The SCHEIE Visual Field Grading System

PubMed Central

Sankar, Prithvi S.; O’Keefe, Laura; Choi, Daniel; Salowe, Rebecca; Miller-Ellis, Eydie; Lehman, Amanda; Addis, Victoria; Ramakrishnan, Meera; Natesh, Vikas; Whitehead, Gideon; Khachatryan, Naira; O’Brien, Joan

2017-01-01

Objective No method of grading visual field (VF) defects has been widely accepted throughout the glaucoma community. The SCHEIE (Systematic Classification of Humphrey visual fields-Easy Interpretation and Evaluation) grading system for glaucomatous visual fields was created to convey qualitative and quantitative information regarding visual field defects in an objective, reproducible, and easily applicable manner for research purposes. Methods The SCHEIE grading system is composed of a qualitative and quantitative score. The qualitative score consists of designation in one or more of the following categories: normal, central scotoma, paracentral scotoma, paracentral crescent, temporal quadrant, nasal quadrant, peripheral arcuate defect, expansive arcuate, or altitudinal defect. The quantitative component incorporates the Humphrey visual field index (VFI), location of visual defects for superior and inferior hemifields, and blind spot involvement. Accuracy and speed at grading using the qualitative and quantitative components was calculated for non-physician graders. Results Graders had a median accuracy of 96.67% for their qualitative scores and a median accuracy of 98.75% for their quantitative scores. Graders took a mean of 56 seconds per visual field to assign a qualitative score and 20 seconds per visual field to assign a quantitative score. Conclusion The SCHEIE grading system is a reproducible tool that combines qualitative and quantitative measurements to grade glaucomatous visual field defects. The system aims to standardize clinical staging and to make specific visual field defects more easily identifiable. Specific patterns of visual field loss may also be associated with genetic variants in future genetic analysis. PMID:28932621

A Hypermedia Computer-Aided Parasitology Tutoring System.

ERIC Educational Resources Information Center

Theodoropoulos, Georgios; Loumos, Vassili

A hypermedia tutoring system for teaching parasitology to college students was developed using an object oriented software development tool, Knowledge Pro. The program was designed to meet four objectives: knowledge incorporation, tutoring, indexing of key words for Boolean search, and random generation of quiz questions with instant scoring. The…

Phantom evaluation of the effect of film processing on mammographic screen-film combinations.

PubMed

McLean, D; Rickard, M T

1994-08-01

Mammographic image quality should be optimal for diagnosis, and the film contrast can be manipulated by altering development parameters. In this study phantom test objects were radiographed and processed for a given range of developer temperatures and times for four film-screen systems. Radiologists scored the phantom test objects on the resultant films to evaluate the effect on diagnosis of varying image contrast. While for three film-screen systems processing led to appreciable contrast differences, for only one film system did maximum contrast correspond with optimal phantom test object scoring. The inability to show an effect on diagnosis in all cases is possibly due to the variation in radiologist responses found in this study and in normal clinical circumstances. Other technical factors such as changes in film fog, grain and mottle may contribute to the study findings.

A reliable and cost effective approach for radiographic monitoring in nutritional rickets

PubMed Central

Gupta, V; Sharma, V; Sinha, B; Samanta, S

2014-01-01

Objective: Radiological scoring is particularly useful in rickets, where pre-treatment radiographical findings can reflect the disease severity and can be used to monitor the improvement. However, there is only a single radiographic scoring system for rickets developed by Thacher and, to the best of our knowledge, no study has evaluated radiographic changes in rickets based on this scoring system apart from the one done by Thacher himself. The main objective of this study is to compare and analyse the pre-treatment and post-treatment radiographic parameters in nutritional rickets with the help of Thacher's scoring technique. Methods: 176 patients with nutritional rickets were given a single intramuscular injection of vitamin D (600 000 IU) along with oral calcium (50 mg kg−1) and vitamin D (400 IU per day) until radiological resolution and followed for 1 year. Pre- and post-treatment radiological parameters were compared and analysed statistically based on Thacher's scoring system. Results: Radiological resolution was complete by 6 months. Time for radiological resolution and initial radiological score were linearly associated on regression analysis. The distal ulna was the last to heal in most cases except when the initial score was 10, when distal femur was the last to heal. Conclusion: Thacher's scoring system can effectively monitor nutritional rickets. The formula derived through linear regression has prognostic significance. Advances in knowledge: The distal femur is a better indicator in radiologically severe rickets and when resolution is delayed. Thacher's scoring is very useful for monitoring of rickets. The formula derived through linear regression can predict the expected time for radiological resolution. PMID:24593231

The Effect of Training Data Set Composition on the Performance of a Neural Image Caption Generator

DTIC Science & Technology

2017-09-01

objects was compared using the Metric for Evaluation of Translation with Explicit Ordering (METEOR) and Consensus-Based Image Description Evaluation...using automated scoring systems. Many such systems exist, including Bilingual Evaluation Understudy (BLEU), Consensus-Based Image Description Evaluation...shown to be essential to automated scoring, which correlates highly with human precision.5 CIDEr uses a system of consensus among the captions and

The use of standardized patients in the plastic surgery residency curriculum: teaching core competencies with objective structured clinical examinations.

PubMed

Davis, Drew; Lee, Gordon

2011-07-01

As of 2006, the Accreditation Council for Graduate Medical Education had defined six "core competencies" of residency education: interpersonal communication skills, medical knowledge, patient care, professionalism, practice-based learning and improvement, and systems-based practice. Objective structured clinical examinations using standardized patients are becoming effective educational tools, and the authors developed a novel use of the examinations in plastic surgery residency education that assesses all six competencies. Six plastic surgery residents, two each from postgraduate years 4, 5, and 6, participated in the plastic surgery-specific objective structured clinical examination that focused on melanoma. The examination included a 30-minute videotaped encounter with a standardized patient actor and a postencounter written exercise. The residents were scored on their performance in all six core competencies by the standardized patients and faculty experts on a three-point scale (1 = novice, 2 = moderately skilled, and 3 = proficient). Resident performance was averaged for each postgraduate year, stratified according to core competency, and scored from a total of 100 percent. Residents overall scored well in interpersonal communications skills (84 percent), patient care (83 percent), professionalism (86 percent), and practice-based learning (84 percent). Scores in medical knowledge showed a positive correlation with level of training (86 percent). All residents scored comparatively lower in systems-based practice (65 percent). The residents reported unanimously that the objective structured clinical examination was realistic and educational. The objective structured clinical examination provided comprehensive and meaningful feedback and identified areas of strengths and weakness for the residents and for the teaching program. The examination is an effective assessment tool for the core competencies and a valuable adjunct to residency training.

A Novel Reporting System to Improve Accuracy in Appendicitis Imaging

PubMed Central

Godwin, Benjamin D.; Drake, Frederick T.; Simianu, Vlad V.; Shriki, Jabi E.; Hippe, Daniel S.; Dighe, Manjiri; Bastawrous, Sarah; Cuevas, Carlos; Flum, David; Bhargava, Puneet

2015-01-01

OBJECTIVE The purpose of this study was to ascertain if standardized radiologic reporting for appendicitis imaging increases diagnostic accuracy. MATERIALS AND METHODS We developed a standardized appendicitis reporting system that includes objective imaging findings common in appendicitis and a certainty score ranging from 1 (definitely not appendicitis) through 5 (definitely appendicitis). Four radiologists retrospectively reviewed the preoperative CT scans of 96 appendectomy patients using our reporting system. The presence of appendicitis-specific imaging findings and certainty scores were compared with final pathology. These comparisons were summarized using odds ratios (ORs) and the AUC. RESULTS The appendix was visualized on CT in 89 patients, of whom 71 (80%) had pathologically proven appendicitis. Imaging findings associated with appendicitis included appendiceal diameter (odds ratio [OR] = 14 [> 10 vs < 6 mm]; p = 0.002), periappendiceal fat stranding (OR = 8.9; p < 0.001), and appendiceal mucosal hyperenhancement (OR = 8.7; p < 0.001). Of 35 patients whose initial clinical findings were reported as indeterminate, 28 (80%) had appendicitis. In this initially indeterminate group, using the standardized reporting system, radiologists assigned higher certainty scores (4 or 5) in 21 of the 28 patients with appendicitis (75%) and lower scores (1 or 2) in five of the seven patients without appendicitis (71%) (AUC = 0.90; p = 0.001). CONCLUSION Standardized reporting and grading of objective imaging findings correlated well with postoperative pathology and may decrease the number of CT findings reported as indeterminate for appendicitis. Prospective evaluation of this reporting system on a cohort of patients with clinically suspected appendicitis is currently under way. PMID:26001230

Method for determining the weight of functional objectives on manufacturing system.

PubMed

Zhang, Qingshan; Xu, Wei; Zhang, Jiekun

2014-01-01

We propose a three-dimensional integrated weight determination to solve manufacturing system functional objectives, where consumers are weighted by triangular fuzzy numbers to determine the enterprises. The weights, subjective parts are determined by the expert scoring method, the objective parts are determined by the entropy method with the competitive advantage of determining. Based on the integration of three methods and comprehensive weight, we provide some suggestions for the manufacturing system. This paper provides the numerical example analysis to illustrate the feasibility of this method.

High-fidelity, low-cost, automated method to assess laparoscopic skills objectively.

