executive dysfunction in subjective and objective measures, although most of this impairment was associated with mood disturbances. Exceptions to this general rule were observed in the

Variability in objective and subjective measures affects baseline values in studies of patients with COPD

PubMed Central

Ha, Jae Wook; Couper, David J.; O’Neal, Wanda K.; Barr, R. Graham; Bleecker, Eugene R.; Carretta, Elizabeth E.; Cooper, Christopher B.; Doerschuk, Claire M.; Drummond, M Bradley; Han, MeiLan K.; Hansel, Nadia N.; Kim, Victor; Kleerup, Eric C.; Martinez, Fernando J.; Rennard, Stephen I.; Tashkin, Donald; Woodruff, Prescott G.; Paine, Robert; Curtis, Jeffrey L.; Kanner, Richard E.

2017-01-01

Rationale Understanding the reliability and repeatability of clinical measurements used in the diagnosis, treatment and monitoring of disease progression is of critical importance across all disciplines of clinical practice and in clinical trials to assess therapeutic efficacy and safety. Objectives Our goal is to understand normal variability for assessing true changes in health status and to more accurately utilize this data to differentiate disease characteristics and outcomes. Methods Our study is the first study designed entirely to establish the repeatability of a large number of instruments utilized for the clinical assessment of COPD in the same subjects over the same period. We utilized SPIROMICS participants (n = 98) that returned to their clinical center within 6 weeks of their baseline visit to repeat complete baseline assessments. Demographics, spirometry, questionnaires, complete blood cell counts (CBC), medical history, and emphysema status by computerized tomography (CT) imaging were obtained. Results Pulmonary function tests (PFTs) were highly repeatable (ICC’s >0.9) but the 6 minute walk (6MW) was less so (ICC = 0.79). Among questionnaires, the Saint George’s Respiratory Questionnaire (SGRQ) was most repeatable. Self-reported clinical features, such as exacerbation history, and features of chronic bronchitis, often produced kappa values <0.6. Reported age at starting smoking and average number of cigarettes smoked were modestly repeatable (kappa = 0.76 and 0.79). Complete blood counts (CBC) variables produced intraclass correlation coefficients (ICC) values between 0.6 and 0.8. Conclusions PFTs were highly repeatable, while subjective measures and subject recall were more variable. Analyses using features with poor repeatability could lead to misclassification and outcome errors. Hence, care should be taken when interpreting change in clinical features based on measures with low repeatability. Efforts to improve repeatability of key clinical

An objective measure of physical function of elderly outpatients. The Physical Performance Test.

PubMed

Reuben, D B; Siu, A L

1990-10-01

Direct observation of physical function has the advantage of providing an objective, quantifiable measure of functional capabilities. We have developed the Physical Performance Test (PPT), which assesses multiple domains of physical function using observed performance of tasks that simulate activities of daily living of various degrees of difficulty. Two versions are presented: a nine-item scale that includes writing a sentence, simulated eating, turning 360 degrees, putting on and removing a jacket, lifting a book and putting it on a shelf, picking up a penny from the floor, a 50-foot walk test, and climbing stairs (scored as two items); and a seven-item scale that does not include stairs. The PPT can be completed in less than 10 minutes and requires only a few simple props. We then tested the validity of PPT using 183 subjects (mean age, 79 years) in six settings including four clinical practices (one of Parkinson's disease patients), a board-and-care home, and a senior citizens' apartment. The PPT was reliable (Cronbach's alpha = 0.87 and 0.79, interrater reliability = 0.99 and 0.93 for the nine-item and seven-item tests, respectively) and demonstrated concurrent validity with self-reported measures of physical function. Scores on the PPT for both scales were highly correlated (.50 to .80) with modified Rosow-Breslau, Instrumental and Basic Activities of Daily Living scales, and Tinetti gait score. Scores on the PPT were more moderately correlated with self-reported health status, cognitive status, and mental health (.24 to .47), and negatively with age (-.24 and -.18). Thus, the PPT also demonstrated construct validity. The PPT is a promising objective measurement of physical function, but its clinical and research value for screening, monitoring, and prediction will have to be determined.

Quantitative method for measuring heat flux emitted from a cryogenic object

DOEpatents

Duncan, Robert V.

1993-01-01

The present invention is a quantitative method for measuring the total heat flux, and of deriving the total power dissipation, of a heat-fluxing object which includes the steps of placing an electrical noise-emitting heat-fluxing object in a liquid helium bath and measuring the superfluid transition temperature of the bath. The temperature of the liquid helium bath is thereafter reduced until some measurable parameter, such as the electrical noise, exhibited by the heat-fluxing object or a temperature-dependent resistive thin film in intimate contact with the heat-fluxing object, becomes greatly reduced. The temperature of the liquid helum bath is measured at this point. The difference between the superfluid transition temperature of the liquid helium bath surrounding the heat-fluxing object, and the temperature of the liquid helium bath when the electrical noise emitted by the heat-fluxing object becomes greatly reduced, is determined. The total heat flux from the heat-fluxing object is determined as a function of this difference between these temperatures. In certain applications, the technique can be used to optimize thermal design parameters of cryogenic electronics, for example, Josephson junction and infra-red sensing devices.

Quantitative method for measuring heat flux emitted from a cryogenic object

DOEpatents

Duncan, R.V.

1993-03-16

The present invention is a quantitative method for measuring the total heat flux, and of deriving the total power dissipation, of a heat-fluxing object which includes the steps of placing an electrical noise-emitting heat-fluxing object in a liquid helium bath and measuring the superfluid transition temperature of the bath. The temperature of the liquid helium bath is thereafter reduced until some measurable parameter, such as the electrical noise, exhibited by the heat-fluxing object or a temperature-dependent resistive thin film in intimate contact with the heat-fluxing object, becomes greatly reduced. The temperature of the liquid helum bath is measured at this point. The difference between the superfluid transition temperature of the liquid helium bath surrounding the heat-fluxing object, and the temperature of the liquid helium bath when the electrical noise emitted by the heat-fluxing object becomes greatly reduced, is determined. The total heat flux from the heat-fluxing object is determined as a function of this difference between these temperatures. In certain applications, the technique can be used to optimize thermal design parameters of cryogenic electronics, for example, Josephson junction and infrared sensing devices.

[Clinical laboratory medicine: continuous amelioration with a book of objectives and satisfaction survey].

PubMed

Reix, Nathalie; Agin, Arnaud; Bahram, Seiamak; Dali-Youcef, Nassim; Grucker, Daniel; Jaulhac, Benoît; Lepiller, Quentin; Lessinger, Jean-Marc; Mauvieux, Laurent; Monier, Laurie; Schramm, Frédéric; Stoll-Keller, Françoise; Vallat, Laurent; Ludes, Bertrand; Candolfi, Ermanno; Filisetti, Denis

2015-01-01

We report in this publication the use of two educational tools, a questionnaire of satisfaction and a training book, to improve the training of students during their internship in clinical laboratory at the "Pôle de biologie des Hôpitaux universitaires de Strasbourg" in France. First, the ongoing training was assessed by the interns with a questionnaire measuring satisfaction. The analysis of this questionnaire identified four key points to improve: 1) define the teaching objectives, 2) organize the training with a schedule, 3) revise certain teaching methods and 4) ensure better integration of the students in the team of medical biologists. After this assessment, we implemented a training book to answer these four points. Indeed, the training book presents the objectives, the schedule of training, and how to validate the educational objectives. A new assessment was performed again using the same methodology. Results showed an improvement in student satisfaction from 74 to 88 %. The questionnaire of satisfaction and the training book are presented in this article. The aim of the assessment of training combined with the training book is to incite the actors of the training (students and teachers) to continually improve the training. The objectives of the Pôle de Biologie are to obtain an 80 % satisfaction rate during the 6 months trainings and to reduce or eliminate dissatisfaction, and finally to ensure the validation by students of 80 to 100 % of their predetermined objectives.

Relative hardness measurement of soft objects by a new fiber optic sensor

NASA Astrophysics Data System (ADS)

Ahmadi, Roozbeh; Ashtaputre, Pranav; Abou Ziki, Jana; Dargahi, Javad; Packirisamy, Muthukumaran

2010-06-01

The measurement of relative hardness of soft objects enables replication of human finger tactile perception capabilities. This ability has many applications not only in automation and robotics industry but also in many other areas such as aerospace and robotic surgery where a robotic tool interacts with a soft contact object. One of the practical examples of interaction between a solid robotic instrument and a soft contact object occurs during robotically-assisted minimally invasive surgery. Measuring the relative hardness of bio-tissue, while contacting the robotic instrument, helps the surgeons to perform this type of surgery more reliably. In the present work, a new optical sensor is proposed to measure the relative hardness of contact objects. In order to measure the hardness of a contact object, like a human finger, it is required to apply a small force/deformation to the object by a tactile sensor. Then, the applied force and resulting deformation should be recorded at certain points to enable the relative hardness measurement. In this work, force/deformation data for a contact object is recorded at certain points by the proposed optical sensor. Recorded data is used to measure the relative hardness of soft objects. Based on the proposed design, an experimental setup was developed and experimental tests were performed to measure the relative hardness of elastomeric materials. Experimental results verify the ability of the proposed optical sensor to measure the relative hardness of elastomeric samples.

Subjective vs objective evaluations of smile esthetics.

PubMed

Schabel, Brian J; Franchi, Lorenzo; Baccetti, Tiziano; McNamara, James A

2009-04-01

The aim of this study was to analyze the relationships between subjective evaluations of posttreatment smiles captured with clinical photography and rated by a panel of orthodontists and parents of orthodontic patients, and objective evaluations of the same smiles from the Smile Mesh program (TDG Computing, Philadelphia, Pa). The clinical photographs of 48 orthodontically treated patients were rated by a panel of 25 experienced orthodontists and 20 parents of patients. Independent samples t tests were used to test whether objective measurements were significantly different between subjects with "attractive" and "unattractive" smiles, and those with the "most attractive" and "least attractive" smiles. Additionally, logistic regression was performed to evaluate whether the measurements could predict whether a smile captured with clinical photography would be attractive or unattractive. The comparison between groups showed no significant differences for any measurement. Subjects with the "most unattractive" smiles had a significantly greater distance between the incisal edge of the maxillary central incisors and the lower lip during smiling, and a significantly smaller smile index than did those with the "most attractive" smiles. As shown by the coefficients of logistic regression, smile attractiveness could not be predicted by any objectively gathered measurement. No objective measure of the smile could predict attractive or unattractive smiles as judged subjectively.

Influence of Objective Three-Dimensional Measures and Movement Images on Surgeon Treatment Planning for Lip Revision Surgery

PubMed Central

Trotman, Carroll-Ann; Phillips, Ceib; Faraway, Julian J.; Hartman, Terry; van Aalst, John A.

2013-01-01

Objective To determine whether a systematic evaluation of facial soft tissues of patients with cleft lip and palate, using facial video images and objective three-dimensional measurements of movement, change surgeons’ treatment plans for lip revision surgery. Design Prospective longitudinal study. Setting The University of North Carolina School of Dentistry. Patients, Participants A group of patients with repaired cleft lip and palate (n = 21), a noncleft control group (n = 37), and surgeons experienced in cleft care. Interventions Lip revision. Main Outcome Measures (1) facial photographic images; (2) facial video images during animations; (3) objective three-dimensional measurements of upper lip movement based on z scores; and (4) objective dynamic and visual three-dimensional measurement of facial soft tissue movement. Results With the use of the video images plus objective three-dimensional measures, changes were made to the problem list of the surgical treatment plan for 86% of the patients (95% confidence interval, 0.64 to 0.97) and the surgical goals for 71% of the patients (95% confidence interval, 0.48 to 0.89). The surgeon group varied in the percentage of patients for whom the problem list was modified, ranging from 24% (95% confidence interval, 8% to 47%) to 48% (95% confidence interval, 26% to 70%) of patients, and the percentage for whom the surgical goals were modified, ranging from 14% (94% confidence interval, 3% to 36%) to 48% (95% confidence interval, 26% to 70%) of patients. Conclusions For all surgeons, the additional assessment components of the systematic valuation resulted in a change in clinical decision making for some patients. PMID:23855676

The Clinical Relevance of Force Platform Measures in Multiple Sclerosis: A Review

PubMed Central

Prosperini, Luca; Pozzilli, Carlo

2013-01-01

Balance impairment and falls are frequent in patients with multiple sclerosis (PwMS), and they may occur even at the earliest stage of the disease and in minimally impaired patients. The introduction of computer-based force platform measures (i.e., static and dynamic posturography) has provided an objective and sensitive tool to document both deficits and improvements in balance. By using more challenging test conditions, force platform measures can also reveal subtle balance disorders undetectable by common clinical scales. Furthermore, posturographic techniques may also allow to reliably identify PwMS who are at risk of accidental falls. Although force platform measures offer several theoretical advantages, only few studies extensively investigated their role in better managing PwMS. Standardised procedures, as well as clinical relevance of changes detected by static or dynamic posturography, are still lacking. In this review, we summarized studies which investigated balance deficit by means of force platform measures, focusing on their ability in detecting patients at high risk of falls and in estimating rehabilitation-induced changes, highlighting the pros and the cons with respect to clinical scales. PMID:23766910

Production tolerance of additive manufactured polymeric objects for clinical applications.

PubMed

Braian, Michael; Jimbo, Ryo; Wennerberg, Ann

2016-07-01

To determine the production tolerance of four commercially available additive manufacturing systems. By reverse engineering annex A and B from the ISO_12836;2012, two geometrical figures relevant to dentistry was obtained. Object A specifies the measurement of an inlay-shaped object and B a multi-unit specimen to simulate a four-unit bridge model. The objects were divided into x, y and z measurements, object A was divided into a total of 16 parameters and object B was tested for 12 parameters. The objects were designed digitally and manufactured by professionals in four different additive manufacturing systems; each system produced 10 samples of each objects. For object A, three manufacturers presented an accuracy of <100μm and one system showed an accuracy of <20μm. For object B, all systems presented an accuracy of <100μm, and most parameters were <40μm. The standard deviation for most parameters were <40μm. The growing interest and use of intra-oral digitizing systems stresses the use of computer aided manufacturing of working models. The additive manufacturing techniques has the potential to help us in the digital workflow. Thus, it is important to have knowledge about production accuracy and tolerances. This study presents a method to test additive manufacturing units for accuracy and repeatability. Copyright © 2016 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Objective Measurement of Erythema in Psoriasis using Digital Color Photography with Color Calibration

PubMed Central

Raina, Abhay; Hennessy, Ricky; Rains, Michael; Allred, James; Hirshburg, Jason M; Diven, Dayna; Markey, Mia K.

2016-01-01

Background Traditional metrics for evaluating the severity of psoriasis are subjective, which complicates efforts to measure effective treatments in clinical trials. Methods We collected images of psoriasis plaques and calibrated the coloration of the images according to an included color card. Features were extracted from the images and used to train a linear discriminant analysis classifier with cross-validation to automatically classify the degree of erythema. The results were tested against numerical scores obtained by a panel of dermatologists using a standard rating system. Results Quantitative measures of erythema based on the digital color images showed good agreement with subjective assessment of erythema severity (κ = 0.4203). The color calibration process improved the agreement from κ = 0.2364 to κ = 0.4203. Conclusions We propose a method for the objective measurement of the psoriasis severity parameter of erythema and show that the calibration process improved the results. PMID:26517973

The Group Objective Structured Clinical Experience: building communication skills in the clinical reasoning context.

PubMed

Konopasek, Lyuba; Kelly, Kevin V; Bylund, Carma L; Wenderoth, Suzanne; Storey-Johnson, Carol

2014-07-01

Students are rarely taught communication skills in the context of clinical reasoning training. The purpose of this project was to combine the teaching of communication skills using SPs with clinical reasoning exercises in a Group Objective Structured Clinical Experience (GOSCE) to study feasibility of the approach, the effect on learners' self-efficacy and attitude toward learning communication skills, and the effect of providing multiple sources of immediate, collaborative feedback. GOSCE sessions were piloted in Pediatrics and Medicine clerkships with students assessing their own performance and receiving formative feedback on communication skills from peers, standardized patients (SPs), and faculty. The sessions were evaluated using a retrospective pre/post-training questionnaire rating changes in self-efficacy and attitudes, and the value of the feedback. Results indicate a positive impact on attitudes toward learning communication skills and self-efficacy regarding communication in the clinical setting. Also, learners considered feedback by peers, SPs, and faculty valuable in each GOSCE. The GOSCE is an efficient and learner-centered method to attend to multiple goals of teaching communication skills, clinical reasoning, self-assessment, and giving feedback in a formative setting. The GOSCE is a low-resource, feasible strategy for experiential learning in communication skills and clinical reasoning. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

34 CFR 200.18 - Annual measurable objectives.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Annual measurable objectives. 200.18 Section 200.18 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION TITLE I-IMPROVING THE ACADEMIC ACHIEVEMENT OF THE DISADVANTAGED Improving...

The Harmonising Outcome Measures for Eczema (HOME) statement to assess clinical signs of atopic eczema in trials.

PubMed

Schmitt, Jochen; Spuls, Phyllis I; Thomas, Kim S; Simpson, Eric; Furue, Masutaka; Deckert, Stefanie; Dohil, Magdalene; Apfelbacher, Christian; Singh, Jasvinder A; Chalmers, Joanne; Williams, Hywel C

2014-10-01

The lack of core outcome sets for atopic eczema (AE) is a major obstacle for advancing evidence-based treatment. The global Harmonising Outcome Measures for Eczema (HOME) initiative has already defined clinical signs, symptoms, quality of life, and long-term control of flares as core outcome domains for AE trials. This article deals with the standardization of measurement instruments to assess clinical signs of AE. To resolve the current lack of standardization of the assessment of clinical signs of AE, we followed a structured process of systematic reviews and international consensus sessions to identify 1 core outcome measurement instrument for assessment of clinical signs in all future AE trials. Systematic reviews indicated that from 16 different instruments identified to assess clinical signs of AE, only the Eczema Area and Severity Index (EASI) and the objective Scoring Atopic Dermatitis (SCORAD) index were identified as extensively validated. The EASI has adequate validity, responsiveness, internal consistency, and intraobserver reliability. The objective SCORAD index has adequate validity, responsiveness, and interobserver reliability but unclear intraobserver reliability to measure clinical signs of AE. In an international consensus study, patients, physicians, nurses, methodologists, and pharmaceutical industry representatives agreed that the EASI is the preferred core instrument to measure clinical signs in all future AE trials. All stakeholders involved in designing, reporting, and using clinical trials on AE are asked to comply with this consensus to enable better evidence-based decision making, clearer scientific communication, and improved patient care. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Moire measuring technology for three-dimensional profile of the object

NASA Astrophysics Data System (ADS)

Fu, Yanjun; Yang, Kuntao

2006-02-01

An optical system is designed to get projection of the transmission grating, the deformed grating is obtained on surface of the object. The image of the deformed grating is given by the lens, the reference grating is put on the place of the image, and then the moire fringe is obtained. The amplify principle of the moire fringe is used to measure the profile of the object. The optical principle of the projection is analyzed. And the relation between the phase and the height of object is deduced. From the different point of geometry optics and the physics opticsl, the optical system is analyzed, the factors that influence the image equality and the measuring result are obtained. So the betterment of improving the measuring precision is brought forward, and in the later information processing, because of the diffuse reflection, the image equality is not very well. In order to get a good image, the digital filter is used to filter the noise and smooth the image firstly. Then in order to improve the measure precision, the subdivision technology is applied. The Fourier transform profilometry and phase shifting technology is used in the calculation. A detail analyses is done both in time field and frequency field. And the method of improving the measuring precision is put forward. A good digital filter algorithm is brought forward in the Fourier transform profilometry. In the phase shifting technology, the detail formula of three-step and four-step is given. At last the phase that is relational with the high information of the object is get, but the phase is disconnected phase, after the unwrapping algorithm,the disconnected phase is changed to be the continuous phase. Taking use of the relation between the phase and height, the height is obtained. Then the three-dimensional profile of the measured object can be reconstructed. The system is very convenient for non-contact measure of profile of some objects.

Objective Assessment of Vergence after Treatment of Concussion-Related CI: A Pilot Study

PubMed Central

Scheiman, Mitchell; Talasan, Henry; Mitchell, Gladys L; Alvarez, Tara L.

2016-01-01

Purpose To evaluate changes in objective measures of disparity vergence after office-based vision therapy (OBVT) for concussion-related convergence insufficiency (CI), and determine the feasibility of using this objective assessment as an outcome measure in a clinical trial. Methods This was a prospective, observational trial. All participants were treated with weekly OBVT with home reinforcement. Participants included two adolescents and three young adults with concussion-related, symptomatic CI. The primary outcome measure was average peak velocity for 4-degree symmetrical convergence steps. Other objective outcome measures of disparity vergence included time to peak velocity, latency, accuracy, settling time, and main sequence. We also evaluated saccadic eye movements using the same outcome measures. Changes in clinical measures (near point of convergence, positive fusional vergence at near, Convergence Insufficiency Symptom Survey (CISS) score) were evaluated. Results There were statistically significant and clinically meaningful changes in all clinical measures for convergence. Four of the five subjects met clinical success criteria. For the objective measures, we found a statistically significant increase in peak velocity, response accuracy to 4° symmetrical convergence and divergence step stimuli and the main sequence ratio for convergence step stimuli. Objective saccadic eye movements (5° and 10°) appeared normal pre-OBVT, and did not show any significant change after treatment. Conclusions This is the first report of the use of objective measures of disparity vergence as outcome measures for concussion-related convergence insufficiency. These measures provide additional information that is not accessible with clinical tests about underlying physiological mechanisms leading to changes in clinical findings and symptoms. The study results also demonstrate that patients with concussion can tolerate the visual demands (over 200 vergence and versional eye

Objective Assessment of Vergence after Treatment of Concussion-Related CI: A Pilot Study.

PubMed

Scheiman, Mitchell M; Talasan, Henry; Mitchell, G Lynn; Alvarez, Tara L

2017-01-01

To evaluate changes in objective measures of disparity vergence after office-based vision therapy (OBVT) for concussion-related convergence insufficiency (CI) and determine the feasibility of using this objective assessment as an outcome measure in a clinical trial. This was a prospective, observational trial. All participants were treated with weekly OBVT with home reinforcement. Participants included two adolescents and three young adults with concussion-related, symptomatic CI. The primary outcome measure was average peak velocity for 4° symmetrical convergence steps. Other objective outcome measures of disparity vergence included time to peak velocity, latency, accuracy, settling time, and main sequence. We also evaluated saccadic eye movements using the same outcome measures. Changes in clinical measures (near point of convergence, positive fusional vergence at near, Convergence Insufficiency Symptom Survey [CISS] score) were evaluated. There were statistically significant and clinically meaningful changes in all clinical measures for convergence. Four of the five subjects met clinical success criteria. For the objective measures, we found a statistically significant increase in peak velocity, response accuracy to 4° symmetrical convergence and divergence step stimuli, and the main sequence ratio for convergence step stimuli. Objective saccadic eye movements (5 and 10°) appeared normal pre-OBVT and did not show any significant change after treatment. This is the first report of the use of objective measures of disparity vergence as outcome measures for concussion-related convergence insufficiency. These measures provide additional information that is not accessible with clinical tests about underlying physiological mechanisms leading to changes in clinical findings and symptoms. The study results also demonstrate that patients with concussion can tolerate the visual demands (over 200 vergence and versional eye movements) during the 25-minute testing time

Impact of bowtie filter and object position on the two-dimensional noise power spectrum of a clinical MDCT system.

PubMed

Gomez-Cardona, Daniel; Cruz-Bastida, Juan Pablo; Li, Ke; Budde, Adam; Hsieh, Jiang; Chen, Guang-Hong

2016-08-01

Noise characteristics of clinical multidetector CT (MDCT) systems can be quantified by the noise power spectrum (NPS). Although the NPS of CT has been extensively studied in the past few decades, the joint impact of the bowtie filter and object position on the NPS has not been systematically investigated. This work studies the interplay of these two factors on the two dimensional (2D) local NPS of a clinical CT system that uses the filtered backprojection algorithm for image reconstruction. A generalized NPS model was developed to account for the impact of the bowtie filter and image object location in the scan field-of-view (SFOV). For a given bowtie filter, image object, and its location in the SFOV, the shape and rotational symmetries of the 2D local NPS were directly computed from the NPS model without going through the image reconstruction process. The obtained NPS was then compared with the measured NPSs from the reconstructed noise-only CT images in both numerical phantom simulation studies and experimental phantom studies using a clinical MDCT scanner. The shape and the associated symmetry of the 2D NPS were classified by borrowing the well-known atomic spectral symbols s, p, and d, which correspond to circular, dumbbell, and cloverleaf symmetries, respectively, of the wave function of electrons in an atom. Finally, simulated bar patterns were embedded into experimentally acquired noise backgrounds to demonstrate the impact of different NPS symmetries on the visual perception of the object. (1) For a central region in a centered cylindrical object, an s-wave symmetry was always present in the NPS, no matter whether the bowtie filter was present or not. In contrast, for a peripheral region in a centered object, the symmetry of its NPS was highly dependent on the bowtie filter, and both p-wave symmetry and d-wave symmetry were observed in the NPS. (2) For a centered region-ofinterest (ROI) in an off-centered object, the symmetry of its NPS was found to be

Impact of bowtie filter and object position on the two-dimensional noise power spectrum of a clinical MDCT system

PubMed Central

Gomez-Cardona, Daniel; Cruz-Bastida, Juan Pablo; Li, Ke; Budde, Adam; Hsieh, Jiang; Chen, Guang-Hong

2016-01-01

Purpose: Noise characteristics of clinical multidetector CT (MDCT) systems can be quantified by the noise power spectrum (NPS). Although the NPS of CT has been extensively studied in the past few decades, the joint impact of the bowtie filter and object position on the NPS has not been systematically investigated. This work studies the interplay of these two factors on the two dimensional (2D) local NPS of a clinical CT system that uses the filtered backprojection algorithm for image reconstruction. Methods: A generalized NPS model was developed to account for the impact of the bowtie filter and image object location in the scan field-of-view (SFOV). For a given bowtie filter, image object, and its location in the SFOV, the shape and rotational symmetries of the 2D local NPS were directly computed from the NPS model without going through the image reconstruction process. The obtained NPS was then compared with the measured NPSs from the reconstructed noise-only CT images in both numerical phantom simulation studies and experimental phantom studies using a clinical MDCT scanner. The shape and the associated symmetry of the 2D NPS were classified by borrowing the well-known atomic spectral symbols s, p, and d, which correspond to circular, dumbbell, and cloverleaf symmetries, respectively, of the wave function of electrons in an atom. Finally, simulated bar patterns were embedded into experimentally acquired noise backgrounds to demonstrate the impact of different NPS symmetries on the visual perception of the object. Results: (1) For a central region in a centered cylindrical object, an s-wave symmetry was always present in the NPS, no matter whether the bowtie filter was present or not. In contrast, for a peripheral region in a centered object, the symmetry of its NPS was highly dependent on the bowtie filter, and both p-wave symmetry and d-wave symmetry were observed in the NPS. (2) For a centered region-ofinterest (ROI) in an off-centered object, the symmetry of

Impact of bowtie filter and object position on the two-dimensional noise power spectrum of a clinical MDCT system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gomez-Cardona, Daniel; Cruz-Bastida, Juan Pablo

2016-08-15

Purpose: Noise characteristics of clinical multidetector CT (MDCT) systems can be quantified by the noise power spectrum (NPS). Although the NPS of CT has been extensively studied in the past few decades, the joint impact of the bowtie filter and object position on the NPS has not been systematically investigated. This work studies the interplay of these two factors on the two dimensional (2D) local NPS of a clinical CT system that uses the filtered backprojection algorithm for image reconstruction. Methods: A generalized NPS model was developed to account for the impact of the bowtie filter and image object locationmore » in the scan field-of-view (SFOV). For a given bowtie filter, image object, and its location in the SFOV, the shape and rotational symmetries of the 2D local NPS were directly computed from the NPS model without going through the image reconstruction process. The obtained NPS was then compared with the measured NPSs from the reconstructed noise-only CT images in both numerical phantom simulation studies and experimental phantom studies using a clinical MDCT scanner. The shape and the associated symmetry of the 2D NPS were classified by borrowing the well-known atomic spectral symbols s, p, and d, which correspond to circular, dumbbell, and cloverleaf symmetries, respectively, of the wave function of electrons in an atom. Finally, simulated bar patterns were embedded into experimentally acquired noise backgrounds to demonstrate the impact of different NPS symmetries on the visual perception of the object. Results: (1) For a central region in a centered cylindrical object, an s-wave symmetry was always present in the NPS, no matter whether the bowtie filter was present or not. In contrast, for a peripheral region in a centered object, the symmetry of its NPS was highly dependent on the bowtie filter, and both p-wave symmetry and d-wave symmetry were observed in the NPS. (2) For a centered region-ofinterest (ROI) in an off-centered object, the

Acute Respiratory Distress Syndrome Measurement Error. Potential Effect on Clinical Study Results

PubMed Central

Cooke, Colin R.; Iwashyna, Theodore J.; Hofer, Timothy P.

2016-01-01

Rationale: Identifying patients with acute respiratory distress syndrome (ARDS) is a recognized challenge. Experts often have only moderate agreement when applying the clinical definition of ARDS to patients. However, no study has fully examined the implications of low reliability measurement of ARDS on clinical studies. Objectives: To investigate how the degree of variability in ARDS measurement commonly reported in clinical studies affects study power, the accuracy of treatment effect estimates, and the measured strength of risk factor associations. Methods: We examined the effect of ARDS measurement error in randomized clinical trials (RCTs) of ARDS-specific treatments and cohort studies using simulations. We varied the reliability of ARDS diagnosis, quantified as the interobserver reliability (κ-statistic) between two reviewers. In RCT simulations, patients identified as having ARDS were enrolled, and when measurement error was present, patients without ARDS could be enrolled. In cohort studies, risk factors as potential predictors were analyzed using reviewer-identified ARDS as the outcome variable. Measurements and Main Results: Lower reliability measurement of ARDS during patient enrollment in RCTs seriously degraded study power. Holding effect size constant, the sample size necessary to attain adequate statistical power increased by more than 50% as reliability declined, although the result was sensitive to ARDS prevalence. In a 1,400-patient clinical trial, the sample size necessary to maintain similar statistical power increased to over 1,900 when reliability declined from perfect to substantial (κ = 0.72). Lower reliability measurement diminished the apparent effectiveness of an ARDS-specific treatment from a 15.2% (95% confidence interval, 9.4–20.9%) absolute risk reduction in mortality to 10.9% (95% confidence interval, 4.7–16.2%) when reliability declined to moderate (κ = 0.51). In cohort studies, the effect on risk factor associations

Finding the Density of Objects without Measuring Mass and Volume

ERIC Educational Resources Information Center

Mumba, Frackson; Tsige, Mesfin

2007-01-01

A simple method based on the moment of forces and Archimedes' principle is described for finding density without measuring the mass and volume of an object. The method involves balancing two unknown objects of masses M[subscript 1] and M[subscript 2] on each side of a pivot on a metre rule and measuring their corresponding moment arms. The object…

Holistic rubric vs. analytic rubric for measuring clinical performance levels in medical students.

PubMed

Yune, So Jung; Lee, Sang Yeoup; Im, Sun Ju; Kam, Bee Sung; Baek, Sun Yong

2018-06-05

Task-specific checklists, holistic rubrics, and analytic rubrics are often used for performance assessments. We examined what factors evaluators consider important in holistic scoring of clinical performance assessment, and compared the usefulness of applying holistic and analytic rubrics respectively, and analytic rubrics in addition to task-specific checklists based on traditional standards. We compared the usefulness of a holistic rubric versus an analytic rubric in effectively measuring the clinical skill performances of 126 third-year medical students who participated in a clinical performance assessment conducted by Pusan National University School of Medicine. We conducted a questionnaire survey of 37 evaluators who used all three evaluation methods-holistic rubric, analytic rubric, and task-specific checklist-for each student. The relationship between the scores on the three evaluation methods was analyzed using Pearson's correlation. Inter-rater agreement was analyzed by Kappa index. The effect of holistic and analytic rubric scores on the task-specific checklist score was analyzed using multiple regression analysis. Evaluators perceived accuracy and proficiency to be major factors in objective structured clinical examinations evaluation, and history taking and physical examination to be major factors in clinical performance examinations evaluation. Holistic rubric scores were highly related to the scores of the task-specific checklist and analytic rubric. Relatively low agreement was found in clinical performance examinations compared to objective structured clinical examinations. Meanwhile, the holistic and analytic rubric scores explained 59.1% of the task-specific checklist score in objective structured clinical examinations and 51.6% in clinical performance examinations. The results show the usefulness of holistic and analytic rubrics in clinical performance assessment, which can be used in conjunction with task-specific checklists for more efficient

Objective Measurement of Emerging Affective Traits in Preschool Children.

ERIC Educational Resources Information Center

Adkins, Dorothy C.

An objective measure of motivation to achieve for preschool children called Gumpgookies is described. It is an objective-projective technique that requires choice between two alternate types of behavior portrayed in pictures and accompanying verbal descriptions. Gumpgookies are amoeba-like creatures who behave in ways intended to show differences…

Generally objective measurement of human temperature and reading ability: some corollaries.

PubMed

Stenner, A Jackson; Stone, Mark

2010-01-01

We argue that a goal of measurement is general objectivity: point estimates of a person's measure (height, temperature, and reader ability) should be independent of the instrument and independent of the sample in which the person happens to find herself. In contrast, Rasch's concept of specific objectivity requires only differences (i.e., comparisons) between person measures to be independent of the instrument. We present a canonical case in which there is no overlap between instruments and persons: each person is measured by a unique instrument. We then show what is required to estimate measures in this degenerate case. The canonical case encourages a simplification and reconceptualization of validity and reliability. Not surprisingly, this reconceptualization looks a lot like the way physicists and chemometricians think about validity and measurement error. We animate this presentation with a technology that blurs the distinction between instruction, assessment, and generally objective measurement of reader ability. We encourage adaptation of this model to health outcomes measurement.

Objective measurement of erythema in psoriasis using digital color photography with color calibration.

PubMed

Raina, A; Hennessy, R; Rains, M; Allred, J; Hirshburg, J M; Diven, D G; Markey, M K

2016-08-01

Traditional metrics for evaluating the severity of psoriasis are subjective, which complicates efforts to measure effective treatments in clinical trials. We collected images of psoriasis plaques and calibrated the coloration of the images according to an included color card. Features were extracted from the images and used to train a linear discriminant analysis classifier with cross-validation to automatically classify the degree of erythema. The results were tested against numerical scores obtained by a panel of dermatologists using a standard rating system. Quantitative measures of erythema based on the digital color images showed good agreement with subjective assessment of erythema severity (κ = 0.4203). The color calibration process improved the agreement from κ = 0.2364 to κ = 0.4203. We propose a method for the objective measurement of the psoriasis severity parameter of erythema and show that the calibration process improved the results. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Personal Career Orientation. Performance Objectives. Criterion Measures. Home Economics.

ERIC Educational Resources Information Center

Allen, Alveta; And Others

Several intermediate performance objectives and corresponding criterion measures are listed for each of six terminal objectives for a personal career orientation course for seventh grade students. This 6- to 9-week course is designed to acquaint the student with personal qualities and characteristics necessary for success in the world of work.…

Predicting changes in clinical status of young asthmatics: clinical scores or objective parameters?

PubMed

Leung, Ting F; Ko, Fanny W S; Wong, Gary W K; Li, Chung Y; Yung, Edmund; Hui, David S C; Lai, Christopher K W

2009-05-01

Preventing asthma exacerbation is an important goal of asthma management. The existing clinical tools are not good in predicting asthma exacerbations in young children. Childhood Asthma Control Test (C-ACT) was recently published to be a simple tool for assessing disease control in young children. This study investigated C-ACT and other disease-related factors for indicating longitudinal changes in asthma status and predicting asthma exacerbations. During the same clinic visit, asthma patients aged 4-11 years completed the Chinese version of C-ACT and underwent exhaled nitric oxide and spirometric measurements. Blinded to these results, the same investigator assigned Disease Severity Score (DSS) and rated asthma control according to Global Initiative for Asthma. Asthma exacerbations during the next 6 months were recorded. Ninety-seven patients were recruited, with their mean (standard deviation [SD]) age being 9.2 (2.0) years. Thirty-six (37.1%) patients had uncontrolled asthma at baseline. C-ACT, DSS, and FEV(1) differed among patients with different control status (P < 0.001 for C-ACT and DSS; P = 0.028 for FEV(1)). Thirty-two patients had asthma exacerbations during the 6-month follow-up. Changes in patients' C-ACT scores correlated with changes in asthma control status, DSS, and FEV(1) (P = 0.019, 0.034, and 0.020, respectively). C-ACT score was lower among patients with asthma exacerbations (mean [SD]: 22.9 [4.2] vs. 24.5 [2.1]; P = 0.015). Logistic regression confirmed that the occurrence of asthma exacerbations was associated only with baseline C-ACT (B = -0.203, P = 0.042). In conclusion, C-ACT is better than DSS and objective parameters in reflecting changes in asthma status and predicting asthma exacerbations in young children. (c) 2009 Wiley-Liss, Inc.

Geriatric Medicine Fellows' Experiences and Attitudes toward an Objective Structured Clinical Examination (OSCE)

ERIC Educational Resources Information Center

Bagri, Anita S.; Zaw, Khin M.; Milanez, Marcos N.; Palacios, Juan J.; Qadri, Syeda S.; Bliss, Linda A.; Roos, Bernard A.; Ruiz, Jorge G.

2009-01-01

A total of 8 geriatric medicine fellows participated in an objective structured clinical examination (OSCE) assessing communication skills and clinical reasoning in common geriatric syndromes. To determine their perceptions about the experience, we conducted surveys and semistructured interviews. We analyzed the survey data using descriptive…

Online phase measuring profilometry for rectilinear moving object by image correction

NASA Astrophysics Data System (ADS)

Yuan, Han; Cao, Yi-Ping; Chen, Chen; Wang, Ya-Pin

2015-11-01

In phase measuring profilometry (PMP), the object must be static for point-to-point reconstruction with the captured deformed patterns. While the object is rectilinearly moving online, the size and pixel position differences of the object in different captured deformed patterns do not meet the point-to-point requirement. We propose an online PMP based on image correction to measure the three-dimensional shape of the rectilinear moving object. In the proposed method, the deformed patterns captured by a charge-coupled diode camera are reprojected from the oblique view to an aerial view first and then translated based on the feature points of the object. This method makes the object appear stationary in the deformed patterns. Experimental results show the feasibility and efficiency of the proposed method.

Inverse optimization of objective function weights for treatment planning using clinical dose-volume histograms

NASA Astrophysics Data System (ADS)

Babier, Aaron; Boutilier, Justin J.; Sharpe, Michael B.; McNiven, Andrea L.; Chan, Timothy C. Y.

2018-05-01

We developed and evaluated a novel inverse optimization (IO) model to estimate objective function weights from clinical dose-volume histograms (DVHs). These weights were used to solve a treatment planning problem to generate ‘inverse plans’ that had similar DVHs to the original clinical DVHs. Our methodology was applied to 217 clinical head and neck cancer treatment plans that were previously delivered at Princess Margaret Cancer Centre in Canada. Inverse plan DVHs were compared to the clinical DVHs using objective function values, dose-volume differences, and frequency of clinical planning criteria satisfaction. Median differences between the clinical and inverse DVHs were within 1.1 Gy. For most structures, the difference in clinical planning criteria satisfaction between the clinical and inverse plans was at most 1.4%. For structures where the two plans differed by more than 1.4% in planning criteria satisfaction, the difference in average criterion violation was less than 0.5 Gy. Overall, the inverse plans were very similar to the clinical plans. Compared with a previous inverse optimization method from the literature, our new inverse plans typically satisfied the same or more clinical criteria, and had consistently lower fluence heterogeneity. Overall, this paper demonstrates that DVHs, which are essentially summary statistics, provide sufficient information to estimate objective function weights that result in high quality treatment plans. However, as with any summary statistic that compresses three-dimensional dose information, care must be taken to avoid generating plans with undesirable features such as hotspots; our computational results suggest that such undesirable spatial features were uncommon. Our IO-based approach can be integrated into the current clinical planning paradigm to better initialize the planning process and improve planning efficiency. It could also be embedded in a knowledge-based planning or adaptive radiation therapy framework to

Inverse optimization of objective function weights for treatment planning using clinical dose-volume histograms.