PubMed

Gray, Richard J; Kahol, Kanav; Islam, Gazi; Smith, Marshall; Chapital, Alyssa; Ferrara, John

2012-01-01

We sought to define the extent to which a motion analysis-based assessment system constructed with simple equipment could measure technical skill objectively and quantitatively. An "off-the-shelf" digital video system was used to capture the hand and instrument movement of surgical trainees (beginner level = PGY-1, intermediate level = PGY-3, and advanced level = PGY-5/fellows) while they performed a peg transfer exercise. The video data were passed through a custom computer vision algorithm that analyzed incoming pixels to measure movement smoothness objectively. The beginner-level group had the poorest performance, whereas those in the advanced group generated the highest scores. Intermediate-level trainees scored significantly (p < 0.04) better than beginner trainees. Advanced-level trainees scored significantly better than intermediate-level trainees and beginner-level trainees (p < 0.04 and p < 0.03, respectively). A computer vision-based analysis of surgical movements provides an objective basis for technical expertise-level analysis with construct validity. The technology to capture the data is simple, low cost, and readily available, and it obviates the need for expert human assessment in this setting. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

ADHD Subtypes and Co-Occurring Anxiety, Depression, and Oppositional-Defiant Disorder: Differences in Gordon Diagnostic System and Wechsler Working Memory and Processing Speed Index Scores

ERIC Educational Resources Information Center

Mayes, Susan Dickerson; Calhoun, Susan L.; Chase, Gary A.; Mink, Danielle M.; Stagg, Ryan E.

2009-01-01

Objective: Wechsler Intelligence Scale for Children Freedom-from-Distractibility/Working Memory Index (FDI/WMI), Processing Speed Index (PSI), and Gordon Diagnostic System (GDS) scores in ADHD children were examined as a function of subtype and coexisting anxiety, depression, and oppositional-defiant disorder. Method: Participants were 587…

Forecast skill score assessment of a relocatable ocean prediction system, using a simplified objective analysis method

NASA Astrophysics Data System (ADS)

Onken, Reiner

2017-11-01

A relocatable ocean prediction system (ROPS) was employed to an observational data set which was collected in June 2014 in the waters to the west of Sardinia (western Mediterranean) in the framework of the REP14-MED experiment. The observational data, comprising more than 6000 temperature and salinity profiles from a fleet of underwater gliders and shipborne probes, were assimilated in the Regional Ocean Modeling System (ROMS), which is the heart of ROPS, and verified against independent observations from ScanFish tows by means of the forecast skill score as defined by Murphy(1993). A simplified objective analysis (OA) method was utilised for assimilation, taking account of only those profiles which were located within a predetermined time window W. As a result of a sensitivity study, the highest skill score was obtained for a correlation length scale C = 12.5 km, W = 24 h, and r = 1, where r is the ratio between the error of the observations and the background error, both for temperature and salinity. Additional ROPS runs showed that (i) the skill score of assimilation runs was mostly higher than the score of a control run without assimilation, (i) the skill score increased with increasing forecast range, and (iii) the skill score for temperature was higher than the score for salinity in the majority of cases. Further on, it is demonstrated that the vast number of observations can be managed by the applied OA method without data reduction, enabling timely operational forecasts even on a commercially available personal computer or a laptop.

Performance evaluation of Al-Zahra academic medical center based on Iran balanced scorecard model.

PubMed

Raeisi, Ahmad Reza; Yarmohammadian, Mohammad Hossein; Bakhsh, Roghayeh Mohammadi; Gangi, Hamid

2012-01-01

Growth and development in any country's national health system, without an efficient evaluation system, lacks the basic concepts and tools necessary for fulfilling the system's goals. The balanced scorecard (BSC) is a technique widely used to measure the performance of an organization. The basic core of the BSC is guided by the organization's vision and strategies, which are the bases for the formation of four perspectives of BSC. The goal of this research is the performance evaluation of Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences, based on Iran BSC model. This is a combination (quantitative-qualitative) research which was done at Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences in 2011. The research populations were hospital managers at different levels. Sampling method was purposive sampling in which the key informed personnel participated in determining the performance indicators of hospital as the BSC team members in focused discussion groups. After determining the conceptual elements in focused discussion groups, the performance objectives (targets) and indicators of hospital were determined and sorted in perspectives by the group discussion participants. Following that, the performance indicators were calculated by the experts according to the predetermined objectives; then, the score of each indicator and the mean score of each perspective were calculated. Research findings included development of the organizational mission, vision, values, objectives, and strategies. The strategies agreed upon by the participants in the focus discussion group included five strategies, which were customer satisfaction, continuous quality improvement, development of human resources, supporting innovation, expansion of services and improving the productivity. Research participants also agreed upon four perspectives for the Al-Zahra hospital BSC. In the patients and community perspective (customer), two objectives and three indicators were agreed upon, with a mean score of 75.9%. In the internal process perspective, 4 objectives and 14 indicators were agreed upon, with a mean score of 79.37%. In the learning and growth perspective, four objectives and eight indicators were agreed upon, with a mean score of 81.11%. Finally, in the financial perspective, two objectives and five indicators were agreed upon, with a mean score of 67.15%. One way to create demand for hospital services is performance evaluation by paying close attention to all BSC perspectives, especially the non-financial perspectives such as customers and internal processes perspectives. In this study, the BSC showed the differences in performance level of the organization in different perspectives, which would assist the hospital managers improve their performance indicators. The learning and growth perspective obtained the highest score, and the financial perspective obtained the least score. Since the learning and growth perspective acts as a base for all other perspectives and they depend on it, hospitals must continuously improve the service processes and the quality of services by educating staff and updating their policies and procedures. This can increase customer satisfaction and productivity and finally improve the BSC in financial perspective.

2D and 3D MOCART scoring systems assessed by 9.4 T high-field MRI correlate with elementary and complex histological scoring systems in a translational model of osteochondral repair.

PubMed

Goebel, L; Zurakowski, D; Müller, A; Pape, D; Cucchiarini, M; Madry, H

2014-10-01

To compare the 2D and 3D MOCART system obtained with 9.4 T high-field magnetic resonance imaging (MRI) for the ex vivo analysis of osteochondral repair in a translational model and to correlate the data with semiquantitative histological analysis. Osteochondral samples representing all levels of repair (sheep medial femoral condyles; n = 38) were scanned in a 9.4 T high-field MRI. The 2D and adapted 3D MOCART systems were used for grading after point allocation to each category. Each score was correlated with corresponding reconstructions between both MOCART systems. Data were next correlated with corresponding categories of an elementary (Wakitani) and a complex (Sellers) histological scoring system as gold standards. Correlations between most 2D and 3D MOCART score categories were high, while mean total point values of 3D MOCART scores tended to be 15.8-16.1 points higher compared to the 2D MOCART scores based on a Bland-Altman analysis. "Defect fill" and "total points" of both MOCART scores correlated with corresponding categories of Wakitani and Sellers scores (all P ≤ 0.05). "Subchondral bone plate" also correlated between 3D MOCART and Sellers scores (P < 0.001). Most categories of the 2D and 3D MOCART systems correlate, while total scores were generally higher using the 3D MOCART system. Structural categories "total points" and "defect fill" can reliably be assessed by 9.4 T MRI evaluation using either system, "subchondral bone plate" using the 3D MOCART score. High-field MRI is valuable to objectively evaluate osteochondral repair in translational settings. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

HPT Clearance Control: Intelligent Engine Systems-Phase 1

NASA Technical Reports Server (NTRS)

2005-01-01

The following work has been completed to satisfy the Phase I Deliverables for the "HPT Clearance Control" project under NASA GRC's "Intelligent Engine Systems" program: (1) Need for the development of an advanced HPT ACC system has been very clearly laid out, (2) Several existing and potential clearance control systems have been reviewed, (3) A scorecard has been developed to document the system, performance (fuel burn, range, payload, etc.), thermal, and mechanical characteristics of the existing clearance control systems, (4) Engine size and flight cycle selection for the advanced HPT ACC system has been reviewed with "large engine"/"long range mission" combination showing the most benefit, (5) A scoring criteria has been developed to tie together performance parameters for an objective, data driven comparison of competing systems, and (6) The existing HPT ACC systems have been scored based on this scoring system.

The Emphasis of Student Test Scores in Teacher Appraisal Systems

ERIC Educational Resources Information Center

Smith, William C.; Kubacka, Katarzyna

2017-01-01

Over the past 30 years teachers have been held increasingly accountable for the quality of education in their classroom. During this transition, the line between teacher appraisals, traditionally an instrument for continuous formative teacher feedback, and summative teacher evaluations has blurred. Student test scores, as an "objective"…

Self-report after randomly assigned supervision does not predict ability to practice Motivational Interviewing

PubMed Central

Kutner, Bryan A.; Smith, Jennifer L.; Carpenter, K. M.; Hu, M-C.; Amrhein, Paul C.; Nunes, E. V.

2015-01-01

The objective of this study was to investigate the relation between self-report and objective assessment of Motivational Interviewing (MI) skills following training and supervision. After an MI workshop, 96 clinicians from 26 community programs (age 21–68, 65% female, 40.8% Black, 29.6% Caucasian, 24.5% Hispanic, 2.0% Asian, 3.1% other) were randomized to supervision (tele-conferencing or tape-based), or workshop only. At four time points, trainees completed a self-report of MI skill, using items from the MI Understanding questionnaire (MIU), and were objectively assessed by raters using the Motivational Interviewing Treatment Integrity (MITI) system. Correlations were calculated between MIU and MITI scores. A generalized linear mixed model was tested on MIU scores, with MITI scores, supervision condition and time as independent variables. MIU scores increased from pre-workshop (Mean = 4.74, SD = 1.79) to post-workshop (Mean = 6.31, SD = 1.03) (t = 8.69, p < .0001). With supervision, scores continued to increase, from post-workshop to week 8 (Mean = 7.07, SD = 0.91, t = 5.60, p < .0001) and from week 8 to week 20 (Mean = 7.28, SD = 0.94, t = 2.43, p = .02). However, MIU scores did not significantly correlate with MITI scores, with or without supervision. Self- reported ability increased with supervision, but self-report was not an indicator of objectively measured skill. This suggests that training does not increase correspondence between self-report and objective assessment, so community treatment programs should not rely on clinician self- report to assess the need for ongoing training and supervision and it may be necessary to train clinicians to accurately assess their own skill. PMID:25963775

Self-Report After Randomly Assigned Supervision Does not Predict Ability to Practice Motivational Interviewing.

PubMed

Wain, R Morgan; Kutner, Bryan A; Smith, Jennifer L; Carpenter, Kenneth M; Hu, Mei-Chen; Amrhein, Paul C; Nunes, Edward V

2015-10-01

The objective of this study was to investigate the relation between self-report and objective assessment of motivational interviewing (MI) skills following training and supervision. After an MI workshop, 96 clinicians from 26 community programs (age 21-68, 65% female, 40.8% Black, 29.6% Caucasian, 24.5% Hispanic, 2.0% Asian, 3.1% other) were randomized to supervision (tele-conferencing or tape-based), or workshop only. At four time points, trainees completed a self-report of MI skill, using items from the MI understanding questionnaire (MIU), and were objectively assessed by raters using the Motivational Interviewing Treatment Integrity (MITI) system. Correlations were calculated between MIU and MITI scores. A generalized linear mixed model was tested on MIU scores, with MITI scores, supervision condition and time as independent variables. MIU scores increased from pre-workshop (mean = 4.74, SD = 1.79) to post-workshop (mean = 6.31, SD = 1.03) (t = 8.69, p < .0001). With supervision, scores continued to increase, from post-workshop to week 8 (mean = 7.07, SD = 0.91, t = 5.60, p < .0001) and from week 8 to week 20 (mean = 7.28, SD = 0.94, t = 2.43, p = .02). However, MIU scores did not significantly correlate with MITI scores, with or without supervision. Self-reported ability increased with supervision, but self-report was not an indicator of objectively measured skill. This suggests that training does not increase correspondence between self-report and objective assessment, so community treatment programs should not rely on clinician self-report to assess the need for ongoing training and supervision and it may be necessary to train clinicians to accurately assess their own skill. Copyright © 2015 Elsevier Inc. All rights reserved.

Validation of the American Board of Orthodontics Objective Grading System for assessing the treatment outcomes of Chinese patients.

PubMed

Song, Guang-Ying; Baumrind, Sheldon; Zhao, Zhi-He; Ding, Yin; Bai, Yu-Xing; Wang, Lin; He, Hong; Shen, Gang; Li, Wei-Ran; Wu, Wei-Zi; Ren, Chong; Weng, Xuan-Rong; Geng, Zhi; Xu, Tian-Min

2013-09-01

Orthodontics in China has developed rapidly, but there is no standard index of treatment outcomes. We assessed the validity of the American Board of Orthodontics Objective Grading System (ABO-OGS) for the classification of treatment outcomes in Chinese patients. We randomly selected 108 patients who completed treatment between July 2005 and September 2008 in 6 orthodontic treatment centers across China. Sixty-nine experienced Chinese orthodontists made subjective assessments of the end-of-treatment casts for each patient. Three examiners then used the ABO-OGS to measure the casts. Pearson correlation analysis and receiver operating characteristic curve analysis were conducted to evaluate the correspondence between the ABO-OGS cast measurements and the orthodontists' subjective assessments. The average subjective grading scores were highly correlated with the ABO-OGS scores (r = 0.7042). Four of the 7 study cast components of the ABO-OGS score-occlusal relationship, overjet, interproximal contact, and alignment-were statistically significantly correlated with the judges' subjective assessments. Together, these 4 accounted for 58% of the variability in the average subjective grading scores. The ABO-OGS cutoff score for cases that the judges deemed satisfactory was 16 points; the corresponding cutoff score for cases that the judges considered acceptable was 21 points. The ABO-OGS is a valid index for the assessment of treatment outcomes in Chinese patients. By comparing the objective scores on this modification of the ABO-OGS with the mean subjective assessment of a panel of highly qualified Chinese orthodontists, a cutoff point for satisfactory treatment outcome was defined as 16 points or fewer, with scores of 16 to 21 points denoting less than satisfactory but still acceptable treatment. Cases that scored greater than 21 points were considered unacceptable. Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Smartphone data as an electronic biomarker of illness activity in bipolar disorder.

PubMed

Faurholt-Jepsen, Maria; Vinberg, Maj; Frost, Mads; Christensen, Ellen Margrethe; Bardram, Jakob E; Kessing, Lars Vedel

2015-11-01

Objective methods are lacking for continuous monitoring of illness activity in bipolar disorder. Smartphones offer unique opportunities for continuous monitoring and automatic collection of real-time data. The objectives of the paper were to test the hypotheses that (i) daily electronic self-monitored data and (ii) automatically generated objective data collected using smartphones correlate with clinical ratings of depressive and manic symptoms in patients with bipolar disorder. Software for smartphones (the MONARCA I system) that collects automatically generated objective data and self-monitored data on illness activity in patients with bipolar disorder was developed by the authors. A total of 61 patients aged 18-60 years and with a diagnosis of bipolar disorder according to ICD-10 used the MONARCA I system for six months. Depressive and manic symptoms were assessed monthly using the Hamilton Depression Rating Scale 17-item (HDRS-17) and the Young Mania Rating Scale (YMRS), respectively. Data are representative of over 400 clinical ratings. Analyses were computed using linear mixed-effect regression models allowing for both between individual variation and within individual variation over time. Analyses showed significant positive correlations between the duration of incoming and outgoing calls/day and scores on the HDRS-17, and significant positive correlations between the number and duration of incoming calls/day and scores on the YMRS; the number of and duration of outgoing calls/day and scores on the YMRS; and the number of outgoing text messages/day and scores on the YMRS. Analyses showed significant negative correlations between self-monitored data (i.e., mood and activity) and scores on the HDRS-17, and significant positive correlations between self-monitored data (i.e., mood and activity) and scores on the YMRS. Finally, the automatically generated objective data were able to discriminate between affective states. Automatically generated objective data and self-monitored data collected using smartphones correlate with clinically rated depressive and manic symptoms and differ between affective states in patients with bipolar disorder. Smartphone apps represent an easy and objective way to monitor illness activity with real-time data in bipolar disorder and may serve as an electronic biomarker of illness activity. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Validity of Walk Score® as a measure of neighborhood walkability in Japan.

PubMed

Koohsari, Mohammad Javad; Sugiyama, Takemi; Hanibuchi, Tomoya; Shibata, Ai; Ishii, Kaori; Liao, Yung; Oka, Koichiro

2018-03-01

Objective measures of environmental attributes have been used to understand how neighborhood environments relate to physical activity. However, this method relies on detailed spatial data, which are often not easily available. Walk Score® is a free, publicly available web-based tool that shows how walkable a given location is based on objectively-derived proximity to several types of local destinations and street connectivity. To date, several studies have tested the concurrent validity of Walk Score as a measure of neighborhood walkability in the USA and Canada. However, it is unknown whether Walk Score is a valid measure in other regions. The current study examined how Walk Score is correlated with objectively-derived attributes of neighborhood walkability, for residential addresses in Japan. Walk Scores were obtained for 1072 residential addresses in urban and rural areas in Japan. Five environmental attributes (residential density, intersection density, number of local destinations, sidewalk availability, and access to public transportation) were calculated using geographic information systems for each address. Pearson's correlation coefficients between Walk Score and these environmental attributes were calculated (conducted in May 2017). Significant positive correlations were observed between Walk Score and environmental attributes relevant to walking. Walk Score was most closely associated with intersection density ( r  = 0.82) and with the number of local destinations ( r  = 0.77). Walk Score appears to be a valid measure of neighborhood walkability in Japan. Walk Score will allow urban designers and public health practitioners to identify walkability of local areas without relying on detailed geographic data.

Method for Determining the Weight of Functional Objectives on Manufacturing System

PubMed Central

Zhang, Qingshan; Xu, Wei; Zhang, Jiekun

2014-01-01

We propose a three-dimensional integrated weight determination to solve manufacturing system functional objectives, where consumers are weighted by triangular fuzzy numbers to determine the enterprises. The weights, subjective parts are determined by the expert scoring method, the objective parts are determined by the entropy method with the competitive advantage of determining. Based on the integration of three methods and comprehensive weight, we provide some suggestions for the manufacturing system. This paper provides the numerical example analysis to illustrate the feasibility of this method. PMID:25243203

Validation of measures from the smartphone sway balance application: a pilot study.