PubMed

Babier, Aaron; Boutilier, Justin J; Sharpe, Michael B; McNiven, Andrea L; Chan, Timothy C Y

2018-05-10

We developed and evaluated a novel inverse optimization (IO) model to estimate objective function weights from clinical dose-volume histograms (DVHs). These weights were used to solve a treatment planning problem to generate 'inverse plans' that had similar DVHs to the original clinical DVHs. Our methodology was applied to 217 clinical head and neck cancer treatment plans that were previously delivered at Princess Margaret Cancer Centre in Canada. Inverse plan DVHs were compared to the clinical DVHs using objective function values, dose-volume differences, and frequency of clinical planning criteria satisfaction. Median differences between the clinical and inverse DVHs were within 1.1 Gy. For most structures, the difference in clinical planning criteria satisfaction between the clinical and inverse plans was at most 1.4%. For structures where the two plans differed by more than 1.4% in planning criteria satisfaction, the difference in average criterion violation was less than 0.5 Gy. Overall, the inverse plans were very similar to the clinical plans. Compared with a previous inverse optimization method from the literature, our new inverse plans typically satisfied the same or more clinical criteria, and had consistently lower fluence heterogeneity. Overall, this paper demonstrates that DVHs, which are essentially summary statistics, provide sufficient information to estimate objective function weights that result in high quality treatment plans. However, as with any summary statistic that compresses three-dimensional dose information, care must be taken to avoid generating plans with undesirable features such as hotspots; our computational results suggest that such undesirable spatial features were uncommon. Our IO-based approach can be integrated into the current clinical planning paradigm to better initialize the planning process and improve planning efficiency. It could also be embedded in a knowledge-based planning or adaptive radiation therapy framework to

Measuring Positions of Objects using Two or More Cameras

NASA Technical Reports Server (NTRS)

Klinko, Steve; Lane, John; Nelson, Christopher

2008-01-01

An improved method of computing positions of objects from digitized images acquired by two or more cameras (see figure) has been developed for use in tracking debris shed by a spacecraft during and shortly after launch. The method is also readily adaptable to such applications as (1) tracking moving and possibly interacting objects in other settings in order to determine causes of accidents and (2) measuring positions of stationary objects, as in surveying. Images acquired by cameras fixed to the ground and/or cameras mounted on tracking telescopes can be used in this method. In this method, processing of image data starts with creation of detailed computer- aided design (CAD) models of the objects to be tracked. By rotating, translating, resizing, and overlaying the models with digitized camera images, parameters that characterize the position and orientation of the camera can be determined. The final position error depends on how well the centroids of the objects in the images are measured; how accurately the centroids are interpolated for synchronization of cameras; and how effectively matches are made to determine rotation, scaling, and translation parameters. The method involves use of the perspective camera model (also denoted the point camera model), which is one of several mathematical models developed over the years to represent the relationships between external coordinates of objects and the coordinates of the objects as they appear on the image plane in a camera. The method also involves extensive use of the affine camera model, in which the distance from the camera to an object (or to a small feature on an object) is assumed to be much greater than the size of the object (or feature), resulting in a truly two-dimensional image. The affine camera model does not require advance knowledge of the positions and orientations of the cameras. This is because ultimately, positions and orientations of the cameras and of all objects are computed in a coordinate

Different Measures of Structural Similarity Tap Different Aspects of Visual Object Processing

PubMed Central

Gerlach, Christian

2017-01-01

The structural similarity of objects has been an important variable in explaining why some objects are easier to categorize at a superordinate level than to individuate, and also why some patients with brain injury have more difficulties in recognizing natural (structurally similar) objects than artifacts (structurally distinct objects). In spite of its merits as an explanatory variable, structural similarity is not a unitary construct, and it has been operationalized in different ways. Furthermore, even though measures of structural similarity have been successful in explaining task and category-effects, this has been based more on implication than on direct empirical demonstrations. Here, the direct influence of two different measures of structural similarity, contour overlap and within-item structural diversity, on object individuation (object decision) and superordinate categorization performance is examined. Both measures can account for performance differences across objects, but in different conditions. It is argued that this reflects differences between the measures in whether they tap: (i) global or local shape characteristics, and (ii) between- or within-category structural similarity. PMID:28861027

Assessment of antitussive efficacy of dextromethorphan in smoking related cough: objective vs. subjective measures

PubMed Central

Ramsay, James; Wright, Caroline; Thompson, Rachel; Hull, David; Morice, Alyn H

2008-01-01

AIMS Using an established model of smokers cough we measured the antitussive effects of dextromethorphan compared with placebo. METHODS The study was a randomized, double-blind placebo controlled, crossover comparison of 22 mg 0.8 ml−1 dextromethorphan delivered pregastrically with matched placebo. Objective and subjective measurements of cough were recorded. Subjective measures included a daily diary record of cough symptoms and the Leicester quality of life questionnaire. Cough frequency was recorded using a manual cough counter. The objective measure of cough reflex sensitivity was the citric acid, dose–response cough challenge. RESULTS Dextromethorphan was significantly associated with an increase in the concentration of citric acid eliciting an average of two coughs/inhalation (C2) when compared with placebo, 1 h post dose by 0.49 mM (95% CI 0.05, 0.45, geometric mean 3.09) compared with placebo 0.24 mM (geometric mean 1.74) P < 0.05 and at 2 h 0.57 mM (95% CI 0.01, 0.43, geometric mean 3.75) compared with placebo 0.34 mM (geometric mean 2.19) P < 0.05). There was a highly significant improvement in the subjective data when compared with baseline. However, there was no significant difference between placebo and active treatment. No correlation was seen between cough sensitivity to citric acid and recorded cough counts or symptoms. When both subjective and objective data were compared with screening data there was evidence of a marked ‘placebo’ effect. CONCLUSIONS The objective measure of cough sensitivity demonstrates dextromethorphan effectively diminishes the cough reflex sensitivity. However, subjective measures do not support this. Other studies support these findings, which may represent a profound sensitivity of the cough reflex to higher influences. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Dextromethorphan is widely used as a cough suppressant in over the counter medications. Its efficacy in altering cough reflex sensitivity has been shown in

Laser flare photometry: a noninvasive, objective, and quantitative method to measure intraocular inflammation.

PubMed

Tugal-Tutkun, Ilknur; Herbort, Carl P

2010-10-01

Aqueous flare and cells are the two inflammatory parameters of anterior chamber inflammation resulting from disruption of the blood-ocular barriers. When examined with the slit lamp, measurement of intraocular inflammation remains subjective with considerable intra- and interobserver variations. Laser flare cell photometry is an objective quantitative method that enables accurate measurement of these parameters with very high reproducibility. Laser flare photometry allows detection of subclinical alterations in the blood-ocular barriers, identifying subtle pathological changes that could not have been recorded otherwise. With the use of this method, it has been possible to compare the effect of different surgical techniques, surgical adjuncts, and anti-inflammatory medications on intraocular inflammation. Clinical studies of uveitis patients have shown that flare measurements by laser flare photometry allowed precise monitoring of well-defined uveitic entities and prediction of disease relapse. Relationships of laser flare photometry values with complications of uveitis and visual loss further indicate that flare measurement by laser flare photometry should be included in the routine follow-up of patients with uveitis.

Objectivity in subjectivity: do students' self and peer assessments correlate with examiners' subjective and objective assessment in clinical skills? A prospective study.

PubMed

Inayah, A'man Talal; Anwer, Lucman A; Shareef, Mohammad Abrar; Nurhussen, Akram; Alkabbani, Haifa Mazen; Alzahrani, Alhanouf A; Obad, Adam Subait; Zafar, Muhammad; Afsar, Nasir Ali

2017-05-09

The qualitative subjective assessment has been exercised either by self-reflection (self-assessment (SA)) or by an observer (peer assessment (PA)) and is considered to play an important role in students' development. The objectivity of PA and SA by students as well as those by faculty examiners has remained debated. This matters most when it comes to a high-stakes examination. We explored the degree of objectivity in PA, SA, as well as the global rating by examiners being Examiners' Subjective Assessment (ESA) compared with Objective Structured Clinical Examinations (OSCE). Prospective cohort study. Undergraduate medical students at Alfaisal University, Riyadh. All second-year medical students (n=164) of genders, taking a course to learn clinical history taking and general physical examination. A Likert scale questionnaire was distributed among the participants during selected clinical skills sessions. Each student was evaluated randomly by peers (PA) as well as by himself/herself (SA). Two OSCEs were conducted where students were assessed by an examiner objectively as well as subjectively (ESA) for a global rating of confidence and well-preparedness. OSCE-1 had fewer topics and stations, whereas OSCE-2 was terminal and full scale. OSCE-1 (B=0.10) and ESA (B=8.16) predicted OSCE-2 scores. 'No nervousness' in PA (r=0.185, p=0.018) and 'confidence' in SA (r=0.207, p=0.008) correlated with 'confidence' in ESA. In 'well-preparedness', SA correlated with ESA (r=0.234, p=0.003). OSCE-1 and ESA predicted students' performance in the OSCE-2, a high-stakes evaluation, indicating practical 'objectivity' in ESA, whereas SA and PA had minimal predictive role. Certain components of SA and PA correlated with ESA, suggesting partial objectivity given the limited objectiveness of ESA. Such difference in 'qualitative' objectivity probably reflects experience. Thus, subjective assessment can be used with some degree of objectivity for continuous assessment. © Article author(s) (or

Dehydration and Performance on Clinical Concussion Measures in Collegiate Wrestlers

PubMed Central

Weber, Amanda Friedline; Mihalik, Jason P.; Register-Mihalik, Johna K.; Mays, Sally; Prentice, William E.; Guskiewicz, Kevin M.

2013-01-01

Context: The effects of dehydration induced by wrestling-related weight-cutting tactics on clinical concussion outcomes, such as neurocognitive function, balance performance, and symptoms, have not been adequately studied. Objective: To evaluate the effects of dehydration on the outcome of clinical concussion measures in National Collegiate Athletic Association Division I collegiate wrestlers. Design: Repeated-measures design. Setting: Clinical research laboratory. Patients or Other Participants: Thirty-two Division I healthy collegiate male wrestlers (age = 20.0 ± 1.4 years; height = 175.0 ± 7.5 cm; baseline mass = 79.2 ± 12.6 kg). Intervention(s): Participants completed preseason concussion baseline testing in early September. Weight and urine samples were also collected at this time. All participants reported to prewrestling practice and postwrestling practice for the same test battery and protocol in mid-October. They had begun practicing weight-cutting tactics a day before prepractice and postpractice testing. Differences between these measures permitted us to evaluate how dehydration and weight-cutting tactics affected concussion measures. Main Outcome Measures: Sport Concussion Assessment Tool 2 (SCAT2), Balance Error Scoring System, Graded Symptom Checklist, and Simple Reaction Time scores. The Simple Reaction Time was measured using the Automated Neuropsychological Assessment Metrics. Results: The SCAT2 measurements were lower at prepractice (P = .002) and postpractice (P < .001) when compared with baseline. The BESS error scores were higher at postpractice when compared with baseline (P = .015). The GSC severity scores were higher at prepractice (P = .011) and postpractice (P < .001) than at baseline and at postpractice when than at prepractice (P = .003). The number of Graded Symptom Checklist symptoms reported was also higher at prepractice (P = .036) and postpractice (P < .001) when compared with baseline, and at postpractice when compared with

Objective pain diagnostics: clinical neurophysiology.

PubMed

Garcia-Larrea, L

2012-06-01

Neurophysiological techniques help in diagnosis, prognosis and treatment of chronic pain, and are particularly useful to determine its neuropathic origin. According to current standards, the diagnosis of definite neuropathic pain (NP) needs objective confirmation of a lesion or disease of somatosensory systems, which can be provided by neurophysiological testing. Lesions causing NP mostly concern the pain-temperature pathways, and therefore neurophysiological procedures allowing the specific testing of these pathways (i.e., A-delta and C-fibres, spino-thalamo-cortical tracts) are essential for objective diagnosis. Different techniques to stimulate selectively pain-temperature pathways are discussed. Of these, laser-evoked potentials (LEPs) appear as the easiest and most reliable neurophysiological method of assessing nociceptive function, and their coupling with autonomic responses (e.g., galvanic skin response) and psychophysics (quantitative sensory testing - QST) can still enhance their diagnostic yield. Neurophysiological techniques not exploring specifically nociception, such as standard nerve conduction velocities (NCV) and SEPs to non-noxious stimulation, should be associated to the exploration of nociceptive systems, not only because both may be simultaneously affected to different degrees, but also because some specific painful symptoms, such as paroxysmal discharges, may depend on specific alteration of highly myelinated A-beta fibres. The choice of techniques is determined after anamnesis and clinical exam, and tries to answer a number of questions: (a) is the pain-related to injury of somatosensory pathways?; (b) to what extent are different subsystems affected?; (c) are mechanisms and lesion site in accordance with imaging data?; (d) are results of use for diagnostic or therapeutic follow-up? Neuropathic pain (NP) affects more than 15 million people in Western countries, and its belated diagnosis leads to insufficient or delayed therapy. The use of

Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures.

PubMed

Jammer, Ib; Wickboldt, Nadine; Sander, Michael; Smith, Andrew; Schultz, Marcus J; Pelosi, Paolo; Leva, Brigitte; Rhodes, Andrew; Hoeft, Andreas; Walder, Bernhard; Chew, Michelle S; Pearse, Rupert M

2015-02-01

There is a need for large trials that test the clinical effectiveness of interventions in the field of perioperative medicine. Clinical outcome measures used in such trials must be robust, clearly defined and patient-relevant. Our objective was to develop standards for the use of clinical outcome measures to strengthen the methodological quality of perioperative medicine research. A literature search was conducted using PubMed and opinion leaders worldwide were invited to nominate papers that they believed the group should consider. The full texts of relevant articles were reviewed by the taskforce members and then discussed to reach a consensus on the required standards. The report was then circulated to opinion leaders for comment and review. This report describes definitions for 22 individual adverse events with a system of severity grading for each. In addition, four composite outcome measures were identified, which were designed to evaluate postoperative outcomes. The group also agreed on standards for four outcome measures for the evaluation of healthcare resource use and quality of life. Guidance for use of these outcome measures is provided, with particular emphasis on appropriate duration of follow-up. This report provides clearly defined and patient-relevant outcome measures for large clinical trials in perioperative medicine. These outcome measures may also be of use in clinical audit. This report is intended to complement and not replace other related work to improve assessment of clinical outcomes following specific surgical procedures.

Background oriented schlieren measurement of the refractive index field of air induced by a hot, cylindrical measurement object.

PubMed

Beermann, Rüdiger; Quentin, Lorenz; Pösch, Andreas; Reithmeier, Eduard; Kästner, Markus

2017-05-10

To optically capture the topography of a hot measurement object with high precision, the light deflection by the inhomogeneous refractive index field-induced by the heat transfer from the measurement object to the ambient medium-has to be considered. We used the 2D background oriented schlieren method with illuminated wavelet background, an optical flow algorithm, and Ciddor's equation to quantify the refractive index field located directly above a red-glowing, hot measurement object. A heat transfer simulation has been implemented to verify the magnitude and the shape of the measured refractive index field. Provided that no forced external flow is disturbing the shape of the convective flow originating from the hot object, a laminar flow can be observed directly above the object, resulting in a sharply bounded, inhomogeneous refractive index field.

Maximum human objectively measured pharmacologically stimulated accommodative amplitude.

PubMed

Grzybowski, Andrzej; Schachar, Ronald A; Gaca-Wysocka, Magdalena; Schachar, Ira H; Pierscionek, Barbara K

2018-01-01

To measure the maximum, objectively measured, accommodative amplitude, produced by pharmacologic stimulation. Thirty-seven healthy subjects were enrolled, with a mean age of 20.2±1.1 years, corrected visual acuity of 20/20, and mean spherical equivalent refraction (SER) =-0.83±1.60 diopters. For each subject, the right pupil was dilated with phenylephrine 10%. After 30 minutes, the pupil was measured, the left eye was patched, and the right eye was autorefracted. Pilocarpine 4% was then instilled in the right eye, followed by phenylephrine. At 45 minutes after the pilocarpine, autorefraction and pupil size were again measured. Mean pupil size pre- and postpilocarpine was 8.0±0.8 mm and 4.4±1.9 mm, respectively. Pre- and postpilocarpine, the mean SER was -0.83±1.60 and -10.55±4.26 diopters, respectively. The mean pilocarpine-induced accommodative amplitude was 9.73±3.64 diopters. Five subjects had accommodative amplitudes ≥14.00 diopters. Accommodative amplitude was not significantly related to baseline SER ( p -value =0.24), pre- or postpilocarpine pupil size ( p -values =0.13 and 0.74), or change in pupil size ( p -value =0.37). Iris color did not statistically significantly affect accommodative amplitude ( p -value =0.83). Following topically applied pilocarpine, the induced objectively measured accommodation in the young eye is greater than or equal to the reported subjectively measured voluntary maximum accommodative amplitude.

The Development of Clinical Reasoning Skills: A Major Objective of the Anatomy Course

ERIC Educational Resources Information Center

Elizondo-Omana, Rodrigo E.; Lopez, Santos Guzman

2008-01-01

Traditional medical school curricula have made a clear demarcation between the basic biomedical sciences and the clinical years. It is our view that a comprehensive medical education necessarily involves an increased correlation between basic science knowledge and its clinical applications. A basic anatomy course should have two main objectives:…

Research on measurement method of optical camouflage effect of moving object

NASA Astrophysics Data System (ADS)

Wang, Juntang; Xu, Weidong; Qu, Yang; Cui, Guangzhen

2016-10-01

Camouflage effectiveness measurement as an important part of the camouflage technology, which testing and measuring the camouflage effect of the target and the performance of the camouflage equipment according to the tactical and technical requirements. The camouflage effectiveness measurement of current optical band is mainly aimed at the static target which could not objectively reflect the dynamic camouflage effect of the moving target. This paper synthetical used technology of dynamic object detection and camouflage effect detection, the digital camouflage of the moving object as the research object, the adaptive background update algorithm of Surendra was improved, a method of optical camouflage effect detection using Lab-color space in the detection of moving-object was presented. The binary image of moving object is extracted by this measurement technology, in the sequence diagram, the characteristic parameters such as the degree of dispersion, eccentricity, complexity and moment invariants are constructed to construct the feature vector space. The Euclidean distance of moving target which through digital camouflage was calculated, the results show that the average Euclidean distance of 375 frames was 189.45, which indicated that the degree of dispersion, eccentricity, complexity and moment invariants of the digital camouflage graphics has a great difference with the moving target which not spray digital camouflage. The measurement results showed that the camouflage effect was good. Meanwhile with the performance evaluation module, the correlation coefficient of the dynamic target image range 0.1275 from 0.0035, and presented some ups and down. Under the dynamic condition, the adaptability of target and background was reflected. In view of the existing infrared camouflage technology, the next step, we want to carry out the camouflage effect measurement technology of the moving target based on infrared band.

Process for the reconstruction of three-dimensional images of an area of interest of an object comprising the combination of measurements over the entire object with measurements of an area of interest of said object, and appropriate installation

DOEpatents

Azevedo, Stephen; Grangeat, Pierre; Rizo, Philippe

1995-01-01

Process and installation making it possible to reconstitute precise images of an area of interest (2) of an object (1) by reducing the errors produced by the contribution of the compliment of the object. A first series of measurements is carried out, where a conical beam (10) only takes in the area of interest of the object (2) and this is followed by a second series of measurements in which the beam takes in the entire object. A combination of the measurements of the two series is carried out in order to make them compatible and obtain a more accurate image of the area of interest (2).

Objections to routine clinical outcomes measurement in mental health services: any evidence so far?

PubMed

MacDonald, Alastair J D; Trauer, Tom

2010-12-01

Routine clinical outcomes measurement (RCOM) is gaining importance in mental health services. To examine whether criticisms published in advance of the development of RCOM have been borne out by data now available from such a programme. This was an observational study of routine ratings using HoNOS65+ at inception/admission and again at discharge in an old age psychiatry service from 1997 to 2008. Testable hypotheses were generated from each criticism amenable to empirical examination. Inter-rater reliability estimates were applied to observed differences between scores between community and ward patients using resampling. Five thousand one hundred eighty community inceptions and 862 admissions had HoNOS65+ ratings at referral/admission and discharge. We could find no evidence of gaming (artificially worse scores at inception and better at discharge), selection, attrition or detection bias, and ratings were consistent with diagnosis and level of service. Anticipated low levels of inter-rater reliability did not vitiate differences between levels of service. Although only hypotheses testable from within RCOM data were examined, and only 46% of eligible episodes had complete outcomes data, no evidence of the alleged biases were found. RCOM seems valid and practical in mental health services.

Objective measurement of bread crumb texture

NASA Astrophysics Data System (ADS)

Wang, Jian; Coles, Graeme D.

1995-01-01

Evaluation of bread crumb texture plays an important role in judging bread quality. This paper discusses the application of image analysis methods to the objective measurement of the visual texture of bread crumb. The application of Fast Fourier Transform and mathematical morphology methods have been discussed by the authors in their previous work, and a commercial bread texture measurement system has been developed. Based on the nature of bread crumb texture, we compare the advantages and disadvantages of the two methods, and a third method based on features derived directly from statistics of edge density in local windows of the bread image. The analysis of various methods and experimental results provides an insight into the characteristics of the bread texture image and interconnection between texture measurement algorithms. The usefulness of the application of general stochastic process modelling of texture is thus revealed; it leads to more reliable and accurate evaluation of bread crumb texture. During the development of these methods, we also gained useful insights into how subjective judges form opinions about bread visual texture. These are discussed here.

Measuring Workplace Climate in Community Clinics and Health Centers

PubMed Central

Friedberg, Mark W.; Rodriguez, Hector P.; Martsolf, Grant; Edelen, Maria Orlando; Vargas-Bustamante, Arturo

2018-01-01

Background The effectiveness of community clinics and health centers’ efforts to improve the quality of care might be modified by clinics’ workplace climates. Several surveys to measure workplace climate exist, but their relationships to each other and to distinguishable dimensions of workplace climate are unknown. Objective To assess the psychometric properties of a survey instrument combining items from several existing surveys of workplace climate and to generate a shorter instrument for future use. Methods We fielded a 106-item survey, which included items from 9 existing instruments, to all clinicians and staff members (n=781) working in 30 California community clinics and health centers, receiving 628 responses (80% response rate). We performed exploratory factor analysis of survey responses, followed by confirmatory factor analysis of 200 reserved survey responses. We generated a new, shorter survey instrument of items with strong factor loadings. Results Six factors, including 44 survey items, emerged from the exploratory analysis. Two factors (Clinic Workload and Teamwork) were independent from the others. The remaining 4 factors (Staff Relationships, Quality Improvement Orientation, Managerial Readiness for Change, and Staff Readiness for Change) were highly correlated, indicating that these represented dimensions of a higher-order factor we called “Clinic Functionality.” This two-level, six-factor model fit the data well in the exploratory and confirmatory samples. For all but one factor, fewer than 20 survey responses were needed to achieve clinic-level reliability >0.7. Conclusion Survey instruments designed to measure workplace climate have substantial overlap. The relatively parsimonious item set we identified might help target and tailor clinics’ quality improvement efforts. PMID:27326549

Relationship between patient-reported and objective measurements of hand function in patients with rheumatoid arthritis.

PubMed

Günay, S M; Tuna, Z; Oskay, D

2016-12-31

Rheumatoid arthritis (RA) often results in impairments in upper extremities, especially in the small joints of hand. Involvement of hand brings limitations in activities of daily living. However, it is commonly observed that patient-reported functional status of hand does not always corresponds to their actual physical performance in the clinical setting. The aim of this pilot study is to investigate the relationship between patient self-reported and objectively measured hand functions in patients with RA. Twenty-six patients (51±13 years) with RA diagnosis participated in the study. Hand grip and pinch (lateral, bipod, tripod) strengths were measured and Jebsen Hand Function Test (JHFT) was performed for objective functional performance. Duruöz Hand Index and Beck Depression Inventory - Turkish version were completed by patients. Grip and all three-pinch strength results significantly correlated with Duruöz Hand Index scores (p<0.05). JHFT results except the sentence writing also correlated with the Duruöz scores (p<0.05). Our results showed that self-reported outcome scales might be used for determining functional level of hand in patients with RA in rheumatology practice. Objective quantitative functional tests are the best methods in evaluating functional level of hand, but require valid and reliable equipment with accurate calibration. Therefore, in case of unavailability of objective assessment tools, patient-reported scales may also reflect the real status of hand functions.

Objective color measurements: clinimetric performance of three devices on normal skin and scar tissue.

PubMed

van der Wal, Martijn; Bloemen, Monica; Verhaegen, Pauline; Tuinebreijer, Wim; de Vet, Henrica; van Zuijlen, Paul; Middelkoop, Esther

2013-01-01

Color measurements are an essential part of scar evaluation. Thus, vascularization (erythema) and pigmentation (melanin) are common outcome parameters in scar research. The aim of this study was to investigate the clinimetric properties and clinical feasibility of the Mexameter, Colorimeter, and the DSM II ColorMeter for objective measurements on skin and scars. Fifty scars with a mean age of 6 years (2 months to 53 years) were included. Reliability was tested using the single-measure interobserver intraclass correlation coefficient. Validity was determined by measuring the Pearson correlation with the Fitzpatrick skin type classification (for skin) and the Patient and Observer Scar Assessment Scale (for scar tissue). All three instruments provided reliable readings (intraclass correlation coefficient ≥ 0.83; confidence interval: 0.71-0.90) on normal skin and scar tissue. Parameters with the highest correlations with the Fitzpatrick classification were melanin (Mexameter), 0.72; ITA (Colorimeter), -0.74; and melanin (DSM II), 0.70. On scars, the highest correlations with the Patient and Observer Scar Assessment Scale vascularization scores were the following: erythema (Mexameter), 0.59; LAB2 (Colorimeter), 0.69; and erythema (DSM II), 0.66. For hyperpigmentation, the highest correlations were melanin (Mexameter), 0.75; ITA (Colorimeter), -0.80; and melanin (DSM II), 0.83. This study shows that all three instruments can provide reliable color data on skin and scars with a single measurement. The authors also demonstrated that they can assist in objective skin type classification. For scar assessment, the most valid parameters in each instrument were identified.

Does measuring BHR add to guideline derived clinical measures in determining treatment for patients with persistent asthma?

PubMed

Koenig, Steven M; Murray, John J; Wolfe, James; Andersen, Leslie; Yancey, Steve; Prillaman, Barbara; Stauffer, John; Dorinsky, Paul

2008-05-01

Little is known about the use of biomarkers in guiding treatment decisions in routine asthma management. The objective of this study was to determine whether adding a LABA to an ICS would control bronchial hyperresponsiveness (BHR) at an overall lower dose of ICS when titration of medication was based upon the assessment of routine clinical measures with or without the measurement of BHR. After a 2-week run-in period, subjects (> or = 12 years) were randomized to one of three treatment groups. Two groups followed a BHR treatment strategy (based on clinical parameters [lung function, asthma symptoms, and bronchodilator use] and BHR) and were treated with either fluticasone propionate/salmeterol (FSC(BHR) group) or fluticasone propionate (FP(BHR) group) (n=156 each). The third group followed a clinical treatment algorithm (based on clinical parameters alone) and were treated with fluticasone propionate (FP(REF) group; n=154). All treatments were administered via Diskus. Treatment doses were adjusted as needed every 8 weeks for 40 weeks according to the subject's derived severity class, which was based on clinical measures of asthma control with or without BHR. The mean total daily inhaled corticosteroids (ICS) dose during the double-blind treatment period was lower, although not statistically significant, in the FSC(BHR) group compared with the FP(BHR) group (a difference of -42.9 mcg; p=0.07). Compared with the FP(REF) group, the mean total daily ICS dose was higher in the FSC(BHR) group (a difference of 85.2 mcg) and was significantly higher in the FP(BHR) group (a difference of 131.2 mcg, p=0.037). This study demonstrated that for most subjects, control of BHR was maintained when treatment was directed toward control of clinical parameters. In addition, there was a trend towards control of BHR and clinical measures at a lower dose of ICS when used concurrently with salmeterol.

Performance Measurement and Investment Objectives for Educational Endowment Funds.

ERIC Educational Resources Information Center

Williamson, J. Peter

This book is one of a series of projects developed to increase understanding of the management of educational endowment funds. Specifics of performance measurement and the setting of objectives are emphasized. Part one deals with measurement of the rate of return, or profitability, of an endowment fund. Part two reviews some statistical measures…

Objective Measures of Swallowing Function Applied to the Dysphagia Population: A One Year Experience.

PubMed

Kendall, Katherine A; Ellerston, Julia; Heller, Amanda; Houtz, Daniel R; Zhang, Chong; Presson, Angela P

2016-08-01

Quantitative, reliable measures of swallowing physiology can be made from an modified barium swallowing study. These quantitative measures have not been previously employed to study large dysphagic patient populations. The present retrospective study of 139 consecutive patients with dysphagia seen in a university tertiary voice and swallowing clinic sought to use objective measures of swallowing physiology to (1) quantify the most prevalent deficits seen in the patient population, (2) identify commonly associated diagnoses and describe the most prevalent swallowing deficits, and (3) determine any correlation between objective deficits and Eating Assessment Tool (EAT-10) scores and body mass index. Poor pharyngeal constriction (34.5 %) and airway protection deficits (65.5 %) were the most common swallowing abnormalities. Reflux-related dysphagia (36 %), nonspecific pharyngeal dysphagia (24 %), Parkinson disease (16 %), esophageal abnormality (13 %), and brain insult (10 %) were the most common diagnoses. Poor pharyngeal constriction was significantly associated with an esophageal motility abnormality (p < 0.001) and central neurologic insult. In general, dysphagia symptoms as determined by the EAT-10 did not correlate with swallowing function abnormalities. This preliminary study indicates that reflux disease is common in patients with dysphagia and that associated esophageal abnormalities are common in dysphagic populations and may be associated with specific pharyngeal swallowing abnormalities. However, symptom scores from the EAT-10 did not correspond to swallowing pathophysiology.

Surgery Clerkship Evaluations Are Insufficient for Clinical Skills Appraisal: The Value of a Medical Student Surgical Objective Structured Clinical Examination.

PubMed

Butler, Kathryn L; Hirsh, David A; Petrusa, Emil R; Yeh, D Dante; Stearns, Dana; Sloane, David E; Linder, Jeffrey A; Basu, Gaurab; Thompson, Lisa A; de Moya, Marc A

Optimal methods for medical student assessment in surgery remain elusive. Faculty- and housestaff-written evaluations constitute the chief means of student assessment in medical education. However, numerous studies show that this approach has poor specificity and a high degree of subjectivity. We hypothesized that an objective structured clinical examination (OSCE) in the surgery clerkship would provide additional data on student performance that would confirm or augment other measures of assessment. We retrospectively reviewed data from OSCEs, National Board of Medical Examiners shelf examinations, oral presentations, and written evaluations for 51 third-year Harvard Medical School students rotating in surgery at Massachusetts General Hospital from 2014 to 2015. We expressed correlations between numeric variables in Pearson coefficients, stratified differences between rater groups by one-way analysis of variance, and compared percentages with 2-sample t-tests. We examined commentary from both OSCE and clinical written evaluations through textual analysis and summarized these results in percentages. OSCE scores and clinical evaluation scores correlated poorly with each other, as well as with shelf examination scores and oral presentation grades. Textual analysis of clinical evaluation comments revealed a heavy emphasis on motivational factors and praise, whereas OSCE written comments focused on cognitive processes, patient management, and methods to improve performance. In this single-center study, an OSCE provided clinical skills data that were not captured elsewhere in the surgery clerkship. Textual analysis of faculty evaluations reflected an emphasis on interpersonal skills, rather than appraisal of clinical acumen. These findings suggest complementary roles of faculty evaluations and OSCEs in medical student assessment. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Embedded measures of performance validity using verbal fluency tests in a clinical sample.

PubMed

Sugarman, Michael A; Axelrod, Bradley N

2015-01-01

The objective of this study was to determine to what extent verbal fluency measures can be used as performance validity indicators during neuropsychological evaluation. Participants were clinically referred for neuropsychological evaluation in an urban-based Veteran's Affairs hospital. Participants were placed into 2 groups based on their objectively evaluated effort on performance validity tests (PVTs). Individuals who exhibited credible performance (n = 431) failed 0 PVTs, and those with poor effort (n = 192) failed 2 or more PVTs. All participants completed the Controlled Oral Word Association Test (COWAT) and Animals verbal fluency measures. We evaluated how well verbal fluency scores could discriminate between the 2 groups. Raw scores and T scores for Animals discriminated between the credible performance and poor-effort groups with 90% specificity and greater than 40% sensitivity. COWAT scores had lower sensitivity for detecting poor effort. A combination of FAS and Animals scores into logistic regression models yielded acceptable group classification, with 90% specificity and greater than 44% sensitivity. Verbal fluency measures can yield adequate detection of poor effort during neuropsychological evaluation. We provide suggested cut points and logistic regression models for predicting the probability of poor effort in our clinical setting and offer suggested cutoff scores to optimize sensitivity and specificity.

Creating objective and measurable postgraduate year 1 residency graduation requirements.

PubMed

Starosta, Kaitlin; Davis, Susan L; Kenney, Rachel M; Peters, Michael; To, Long; Kalus, James S

2017-03-15

The process of developing objective and measurable postgraduate year 1 (PGY1) residency graduation requirements and a progress tracking system is described. The PGY1 residency accreditation standard requires that programs establish criteria that must be met by residents for successful completion of the program (i.e., graduation requirements), which should presumably be aligned with helping residents to achieve the purpose of residency training. In addition, programs must track a resident's progress toward fulfillment of residency goals and objectives. Defining graduation requirements and establishing the process for tracking residents' progress are left up to the discretion of the residency program. To help standardize resident performance assessments, leaders of an academic medical center-based PGY1 residency program developed graduation requirement criteria that are objective, measurable, and linked back to residency goals and objectives. A system for tracking resident progress relative to quarterly progress targets was instituted. Leaders also developed a focused, on-the-spot skills assessment termed "the Thunderdome," which was designed for objective evaluation of direct patient care skills. Quarterly data on residents' progress are used to update and customize each resident's training plan. Implementation of this system allowed seamless linkage of the training plan, the progress tracking system, and the specified graduation requirement criteria. PGY1 residency requirements that are objective, that are measurable, and that attempt to identify what skills the resident must demonstrate in order to graduate from the program were developed for use in our residency program. A system for tracking the residents' progress by comparing residents' performance to predetermined quarterly benchmarks was developed. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Optometric measurements predict performance but not comfort on a virtual object placement task with a stereoscopic three-dimensional display

NASA Astrophysics Data System (ADS)

McIntire, John P.; Wright, Steve T.; Harrington, Lawrence K.; Havig, Paul R.; Watamaniuk, Scott N. J.; Heft, Eric L.

2014-06-01

Twelve participants were tested on a simple virtual object precision placement task while viewing a stereoscopic three-dimensional (S3-D) display. Inclusion criteria included uncorrected or best corrected vision of 20/20 or better in each eye and stereopsis of at least 40 arc sec using the Titmus stereotest. Additionally, binocular function was assessed, including measurements of distant and near phoria (horizontal and vertical) and distant and near horizontal fusion ranges using standard optometric clinical techniques. Before each of six 30 min experimental sessions, measurements of phoria and fusion ranges were repeated using a Keystone View Telebinocular and an S3-D display, respectively. All participants completed experimental sessions in which the task required the precision placement of a virtual object in depth at the same location as a target object. Subjective discomfort was assessed using the simulator sickness questionnaire. Individual placement accuracy in S3-D trials was significantly correlated with several of the binocular screening outcomes: viewers with larger convergent fusion ranges (measured at near distance), larger total fusion ranges (convergent plus divergent ranges, measured at near distance), and/or lower (better) stereoscopic acuity thresholds were more accurate on the placement task. No screening measures were predictive of subjective discomfort, perhaps due to the low levels of discomfort induced.

Serial Liver Stiffness Measurements and Monitoring of Liver-Transplanted Patients in a Real-Life Clinical Practice

PubMed Central

Rinaldi, Luca; Valente, Giovanna; Piai, Guido

2016-01-01

Background Liver transplanted patients need close surveillance for early signs of graft disease. Objectives Transient elastography can safely be repeated over time, offering serial liver stiffness measurement values. Serial stiffness measurements were compared to single baseline stiffness measurements in predicting the appearance of liver-related clinical events and guiding subsequent clinical decisions. Methods One hundred and sixty liver transplanted patients were observed for three years in our real-life practice. Results Liver stiffness measurements were stable in 75% of patients, decreased in 4% of patients, and increased in 21% of patients. The pattern of increased stiffness measurements was associated with both HCV-RNA positive status and the presence of an active biliary complication of liver transplantation and was more predictive of a clinically significant event resulting from any disease of the transplanted liver when compared to a stable pattern or to a single liver stiffness measurement. The procedures that were consequently performed were often diagnostic for unexpected situations, both in HCV-RNA positive and HCV-RNA negative patients. Conclusions The pattern of longitudinally increased liver stiffness measurements efficiently supported clinical decisions for individualized management strategies. Repeated transient elastography in real-life clinical practice appears to have a practical role in monitoring liver transplanted patients. PMID:28123442

Adaptation or recovery after health shocks? Evidence using subjective and objective health measures.

PubMed

Baji, Petra; Bíró, Anikó

2018-05-01

In this paper, we analyse the effect of an onset of a health shock on subjective survival probability and compare it with objective survival probability and self-reported health measures. In particular, we are interested in whether expectations of people respond to health shocks and whether these follow the evolution of objective life expectations and self-reported health measures over time. Using longitudinal data from the Health and Retirement Study, we estimate fixed effects models of adaptation for the objective and subjective survival probabilities and for some self-reported health measures. The results show that after cancer diagnosis, conditional on surviving, both the objective and subjective longevity and self-reported health measures drift back to the before diagnosis trajectories. For stroke and heart attack, in spite of their persistent negative effect on survival, subjective life expectations and self-reported health measures seem to indicate only a transient effect of the health shock. The differences between the objective and subjective measures are in line with the concept of adaptation. We discuss the policy implications of our results. Copyright © 2018 John Wiley & Sons, Ltd.

Measurement of Erythrocyte Methotrexate Polyglutamate Levels: Ready for Clinical Use in Rheumatoid Arthritis?

PubMed Central

Danila, Maria I.; Hughes, Laura B.; Brown, Elizabeth E.; Morgan, Sarah L.; Baggott, Joseph E.; Arnett, Donna K.; Bridges, S. Louis

2013-01-01

Methotrexate (MTX) is one of the most commonly prescribed and most effective drugs for the treatment of rheumatoid arthritis (RA). Given the partial response of many patients and the side effect profile of the drug, there is considerable interest in identification of biomarkers to guide MTX therapy in RA. Upon entering cells, MTX is polyglutamated. Measuring methotrexate polyglutamates (MTX PGs) levels in circulating red blood cells (RBC) has been proposed as an objective measure that can help to optimize MTX therapy in RA. There is conflicting data with regard to the clinical utility of measurement of MTX PGs measurements as a predictor of the efficacy or toxicity of low-dose MTX effects in RA. Should large, randomized clinical trials of this assay show consistent, reproducible, long-term correlations between MTX PG levels and efficacy and toxicity, this test could become a prominent tool for clinicians to optimize the use of MTX in RA. PMID:20665136

The beam stop array method to measure object scatter in digital breast tomosynthesis

NASA Astrophysics Data System (ADS)

Lee, Haeng-hwa; Kim, Ye-seul; Park, Hye-Suk; Kim, Hee-Joung; Choi, Jae-Gu; Choi, Young-Wook

2014-03-01

Scattered radiation is inevitably generated in the object. The distribution of the scattered radiation is influenced by object thickness, filed size, object-to-detector distance, and primary energy. One of the investigations to measure scatter intensities involves measuring the signal detected under the shadow of the lead discs of a beam-stop array (BSA). The measured scatter by BSA includes not only the scattered radiation within the object (object scatter), but also the external scatter source. The components of external scatter source include the X-ray tube, detector, collimator, x-ray filter, and BSA. Excluding background scattered radiation can be applied to different scanner geometry by simple parameter adjustments without prior knowledge of the scanned object. In this study, a method using BSA to differentiate scatter in phantom (object scatter) from external background was used. Furthermore, this method was applied to BSA algorithm to correct the object scatter. In order to confirm background scattered radiation, we obtained the scatter profiles and scatter fraction (SF) profiles in the directions perpendicular to the chest wall edge (CWE) with and without scattering material. The scatter profiles with and without the scattering material were similar in the region between 127 mm and 228 mm from chest wall. This result indicated that the measured scatter by BSA included background scatter. Moreover, the BSA algorithm with the proposed method could correct the object scatter because the total radiation profiles of object scatter correction corresponded to original image in the region between 127 mm and 228 mm from chest wall. As a result, the BSA method to measure object scatter could be used to remove background scatter. This method could apply for different scanner geometry after background scatter correction. In conclusion, the BSA algorithm with the proposed method is effective to correct object scatter.

[Clinical research=design*measurements*statistical analyses].

PubMed

Furukawa, Toshiaki

2012-06-01

A clinical study must address true endpoints that matter for the patients and the doctors. A good clinical study starts with a good clinical question. Formulating a clinical question in the form of PECO can sharpen one's original question. In order to perform a good clinical study one must have a knowledge of study design, measurements and statistical analyses: The first is taught by epidemiology, the second by psychometrics and the third by biostatistics.

Consumer Education--Home Economics. Performance Objectives. Criterion Measures. Home Economics.

ERIC Educational Resources Information Center

Duval County School Board, Jacksonville, FL.