PubMed

Patterson, Jeremy A; Amick, Ryan Z; Thummar, Tarunkumar; Rogers, Michael E

2014-04-01

A number of different balance assessment techniques are currently available and widely used. These include both subjective and objective assessments. The ability to provide quantitative measures of balance and posture is the benefit of objective tools, however these instruments are not generally utilized outside of research laboratory settings due to cost, complexity of operation, size, duration of assessment, and general practicality. The purpose of this pilot study was to assess the value and validity of using software developed to access the iPod and iPhone accelerometers output and translate that to the measurement of human balance. Thirty healthy college-aged individuals (13 male, 17 female; age = 26.1 ± 8.5 years) volunteered. Participants performed a static Athlete's Single Leg Test protocol for 10 sec, on a Biodex Balance System SD while concurrently utilizing a mobile device with balance software. Anterior/posterior stability was recorded using both devices, described as the displacement in degrees from level, and was termed the "balance score." There were no significant differences between the two reported balance scores (p = 0.818. Mean balance score on the balance platform was 1.41 ± 0.90, as compared to 1.38 ± 0.72 using the mobile device. There is a need for a valid, convenient, and cost-effective tool to objectively measure balance. Results of this study are promising, as balance score derived from the Smartphone accelerometers were consistent with balance scores obtained from a previously validated balance system. However, further investigation is necessary as this version of the mobile software only assessed balance in the anterior/posterior direction. Additionally, further testing is necessary on a healthy populations and as well as those with impairment of the motor control system. Level 2b (Observational study of validity)(1.)

Assessment of Pharmacy Students' Communication Competence Using the Roter Interaction Analysis System During Objective Structured Clinical Examinations

PubMed Central

Kubota, Yoshie; Seki, Susumu; Takada, Kaori; Sakuma, Mio; Morimoto, Takeshi; Akaike, Akinori; Hiraide, Atsushi

2011-01-01

Objective To determine the value of using the Roter Interaction Analysis System during objective structured clinical examinations (OSCEs) to assess pharmacy students' communication competence. Methods As pharmacy students completed a clinical OSCE involving an interview with a simulated patient, 3 experts used a global rating scale to assess students' overall performance in the interview, and both the student's and patient's languages were coded using the Roter Interaction Analysis System (RIAS). The coders recorded the number of utterances (ie, units of spoken language) in each RIAS category. Correlations between the raters' scores and the number and types of utterances were examined. Results There was a significant correlation between students' global rating scores on the OSCE and the number of utterances in the RIAS socio-emotional category but not the RIAS business category. Conclusions The RIAS proved to be a useful tool for assessing the socio-emotional aspect of students' interview skills. PMID:21655397

Mortality Prediction Using Acute Physiology and Chronic Health Evaluation II and Acute Physiology and Chronic Health Evaluation IV Scoring Systems: Is There a Difference?

PubMed Central

Venkataraman, Ramesh; Gopichandran, Vijayaprasad; Ranganathan, Lakshmi; Rajagopal, Senthilkumar; Abraham, Babu K; Ramakrishnan, Nagarajan

2018-01-01

Background: Mortality prediction in the Intensive Care Unit (ICU) setting is complex, and there are several scoring systems utilized for this process. The Acute Physiology and Chronic Health Evaluation (APACHE) II has been the most widely used scoring system; although, the more recent APACHE IV is considered an updated and advanced prediction model. However, these two systems may not give similar mortality predictions. Objectives: The aim of this study is to compare the mortality prediction ability of APACHE II and APACHE IV scoring systems among patients admitted to a tertiary care ICU. Methods: In this prospective longitudinal observational study, APACHE II and APACHE IV scores of ICU patients were computed using an online calculator. The outcome of the ICU admissions for all the patients was collected as discharged or deceased. The data were analyzed to compare the discrimination and calibration of the mortality prediction ability of the two scores. Results: Out of the 1670 patients' data analyzed, the area under the receiver operating characteristic of APACHE II score was 0.906 (95% confidence interval [CI] – 0.890–0.992), and APACHE IV score was 0.881 (95% CI – 0.862–0.890). The mean predicted mortality rate of the study population as given by the APACHE II scoring system was 44.8 ± 26.7 and as given by APACHE IV scoring system was 29.1 ± 28.5. The observed mortality rate was 22.4%. Conclusions: The APACHE II and IV scoring systems have comparable discrimination ability, but the calibration of APACHE IV seems to be better than that of APACHE II. There is a need to recalibrate the scales with weights derived from the Indian population. PMID:29910542

Performance evaluation of Al-Zahra academic medical center based on Iran balanced scorecard model

PubMed Central

Raeisi, Ahmad Reza; Yarmohammadian, Mohammad Hossein; Bakhsh, Roghayeh Mohammadi; Gangi, Hamid

2012-01-01

Background: Growth and development in any country's national health system, without an efficient evaluation system, lacks the basic concepts and tools necessary for fulfilling the system's goals. The balanced scorecard (BSC) is a technique widely used to measure the performance of an organization. The basic core of the BSC is guided by the organization's vision and strategies, which are the bases for the formation of four perspectives of BSC. The goal of this research is the performance evaluation of Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences, based on Iran BSC model. Materials and Methods: This is a combination (quantitative–qualitative) research which was done at Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences in 2011. The research populations were hospital managers at different levels. Sampling method was purposive sampling in which the key informed personnel participated in determining the performance indicators of hospital as the BSC team members in focused discussion groups. After determining the conceptual elements in focused discussion groups, the performance objectives (targets) and indicators of hospital were determined and sorted in perspectives by the group discussion participants. Following that, the performance indicators were calculated by the experts according to the predetermined objectives; then, the score of each indicator and the mean score of each perspective were calculated. Results: Research findings included development of the organizational mission, vision, values, objectives, and strategies. The strategies agreed upon by the participants in the focus discussion group included five strategies, which were customer satisfaction, continuous quality improvement, development of human resources, supporting innovation, expansion of services and improving the productivity. Research participants also agreed upon four perspectives for the Al-Zahra hospital BSC. In the patients and community perspective (customer), two objectives and three indicators were agreed upon, with a mean score of 75.9%. In the internal process perspective, 4 objectives and 14 indicators were agreed upon, with a mean score of 79.37%. In the learning and growth perspective, four objectives and eight indicators were agreed upon, with a mean score of 81.11%. Finally, in the financial perspective, two objectives and five indicators were agreed upon, with a mean score of 67.15%. Conclusion: One way to create demand for hospital services is performance evaluation by paying close attention to all BSC perspectives, especially the non-financial perspectives such as customers and internal processes perspectives. In this study, the BSC showed the differences in performance level of the organization in different perspectives, which would assist the hospital managers improve their performance indicators. The learning and growth perspective obtained the highest score, and the financial perspective obtained the least score. Since the learning and growth perspective acts as a base for all other perspectives and they depend on it, hospitals must continuously improve the service processes and the quality of services by educating staff and updating their policies and procedures. This can increase customer satisfaction and productivity and finally improve the BSC in financial perspective. PMID:23555104

University clinic and private practice treatment outcomes in Class I extraction and nonextraction patients: A comparative study with the American Board of Orthodontics Objective Grading System.

PubMed

Mislik, Barbara; Konstantonis, Dimitrios; Katsadouris, Alexios; Eliades, Theodore

2016-02-01

The aim of this study was to compare treatment outcomes in university vs private practice settings with Class I patients using the American Board of Orthodontics Objective Grading System. A parent sample of 580 Class I patients treated with and without extractions of 4 first premolars was subjected to discriminant analysis to identify a borderline spectrum of 66 patients regarding the extraction modality. Of these patients, 34 were treated in private orthodontic practices, and 32 were treated in a university graduate orthodontic clinic. The treatment outcomes were evaluated using the 8 variables of the American Board of Orthodontics Objective Grading System. The total scores ranged from 10 to 47 (mean, 25.44; SD, 9.8) for the university group and from 14 to 45 (mean, 25.94; SD, 7.7) for the private practice group. The university group achieved better scores for the variables of buccolingual inclination (mean difference, 2.28; 95% confidence interval [CI], 0.59, 3.98; P = 0.01) and marginal ridges (mean difference, 1.32; 95% CI, 0.28, 2.36; P = 0.01), and the private practice group achieved a better score for the variable of root angulation (mean difference, -0.65; 95% CI, -1.26, -0.03; P = 0.04). However, no statistically intergroup differences were found between the total American Board of Orthodontics Objective Grading System scores (mean difference, -0.5; 95% CI, -3.82, 4.82; P = 0.82). Patients can receive similar quality of orthodontic treatment in a private practice and a university clinic. The orthodontists in the private practices were more successful in angulating the roots properly, whereas the orthodontic residents accomplished better torque control of the posterior segments and better marginal ridges. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Environmental perceptions as mediators of the relationship between the objective built environment and walking among socio-economically disadvantaged women.

PubMed

Van Dyck, Delfien; Veitch, Jenny; De Bourdeaudhuij, Ilse; Thornton, Lukar; Ball, Kylie

2013-09-19

Women living in socio-economically disadvantaged neighbourhoods are at increased risk for physical inactivity and associated health outcomes and are difficult to reach through personally tailored interventions. Targeting the built environment may be an effective strategy in this population subgroup. The aim of this study was to examine the mediating role of environmental perceptions in the relationship between the objective environment and walking for transportation/recreation among women from socio-economically disadvantaged neighbourhoods. Baseline data of the Resilience for Eating and Activity Despite Inequality (READI) study were used. In total, 4139 women (18-46 years) completed a postal survey assessing physical environmental perceptions (aesthetics, neighbourhood physical activity environment, personal safety, neighbourhood social cohesion), physical activity, and socio-demographics. Objectively-assessed data on street connectivity and density of destinations were collected using a Geographic Information System database and based on the objective z-scores, an objective destinations/connectivity score was calculated. This index was positively scored, with higher scores representing a more favourable environment. Two-level mixed models regression analyses were conducted and the MacKinnon product-of-coefficients test was used to examine the mediating effects. The destinations/connectivity score was positively associated with transport-related walking. The perceived physical activity environment mediated 6.1% of this positive association. The destinations/connectivity score was negatively associated with leisure-time walking. Negative perceptions of aesthetics, personal safety and social cohesion of the neighbourhood jointly mediated 24.1% of this negative association. For women living in socio-economically disadvantaged neighbourhoods, environmental perceptions were important mediators of the relationship between the objective built environment and walking. To increase both transport-related and leisure-time walking, it is necessary to improve both objective walkability-related characteristics (street connectivity and proximity of destinations), and perceptions of personal safety, favourable aesthetics and neighbourhood social cohesion.

Disease scoring systems for oral lichen planus; a critical appraisal

PubMed Central

Wang, Jing

2015-01-01

The aim of the present study has been to critically review 22 disease scoring systems (DSSs) on oral lichen planus (OLP) that have been reported in the literature during the past decades. Although the presently available DSSs may all have some merit, particularly for research purposes, the diversity of both the objective and subjective parameters used in these systems and the lack of acceptance of one of these systems for uniform use, there is a need for an international, authorized consensus meeting on this subject. Because of the natural course of OLP characterized by remissions and exacerbations and also due to the varying distribution pattern and the varying clinical types, e.g. reticular and erosive, the relevance of a DSS based on morphologic parameters is somewhat questionable. Instead, one may consider to only look for a quality of life scoring system adapted for use in OLP patients. Key words:Oral lichen planus, disease scoring system, classification. PMID:25681372

Audience Response System Facilitates Prediction of Scores on In-Training Examination.

PubMed

Shah, Kaushal H; Jordan, Jaime; Jahnes, Katherine; Lisbon, David P; Lutfy-Clayton, Lucienne; Wei, Grant; Winkel, Gary; Santen, Sally A

2017-04-01

Audience response systems (ARS) are increasingly popular; however, their contribution to education is not completely clear. Our study found that scores from review quizzes delivered by an ARS correlate with in-training exam (ITE) scores and are viewed positively by residents. This information may be useful in identifying poor performers early so that targeted educational interventions can be made. The objective was to determine if scores on review quizzes delivered by an ARS correlate with ITE scores and to obtain participant feedback on use of the ARS for ITE preparation. This was a prospective observational study of emergency medicine (EM) residents at six accredited EM residency programs. Subjects included residents who had taken previous ITEs. Subjects participated in bimonthly review sessions using an ARS. Twelve review quizzes were administered, each consisting of 10 multiple-choice questions. After the ITE, subjects completed an attitudinal survey consisting of six Likert-scale items and one "yes/no" item. We used a mixed linear model to analyze the data, accounting for prior 2012 ITE scores and nesting due to institution. Among 192 participants, 135 (70.3%) completed the ITE in both 2012 and 2013; we analyzed their data for the first objective. Results from the mixed linear model indicate that the total mean score on the review quizzes was a significant [t(127) = 6.68; p < 0.001] predictor of the 2013 ITE after controlling for the 2012 ITE score. One hundred forty-six (76.0%) participants completed the attitudinal survey; 96% of respondents stated that they would like ARS to be used more often in resident education. Respondents felt the sessions aided in learning (mean 7.7/10), assisted in preparation for the ITE (mean 6.7/10), and helped identify content areas of weakness (mean 7.6/10). Our results suggest that scores from review quizzes delivered by an audience response system correlate with in-training exam scores and is viewed positively by residents.

The Simplest Chronoscope V: A Theory of Dual Primary and Secondary Reaction Time Systems.

PubMed

Montare, Alberto

2016-12-01

Extending work by Montare, visual simple reaction time, choice reaction time, discriminative reaction time, and overall reaction time scores obtained from college students by the simplest chronoscope (a falling meterstick) method were significantly faster as well as significantly less variable than scores of the same individuals from electromechanical reaction timers (machine method). Results supported the existence of dual reaction time systems: an ancient primary reaction time system theoretically activating the V5 parietal area of the dorsal visual stream that evolved to process significantly faster sensory-motor reactions to sudden stimulations arising from environmental objects in motion, and a secondary reaction time system theoretically activating the V4 temporal area of the ventral visual stream that subsequently evolved to process significantly slower sensory-perceptual-motor reactions to sudden stimulations arising from motionless colored objects. © The Author(s) 2016.

Complex and elementary histological scoring systems for articular cartilage repair.

PubMed

Orth, Patrick; Madry, Henning

2015-08-01

The repair of articular cartilage defects is increasingly moving into the focus of experimental and clinical investigations. Histological analysis is the gold standard for a valid and objective evaluation of cartilaginous repair tissue and predominantly relies on the use of established scoring systems. In the past three decades, numerous elementary and complex scoring systems have been described and modified, including those of O'Driscoll, Pineda, Wakitani, Sellers and Fortier for entire defects as well as those according to the International Cartilage Repair Society (ICRS-I/II) for osteochondral tissue biopsies. Yet, this coexistence of different grading scales inconsistently addressing diverse parameters may impede comparability between reported study outcomes. Furthermore, validation of these histological scoring systems has only seldom been performed to date. The aim of this review is (1) to give a comprehensive overview and to compare the most important established histological scoring systems for articular cartilage repair, (2) to describe their specific advantages and pitfalls, and (3) to provide valid recommendations for their use in translational and clinical studies of articular cartilage repair.

Scientific assessment of accuracy, skill and reliability of ocean probabilistic forecast products.

NASA Astrophysics Data System (ADS)

Wei, M.; Rowley, C. D.; Barron, C. N.; Hogan, P. J.

2016-02-01

As ocean operational centers are increasingly adopting and generating probabilistic forecast products for their customers with valuable forecast uncertainties, how to assess and measure these complicated probabilistic forecast products objectively is challenging. The first challenge is how to deal with the huge amount of the data from the ensemble forecasts. The second one is how to describe the scientific quality of probabilistic products. In fact, probabilistic forecast accuracy, skills, reliability, resolutions are different attributes of a forecast system. We briefly introduce some of the fundamental metrics such as the Reliability Diagram, Reliability, Resolution, Brier Score (BS), Brier Skill Score (BSS), Ranked Probability Score (RPS), Ranked Probability Skill Score (RPSS), Continuous Ranked Probability Score (CRPS), and Continuous Ranked Probability Skill Score (CRPSS). The values and significance of these metrics are demonstrated for the forecasts from the US Navy's regional ensemble system with different ensemble members. The advantages and differences of these metrics are studied and clarified.

An Educational Board Game to Assist PharmD Students in Learning Autonomic Nervous System Pharmacology.

PubMed

Jones, J Shawn; Tincher, Lindsay; Odeng-Otu, Emmanuel; Herdman, Michelle

2015-10-25

Objective. To examine whether playing a board game can assist PharmD students in learning autonomic nervous system (ANS) pharmacology. Design. Of 72 students enrolled in a required second-year pharmacology course, 22 students volunteered to play the board game, which was followed by an in-class examination consisting of 42 ANS questions (ANSQs) and 8 control questions (CTLQs). Participants were given a pretest and a posttest to assess immediate educational improvement. Participants' scores for pretest, posttest, in-class examination, and ANSQs were compared. Also, scores for examination, ANSQs, and CTLQs were compared between board game participants (PART) and nonparticipating classmates (NPART). Assessment. Board game participants scored progressively higher between the pretest, posttest, examination, and ANSQs. Additionally, PART scores were higher than NPART scores for examination and ANSQs. Difference between PART and NPART CTLQ scores was not significant. Conclusion. A board game can assist PharmD students in learning ANS pharmacology.