Several intermediate performance objectives and corresponding criterion measures are listed for each of six terminal objectives for an 18-week consumer education-home economics course for 10th, 11th, and 12th grade students. Purposes listed for the course are to develop an understanding of the American market system, and how the individual affects…

Domain-Specific Self-Reported and Objectively Measured Physical Activity in Children.

PubMed

Sprengeler, Ole; Wirsik, Norman; Hebestreit, Antje; Herrmann, Diana; Ahrens, Wolfgang

2017-03-01

Little is known about the extent that different domains contribute to total sedentary (SED), light (LPA) and moderate-to-vigorous physical activity (MVPA). We aimed to identify domain-specific physical activity (PA) patterns in school-aged children who were assessed by questionnaire and accelerometry. For the study, 298 German school children and adolescents aged 6-17 years wore an accelerometer for one week and completed a PA recall-questionnaire for the same period. Spearman coefficients (r) were used to evaluate the agreement between self-reported and objectively measured PA in five domains (transport, school hours, physical education, leisure-time, organized sports activities). School hours mainly contributed to the total objectively measured SED, LPA and MVPA (55%, 53% and 46%, respectively), whilst sports activities contributed only 24% to total MVPA. Compared to accelerometry, the proportion of self-reported LPA and MVPA during school hours was substantially underestimated but overestimated during leisure-time. The agreement of self-reported and objectively measured PA was low for total LPA (r = 0.09, 95% CI (confidence interval): -0.03-0.20) and total MVPA (r = 0.21, 95% CI: 0.10-0.32), while moderate agreement was only found for total SED (r = 0.44, 95% CI: 0.34-0.53), LPA during transport (r = 0.59; 95% CI: 0.49-0.67) and MVPA during organized sports activities (r = 0.54; 95% CI: 0.38-0.67). Since school hours mainly contribute to total SED, LPA and MVPA and self-reported LPA and MVPA during school were importantly underestimated compared to objectively measured LPA and MVPA, the application of objective measurements is compulsory to characterize the entire activity pattern of school-aged children.

Clinical height measurements are unreliable: a call for improvement.

PubMed

Mikula, A L; Hetzel, S J; Binkley, N; Anderson, P A

2016-10-01

Height measurements are currently used to guide imaging decisions that assist in osteoporosis care, but their clinical reliability is largely unknown. We found both clinical height measurements and electronic health record height data to be unreliable. Improvement in height measurement is needed to improve osteoporosis care. The aim of this study is to assess the accuracy and reliability of clinical height measurement in a university healthcare clinical setting. Electronic health record (EHR) review, direct measurement of clinical stadiometer accuracy, and observation of staff height measurement technique at outpatient facilities of the University of Wisconsin Hospital and Clinics. We examined 32 clinical stadiometers for reliability and observed 34 clinic staff perform height measurements at 12 outpatient primary care and specialty clinics. An EHR search identified 4711 men and women age 43 to 89 with no known metabolic bone disease who had more than one height measurement over 3 months. The short study period and exclusion were selected to evaluate change in recorded height not due to pathologic processes. Mean EHR recorded height change (first to last measurement) was -0.02 cm (SD 1.88 cm). Eighteen percent of patients had height measurement differences noted in the EHR of ≥2 cm over 3 months. The technical error of measurement (TEM) was 1.77 cm with a relative TEM of 1.04 %. None of the staff observed performing height measurements followed all recommended height measurement guidelines. Fifty percent of clinic staff reported they on occasion enter patient reported height into the EHR rather than performing a measurement. When performing direct measurements on stadiometers, the mean difference from a gold standard length was 0.24 cm (SD 0.80). Nine percent of stadiometers examined had an error of >1.5 cm. Clinical height measurements and EHR recorded height results are unreliable. Improvement in this measure is needed as an adjunct to improve

Correlational Analysis of Objective and Subjective Measures of Cataract Quantification.

PubMed

Cochener, Béatrice; Patel, Sunni R; Galliot, Florence

2016-02-01

To evaluate whether correlations exist between objective and subjective measures of vision quality as a consequence of cataract and whether this may qualify the Objective Scatter Index as a supplementary means of cataract assessment. A prospective multicenter, cross-sectional study was conducted in 10 centers across France in patients undergoing cataract extraction surgery (lens opacity evaluated with the Lens Opacities Classification System III). A quality of life assessment using the Visual Function Index-14 (VF-14) (14 questions scored from 0 to 4) and measurement of visual acuity and evaluation of the Objective Scatter Index (HD Analyzer, Visiometrics SL, Terrassa, Spain) to assess the alteration of light scatter were used as measures in the study. The study included 1,768 eyes of 1,768 patients (mean age: 72.5 years; range: 28 to 93 years). The average OSI score was 4.97 ± 3.13 (range: 0.4 to 20.5). There was good correlation between visual acuity and OSI (r = -0.47, P < .001) and between OSI and VF-14 (r = -0.11, P < .001). The results presented in this study confirm that the Objective Scatter Index has sufficient correlations with visual acuity and VF-14 to supplement existing cataract diagnosis in a large population encompassing a broad spectrum of cataract presentations. Copyright 2016, SLACK Incorporated.

Self-assessment differences between genders in a low-stakes objective structured clinical examination (OSCE).

PubMed

Madrazo, Lorenzo; Lee, Claire B; McConnell, Meghan; Khamisa, Karima

2018-06-15

Physicians and medical students are generally poor-self assessors. Research suggests that this inaccuracy in self-assessment differs by gender among medical students whereby females underestimate their performance compared to their male counterparts. However, whether this gender difference in self-assessment is observable in low-stakes scenarios remains unclear. Our study's objective was to determine whether self-assessment differed between male and female medical students when compared to peer-assessment in a low-stakes objective structured clinical examination. Thirty-three (15 males, 18 females) third-year students participated in a 5-station mock objective structured clinical examination. Trained fourth-year student examiners scored their performance on a 6-point Likert-type global rating scale. Examinees also scored themselves using the same scale. To examine gender differences in medical students' self-assessment abilities, mean self-assessment global rating scores were compared with peer-assessment global rating scores using an independent samples t test. Overall, female students' self-assessment scores were significantly lower compared to peer-assessment (p < 0.001), whereas no significant difference was found between self- and peer-assessment scores for male examinees (p = 0.228). This study provides further evidence that underestimation in self-assessment among females is observable even in a low-stakes formative objective structured clinical examination facilitated by fellow medical students.

The Reliability, Validity, and Evaluation of the Objective Structured Clinical Examination in Podiatry (Chiropody).

ERIC Educational Resources Information Center

Woodburn, Jim; Sutcliffe, Nick

1996-01-01

The Objective Structured Clinical Examination (OSCE), initially developed for undergraduate medical education, has been adapted for assessment of clinical skills in podiatry students. A 12-month pilot study found the test had relatively low levels of reliability, high construct and criterion validity, and good stability of performance over time.…

Description and status update on GELLO: a proposed standardized object-oriented expression language for clinical decision support.

PubMed

Sordo, Margarita; Boxwala, Aziz A; Ogunyemi, Omolola; Greenes, Robert A

2004-01-01

A major obstacle to sharing computable clinical knowledge is the lack of a common language for specifying expressions and criteria. Such a language could be used to specify decision criteria, formulae, and constraints on data and action. Al-though the Arden Syntax addresses this problem for clinical rules, its generalization to HL7's object-oriented data model is limited. The GELLO Expression language is an object-oriented language used for expressing logical conditions and computations in the GLIF3 (GuideLine Interchange Format, v. 3) guideline modeling language. It has been further developed under the auspices of the HL7 Clinical Decision Support Technical Committee, as a proposed HL7 standard., GELLO is based on the Object Constraint Language (OCL), because it is vendor-independent, object-oriented, and side-effect-free. GELLO expects an object-oriented data model. Although choice of model is arbitrary, standardization is facilitated by ensuring that the data model is compatible with the HL7 Reference Information Model (RIM).

Disability and Fatigue Can Be Objectively Measured in Multiple Sclerosis.

PubMed

Motta, Caterina; Palermo, Eduardo; Studer, Valeria; Germanotta, Marco; Germani, Giorgio; Centonze, Diego; Cappa, Paolo; Rossi, Silvia; Rossi, Stefano

2016-01-01

The available clinical outcome measures of disability in multiple sclerosis are not adequately responsive or sensitive. To investigate the feasibility of inertial sensor-based gait analysis in multiple sclerosis. A cross-sectional study of 80 multiple sclerosis patients and 50 healthy controls was performed. Lower-limb kinematics was evaluated by using a commercially available magnetic inertial measurement unit system. Mean and standard deviation of range of motion (mROM, sROM) for each joint of lower limbs were calculated in one minute walking test. A motor performance index (E) defined as the sum of sROMs was proposed. We established two novel observer-independent measures of disability. Hip mROM was extremely sensitive in measuring lower limb motor impairment, being correlated with muscle strength and also altered in patients without clinically detectable disability. On the other hand, E index discriminated patients according to disability, being altered only in patients with moderate and severe disability, regardless of walking speed. It was strongly correlated with fatigue and patient-perceived health status. Inertial sensor-based gait analysis is feasible and can detect clinical and subclinical disability in multiple sclerosis.

Objectively measured sedentary time and physical activity in women with fibromyalgia: a cross-sectional study

PubMed Central

Ruiz, Jonatan R; Segura-Jiménez, Víctor; Ortega, Francisco B; Álvarez-Gallardo, Inmaculada C; Camiletti-Moirón, Daniel; Aparicio, Virginia A; Carbonell-Baeza, Ana; Femia, Pedro; Munguía-Izquierdo, Diego; Delgado-Fernández, Manuel

2013-01-01

Objectives To characterise levels of objectively measured sedentary time and physical activity in women with fibromyalgia. Design Cross-sectional study. Setting Local Association of Fibromyalgia (Granada, Spain). Participants The study comprised 94 women with diagnosed fibromyalgia who did not have other severe somatic or psychiatric disorders, or other diseases that prevent physical loading, able to ambulate and to communicate and capable and willing to provide informed consent. Primary outcome measures Sedentary time and physical activity were measured by accelerometry and expressed as time spent in sedentary behaviours, average physical activity intensity (counts/minute) and amount of time (minutes/day) spent in moderate intensity and in moderate-to-vigorous-intensity physical activity (MVPA). Results The proportion of women meeting the physical activity recommendations of 30 min/day of MVPA on 5 or more days a week was 60.6%. Women spent, on average, 71% of their waking time (approximately 10 h/day) in sedentary behaviours. Both sedentary behaviour and physical activity levels were similar across age groups, waist circumference and percentage body fat categories, years since clinical diagnosis, marital status, educational level and occupational status, regardless of the severity of the disease (all p>0.1). Time spent on moderate-intensity physical activity and MVPA was, however, lower in those with greater body mass index (BMI) (−6.6 min and −7 min, respectively, per BMI category increase, <25, 25–30, >30 kg/m2; p values for trend were 0.056 and 0.051, respectively). Women spent, on average, 10 min less on MVPA (p<0.001) and 22 min less on sedentary behaviours during weekends compared with weekdays (p=0.051). Conclusions These data provide an objective measure of the amount of time spent on sedentary activities and on physical activity in women with fibromyalgia. PMID:23794573

School-based clinics: their role in helping students meet the 1990 objectives.

PubMed

Dryfoos, J G; Klerman, L V

1988-01-01

Service statistics and observations from site visits across the country indicate that school-based clinics (SBCs) may be having an impact on several of the problems targeted in the 1990 health objectives, including unplanned pregnancy and substance abuse. At least 120 junior and senior high schools in 61 communities are currently operating or developing clinics. Growth is attributed to increasing concern about high-risk youth, especially among educators in their roles of "surrogate parents"; to disillusion with categorical interventions and a movement toward more comprehensive services; and to student, parent, school, and community approval of the new programs. This article describes the comprehensive school-based clinic model, including its history, organizational strategies, school/community partnerships, and services.

Perceived and Objective Measures of Neighborhood Environment for Physical Activity Among Mexican Adults, 2011

PubMed Central

Salvo, Deborah; Lamadrid-Figueroa, Héctor; Hernández, Bernardo; Rivera-Dommarco, Juan A.; Pratt, Michael

2016-01-01

Introduction Environmental supports for physical activity may help residents to be physically active. However, such supports might not help if residents’ perceptions of the built environment do not correspond with objective measures. We assessed the associations between objective and perceived measures of the built environment among adults in Cuernavaca, Mexico, and examined whether certain variables modified this relationship. Methods We conducted a population-based (n = 645) study in 2011 that used objective (based on geographic information systems) and perceived (by questionnaire) measures of the following features of the built environment: residential density, mixed-land use, intersection density, and proximity to parks and transit stops. We used linear regression to assess the adjusted associations between these measures and to identify variables modifying these relationships. Results Adjusted associations were significant for all features (P < .05) except intersection density and proximity to transit stops. Significantly stronger associations between perceived and objective measures were observed among participants with low socioeconomic status, participants who did not own a motor vehicle or did not meet physical activity recommendations, and participants perceiving parks as safe. Conclusion Perceived measures of residential density, mixed-land use, and proximity to parks are associated with objective environmental measures related to physical activity. However, in Mexico, it should not be assumed that perceived measures of intersection density and proximity to transit stops are the same as objective measures. Our results are consistent with those from high-income countries in that associations between perceived and objective measures are modified by individual sociodemographic and psychosocial factors. PMID:27281391

Domain-Specific Self-Reported and Objectively Measured Physical Activity in Children

PubMed Central

Sprengeler, Ole; Wirsik, Norman; Hebestreit, Antje; Herrmann, Diana; Ahrens, Wolfgang

2017-01-01

Little is known about the extent that different domains contribute to total sedentary (SED), light (LPA) and moderate-to-vigorous physical activity (MVPA). We aimed to identify domain-specific physical activity (PA) patterns in school-aged children who were assessed by questionnaire and accelerometry. For the study, 298 German school children and adolescents aged 6–17 years wore an accelerometer for one week and completed a PA recall-questionnaire for the same period. Spearman coefficients (r) were used to evaluate the agreement between self-reported and objectively measured PA in five domains (transport, school hours, physical education, leisure-time, organized sports activities). School hours mainly contributed to the total objectively measured SED, LPA and MVPA (55%, 53% and 46%, respectively), whilst sports activities contributed only 24% to total MVPA. Compared to accelerometry, the proportion of self-reported LPA and MVPA during school hours was substantially underestimated but overestimated during leisure-time. The agreement of self-reported and objectively measured PA was low for total LPA (r = 0.09, 95% CI (confidence interval): −0.03–0.20) and total MVPA (r = 0.21, 95% CI: 0.10–0.32), while moderate agreement was only found for total SED (r = 0.44, 95% CI: 0.34–0.53), LPA during transport (r = 0.59; 95% CI: 0.49–0.67) and MVPA during organized sports activities (r = 0.54; 95% CI: 0.38–0.67). Since school hours mainly contribute to total SED, LPA and MVPA and self-reported LPA and MVPA during school were importantly underestimated compared to objectively measured LPA and MVPA, the application of objective measurements is compulsory to characterize the entire activity pattern of school-aged children. PMID:28257046

Assessing nursing clinical skills competence through objective structured clinical examination (OSCE) for open distance learning students in Open University Malaysia.

PubMed

Oranye, Nelson Ositadimma; Ahmad, Che'an; Ahmad, Nora; Bakar, Rosnida Abu

2012-06-01

The objective structured clinical skills examination (OSCE) has over the years emerged as a method of evaluating clinical skills in most medical and allied professions. Although its validity and objectivity has evoked so much debate in the literature, little has been written about its application in non-traditional education systems such as in distance learning. This study examined clinical skills competence among practising nursing students who were enrolled in a distance learning programme. The study examined the effect of work and years of nursing practice on nurses' clinical skills competence. This study used observational design whereby nursing students' clinical skills were observed and scored in five OSCE stations. Two instruments were used for the data collection - A self-administered questionnaire on the students' bio-demographic data, and a check list on the clinical skills which the examiners rated on a four point scale. The findings revealed that 14% of the nurses had level four competence, which indicated that they could perform the tasks correctly and complete. However, 12% failed the OSCE, even though they had more than 10 years experience in nursing and post basic qualifications. Inter-rater reliability was 0.92 for the five examiners. Factor analysis indicated that five participant factors accounted for 74.1% of the variations in clinical skills performance. An OSCE is a necessary assessment tool that should be continuously applied in nursing education, regardless of the mode of the education program, the student's years of experience or his/her clinical placement. This study validates the need for OSCE in both the design of tertiary nursing degree programs and the assessment of nurses' clinical competency level.

Speckle interferometry with temporal phase evaluation for measuring large-object deformation.

PubMed

Joenathan, C; Franze, B; Haible, P; Tiziani, H J

1998-05-01

We propose a new method for measuring large-object deformations byusing temporal evolution of the speckles in speckleinterferometry. The principle of the method is that by deformingthe object continuously, one obtains fluctuations in the intensity ofthe speckle. A large number of frames of the object motion arecollected to be analyzed later. The phase data for whole-objectdeformation are then retrieved by inverse Fourier transformation of afiltered spectrum obtained by Fourier transformation of thesignal. With this method one is capable of measuring deformationsof more than 100 mum, which is not possible using conventionalelectronic speckle pattern interferometry. We discuss theunderlying principle of the method and the results of theexperiments. Some nondestructive testing results are alsopresented.

Objective measurement of accommodative biometric changes using ultrasound biomicroscopy

PubMed Central

Ramasubramanian, Viswanathan; Glasser, Adrian

2015-01-01

PURPOSE To demonstrate that ultrasound biomicroscopy (UBM) can be used for objective quantitative measurements of anterior segment accommodative changes. SETTING College of Optometry, University of Houston, Houston, Texas, USA. DESIGN Prospective cross-sectional study. METHODS Anterior segment biometric changes in response to 0 to 6.0 diopters (D) of accommodative stimuli in 1.0 D steps were measured in eyes of human subjects aged 21 to 36 years. Imaging was performed in the left eye using a 35 MHz UBM (Vumax) and an A-scan ultrasound (A-5500) while the right eye viewed the accommodative stimuli. An automated Matlab image-analysis program was developed to measure the biometry parameters from the UBM images. RESULTS The UBM-measured accommodative changes in anterior chamber depth (ACD), lens thickness, anterior lens radius of curvature, posterior lens radius of curvature, and anterior segment length were statistically significantly (P < .0001) linearly correlated with accommodative stimulus amplitudes. Standard deviations of the UBM-measured parameters were independent of the accommodative stimulus demands (ACD 0.0176 mm, lens thickness 0.0294 mm, anterior lens radius of curvature 0.3350 mm, posterior lens radius of curvature 0.1580 mm, and anterior segment length 0.0340 mm). The mean difference between the A-scan and UBM measurements was −0.070 mm for ACD and 0.166 mm for lens thickness. CONCLUSIONS Accommodating phakic eyes imaged using UBM allowed visualization of the accommodative response, and automated image analysis of the UBM images allowed reliable, objective, quantitative measurements of the accommodative intraocular biometric changes. PMID:25804579

A patient safety objective structured clinical examination.

PubMed

Singh, Ranjit; Singh, Ashok; Fish, Reva; McLean, Don; Anderson, Diana R; Singh, Gurdev

2009-06-01

There are international calls for improving education for health care workers around certain core competencies, of which patient safety and quality are integral and transcendent parts. Although relevant teaching programs have been developed, little is known about how best to assess their effectiveness. The objective of this work was to develop and implement an objective structured clinical examination (OSCE) to evaluate the impact of a patient safety curriculum. The curriculum was implemented in a family medicine residency program with 47 trainees. Two years after commencing the curriculum, a patient safety OSCE was developed and administered at this program and, for comparison purposes, to incoming residents at the same program and to residents at a neighboring residency program. All 47 residents exposed to the training, all 16 incoming residents, and 10 of 12 residents at the neighboring program participated in the OSCE. In a standardized patient case, error detection and error disclosure skills were better among trained residents. In a chart-based case, trained residents showed better performance in identifying deficiencies in care and described more appropriate means of addressing them. Third year residents exposed to a "Systems Approach" course performed better at system analysis and identifying system-based solutions after the course than before. Results suggest increased systems thinking and inculcation of a culture of safety among residents exposed to a patient safety curriculum. The main weaknesses of the study are its small size and suboptimal design. Much further investigation is needed into the effectiveness of patient safety curricula.

Clinical examiners, simulated patients, and student self-assessed empathy in medical students during a psychiatry objective structured clinical examination.

PubMed

O'Connor, Karen; King, Romaine; Malone, Kevin M; Guerandel, Allys

2014-08-01

This study aims to assess and compare objective and subjective scores of empathy in final-year medical students by using firstly a validated student self-assessment just prior to the psychiatry objective structured clinical examination (OSCE), and then comparing this to clinical examiner's and simulated patient's (SP's) assessments of empathy of students using a Global Rating of Empathy scale (GRE) during a psychiatry OSCE. In 2011, all final-year medical students in the University College Dublin were invited to complete a subjective, self-assessed empathy questionnaire (The Jefferson scale of physician empathy-student version (JSPE-S)). They were also assessed for empathy in four OSCEs by the clinical examiner and the SP acting in that OSCE scenario. Included in the analysis were 163 of 184 final-year students JSPE-S (88.6%) questionnaires. The female students scores on the JSPE-S were significantly higher than those of their male peers (t=3.34, p=0.001). Concurrent validity was greater between the SPs' assessments of empathy in the OSCE and the JSPE-S score than between the clinical examiners assessments of empathy and the JSPE-S score (r=0.23, p<0.005; r=0.14, p<0.08). Inter-rater reliability of SP's and clinical examiner's using the GRE was found to be high (F=0.868 (df=171, 171), p value<0.001). SPs may be valid assessors of empathy in medical students during an OSCE.

Non-contact local temperature measurement inside an object using an infrared point detector

NASA Astrophysics Data System (ADS)

Hisaka, Masaki

2017-04-01

Local temperature measurement in deep areas of objects is an important technique in biomedical measurement. We have investigated a non-contact method for measuring temperature inside an object using a point detector for infrared (IR) light. An IR point detector with a pinhole was constructed and the radiant IR light emitted from the local interior of the object is photodetected only at the position of pinhole located in imaging relation. We measured the thermal structure of the filament inside the miniature bulb using the IR point detector, and investigated the temperature dependence at approximately human body temperature using a glass plate positioned in front of the heat source.

Measurement of Cognitive Load in Multimedia Learning: A Comparison of Different Objective Measures

ERIC Educational Resources Information Center

Korbach, Andreas; Brünken, Roland; Park, Babette

2017-01-01

Different indicators are interesting for analyzing human learning processes. Recent studies analyze learning performance in combination with cognitive load, as an indicator for learners' invested mental effort. In order to compare different measures of cognitive load research, the present study uses three different objective methods and one…

Use of Continuous Glucose Monitoring as an Outcome Measure in Clinical Trials

PubMed Central

Calhoun, Peter; Kollman, Craig

2012-01-01

Abstract Objective Although developed to be a management tool for individuals with diabetes, continuous glucose monitoring (CGM) also has potential value for the assessment of outcomes in clinical studies. We evaluated using CGM as such an outcome measure. Research Design and Methods Data were analyzed from six previously completed inpatient studies in which both CGM (Freestyle Navigator™ [Abbott Diabetes Care, Alameda, CA] or Guardian® [Medtronic, Northridge, CA]) and reference glucose measurements were available. The analyses included 97 days of data from 93 participants with type 1 diabetes (age range, 5–57 years; mean, 18±12 years). Results Mean glucose levels per day were similar for the CGM and reference measurements (median, 148 mg/dL vs. 143 mg/dL, respectively; P=0.92), and the correlation of the two was high (r=0.89). Similarly, most glycemia metrics showed no significant differences comparing CGM and reference values, except that the nadir glucose tended to be slightly lower and peak glucose slightly higher with reference measurements than CGM measurements (respective median, 59 mg/dL vs. 66 mg/dL [P=0.05] and 262 mg/dL vs. 257 mg/dL [P=0.003]) and glucose variability as measured with the coefficient of variation was slightly lower with CGM than reference measurements (respective median, 31% vs. 35%; P<0.001). Conclusions A reasonably high degree of concordance exists when comparing outcomes based on CGM measurements with outcomes based on reference blood glucose measurements. CGM inaccuracy and underestimation of the extremes of hyperglycemia and hypoglycemia can be accounted for in a clinical trial's study design. Thus, in appropriate settings, CGM can be a very meaningful and feasible outcome measure for clinical trials. PMID:23013201

The Reliability, Validity, and Usefulness of the Objective Structured Clinical Examination (OSCE) in Dental Education

ERIC Educational Resources Information Center

Graham, Roseanna

2010-01-01

This study evaluated the reliability, validity, and educational usefulness of a comprehensive, multidisciplinary Objective Structured Clinical Examination (OSCE) in dental education. The OSCE was administered to dental students at the Columbia University College of Dental Medicine (CDM) before they entered clinical training. Participants in this…

Facilitating peer based learning through summative assessment - An adaptation of the Objective Structured Clinical Assessment tool for the blended learning environment.

PubMed

Wikander, Lolita; Bouchoucha, Stéphane L

2018-01-01

Adapting a course from face to face to blended delivery necessitates that assessments are modified accordingly. In Australia the Objective Structured Clinical Assessment tool, as a derivative from the Objective Structured Clinical Examination, has been used in the face-to-face delivery mode as a formative or summative assessment tool in medicine and nursing since 1990. The Objective Structured Clinical Assessment has been used at Charles Darwin University to assess nursing students' simulated clinical skills prior to the commencement of their clinical placements since 2008. Although the majority of the course is delivered online, students attend a one-week intensive clinical simulation block yearly, prior to attending clinical placements. Initially, the Objective Structured Clinical Assessment was introduced as a lecturer assessed summative assessment, over time it was adapted to better suit the blended learning environment. The modification of the tool from an academic to peer assessed assessment tool, was based on the empirical literature, student feedback and a cross-sectional, qualitative study exploring academics' perceptions of the Objective Structured Clinical Assessment (Bouchoucha et al., 2013a, b). This paper presents an overview of the process leading to the successful adaptation of the Objective Structured Clinical Assessment to suit the requirements of a preregistration nursing course delivered through blended learning. This is significant as many universities are moving their curriculum to fully online or blended delivery, yet little attention has been paid to adapting the assessment of simulated clinical skills. The aim is to identify the benefits and drawbacks of using the peer assessed Objective Structured Clinical Assessment and share recommendations for successful implementation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Objective measurements to evaluate glottal space segmentation from laryngeal images.

PubMed

Gutiérrez-Arriola, J M; Osma-Ruiz, V; Sáenz-Lechón, N; Godino-Llorente, J I; Fraile, R; Arias-Londoño, J D

2012-01-01

Objective evaluation of the results of medical image segmentation is a known problem. Applied to the task of automatically detecting the glottal area from laryngeal images, this paper proposes a new objective measurement to evaluate the quality of a segmentation algorithm by comparing with the results given by a human expert. The new figure of merit is called Area Index, and its effectiveness is compared with one of the most used figures of merit found in the literature: the Pratt Index. Results over 110 laryngeal images presented high correlations between both indexes, demonstrating that the proposed measure is comparable to the Pratt Index and it is a good indicator of the segmentation quality.

Thickness and air gap measurement of assembled IR objectives

NASA Astrophysics Data System (ADS)

Lueerss, B.; Langehanenberg, P.

2015-05-01

A growing number of applications like surveillance, thermography, or automotive demand for infrared imaging systems. Their imaging performance is significantly influenced by the alignment of the individual lens elements. Besides the lateral orientation of lenses, the air spacing between the lenses is a crucial parameter. Because of restricted mechanical accessibility within an assembled objective, a non-contact technique is required for the testing of these parameters. So far commercial measurement systems were not available for testing of IR objectives since many materials used for infrared imaging are non-transparent at wavelengths below 2 μm. We herewith present a time-domain low coherent interferometer capable of measuring any kind of infrared material (e.g., Ge, Si, etc.) as well as VIS materials. The fiber-optic set-up is based on a Michelson-Interferometer in which the light from a broadband super-luminescent diode is split into a reference arm with a variable optical delay and a measurement arm where the sample is placed. On a photo detector, the reflected signals from both arms are superimposed and recorded as a function of the variable optical path. Whenever the group delay difference is zero, a coherence peak occurs and the relative lens' surface distances are derived from the optical delay. In order to penetrate IR materials, the instrument operates at 2.2 μm. The set-up allows the contactless determination of thicknesses and air gaps inside of assembled infrared objective lenses with accuracy in the micron range. It therefore is a tool for the precise manufacturing or quality control.

Thickness and air gap measurement of assembled IR objectives

NASA Astrophysics Data System (ADS)

Lueerss, B.; Langehanenberg, P.

2015-10-01

A growing number of applications like surveillance, thermography, or automotive demand for infrared imaging systems. Their imaging performance is significantly influenced by the alignment of the individual lenses. Besides the lateral orientation of lenses, the air spacing between the lenses is a crucial parameter. Because of restricted mechanical accessibility within an assembled objective, a non-contact technique is required for the testing of these parameters. So far, commercial measurement systems were not available for testing of IR objectives since most materials used for infrared imaging are non-transparent at wavelengths below 2 μm. We herewith present a time-domain low coherent interferometer capable of measuring any kind of infrared material (e.g., Ge, Si, etc.) as well as VIS materials. The set-up is based on a Michelson interferometer in which the light from a broadband superluminescent diode is split into a reference arm with a variable optical delay and a measurement arm where the sample is placed. On a detector, the reflected signals from both arms are superimposed and recorded as a function of the variable optical path. Whenever the group delay difference is zero, a coherence peak occurs and the relative distances of the lens surfaces are derived from the optical delay. In order to penetrate IR materials, the instrument operates at 2.2 μm. Together with an LWIR autocollimator, this technique allows for the determination of centering errors, lens thicknesses and air spacings of assembled IR objective lenses with a micron accuracy. It is therefore a tool for precision manufacturing and quality control.

Persistent fatigue in young athletes: measuring the clinical course and identifying variables affecting clinical recovery.

PubMed

Locke, S; Osborne, M; O'Rourke, P

2011-02-01

The objective of this paper is to measure the clinical course (months) in young athletes with persistent fatigue and to identify any covariates affecting the duration of recovery. This was a prospective longitudinal study of 68 athletes; 87% were elite (42 males, 26 females), aged 20.5±3.74 years (SD), who presented with the symptom of persistent fatigue. The collective duration to full clinical recovery was estimated using Kaplan-Meier product-limit curves, and covariates associated with prolonging recovery were identified from Cox proportional hazard models. The median recovery was 5 months (range 1-60 months). The range of presenting symptom duration was 0.5-36 months. The covariates identified were an increased duration of presenting symptoms [hazard ratio (HR), 1.06; 95% confidence interval (CI), 1.02-1.12; P=0.005] and the response of serum cortisol concentration to a standard exercise challenge (HR, 1.92; 95% CI, 1.09-3.38; P=0.03). Delay in recovery was not associated with categories of fatigue that included medical, training-related diagnoses, or other causes. In conclusion, the fatigued athlete represents a significant clinical problem with a median recovery of 5 months, whose collective clinical course to recovery can be estimated by Kaplan-Meier curves and appears to be a continuum. © 2009 John Wiley & Sons A/S.

The need for an objective measure in septorhinoplasty surgery: are we any closer to finding an answer?

PubMed

Andrews, P J; Choudhury, N; Takhar, A; Poirrier, A L; Jacques, T; Randhawa, P S

2015-12-01

To assess the reliability of nasal inspiratory peak flow (NIPF) in providing a clinically accurate objective measure following functional septorhinoplasty by comparing it to the validated disease-specific quality-of-life questionnaire, SNOT-22. Studies so far have demonstrated poor correlation between bilateral NIPF and symptom-specific nasal questionnaires following septorhinoplasty. To perform a prospective comparative analysis between NIPF and the validated disease-specific quality-of-life questionnaire SNOT-22 and to determine whether a correlation exists following septorhinoplasty surgery. The Royal National Throat Nose and Ear Hospital, London. A total of 122 patients (78 males, 44 females; mean age 33.5 ± 12.2 years) were recruited from the senior authors rhinology clinic and underwent functional septorhinoplasty surgery. Preoperative and postoperative nasal inspiratory peak flow (NIPF) measurements were performed in addition to the completion of three subjective quality-of-life and symptom assessment tool questionnaires; Sinonasal Outcome Test 22 (SNOT-22), Nasal Obstruction Symptom Evaluation (NOSE) and Visual Analogue Scale (VAS: 0-10). The mean preoperative NIPF was 88.2 L/min, and the postoperative value was 101.6 L/min and showed a significant improvement following surgery (P = 0.0064). The mean total SNOT-22 score improved significantly from 48.6 to 26.6 (P < 0.0001); the NOSE score from 14.1 to 6.6 (P < 0.0001); and the Visual Analogue Scale (VAS) blockage score from 6.9 to 3.2 (P < 0.0001). All individual domains assessed showed improvements postoperatively, but no correlation was found between the NIPF and SNOT-22 score. Equally, we did not find a correlation between NIPF and the symptom-specific NOSE questionnaire and the nasal blockage domain on the Visual Analogue Scale (VAS) scale. We have demonstrated that NIPF does not correlate with the SNOT-22 disease-specific questionnaire, although both outcomes significantly improve postoperatively. At

Measuring the circular motion of small objects using laser stroboscopic images.

PubMed

Wang, Hairong; Fu, Y; Du, R

2008-01-01

Measuring the circular motion of a small object, including its displacement, speed, and acceleration, is a challenging task. This paper presents a new method for measuring repetitive and/or nonrepetitive, constant speed and/or variable speed circular motion using laser stroboscopic images. Under stroboscopic illumination, each image taken by an ordinary camera records multioutlines of an object in motion; hence, processing the stroboscopic image will be able to extract the motion information. We built an experiment apparatus consisting of a laser as the light source, a stereomicroscope to magnify the image, and a normal complementary metal oxide semiconductor camera to record the image. As the object is in motion, the stroboscopic illumination generates a speckle pattern on the object that can be recorded by the camera and analyzed by a computer. Experimental results indicate that the stroboscopic imaging is stable under various conditions. Moreover, the characteristics of the motion, including the displacement, the velocity, and the acceleration can be calculated based on the width of speckle marks, the illumination intensity, the duty cycle, and the sampling frequency. Compared with the popular high-speed camera method, the presented method may achieve the same measuring accuracy, but with much reduced cost and complexity.

Functional Requirements: 2014 No Child Left Behind--Annual Measurable Achievement Objectives

ERIC Educational Resources Information Center

Minnesota Department of Education, 2014

2014-01-01

This document describes the Minnesota No Child Left Behind (NCLB) calculation as it relates to measuring Title III districts for Annual Measurable Achievement Objectives (AMAO). In 2012, a new assessment was used to measure language proficiency skills for English Learners. New AMAO targets were created, and new values for determining individual…

Math: Figure and Object Characteristics. Measurement and Geometry. Grades K-9. Revised Edition.

ERIC Educational Resources Information Center

Instructional Objectives Exchange, Los Angeles, CA.

To help classroom teachers construct mathematics tests, thirty-seven general objectives, corresponding sub-objectives, sample test items, and answers are presented. In general, sub-objectives are arranged in increasing order of difficulty. The objectives were written to comprehensively cover two categories: measurement and geometry. Measurement…

Measures of rheumatoid arthritis disease activity in Australian clinical practice.

PubMed

Taylor, Andrew; Bagga, Hanish

2011-01-01

Objectives. To investigate which rheumatoid arthritis (RA) disease activity measures are being collected in patients receiving glucocorticoids, non-biologic or biologic disease-modifying antirheumatic drugs (DMARDs) in Australian rheumatology practice. Methods. A retrospective audit of medical records was conducted from eight rheumatology practices around Australia. Each rheumatologist recruited 30 consecutive eligible patients into the review, 10 of whom must have been receiving a biological agent for rheumatoid arthritis. Disease activity measures and radiographic assessments were collected from each patient's last consultation. For biologic patients, disease activity measures were also collected from when the patient was first initiated on the biological agent. Results. At last consultation, the disease measures that were recorded most often were ESR (89.2%), haemoglobin (87.5%), and CRP (84.2%). DAS28 was infrequently recorded (16.3%). The rate of recording disease activity measures for patients receiving biologic DMARDs decreased over time (mean 27 months). Conclusion. This review has shown inconsistency of RA activity measures being recorded in Australian rheumatology clinical practice. An accurate assessment of the disease process is necessary to effectively target rheumatoid arthritis patients to treat in order to achieve optimal outcomes.

[Do you measure gait speed in your daily clinical practice? A review].

PubMed

Inzitari, Marco; Calle, Alicia; Esteve, Anna; Casas, Álvaro; Torrents, Núria; Martínez, Nicolás

Gait speed (GS), measured at usual pace, is an easy, quick, reliable, non-expensive and informative measurement. With a standard chronometer, like those that currently found in mobile phones, and with two marks on the floor, trained health professionals obtain a more objective and quick measurement compared with many geriatric scales used in daily practice. GS is one of the pillars of the frailty phenotype, and is closely related to sarcopenia. It is a powerful marker of falls incidence, disability and death, mostly useful in the screening of older adults that live in the community. In recent years, the evidence is reinforcing the usefulness of GS in acute care and post-surgical patients. Its use in patients with cognitive impairment is suggested, due to the strong link between cognitive and physical function. Although GS meets the criteria for a good geriatric screening tool, it is not much used in clinical practice. Why? This review has different aims: (i)disentangling the relationship between GS and frailty; (ii)reviewing the protocols to measure GS and the reference values; (iii)reviewing the evidence in different clinical groups (older adults with frailty, with cognitive impairment, with cancer or other pathologies), and in different settings (community, acute care, rehabilitation), and (iv)speculating about the reasons for its poor use in clinical practice and about the gaps to be filled. Copyright © 2016 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

Utilising the Intel RealSense Camera for Measuring Health Outcomes in Clinical Research.

PubMed

Siena, Francesco Luke; Byrom, Bill; Watts, Paul; Breedon, Philip

2018-02-05

Applications utilising 3D Camera technologies for the measurement of health outcomes in the health and wellness sector continues to expand. The Intel® RealSense™ is one of the leading 3D depth sensing cameras currently available on the market and aligns itself for use in many applications, including robotics, automation, and medical systems. One of the most prominent areas is the production of interactive solutions for rehabilitation which includes gait analysis and facial tracking. Advancements in depth camera technology has resulted in a noticeable increase in the integration of these technologies into portable platforms, suggesting significant future potential for pervasive in-clinic and field based health assessment solutions. This paper reviews the Intel RealSense technology's technical capabilities and discusses its application to clinical research and includes examples where the Intel RealSense camera range has been used for the measurement of health outcomes. This review supports the use of the technology to develop robust, objective movement and mobility-based endpoints to enable accurate tracking of the effects of treatment interventions in clinical trials.

Attitudes and perceptions towards novel objective measures of ARV-based vaginal ring use: Results from a global stakeholder survey

PubMed Central

Tharaldson, Jenae; Owen, Derek H.; Okumu, Eunice; Moench, Thomas; Mack, Natasha; Tolley, Elizabeth E.; MacQueen, Kathleen M.

2017-01-01

Results of recent microbicide and pre-exposure prophylaxis clinical trials have shown adherence to be a significant challenge with new HIV prevention technologies. As the vaginal ring containing dapivirine moves into two open label follow-on studies (HOPE/MTN-025 and DREAM) and other antiretroviral-based and multi-purpose prevention technology ring products advance through the development pipeline, there is a need for more accurate and reliable measures of adherence to microbicide ring products. We previously conducted a comprehensive landscape analysis to identify new technologies that could be applied to adherence measurement of vaginal rings containing antiretrovirals. To explore attitudes and perceptions towards the approaches that we identified, we conducted a survey of stakeholders with experience and expertise in microbicide and HIV prevention clinical trials. From May to July 2015 an electronic survey was distributed via email to 894 stakeholders; a total of 206 eligible individuals responded to at least one question and were included in the data analysis. Survey respondents were presented with various objective measures and asked about their perceived acceptability to trial participants, feasibility of implementation by study staff, usefulness for measuring adherence and ethical concerns. Methods that require no additional input from the participant and require no modifications to the existing ring product (i.e., measurement of residual drug or excipient, or a vaginal analyte that enters the ring) were viewed as being more acceptable to trial participants and more feasible to implement in the field. Respondents saw value in using objective measures to provide real-time feedback on adherence. However, approaches that involve unannounced home visits for sample collection or spot checks of ring use, which could provide significant value to adherence feedback efforts, were met with skepticism. Additional research on the acceptability of these methods to

Attitudes and perceptions towards novel objective measures of ARV-based vaginal ring use: Results from a global stakeholder survey.