Learning Object Retrieval and Aggregation Based on Learning Styles

ERIC Educational Resources Information Center

Ramirez-Arellano, Aldo; Bory-Reyes, Juan; Hernández-Simón, Luis Manuel

2017-01-01

The main goal of this article is to develop a Management System for Merging Learning Objects (msMLO), which offers an approach that retrieves learning objects (LOs) based on students' learning styles and term-based queries, which produces a new outcome with a better score. The msMLO faces the task of retrieving LOs via two steps: The first step…

Automated aortic calcium scoring on low-dose chest computed tomography

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

Isgum, Ivana; Rutten, Annemarieke; Prokop, Mathias

Purpose: Thoracic computed tomography (CT) scans provide information about cardiovascular risk status. These scans are non-ECG synchronized, thus precise quantification of coronary calcifications is difficult. Aortic calcium scoring is less sensitive to cardiac motion, so it is an alternative to coronary calcium scoring as an indicator of cardiovascular risk. The authors developed and evaluated a computer-aided system for automatic detection and quantification of aortic calcifications in low-dose noncontrast-enhanced chest CT. Methods: The system was trained and tested on scans from participants of a lung cancer screening trial. A total of 433 low-dose, non-ECG-synchronized, noncontrast-enhanced 16 detector row examinations of themore » chest was randomly divided into 340 training and 93 test data sets. A first observer manually identified aortic calcifications on training and test scans. A second observer did the same on the test scans only. First, a multiatlas-based segmentation method was developed to delineate the aorta. Segmented volume was thresholded and potential calcifications (candidate objects) were extracted by three-dimensional connected component labeling. Due to image resolution and noise, in rare cases extracted candidate objects were connected to the spine. They were separated into a part outside and parts inside the aorta, and only the latter was further analyzed. All candidate objects were represented by 63 features describing their size, position, and texture. Subsequently, a two-stage classification with a selection of features and k-nearest neighbor classifiers was performed. Based on the detected aortic calcifications, total calcium volume score was determined for each subject. Results: The computer system correctly detected, on the average, 945 mm{sup 3} out of 965 mm{sup 3} (97.9%) calcified plaque volume in the aorta with an average of 64 mm{sup 3} of false positive volume per scan. Spearman rank correlation coefficient was {rho}=0.960 between the system and the first observer compared to {rho}=0.961 between the two observers. Conclusions: Automatic calcium scoring in the aorta thus appears feasible with good correlation between manual and automatic scoring.« less

[An analysis of residents' self-evaluation and faculty-evaluation in internal medicine standardized residency training program using Milestones evaluation system].

PubMed

Zhang, Y; Chu, X T; Zeng, X J; Li, H; Zhang, F C; Zhang, S Y; Shen, T

2018-06-01

Objective: To assess the value of internal medicine residency training program at Peking Union Medical College Hospital (PUMCH), and the feasibility of applying revised Milestones evaluation system. Methods: Postgraduate-year-one to four (PGY-1 to PGY-4) residents in PUMCH finished the revised Milestones evaluation scales in September 2017. Residents' self-evaluation and faculty-evaluation scores were calculated. Statistical analysis was conducted on the data. Results: A total of 207 residents were enrolled in this cross-sectional study. Both self and faculty scores showed an increasing trend in senior residents. PGY-1 residents were assessed during their first month of residency with scores of 4 points or higher, suggesting that residents have a high starting level. More strikingly, the mean score in PGY-4 was 7 points or higher, proving the career development of residency training program. There was no statistically significant difference between total self- and faculty-evaluation scores. Evaluation scores of learning ability and communication ability were lower in faculty group ( t =-2.627, -4.279, all P <0.05). The scores in graduate students were lower than those in standardized training residents. Conclusions: The goal of national standardized residency training is to improve the quality of healthcare and residents' career development. The evaluation results would guide curriculum design and emphasize the importance and necessity of multi-level teaching. Self-evaluation contributes to the understanding of training objectives and personal cognition.

Computer-Assisted Automated Scoring of Polysomnograms Using the Somnolyzer System

PubMed Central

Punjabi, Naresh M.; Shifa, Naima; Dorffner, Georg; Patil, Susheel; Pien, Grace; Aurora, Rashmi N.

2015-01-01

Study Objectives: Manual scoring of polysomnograms is a time-consuming and tedious process. To expedite the scoring of polysomnograms, several computerized algorithms for automated scoring have been developed. The overarching goal of this study was to determine the validity of the Somnolyzer system, an automated system for scoring polysomnograms. Design: The analysis sample comprised of 97 sleep studies. Each polysomnogram was manually scored by certified technologists from four sleep laboratories and concurrently subjected to automated scoring by the Somnolyzer system. Agreement between manual and automated scoring was examined. Sleep staging and scoring of disordered breathing events was conducted using the 2007 American Academy of Sleep Medicine criteria. Setting: Clinical sleep laboratories. Measurements and Results: A high degree of agreement was noted between manual and automated scoring of the apnea-hypopnea index (AHI). The average correlation between the manually scored AHI across the four clinical sites was 0.92 (95% confidence interval: 0.90–0.93). Similarly, the average correlation between the manual and Somnolyzer-scored AHI values was 0.93 (95% confidence interval: 0.91–0.96). Thus, interscorer correlation between the manually scored results was no different than that derived from manual and automated scoring. Substantial concordance in the arousal index, total sleep time, and sleep efficiency between manual and automated scoring was also observed. In contrast, differences were noted between manually and automated scored percentages of sleep stages N1, N2, and N3. Conclusion: Automated analysis of polysomnograms using the Somnolyzer system provides results that are comparable to manual scoring for commonly used metrics in sleep medicine. Although differences exist between manual versus automated scoring for specific sleep stages, the level of agreement between manual and automated scoring is not significantly different than that between any two human scorers. In light of the burden associated with manual scoring, automated scoring platforms provide a viable complement of tools in the diagnostic armamentarium of sleep medicine. Citation: Punjabi NM, Shifa N, Dorffner G, Patil S, Pien G, Aurora RN. Computer-assisted automated scoring of polysomnograms using the Somnolyzer system. SLEEP 2015;38(10):1555–1566. PMID:25902809

Effect of a Bluetooth-implemented hearing aid on speech recognition performance: subjective and objective measurement.

PubMed

Kim, Min-Beom; Chung, Won-Ho; Choi, Jeesun; Hong, Sung Hwa; Cho, Yang-Sun; Park, Gyuseok; Lee, Sangmin

2014-06-01

The object was to evaluate speech perception improvement through Bluetooth-implemented hearing aids in hearing-impaired adults. Thirty subjects with bilateral symmetric moderate sensorineural hearing loss participated in this study. A Bluetooth-implemented hearing aid was fitted unilaterally in all study subjects. Objective speech recognition score and subjective satisfaction were measured with a Bluetooth-implemented hearing aid to replace the acoustic connection from either a cellular phone or a loudspeaker system. In each system, participants were assigned to 4 conditions: wireless speech signal transmission into hearing aid (wireless mode) in quiet or noisy environment and conventional speech signal transmission using external microphone of hearing aid (conventional mode) in quiet or noisy environment. Also, participants completed questionnaires to investigate subjective satisfaction. Both cellular phone and loudspeaker system situation, participants showed improvements in sentence and word recognition scores with wireless mode compared to conventional mode in both quiet and noise conditions (P < .001). Participants also reported subjective improvements, including better sound quality, less noise interference, and better accuracy naturalness, when using the wireless mode (P < .001). Bluetooth-implemented hearing aids helped to improve subjective and objective speech recognition performances in quiet and noisy environments during the use of electronic audio devices.

Renal Tumor Anatomic Complexity: Clinical Implications for Urologists.

PubMed

Joshi, Shreyas S; Uzzo, Robert G

2017-05-01

Anatomic tumor complexity can be objectively measured and reported using nephrometry. Various scoring systems have been developed in an attempt to correlate tumor complexity with intraoperative and postoperative outcomes. Nephrometry may also predict tumor biology in a noninvasive, reproducible manner. Other scoring systems can help predict surgical complexity and the likelihood of complications, independent of tumor characteristics. The accumulated data in this new field provide provocative evidence that objectifying anatomic complexity can consolidate reporting mechanisms and improve metrics of comparisons. Further prospective validation is needed to understand the full descriptive and predictive ability of the various nephrometry scores. Copyright © 2017 Elsevier Inc. All rights reserved.

A Method to Calculate and Analyze Residents' Evaluations by Using a Microcomputer Data-Base Management System.

ERIC Educational Resources Information Center

Mills, Myron L.

1988-01-01

A system developed for more efficient evaluation of graduate medical students' progress uses numerical scoring and a microcomputer database management system as an alternative to manual methods to produce accurate, objective, and meaningful summaries of resident evaluations. (Author/MSE)

64 slice MDCT generally underestimates coronary calcium scores as compared to EBT: A phantom study

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

Greuter, M. J. W.; Dijkstra, H.; Groen, J. M.

The objective of our study was the determination of the influence of the sequential and spiral acquisition modes on the concordance and deviation of the calcium score on 64-slice multi-detector computed tomography (MDCT) scanners in comparison to electron beam tomography (EBT) as the gold standard. Our methods and materials were an anthropomorphic cardio CT phantom with different calcium inserts scanned in sequential and spiral acquisition modes on three identical 64-slice MDCT scanners of manufacturer A and on three identical 64-slice MDCT scanners of manufacturer B and on an EBT system. Every scan was repeated 30 times with and 15 timesmore » without a small random variation in the phantom position for both sequential and spiral modes. Significant differences were observed between EBT and 64-slice MDCT data for all inserts, both acquisition modes, and both manufacturers of MDCT systems. High regression coefficients (0.90-0.98) were found between the EBT and 64-slice MDCT data for both scoring methods and both systems with high correlation coefficients (R{sup 2}>0.94). System A showed more significant differences between spiral and sequential mode than system B. Almost no differences were observed in scanners of the same manufacturer for the Agatston score and no differences for the Volume score. The deviations of the Agatston and Volume scores showed regression dependencies approximately equal to the square root of the absolute score. The Agatston and Volume scores obtained with 64-slice MDCT imaging are highly correlated with EBT-obtained scores but are significantly underestimated (-10% to -2%) for both sequential and spiral acquisition modes. System B is more independent of acquisition mode to calcium score than system A. The Volume score shows no intramanufacturer dependency and its use is advocated versus the Agatston score. Using the same cut points for MDCT-based calcium scores as for EBT-based calcium scores can result in classifying individuals into a too low risk category. System information and scanprotocol is therefore needed for every calcium score procedure to ensure a correct clinical interpretation of the obtained calcium score results.« less

Prediction of pork loin quality using online computer vision system and artificial intelligence model.