PubMed

Stalter, Randy M; Tharaldson, Jenae; Owen, Derek H; Okumu, Eunice; Moench, Thomas; Mack, Natasha; Tolley, Elizabeth E; MacQueen, Kathleen M

2017-01-01

Results of recent microbicide and pre-exposure prophylaxis clinical trials have shown adherence to be a significant challenge with new HIV prevention technologies. As the vaginal ring containing dapivirine moves into two open label follow-on studies (HOPE/MTN-025 and DREAM) and other antiretroviral-based and multi-purpose prevention technology ring products advance through the development pipeline, there is a need for more accurate and reliable measures of adherence to microbicide ring products. We previously conducted a comprehensive landscape analysis to identify new technologies that could be applied to adherence measurement of vaginal rings containing antiretrovirals. To explore attitudes and perceptions towards the approaches that we identified, we conducted a survey of stakeholders with experience and expertise in microbicide and HIV prevention clinical trials. From May to July 2015 an electronic survey was distributed via email to 894 stakeholders; a total of 206 eligible individuals responded to at least one question and were included in the data analysis. Survey respondents were presented with various objective measures and asked about their perceived acceptability to trial participants, feasibility of implementation by study staff, usefulness for measuring adherence and ethical concerns. Methods that require no additional input from the participant and require no modifications to the existing ring product (i.e., measurement of residual drug or excipient, or a vaginal analyte that enters the ring) were viewed as being more acceptable to trial participants and more feasible to implement in the field. Respondents saw value in using objective measures to provide real-time feedback on adherence. However, approaches that involve unannounced home visits for sample collection or spot checks of ring use, which could provide significant value to adherence feedback efforts, were met with skepticism. Additional research on the acceptability of these methods to

3D shape measurement of moving object with FFT-based spatial matching

NASA Astrophysics Data System (ADS)

Guo, Qinghua; Ruan, Yuxi; Xi, Jiangtao; Song, Limei; Zhu, Xinjun; Yu, Yanguang; Tong, Jun

2018-03-01

This work presents a new technique for 3D shape measurement of moving object in translational motion, which finds applications in online inspection, quality control, etc. A low-complexity 1D fast Fourier transform (FFT)-based spatial matching approach is devised to obtain accurate object displacement estimates, and it is combined with single shot fringe pattern prolometry (FPP) techniques to achieve high measurement performance with multiple captured images through coherent combining. The proposed technique overcomes some limitations of existing ones. Specifically, the placement of marks on object surface and synchronization between projector and camera are not needed, the velocity of the moving object is not required to be constant, and there is no restriction on the movement trajectory. Both simulation and experimental results demonstrate the effectiveness of the proposed technique.

Assessment of tissue fibrosis in skin biopsies from patients with systemic sclerosis employing confocal laser scanning microscopy: an objective outcome measure for clinical trials?

PubMed Central

Busquets, Joanna; Del Galdo, Francesco; Kissin, Eugene Y.

2010-01-01

Objectives. To obtain an objective, unbiased assessment of skin fibrosis in patients with SSc for use in clinical trials of SSc disease-modifying therapeutics. Methods. Skin biopsies from the dorsal forearm of six patients with diffuse SSc and six healthy controls, and skin biopsies from the forearm of one patient with diffuse SSc before and following 1 year treatment with mycophenolate mofetil were analysed by confocal laser scanning microscopy (CLSM) with specific antibodies against collagen types I and III or fibronectin. The integrated density of fluorescence (IDF) was calculated employing National Institutes of Health-ImageJ software in at least four different fields per biopsy spanning the full dermal thickness. Results. The intensities of collagen types I and III and fibronectin IDF were 174, 147 and 139% higher in SSc skin than in normal skin, respectively. All differences were statistically significant. The sum of the IDF values obtained for the three proteins yielded a comprehensive fibrosis score. The average fibrosis score for the six SSc samples was 28.3 × 106 compared with 18.6 × 106 for the six normal skin samples (P < 0.0001). Comparison of skin biopsies obtained from the same SSc patient before treatment and after 12 months of treatment with mycophenolate mofetil showed a reduction of 39% in total fibrosis score after treatment. Conclusions. CLSM followed by quantitative image analysis provides an objective and unbiased assessment of skin fibrosis in SSc and could be a useful end-point for clinical trials with disease-modifying agents to monitor the response or progression of the disease. PMID:20202926

Objective Measure of Nasal Air Emission Using Nasal Accelerometry

ERIC Educational Resources Information Center

Cler, Meredith J.; Lien, Yu-An, S.; Braden, Maia N.; Mittleman, Talia; Downing, Kerri; Stepp, Cara, E.

2016-01-01

Purpose: This article describes the development and initial validation of an objective measure of nasal air emission (NAE) using nasal accelerometry. Method: Nasal acceleration and nasal airflow signals were simultaneously recorded while an expert speech language pathologist modeled NAEs at a variety of severity levels. In addition, microphone and…

Distance Between Sets as an Objective Measure of Retrieval Effectiveness

ERIC Educational Resources Information Center

Heine, M. H.

1973-01-01

The Marczewski-Steinhaus metric provides what appears to be an objective general measure of retrieval effectiveness within the framework of set theory and the theory of metric spaces. (19 references) (Author/SJ)

Blood Pressure Measurement: Clinic, Home, Ambulatory, and Beyond

PubMed Central

Drawz, Paul E.; Abdalla, Mohamed; Rahman, Mahboob

2014-01-01

Blood pressure has traditionally been measured in the clinic setting using the auscultory method and a mercury sphygmomanometer. Technological advances have led to improvements in measuring clinic blood pressure and allowed for measuring blood pressures outside the clinic. This review outlines various methods for evaluating blood pressure and the clinical utility of each type of measurement. Home blood pressures and 24 hour ambulatory blood pressures have improved our ability to evaluate risk for target organ damage and hypertension related morbidity and mortality. Measuring home blood pressures may lead to more active participation in health care by patients and has the potential to improve blood pressure control. Ambulatory blood pressure monitoring enables the measuring nighttime blood pressures and diurnal changes, which may be the most accurate predictors of risk associated with elevated blood pressure. Additionally, reducing nighttime blood pressure is feasible and may be an important component of effective antihypertensive therapy. Finally, estimating central aortic pressures and pulse wave velocity are two of the newer methods for assessing blood pressure and hypertension related target organ damage. PMID:22521624

Standard Setting Methods for Pass/Fail Decisions on High-Stakes Objective Structured Clinical Examinations: A Validity Study.

PubMed

Yousuf, Naveed; Violato, Claudio; Zuberi, Rukhsana W

2015-01-01

CONSTRUCT: Authentic standard setting methods will demonstrate high convergent validity evidence of their outcomes, that is, cutoff scores and pass/fail decisions, with most other methods when compared with each other. The objective structured clinical examination (OSCE) was established for valid, reliable, and objective assessment of clinical skills in health professions education. Various standard setting methods have been proposed to identify objective, reliable, and valid cutoff scores on OSCEs. These methods may identify different cutoff scores for the same examinations. Identification of valid and reliable cutoff scores for OSCEs remains an important issue and a challenge. Thirty OSCE stations administered at least twice in the years 2010-2012 to 393 medical students in Years 2 and 3 at Aga Khan University are included. Psychometric properties of the scores are determined. Cutoff scores and pass/fail decisions of Wijnen, Cohen, Mean-1.5SD, Mean-1SD, Angoff, borderline group and borderline regression (BL-R) methods are compared with each other and with three variants of cluster analysis using repeated measures analysis of variance and Cohen's kappa. The mean psychometric indices on the 30 OSCE stations are reliability coefficient = 0.76 (SD = 0.12); standard error of measurement = 5.66 (SD = 1.38); coefficient of determination = 0.47 (SD = 0.19), and intergrade discrimination = 7.19 (SD = 1.89). BL-R and Wijnen methods show the highest convergent validity evidence among other methods on the defined criteria. Angoff and Mean-1.5SD demonstrated least convergent validity evidence. The three cluster variants showed substantial convergent validity with borderline methods. Although there was a high level of convergent validity of Wijnen method, it lacks the theoretical strength to be used for competency-based assessments. The BL-R method is found to show the highest convergent validity evidences for OSCEs with other standard setting methods used in the present study

Combination of optically measured coordinates and displacements for quantitative investigation of complex objects

NASA Astrophysics Data System (ADS)

Andrae, Peter; Beeck, Manfred-Andreas; Jueptner, Werner P. O.; Nadeborn, Werner; Osten, Wolfgang

1996-09-01

Holographic interferometry makes it possible to measure high precision displacement data in the range of the wavelength of the used laser light. However, the determination of 3D- displacement vectors of objects with complex surfaces requires the measurement of 3D-object coordinates not only to consider local sensitivities but to distinguish between in-plane deformation, i.e. strains, and out-of-plane components, i.e. shears, too. To this purpose both the surface displacement and coordinates have to be combined and it is advantageous to make the data available for CAE- systems. The object surface has to be approximated analytically from the measured point cloud to generate a surface mesh. The displacement vectors can be assigned to the nodes of this surface mesh for visualization of the deformation of the object under test. They also can be compared to the results of FEM-calculations or can be used as boundary conditions for further numerical investigations. Here the 3D-object coordinates are measured in a separate topometric set-up using a modified fringe projection technique to acquire absolute phase values and a sophisticated geometrical model to map these phase data onto coordinates precisely. The determination of 3D-displacement vectors requires the measurement of several interference phase distributions for at least three independent sensitivity directions depending on the observation and illumination directions as well as the 3D-position of each measuring point. These geometric quantities have to be transformed into a reference coordinate system of the interferometric set-up in order to calculate the geometric matrix. The necessary transformation can be realized by means of a detection of object features in both data sets and a subsequent determination of the external camera orientation. This paper presents a consistent solution for the measurement and combination of shape and displacement data including their transformation into simulation systems. The

Pro-Bono Service Through Student-Run Clinics: How Does Physical Therapy Measure Up?

PubMed

Stickler, Kellie; Sabus, Carla; Gustafson, Hedi; Kueser, Molly; Lavaveshkul, Bridget; Denney, Linda

2016-01-01

The objectives of this paper were to evaluate pre- to post-treatment outcomes of patients attending a student-run free physical therapy clinic in order to provide new evidence concerning patient response to student care. We hypothesize improved functional and quality of life scores as measured by outcome scales. Twenty-eight patients were included in this retrospective chart review. Data were analyzed through SPSS Statistical software (ver. 13) using paired t-tests to compare baseline and follow-up data for the following measures: blood pressure, numeric pain rating scale (NPRS), quality of life visual analog scale, SF-8 quality of life scale, and population demographics. Most of the patient population was between the ages of 30 and 59 yrs (78.4%) with an unemployment rate of 75%. Significant changes (p<0.05) were exhibited in both the physical health portion of the SF-8 survey and the NPRS. Although not statistically significant, the mental health portion of the SF-8 survey showed notable improvement. Service learning provides opportunities for students to serve the community while expanding clinical experience. The results demonstrated the effectiveness of student-run pro-bono physical therapy clinics in improving the quality of life for both physical and pain measures.

Objective Dysphonia Quantification in Vocal Fold Paralysis: Comparing Nonlinear with Classical Measures

PubMed Central

Little, Max A.; Costello, Declan A. E.; Harries, Meredydd L.

2010-01-01

Summary Clinical acoustic voice-recording analysis is usually performed using classical perturbation measures, including jitter, shimmer, and noise-to-harmonic ratios (NHRs). However, restrictive mathematical limitations of these measures prevent analysis for severely dysphonic voices. Previous studies of alternative nonlinear random measures addressed wide varieties of vocal pathologies. Here, we analyze a single vocal pathology cohort, testing the performance of these alternative measures alongside classical measures. We present voice analysis pre- and postoperatively in 17 patients with unilateral vocal fold paralysis (UVFP). The patients underwent standard medialization thyroplasty surgery, and the voices were analyzed using jitter, shimmer, NHR, nonlinear recurrence period density entropy (RPDE), detrended fluctuation analysis (DFA), and correlation dimension. In addition, we similarly analyzed 11 healthy controls. Systematizing the preanalysis editing of the recordings, we found that the novel measures were more stable and, hence, reliable than the classical measures on healthy controls. RPDE and jitter are sensitive to improvements pre- to postoperation. Shimmer, NHR, and DFA showed no significant change (P > 0.05). All measures detect statistically significant and clinically important differences between controls and patients, both treated and untreated (P < 0.001, area under curve [AUC] > 0.7). Pre- to postoperation grade, roughness, breathiness, asthenia, and strain (GRBAS) ratings show statistically significant and clinically important improvement in overall dysphonia grade (G) (AUC = 0.946, P < 0.001). Recalculating AUCs from other study data, we compare these results in terms of clinical importance. We conclude that, when preanalysis editing is systematized, nonlinear random measures may be useful for monitoring UVFP-treatment effectiveness, and there may be applications to other forms of dysphonia. PMID:19900790

Multiple wavelength interferometry for distance measurements of moving objects with nanometer uncertainty

NASA Astrophysics Data System (ADS)

Kuschmierz, R.; Czarske, J.; Fischer, A.

2014-08-01

Optical measurement techniques offer great opportunities in diverse applications, such as lathe monitoring and microfluidics. Doppler-based interferometric techniques enable simultaneous measurement of the lateral velocity and axial distance of a moving object. However, there is a complementarity between the unambiguous axial measurement range and the uncertainty of the distance. Therefore, we present an extended sensor setup, which provides an unambiguous axial measurement range of 1 mm while achieving uncertainties below 100 nm. Measurements at a calibration system are performed. When using a pinhole for emulating a single scattering particle, the tumbling motion of the rotating object is resolved with a distance uncertainty of 50 nm. For measurements at the rough surface, the distance uncertainty amounts to 280 nm due to a lower signal-to-noise ratio. Both experimental results are close to the respective Cramér-Rao bound, which is derived analytically for both surface and single particle measurements.

Determinants of Objectively Measured Physical Functional Performance in Early to Mid-stage Parkinson Disease

PubMed Central

Kluger, Benzi M.; Brown, R. Preston; Aerts, Shanae; Schenkman, Margaret

2014-01-01

Background Parkinson disease (PD) may lead to functional limitations through both motor and non-motor symptoms. While patients with advanced disease have well-documented and profound functional limitations, less is known about the determinants of function in early to mid-stage disease where interventions may be more likely to benefit and preserve function. Objective The objective of the current study was to identify motor, cognitive and gait determinants of physical functional performance in patients with early to mid-stage PD. Design Secondary analysis of cross-sectional baseline data from a randomized clinical trial of exercise. Setting Tertiary academic medical center. Participants 121 patients with early to mid-stage PD. Methods Our functional performance outcomes included: 1) the Continuous Scale Functional Performance Test (CS-PFP; primary outcome); 2) the timed up and go (TUG) tests; and Section 2 (Activities of Daily Living) of the Unified Parkinson's Disease Rating Scale (UPDRS). Explanatory variables included measures of disease severity, motor function, cognitive function, balance and gait. Step-wise linear regression models were used to determine correlations between explanatory variables and outcome measures. Results In our regression models the CS-PFP significantly correlated with walking endurance (six minute walk; r2 = 0.12, p < .0001), turning ability (360 degree turn; r2 = .03, p = .002), attention (brief test of attention; r2 = .01, p = .03), overall cognitive status (Mini-mental State Examination; r2 = .01, p = .04) and bradykinesia (timed tapping; r2 = .02, p = .02). The TUG significantly correlated with walking speed (5 meter walk; r2 = 0.33, p <.0001), stride length (r2 = 0.25, p <.0001), turning ability (360 turn r2 = .05, p = .0003) and attention (r2 = .016, p = .03). Section 2 of the UPDRS was significantly correlated with endurance (r2 = .09, p < .0001), turning ability (r2 = .03, p = .001) and attention (r2 = .01, p = .03). Conclusions

Objective and subjective measurement of sleep disturbance in female trauma survivors with posttraumatic stress disorder.

PubMed

Werner, Kimberly B; Griffin, Michael G; Galovski, Tara E

2016-06-30

Sleep disturbance may be the most often endorsed symptom of posttraumatic stress disorder (PTSD). Much of this research is based on subjective reports from trauma survivors; however, objective measures of sleep-related impairment have yielded findings inconsistent with self-report data. More studies investigating subjective and objective assessments concordantly are needed to understand sleep impairment in PTSD. The current study examined PTSD-related sleep disturbance in a female interpersonal violence cohort with full PTSD diagnoses (N=51) assessing subjective (global and daily diary measures) and objective (actigraphy) sleep measures concurrently. PTSD severity was positively associated with global, subjective reports of sleep impairment and insomnia. Subjective measures of sleep (including global sleep impairment, insomnia, and daily sleep diary reports of total sleep time, sleep efficiency, and sleep onset latency) were moderately to strongly correlated. However, no significant correlations between subjective and objective reports of sleep impairment were found in this cohort. Analyses demonstrated an overall elevation in subjectively reported sleep impairment when compared to objective measurement assessed concurrently. Findings demonstrate a lack of agreement between subjective and objective measurements of sleep in a PTSD-positive female cohort, suggesting objective and subjective sleep impairments are distinct sleep parameters that do not necessarily directly co-vary. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Relationship between parental estimate and an objective measure of child television watching

PubMed Central

Robinson, Jodie L; Winiewicz, Dana D; Fuerch, Janene H; Roemmich, James N; Epstein, Leonard H

2006-01-01

Many young children have televisions in their bedrooms, which may influence the relationship between parental estimate and objective measures of child television usage/week. Parental estimates of child television time of eighty 4–7 year old children (6.0 ± 1.2 years) at the 75th BMI percentile or greater (90.8 ± 6.8 BMI percentile) were compared to an objective measure of television time obtained from TV Allowance™ devices attached to every television in the home over a three week period. Results showed that parents overestimate their child's television time compared to an objective measure when no television is present in the bedroom by 4 hours/week (25.4 ± 11.5 vs. 21.4 ± 9.1) in comparison to underestimating television time by over 3 hours/week (26.5 ± 17.2 vs. 29.8 ± 14.4) when the child has a television in their bedroom (p = 0.02). Children with a television in their bedroom spend more objectively measured hours in television time than children without a television in their bedroom (29.8 ± 14.2 versus 21.4 ± 9.1, p = 0.003). Research on child television watching should take into account television watching in bedrooms, since it may not be adequately assessed by parental estimates. PMID:17129381

Introducing the Objective Structured Clinical Examination (OSCE) in the Undergraduate Psychiatric Curriculum: Evaluation after One Year

ERIC Educational Resources Information Center

Zahid, Muhammad Ajmal; Al-Zayed, Adel; Ohaeri, Jude; Varghese, Ramani

2011-01-01

Objective: The Objective Structured Clinical Examination (OSCE) was introduced in undergraduate psychiatry clerkship in 2008. The authors studied the effect of OSCE on the students' performance. Methods: The "short case" (SC) and "oral examination" (OE), two of the five components of the previous assessment format, were…

Adapting Objective Structured Clinical Examinations to Assess Social Work Students' Performance and Reflections

ERIC Educational Resources Information Center

Bogo, Marion; Regehr, Cheryl; Logie, Carmen; Katz, Ellen; Mylopoulos, Maria; Regehr, Glenn

2011-01-01

The development of standardized, valid, and reliable methods for assessment of students' practice competence continues to be a challenge for social work educators. In this study, the Objective Structured Clinical Examination (OSCE), originally used in medicine to assess performance through simulated interviews, was adapted for social work to…

Toward an objective measure of functional disability in dysferlinopathy.

PubMed

Woudt, Lisanne; Di Capua, Gabriella A; Krahn, Martin; Castiglioni, Claudia; Hughes, Ricardo; Campero, Mario; Trangulao, Alejandra; González-Hormazábal, Patricio; Godoy-Herrera, Raúl; Lévy, Nicolas; Urtizberea, Jon Andoni; Jara, Lilian; Bevilacqua, Jorge A

2016-01-01

Understanding the natural history of dysferlinopathy is essential to design and quantify novel therapeutic protocols. Our aim in this study was to assess, clinically and functionally, a cohort of patients with dysferlinopathy, using validated scales. Thirty-one patients with genetically confirmed dysferlinopathy were assessed using the motor function measure (MFM), Modified Rankin Scale (MRS), Muscle Research Council (MRC) scale, serum creatine kinase (CK) assessment, baseline spirometry data, and echocardiographic and electrophysiologic studies. MFM and MRC scores showed a significant negative correlation with disease duration and inverse correlation with MRS, but not with onset age, clinical phenotype, or CK levels. Percent forced vital capacity (%FVC) correlated negatively with disease duration and onset age. Eight known pathogenic mutations were identified recurrently, 4 of which accounted for 79% of the total. The results suggest that MFM is a reliable outcome measure that may be useful for longitudinal follow-up in dysferlinopathy. Recurrent mutations suggest a founder effect in the Chilean population. © 2015 Wiley Periodicals, Inc.

Automatic trajectory measurement of large numbers of crowded objects

NASA Astrophysics Data System (ADS)

Li, Hui; Liu, Ye; Chen, Yan Qiu

2013-06-01

Complex motion patterns of natural systems, such as fish schools, bird flocks, and cell groups, have attracted great attention from scientists for years. Trajectory measurement of individuals is vital for quantitative and high-throughput study of their collective behaviors. However, such data are rare mainly due to the challenges of detection and tracking of large numbers of objects with similar visual features and frequent occlusions. We present an automatic and effective framework to measure trajectories of large numbers of crowded oval-shaped objects, such as fish and cells. We first use a novel dual ellipse locator to detect the coarse position of each individual and then propose a variance minimization active contour method to obtain the optimal segmentation results. For tracking, cost matrix of assignment between consecutive frames is trainable via a random forest classifier with many spatial, texture, and shape features. The optimal trajectories are found for the whole image sequence by solving two linear assignment problems. We evaluate the proposed method on many challenging data sets.

Correlations of Clinical and Laboratory Measures of Balance in Older Men and Women: The MOBILIZE Boston Study

PubMed Central

Nguyen, Uyen-Sa D.T.; Kiel, Douglas P.; Li, Wenjun; Galica, Andrew M.; Kang, Hyun Gu; Casey, Virginia A.; Hannan, Marian T.

2012-01-01

Objective Impaired balance is associated with falls in older adults. However, there is no accepted gold standard on how balance should be measured. Few studies have examined measures of postural sway and clinical balance concurrently in large samples of community-dwelling older adults. We examined the associations among four types of measures of laboratory- and clinic-based balance in a large population-based cohort of older adults. Methods We evaluated balance measures in the MOBILIZE Boston Study (276 men, 489 women, 64–97 years). Measures included: (1) laboratory-based anteroposterior (AP) path length and average sway speed, mediolateral (ML) average sway and root-mean-square, and area of ellipse postural sway; (2) Short Physical Performance Battery (SPPB); (3) Berg Balance Scale; and (4) one-leg stand. Spearman Rank Correlation Coefficients (r) were assessed among the balance measures. Results Area of ellipse sway was highly correlated with the ML sway measures (r >0.9, p < 0.0001), and sway speed was highly correlated with AP sway (r=0.97, p < 0.0001). The Berg Balance Scale was highly correlated with SPPB (r=0.7, p<0.001), and one-leg stand (r=0.8, p<0.001). Correlations between the laboratory- and clinic-based balance measures were low but statistically significant (0.2 < r < 0.3, p<0.0001). Conclusion Clinic-based balance measures, and laboratory-based measures comparing area of ellipse with ML sways or sway speed with AP sway, are highly correlated. Clinic- with laboratory-based measures are less correlated. As both laboratory- and clinic-based measures inform balance in older adults but are not highly correlated with each other, future work should investigate the differences. PMID:22745045

Objectively-measured outdoor time and physical and psychological function among older adults.

PubMed

Harada, Kazuhiro; Lee, Sangyoon; Lee, Sungchul; Bae, Seongryu; Harada, Kenji; Suzuki, Takao; Shimada, Hiroyuki

2017-10-01

Objective measurements of outdoor time are essential to establishing evidence about the health benefits of going outdoors among older adults. To better understanding the health benefits of going outdoors, clarification of potential mediators to connect going outdoors with health benefits is necessary. The present study aimed to investigate associations of objectively-measured outdoor time with older adults' physical and psychological function, and examine the mediating role of physical activity on these associations. Baseline data from a randomized control trial of physical activity among older adults with global cognitive impairment was used. Data from 192 participants were analyzed. Measures included steps-per-day, objectively-measured outdoor time per day using global positioning systems, physical function (cardiorespiratory fitness, lower-extremity strength), psychological function (depression, well-being) and basic factors. Path analysis showed that outdoor time was significantly associated with steps-per-day (path coefficient = 0.23) and depression (path coefficient = -0.16). Outdoor time was not directly associated with cardiorespiratory fitness, lower-extremity strength and well-being. However, steps-per-day was associated with cardiorespiratory fitness (path coefficient = 0.18), lower-extremity strength (path coefficient = -0.22) and well-being (path coefficient = 0.14). We found that objectively-measured outdoor time was indirectly associated with physical function, and both directly and indirectly with psychological function through physical activity among older adults. This finding indicates that going outdoors influences older adults' health outcomes, and is mainly mediated by physical activity. Geriatr Gerontol Int 2017; 17: 1455-1462. © 2016 Japan Geriatrics Society.

Competency-Based Training: Objective Structured Clinical Exercises (OSCE) in Marriage and Family Therapy

ERIC Educational Resources Information Center

Miller, John K.

2010-01-01

The field of marriage and family therapy (MFT) has recently engaged in the process of defining core competencies for the profession. Many MFT training programs are adapting their curriculum to develop more competency-based training strategies. The Objective Structured Clinical "Examination" (OSCE) is widely used in the medical profession to assess…

The better way to determine the validity, reliability, objectivity and accuracy of measuring devices.

PubMed

Pazira, Parvin; Rostami Haji-Abadi, Mahdi; Zolaktaf, Vahid; Sabahi, Mohammadfarzan; Pazira, Toomaj

2016-06-08

In relation to statistical analysis, studies to determine the validity, reliability, objectivity and precision of new measuring devices are usually incomplete, due in part to using only correlation coefficient and ignoring the data dispersion. The aim of this study was to demonstrate the best way to determine the validity, reliability, objectivity and accuracy of an electro-inclinometer or other measuring devices. Another purpose of this study is to answer the question of whether reliability and objectivity represent accuracy of measuring devices. The validity of an electro-inclinometer was examined by mechanical and geometric methods. The objectivity and reliability of the device was assessed by calculating Cronbach's alpha for repeated measurements by three raters and by measurements on the same person by mechanical goniometer and the electro-inclinometer. Measurements were performed on "hip flexion with the extended knee" and "shoulder abduction with the extended elbow." The raters measured every angle three times within an interval of two hours. The three-way ANOVA was used to determine accuracy. The results of mechanical and geometric analysis showed that validity of the electro-inclinometer was 1.00 and level of error was less than one degree. Objectivity and reliability of electro-inclinometer was 0.999, while objectivity of mechanical goniometer was in the range of 0.802 to 0.966 and the reliability was 0.760 to 0.961. For hip flexion, the difference between raters in joints angle measurement by electro-inclinometer and mechanical goniometer was 1.74 and 16.33 degree (P<0.05), respectively. The differences for shoulder abduction measurement by electro-inclinometer and goniometer were 0.35 and 4.40 degree (P<0.05). Although both the objectivity and reliability are acceptable, the results showed that measurement error was very high in the mechanical goniometer. Therefore, it can be concluded that objectivity and reliability alone cannot determine the accuracy

[An objective measurement of physical property of the human uterine cervix and its clinical significance].

PubMed

Amano, K

1983-02-01

A new mechanical instrument, "Cervical Texturometer", has been developed for the objective measurement of cervical consistency by the use of TENSIPRESSER which was originally developed to evaluate the texture of food. The values obtained thereby have been found highly reproducible. 1. The anterior lip of the cervix was kept pressed between the disks to maintain the strain. Initial height, H(0), of the recorded stress-relaxation curve was defined as "Hardness" (100g load = 20 consistency units: C.U.) and the ratio H(0)/H(10)(H(10) = hardness after strain of 10 sec.) as "Viscoelastic Index (V.E.I.)" 2. The values of C.U. and V.E.I. were significantly correlated with the uronic acid/hydroxyproline ratio of the cervix. They gradually decreased with the progress of pregnancy under the possible influence of the changes of hormonal milieu irrespective of the presence or absence of uterine contraction. They did not change significantly, however, after 37 weeks of gestation or 2-3 weeks before the onset of labor. 3. Administration of DHAS improved the cervical consistency effectively in terms of the values of C.U. and V.E.I.. When the cervix is noted to have C.U. greater than or equal to 30, V.E.I. greater than or equal to 0.65 at the 37 weeks of gestation, administration of DHAS (200mg weekly X 2) is recommended to ripen the cervix.

Objective Structured Clinical Examination as an Assessment Tool for Clinical Skills in Dermatology.

PubMed

Saceda-Corralo, D; Fonda-Pascual, P; Moreno-Arrones, Ó M; Alegre-Sánchez, A; Hermosa-Gelbard, Á; Jiménez-Gómez, N; Vañó-Galván, S; Jaén-Olasolo, P

2017-04-01

Objective Structured Clinical Evaluation (OSCE) is an excellent method to evaluate student's abilities, but there are no previous reports implementing it in dermatology. To determine the feasibility of implementation of a dermatology OSCE in the medical school. Five stations with standardized patients and image-based assessment were designed. A specific checklist was elaborated in each station with different items which evaluated one competency and were classified into five groups (medical history, physical examination, technical skills, case management and prevention). A total of 28 students were tested. Twenty-five of them (83.3%) passed the exam globally. Concerning each group of items tested: medical interrogation had a mean score of 71.0; physical examination had a mean score of 63.0; management had a mean score of 58.0; and prevention had a mean score of 58.0 points. The highest results were obtained in interpersonal skills items with 91.8 points. Testing a small sample of voluntary students may hinder generalization of our study. OSCE is an useful tool for assessing clinical skills in dermatology and it is possible to carry it out. Our experience enhances that medical school curriculum needs to establish OSCE as an assessment tool in dermatology. Copyright © 2016 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

Objective physical activity measurement in the osteoarthritis initiative: Are guidelines being met?

PubMed

Dunlop, Dorothy D; Song, Jing; Semanik, Pamela A; Chang, Rowland W; Sharma, Leena; Bathon, Joan M; Eaton, Charles B; Hochberg, Marc C; Jackson, Rebecca D; Kwoh, C Kent; Mysiw, W Jerry; Nevitt, Michael C; Hootman, Jennifer M

2011-11-01

Osteoarthritis (OA) clinical practice guidelines identify a substantial therapeutic role for physical activity, but objective information about the physical activity of this population is lacking. The aim of this study was to objectively measure levels of physical activity in adults with knee OA and report the prevalence of meeting public health physical activity guidelines. Cross-sectional accelerometry data from 1,111 adults with radiographic knee OA (49-84 years old) participating in the Osteoarthritis Initiative accelerometry monitoring ancillary study were assessed for meeting the aerobic component of the 2008 Physical Activity Guidelines for Americans (≥150 minutes/week moderate-to-vigorous-intensity activity lasting ≥10 minutes). Quantile regression was used to test median sex differences in physical activity levels. Aerobic physical activity guidelines were met by 12.9% of men and 7.7% of women with knee OA. A substantial proportion of men and women (40.1% and 56.5%, respectively) were inactive, having done no moderate-to-vigorous activity that lasted 10 minutes or more during the 7 days. Although men engaged in significantly more moderate-to-vigorous activity (average daily minutes 20.7 versus 12.3), they also spent more time in no or very-low-intensity activity than women (average daily minutes 608.2 versus 585.8). Despite substantial health benefits from physical activity, adults with knee OA were particularly inactive based on objective accelerometry monitoring. The proportions of men and women who met public health physical activity guidelines were substantially less than those previously reported based on self-reported activity in arthritis populations. These findings support intensified public health efforts to increase physical activity levels among people with knee OA. Copyright © 2011 by the American College of Rheumatology.

Full-field 3D shape measurement of specular object having discontinuous surfaces

NASA Astrophysics Data System (ADS)

Zhang, Zonghua; Huang, Shujun; Gao, Nan; Gao, Feng; Jiang, Xiangqian

2017-06-01

This paper presents a novel Phase Measuring Deflectometry (PMD) method to measure specular objects having discontinuous surfaces. A mathematical model is established to directly relate the absolute phase and depth, instead of the phase and gradient. Based on the model, a hardware measuring system has been set up, which consists of a precise translating stage, a projector, a diffuser and a camera. The stage locates the projector and the diffuser together to a known position during measurement. By using the model-based and machine vision methods, system calibration is accomplished to provide the required parameters and conditions. The verification tests are given to evaluate the effectiveness of the developed system. 3D (Three-Dimensional) shapes of a concave mirror and a monolithic multi-mirror array having multiple specular surfaces have been measured. Experimental results show that the proposed method can obtain 3D shape of specular objects having discontinuous surfaces effectively

ULTRASOUND MEASUREMENTS AND OBJECTIVE FORCES OF GLENOHUMERAL TRANSLATIONS DURING SHOULDER ACCESSORY PASSIVE MOTION TESTING IN HEALTHY INDIVIDUALS

PubMed Central

Worst, Haley; Decarreau, Ryan; Davies, George

2016-01-01

Background Clinical examination of caspuloligamentous structures of the glenohumeral joint has historically been subjective in nature, as demonstrated by limited intra-rater and inter-rater reproducibility. Musculoskeletal diagnostic ultrasound was utilized to develop a clinically objective measurement technique for glenohumeral inferior and posterolateral translation. Purpose The purpose of this study was to measure the accessory passive force required to achieve end range glenohumeral posterolateral and inferior accessory translation, as well as, to quantify the amount of translation of the glenohumeral joint caused by the applied force. Study Design Cross-sectional descriptive correlational study Methods Twenty-five asymptomatic subjects between the ages of 18 and 30 were recruited via convenience sampling. Posterolateral and inferior shoulder accessory passive translation was assessed and measured using a GE LOGIQe ultrasound, while concurrently using a hand held dynamometer to quantify the passive force applied during assessment. Normative values for force and translation were described as means and standard deviations. Results Mean values for posterolateral translation were 6.5 +/− 4.0 mm on the right shoulder and 6.3 +/− 3.5 mm on the left with an associated mean force of 127.1 +/− 55.6 N and 114.4 +/− 50.7 N, respectively. Mean values for inferior translation were 4.8 +/− 1.7 mm on the right shoulder and 5.4 +/− 1.8 mm on the left with an associated mean force of 84.5 +/− 30.5 N and 76.1 +/− 30.1 N, respectively. There was a significant association between inferior translation and inferior force (r = .51). No significant association was found between posterolateral translation and posterolateral force. Significant differences were found between dominant and non-dominant shoulders for posterolateral translation, posterolateral force to produce translation, and inferior translation values

Recommendations for Self-Report Outcome Measures in Vulvodynia Clinical Trials.

PubMed

Pukall, Caroline F; Bergeron, Sophie; Brown, Candace; Bachmann, Gloria; Wesselmann, Ursula

2017-08-01

Vulvodynia (idiopathic chronic vulvar pain) is a prevalent condition associated with significant and negative impacts in many areas of function. Despite the increased research interest in vulvodynia in recent years, recommendations for outcome measures for use in clinical trials are missing. The purpose of this paper, therefore, was to provide recommendations for outcome measures for vulvodynia clinical trials so that consistent measures are used across trials to facilitate between-study comparisons and the conduct of large multicenter trials, and to improve measurement of the multiple dimensions of vulvodynia. Given that provoked vestibulodynia (PVD)-characterized by provoked pain localized to the vaginal opening-is the most common subtype of vulvodynia and the current main focus of clinical trials, this paper focused on recommended outcome measures in PVD clinical trials. The framework used to guide the selection of outcome measures was based on the one proposed by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). The IMMPACT framework provided a well-suited guideline for outcome measure recommendations in PVD clinical trials. However, given the provoked presentation of PVD and the significant impact it has on sexuality, modifications to some of the IMMPACT recommendations were made and specific additional measures were suggested. Measures that are specific to vulvovaginal pain are ideal for adoption in PVD clinical trials, and many such measures currently exist that allow the relevant IMMPACT domains to be captured.

Use of outcome measures in pulmonary hypertension clinical trials.

PubMed

Parikh, Kishan S; Rajagopal, Sudarshan; Arges, Kristine; Ahmad, Tariq; Sivak, Joseph; Kaul, Prashant; Shah, Svati H; Tapson, Victor; Velazquez, Eric J; Douglas, Pamela S; Samad, Zainab

2015-09-01

To evaluate the use of surrogate measures in pulmonary hypertension (PH) clinical trials and how it relates to clinical practice. Studies of pulmonary arterial hypertension (PAH) employ a variety of surrogate measures in addition to clinical events because of a small patient population, participant burden, and costs. The use of these measures in PH drug trials is poorly defined. We searched PubMed/MEDLINE/Embase for randomized or prospective cohort PAH clinical treatment trials from 1985 to 2013. Extracted data included intervention, trial duration, study design, patient characteristics, and primary and secondary outcome measures. To compare with clinical practice, we assessed the use of surrogate measures in a clinical sample of patients on PH medications at Duke University Medical Center between 2003 and 2014. Between 1985 and 2013, 126 PAH trials were identified and analyzed. Surrogate measures served as primary endpoints in 119 trials (94.0%). Inclusion of invasive hemodynamics decreased over time (78.6%, 75.0%, 52.2%; P for trend = .02), while functional testing (7.1%, 60.0%, 81.5%; P for trend < .0001) and functional status or quality of life (0%, 47.6%, 62.8%; P for trend < .0001) increased in PAH trials over the same time periods. Echocardiography data were reported as a primary or secondary outcome in 32 trials (25.4%) with increased use from 1985-1994 to 1995-2004 (7.1% vs 35.0%, P = .04), but the trend did not continue to 2005-2013 (25.0%). In comparison, among 450 patients on PAH therapies at our institution between 2003 and 2013, clinical assessments regularly incorporated serial echocardiography and 6-minute walk distance tests (92% and 95% of patients, respectively) and repeat measurement of invasive hemodynamics (46% of patients). The majority of PAH trials have utilized surrogate measures as primary endpoints. The use of these surrogate endpoints has evolved significantly over time with increasing use of patient-centered endpoints and decreasing or

Clinical usefulness of the pendulum test using a NK table to measure the spasticity of patients with brain lesions.

PubMed

Kim, Yong-Wook

2013-10-01

. [Purpose] The purpose of the present study was to investigate the clinical usefulness (reliability and validity) of the pendulum test using a Noland-Kuckhoff (NK) table with an attached electrogoniometer to measure the spasticity of patients with brain lesions. [Subjects] The subjects were 31 patients with stroke or traumatic brain injury. [Methods] The intraclass correlation coefficient (ICC) was used to verify the test-retest reliability of spasticity measures obtained using the pendulum test. Pearson's product correlation coefficient was used to examine the validity of the pendulum test using the amplitude of the patellar tendon reflex (PTR) test, an objective and quantitative measure of spasticity. [Results] The test-retest reliability was high, reflecting a significant correlation between the test and the retest (ICCs = 0.95-0.97). A significant negative correlation was found between the amplitude of the PTR test and the four variables measured in the pendulum test (r = -0.77- -0.85). [Conclusion] The pendulum test using a NK table is an objective measure of spasticity and can be used in the clinical setting in place of more expensive and complicated equipment. Further studies are needed to investigate the therapeutic effect of this method on spasticity.

Mismatch between perceived and objectively measured environmental obesogenic features in European neighbourhoods.

PubMed

Roda, C; Charreire, H; Feuillet, T; Mackenbach, J D; Compernolle, S; Glonti, K; Ben Rebah, M; Bárdos, H; Rutter, H; McKee, M; De Bourdeaudhuij, I; Brug, J; Lakerveld, J; Oppert, J-M

2016-01-01

Findings from research on the association between the built environment and obesity remain equivocal but may be partly explained by differences in approaches used to characterize the built environment. Findings obtained using subjective measures may differ substantially from those measured objectively. We investigated the agreement between perceived and objectively measured obesogenic environmental features to assess (1) the extent of agreement between individual perceptions and observable characteristics of the environment and (2) the agreement between aggregated perceptions and observable characteristics, and whether this varied by type of characteristic, region or neighbourhood. Cross-sectional data from the SPOTLIGHT project (n = 6037 participants from 60 neighbourhoods in five European urban regions) were used. Residents' perceptions were self-reported, and objectively measured environmental features were obtained by a virtual audit using Google Street View. Percent agreement and Kappa statistics were calculated. The mismatch was quantified at neighbourhood level by a distance metric derived from a factor map. The extent to which the mismatch metric varied by region and neighbourhood was examined using linear regression models. Overall, agreement was moderate (agreement < 82%, kappa < 0.3) and varied by obesogenic environmental feature, region and neighbourhood. Highest agreement was found for food outlets and outdoor recreational facilities, and lowest agreement was obtained for aesthetics. In general, a better match was observed in high-residential density neighbourhoods characterized by a high density of food outlets and recreational facilities. Future studies should combine perceived and objectively measured built environment qualities to better understand the potential impact of the built environment on health, particularly in low residential density neighbourhoods. © 2016 World Obesity.

Comparison between objective measures and parental behavioral rating scales of memory and attention in pediatric endocrinology patients.

PubMed

Limbers, Christine; Young, Danielle; Jernigan, Stephanie; Bryant, William; Stephen, Matt

2017-01-01

Behavioral rating scales represent one potential method for screening of cognitive functioning in routine clinical care. It is not yet known if objective performance based measures and behavioral rating scales of cognitive functioning completed by parents yield similar information in pediatric endocrinology patients. The purpose of the present study was to evaluate the associations between performance-based measures and behavioral rating scales of memory and attention/concentration completed by parents of pediatric patients with Type 1 Diabetes or obesity. The sample consisted of 73 pediatric patients with Type 1 Diabetes or obesity (BMI > 95th percentile) ages 6-16 years (mean age = 12.29 years) referred to an outpatient pediatric endocrinology clinic. Youth were administered the Wide Range Assessment of Memory and Learning (WRAML-2). Parents completed the Child Behavior Checklist (CBCL) and the PedsQL Cognitive Functioning Scale. Pearson's Product Moment Correlations were examined among the performance-based measures and behavioral rating scales. All intercorrelations between the performance-based measures and behavioral rating scales completed by parents were in the small range. The only statistically significant (P < 0.05) and approaching medium correlation was between the PedsQL Cognitive Functioning Scale and WRAML-2 Verbal Memory Index (r = 0.28). On behavioral rating scales and performance-based measures of visual memory and attention/concentration, our sample exhibited greater difficulties than healthy youth from previously published data (P < 0.05). One possible explanation for our findings is that behavioral rating scales of attention/concentration and memory completed by parents measure different aspects of cognitive functioning than performance based measures in pediatric patients with Type 1 Diabetes or obesity.

GELLO: an object-oriented query and expression language for clinical decision support.

PubMed

Sordo, Margarita; Ogunyemi, Omolola; Boxwala, Aziz A; Greenes, Robert A

2003-01-01

GELLO is a purpose-specific, object-oriented (OO) query and expression language. GELLO is the result of a concerted effort of the Decision Systems Group (DSG) working with the HL7 Clinical Decision Support Technical Committee (CDSTC) to provide the HL7 community with a common format for data encoding and manipulation. GELLO will soon be submitted for ballot to the HL7 CDSTC for consideration as a standard.

Objective assessment of attention in delirium: a narrative review.

PubMed

Tieges, Zoë; Brown, Laura J E; MacLullich, Alasdair M J

2014-12-01

Inattention is a core feature of delirium, and valid assessment of attention is central to diagnosis. Methods of measuring attention in delirium can be divided into two broad categories: (i) objective neuropsychological testing; and (ii) subjective grading of behaviour during interview and clinical examination. Here, we review and critically evaluate studies of objective neuropsychological testing of attention in delirium. We examine the implications of these studies for delirium detection and monitoring in clinical practice and research, and how these studies inform understanding of the nature of attentional deficits in delirium. Searches of MEDLINE and ISI Web of Knowledge databases were performed to identify studies in which objective tests of attention had been administered to patients with delirium, who had been diagnosed using DSM or ICD criteria. Sixteen publications were identified. The attention tests administered in these studies were grouped into the following categories: measures of attention span, vigilance tests, other pen-and-paper tests (e.g. Trail Making Test) and computerised tests of speeded reaction, vigilance and sustained attention. Patients with delirium showed deficits on all tasks, although most tasks were not considered pure measures of attention. Five papers provided data on differential diagnosis from dementia. Cancellation tests, spatial span tests and computerised tests of sustained attention discriminated delirium from dementia. Five studies presented reliability or validity statistics. The existing evidence base on objective assessment of attention in delirium is small. Objective testing of attention is underdeveloped but shows considerable promise in clinical practice and research. Copyright © 2014 John Wiley & Sons, Ltd.

Comparison of self-report and objective measures of driving behavior and road safety: A systematic review.

PubMed

Kaye, Sherrie-Anne; Lewis, Ioni; Freeman, James

2018-06-01

This research systematically reviewed the existing literature in regards to studies which have used both self-report and objective measures of driving behavior. The objective of the current review was to evaluate disparities or similarities between self-report and objective measures of driving behavior. Searches were undertaken in the following electronic databases, PsycINFO, PubMed, and Scopus, for peer-reviewed full-text articles that (1) focused on road safety, and (2) compared both subjective and objective measures of driving performance or driver safety. A total of 22,728 articles were identified, with 19 articles, comprising 20 studies, included as part of the review. The research reported herein suggested that for some behaviors (e.g., driving in stressful situations) there were similarities between self-report and objective measures while for other behaviors (e.g., sleepiness and vigilance states) there were differences between these measurement techniques. In addition, findings from some studies suggested that in-vehicle devices may be a valid measurement tool to assess driving exposure in older drivers. Further research is needed to examine the correspondence between self-report and objective measures of driving behavior. In particular, there is a need to increase the number of studies which compare "like with like" as it is difficult to draw comparisons when there are variations in measurement tools used. Incorporating a range of objective and self-report measurements tools in research would help to ensure that the methods used offer the most reliable measures of assessing on-road behaviors. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

A comparison of subjective and objective measures of physical activity from the Newcastle 85+ study.

PubMed

Innerd, Paul; Catt, Michael; Collerton, Joanna; Davies, Karen; Trenell, Michael; Kirkwood, Thomas B L; Jagger, Carol

2015-07-01

Little is known about physical activity (PA) in the very old, the fastest growing age group in the population. We aimed to examine the convergent validity of subjective and objective measures of PA in adults aged over 85 years. A total of 484 participants aged 87-89 years recruited to the Newcastle 85+ study completed a purpose-designed physical activity questionnaire (PAQ), which categorised participants as mildly active, moderately active and very active. Out of them, 337 participants wore a triaxial, raw accelerometer on the right wrist over a 5-7-day period to obtain objective measures of rest/activity, PA intensity and PA type. Data from subjective and objective measurement methods were compared. Self-reported PA was significantly associated with objective measures of the daily sedentary time, low-intensity PA and activity type classified as sedentary, activities of daily living and walking. Objective measures of PA were significantly different when low, moderate and high self-reported PA categories were compared (all P < 0.001). The Newcastle 85+ PAQ demonstrated convergent validity with objective measures of PA. Our findings suggest that this PAQ can be used in the very old to rank individuals according to their level of total PA. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society.

Evaluating the results of stress urinary incontinence surgery with objective and subjective outcome measures.

PubMed

Diez-Itza, I; Espuña-Pons, M

2014-09-01

To assess the outcomes of stress urinary incontinence (SUI) surgery using objective and subjective measures in women with pure SUI and mixed urinary incontinence (MUI). The degree of correlation between the different outcome measures was also evaluated for both groups. A multicentre prospective cohort study of women who underwent surgery for SUI. A standardized cough stress test was used as the objective outcome measure, and specific items of the Epidemiology of Prolapse and Incontinence Questionnaire were used as the subjective outcome measure. The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the Patient Global Impression of Improvement (PGI-I) questionnaires were used for global assessment. Kappa test was used to measure the degree of correlation between the outcome measures. The participants were categorized into two groups before surgery: pure SUI (n=116) and MUI (n=161). Six months after surgery, the cure rate of the SUI component was high in both groups according to the objective and subjective outcome measures. Global assessment showed lower cure rates. The degree of agreement between objective and subjective outcome measures was moderate (kappa 0.541, p<0.001) for women with pure SUI, and fair (kappa 0.377, p<0.001) for women with MUI. Correlation between the change in ICIQ-UI SF score (pre to post surgery) and the degree of satisfaction (PGI-I) was significant (p<0.01) for both the pure SUI group (0.43) and the MUI group (0.48). Both objective and subjective cure rates are high for women with pure SUI and MUI following SUI surgery in Spain. The degree of agreement between different outcome measures varies. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

2013 AMAOs Guide: Annual Measurable Achievement Objectives (AMAOs). Title III, Part A Accountability System

ERIC Educational Resources Information Center

Texas Education Agency, 2013

2013-01-01

Under Title III of the No Child Left Behind Act of 2001 (NCLB), the Texas Education Agency is required to establish Annual Measurable Achievement Objectives (AMAOs) for the English language acquisition and academic achievement of limited English proficient (LEP) students. This 2013 Guide to Annual Measurable Achievement Objectives provides AMAO…

Motion measurement of acoustically levitated object

NASA Technical Reports Server (NTRS)

Watkins, John L. (Inventor); Barmatz, Martin B. (Inventor)

1993-01-01

A system is described for determining motion of an object that is acoustically positioned in a standing wave field in a chamber. Sonic energy in the chamber is sensed, and variation in the amplitude of the sonic energy is detected, which is caused by linear motion, rotational motion, or drop shape oscillation of the object. Apparatus for detecting object motion can include a microphone coupled to the chamber and a low pass filter connected to the output of the microphone, which passes only frequencies below the frequency of sound produced by a transducer that maintains the acoustic standing wave field. Knowledge about object motion can be useful by itself, can be useful to determine surface tension, viscosity, and other information about the object, and can be useful to determine the pressure and other characteristics of the acoustic field.

Semi-spontaneous oral text production: measurements in clinical practice.

PubMed

Lind, Marianne; Kristoffersen, Kristian Emil; Moen, Inger; Simonsen, Hanne Gram

2009-12-01

Functionally relevant assessment of the language production of speakers with aphasia should include assessment of connected speech production. Despite the ecological validity of everyday conversations, more controlled and monological types of texts may be easier to obtain and analyse in clinical practice. This article discusses some simple measurements for the analysis of semi-spontaneous oral text production by speakers with aphasia. Specifically, the measurements are related to the production of verbs and nouns, and the realization of different sentence types. The proposed measurements should be clinically relevant, easily applicable, and linguistically meaningful. The measurements have been applied to oral descriptions of the 'Cookie Theft' picture by eight monolingual Norwegian speakers, four with an anomic type of aphasia and four without any type of language impairment. Despite individual differences in both the clinical and the non-clinical group, most of the measurements seem to distinguish between speakers with and without aphasia.

Obstructive Sleep Apnea Syndrome, Objectively Measured Physical Activity and Exercise Training Interventions: A Systematic Review and Meta-Analysis.

PubMed

Mendelson, Monique; Bailly, Sébastien; Marillier, Mathieu; Flore, Patrice; Borel, Jean Christian; Vivodtzev, Isabelle; Doutreleau, Stéphane; Verges, Samuel; Tamisier, Renaud; Pépin, Jean-Louis

2018-01-01

A systematic review of English and French articles using Pubmed/Medline and Embase included studies assessing objective physical activity levels of obstructive sleep apnea (OSA) patients and exploring the effects of exercise training on OSA severity, body mass index (BMI), sleepiness, and cardiorespiratory fitness [peak oxygen consumption (VO2peak)]. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. For objective physical activity levels, eight studies were included. The mean number of steps per day across studies was 5,388 (95% CI: 3,831-6,945; p  < 0.001), which was by far lower than the recommended threshold of 10,000 steps per day. For exercise training, six randomized trials were included. There was a significant decrease in apnea-hypopnea-index following exercise training (mean decrease of 8.9 events/h; 95% CI: -13.4 to -4.3; p  < 0.01), which was accompanied by a reduction in subjective sleepiness, an increase in VO2peak and no change in BMI. OSA patients present low levels of physical activity and exercise training is associated with improved outcomes. Future interventions (including exercise training) focusing on increasing physical activity levels may have important clinical impacts on both OSA severity and the burden of associated co-morbidities. Objective measurement of physical activity in routine OSA management and well-designed clinical trials are recommended. Registration # CRD42017057319 (Prospero).

Obstructive Sleep Apnea Syndrome, Objectively Measured Physical Activity and Exercise Training Interventions: A Systematic Review and Meta-Analysis

PubMed Central

Mendelson, Monique; Bailly, Sébastien; Marillier, Mathieu; Flore, Patrice; Borel, Jean Christian; Vivodtzev, Isabelle; Doutreleau, Stéphane; Verges, Samuel; Tamisier, Renaud; Pépin, Jean-Louis

2018-01-01

A systematic review of English and French articles using Pubmed/Medline and Embase included studies assessing objective physical activity levels of obstructive sleep apnea (OSA) patients and exploring the effects of exercise training on OSA severity, body mass index (BMI), sleepiness, and cardiorespiratory fitness [peak oxygen consumption (VO2peak)]. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. For objective physical activity levels, eight studies were included. The mean number of steps per day across studies was 5,388 (95% CI: 3,831–6,945; p < 0.001), which was by far lower than the recommended threshold of 10,000 steps per day. For exercise training, six randomized trials were included. There was a significant decrease in apnea–hypopnea-index following exercise training (mean decrease of 8.9 events/h; 95% CI: −13.4 to −4.3; p < 0.01), which was accompanied by a reduction in subjective sleepiness, an increase in VO2peak and no change in BMI. OSA patients present low levels of physical activity and exercise training is associated with improved outcomes. Future interventions (including exercise training) focusing on increasing physical activity levels may have important clinical impacts on both OSA severity and the burden of associated co-morbidities. Objective measurement of physical activity in routine OSA management and well-designed clinical trials are recommended. Registration # CRD42017057319 (Prospero). PMID:29520251

Exploring nurses' perceptions of collecting and using HOBIC measures to guide clinical practice and improve care.

PubMed

Jeffs, Lianne; Wilson, Gail; Ferris, Ella; Cardiff, Brenda; Ng, San; Lanceta, Mary; White, Peggy; Pringle, Dorothy

2012-03-01

Ontario's Health Outcomes for Better Information and Care (HOBIC) is designed to help organizations and nurses plan and evaluate care by comparing patient outcomes with historical data on similar cases. Yet, fewer than 15% of patients in a 2010 study were found to have complete admission and discharge data sets. This low utilization rate of HOBIC measures prompted the current qualitative study, in which nurses from three clinical settings in an academic teaching hospital were interviewed to gain their perceptions related to collecting and using HOBIC measures in practice. The objective was to identify factors that promote or impede the collection and use of HOBIC data in clinical practice to improve patient care and outcomes. Analysis of interview results produced four key themes related to (a) use of HOBIC measures to inform patient care, (b) collecting and documenting HOBIC measures, (c) HOBIC as an afterthought and "black hole" and (d) impediments to assessing and documenting HOBIC measures because of language barriers, patients' cognitive status and lack of time. Recommendations to improve uptake include developing, implementing and evaluating a communication and learning plan that promotes HOBIC's values and benefits, and determining how managers and administrators perceive utilization of HOBIC at the clinical unit and organizational levels.

Objective measurement of motor speech characteristics in the healthy pediatric population.

PubMed

Wong, A W; Allegro, J; Tirado, Y; Chadha, N; Campisi, P

2011-12-01

To obtain objective measurements of motor speech characteristics in normal children, using a computer-based motor speech software program. Cross-sectional, observational design in a university-based ambulatory pediatric otolaryngology clinic. Participants included 112 subjects (54 females and 58 males) aged 4-18 years. Participants with previously diagnosed hearing loss, voice and motor disorders, and children unable to repeat a passage in English were excluded. Voice samples were recorded and analysed using the Motor Speech Profile (MSP) software (KayPENTAX, Lincoln Park, NJ). The MSP produced measures of diadochokinetics, second formant transition, intonation, and syllabic rates. Demographic data, including sex, age, and cigarette smoke exposure were obtained. Normative data for several motor speech characteristics were derived for children ranging from age 4 to 18 years. A number of age-dependent changes were indentified, including an increase in average diadochokinetic rate (p<0.001) and standard syllabic duration (p<0.001) with age. There were no identified differences in motor speech characteristics between males and females across the measured age range. Variations in fundamental frequency (Fo) during speech did not change significantly with age for both males and females. To our knowledge, this is the first pediatric normative database for the MSP progam. The MSP is suitable for testing children and can be used to study developmental changes in motor speech. The analysis demonstrated that males and females behave similarly and show the same relationship with age for the motor speech characteristics studied. This normative database will provide essential comparative data for future studies exploring alterations in motor speech that may occur with hearing, voice, and motor disorders and to assess the results of targeted therapies. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Detection and Purging of Specular Reflective and Transparent Object Influences in 3d Range Measurements

NASA Astrophysics Data System (ADS)

Koch, R.; May, S.; Nüchter, A.

2017-02-01

3D laser scanners are favoured sensors for mapping in mobile service robotics at indoor and outdoor applications, since they deliver precise measurements at a wide scanning range. The resulting maps are detailed since they have a high resolution. Based on these maps robots navigate through rough terrain, fulfil advanced manipulation, and inspection tasks. In case of specular reflective and transparent objects, e.g., mirrors, windows, shiny metals, the laser measurements get corrupted. Based on the type of object and the incident angle of the incoming laser beam there are three results possible: a measurement point on the object plane, a measurement behind the object plane, and a measurement of a reflected object. It is important to detect such situations to be able to handle these corrupted points. This paper describes why it is difficult to distinguish between specular reflective and transparent surfaces. It presents a 3DReflection- Pre-Filter Approach to identify specular reflective and transparent objects in point clouds of a multi-echo laser scanner. Furthermore, it filters point clouds from influences of such objects and extract the object properties for further investigations. Based on an Iterative-Closest-Point-algorithm reflective objects are identified. Object surfaces and points behind surfaces are masked according to their location. Finally, the processed point cloud is forwarded to a mapping module. Furthermore, the object surface corners and the type of the surface is broadcasted. Four experiments demonstrate the usability of the 3D-Reflection-Pre-Filter. The first experiment was made in a empty room containing a mirror, the second experiment was made in a stairway containing a glass door, the third experiment was made in a empty room containing two mirrors, the fourth experiment was made in an office room containing a mirror. This paper demonstrate that for single scans the detection of specular reflective and transparent objects in 3D is possible. It

Clinimetrics: the science of clinical measurements.

PubMed

Fava, G A; Tomba, E; Sonino, N

2012-01-01

'Clinimetrics' is the term introduced by Alvan R. Feinstein in the early 1980s to indicate a domain concerned with indexes, rating scales and other expressions that are used to describe or measure symptoms, physical signs and other clinical phenomena. Clinimetrics has a set of rules that govern the structure of indexes, the choice of component variables, the evaluation of consistency, validity and responsiveness. This review illustrates how clinimetrics may help expanding the narrow range of information that is currently used in clinical science. It will focus on characteristics and types of clinimetric indexes and their current use. The clinimetric perspective provides an intellectual home for clinical judgment, whose implementation is likely to improve outcomes both in clinical research and practice. © 2011 Blackwell Publishing Ltd.

The core learning objectives education model: an approach to the teaching of core concepts in the clinical clerkship.

PubMed

Rapp, David E; Lyon, Mark B; Orvieto, Marcelo A; Zagaja, Gregory P

2005-10-01

The classical approach to the undergraduate medical clerkship has several limitations, including variability of clinical exposure and method of examination. As a result, the clerkship experience does not ensure exposure to and reinforcement of the fundamental concepts of a given specialty. This article reviews the classic approach to clerkship education within the undergraduate medical education. Specific attention is placed on clinical exposure and clerkship examination. We describe the introduction of the Core Learning Objective (CLO) educational model at the University of Chicago Section of Urology. This model is designed to provide an efficient exposure to and evaluation of core clerkship learning objectives. The CLO model has been successfully initiated, focusing on both technical and clinical skill sets. The proposed model has been introduced with positive initial results and should allow for an efficient approach to the teaching and evaluation of core objectives in clerkship education.

Ultrasonic Measurement of Strain Distribution Inside Object Cyclically Compressed by Dual Acoustic Radiation Force

NASA Astrophysics Data System (ADS)

Odagiri, Yoshitaka; Hasegawa, Hideyuki; Kanai, Hiroshi

2008-05-01

One possible way to evaluate acupuncture therapy quantitatively is to measure the change in the elastic property of muscle after application of the therapy. Many studies have been conducted to measure mechanical properties of tissues using ultrasound-induced acoustic radiation force. To assess mechanical properties, strain must be generated in an object. However, a single radiation force is not effective because it mainly generates translational motion when the object is much harder than the surrounding medium. In this study, two cyclic radiation forces are simultaneously applied to a muscle phantom from two opposite horizontal directions so that the object is cyclically compressed in the horizontal direction. By the horizontal compression, the object is expanded vertically based on its incompressibility. The resultant vertical displacement is measured using another ultrasound pulse. Two ultrasonic transducers for actuation were both driven by the sum of two continuous sinusoidal signals at two slightly different frequencies [1 MHz and (1 M + 5) Hz]. The displacement of several micrometers in amplitude, which fluctuated at 5 Hz, was measured by the ultrasonic phased tracking method. Increase in thickness inside the object was observed just when acoustic radiation forces increased. Such changes in thickness correspond to vertical expansion due to horizontal compression.

Teaching concepts of clinical measurement variation to medical students.

PubMed

Hodder, R A; Longfield, J N; Cruess, D F; Horton, J A

1982-09-01

An exercise in clinical epidemiology was developed for medical students to demonstrate the process and limitations of scientific measurement using models that simulate common clinical experiences. All scales of measurement (nominal, ordinal and interval) were used to illustrate concepts of intra- and interobserver variation, systematic error, recording error, and procedural error. In a laboratory, students a) determined blood pressures on six videotaped subjects, b) graded sugar content of unknown solutions from 0 to 4+ using Clinitest tablets, c) measured papules that simulated PPD reactions, d) measured heart and kidney size on X-rays and, e) described a model skin lesion (melanoma). Traditionally, measurement variation is taught in biostatistics or epidemiology courses using previously collected data. Use of these models enables students to produce their own data using measurements commonly employed by the clinician. The exercise provided material for a meaningful discussion of the implications of measurement error in clinical decision-making.

Well-Being With Objects: Evaluating a Museum Object-Handling Intervention for Older Adults in Health Care Settings.

PubMed

Thomson, Linda J M; Chatterjee, Helen J

2016-03-01

The extent to which a museum object-handling intervention enhanced older adult well-being across three health care settings was examined. The program aimed to determine whether therapeutic benefits could be measured objectively using clinical scales. Facilitator-led, 30 to 40 min sessions handling and discussing museum objects were conducted in acute and elderly care (11 one-to-ones), residential (4 one-to-ones and 1 group of five), and psychiatric (4 groups of five) settings. Pre-post measures of psychological well-being (Positive Affect and Negative Affect Schedule) and subjective wellness and happiness (Visual Analogue Scales) were compared. Positive affect and wellness increased significantly in acute and elderly and residential care though not psychiatric care whereas negative affect decreased and happiness increased in all settings. Examination of audio recordings revealed enhanced confidence, social interaction, and learning. The program allowed adults access to a museum activity who by virtue of age and ill health would not otherwise have engaged with museum objects. © The Author(s) 2014.

Probing optimal measurement configuration for optical scatterometry by the multi-objective genetic algorithm

NASA Astrophysics Data System (ADS)

Chen, Xiuguo; Gu, Honggang; Jiang, Hao; Zhang, Chuanwei; Liu, Shiyuan

2018-04-01

Measurement configuration optimization (MCO) is a ubiquitous and important issue in optical scatterometry, whose aim is to probe the optimal combination of measurement conditions, such as wavelength, incidence angle, azimuthal angle, and/or polarization directions, to achieve a higher measurement precision for a given measuring instrument. In this paper, the MCO problem is investigated and formulated as a multi-objective optimization problem, which is then solved by the multi-objective genetic algorithm (MOGA). The case study on the Mueller matrix scatterometry for the measurement of a Si grating verifies the feasibility of the MOGA in handling the MCO problem in optical scatterometry by making a comparison with the Monte Carlo simulations. Experiments performed at the achieved optimal measurement configuration also show good agreement between the measured and calculated best-fit Mueller matrix spectra. The proposed MCO method based on MOGA is expected to provide a more general and practical means to solve the MCO problem in the state-of-the-art optical scatterometry.

Effect of a grounded object on radon measurement using AlphaGUARD.

PubMed

Ichitsubo, Hirokazu; Yamada, Yuji

2004-07-01

ABSTRACT-: The effects on radon concentration measurement of a grounded object near the opening of a cylindrical ionization chamber were studied using AlphaGUARD. AlphaGUARD comes with a flow measurement adapter that fits on the front of the AlphaGUARD ionization chamber. If the adapter nozzle is grounded, the radon concentration is falsely measured at 0 Bq m. A metal connector for use between the AlphaGUARD and the air duct wall was manufactured in our laboratory. When the connector is grounded, the radon concentration is again falsely measured as 0 Bq m. If the nozzle or connector is ungrounded, the AlphaGUARD measures radon concentration accurately. Health Phys.

Measuring urgency in clinical practice.

PubMed

Dmochowski, Roger R; FitzGerald, Mary P; Wyndaele, Jean-Jacques

2009-12-01

The study of urinary urgency is challenging for a number of reasons, including our lack of understanding of the normal physiology of urinary sensation and the pathophysiology of abnormal sensation. Issues with nomenclature and lack of agreement about the nature of the experience of normal and abnormal urinary sensation add to this difficulty. Review of published literature and critique. Currently available tools for measurement of urgency include validated questionnaires that describe the severity of urgency and its impact on quality of life, modified bladder diaries, body maps of urgency, and measures of urinary sensation during filling cystometry. All these provide some information about the experience of urinary urgency, but no single measure currently captures its multidimensional nature. Measurement of urgency in clinical practice and indeed the optimal treatment strategy has yet to come of age.

Apparatus for measuring surface movement of an object that is subjected to external vibrations

DOEpatents

Kotidis, Petros A.; Woodroffe, Jaime A.; Rostler, Peter S.

1997-01-01

A system for non-destructively measuring an object and controlling industrial processes in response to the measurement is disclosed in which an impulse laser generates a plurality of sound waves over timed increments in an object. A polarizing interferometer is used to measure surface movement of the object caused by the sound waves and sensed by phase shifts in the signal beam. A photon multiplier senses the phase shift and develops an electrical signal. A signal conditioning arrangement modifies the electrical signals to generate an average signal correlated to the sound waves which in turn is correlated to a physical or metallurgical property of the object, such as temperature, which property may then be used to control the process. External, random vibrations of the workpiece are utilized to develop discernible signals which can be sensed in the interferometer by only one photon multiplier. In addition the interferometer includes an arrangement for optimizing its sensitivity so that movement attributed to various waves can be detected in opaque objects. The interferometer also includes a mechanism for sensing objects with rough surfaces which produce speckle light patterns. Finally the interferometer per se, with the addition of a second photon multiplier is capable of accurately recording beam length distance differences with only one reading.

Method and apparatus for measuring surface movement of an object using a polarizing interfeometer

DOEpatents

Schultz, Thomas J.; Kotidis, Petros A.; Woodroffe, Jaime A.; Rostler, Peter S.

1995-01-01

A system for non-destructively measuring an object and controlling industrial processes in response to the measurement is disclosed in which an impulse laser generates a plurality of sound waves over timed increments in an object. A polarizing interferometer is used to measure surface movement of the object caused by the sound waves and sensed by phase shifts in the signal beam. A photon multiplier senses the phase shift and develops an electrical signal. A signal conditioning arrangement modifies the electrical signals to generate an average signal correlated to the sound waves which in turn is correlated to a physical or metallurgical property of the object, such as temperature, which property may then be used to control the process. External, random vibrations of the workpiece are utilized to develop discernible signals which can be sensed in the interferometer by only one photon multiplier. In addition the interferometer includes an arrangement for optimizing its sensitivity so that movement attributed to various waves can be detected in opaque objects. The interferometer also includes a mechanism for sensing objects with rough surfaces which produce speckle light patterns. Finally the interferometer per se, with the addition of a second photon multiplier is capable of accurately recording beam length distance differences with only one reading.

Method and apparatus for measuring surface movement of an object using a polarizing interferometer

DOEpatents

Schultz, T.J.; Kotidis, P.A.; Woodroffe, J.A.; Rostler, P.S.

1995-05-09

A system for non-destructively measuring an object and controlling industrial processes in response to the measurement is disclosed in which an impulse laser generates a plurality of sound waves over timed increments in an object. A polarizing interferometer is used to measure surface movement of the object caused by the sound waves and sensed by phase shifts in the signal beam. A photon multiplier senses the phase shift and develops an electrical signal. A signal conditioning arrangement modifies the electrical signals to generate an average signal correlated to the sound waves which in turn is correlated to a physical or metallurgical property of the object, such as temperature, which property may then be used to control the process. External, random vibrations of the workpiece are utilized to develop discernible signals which can be sensed in the interferometer by only one photon multiplier. In addition the interferometer includes an arrangement for optimizing its sensitivity so that movement attributed to various waves can be detected in opaque objects. The interferometer also includes a mechanism for sensing objects with rough surfaces which produce speckle light patterns. Finally the interferometer per se, with the addition of a second photon multiplier is capable of accurately recording beam length distance differences with only one reading. 38 figs.

Apparatus for measuring surface movement of an object that is subjected to external vibrations

DOEpatents

Kotidis, P.A.; Woodroffe, J.A.; Rostler, P.S.

1997-04-22

A system for non-destructively measuring an object and controlling industrial processes in response to the measurement is disclosed in which an impulse laser generates a plurality of sound waves over timed increments in an object. A polarizing interferometer is used to measure surface movement of the object caused by the sound waves and sensed by phase shifts in the signal beam. A photon multiplier senses the phase shift and develops an electrical signal. A signal conditioning arrangement modifies the electrical signals to generate an average signal correlated to the sound waves which in turn is correlated to a physical or metallurgical property of the object, such as temperature, which property may then be used to control the process. External, random vibrations of the workpiece are utilized to develop discernible signals which can be sensed in the interferometer by only one photon multiplier. In addition the interferometer includes an arrangement for optimizing its sensitivity so that movement attributed to various waves can be detected in opaque objects. The interferometer also includes a mechanism for sensing objects with rough surfaces which produce speckle light patterns. Finally the interferometer per se, with the addition of a second photon multiplier is capable of accurately recording beam length distance differences with only one reading. 38 figs.

Clinical Usefulness of the Pendulum Test Using a NK Table to Measure the Spasticity of Patients with Brain Lesions

PubMed Central

Kim, Yong-Wook

2013-01-01

. [Purpose] The purpose of the present study was to investigate the clinical usefulness (reliability and validity) of the pendulum test using a Noland-Kuckhoff (NK) table with an attached electrogoniometer to measure the spasticity of patients with brain lesions. [Subjects] The subjects were 31 patients with stroke or traumatic brain injury. [Methods] The intraclass correlation coefficient (ICC) was used to verify the test–retest reliability of spasticity measures obtained using the pendulum test. Pearson's product correlation coefficient was used to examine the validity of the pendulum test using the amplitude of the patellar tendon reflex (PTR) test, an objective and quantitative measure of spasticity. [Results] The test–retest reliability was high, reflecting a significant correlation between the test and the retest (ICCs = 0.95–0.97). A significant negative correlation was found between the amplitude of the PTR test and the four variables measured in the pendulum test (r = −0.77– −0.85). [Conclusion] The pendulum test using a NK table is an objective measure of spasticity and can be used in the clinical setting in place of more expensive and complicated equipment. Further studies are needed to investigate the therapeutic effect of this method on spasticity. PMID:24259775

Measurement-based Treatment of Residual Symptoms Using Clinically Useful Depression Outcome Scale: Korean Validation Study

PubMed Central

Jeon, Sang Won; Han, Changsu; Ko, Young-Hoon; Yoon, Seo Young; Pae, Chi-Un; Choi, Joonho; Park, Yong Chon; Kim, Jong-Woo; Yoon, Ho-Kyoung; Ko, Seung-Duk; Patkar, Ashwin A.; Zimmerman, Mark

2017-01-01

Objective This study was aimed at evaluating the diagnostic validity of the Korean version of the Clinically Useful Depression Outcome Scale (CUDOS) with varying follow-up in a typical clinical setting in multiple centers. Methods In total, 891 psychiatric outpatients were enrolled at the time of their intake appointment. Current diagnostic characteristics were examined using the Structured Clinical Interview for DSM-IV (41% major depressive disorder). The CUDOS was measured and compared with three clinician rating scales and four self-report scales. Results The CUDOS showed excellent results for internal consistency (Cronbach’s α, 0.91), test-retest reliability (patients at intake, r=0.81; depressed patients in ongoing treatment, r=0.89), and convergent and discriminant validity (measures of depression, r=0.80; measures of anxiety and somatization, r=0.42). The CUDOS had a high ability to discriminate between different levels of depression severity based on the rating of Clinical Global Impression for depression severity and the diagnostic classification of major depression, minor depression, and non-depression. The ability of the CUDOS to identify patients with major depression was high (area under the receiver operating characteristic curve=0.867). A score of 20 as the optimal cutoff point was suggested when screening for major depression using the CUDOS (sensitivity=89.9%, specificity=69.5%). The CUDOS was sensitive to change after antidepressant treatment: patients with greater improvement showed a greater decrease in CUDOS scores (p<0.001). Conclusion The results of this multi-site outpatient study found that the Korean version of the CUDOS is a very useful measurement for research and for clinical practice. PMID:28138107

Operationalizing the Diagnostic Criteria for Mild Cognitive Impairment: The Salience of Objective Measures in Predicting Incident Dementia.

PubMed

Brodaty, Henry; Aerts, Liesbeth; Crawford, John D; Heffernan, Megan; Kochan, Nicole A; Reppermund, Simone; Kang, Kristan; Maston, Kate; Draper, Brian; Trollor, Julian N; Sachdev, Perminder S

2017-05-01

Mild cognitive impairment (MCI) is considered an intermediate stage between normal aging and dementia. It is diagnosed in the presence of subjective cognitive decline and objective cognitive impairment without significant functional impairment, although there are no standard operationalizations for each of these criteria. The objective of this study is to determine which operationalization of the MCI criteria is most accurate at predicting dementia. Six-year longitudinal study, part of the Sydney Memory and Ageing Study. Community-based. 873 community-dwelling dementia-free adults between 70 and 90 years of age. Persons from a non-English speaking background were excluded. Seven different operationalizations for subjective cognitive decline and eight measures of objective cognitive impairment (resulting in 56 different MCI operational algorithms) were applied. The accuracy of each algorithm to predict progression to dementia over 6 years was examined for 618 individuals. Baseline MCI prevalence varied between 0.4% and 30.2% and dementia conversion between 15.9% and 61.9% across different algorithms. The predictive accuracy for progression to dementia was poor. The highest accuracy was achieved based on objective cognitive impairment alone. Inclusion of subjective cognitive decline or mild functional impairment did not improve dementia prediction accuracy. Not MCI, but objective cognitive impairment alone, is the best predictor for progression to dementia in a community sample. Nevertheless, clinical assessment procedures need to be refined to improve the identification of pre-dementia individuals. Copyright © 2016 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Choice Impulsivity: Definitions, Measurement Issues, and Clinical Implications

PubMed Central

Hamilton, Kristen R.; Mitchell, Marci R.; Wing, Victoria C.; Balodis, Iris M.; Bickel, Warren K.; Fillmore, Mark; Lane, Scott D.; Lejuez, C. W.; Littlefield, Andrew K.; Luijten, Maartje; Mathias, Charles W.; Mitchell, Suzanne H.; Napier, T. Celeste; Reynolds, Brady; Schütz, Christian G.; Setlow, Barry; Sher, Kenneth J.; Swann, Alan C.; Tedford, Stephanie E.; White, Melanie J.; Winstanley, Catharine A.; Yi, Richard; Potenza, Marc N.; Moeller, F. Gerard

2015-01-01

Background Impulsivity critically relates to many psychiatric disorders. Given the multi-faceted construct that impulsivity represents, defining core aspects of impulsivity is vital for the assessment and understanding of clinical conditions. Choice impulsivity (CI), involving the preferential selection of smaller sooner rewards over larger later rewards, represents one important type of impulsivity. Method The International Society for Research on Impulsivity (InSRI) convened to discuss the definition and assessment of CI and provide recommendations regarding measurement across species. Results Commonly used preclinical and clinical CI behavioral tasks are described, and considerations for each task are provided to guide CI task selection. Differences in assessment of CI (self-report, behavioral) and calculating CI indices (e.g., area-under-the-curve, indifference point, steepness of discounting curve) are discussed along with properties of specific behavioral tasks used in preclinical and clinical settings. Conclusions The InSRI group recommends inclusion of measures of CI in human studies examining impulsivity. Animal studies examining impulsivity should also include assessments of CI and these measures should be harmonized in accordance with human studies of the disorders being modeled in the preclinical investigations. The choice of specific CI measures to be included should be based on the goals of the study and existing preclinical and clinical literature using established CI measures. PMID:25867841

Exploring the Clinical Utility of Relative Fundamental Frequency as an Objective Measure of Vocal Hyperfunction

ERIC Educational Resources Information Center

Roy, Nelson; Fetrow, Rebecca A.; Merrill, Ray M.; Dromey, Christopher

2016-01-01

Purpose: Vocal hyperfunction, related to abnormal laryngeal muscle activity, is considered the proximal cause of primary muscle tension dysphonia (pMTD). Relative fundamental frequency (RFF) has been proposed as an objective acoustic marker of vocal hyperfunction. This study examined (a) the ability of RFF to track changes in vocal hyperfunction…

Evaluating Robotic Surgical Skills Performance Under Distractive Environment Using Objective and Subjective Measures.

PubMed

Suh, Irene H; LaGrange, Chad A; Oleynikov, Dmitry; Siu, Ka-Chun

2016-02-01

Distractions are recognized as a significant factor affecting performance in safety critical domains. Although operating rooms are generally full of distractions, the effect of distractions on robot-assisted surgical (RAS) performance is unclear. Our aim was to investigate the effect of distractions on RAS performance using both objective and subjective measures. Fifteen participants performed a knot-tying task using the da Vinci Surgical System and were exposed to 3 distractions: (1) passive distraction entailed listening to noise with a constant heart rate, (2) active distraction included listening to noise and acknowledging a change of random heart rate from 60 to 120 bpm, and (3) interactive distraction consisted of answering math questions. The objective kinematics of the surgical instrument tips were used to evaluate performance. Electromyography (EMG) of the forearm and hand muscles of the participants were collected. The median EMG frequency (EMG(fmed)) and the EMG envelope (EMG(env)) were analyzed. NASA Task Load Index and Fundamentals of Laparoscopic Surgery score were used to evaluate the subjective performance. One-way repeated analysis of variance was applied to examine the effects of distraction on skills performance. Spearman's correlations were conducted to compare objective and subjective measures. Significant distraction effect was found for all objective kinematics measures (P < .05). There were significant distraction effects for EMG measures (EMG(env), P < .004; EMG(fmed), P = .031). Significant distraction effects were also found for subjective measurements. Distraction impairs surgical skills performance and increases muscle work. Understanding how the surgeons cope with distractions is important in developing surgical education. © The Author(s) 2015.

Determining the feasibility of objective adherence measurement with blister packaging smart technology.

PubMed

van Onzenoort, Hein A; Neef, Cees; Verberk, Willem W; van Iperen, H Peter; de Leeuw, Peter W; van der Kuy, Paul-Hugo M

2012-05-15

The results of a feasibility study of blister-pack smart technology for monitoring medication adherence are reported. Research in the area of objective therapy compliance measurement has led to the development of microprocessor-driven systems that record the time a unit dose is removed from blister packaging. One device under development is the Smart Blister-a label imprinted with event-detection circuitry that can be affixed to standard commercial blister cards. In the first trial of the device in actual clinical practice, 115 community-dwelling Dutch patients receiving valsartan maintenance therapy (160 mg once daily) were given 14-day blister packages equipped with the Smart Blister. On the return of empty blister cards to the 20 participating community pharmacies, the stored information was scanned and downloaded for data analysis and patient counseling purposes. A total of 245 Smart Blister-equipped packages were used by valsartan recipients during the eight-month study. The device was largely effective in recording patient and blister-card identification data and other desired information. However, in 17% of cases, the Smart Blister system registered multiple tablet-removal events at the same time, presumably indicating unintentional breakage of nearby conductive circuits and the need for design refinements. The Smart Blister-equipped medication cards were generally well received by patients and pharmacies. An evaluation of the functionality and robustness of the Smart Blister in a real-world clinical practice situation yielded some promising results, but the findings also indicated a need for design refinements and additional performance testing of the device.

Connecting Stuttering Management and Measurement: I. Core Speech Measures of Clinical Process and Outcome

ERIC Educational Resources Information Center

Shenker, Rosalee C.

2006-01-01

Background: There will always be a place for stuttering treatments designed to eliminate or reduce stuttered speech. When those treatments are required, direct speech measures of treatment process and outcome are needed in clinical practice. Aims: Based on the contents of published clinical trials of such treatments, three "core" measures of…

Ubiquitous computing to support co-located clinical teams: using the semiotics of physical objects in system design.

PubMed

Bang, Magnus; Timpka, Toomas

2007-06-01

Co-located teams often use material objects to communicate messages in collaboration. Modern desktop computing systems with abstract graphical user interface (GUIs) fail to support this material dimension of inter-personal communication. The aim of this study is to investigate how tangible user interfaces can be used in computer systems to better support collaborative routines among co-located clinical teams. The semiotics of physical objects used in team collaboration was analyzed from data collected during 1 month of observations at an emergency room. The resulting set of communication patterns was used as a framework when designing an experimental system. Following the principles of augmented reality, physical objects were mapped into a physical user interface with the goal of maintaining the symbolic value of those objects. NOSTOS is an experimental ubiquitous computing environment that takes advantage of interaction devices integrated into the traditional clinical environment, including digital pens, walk-up displays, and a digital desk. The design uses familiar workplace tools to function as user interfaces to the computer in order to exploit established cognitive and collaborative routines. Paper-based tangible user interfaces and digital desks are promising technologies for co-located clinical teams. A key issue that needs to be solved before employing such solutions in practice is associated with limited feedback from the passive paper interfaces.