PubMed

Sun, Xin; Young, Jennifer; Liu, Jeng-Hung; Newman, David

2018-06-01

The objective of this project was to develop a computer vision system (CVS) for objective measurement of pork loin under industry speed requirement. Color images of pork loin samples were acquired using a CVS. Subjective color and marbling scores were determined according to the National Pork Board standards by a trained evaluator. Instrument color measurement and crude fat percentage were used as control measurements. Image features (18 color features; 1 marbling feature; 88 texture features) were extracted from whole pork loin color images. Artificial intelligence prediction model (support vector machine) was established for pork color and marbling quality grades. The results showed that CVS with support vector machine modeling reached the highest prediction accuracy of 92.5% for measured pork color score and 75.0% for measured pork marbling score. This research shows that the proposed artificial intelligence prediction model with CVS can provide an effective tool for predicting color and marbling in the pork industry at online speeds. Copyright © 2018 Elsevier Ltd. All rights reserved.

Scoring and staging systems using cox linear regression modeling and recursive partitioning.

PubMed

Lee, J W; Um, S H; Lee, J B; Mun, J; Cho, H

2006-01-01

Scoring and staging systems are used to determine the order and class of data according to predictors. Systems used for medical data, such as the Child-Turcotte-Pugh scoring and staging systems for ordering and classifying patients with liver disease, are often derived strictly from physicians' experience and intuition. We construct objective and data-based scoring/staging systems using statistical methods. We consider Cox linear regression modeling and recursive partitioning techniques for censored survival data. In particular, to obtain a target number of stages we propose cross-validation and amalgamation algorithms. We also propose an algorithm for constructing scoring and staging systems by integrating local Cox linear regression models into recursive partitioning, so that we can retain the merits of both methods such as superior predictive accuracy, ease of use, and detection of interactions between predictors. The staging system construction algorithms are compared by cross-validation evaluation of real data. The data-based cross-validation comparison shows that Cox linear regression modeling is somewhat better than recursive partitioning when there are only continuous predictors, while recursive partitioning is better when there are significant categorical predictors. The proposed local Cox linear recursive partitioning has better predictive accuracy than Cox linear modeling and simple recursive partitioning. This study indicates that integrating local linear modeling into recursive partitioning can significantly improve prediction accuracy in constructing scoring and staging systems.

A Survey of Attitudes towards the Clinical Application of Systemic Inflammation Based Prognostic Scores in Cancer.

PubMed

Watt, David G; Roxburgh, Campbell S; White, Mark; Chan, Juen Zhik; Horgan, Paul G; McMillan, Donald C

2015-01-01

The systemic inflammatory response (SIR) plays a key role in determining nutritional status and survival of patients with cancer. A number of objective scoring systems have been shown to have prognostic value; however, their application in routine clinical practice is not clear. The aim of the present survey was to examine the range of opinions internationally on the routine use of these scoring systems. An online survey was distributed to a target group consisting of individuals worldwide who have reported an interest in systemic inflammation in patients with cancer. Of those invited by the survey (n = 238), 65% routinely measured the SIR, mainly for research and prognostication purposes and clinically for allocation of adjuvant therapy or palliative chemotherapy. 40% reported that they currently used the Glasgow Prognostic Score/modified Glasgow Prognostic Score (GPS/mGPS) and 81% reported that a measure of systemic inflammation should be incorporated into clinical guidelines, such as the definition of cachexia. The majority of respondents routinely measured the SIR in patients with cancer, mainly using the GPS/mGPS for research and prognostication purposes. The majority reported that a measure of the SIR should be adopted into clinical guidelines.

SU-E-T-106: An Institutional Review of Using Commercially Available Software to Evaluate Treatment Plan Quality for Various Treatment Sites and Beam Deliveries

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

Esquivel, C; Patton, L; Walker, S

Purpose: Use Sun Nuclear Quality Reports™ with PlanIQ™ to evaluate different treatment delivery techniques for various treatment sites. Methods: Fifteen random patients with different treatment sites were evaluated. These include the Head/Neck, prostate, pelvis, lung, esophagus, axilla, bladder and abdomen. Initially, these sites were planned on the Pinnacle {sup 3} V9.6 treatment planning system and utilized nine 6MV step-n-shoot IMRT fields. The RT plan, dose and structure sets were sent to Quality Reports™ where a DVH was recreated and the plans were compared to a unique Plan Algorithm for each treatment site. Each algorithm has its own plan quality metricsmore » and objectives, which include the PTV coverage, PTV maximum dose, the prescription dose outside the target, doses to the critical structures, and the global maximum dose and its location. Each plan was scored base on meeting each objective. Plans may have been reoptimized and reevaluated with Quality Reports™ based on the initial score. PlanIQ™ was used to evaluate if any objective not met was achievable or difficult to obtain. A second plan using VMAT delivery was created for each patient and scored with Quality Reports™. Results: There were a wide range of scores for the different treatment sites with some scoring better for IMRT plans and some better for the VMAT deliveries. The variation in the scores could be attributed to the treatment site, location, and shape of the target. Most deliveries were chosen for the VMAT due to the short treatment times and quick patient throughput with acceptable plan scores. Conclusion: The tools are provided for both physician and dosimetrist to objectively evaluate the use of VMAT delivery versus the step-n-shoot IMRT delivery for various sites. PlanIQ validates if objectives can be met. For the physicist, a concise pass/fail report is created for plan evaluation.« less

Modified PADSS (Post Anaesthetic Discharge Scoring System) for monitoring outpatients discharge.

PubMed

Palumbo, Piergaspare; Tellan, Guglielmo; Perotti, Bruno; Pacilè, Maria Antonietta; Vietri, Francesco; Illuminati, Giulio

2013-01-01

The decision to discharge a patient undergoing day surgery is a major step in the hospitalization pathway, because it must be achieved without compromising the quality of care, thus ensuring the same assistance and wellbeing as for a long-term stay. Therefore, the use of an objective assessment for the management of a fair and safe discharge is essential. The authors propose the Post Anaesthetic Discharge Scoring System (PADSS), which considers six criteria: vital signs, ambulation, nausea/vomiting, pain, bleeding and voiding. Each criterion is given a score ranging from 0 to 2. Only patients who achieve a score of 9 or more are considered ready for discharge. Furthermore, PADSS has been modified to ensure a higher level of safety, thus the "vital signs" criteria must never score lower than 2, and none of the other five criteria must ever be equal to 0, even if the total score reaches 9. The effectiveness of PADSS was analyzed on 2432 patients, by recording the incidence of postoperative complications and the readmission to hospital. So far PADDS has proved to be an efficient system that guarantees safe discharge.

Assessment of pharmacy students' communication competence using the Roter Interaction Analysis System during objective structured clinical examinations.

PubMed

Kubota, Yoshie; Yano, Yoshitaka; Seki, Susumu; Takada, Kaori; Sakuma, Mio; Morimoto, Takeshi; Akaike, Akinori; Hiraide, Atsushi

2011-04-11

To determine the value of using the Roter Interaction Analysis System during objective structured clinical examinations (OSCEs) to assess pharmacy students' communication competence. As pharmacy students completed a clinical OSCE involving an interview with a simulated patient, 3 experts used a global rating scale to assess students' overall performance in the interview, and both the student's and patient's languages were coded using the Roter Interaction Analysis System (RIAS). The coders recorded the number of utterances (ie, units of spoken language) in each RIAS category. Correlations between the raters' scores and the number and types of utterances were examined. There was a significant correlation between students' global rating scores on the OSCE and the number of utterances in the RIAS socio-emotional category but not the RIAS business category. The RIAS proved to be a useful tool for assessing the socio-emotional aspect of students' interview skills.

A Metric-Based System for Evaluating the Productivity of Preclinical Faculty at an Academic Medical Center in the Era of Clinical and Translational Science.

PubMed

Wiegers, Susan E; Houser, Steven R; Pearson, Helen E; Untalan, Ann; Cheung, Joseph Y; Fisher, Susan G; Kaiser, Larry R; Feldman, Arthur M

2015-08-01

Academic medical centers are faced with increasing budgetary constraints due to a flat National Institutes of Health budget, lower reimbursements for clinical services, higher costs of technology including informatics and a changing competitive landscape. As such, institutional stakeholders are increasingly asking whether resources are allocated appropriately and whether there are objective methods for measuring faculty contributions and engagement. The complexities of translational research can be particularly challenging when trying to assess faculty contributions because of team science. For over a decade, we have used an objective scoring system called the Matrix to assess faculty productivity and engagement in four areas: research, education, scholarship, and administration or services. The Matrix was developed to be dynamic, quantitative, and able to insure that a fully engaged educator would have a Matrix score that was comparable to a fully engaged investigator. In this report, we present the Matrix in its current form in order to provide a well-tested objective system of performance evaluation for nonclinical faculty to help academic leaders in decision making. © 2015 Wiley Periodicals, Inc.

Scoring Idiopathic Granulomatous Mastitis: An Effective System for Predicting Recurrence?