Integrating Validity Theory with Use of Measurement Instruments in Clinical Settings

PubMed Central

Kelly, P Adam; O'Malley, Kimberly J; Kallen, Michael A; Ford, Marvella E

2005-01-01

Objective To present validity concepts in a conceptual framework useful for research in clinical settings. Principal Findings We present a three-level decision rubric for validating measurement instruments, to guide health services researchers step-by-step in gathering and evaluating validity evidence within their specific situation. We address construct precision, the capacity of an instrument to measure constructs it purports to measure and differentiate from other, unrelated constructs; quantification precision, the reliability of the instrument; and translation precision, the ability to generalize scores from an instrument across subjects from the same or similar populations. We illustrate with specific examples, such as an approach to validating a measurement instrument for veterans when prior evidence of instrument validity for this population does not exist. Conclusions Validity should be viewed as a property of the interpretations and uses of scores from an instrument, not of the instrument itself: how scores are used and the consequences of this use are integral to validity. Our advice is to liken validation to building a court case, including discovering evidence, weighing the evidence, and recognizing when the evidence is weak and more evidence is needed. PMID:16178998

Standards for Clinical Trials in Male and Female Sexual Dysfunction: II. Patient-Reported Outcome Measures.

PubMed

Fisher, William A; Gruenwald, Ilan; Jannini, Emmanuele A; Lev-Sagie, Ahinoam; Lowenstein, Lior; Pyke, Robert E; Reisman, Yakov; Revicki, Dennis A; Rubio-Aurioles, Eusebio

2016-12-01

The second article in this series, Standards for Clinical Trials in Male and Female Sexual Dysfunction, focuses on measurement of patient-reported outcomes (PROs). Together with the design of appropriate phase I to phase IV clinical trials, the development, validation, choice, and implementation of valid PRO measurements-the focus of the present article-form the foundation of research on treatments for male and female sexual dysfunctions. PRO measurements are assessments of any aspect of a patient's health status that come directly from the patient (ie, without the interpretation of the patient's responses by a physician or anyone else). PROs are essential for assessing male and female sexual dysfunction and treatment response, including symptom frequency and severity, personal distress, satisfaction, and other measurements of sexual and general health-related quality of life. Although there are some relatively objective measurements of sexual dysfunction (ie, intravaginal ejaculatory latency time, frequency of sexual activity, etc), these measurements do not comprehensively assess the occurrence and extent of sexual dysfunction or treatment on the patient's symptoms, functioning, and well-being. Data generated by a PRO instrument can provide evidence of a treatment benefit from the patient's perspective. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Outcome Measures for Clinical Trials in Down Syndrome

PubMed Central

Esbensen, Anna J.; Hooper, Stephen R.; Fidler, Deborah; Hartley, Sigan; Edgin, Jamie; d’Ardhuy, Xavier Liogier; Capone, George; Conners, Frances; Mervis, Carolyn B.; Abbeduto, Leonard; Rafii, Michael; Krinsky-McHale, Sharon J.; Urv, Tiina

2017-01-01

Increasingly individuals with intellectual and developmental disabilities, including Down syndrome, are being targeted for clinical trials. However, a challenge exists in effectively evaluating the outcomes of these new pharmacological interventions. Few empirically evaluated, psychometrically sound outcome measures appropriate for use in clinical trials with individuals with Down syndrome have been identified. To address this challenge, the NIH assembled leading clinicians and scientists to review existing measures and identify those that currently are appropriate for trials; those that may be appropriate after expansion of age range addition of easier items, and/or downward extension of psychometric norms; and areas where new measures need to be developed. This paper focuses on measures in the areas of cognition and behavior. PMID:28452584

Functional Recovery Measures for Spinal Cord Injury: An Evidence-Based Review for Clinical Practice and Research

PubMed Central

Anderson, Kim; Aito, Sergio; Atkins, Michal; Biering-Sørensen, Fin; Charlifue, Susan; Curt, Armin; Ditunno, John; Glass, Clive; Marino, Ralph; Marshall, Ruth; Mulcahey, Mary Jane; Post, Marcel; Savic, Gordana; Scivoletto, Giorgio; Catz, Amiram

2008-01-01

Background/Objective: The end goal of clinical care and clinical research involving spinal cord injury (SCI) is to improve the overall ability of persons living with SCI to function on a daily basis. Neurologic recovery does not always translate into functional recovery. Thus, sensitive outcome measures designed to assess functional status relevant to SCI are important to develop. Method: Evaluation of currently available SCI functional outcome measures by a multinational work group. Results: The 4 measures that fit the prespecified inclusion criteria were the Modified Barthel Index (MBI), the Functional Independence Measure (FIM), the Quadriplegia Index of Function (QIF), and the Spinal Cord Independence Measure (SCIM). The MBI and the QIF were found to have minimal evidence for validity, whereas the FIM and the SCIM were found to be reliable and valid. The MBI has little clinical utility for use in the SCI population. Likewise, the FIM applies mainly when measuring burden of care, which is not necessarily a reflection of functional recovery. The QIF is useful for measuring functional recovery but only in a subpopulation of people with SCI, and substantial validity data are still required. The SCIM is the only functional recovery outcome measure designed specifically for SCI. Conclusions: The multinational work group recommends that the latest version of the SCIM (SCIM III) continue to be refined and validated and subsequently implemented worldwide as the primary functional recovery outcome measure for SCI. The QIF may continue to be developed and validated for use as a supplemental tool for the nonambulatory tetraplegic population. PMID:18581660

Prediction of objectively measured physical activity and sedentariness among blue-collar workers using survey questionnaires.

PubMed

Gupta, Nidhi; Heiden, Marina; Mathiassen, Svend Erik; Holtermann, Andreas

2016-05-01

We aimed at developing and evaluating statistical models predicting objectively measured occupational time spent sedentary or in physical activity from self-reported information available in large epidemiological studies and surveys. Two-hundred-and-fourteen blue-collar workers responded to a questionnaire containing information about personal and work related variables, available in most large epidemiological studies and surveys. Workers also wore accelerometers for 1-4 days measuring time spent sedentary and in physical activity, defined as non-sedentary time. Least-squares linear regression models were developed, predicting objectively measured exposures from selected predictors in the questionnaire. A full prediction model based on age, gender, body mass index, job group, self-reported occupational physical activity (OPA), and self-reported occupational sedentary time (OST) explained 63% (R (2)adjusted) of the variance of both objectively measured time spent sedentary and in physical activity since these two exposures were complementary. Single-predictor models based only on self-reported information about either OPA or OST explained 21% and 38%, respectively, of the variance of the objectively measured exposures. Internal validation using bootstrapping suggested that the full and single-predictor models would show almost the same performance in new datasets as in that used for modelling. Both full and single-predictor models based on self-reported information typically available in most large epidemiological studies and surveys were able to predict objectively measured occupational time spent sedentary or in physical activity, with explained variances ranging from 21-63%.

Failure to Integrate Quantitative Measurement Methods of Ocular Inflammation Hampers Clinical Practice and Trials on New Therapies for Posterior Uveitis.

PubMed

Herbort, Carl P; Tugal-Tutkun, Ilknur; Neri, Piergiorgio; Pavésio, Carlos; Onal, Sumru; LeHoang, Phuc

2017-05-01

Uveitis is one of the fields in ophthalmology where a tremendous evolution took place in the past 25 years. Not only did we gain access to more efficient, more targeted, and better tolerated therapies, but also in parallel precise and quantitative measurement methods developed allowing the clinician to evaluate these therapies and adjust therapeutic intervention with a high degree of precision. Objective and quantitative measurement of the global level of intraocular inflammation became possible for most inflammatory diseases with direct or spill-over anterior chamber inflammation, thanks to laser flare photometry. The amount of retinal inflammation could be quantified by using fluorescein angiography to score retinal angiographic signs. Indocyanine green angiography gave imaging insight into the hitherto inaccessible choroidal compartment, rendering possible the quantification of choroiditis by scoring indocyanine green angiographic signs. Optical coherence tomography has enabled measurement and objective monitoring of retinal and choroidal thickness. This multimodal quantitative appraisal of intraocular inflammation represents an exquisite security in monitoring uveitis. What is enigmatic, however, is the slow pace with which these improvements are integrated in some areas. What is even more difficult to understand is the fact that clinical trials to assess new therapeutic agents still mostly rely on subjective parameters such as clinical evaluation of vitreous haze as a main endpoint; whereas a whole array of precise, quantitative, and objective modalities are available for the design of clinical studies. The scope of this work was to review the quantitative investigations that improved the management of uveitis in the past 2-3 decades.

Evaluation of perceived and actual competency in a family medicine objective structured clinical examination.

PubMed

Graves, Lisa; Lalla, Leonora; Young, Meredith

2017-04-01

To examine the relationship between objective assessment of performance and self-rated competence immediately before and after participation in a required summative family medicine clerkship objective structured clinical examination (OSCE). Learners rated their competence (on a 7-point Likert scale) before and after an OSCE along 3 dimensions: general, specific, and professional competencies relevant to family medicine. McGill University in Montreal, Que. All 168 third-year clinical clerks completing their mandatory family medicine rotation in 2010 to 2011 were invited to participate. Self-ratings of competence and objective performance scores were compared, and were examined to determine if OSCEs could be a "corrective" tool for self-rating perceived competence (ie, if the experience of undergoing an assessment might assist learners in recalibrating their understanding of their own performance). A total of 140 (83%) of the third-year clinical clerks participated. Participating in an OSCE decreased learners' ratings of perceived competence (pre-OSCE score = 4.9, post-OSCE score = 4.7; F 1,3192 = 4.2; P  < .05). Learners' mean self-rated competence for all categories of behaviour (before and after) showed no relationship to OSCE performance ( r < 0.12 and P > .08 for all), nor did ratings of station-relevant competence (before and after) ( r < 0.19 and P > .09 for all). Ratings of competence before and after the OSCE were correlated for individual students ( r > 0.40 and P < .001 for all). After the OSCE, students' self-ratings of perceived competence had decreased, and these ratings had little relationship to actual performance, regardless of the specificity of the rated competency. Discordance between perceived and actual competence is neither novel nor unique to family medicine. However, this discordance is an important consideration for the development of competency-based curricula. Copyright© the College of Family Physicians of Canada.

Objectively measured sedentary time and physical activity in women with fibromyalgia: a cross-sectional study.

PubMed

Ruiz, Jonatan R; Segura-Jiménez, Víctor; Ortega, Francisco B; Alvarez-Gallardo, Inmaculada C; Camiletti-Moirón, Daniel; Aparicio, Virginia A; Carbonell-Baeza, Ana; Femia, Pedro; Munguía-Izquierdo, Diego; Delgado-Fernández, Manuel

2013-06-20

To characterise levels of objectively measured sedentary time and physical activity in women with fibromyalgia. Cross-sectional study. Local Association of Fibromyalgia (Granada, Spain). The study comprised 94 women with diagnosed fibromyalgia who did not have other severe somatic or psychiatric disorders, or other diseases that prevent physical loading, able to ambulate and to communicate and capable and willing to provide informed consent. Sedentary time and physical activity were measured by accelerometry and expressed as time spent in sedentary behaviours, average physical activity intensity (counts/minute) and amount of time (minutes/day) spent in moderate intensity and in moderate-to-vigorous-intensity physical activity (MVPA). The proportion of women meeting the physical activity recommendations of 30 min/day of MVPA on 5 or more days a week was 60.6%. Women spent, on average, 71% of their waking time (approximately 10 h/day) in sedentary behaviours. Both sedentary behaviour and physical activity levels were similar across age groups, waist circumference and percentage body fat categories, years since clinical diagnosis, marital status, educational level and occupational status, regardless of the severity of the disease (all p>0.1). Time spent on moderate-intensity physical activity and MVPA was, however, lower in those with greater body mass index (BMI) (-6.6 min and -7 min, respectively, per BMI category increase, <25, 25-30, >30 kg/m(2); p values for trend were 0.056 and 0.051, respectively). Women spent, on average, 10 min less on MVPA (p<0.001) and 22 min less on sedentary behaviours during weekends compared with weekdays (p=0.051). These data provide an objective measure of the amount of time spent on sedentary activities and on physical activity in women with fibromyalgia.

Objective evaluation by reflectance spectrophotometry can be of clinical value for the verification of blanching/non blanching erythema in the sacral area.

PubMed

Sterner, Eila; Fossum, Bjöörn; Berg, Elisabeth; Lindholm, Christina; Stark, André

2014-08-01

Early detection of non blanching erythema (pressure ulcer category I) is necessary to prevent any further skin damage. An objective method to discriminate between blanching/non blanching erythema is presently not available. The purpose of this investigation was to explore if a non invasive objective method could differentiate between blanching/non blanching erythema in the sacral area of patients undergoing hip fracture surgery. Seventy-eight patients were included. The sacral area of all patients was assessed using (i) conventional finger-press test and (ii) digital reading of the erythema index assessed with reflectance spectrophotometry. The patients were examined at admission and during 5 days postsurgery. Reflectance spectrophotometry measurements proved able to discriminate between blanching/non blanching erythema. The reliability, quantified by the intra-class correlation coefficient, was excellent between repeated measurements over the measurement period, varying between 0·82 and 0·96, and a significant change was recorded in the areas from day 1 to day 5 (P < 0·0001). The value from the reference point did not show any significant changes over the same period (P = 0·32). An objective method proven to identify early pressure damage to tissue can be a valuable tool in clinical practice. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

The Objective Assessment of Cough Frequency in Bronchiectasis.

PubMed

Spinou, Arietta; Lee, Kai K; Sinha, Aish; Elston, Caroline; Loebinger, Michael R; Wilson, Robert; Chung, Kian Fan; Yousaf, Nadia; Pavord, Ian D; Matos, Sergio; Garrod, Rachel; Birring, Surinder S

2017-10-01

Cough in bronchiectasis is associated with significant impairment in health status. This study aimed to quantify cough frequency objectively with a cough monitor and investigate its relationship with health status. A secondary aim was to identify clinical predictors of cough frequency. Fifty-four patients with bronchiectasis were compared with thirty-five healthy controls. Objective 24-h cough, health status (cough-specific: Leicester Cough Questionnaire LCQ and bronchiectasis specific: Bronchiectasis Health Questionnaire BHQ), cough severity and lung function were measured. The clinical predictors of cough frequency in bronchiectasis were determined in a multivariate analysis. Objective cough frequency was significantly raised in patients with bronchiectasis compared to healthy controls [geometric mean (standard deviation)] 184.5 (4.0) vs. 20.6 (3.2) coughs/24-h; mean fold-difference (95% confidence interval) 8.9 (5.2, 15.2); p < 0.001 and they had impaired health status. There was a significant correlation between objective cough frequency and subjective measures; LCQ r = -0.52 and BHQ r = -0.62, both p < 0.001. Sputum production, exacerbations (between past 2 weeks to 12 months) and age were significantly associated with objective cough frequency in multivariate analysis, explaining 52% of the variance (p < 0.001). There was no statistically significant association between cough frequency and lung function. Cough is a common and significant symptom in patients with bronchiectasis. Sputum production, exacerbations and age, but not lung function, were independent predictors of cough frequency. Ambulatory objective cough monitoring provides novel insights and should be further investigated as an outcome measure in bronchiectasis.

Effects of Job Burnout and Emotional Labor on Objective Structured Clinical Examination Performance Among Interns and Residents in Taiwan.

PubMed

Wang, Chen-Yu; Chen, Jen-De; Wang, Chih-Hung; Wang, Jong-Yi; Tai, Chih-Jaan; Hsieh, Tsu-Yi; Chen, Der-Yuan

2017-01-01

Medical education faces challenges concerning job burnout and emotional labor among junior physicians, which poses a potential threat to the quality of medical care. Although studies have investigated job burnout and emotional labor among physicians, empirical research on the association between job burnout, emotional labor, and clinical performance is lacking. This study investigated the effects of job burnout and emotional labor on clinical performance by using the objective structured clinical examination (OSCE) scores of interns and residents. Specifically, this cross-sectional study utilized the Maslach Burnout Inventory and the Emotional Labor Questionnaire as measurement instruments. A total of 225 interns and residents in central Taiwan answered structured questionnaires before beginning their OSCE. The major statistical analysis method employed was logistic regression. After adjustment for covariates, first-year residents were less likely than other residents to obtain high OSCE scores. The odds of high OSCE performance among interns and residents with high interaction component scores in emotional labor were significantly higher than those with low interaction scores. A high score in the interaction dimension of emotional labor was associated with strong clinical performance. The findings suggest that interventions which motivate positive attitudes and increase interpersonal interaction skills among physicians should receive higher priority.

Associations of Objectively and Subjectively Measured Sleep Quality with Subsequent Cognitive Decline in Older Community-Dwelling Men: The MrOS Sleep Study

PubMed Central

Blackwell, Terri; Yaffe, Kristine; Laffan, Alison; Ancoli-Israel, Sonia; Redline, Susan; Ensrud, Kristine E.; Song, Yeonsu; Stone, Katie L.

2014-01-01

Study Objectives: To examine associations of objectively and subjectively measured sleep with subsequent cognitive decline. Design: A population-based longitudinal study. Setting: Six centers in the United States. Participants: Participants were 2,822 cognitively intact community-dwelling older men (mean age 76.0 ± 5.3 y) followed over 3.4 ± 0.5 y. Interventions: None. Measurements and Results: Objectively measured sleep predictors from wrist actigraphy: total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), number of long wake episodes (LWEP). Self-reported sleep predictors: sleep quality (Pittsburgh Sleep Quality Index [PSQI]), daytime sleepiness (Epworth Sleepiness Scale [ESS]), TST. Clinically significant cognitive decline: five-point decline on the Modified Mini-Mental State examination (3MS), change score for the Trails B test time in the worse decile. Associations of sleep predictors and cognitive decline were examined with logistic regression and linear mixed models. After multivariable adjustment, higher levels of WASO and LWEP and lower SE were associated with an 1.4 to 1.5-fold increase in odds of clinically significant decline (odds ratio 95% confidence interval) Trails B test: SE < 70% versus SE ≥ 70%: 1.53 (1.07, 2.18); WASO ≥ 90 min versus WASO < 90 min: 1.47 (1.09, 1.98); eight or more LWEP versus fewer than eight: 1.38 (1.02, 1.86). 3MS: eight or more LWEP versus fewer than eight: 1.36 (1.09, 1.71), with modest relationships to linear change in cognition over time. PSQI was related to decline in Trails B performance (3 sec/y per standard deviation increase). Conclusions: Among older community-dwelling men, reduced sleep efficiency, greater nighttime wakefulness, greater number of long wake episodes, and poor self-reported sleep quality were associated with subsequent cognitive decline. Citation: Blackwell T; Yaffe K; Laffan A; Ancoli-Israel S; Redline S; Ensrud KE; Song Y; Stone KL. Associations of objectively and

Comparison between refraction measured by Spot Vision ScreeningTM and subjective clinical refractometry

PubMed Central

de Jesus, Daniela Lima; Villela, Flávio Fernandes; Orlandin, Luis Fernando; Eiji, Fernando Naves; Dantas, Daniel Oliveira; Alves, Milton Ruiz

2016-01-01

OBJECTIVE: The purpose of this study was to evaluate the accuracy of Spot Vision ScreeningTM as an autorefractor by comparing refraction measurements to subjective clinical refractometry results in children and adult patients. METHODS: One-hundred and thirty-four eyes of 134 patients were submitted to refractometry by Spot and clinical refractometry under cycloplegia. Patients, students, physicians, staff and children of staff from the Hospital das Clínicas (School of Medicine, University of São Paulo) aged 7-50 years without signs of ocular disease were examined. Only right-eye refraction data were analyzed. The findings were converted in magnitude vectors for analysis. RESULTS: The difference between Spot Vision ScreeningTM and subjective clinical refractometry expressed in spherical equivalents was +0.66±0.56 diopters (D), +0.16±0.27 D for the vector projected on the 90 axis and +0.02±0.15 D for the oblique vector. CONCLUSIONS: Despite the statistical significance of the difference between the two methods, we consider the difference non-relevant in a clinical setting, supporting the use of Spot Vision ScreeningTM as an ancillary method for estimating refraction. PMID:26934234

The Validation by Measurement Theory of Proposed Object-Oriented Software Metrics

NASA Technical Reports Server (NTRS)

Neal, Ralph D.

1996-01-01

Moving software development into the engineering arena requires controllability, and to control a process, it must be measurable. Measuring the process does no good if the product is not also measured, i.e., being the best at producing an inferior product does not define a quality process. Also, not every number extracted from software development is a valid measurement. A valid measurement only results when we are able to verify that the number is representative of the attribute that we wish to measure. Many proposed software metrics are used by practitioners without these metrics ever having been validated, leading to costly but often useless calculations. Several researchers have bemoaned the lack of scientific precision in much of the published software measurement work and have called for validation of software metrics by measurement theory. This dissertation applies measurement theory to validate fifty proposed object-oriented software metrics.

Temperature grid sensor for the measurement of spatial temperature distributions at object surfaces.

PubMed

Schäfer, Thomas; Schubert, Markus; Hampel, Uwe

2013-01-25

This paper presents results of the development and application of a new temperature grid sensor based on the wire-mesh sensor principle. The grid sensor consists of a matrix of 256 Pt1000 platinum chip resistors and an associated electronics that measures the grid resistances with a multiplexing scheme at high speed. The individual sensor elements can be spatially distributed on an object surface and measure transient temperature distributions in real time. The advantage compared with other temperature field measurement approaches such as infrared cameras is that the object under investigation can be thermally insulated and the radiation properties of the surface do not affect the measurement accuracy. The sensor principle is therefore suited for various industrial monitoring applications. Its applicability for surface temperature monitoring has been demonstrated through heating and mixing experiments in a vessel.

Archimedes Revisited: A Faster, Better, Cheaper Method of Accurately Measuring the Volume of Small Objects

ERIC Educational Resources Information Center

Hughes, Stephen W.

2005-01-01

A little-known method of measuring the volume of small objects based on Archimedes' principle is described, which involves suspending an object in a water-filled container placed on electronic scales. The suspension technique is a variation on the hydrostatic weighing technique used for measuring volume. The suspension method was compared with two…

Detection and measurement of clinically meaningful visual field progression in clinical trials for glaucoma.

PubMed

De Moraes, C Gustavo; Liebmann, Jeffrey M; Levin, Leonard A

2017-01-01

Glaucomatous visual field progression has both personal and societal costs and therefore has a serious impact on quality of life. At the present time, intraocular pressure (IOP) is considered to be the most important modifiable risk factor for glaucoma onset and progression. Reduction of IOP has been repeatedly demonstrated to be an effective intervention across the spectrum of glaucoma, regardless of subtype or disease stage. In the setting of approval of IOP-lowering therapies, it is expected that effects on IOP will translate into benefits in long-term patient-reported outcomes. Nonetheless, the effect of these medications on IOP and their associated risks can be consistently and objectively measured. This helps to explain why regulatory approval of new therapies in glaucoma has historically used IOP as the outcome variable. Although all approved treatments for glaucoma involve IOP reduction, patients frequently continue to progress despite treatment. It would therefore be beneficial to develop treatments that preserve visual function through mechanisms other than lowering IOP. The United States Food and Drug Administration (FDA) has stated that they will accept a clinically meaningful definition of visual field progression using Glaucoma Change Probability criteria. Nonetheless, these criteria do not take into account the time (and hence, the speed) needed to reach significant change. In this paper we provide an analysis based on the existing literature to support the hypothesis that decreasing the rate of visual field progression by 30% in a trial lasting 12-18 months is clinically meaningful. We demonstrate that a 30% decrease in rate of visual field progression can be reliably projected to have a significant effect on health-related quality of life, as defined by validated instruments designed to measure that endpoint. Copyright © 2016 Elsevier Ltd. All rights reserved.

Detection and measurement of clinically meaningful visual field progression in clinical trials for glaucoma

PubMed Central

De Moraes, C. Gustavo; Liebmann, Jeffrey M.; Levin, Leonard A.

2016-01-01

Glaucomatous visual field progression has both personal and societal costs and therefore has a serious impact on quality of life. At the present time, intraocular pressure (IOP) is considered to be the most important modifiable risk factor for glaucoma onset and progression. Reduction of IOP has been repeatedly demonstrated to be an effective intervention across the spectrum of glaucoma, regardless of subtype or disease stage. In the setting of approval of IOP-lowering therapies, it is expected that effects on IOP will translate into benefits in long-term patient-reported outcomes. Nonetheless, the effect of these medications on IOP and their associated risks can be consistently and objectively measured. This helps to explain why regulatory approval of new therapies in glaucoma has historically used IOP as the outcome variable. Although all approved treatments for glaucoma involve IOP reduction, patients frequently continue to progress despite treatment. It would therefore be beneficial to develop treatments that preserve visual function through mechanisms other than lowering IOP. The United States Food and Drug Administration (FDA) has stated that they will accept a clinically meaningful definition of visual field progression using Glaucoma Change Probability criteria. Nonetheless, these criteria do not take into account the time (and hence, the speed) needed to reach significant change. In this paper we provide an analysis based on the existing literature to support the hypothesis that decreasing the rate of visual field progression by 30% in a trial lasting 12–18 months is clinically meaningful. We demonstrate that a 30% decrease in rate of visual field progression can be reliably projected to have a significant effect on health-related quality of life, as defined by validated instruments designed to measure that endpoint. PMID:27773767

Reach and Validity of An Objective Medication Adherence Measure among Safety Net Health Plan Members with Diabetes: A Cross-Sectional Study

PubMed Central

Ratanawongsa, Neda; Karter, Andrew J.; Quan, Judy; Parker, Melissa M.; Handley, Margaret; Sarkar, Urmimala; Schmittdiel, Julie A.; Schillinger, Dean

2015-01-01

Background With the expansion of Medicaid and low-cost health insurance plans among diverse patient populations, objective measures of medication adherence using pharmacy claims could advance clinical care and translational research for safety net care. However, safety net patients may experience fluctuating prescription drug coverage, affecting the performance of adherence measures. Objective To evaluate the performance of continuous medication gap (CMG) for diverse, low-income managed care members with diabetes. Methods We conducted this cross-sectional analysis using administrative and clinical data for 680 members eligible for a self-management support trial at a non-profit, government-sponsored managed care plan. We applied CMG methodology to cardiometabolic medication claims for English-, Cantonese-, or Spanish-speaking members with diabetes. We examined inclusiveness (the proportion with calculable CMG) and selectivity (sociodemographic and medical differences from members without CMG). To examine validity, we examined unadjusted associations of suboptimal adherence (CMG>20%) with suboptimal cardiometabolic control. Results 429 members (63%) had calculable CMG. Compared to members without CMG, members with CMG were younger; more likely employed; and had poorer glycemic control, but better blood pressure and lipid control. Suboptimal adherence occurred more frequently among members with poor cardiometabolic control than among members with optimal control (28% vs. 12%, p=0.02). Conclusions CMG demonstrated acceptable inclusiveness and validity in a diverse, low-income safety net population, comparable to its performance in studies among other insured populations. CMG may provide a useful tool to measure adherence among increasingly diverse Medicaid populations, complemented by other strategies to reach those not captured by CMG. Trial Registration NCT00683020 PMID:26233541

Shifting attention from objective risk factors to patients' self-assessed health resources: a clinical model for general practice.

PubMed

Hollnagel, H; Malterud, K

1995-12-01

The study was designed to present and apply theoretical and empirical knowledge for the construction of a clinical model intended to shift the attention of the general practitioner from objective risk factors to self-assessed health resources in male and female patients. Review, discussion and analysis of selected theoretical models about personal health resources involving assessing existing theories according to their emphasis concerning self-assessed vs. doctor-assessed health resources, specific health resources vs. life and coping in general, abstract vs. clinically applicable theory, gender perspective explicitly included or not. Relevant theoretical models on health and coping (salutogenesis, coping and social support, control/demand, locus of control, health belief model, quality of life), and the perspective of the underprivileged Other (critical theory, feminist standpoint theory, the patient-centred clinical method) were presented and assessed. Components from Antonovsky's salutogenetic perspective and McWhinney's patient-centred clinical method, supported by gender perspectives, were integrated to a clinical model which is presented. General practitioners are recommended to shift their attention from objective risk factors to self-assessed health resources by means of the clinical model. The relevance and feasibility of the model should be explored in empirical research.

Outcome Measures for Clinical Trials in Down Syndrome.

PubMed

Esbensen, Anna J; Hooper, Stephen R; Fidler, Deborah; Hartley, Sigan L; Edgin, Jamie; d'Ardhuy, Xavier Liogier; Capone, George; Conners, Frances A; Mervis, Carolyn B; Abbeduto, Leonard; Rafii, Michael; Krinsky-McHale, Sharon J; Urv, Tiina

2017-05-01

Increasingly individuals with intellectual and developmental disabilities, including Down syndrome, are being targeted for clinical trials. However, a challenge exists in effectively evaluating the outcomes of these new pharmacological interventions. Few empirically evaluated, psychometrically sound outcome measures appropriate for use in clinical trials with individuals with Down syndrome have been identified. To address this challenge, the National Institutes of Health (NIH) assembled leading clinicians and scientists to review existing measures and identify those that currently are appropriate for trials; those that may be appropriate after expansion of age range addition of easier items, and/or downward extension of psychometric norms; and areas where new measures need to be developed. This article focuses on measures in the areas of cognition and behavior.

Atopy patch tests in young adult patients with atopic dermatitis and controls: dose-response relationship, objective reading, reproducibility and clinical interpretation.

PubMed

Bygum, Anette; Mortz, Charlotte Gotthard; Andersen, Klaus Ejner

2003-01-01

The clinical interpretation and reproducibility of atopy patch tests was studied in 23 selected young adult patients with atopic dermatitis and 25 healthy controls using standard inhalant allergens. Non-invasive measurements were used for objective assessment of test reactions and the participants were retested after 6 weeks. Ten of 19 (53%) evaluable patients with atopic dermatitis had at least one positive atopy patch test. However, there was no clear clinical relevance of the atopy patch test results when related to patient history and distribution of dermatitis. Reproducible and dose-dependent results were obtained with Dermatophagoides pteronyssinus, grass and cat with a reproducibility rate of 0.69 to 0.81 in patients and 0.60-0.96 in controls. A unique finding was a significant positive correlation between a positive atopy patch test, allergen dose and increase in transepidermal water loss and erythema, while measurement of capacitance did not distinguish between positive and negative reactions. The results of the present study do not support the routine use of atopy patch tests in the evaluation of adult patients with atopic dermatitis.

Measuring pacemaker dose: A clinical perspective

DOE Office of Scientific and Technical Information (OSTI.GOV)

Studenski, Matthew T., E-mail: matthew.studenski@jeffersonhospital.org; Xiao Ying; Harrison, Amy S.

2012-07-01

Recently in our clinic, we have seen an increased number of patients presenting with pacemakers and defibrillators. Precautions are taken to develop a treatment plan that minimizes the dose to the pacemaker because of the adverse effects of radiation on the electronics. Here we analyze different dosimeters to determine which is the most accurate in measuring pacemaker or defibrillator dose while at the same time not requiring a significant investment in time to maintain an efficient workflow in the clinic. The dosimeters analyzed here were ion chambers, diodes, metal-oxide-semiconductor field effect transistor (MOSFETs), and optically stimulated luminescence (OSL) dosimeters. Amore » simple phantom was used to quantify the angular and energy dependence of each dosimeter. Next, 8 patients plans were delivered to a Rando phantom with all the dosimeters located where the pacemaker would be, and the measurements were compared with the predicted dose. A cone beam computed tomography (CBCT) image was obtained to determine the dosimeter response in the kilovoltage energy range. In terms of the angular and energy dependence of the dosimeters, the ion chamber and diode were the most stable. For the clinical cases, all the dosimeters match relatively well with the predicted dose, although the ideal dosimeter to use is case dependent. The dosimeters, especially the MOSFETS, tend to be less accurate for the plans, with many lateral beams. Because of their efficiency, we recommend using a MOSFET or a diode to measure the dose. If a discrepancy is observed between the measured and expected dose (especially when the pacemaker to field edge is <10 cm), we recommend analyzing the treatment plan to see whether there are many lateral beams. Follow-up with another dosimeter rather than repeating multiple times with the same type of dosimeter. All dosimeters should be placed after the CBCT has been acquired.« less

Patient-reported outcomes (PROs): the significance of using humanistic measures in clinical trial and clinical practice.

PubMed

Refolo, P; Minacori, R; Mele, V; Sacchini, D; Spagnolo, A G

2012-10-01

Patient-reported outcome (PRO) is an "umbrella term" that covers a whole range of potential types of measurement but it is used specifically to refer to all measures quantifying the state of health through the evaluation of outcomes reported by the patient himself/herself. PROs are increasingly seen as complementary to biomedical measures and they are being incorporated more frequently into clinical trials and clinical practice. After considering the cultural background of PROs - that is the well known patient-centered model of medicine -, their historical profile (since 1914, the year of the first outcome measure) and typologies, the paper aims at debating their methodological complexity and implementation into practice. Some clinical trials and therapeutic managements utilizing patient-centered measures will be also analyzed.

Optical derotator alignment using image-processing algorithm for tracking laser vibrometer measurements of rotating objects.

PubMed

Khalil, Hossam; Kim, Dongkyu; Jo, Youngjoon; Park, Kyihwan

2017-06-01

An optical component called a Dove prism is used to rotate the laser beam of a laser-scanning vibrometer (LSV). This is called a derotator and is used for measuring the vibration of rotating objects. The main advantage of a derotator is that it works independently from an LSV. However, this device requires very specific alignment, in which the axis of the Dove prism must coincide with the rotational axis of the object. If the derotator is misaligned with the rotating object, the results of the vibration measurement are imprecise, owing to the alteration of the laser beam on the surface of the rotating object. In this study, a method is proposed for aligning a derotator with a rotating object through an image-processing algorithm that obtains the trajectory of a landmark attached to the object. After the trajectory of the landmark is mathematically modeled, the amount of derotator misalignment with respect to the object is calculated. The accuracy of the proposed method for aligning the derotator with the rotating object is experimentally tested.

Predicting out-of-office blood pressure level using repeated measurements in the clinic: an observational cohort study

PubMed Central

Sheppard, James P.; Holder, Roger; Nichols, Linda; Bray, Emma; Hobbs, F.D. Richard; Mant, Jonathan; Little, Paul; Williams, Bryan; Greenfield, Sheila; McManus, Richard J.

2014-01-01

Objectives: Identification of people with lower (white-coat effect) or higher (masked effect) blood pressure at home compared to the clinic usually requires ambulatory or home monitoring. This study assessed whether changes in SBP with repeated measurement at a single clinic predict subsequent differences between clinic and home measurements. Methods: This study used an observational cohort design and included 220 individuals aged 35–84 years, receiving treatment for hypertension, but whose SBP was not controlled. The characteristics of change in SBP over six clinic readings were defined as the SBP drop, the slope and the quadratic coefficient using polynomial regression modelling. The predictive abilities of these characteristics for lower or higher home SBP readings were investigated with logistic regression and repeated operating characteristic analysis. Results: The single clinic SBP drop was predictive of the white-coat effect with a sensitivity of 90%, specificity of 50%, positive predictive value of 56% and negative predictive value of 88%. Predictive values for the masked effect and those of the slope and quadratic coefficient were slightly lower, but when the slope and quadratic variables were combined, the sensitivity, specificity, positive and negative predictive values for the masked effect were improved to 91, 48, 24 and 97%, respectively. Conclusion: Characteristics obtainable from multiple SBP measurements in a single clinic in patients with treated hypertension appear to reasonably predict those unlikely to have a large white-coat or masked effect, potentially allowing better targeting of out-of-office monitoring in routine clinical practice. PMID:25144295

The validation by measurement theory of proposed object-oriented software metrics

NASA Technical Reports Server (NTRS)

Neal, Ralph D.

1994-01-01

Moving software development into the engineering arena requires controllability, and to control a process, it must be measurable. Measuring the process does no good if the product is not also measured, i.e., being the best at producing an inferior product does not define a quality process. Also, not every number extracted from software development is a valid measurement. A valid measurement only results when we are able to verify that the number is representative of the attribute that we wish to measure. Many proposed software metrics are used by practitioners without these metrics ever having been validated, leading to costly but often useless calculations. Several researchers have bemoaned the lack of scientific precision in much of the published software measurement work and have called for validation of software metrics by measurement theory. This dissertation applies measurement theory to validate fifty proposed object-oriented software metrics (Li and Henry, 1993; Chidamber and Kemerrer, 1994; Lorenz and Kidd, 1994).

On the correlation between objective measurements and subjectively felt disturbance from traffic

NASA Technical Reports Server (NTRS)

Lans, J.

1981-01-01

Measurements of traffic noise during the day were taken at 90 measurement points over the urban area of Vienna; in addition, the vehicle frequency ascertained at the individual measurement points was also noted. Results of these objective measurements or various characteristic single values derived from them are compared with the results of the environmental survey of 1973 on the subjective noise stress experienced within buildings but caused by outside factors. Suggestions for suitable measures to describe the traffic noise and to derive limit values are given considering the relationship between number of vehicles and noise and annoyance.

Waist Circumference and Objectively Measured Sedentary Behavior in Rural School Adolescents

ERIC Educational Resources Information Center

Machado-Rodrigues, Aristides M.; Coelho e Silva, Manuel J.; Ribeiro, Luís P.; Fernandes, Romulo; Mota, Jorge; Malina, Robert M.

2016-01-01

Background: Research on relationships between lifestyle behaviors and adiposity in school youth is potentially important for identifying subgroups at risk. This study evaluates the associations between waist circumference (WC) and objective measures of sedentary behavior (SB) in a sample of rural school adolescents. Methods: The sample included…

Colors of Outer Solar System Objects Measured with VATT

NASA Astrophysics Data System (ADS)

Romanishin, William; Tegler, S. C.; Consolmagno, G. J.

2010-10-01

Over the past 7 years, we have measured optical B-V and V-R colors for about 40 minor outer solar system objects using the 1.8-m Vatican Advanced Technology Telescope (VATT) located on Mt. Graham in southeast Arizona. We will present these colors and use them to update the discussion of colors of minor bodies in the outer solar system. We gratefully acknowledge funding from the NASA Planetary Astronomy Program to Northern Arizona University and the U. of Oklahoma which helped support this work.

Objective quantification of the tinnitus decompensation by synchronization measures of auditory evoked single sweeps.

PubMed

Strauss, Daniel J; Delb, Wolfgang; D'Amelio, Roberto; Low, Yin Fen; Falkai, Peter

2008-02-01

Large-scale neural correlates of the tinnitus decompensation might be used for an objective evaluation of therapies and neurofeedback based therapeutic approaches. In this study, we try to identify large-scale neural correlates of the tinnitus decompensation using wavelet phase stability criteria of single sweep sequences of late auditory evoked potentials as synchronization stability measure. The extracted measure provided an objective quantification of the tinnitus decompensation and allowed for a reliable discrimination between a group of compensated and decompensated tinnitus patients. We provide an interpretation for our results by a neural model of top-down projections based on the Jastreboff tinnitus model combined with the adaptive resonance theory which has not been applied to model tinnitus so far. Using this model, our stability measure of evoked potentials can be linked to the focus of attention on the tinnitus signal. It is concluded that the wavelet phase stability of late auditory evoked potential single sweeps might be used as objective tinnitus decompensation measure and can be interpreted in the framework of the Jastreboff tinnitus model and adaptive resonance theory.

Temperature measurements on fast-rotating objects using a thermographic camera with an optomechanical image derotator

NASA Astrophysics Data System (ADS)

Altmann, Bettina; Pape, Christian; Reithmeier, Eduard

2017-08-01

Increasing requirements concerning the quality and lifetime of machine components in industrial and automotive applications require comprehensive investigations of the components in conditions close to the application. Irregularities in heating of mechanical parts reveal regions with increased loading of pressure, draft or friction. In the long run this leads to damage and total failure of the machine. Thermographic measurements of rotating objects, e.g., rolling bearings, brakes, and clutches provide an approach to investigate those defects. However, it is challenging to measure fast-rotating objects accurately. Currently one contact-free approach is performing stroboscopic measurements using an infrared sensor. The data acquisition is triggered so that the image is taken once per revolution. This leads to a huge loss of information on the majority of the movement and to motion blur. The objective of this research is showing the potential of using an optomechanical image derotator together with a thermographic camera. The derotator follows the rotation of the measurement object so that quasi-stationary thermal images during motion can be acquired by the infrared sensor. Unlike conventional derotators which use a glass prism to achieve this effect, the derotator within this work is equipped with a sophisticated reflector assembly. These reflectors are made of aluminum to transfer infrared radiation emitted by the rotating object. Because of the resulting stationary thermal image, the operation can be monitored continuously even for fast-rotating objects. The field of view can also be set to a small off-axis region of interest which then can be investigated with higher resolution or frame rate. To depict the potential of this approach, thermographic measurements on a rolling bearings in different operating states are presented.

A Grading System To Evaluate Objectively the Strength of Pre-Clinical Data of Acute Neuroprotective Therapies for Clinical Translation in Spinal Cord Injury

PubMed Central

Okon, Elena B.; Tsai, Eve; Beattie, Michael S.; Bresnahan, Jacqueline C.; Magnuson, David K.; Reier, Paul J.; McTigue, Dana M.; Popovich, Phillip G.; Blight, Andrew R.; Oudega, Martin; Guest, James D.; Weaver, Lynne C.; Fehlings, Michael G.; Tetzlaff, Wolfram

2011-01-01

Abstract The past three decades have seen an explosion of research interest in spinal cord injury (SCI) and the development of hundreds of potential therapies that have demonstrated some promise in pre-clinical experimental animal models. A growing number of these treatments are seeking to be translated into human clinical trials. Conducting such a clinical trial, however, is extremely costly, not only for the time and money required to execute it, but also for the limited resources that will then no longer be available to evaluate other promising therapies. The decision about what therapies have sufficient pre-clinical evidence of efficacy to justify testing in humans is therefore of utmost importance. Here, we have developed a scoring system for objectively grading the body of pre-clinical literature on neuroprotective treatments for acute SCI. The components of the system include an evaluation of a number of factors that are thought to be important in considering the “robustness” of a therapy's efficacy, including the animal species and injury models that have been used to test it, the time window of efficacy, the types of functional improvements effected by it, and whether efficacy has been independently replicated. The selection of these factors was based on the results of a questionnaire that was performed within the SCI research community. A modified Delphi consensus-building exercise was then conducted with experts in pre-clinical SCI research to refine the criteria and decide upon how to score them. Finally, the grading system was applied to a series of potential neuroprotective treatments for acute SCI. This represents a systematic approach to developing an objective method of evaluating the extent to which the pre-clinical literature supports the translation of a particular experimental treatment into human trials. PMID:20507235

A framework for developing objective and measurable recovery criteria for threatened and endangered species.

PubMed

Himes Boor, Gina K

2014-02-01

For species listed under the U.S. Endangered Species Act (ESA), the U.S. Fish and Wildlife Service and National Marine Fisheries Service are tasked with writing recovery plans that include "objective, measurable criteria" that define when a species is no longer at risk of extinction, but neither the act itself nor agency guidelines provide an explicit definition of objective, measurable criteria. Past reviews of recovery plans, including one published in 2012, show that many criteria lack quantitative metrics with clear biological rationale and are not meeting the measureable and objective mandate. I reviewed how objective, measureable criteria have been defined implicitly and explicitly in peer-reviewed literature, the ESA, other U.S. statutes, and legal decisions. Based on a synthesis of these sources, I propose the following 6 standards be used as minimum requirements for objective, measurable criteria: contain a quantitative threshold with calculable units, stipulate a timeframe over which they must be met, explicitly define the spatial extent or population to which they apply, specify a sampling procedure that includes sample size, specify a statistical significance level, and include justification by providing scientific evidence that the criteria define a species whose extinction risk has been reduced to the desired level. To meet these 6 standards, I suggest that recovery plans be explicitly guided by and organized around a population viability modeling framework even if data or agency resources are too limited to complete a viability model. When data and resources are available, recovery criteria can be developed from the population viability model results, but when data and resources are insufficient for model implementation, extinction risk thresholds can be used as criteria. A recovery-planning approach centered on viability modeling will also yield appropriately focused data-acquisition and monitoring plans and will facilitate a seamless transition

Personalized objects can optimize the diagnosis of EMCS in the assessment of functional object use in the CRS-R: a double blind, randomized clinical trial.

PubMed

Sun, Yuxiao; Wang, Jianan; Heine, Lizette; Huang, Wangshan; Wang, Jing; Hu, Nantu; Hu, Xiaohua; Fang, Xiaohui; Huang, Supeng; Laureys, Steven; Di, Haibo

2018-04-12

Behavioral assessment has been acted as the gold standard for the diagnosis of disorders of consciousness (DOC) patients. The item "Functional Object Use" in the motor function sub-scale in the Coma Recovery Scale-Revised (CRS-R) is a key item in differentiating between minimally conscious state (MCS) and emergence from MCS (EMCS). However, previous studies suggested that certain specific stimuli, especially something self-relevant can affect DOC patients' scores of behavioral assessment scale. So, we attempted to find out if personalized objects can improve the diagnosis of EMCS in the assessment of Functional Object Use by comparing the use of patients' favorite objects and other common objects in MCS patients. Twenty-one post-comatose patients diagnosed as MCS were prospectively included. The item "Functional Object Use" was assessed by using personalized objects (e.g., cigarette, paper) and non-personalized objects, which were presented in a random order. The rest assessments were performed following the standard protocol of the CRS-R. The differences between functional uses of the two types of objects were analyzed by the McNemar test. The incidence of Functional Object Use was significantly higher using personalized objects than non-personalized objects in the CRS-R. Five out of the 21 MCS studied patients, who were assessed with non-personalized objects, were re-diagnosed as EMCS with personalized objects (χ 2  = 5, df = 1, p < 0.05). Personalized objects employed here seem to be more effective to elicit patients' responses as compared to non-personalized objects during the assessment of Functional Object Use in DOC patients. Clinical Trials.gov: NCT02988206 ; Date of registration: 2016/12/12.

No Measured Effect of a Familiar Contextual Object on Color Constancy.

PubMed

Kanematsu, Erika; Brainard, David H

2014-08-01

Some familiar objects have a typical color, such as the yellow of a banana. The presence of such objects in a scene is a potential cue to the scene illumination, since the light reflected from them should on average be consistent with their typical surface reflectance. Although there are many studies on how the identity of an object affects how its color is perceived, little is known about whether the presence of a familiar object in a scene helps the visual system stabilize the color appearance of other objects with respect to changes in illumination. We used a successive color matching procedure in three experiments designed to address this question. Across the experiments we studied a total of 6 subjects (2 in Experiment 1, 3 in Experiment 2, and 4 in Experiment 3) with partial overlap of subjects between experiments. We compared measured color constancy across conditions in which a familiar object cue to the illuminant was available with conditions in which such a cue was not present. Overall, our results do not reveal a reliable improvement in color constancy with the addition of a familiar object to a scene. An analysis of the experimental power of our data suggests that if there is such an effect, it is small: less than approximately a change of 0.09 in a constancy index where an absence of constancy corresponds to an index value of 0 and perfect constancy corresponds to an index value of 1.

No Measured Effect of a Familiar Contextual Object on Color Constancy

PubMed Central

Kanematsu, Erika; Brainard, David H.

2013-01-01

Some familiar objects have a typical color, such as the yellow of a banana. The presence of such objects in a scene is a potential cue to the scene illumination, since the light reflected from them should on average be consistent with their typical surface reflectance. Although there are many studies on how the identity of an object affects how its color is perceived, little is known about whether the presence of a familiar object in a scene helps the visual system stabilize the color appearance of other objects with respect to changes in illumination. We used a successive color matching procedure in three experiments designed to address this question. Across the experiments we studied a total of 6 subjects (2 in Experiment 1, 3 in Experiment 2, and 4 in Experiment 3) with partial overlap of subjects between experiments. We compared measured color constancy across conditions in which a familiar object cue to the illuminant was available with conditions in which such a cue was not present. Overall, our results do not reveal a reliable improvement in color constancy with the addition of a familiar object to a scene. An analysis of the experimental power of our data suggests that if there is such an effect, it is small: less than approximately a change of 0.09 in a constancy index where an absence of constancy corresponds to an index value of 0 and perfect constancy corresponds to an index value of 1. PMID:25313267

Validity of self-reported solar UVR exposure compared with objectively measured UVR exposure.

PubMed

Glanz, Karen; Gies, Peter; O'Riordan, David L; Elliott, Tom; Nehl, Eric; McCarty, Frances; Davis, Erica

2010-12-01

Reliance on verbal self-report of solar exposure in skin cancer prevention and epidemiologic studies may be problematic if self-report data are not valid due to systematic errors in recall, social desirability bias, or other reasons. This study examines the validity of self-reports of exposure to ultraviolet radiation (UVR) compared to objectively measured exposure among children and adults in outdoor recreation settings in 4 regions of the United States. Objective UVR exposures of 515 participants were measured using polysulfone film badge UVR dosimeters on 2 days. The same subjects provided self-reported UVR exposure data on surveys and 4-day sun exposure diaries, for comparison to their objectively measured exposure. Dosimeter data showed that lifeguards had the greatest UVR exposure (24.5% of weekday ambient UVR), children the next highest exposures (10.3% ambient weekday UVR), and parents had the lowest (6.6% ambient weekday UVR). Similar patterns were observed in self-report data. Correlations between diary reports and dosimeter findings were fair to good and were highest for lifeguards (r = 0.38-0.57), followed by parents (r = 0.28-0.29) and children (r = 0.18-0.34). Correlations between survey and diary measures were moderate to good for lifeguards (r = 0.20-0.54) and children (r = 0.35-0.53). This is the largest study of its kind to date, and supports the utility of self-report measures of solar UVR exposure. Overall, self-reports of sun exposure produce valid measures of UVR exposure among parents, children, and lifeguards who work outdoors. ©2010 AACR.

Germ line genome editing in clinics: the approaches, objectives and global society

PubMed Central

2017-01-01

Genome editing allows for the versatile genetic modification of somatic cells, germ cells and embryos. In particular, CRISPR/Cas9 is worldwide used in biomedical research. Although the first report on Cas9-mediated gene modification in human embryos focused on the prevention of a genetic disease in offspring, it raised profound ethical and social concerns over the safety of subsequent generations and the potential misuse of genome editing for human enhancement. The present article considers germ line genome editing approaches from various clinical and ethical viewpoints and explores its objectives. The risks and benefits of the following three likely objectives are assessed: the prevention of monogenic diseases, personalized assisted reproductive technology (ART) and genetic enhancement. Although genetic enhancement should be avoided, the international regulatory landscape suggests the inevitability of this misuse at ART centers. Under these circumstances, possible regulatory responses and the potential roles of public dialogue are discussed. PMID:26615180

Germ line genome editing in clinics: the approaches, objectives and global society.

PubMed

Ishii, Tetsuya

2017-01-01

Genome editing allows for the versatile genetic modification of somatic cells, germ cells and embryos. In particular, CRISPR/Cas9 is worldwide used in biomedical research. Although the first report on Cas9-mediated gene modification in human embryos focused on the prevention of a genetic disease in offspring, it raised profound ethical and social concerns over the safety of subsequent generations and the potential misuse of genome editing for human enhancement. The present article considers germ line genome editing approaches from various clinical and ethical viewpoints and explores its objectives. The risks and benefits of the following three likely objectives are assessed: the prevention of monogenic diseases, personalized assisted reproductive technology (ART) and genetic enhancement. Although genetic enhancement should be avoided, the international regulatory landscape suggests the inevitability of this misuse at ART centers. Under these circumstances, possible regulatory responses and the potential roles of public dialogue are discussed. © The Author 2015. Published by Oxford University Press.

Non-destructive 3D shape measurement of transparent and black objects with thermal fringes

NASA Astrophysics Data System (ADS)

Brahm, Anika; Rößler, Conrad; Dietrich, Patrick; Heist, Stefan; Kühmstedt, Peter; Notni, Gunther

2016-05-01

Fringe projection is a well-established optical method for the non-destructive contactless three-dimensional (3D) measurement of object surfaces. Typically, fringe sequences in the visible wavelength range (VIS) are projected onto the surfaces of objects to be measured and are observed by two cameras in a stereo vision setup. The reconstruction is done by finding corresponding pixels in both cameras followed by triangulation. Problems can occur if the properties of some materials disturb the measurements. If the objects are transparent, translucent, reflective, or strongly absorbing in the VIS range, the projected patterns cannot be recorded properly. To overcome these challenges, we present a new alternative approach in the infrared (IR) region of the electromagnetic spectrum. For this purpose, two long-wavelength infrared (LWIR) cameras (7.5 - 13 μm) are used to detect the emitted heat radiation from surfaces which is induced by a pattern projection unit driven by a CO2 laser (10.6 μm). Thus, materials like glass or black objects, e.g. carbon fiber materials, can be measured non-destructively without the need of any additional paintings. We will demonstrate the basic principles of this heat pattern approach and show two types of 3D systems based on a freeform mirror and a GOBO wheel (GOes Before Optics) projector unit.

Rapid-Response Impulsivity: Definitions, Measurement Issues, and Clinical Implications

PubMed Central

Hamilton, Kristen R.; Littlefield, Andrew K.; Anastasio, Noelle C.; Cunningham, Kathryn A.; Fink, Latham H.; Wing, Victoria C.; Mathias, Charles W.; Lane, Scott D.; Schutz, Christian; Swann, Alan C.; Lejuez, C.W.; Clark, Luke; Moeller, F. Gerard; Potenza, Marc N.

2015-01-01

Impulsivity is a multi-faceted construct that is a core feature of multiple psychiatric conditions and personality disorders. However, progress in understanding and treating impulsivity in the context of these conditions is limited by a lack of precision and consistency in its definition and assessment. Rapid-response-impulsivity (RRI) represents a tendency toward immediate action that occurs with diminished forethought and is out of context with the present demands of the environment. Experts from the International Society for Research on Impulsivity (InSRI) met to discuss and evaluate RRI-measures in terms of reliability, sensitivity, and validity with the goal of helping researchers and clinicians make informed decisions about the use and interpretation of findings from RRI-measures. Their recommendations are described in this manuscript. Commonly-used clinical and preclinical RRI-tasks are described, and considerations are provided to guide task selection. Tasks measuring two conceptually and neurobiologically distinct types of RRI, “refraining from action initiation” (RAI) and “stopping an ongoing action” (SOA) are described. RAI and SOA-tasks capture distinct aspects of RRI that may relate to distinct clinical outcomes. The InSRI group recommends that: 1) selection of RRI-measures should be informed by careful consideration of the strengths, limitations, and practical considerations of the available measures; 2) researchers use both RAI and SOA tasks in RRI studies to allow for direct comparison of RRI types and examination of their associations with clinically relevant measures; and, 3) similar considerations should be made for human and non-human studies in an effort to harmonize and integrate pre-clinical and clinical research. PMID:25867840

Clinical history and biologic age predicted falls better than objective functional tests.

PubMed

Gerdhem, Paul; Ringsberg, Karin A M; Akesson, Kristina; Obrant, Karl J

2005-03-01

Fall risk assessment is important because the consequences, such as a fracture, may be devastating. The objective of this study was to find the test or tests that best predicted falls in a population-based sample of elderly women. The fall-predictive ability of a questionnaire, a subjective estimate of biologic age and objective functional tests (gait, balance [Romberg and sway test], thigh muscle strength, and visual acuity) were compared in 984 randomly selected women, all 75 years of age. A recalled fall was the most important predictor for future falls. Only recalled falls and intake of psycho-active drugs independently predicted future falls. Women with at least five of the most important fall predictors (previous falls, conditions affecting the balance, tendency to fall, intake of psychoactive medication, inability to stand on one leg, high biologic age) had an odds ratio of 11.27 (95% confidence interval 4.61-27.60) for a fall (sensitivity 70%, specificity 79%). The more time-consuming objective functional tests were of limited importance for fall prediction. A simple clinical history, the inability to stand on one leg, and a subjective estimate of biologic age were more important as part of the fall risk assessment.

Objective Biomarkers of Balance and Gait for Parkinson’s Disease using Body-worn Sensors

PubMed Central

Horak, Fay B; Mancini, Martina

2014-01-01

Balance and gait impairments characterize progression of Parkinson’s disease (PD), predict fall risk, and are important contributors to reduced quality of life. Advances in technology of small, body-worn inertial sensors have made it possible to develop quick, objective measures of balance and gait impairments in the clinic for research trials and clinical practice. Objective balance and gait metrics may eventually provide useful biomarkers for PD. In fact, objective balance and gait measures are already being used as surrogate end-points for demonstrating clinical efficacy of new treatments, in place of counting falls from diaries, using stop-watch measures of gait speed, or clinical balance rating scales. This review summarizes the types of objective measures available from body-worn sensors. We organize the metrics based on the neural control system for mobility affected by PD: postural stability in stance, postural responses, gait initiation, gait (temporal-spatial lower and upper body coordination and dynamic equilibrium), postural transitions, and freezing of gait. However, the explosion of metrics derived by wearable sensors during prescribed balance and gait tasks that are abnormal in people with PD do not yet qualify as behavioral biomarkers because many balance and gait impairments observed in PD are not specific to the disease, nor shown to be related to specific pathophysiologic biomarkers. In the future, the most useful balance and gait biomarkers for PD will be those that are sensitive and specific for early PD and related to the underlying disease process. PMID:24132842

A Comparison of Two Objective Measures of Binaural Processing: The Interaural Phase Modulation Following Response and the Binaural Interaction Component.

PubMed

Haywood, Nicholas R; Undurraga, Jaime A; Marquardt, Torsten; McAlpine, David

2015-12-30

There has been continued interest in clinical objective measures of binaural processing. One commonly proposed measure is the binaural interaction component (BIC), which is obtained typically by recording auditory brainstem responses (ABRs)-the BIC reflects the difference between the binaural ABR and the sum of the monaural ABRs (i.e., binaural - (left + right)). We have recently developed an alternative, direct measure of sensitivity to interaural time differences, namely, a following response to modulations in interaural phase difference (the interaural phase modulation following response; IPM-FR). To obtain this measure, an ongoing diotically amplitude-modulated signal is presented, and the interaural phase difference of the carrier is switched periodically at minima in the modulation cycle. Such periodic modulations to interaural phase difference can evoke a steady state following response. BIC and IPM-FR measurements were compared from 10 normal-hearing subjects using a 16-channel electroencephalographic system. Both ABRs and IPM-FRs were observed most clearly from similar electrode locations-differential recordings taken from electrodes near the ear (e.g., mastoid) in reference to a vertex electrode (Cz). Although all subjects displayed clear ABRs, the BIC was not reliably observed. In contrast, the IPM-FR typically elicited a robust and significant response. In addition, the IPM-FR measure required a considerably shorter recording session. As the IPM-FR magnitude varied with interaural phase difference modulation depth, it could potentially serve as a correlate of perceptual salience. Overall, the IPM-FR appears a more suitable clinical measure than the BIC. © The Author(s) 2015.

Objective measurement of paranormal belief: a rebuttal to Vitulli.

PubMed

Lange, R; Irwin, H J; Houran, J

2001-06-01

Effects of age and sex in paranormal belief remain controversial because issues of scaling and differential item function are not given due attention. Therefore, in response to the recent debate between Irwin and Vitulli, these issues are reviewed and validated as crucial approaches for obtaining an objective measure of paranormal belief. A Rasch version of Tobacyk's Paranormal Belief Scale has been developed, but research with this scale suggests that--contrary to past literature and recently refined studies--age and sex are neither consistent nor crucial factors mediating paranormal belief.

Adding Debriefing to Objective Structured Clinical Examinations to Enhance Disability Cultural Sensitivity in Pharmacy Students

ERIC Educational Resources Information Center

Smith, Mark Joseph

2016-01-01

Debriefing was added to the design of an objective structured clinical examination (OSCE) after second-year pharmacy students performed poorly at considering patient disability in planning for patient care. This mixed-methods study examines secondary data to explore whether and how the addition of a debriefing to an OSCE impacted pharmacy…

Spinal Muscular Atrophy Biomarker Measurements from Blood Samples in a Clinical Trial of Valproic Acid in Ambulatory Adults

PubMed Central

Renusch, Samantha R.; Harshman, Sean; Pi, Hongyang; Workman, Eileen; Wehr, Allison; Li, Xiaobai; Prior, Thomas W.; Elsheikh, Bakri H.; Swoboda, Kathryn J.; Simard, Louise R.; Kissel, John T.; Battle, Daniel; Parthun, Mark R.; Freitas, Michael A.; Kolb, Stephen J.

2015-01-01

Abstract Background: Clinical trials of therapies for spinal muscular atrophy (SMA) that are designed to increase the expression the SMN protein ideally include careful assessment of relevant SMN biomarkers. Objective: In the SMA VALIANT trial, a recent double-blind placebo-controlled crossover study of valproic acid (VPA) in ambulatory adult subjects with SMA, we investigated relevant pharmacodynamic biomarkers in blood samples from SMA subjects by direct longitudinal measurement of histone acetylation and SMN mRNA and protein levels in the presence and absence of VPA treatment. Methods: Thirty-three subjects were randomized to either VPA or placebo for the first 6 months followed by crossover to the opposite arm for an additional 6 months. Outcome measures were compared between the two treatments (VPA and placebo) using a standard crossover analysis. Results: A significant increase in histone H4 acetylation was observed with VPA treatment (p = 0.005). There was insufficient evidence to suggest a treatment effect with either full length or truncated SMN mRNA transcript levels or SMN protein levels. Conclusions: These measures were consistent with the observed lack of change in the primary clinical outcome measure in the VALIANT trial. These results also highlight the added benefit of molecular and pharmacodynamic biomarker measurements in the interpretation of clinical trial outcomes. PMID:27858735

Improving site selection in clinical studies: a standardised, objective, multistep method and first experience results.

PubMed

Hurtado-Chong, Anahí; Joeris, Alexander; Hess, Denise; Blauth, Michael

2017-07-12

A considerable number of clinical studies experience delays, which result in increased duration and costs. In multicentre studies, patient recruitment is among the leading causes of delays. Poor site selection can result in low recruitment and bad data quality. Site selection is therefore crucial for study quality and completion, but currently no specific guidelines are available. Selection of sites adequate to participate in a prospective multicentre cohort study was performed through an open call using a newly developed objective multistep approach. The method is based on use of a network, definition of objective criteria and a systematic screening process. Out of 266 interested sites, 24 were shortlisted and finally 12 sites were selected to participate in the study. The steps in the process included an open call through a network, use of selection questionnaires tailored to the study, evaluation of responses using objective criteria and scripted telephone interviews. At each step, the number of candidate sites was quickly reduced leaving only the most promising candidates. Recruitment and quality of data went according to expectations in spite of the contracting problems faced with some sites. The results of our first experience with a standardised and objective method of site selection are encouraging. The site selection method described here can serve as a guideline for other researchers performing multicentre studies. ClinicalTrials.gov: NCT02297581. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The influence of initial bipedal stance width on the clinical measurement of unipedal balance time

PubMed Central

Richardson, James K.; Tang, Chi; Nwagwu, Chijioke; Nnodim, Joseph

2012-01-01

Objective To determine the effect of varying initial bipedal stance width (ISW) on the clinical measurement of unipedal balance time (UBT). Design Observational, cross sectional study. Setting Academic physiatric outpatient facility. Subjects Thirty-one clinic subjects with neuromuscular and/or musculoskeletal conditions known to influence mobility, and 30 similarly-aged healthy subjects. Methods Demographic and clinical information were recorded. UBT was determined under three distinct conditions by varying bipedal inter-malleolar distance: 1) ISW of 0.3 body height; 2) ISW of 0.05 body height; and 3) ISW of 0 body height. The last was accomplished by subjects assuming unipedal balance while using the hands on a horizontal surface for stabilization. Subjects lifted the contralateral foot (or hands in the case of 0 body height condition) in response to a cadenced command to minimize variation in rate of weight transfer Main Outcome Measurements UBT under each of the three ISW conditions. Results Mean UBT increased with decreasing ISW, and the differences were significant when comparing each ISW with the next smaller. Healthy subjects demonstrated greater UBT than clinic subjects at each ISW, but the magnitude of these group differences were similar across ISW condition. A UBT > 10 seconds in the 0.3 body height ISW was the best discriminator between clinic and healthy subjects. Conclusions Because UBT varies with ISW, standardization of ISW is necessary for accurate within subject, and between subject, comparisons in UBT. Healthy subjects were best differentiated from clinic subjects by UBT > 10 sec in the 0.3 body height ISW condition. PMID:20430326

Measuring the electronic transport properties of individual nano-objects under high pressures

NASA Astrophysics Data System (ADS)

Caillier, C.; Ayari, A.; Le Floch, S.; Féret, H.; Guiraud, G.; San-Miguel, A.

2011-09-01

We describe a setup to carry out electronic transport measurements under high pressures on individual nano-objects. It is based on a home-automated three-stage gas compressor working with argon or helium up to 1 GPa. The setup was successfully tested on contacted individual nanotubes, for which we evidence strong evolutions of the transport properties. These evolutions are related to fundamental issues such as the modification of the nano-object contact resistance, the pressure-induced modification of the nano-object geometry or pressure-induced changes in the intrinsic electronic properties of the nanosystem. A cryostat has also been adapted to the pressure cell, allowing combined pressure and temperature experiments down to 12 K.

Comparison of an objective method of measuring bulbar redness to the use of traditional grading scales.

PubMed

Sorbara, Luigina; Simpson, Trefford; Duench, Stephanie; Schulze, Marc; Fonn, Desmond

2007-03-01

The primary objective was to compare measures of bulbar redness objectively using a photometric method with standard grading methods. Measures of redness were made on 24 participants wearing a silicone hydrogel contact lens in one eye for overnight wear. This report compares hyperaemia after 1 week of daily wear (baseline) with redness measured after 6 months of overnight wear. A new method of objectively measuring bulbar conjunctival redness was performed using the Spectrascan650 Photometer by Photo Research under fixed illumination. Photometric measures in CIEu(*) chromaticity values involve the measurement of chromaticity, a physical analogue of redness, greenness and blueness in the image. This method was validated in Part 1 of the study using repeated measurements on the photographic CCLRU scale. In Part 2 of the study, the photographic grading scale (CCLRU) from 0 (none) to 100 (extreme) was used to make the comparison. Part 1 indicated that the photometer provides a repeatable and reliable measure of bulbar redness (CCC=0.989). A moderately strong and significant correlation was found between the CIEu(*) chromaticity values and the analogue data (R=0.795, p=0.000) at each measurement session (from baseline to 1 day, 1 week, and 1, 3 and 6 months of overnight wear). This new standardized and objective method of measuring bulbar redness has great potential to replace subjective grading scales, especially with multi-centre studies, where variability between investigators occurs. This method may also detect smaller changes between visits or between eyes.

Identifying uncontrolled asthma in young children: clinical scores or objective variables?

PubMed

Leung, T F; Ko, F W S; Sy, H Y; Wong, E; Li, C Y; Yung, E; Hui, D S C; Wong, G W K; Lai, C K W

2009-03-01

Several international asthma guidelines emphasize the importance of assessing asthma control. However, there is limited data on the usefulness of available assessment tools in indicating disease control in young asthmatics. This study investigated the ability of Chinese version of Childhood Asthma Control Test (C-ACT) and other disease-related factors in identifying uncontrolled asthma (UA) in young children. During the same clinic visit, asthma patients 4 to 11 years of age completed C-ACT and underwent exhaled nitric oxide and spirometric measurements. Blinded to these results, the same investigator assigned Disease Severity Score (DSS) and rated asthma control according to Global Initiative for Asthma. The mean (SD) age of 113 recruited patients was 9.1 (2.0) years, and 35% of them had UA. C-ACT, DSS and forced expiratory volume in 1 second (FEV(1)) differed among patients with different control status (p < 0.001 for C-ACT and DSS; p = 0.014 for FEV(1)). Logistic regression confirmed that UA was associated with DSS (p < 0.001), PEF (p = 0.002), C-ACT (p = 0.011), and FEV(1) (p = 0.012). By ROC analysis, C-ACT and DSS were the best predictors for UA (p < 0.001), followed by PEF (p = 0.006) and FEV(1) (p = 0.007). When analyzed by the Classification and Regression Tree (CART) approach, the sequential use of DSS and C-ACT had 77% sensitivity and 84% specificity in identifying UA. C-ACT is better than objective parameters in identifying young Chinese children with UA.

Formative Assessment of Procedural Skills: Students' Responses to the Objective Structured Clinical Examination and the Integrated Performance Procedural Instrument

ERIC Educational Resources Information Center

Nestel, Debra; Kneebone, Roger; Nolan, Carmel; Akhtar, Kash; Darzi, Ara

2011-01-01

Assessment of clinical skills is a critical element of undergraduate medical education. We compare a traditional approach to procedural skills assessment--the Objective Structured Clinical Examination (OSCE) with the Integrated Performance Procedural Instrument (IPPI). In both approaches, students work through "stations" or…

A systematic review of patient-reported outcome measures in clinical vestibular research

PubMed Central

Fong, Eric; Li, Carol; Aslakson, Rebecca; Agrawal, Yuri

2014-01-01

Objective To identify the most commonly-used patient-reported outcome (PRO) measures in clinical vestibular research, and assess their test characteristics and applicability to study age-related vestibular loss (ARVL) in clinical trials. Data Sources We performed a systematic review of the PubMed, CINAHL, and PsycINFO databases from 1950 to August 13, 2013. Study Selection PRO measures were defined as outcomes that capture the subjective experience of the patient, such as symptoms, functional status, health perceptions, and quality of life. Two independent reviewers selected studies that used PRO measures in clinical vestibular research. Disparities were resolved with consensus between the reviewers. Of 2260 articles initially found on literature search, 255 full-text articles were retrieved for assessment. One-hundred and four studies met inclusion criteria for data collection. Data Extraction PRO measures were identified by two independent reviewers. The four most commonly used PROs were evaluated for their applicability to the condition of ARVL. Specifically, for these four PROs, data were collected pertaining to instrument test-retest reliability, item domains, and target population of the instrument. Data Synthesis A total of 50 PRO instruments were identified. The four most frequently utilized PROs were the Dizziness Handicap Inventory (DHI), the Activities-specific Balance Confidence (ABC) scale, the Vertigo Symptom Scale (VSS), and the Visual Analogue Scale (VAS). Of these four PROs, three were validated for use in patients with vestibular disease, and one was validated in community-dwelling older individuals with balance impairments. Items across the four PROs were categorized into three domains based on the International Classification of Functioning, Disability and Health: Activity, Participation, and Body Functions and Structures. Conclusions None of the most commonly-used PRO instruments were validated for use in community-dwelling older adults

The use of objective measurements in the evaluation of therapy programs

NASA Technical Reports Server (NTRS)

Chaplin, H.

1974-01-01

The importance of objective measurements is discussed as a means of assessing the efficacy of physical and occupational therapy programs applied to patients recovering from neurological diseases. Considered are three primary categories of neurologically injured patients: patients with hemiplegia, patients with spinal cord injuries, and the heterogeneous group of cerebral palsy patients.

Single-beam, dual-view digital holographic interferometry for biomechanical strain measurements of biological objects

NASA Astrophysics Data System (ADS)

Pantelić, Dejan V.; Grujić, Dušan Ž.; Vasiljević, Darko M.

2014-12-01

We describe a method for dual-view biomechanical strain measurements of highly asymmetrical biological objects, like teeth or bones. By using a spherical mirror, we were able to simultaneously record a digital hologram of the object itself and the mirror image of its (otherwise invisible) rear side. A single laser beam was sufficient to illuminate both sides of the object, and to provide a reference beam. As a result, the system was mechanically very stable, enabling long exposure times (up to 2 min) without the need for vibration isolation. The setup is simple to construct and adjust, and can be used to interferometrically observe any object that is smaller than the mirror diameter. Parallel data processing on a CUDA-enabled (compute unified device architecture) graphics card was used to reconstruct digital holograms and to further correct image distortion. We used the setup to measure the deformation of a tooth due to mastication forces. The finite-element method was used to compare experimental results and theoretical predictions.

Single-beam, dual-view digital holographic interferometry for biomechanical strain measurements of biological objects.

PubMed

Pantelić, Dejan V; Grujić, Dušan Ž; Vasiljević, Darko M

2014-12-01

We describe a method for dual-view biomechanical strain measurements of highly asymmetrical biological objects, like teeth or bones. By using a spherical mirror, we were able to simultaneously record a digital hologram of the object itself and the mirror image of its (otherwise invisible) rear side. A single laser beam was sufficient to illuminate both sides of the object, and to provide a reference beam. As a result, the system was mechanically very stable, enabling long exposure times (up to 2 min) without the need for vibration isolation. The setup is simple to construct and adjust, and can be used to interferometrically observe any object that is smaller than the mirror diameter. Parallel data processing on a CUDA-enabled (compute unified device architecture) graphics card was used to reconstruct digital holograms and to further correct image distortion. We used the setup to measure the deformation of a tooth due to mastication forces. The finite-element method was used to compare experimental results and theoretical predictions.

Assessing stability in mild and moderate Parkinson's disease: Can clinical measures provide insight?

PubMed

Hubble, Ryan P; Silburn, Peter A; Naughton, Geraldine A; Cole, Michael H

2016-09-01

This cross-sectional study aimed to investigate the relationship between accelerometer-derived measures of movement rhythmicity and clinical measures of mobility, balance confidence and gait difficulty in people with Parkinson's disease (PD). Twenty-nine independently-living PD patients (Hoehn & Yahr Stages 1-3) with no history of significant injury or orthopaedic/deep brain stimulation surgery were recruited from a database of patients who had expressed an interest to participate in research. Participants completed clinical assessments of mobility, postural stability, balance confidence and symptom severity, while head and trunk rhythmicity was evaluated during gait using accelerometers. Following data collection, patients were stratified based on disease stage into either a Mild (Hoehn & Yahr Stage 1) or Moderate (Hoehn & Yahr Stages 2-3) PD group. The results highlighted that the Moderate PD group had poorer quality of life, reduced balance confidence and increased gait and falls difficulty. Furthermore, for these patients, gait disability and the number of previous falls were both negatively correlated with multiple components of head and trunk rhythmicity. For the Mild PD group, six-meter walk time was positively correlated with ML head rhythmicity and linear regression highlighted a significant predictive relationship between these outcomes. For the Mild and Moderate PD groups, balance confidence respectively predicted anterior-posterior trunk rhythmicity and vertical head rhythmicity. While these findings demonstrate that falls history and the Gait and Falls questionnaire provide moderate insight into head and trunk rhythmicity in Moderate PD patients, objective and clinically-feasible measures of postural instability would assist with the management of these symptoms. Copyright © 2016 Elsevier B.V. All rights reserved.

Clinical Utility of Noninvasive Method to Measure Specific Gravity in the Pediatric Population.

PubMed

Hall, Jeanine E; Huynh, Pauline P; Mody, Ameer P; Wang, Vincent J

2018-04-01

Clinicians rely on any combination of signs and symptoms, clinical scores, or invasive procedures to assess the hydration status in children. Noninvasive tests to evaluate for dehydration in the pediatric population are appealing. The objective of our study is to assess the utility of measuring specific gravity of tears compared to specific gravity of urine and the clinical assessment of dehydration. We conducted a prospective cohort convenience sample study, in a pediatric emergency department at a tertiary care children's hospital. We approached parents/guardians of children aged 6 months to 4 years undergoing transurethral catheterization for evaluation of urinary tract infection for enrollment. We collected tears and urine for measurement of tear specific gravity (TSG) and urine specific gravity (USG), respectively. Treating physicians completed dehydration assessment forms to assess for hydration status. Among the 60 participants included, the mean TSG was 1.0183 (SD = 0.007); the mean USG was 1.0186 (SD = 0.0083). TSG and USG were positively correlated with each other (Pearson Correlation = 0.423, p = 0.001). Clinical dehydration scores ranged from 0 to 3, with 87% assigned a score of 0, by physician assessment. Mean number of episodes of vomiting and diarrhea in a 24-hour period were 2.2 (SD = 3.9) and 1.5 (SD = 3.2), respectively. Sixty-two percent of parents reported decreased oral intake. TSG measurements yielded similar results compared with USG. Further studies are needed to determine if TSG can be used as a noninvasive method of dehydration assessment in children. Copyright © 2017 Elsevier Inc. All rights reserved.

Measuring pacemaker dose: a clinical perspective.

PubMed

Studenski, Matthew T; Xiao, Ying; Harrison, Amy S

2012-01-01

Recently in our clinic, we have seen an increased number of patients presenting with pacemakers and defibrillators. Precautions are taken to develop a treatment plan that minimizes the dose to the pacemaker because of the adverse effects of radiation on the electronics. Here we analyze different dosimeters to determine which is the most accurate in measuring pacemaker or defibrillator dose while at the same time not requiring a significant investment in time to maintain an efficient workflow in the clinic. The dosimeters analyzed here were ion chambers, diodes, metal-oxide-semiconductor field effect transistor (MOSFETs), and optically stimulated luminescence (OSL) dosimeters. A simple phantom was used to quantify the angular and energy dependence of each dosimeter. Next, 8 patients plans were delivered to a Rando phantom with all the dosimeters located where the pacemaker would be, and the measurements were compared with the predicted dose. A cone beam computed tomography (CBCT) image was obtained to determine the dosimeter response in the kilovoltage energy range. In terms of the angular and energy dependence of the dosimeters, the ion chamber and diode were the most stable. For the clinical cases, all the dosimeters match relatively well with the predicted dose, although the ideal dosimeter to use is case dependent. The dosimeters, especially the MOSFETS, tend to be less accurate for the plans, with many lateral beams. Because of their efficiency, we recommend using a MOSFET or a diode to measure the dose. If a discrepancy is observed between the measured and expected dose (especially when the pacemaker to field edge is <10 cm), we recommend analyzing the treatment plan to see whether there are many lateral beams. Follow-up with another dosimeter rather than repeating multiple times with the same type of dosimeter. All dosimeters should be placed after the CBCT has been acquired. Copyright © 2012 American Association of Medical Dosimetrists. Published by

Clinical use of three-dimensional video measurements of eye movements

NASA Technical Reports Server (NTRS)

Merfeld, D. M.; Black, F. O.; Wade, S.; Paloski, W. H. (Principal Investigator)

1998-01-01

Noninvasive measurements of three-dimensional eye position can be accurately achieved with video methods. A case study showing the potential clinical benefit of these enhanced measurements is presented along with some thoughts about technological advances, essential for clinical application, that are likely to occur in the next several years.

Computed Tomographic Measures of Pulmonary Vascular Morphology in Smokers and Their Clinical Implications

PubMed Central

Estépar, Raúl San José; Kinney, Gregory L.; Black-Shinn, Jennifer L.; Bowler, Russell P.; Kindlmann, Gordon L.; Ross, James C.; Kikinis, Ron; Han, MeiLan K.; Come, Carolyn E.; Diaz, Alejandro A.; Cho, Michael H.; Hersh, Craig P.; Schroeder, Joyce D.; Reilly, John J.; Lynch, David A.; Crapo, James D.; Wells, J. Michael; Dransfield, Mark T.; Hokanson, John E.

2013-01-01

Rationale: Angiographic investigation suggests that pulmonary vascular remodeling in smokers is characterized by distal pruning of the blood vessels. Objectives: Using volumetric computed tomography scans of the chest we sought to quantitatively evaluate this process and assess its clinical associations. Methods: Pulmonary vessels were automatically identified, segmented, and measured. Total blood vessel volume (TBV) and the aggregate vessel volume for vessels less than 5 mm2 (BV5) were calculated for all lobes. The lobe-specific BV5 measures were normalized to the TBV of that lobe and the nonvascular tissue volume (BV5/TissueV) to calculate lobe-specific BV5/TBV and BV5/TissueV ratios. Densitometric measures of emphysema were obtained using a Hounsfield unit threshold of −950 (%LAA-950). Measures of chronic obstructive pulmonary disease severity included single breath measures of diffusing capacity of carbon monoxide, oxygen saturation, the 6-minute-walk distance, St George’s Respiratory Questionnaire total score (SGRQ), and the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index. Measurements and Main Results: The %LAA-950 was inversely related to all calculated vascular ratios. In multivariate models including age, sex, and %LAA-950, lobe-specific measurements of BV5/TBV were directly related to resting oxygen saturation and inversely associated with both the SGRQ and BODE scores. In similar multivariate adjustment lobe-specific BV5/TissueV ratios were inversely related to resting oxygen saturation, diffusing capacity of carbon monoxide, 6-minute-walk distance, and directly related to the SGRQ and BODE. Conclusions: Smoking-related chronic obstructive pulmonary disease is characterized by distal pruning of the small blood vessels (<5 mm2) and loss of tissue in excess of the vasculature. The magnitude of these changes predicts the clinical severity of disease. PMID:23656466

The Sensitivity of Derived Estimates to the Measurement Quality Objectives for Independent Variables

Treesearch

Francis A. Roesch

2005-01-01

The effect of varying the allowed measurement error for individual tree variables upon county estimates of gross cubic-foot volume was examined. Measurement Quality Objectives (MQOs) for three forest tree variables (biological identity, diameter, and height) used in individual tree gross cubic-foot volume equations were varied from the current USDA Forest Service...

Objectively measured physical activity in obese women with and without migraine.

PubMed

Bond, Dale S; Thomas, J Graham; O'Leary, Kevin C; Lipton, Richard B; Peterlin, B Lee; Roth, Julie; Rathier, Lucille; Wing, Rena R

2015-09-01

The aim of this article is to cross-sectionally compare objectively measured physical activity (PA) levels and their association with migraine characteristics in obese women with and without migraine. Obese women seeking weight loss treatment were divided into migraine (n = 25) and control (n = 25) groups matched by age and body mass index (BMI). Participants wore the SenseWear Armband monitor for seven days to objectively evaluate daily light-(LPA) and moderate-to-vigorous intensity PA (MVPA). Migraine diagnosis was confirmed by a neurologist using ICHD-3-beta criteria. Migraine characteristics were tracked daily using a smartphone-based diary over a four-week period immediately preceding the objective PA assessment. Migraine participants spent 57.9 fewer minutes/day in LPA (141.1 ± 56.4 vs. 199.1 ± 87.7, p = 0.019) and 24.5 fewer minutes/day in MVPA (27.8 ± 17.0 vs. 52.3 ± 26.0, p < 0.001), compared to controls. Migraine participants reported 4.8 ± 3.1 migraine days/month (mean duration = 17.1 ± 8.9 hours; mean maximum pain severity = 6.4 ± 1.7 on a 0-10 scale). Higher BMI (p < 0.05), but not migraine characteristics, were related to lower total PA. Additionally, total objectively measured PA was not associated with how often PA was reported to exacerbate migraine attacks during the four-week diary assessment. Obese women with migraine spent nearly 1.5 hours/day less in PA compared to controls; however, lower PA was not related to migraine characteristics. Further research is needed to identify PA barriers and effective interventions in obese women with migraine. © International Headache Society 2014.

Wearable sensor-based objective assessment of motor symptoms in Parkinson's disease.

PubMed

Ossig, Christiana; Antonini, Angelo; Buhmann, Carsten; Classen, Joseph; Csoti, Ilona; Falkenburger, Björn; Schwarz, Michael; Winkler, Jürgen; Storch, Alexander

2016-01-01

Effective management and development of new treatment strategies of motor symptoms in Parkinson's disease (PD) largely depend on clinical rating instruments like the Unified PD rating scale (UPDRS) and the modified abnormal involuntary movement scale (mAIMS). Regarding inter-rater variability and continuous monitoring, clinical rating scales have various limitations. Patient-administered questionnaires such as the PD home diary to assess motor stages and fluctuations in late-stage PD are frequently used in clinical routine and as clinical trial endpoints, but diary/questionnaire are tiring, and recall bias impacts on data quality, particularly in patients with cognitive dysfunction or depression. Consequently, there is a strong need for continuous and objective monitoring of motor symptoms in PD for improving therapeutic regimen and for usage in clinical trials. Recent advances in battery technology, movement sensors such as gyroscopes, accelerometers and information technology boosted the field of objective measurement of movement in everyday life and medicine using wearable sensors allowing continuous (long-term) monitoring. This systematic review summarizes the current wearable sensor-based devices to objectively assess the various motor symptoms of PD.

Objective measurements for grading the nasal esthetics on Basal view in individuals with secondary cleft nasal deformity.

PubMed

He, Xing; Li, Hua; Shao, Yan; Shi, Bing

2015-01-01

The purpose of this study is to ascertain objective nasal measurements from the basal view that are predictive of nasal esthetics in individuals with secondary cleft nasal deformity. Thirty-three patients who had undergone unilateral cleft lip repair were retrospectively reviewed in this study. The degree of nasal deformity was subjectively ranked by seven surgeons using standardized basal-view measurements. Nine physical objective parameters including angles and ratios were measured. Correlations and regressions between these objective and subjective measurements were then analyzed. There was high concordance in subjective measurements by different surgeons (Kendall's harmonious coefficient = W = .825, P = .006). The strongest predictive factors for nasal aesthetics were the ratio of length of nasal alar (r = .370, P = .034) and the degree of deviation of the columnar axis (r = .451, P = .008). The columellar angle had a more powerful effect in rating nasal esthetics. There was reliable concordance in subjective ranking of nasal esthetics by surgeons. Measurement of the columnar angle may serve as an independent, objective predictor of esthetics of the nose.

Accuracy and Reliability of the Kinect Version 2 for Clinical Measurement of Motor Function

PubMed Central

Kayser, Bastian; Mansow-Model, Sebastian; Verrel, Julius; Paul, Friedemann; Brandt, Alexander U.; Schmitz-Hübsch, Tanja

2016-01-01

Background The introduction of low cost optical 3D motion tracking sensors provides new options for effective quantification of motor dysfunction. Objective The present study aimed to evaluate the Kinect V2 sensor against a gold standard motion capture system with respect to accuracy of tracked landmark movements and accuracy and repeatability of derived clinical parameters. Methods Nineteen healthy subjects were concurrently recorded with a Kinect V2 sensor and an optical motion tracking system (Vicon). Six different movement tasks were recorded with 3D full-body kinematics from both systems. Tasks included walking in different conditions, balance and adaptive postural control. After temporal and spatial alignment, agreement of movements signals was described by Pearson’s correlation coefficient and signal to noise ratios per dimension. From these movement signals, 45 clinical parameters were calculated, including ranges of motions, torso sway, movement velocities and cadence. Accuracy of parameters was described as absolute agreement, consistency agreement and limits of agreement. Intra-session reliability of 3 to 5 measurement repetitions was described as repeatability coefficient and standard error of measurement for each system. Results Accuracy of Kinect V2 landmark movements was moderate to excellent and depended on movement dimension, landmark location and performed task. Signal to noise ratio provided information about Kinect V2 landmark stability and indicated larger noise behaviour in feet and ankles. Most of the derived clinical parameters showed good to excellent absolute agreement (30 parameters showed ICC(3,1) > 0.7) and consistency (38 parameters showed r > 0.7) between both systems. Conclusion Given that this system is low-cost, portable and does not require any sensors to be attached to the body, it could provide numerous advantages when compared to established marker- or wearable sensor based system. The Kinect V2 has the potential to be used

The status of and future research into Myalgic Encephalomyelitis and Chronic Fatigue Syndrome: the need of accurate diagnosis, objective assessment, and acknowledging biological and clinical subgroups

PubMed Central

Twisk, Frank N. M.

2014-01-01

Although Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS) are used interchangeably, the diagnostic criteria define two distinct clinical entities. Cognitive impairment, (muscle) weakness, circulatory disturbances, marked variability of symptoms, and, above all, post-exertional malaise: a long-lasting increase of symptoms after a minor exertion, are distinctive symptoms of ME. This latter phenomenon separates ME, a neuro-immune illness, from chronic fatigue (syndrome), other disorders and deconditioning. The introduction of the label, but more importantly the diagnostic criteria for CFS have generated much confusion, mostly because chronic fatigue is a subjective and ambiguous notion. CFS was redefined in 1994 into unexplained (persistent or relapsing) chronic fatigue, accompanied by at least four out of eight symptoms, e.g., headaches and unrefreshing sleep. Most of the research into ME and/or CFS in the last decades was based upon the multivalent CFS criteria, which define a heterogeneous patient group. Due to the fact that fatigue and other symptoms are non-discriminative, subjective experiences, research has been hampered. Various authors have questioned the physiological nature of the symptoms and qualified ME/CFS as somatization. However, various typical symptoms can be assessed objectively using standardized methods. Despite subjective and unclear criteria and measures, research has observed specific abnormalities in ME/CFS repetitively, e.g., immunological abnormalities, oxidative and nitrosative stress, neurological anomalies, circulatory deficits and mitochondrial dysfunction. However, to improve future research standards and patient care, it is crucial that patients with post-exertional malaise (ME) and patients without this odd phenomenon are acknowledged as separate clinical entities that the diagnosis of ME and CFS in research and clinical practice is based upon accurate criteria and an objective assessment of characteristic symptoms

Appropriate Objective Functions for Quantifying Iris Mechanical Properties Using Inverse Finite Element Modeling.

PubMed

Pant, Anup D; Dorairaj, Syril K; Amini, Rouzbeh

2018-07-01

Quantifying the mechanical properties of the iris is important, as it provides insight into the pathophysiology of glaucoma. Recent ex vivo studies have shown that the mechanical properties of the iris are different in glaucomatous eyes as compared to normal ones. Notwithstanding the importance of the ex vivo studies, such measurements are severely limited for diagnosis and preclude development of treatment strategies. With the advent of detailed imaging modalities, it is possible to determine the in vivo mechanical properties using inverse finite element (FE) modeling. An inverse modeling approach requires an appropriate objective function for reliable estimation of parameters. In the case of the iris, numerous measurements such as iris chord length (CL) and iris concavity (CV) are made routinely in clinical practice. In this study, we have evaluated five different objective functions chosen based on the iris biometrics (in the presence and absence of clinical measurement errors) to determine the appropriate criterion for inverse modeling. Our results showed that in the absence of experimental measurement error, a combination of iris CL and CV can be used as the objective function. However, with the addition of measurement errors, the objective functions that employ a large number of local displacement values provide more reliable outcomes.

The sensitivity and specificity of clinical measures of sport concussion: three tests are better than one

PubMed Central

Resch, Jacob E; Brown, Cathleen N; Schmidt, Julianne; Macciocchi, Stephen N; Blueitt, Damond; Cullum, C Munro; Ferrara, Michael S

2016-01-01

Context A battery of clinical measures of neurocognition, balance and symptoms has been recommended for the management of sport concussion (SC) but is based on variable evidence. Objective To examine the sensitivity and specificity of a battery of tests to assess SC in college athletes. Design Cross-sectional. Setting Research laboratory. Patients or other participants Division 1 athletes diagnosed with a SC (n=40) who were 20.2±1.60 years of age and 180.5±11.12 cm tall and healthy athletes (n=40) who were 19.0±0.93 years of age and 179.1±11.39 cm tall were enrolled. Intervention(s) Participants were administered Immediate Postconcussion Assessment and Cognitive Test (ImPACT), the Sensory Organization Test (SOT) and the Revised Head Injury Scale (HIS-r) prior to and up to 24 h following injury between the 2004 and 2014 sport seasons. Sensitivity and specificity were calculated using predictive discriminant analyses (PDA) and clinical interpretation guidelines. Main outcome measures Outcome measures included baseline and postinjury ImPACT, SOT and HIS-r composite scores. Results Using PDA, each clinical measure's sensitivity ranged from 55.0% to 77.5% and specificity ranged from 52.5% to 100%. The test battery possessed a sensitivity and specificity of 80.0% and 100%, respectively. Using clinical interpretation guidelines, sensitivity ranged from 55% to 97.5% individually, and 100% when combined. Conclusions Our results support a multidimensional approach to assess SC in college athletes which correctly identified 80–100% of concussed participants as injured. When each test was evaluated separately, up to 47.5% of our sample was misclassified. Caution is warranted when using singular measures to manage SC. PMID:27900145

Challenges in Measuring Benefit of Clinical Research Training Programs--the ASH Clinical Research Training Institute Example.

PubMed

Sung, Lillian; Crowther, Mark; Byrd, John; Gitlin, Scott D; Basso, Joe; Burns, Linda

2015-12-01

The American Society of Hematology developed the Clinical Research Training Institute (CRTI) to address the lack of training in patient-oriented research among hematologists. As the program continues, we need to consider metrics for measuring the benefits of such a training program. This article addresses the benefits of clinical research training programs. The fundamental and key components are education and mentorship. However, there are several other benefits including promotion of collaboration, job and advancement opportunities, and promotion of work-life balance. The benefits of clinical research training programs need to be measured so that funders and society can judge if they are worth the investment in time and resources. Identification of elements that are important to program benefit is essential to measuring the benefit of the program as well as program planning. Future work should focus on the constructs which contribute to benefits of clinical research training programs such as CRTI.

Multicentre investigation on electrically evoked compound action potential and stapedius reflex: how do these objective measures relate to implant programming parameters?

PubMed

Van Den Abbeele, Thierry; Noël-Petroff, Nathalie; Akin, Istemihan; Caner, Gül; Olgun, Levent; Guiraud, Jeanne; Truy, Eric; Attias, Josef; Raveh, Eyal; Belgin, Erol; Sennaroglu, Gonca; Basta, Dietmar; Ernst, Arneborg; Martini, Alessandro; Rosignoli, Monica; Levi, Haya; Elidan, Joseph; Benghalem, Abdelhamid; Amstutz-Montadert, Isabelle; Lerosey, Yannick; De Vel, Eddy; Dhooge, Ingeborg; Hildesheimer, Minka; Kronenberg, Jona; Arnold, Laure

2012-02-01

The aims of this study were to collect data on electrically evoked compound action potential (eCAP) and electrically evoked stapedius reflex thresholds (eSRT) in HiResolution(TM) cochlear implant (CI) users, and to explore the relationships between these objective measures and behavioural measures of comfort levels (M-levels). A prospective study on newly implanted subjects was designed. The eCAP was measured intra-operatively and at first fitting through neural response imaging (NRI), using the SoundWave(TM) fitting software. The eSRT was measured intra-operatively by visual monitoring of the stapes, using both single-electrode stimulation and speech bursts (four electrodes stimulated at the same time). Measures of M-levels were performed according to standard clinical practice and collected at first fitting, 3 and 6 months of CI use. One hundred seventeen subjects from 14 centres, all implanted unilaterally with a HiResolution CII Bionic Ear(®) or HiRes 90K(®), were included in the study. Speech burst stimulation elicited a significantly higher eSRT success rate than single-electrode stimulation, 84 vs. 64% respectively. The NRI success rate was 81% intra-operatively, significantly increasing to 96% after 6 months. Fitting guidelines were defined on the basis of a single NRI measurement. Correlations, analysis of variance, and multiple regression analysis were applied to generate a predictive model for the M-levels. Useful insights were produced into the behaviour of objective measures according to time, electrode location, and fitting parameters. They may usefully assist in programming the CI when no reliable feedback is obtained through standard behavioural procedures.

Subjective vs Objective Accommodative Amplitude: Preschool to Presbyopia

PubMed Central

Anderson, Heather A.; Stuebing, Karla K.

2014-01-01

Purpose This study compared subjective and objective accommodative amplitudes to characterize changes from preschool to presbyopia. Methods Monocular accommodative amplitude was measured with three techniques in random order (subjective push-up, objective minus lens stimulated, and objective proximal stimulated) on 236 subjects 3–64 years using a 1.5mm letter. Subjective push-up amplitudes were the dioptric distance at which the target first blurred along a near-point rod. Objective minus lens stimulated amplitudes were the greatest accommodative response obtained by Grand Seiko autorefraction as subjects viewed the stimulus at 33cm through increasing minus lens powers. Objective proximal stimulated amplitudes were the greatest accommodative response obtained by Grand Seiko autorefraction as subjects viewed the stimulus at increasing proximity from 40cm up to 3.33cm. Results In comparison with subjective push-up amplitudes, objective amplitudes were lower at all ages, with the most dramatic difference occurring in the 3–5 year group (subjective push-up = 16.00 ± 4.98D versus objective proximal stimulated = 7.94 ± 2.37D and objective lens stimulated = 6.20 ± 1.99D). Objective proximal and lens stimulated amplitudes were largest in the 6–10 year group (8.81 ± 1.24D and 8.05 ± 1.82D, respectively) and gradually decreased until the fourth decade of life when a rapid decline to presbyopia occurred. There was a significant linear relationship between objective techniques (y = 0.74 + 0.96x, R2 = 0.85, p<0.001) with greater amplitudes measured for the proximal stimulated technique (mean difference = 0.55D). Conclusions Objective measurements of accommodation demonstrate that accommodative amplitude is substantially less than that measured by the subjective push-up technique, particularly in young children. These findings have important clinical implications for the management of uncorrected hyperopia. PMID:25602235

[The objective structured clinical evaluation of teaching in anaesthesiology and resuscitation].

PubMed

Echevarría Moreno, M; Prieto Vera, C; Martín Tellería, A; Neira Reina, F; Martín, J S; Fernández Jurado, M L; Luis Navarro, J C; Ortega Garcia, J L; Alarcón Martínez, L; López-Cuervo Derqui, R

2012-03-01

To find out the acquirement of professional competencies of Anaesthesiology and Resuscitation medical residents at the end of their training period using the Objective Structured Clinical Evaluation (OCSE) tool. Six competency components to evalúate were defined as follows: clinical interview (communication), technical ability and relationship abilities (leadership, decision making, work in a team), diagnostic assessment, therapeutic management, and medical records. Different methodologies were determined depending on the knowledge and skills to evaluate. Twelve clinical cases were developed that were performed in 12 stations. A total of 107 Ítems, specified within the stations, evaluated the competency components. A total of 43 residents were invited to participate in the last 4 months of their training in hospitals in Andalusia and Extremadura. A total of 33 residents participated. The overall mean of the classifications obtained in the 12 stations was 64.2 out of a maximum of 100. The medical residents demonstrated higher competency in obstetrics, paediatric anaesthesia, and that associated with difficult airway. The main competency gaps were detected in the area of one-day surgery, chronic pain, and literature management, in which approximately half passed the test. We believe that training evaluations, such as the OCSE, help in determining the skill levels of the medical resident, making it easier to continually improve the training of the future anaesthesiologist. Copyright © 2011 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España.. All rights reserved.

Inter-relationships between objective and subjective measures of the residential environment among urban African American women

PubMed Central

Sealy-Jefferson, Shawnita; Messer, Lynne; Slaughter-Acey, Jaime; Misra, Dawn P.

2016-01-01

Background The inter-relationships between objective (census-based) and subjective (resident reported) measures of the residential environment is understudied in African American (AA) populations. Methods Using data from the Life Influences on Fetal Environments Study (2009–2011) (n=1,387) of AA women, we quantified the area-level variation in subjective reports of residential healthy food availability, walkability, safety and disorder that can be accounted for with an objective neighborhood disadvantage index (NDI). Two-level generalized linear models estimated associations between objective and subjective measures of the residential environment, accounting for individual-level covariates. Results In unconditional models, intraclass correlation coefficients for block-group variance in subjective reports ranged from 11% (healthy food availability) to 30% (safety). Models accounting for the NDI (versus both NDI and individual level covariates) accounted for more variance in healthy food availability (23% versus 8%) and social disorder (40% versus 38%). The NDI and individual level variables accounted for 39% and 51% of the area-level variation in walkability and safety. Associations between subjective and objective measures of the residential environment were significant and in the expected direction. Conclusions Future studies on neighborhood effects on health, especially among AAs, should include a wide range of residential environment measures, including subjective, objective and spatial contextual variables. PMID:28160971

Inter-relationships between objective and subjective measures of the residential environment among urban African American women.

PubMed

Sealy-Jefferson, Shawnita; Messer, Lynne; Slaughter-Acey, Jaime; Misra, Dawn P

2017-03-01

The inter-relationships between objective (census based) and subjective (resident reported) measures of the residential environment is understudied in African American (AA) populations. Using data from the Life Influences on Fetal Environments Study (2009-2011; n = 1387) of AA women, we quantified the area-level variation in subjective reports of residential healthy food availability, walkability, safety, and disorder that can be accounted for with an objective neighborhood disadvantage index (NDI). Two-level generalized linear models estimated associations between objective and subjective measures of the residential environment, accounting for individual-level covariates. In unconditional models, intraclass correlation coefficients for block-group variance in subjective reports ranged from 11% (healthy food availability) to 30% (safety). Models accounting for the NDI (vs. both NDI and individual-level covariates) accounted for more variance in healthy food availability (23% vs. 8%) and social disorder (40% vs. 38%). The NDI and individual-level variables accounted for 39% and 51% of the area-level variation in walkability and safety, respectively. Associations between subjective and objective measures of the residential environment were significant and in the expected direction. Future studies on neighborhood effects on health, especially among AAs, should include a wide range of residential environment measures, including subjective, objective, and spatial contextual variables. Copyright © 2016 Elsevier Inc. All rights reserved.

Objective-subjective disparity in cancer-related cognitive impairment: does the use of change measures help reconcile the difference?

PubMed

O'Farrell, Erin; Smith, Andra; Collins, Barbara

2017-10-01

Studies to date have found little correlation between subjective and objective measures of cognitive function in cancer patients, making it difficult to interpret the significance of their cognitive complaints. The purpose of this study was to determine if a stronger correlation would be obtained using measures of cognitive change rather than static scores. Sixty women with early stage breast cancer underwent repeated cognitive assessment over the course of chemotherapy with a neuropsychological test battery (objective measure) and with the FACT-Cog (subjective measure). Their results were compared to 60 healthy women matched on age and education and assessed at similar intervals. We used multilevel modeling, with FACT-Cog as the dependent measure and ordinary least squares slopes of a neuropsychological summary score as the independent variable, to evaluate the co-variation between the subjective and objective measures over time RESULTS: Measures of both objective and subjective cognitive function declined over the course of chemotherapy in the breast cancer patients but there was no significant relationship between them, even when using change measures. Change in objective cognitive function was not related to change in anxiety or fatigue scores but the decline in perceived cognitive function was associated with greater anxiety and fatigue. The discrepancy in objective and subjective measures of cognition in breast cancer patients cannot be accounted for in terms of a failure to use change measures. Although the results are negative, we contend that this is the more appropriate methodology for analyzing cancer-related changes in cognition. Copyright © 2016 John Wiley & Sons, Ltd.

Home Economics. Exploration of Clothing Management, Production and Service Occupations. Performance Objectives. Criterion Measures.

ERIC Educational Resources Information Center

Duval County School Board, Jacksonville, FL.

Several intermediate performance objectives and corresponding criterion measures are presented for each of five terminal objectives for a 12- to 18-week course designed to provide students in grades 8 or 9 with opportunities to explore a broad range of clothing management, production, and service occupations. The course was designed to provide…

Twin Study on Heritability of Activity, Attention, and Impulsivity as Assessed by Objective Measures

ERIC Educational Resources Information Center

Heiser, Philip; Heinzel-Gutenbrunner, Monika; Frey, Joachim; Smidt, Judith; Grabarkiewicz, Justyna; Friedel, Susann; Kuhnau, Wolfgang; Schmidtke, Jorg; Remschmidt, Helmut; Hebebrand, Johannes

2006-01-01

Objective: The purpose of this study was to assess heritability of activity, attention, and impulsivity by comparing young monozygotic (MZ) twins with dizygotic (DZ) twins using objective measures. Method: The OPTAx test is an infrared motion analysis to record the movement pattern during a continuous performance test. Seventeen MZ and 12 same…

Validity of patient-reported swallowing and speech outcomes in relation to objectively measured oral function among patients treated for oral or oropharyngeal cancer.

PubMed

Rinkel, R N P M; Verdonck-de Leeuw, I M; de Bree, R; Aaronson, N K; Leemans, C R

2015-04-01

The objective of this study was to test the construct validity of the patient-reported outcomes Swallowing Quality of Life Questionnaire (SWAL-QOL) and Speech Handicap Index (SHI) in relation to objectively measured oral function among patients treated for oral or oropharyngeal cancer. The study sample consisted of patients treated for oral or oropharyngeal cancer. Outcome measures were the SWAL-QOL and the SHI, and the Functional Rehabilitation Outcomes Grade (FROG), a test to measure oral and shoulder function. Spearman's rank correlation coefficient was used to test associations between the SHI and SWAL-QOL scales, and the FROG scales. During a study period of 3 months, 38 patients (21 males, 17 females; mean age 54 years) were included who visited the outpatient clinic for follow-up care 6-155 months after surgical treatment (n = 14) or combined surgery and radiotherapy (n = 24) for oral (n = 21) or oropharyngeal cancer (n = 17). Most SWAL-QOL and SHI scales (except the SWAL-QOL Fatigue scale) correlated significantly with one or more FROG oral function scales. None of the SWAL-QOL and SHI scales correlated significantly with the FROG shoulder function scale. These results support the construct validity of the SWAL-QOL and SHI questionnaires for assessing speech and swallowing problems in daily life that are moderately but significantly related to oral function. A multidimensional assessment protocol is recommended for use in clinical practice and for research purposes for measuring oral function and swallowing- and speech-related problems in daily life among head and neck cancer patients.

Objective Versus Subjective Measures of Executive Functions: Predictors of Participation and Quality of Life in Parkinson Disease?

PubMed

Vlagsma, Thialda T; Koerts, Janneke; Tucha, Oliver; Dijkstra, Hilde T; Duits, Annelien A; van Laar, Teus; Spikman, Jacoba M

2017-11-01

To determine whether objective (neuropsychological tests) and subjective measures (questionnaires) of executive functions (EFs) are associated in patients with Parkinson disease (PD), and to determine to what extent level of participation and quality of life (QoL) of patients with PD can be predicted by these measures of EFs. Correlational research design (case-control and prediction design). Departments of neuropsychology of 3 medical centers. A sample (N=136) of patients with PD (n=42) and their relatives, and controls without PD (n=94). Not applicable. A test battery measuring EFs. In addition, patients, their relatives, and controls completed the Dysexecutive Questionnaire, Brock Adaptive Functioning Questionnaire, and Barkley Deficits in Executive Functioning Scale - time management questionnaires measuring complaints about EFs. Participation and QoL were measured with the Impact on Participation and Autonomy scale and the Parkinson's Disease Questionnaire-39, respectively. Patients with PD showed impairments in EFs on objective tests and reported significantly more complaints about EFs than did controls without PD. No associations were found between patients' performances on objective and subjective measures of EFs. However, both objective and subjective measures predicted patients' level of participation. In addition, subjective measures of EFs predicted QoL in patients with PD. These findings show that objective and subjective measures of EFs are not interchangeable and that both approaches predict level of participation and QoL in patients with PD. However, within this context, sex needs to be taken into account. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Objective and subjective measures of neighborhood environment (NE): relationships with transportation physical activity among older persons.

PubMed

Nyunt, Ma Shwe Zin; Shuvo, Faysal Kabir; Eng, Jia Yen; Yap, Keng Bee; Scherer, Samuel; Hee, Li Min; Chan, Siew Pang; Ng, Tze Pin

2015-09-15

This study examined the associations of subjective and objective measures of the neighbourhood environment with the transportation physical activity of community-dwelling older persons in Singapore. A modified version of the Neighborhood Environment Walkability Scale (NEWS) and Geographical Information System (GIS) measures of the built environment characteristics were related to the frequency of walking for transportation purpose in a study sample of older persons living in high-density apartment blocks within a public housing estate in Singapore. Relevant measured variables to assess the complex relationships among built environment measures and transportation physical activity were examined using structural equation modelling and multiple regression analyses. The subjective measures of residential density, street connectivity, land use mix diversity and aesthetic environment and the objective GIS measure of Accessibility Index have positively significant independent associations with transportation physical activity, after adjusting for demographics, socio-economic and health status. Subjective and objective measures are non-overlapping measures complementing each other in providing information on built environment characteristics. For elderly living in a high-density urban neighborhood, well connected street, diversity of land use mix, close proximity to amenities and facilities, and aesthetic environment were associated with higher frequency of walking for transportation purposes.

Utilizing measure-based feedback in control-mastery theory: A clinical error.

PubMed

Snyder, John; Aafjes-van Doorn, Katie

2016-09-01

Clinical errors and ruptures are an inevitable part of clinical practice. Often times, therapists are unaware that a clinical error or rupture has occurred, leaving no space for repair, and potentially leading to patient dropout and/or less effective treatment. One way to overcome our blind spots is by frequently and systematically collecting measure-based feedback from the patient. Patient feedback measures that focus on the process of psychotherapy such as the Patient's Experience of Attunement and Responsiveness scale (PEAR) can be used in conjunction with treatment outcome measures such as the Outcome Questionnaire 45.2 (OQ-45.2) to monitor the patient's therapeutic experience and progress. The regular use of these types of measures can aid clinicians in the identification of clinical errors and the associated patient deterioration that might otherwise go unnoticed and unaddressed. The current case study describes an instance of clinical error that occurred during the 2-year treatment of a highly traumatized young woman. The clinical error was identified using measure-based feedback and subsequently understood and addressed from the theoretical standpoint of the control-mastery theory of psychotherapy. An alternative hypothetical response is also presented and explained using control-mastery theory. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Subjectively and objectively measured sleep with and without posttraumatic stress disorder and trauma exposure.

PubMed

Kobayashi, Ihori; Huntley, Edward; Lavela, Joseph; Mellman, Thomas A

2012-07-01

Although reports of sleep disturbances are common among individuals with posttraumatic stress disorder (PTSD), results of polysomnographic (PSG) studies have inconsistently documented abnormalities and have therefore suggested "sleep state misperception." The authors' study objectives were to compare sleep parameters measured objectively and subjectively in the laboratory and at home in civilians with and without trauma exposure and PTSD. Cross-sectional study. PSG recordings in a sleep laboratory and actigraphic recordings in participants' homes. One hundred three urban-residing African Americans with and without trauma exposure and PTSD who participated in a larger study. N/A. Sleep parameters (total sleep time [TST], sleep onset latency [SOL], and wake after sleep onset [WASO]) were assessed using laboratory PSG and home actigraphy. A sleep diary was completed in the morning after PSG and actigraphy recordings. Habitual TST, SOL, and WASO were assessed using a sleep questionnaire. The Clinician Administered PTSD Scale was administered to assess participants' trauma exposure and PTSD diagnostic status. Participants, regardless of their trauma exposure/PTSD status, underestimated WASO in the diary and questionnaire relative to actigraphy and overestimated SOL in the diary relative to PSG. Among participants with current PTSD, TST diary estimates did not differ from the actigraphy measure in contrast with those without current PTSD who overestimated TST. No other significant group differences in discrepancies between subjective and objective sleep measures were found. Discrepancies between subjectively and objectively measured sleep parameters were not associated with trauma exposure or PTSD. This challenges prior assertions that individuals with PTSD overreport their sleep disturbances.

Objective measures of motor dysfunction after compression spinal cord injury in adult rats: correlations with locomotor rating scores.

PubMed

Semler, Joerg; Wellmann, Katharina; Wirth, Felicitas; Stein, Gregor; Angelova, Srebrina; Ashrafi, Mahak; Schempf, Greta; Ankerne, Janina; Ozsoy, Ozlem; Ozsoy, Umut; Schönau, Eckhard; Angelov, Doychin N; Irintchev, Andrey

2011-07-01

Precise assessment of motor deficits after traumatic spinal cord injury (SCI) in rodents is crucial for understanding the mechanisms of functional recovery and testing therapeutic approaches. Here we analyzed the applicability to a rat SCI model of an objective approach, the single-frame motion analysis, created and used for functional analysis in mice. Adult female Wistar rats were subjected to graded compression of the spinal cord. Recovery of locomotion was analyzed using video recordings of beam walking and inclined ladder climbing. Three out of four parameters used in mice appeared suitable: the foot-stepping angle (FSA) and the rump-height index (RHI), measured during beam walking, and for estimating paw placement and body weight support, respectively, and the number of correct ladder steps (CLS), assessing skilled limb movements. These parameters, similar to the Basso, Beattie, and Bresnahan (BBB) locomotor rating scores, correlated with lesion volume and showed significant differences between moderately and severely injured rats at 1-9 weeks after SCI. The beam parameters, but not CLS, correlated well with the BBB scores within ranges of poor and good locomotor abilities. FSA co-varied with RHI only in the severely impaired rats, while RHI and CLS were barely correlated. Our findings suggest that the numerical parameters estimate, as intended by design, predominantly different aspects of locomotion. The use of these objective measures combined with BBB rating provides a time- and cost-efficient opportunity for versatile and reliable functional evaluations in both severely and moderately impaired rats, combining clinical assessment with precise numerical measures.

Accuracy of vertical height measurements on direct digital panoramic radiographs using posterior mandibular implants and metal balls as reference objects.

PubMed

Vazquez, L; Nizamaldin, Y; Combescure, C; Nedir, R; Bischof, M; Dohan Ehrenfest, D M; Carrel, J-P; Belser, U C

2013-01-01

Conventional panoramic radiography, a widely used radiographic examination tool in implant treatment planning, allows evaluation of the available bone height before inserting posterior mandibular implants. Image distortion and vertical magnification due to projection geometry is well described for rotational panoramic radiographs. To assess the accuracy of vertical height measurements on direct digital panoramic radiographs, implants and metal balls positioned in the posterior mandible were used as radio-opaque reference objects. The reproducibility of the measuring method was assessed by the inter- and intraobserver agreements. Direct digital panoramic radiographs, performed using a Kodak 8000C (Eastman Kodak Company, Rochester, NY), of 17 partially edentulous patients (10 females, 7 males, mean age 65 years) were selected from an X-ray database gathered during routine clinical evaluation of implant sites. Proprietary software and a mouse-driven calliper were used to measure the radiological length of 25 implants and 18 metal reference balls, positioned in mandibular posterior segments. The distortion ratio (DR) was calculated by dividing the radiological implant length by the implant's real length and the radiological ball height by the ball's real height. Mean vertical DR was 0.99 for implants and 0.97 for balls, and was unrelated to mandibular sites, side, age, gender or observer. Inter- and intraobserver agreements were acceptable for both reference objects. Vertical measurements had acceptable accuracy and reproducibility when a software-based calibrated measurement tool was used, confirming that digital panoramic radiography can be reliably utilized to determine the pre-operative implant length in premolar and molar mandibular segments.

'I found the OSCE very stressful': student midwives' attitudes towards an objective structured clinical examination (OSCE).

PubMed

Muldoon, Kathryn; Biesty, Linda; Smith, Valerie

2014-03-01

The Objective Structured Clinical Examination (OSCE) has become widely accepted as a strategy for assessing clinical competence in nursing and midwifery education and training. There is a dearth of information, however, on the OSCE procedure from the perspective of midwifery students. In particular, there is an absence of an objective quantification of midwifery students' attitudes towards the OSCE. The objective of this study is to report the conduct and findings of a survey of midwifery students' attitudes towards a Lactation and Infant Feeding OSCE and to consider these attitudes in the context of the international literature and the empirical evidence base. A descriptive survey design using an 18-item Likert (1 to 5 point) scale was used to capture the relevant data. Potential participants were 3rd year midwifery students who had undertaken a Lactation and Infant Feeding OSCE (n=35) in one School of Nursing & Midwifery in the Republic of Ireland. Survey responses were analysed using the Statistical Package for the Social Sciences Version 18. Thirty-three students completed the survey providing a 94% response rate. Midwifery students' attitudes towards individual aspects of the OSCE varied. Overall, midwifery students were neutral/unsure of the OSCE as a strategy for assessing clinical competence (mean 3.3). Most agreed that the examiner made them feel at ease (mean 3.94). Contrastingly this does not appear to appease student nerves and stress as the majority agreed that the OSCE evokes nervousness (mean 4.27) and stress (mean 4.30). Midwifery students, overall, disagreed that the OSCE reflected real life clinical situations (mean 2.48). Midwifery students were neutral/unsure that the OSCE provided an opportunity to show their practical skills (mean 3.36). The findings of this study identified that midwifery students were neutral/unsure of the OSCE as a strategy for assessing clinical competence. This has relevance for OSCE development at the authors

Children’s sedentary behaviour: descriptive epidemiology and associations with objectively-measured sedentary time

PubMed Central

2013-01-01

Background Little is known regarding the patterning and socio-demographic distribution of multiple sedentary behaviours in children. The aims of this study were to: 1) describe the leisure-time sedentary behaviour of 9–10 year old British children, and 2) establish associations with objectively-measured sedentary time. Methods Cross-sectional analysis in the SPEEDY study (Sport, Physical activity and Eating behaviour: Environmental Determinants in Young people) (N=1513, 44.3% boys). Twelve leisure-time sedentary behaviours were assessed by questionnaire. Objectively-measured leisure-time sedentary time (Actigraph GT1M, <100 counts/minute) was assessed over 7 days. Differences by sex and socioeconomic status (SES) in self-reported sedentary behaviours were tested using Kruskal-Wallis tests. The association between objectively-measured sedentary time and the separate sedentary behaviours (continuous (minutes) and categorised into 'none’ 'low’ or 'high’ participation) was assessed using multi-level linear regression. Results Sex differences were observed for time spent in most sedentary behaviours (all p ≤ 0.02), except computer use. Girls spent more time in combined non-screen sedentary behaviour (median, interquartile range: girls: 770.0 minutes, 390.0-1230.0; boys: 725.0, 365.0 - 1182.5; p = 0.003), whereas boys spent more time in screen-based behaviours (girls: 540.0, 273.0 - 1050.0; boys: 885.0, 502.5 - 1665.0; p < 0.001). Time spent in five non-screen behaviours differed by SES, with higher values in those of higher SES (all p ≤ 0.001). Regression analyses with continuous exposures indicated that reading (β = 0.1, p < 0.001) and watching television (β = 0.04, p < 0.01) were positively associated with objectively-measured sedentary time, whilst playing board games (β = -0.12, p < 0.05) was negatively associated. Analysed in categorical form, sitting and talking (vs. none: 'low’ β = 26.1,ns

High-Accuracy Measurement of Small Movement of an Object behind Cloth Using Airborne Ultrasound

NASA Astrophysics Data System (ADS)

Hoshiba, Kotaro; Hirata, Shinnosuke; Hachiya, Hiroyuki

2013-07-01

The acoustic measurement of vital information such as breathing and heartbeat in the standing position whilst the subject is wearing clothes is a difficult problem. In this paper, we present the basic experimental results to measure small movement of an object behind cloth. We measured acoustic characteristics of various types of cloth to obtain the transmission loss through cloth. To observe the relationship between measurement error and target speed under a low signal-to-noise ratio (SNR), we tried to measure the movement of an object behind cloth. The target was placed apart from the cloth to separate the target reflection from the cloth reflection. We found that a small movement of less than 6 mm/s could be observed using the M-sequence, moving target indicator (MTI) filter, and tracking phase difference, when the SNR was less than 0 dB. We also present the results of theoretical error analysis in the MTI filter and phase tracking for high-accuracy measurement. Characteristics of the systematic error were clarified.

Comparison of objective texture measurements in raw and cooked wooden breast meat.

USDA-ARS?s Scientific Manuscript database

Broiler breast meat exhibiting the wooden breast condition is characterized as having an abnormally hard or rigid texture. The efficacy of using objective texture measurements to characterize the texture attributes of breast meat exhibiting this condition before and after cooking are not well under...

Impact of Glucose Measurement Processing Delays on Clinical Accuracy and Relevance

PubMed Central

Jangam, Sujit R.; Hayter, Gary; Dunn, Timothy C.

2013-01-01

Background In a hospital setting, glucose is often measured from venous blood in the clinical laboratory. However, laboratory glucose measurements are typically not available in real time. In practice, turn-around times for laboratory measurements can be minutes to hours. This analysis assesses the impact of turn-around time on the effective clinical accuracy of laboratory measurements. Methods Data obtained from an earlier study with 58 subjects with type 1 diabetes mellitus (T1DM) were used for this analysis. In the study, glucose measurements using a YSI glucose analyzer were obtained from venous blood samples every 15 min while the subjects were at the health care facility. To simulate delayed laboratory results, each YSI glucose value from a subject was paired with one from a later time point (from the same subject) separated by 15, 30, 45, and 60 min. To assess the clinical accuracy of a delayed YSI result relative to a real-time result, the percentage of YSI pairs that meet the International Organization for Standardization (ISO) 15197:2003(E) standard for glucose measurement accuracy (±15 mg/dl for blood glucose < 75 mg/dl, ±20% for blood glucose ≥ 75 mg/dl) was calculated. Results It was observed that delays of 15 min or more reduce clinical accuracy below the ISO 15197:2003(E) recommendation of 95%. The accuracy was less than 65% for delays of 60 min. Conclusion This analysis suggests that processing delays in glucose measurements reduce the clinical relevance of results in patients with T1DM and may similarly degrade the clinical value of measurements in other patient populations. PMID:23759399

Impact of glucose measurement processing delays on clinical accuracy and relevance.

PubMed

Jangam, Sujit R; Hayter, Gary; Dunn, Timothy C

2013-05-01

In a hospital setting, glucose is often measured from venous blood in the clinical laboratory. However, laboratory glucose measurements are typically not available in real time. In practice, turn-around times for laboratory measurements can be minutes to hours. This analysis assesses the impact of turn-around time on the effective clinical accuracy of laboratory measurements. Data obtained from an earlier study with 58 subjects with type 1 diabetes mellitus (T1DM) were used for this analysis. In the study, glucose measurements using a YSI glucose analyzer were obtained from venous blood samples every 15 min while the subjects were at the health care facility. To simulate delayed laboratory results, each YSI glucose value from a subject was paired with one from a later time point (from the same subject) separated by 15, 30, 45, and 60 min. To assess the clinical accuracy of a delayed YSI result relative to a real-time result, the percentage of YSI pairs that meet the International Organization for Standardization (ISO) 15197:2003(E) standard for glucose measurement accuracy (±15 mg/dl for blood glucose < 75 mg/dl, ±20% for blood glucose ≥ 75 mg/dl) was calculated. It was observed that delays of 15 min or more reduce clinical accuracy below the ISO 15197:2003(E) recommendation of 95%. The accuracy was less than 65% for delays of 60 min. This analysis suggests that processing delays in glucose measurements reduce the clinical relevance of results in patients with T1DM and may similarly degrade the clinical value of measurements in other patient populations. © 2013 Diabetes Technology Society.

Wavefront-aberration measurement and systematic-error analysis of a high numerical-aperture objective