PubMed Central

Gürel, Bora; Güler, Sertaç Ata; Baran, Mehmet Ali; Erşan, Büşra; Duman, Seda; Utkan, Zafer

2018-01-01

Objective Idiopathic granulomatous mastitis is a breast disease without a definitive etiology. There are no definitive classifications, scoring systems or certitudes. The aim of this study is to define the factors related to the recurrence and design a scoring system. Material and Methods Patients who were admitted to the general surgery department with symptoms of granulomatous mastitis were evaluated by ultrasonography and underwent antibiotic therapy. Granulomatous mastitis is diagnosed by core biopsy and treated with steroid therapy. Patients without improvement underwent surgery and were included in the study. In total, 53 patients were included in the study. There were 8 recurrent cases. Factors related with recurrences were defined. Results Number of births over 2, duration of lactation more than 18 months, body mass index greater than 31, having fistula in physical examination, abscess collection in ultrasonographic examination, and luminal inflammation score over 2 were scored as 1. Severity score in recurrent cases were 5.1±0.6 whereas 1.9±1.0 in nonrecurrent cases. Conclusion Granulomatous mastitis score is a tool targeted at predicting the risk of recurrences. The patients with these factors are more prone for recurrences. PMID:29774320

Rating Pregnancy Wheel Applications Using the APPLICATIONS Scoring System.

PubMed

Chyjek, Kathy; Farag, Sara; Chen, Katherine T

2015-06-01

To identify the top-rated pregnancy wheel applications (apps) using a newly developed APPLICATIONS scoring system. A list of pregnancy wheel apps was identified. Consumer-based and inaccurate apps were excluded. The APPLICATIONS scoring system was developed to rate the remaining apps. Application comprehensiveness was evaluated. Objective rating components included price, paid subscription, literature used, in-app purchases, connectivity to the Internet, advertisements, text search field, interdevice compatibility, and other components such as images or figures, videos, and special features. Subjective rating components were ease of navigation and subjective presentation. A complete list of 55 pregnancy wheel apps was created from three sources. Thirty-nine (71%) were consumer-based, inaccurate, or both, leaving 16 (29%) for analysis using the APPLICATIONS scoring system. More than two thirds of pregnancy wheel apps were excluded from our study secondary to being consumer-based, inaccurate, or both. This highlights the importance of identifying systematically, reviewing critically, and rating the thousands of available apps to health care providers to ensure accuracy and applicability. We propose that our APPLICATIONS scoring system be used to rate apps in all specialties with the goal of improving health care provider performance and thereby patient outcomes. III.

A Scoring System to Predict the Severity of Hirschsprung Disease at Diagnosis and Its Correlation With Molecular Genetics.

PubMed

Núñez-Ramos, Raquel; Fernández, Raquel M; González-Velasco, Miguel; Ruiz-Contreras, Jesús; Galán-Gómez, Enrique; Núñez-Núñez, Ramón; Borrego, Salud

2017-01-01

Objectives Hirschsprung disease (HSCR) has a wide range of severity. There are nonsevere forms treated conservatively until surgery and severe forms that require an early stoma and prolonged hospitalization. Our objective was to establish a clinical scoring system to predict the severity of HSCR and to evaluate the possible existence of a clinical-genetic correlation. Methods We carried out a retrospective observational study including all HSCR cases treated in our hospital. The sample was divided into severe and nonsevere disease according to the number of surgical procedures, hospitalization time, and episodes of enterocolitis. The proposed score was applied at diagnosis, and the sensitivity, specificity, and optimal cut-point were determined. We conducted a prospective molecular study of RET, EDNRB, and EDN3 on all patients, as well as SOX10 in Waardenburg Syndrome type 4 forms. Results Among the 42 patients treated between 1983 and 2013, 15 met the severe disease criteria. This group had a higher mean score (13.15 ± 2.36) than the nonsevere group (8.15 ± 2.13; p < 0.001). A score ≥11 had a sensitivity of 87% and a specificity of 81% in detecting the severe cases. Causative mutations were identified in 12 patients, 8 of them in the severe group ( p = 0.015). Most of these mutations (75%) were located in the RET proto-oncogene. Conclusion The proposed scoring system enables the early selection of patients with severe behavior of HSCR. A value ≥11 showed good sensitivity and specificity for this purpose. Causative mutations were identified in more than 50% of patients who met the criteria for severe disease.

Is chest CT useful in newborn screened infants with cystic fibrosis at 1 year of age?

PubMed Central

Thia, Lena P; Calder, Alistair; Stocks, Janet; Bush, Andrew; Owens, Catherine M; Wallis, Colin; Young, Carolyn; Sullivan, Yvonne; Wade, Angie; McEwan, Angus; Brody, Alan S

2014-01-01

Rationale Sensitive outcome measures applicable in different centres to quantify and track early pulmonary abnormalities in infants with cystic fibrosis (CF) are needed both for clinical care and interventional trials. Chest CT has been advocated as such a measure yet there is no validated scoring system in infants. Objectives The objectives of this study were to standardise CT data collection across multiple sites; ascertain the incidence of bronchial dilatation and air trapping in newborn screened (NBS) infants with CF at 1 year; and assess the reproducibility of Brody-II, the most widely used scoring system in children with CF, during infancy. Methods A multicentre observational study of early pulmonary lung disease in NBS infants with CF at age 1 year using volume-controlled chest CT performed under general anaesthetic. Main results 65 infants with NBS-diagnosed CF had chest CT in three centres. Small insignificant variations in lung recruitment manoeuvres but significant centre differences in radiation exposures were found. Despite experienced scorers and prior training, with the exception of air trapping, inter- and intraobserver agreement on Brody-II score was poor to fair (eg, interobserver total score mean (95% CI) κ coefficient: 0.34 (0.20 to 0.49)). Only 7 (11%) infants had a total CT score ≥12 (ie, ≥5% maximum possible) by either scorer. Conclusions In NBS infants with CF, CT changes were very mild at 1 year, and assessment of air trapping was the only reproducible outcome. CT is thus of questionable value in infants of this age, unless an improved scoring system for use in mild CF disease can be developed. PMID:24132911

Relationship Between the Functional Status Scale and the Pediatric Overall Performance Category and Pediatric Cerebral Performance Category Scales FREE

PubMed Central

Pollack, Murray M.; Holubkov, Richard; Funai, Tomohiko; Clark, Amy; Moler, Frank; Shanley, Thomas; Meert, Kathy; Newth, Christopher J. L.; Carcillo, Joseph; Berger, John T.; Doctor, Allan; Berg, Robert A.; Dalton, Heidi; Wessel, David L.; Harrison, Rick E.; Dean, J. Michael; Jenkins, Tammara L.

2015-01-01

Importance Functional status assessment methods are important as outcome measures for pediatric critical care studies. Objective To investigate the relationships between the 2 functional status assessment methods appropriate for large-sample studies, the Functional Status Scale (FSS) and the Pediatric Overall Performance Category and Pediatric Cerebral Performance Category (POPC/PCPC) scales. Design, Setting, and Participants Prospective cohort study with random patient selection at 7 sites and 8 children’s hospitals with general/medical and cardiac/cardiovascular pediatric intensive care units (PICUs) in the Collaborative Pediatric Critical Care Research Network. Participants included all PICU patients younger than 18 years. Main Outcomes and Measures Functional Status Scale and POPC/PCPC scores determined at PICU admission (baseline) and PICU discharge. We investigated the association between the baseline and PICU discharge POPC/PCPC scores and the baseline and PICU discharge FSS scores, the dispersion of FSS scores within each of the POPC/PCPC ratings, and the relationship between the FSS neurologic components (FSS-CNS) and the PCPC. Results We included 5017 patients. We found a significant (P < .001) difference between FSS scores in each POPC or PCPC interval, with an FSS score increase with each worsening POPC/PCPC rating. The FSS scores for the good and mild disability POPC/PCPC ratings were similar and increased by 2 to 3 points for the POPC/PCPC change from mild to moderate disability, 5 to 6 points for moderate to severe disability, and 8 to 9 points for severe disability to vegetative state or coma. The dispersion of FSS scores within each POPC and PCPC rating was substantial and increased with worsening POPC and PCPC scores. We also found a significant (P < .001) difference between the FSS-CNS scores between each of the PCPC ratings with increases in the FSS-CNS score for each higher PCPC rating. Conclusions and Relevance The FSS and POPC/PCPC system are closely associated. Increases in FSS scores occur with each higher POPC and PCPC rating and with greater magnitudes of change as the dysfunction severity increases. However, the dispersion of the FSS scores indicated a lack of precision in the POPC/PCPC system when compared with the more objective and granular FSS. The relationship between the PCPC and the FSS-CNS paralleled the relationship between the FSS and POPC/PCPC system. PMID:24862461

Foreign object detection and removal to improve automated analysis of chest radiographs

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

Hogeweg, Laurens; Sanchez, Clara I.; Melendez, Jaime

2013-07-15

Purpose: Chest radiographs commonly contain projections of foreign objects, such as buttons, brassier clips, jewellery, or pacemakers and wires. The presence of these structures can substantially affect the output of computer analysis of these images. An automated method is presented to detect, segment, and remove foreign objects from chest radiographs.Methods: Detection is performed using supervised pixel classification with a kNN classifier, resulting in a probability estimate per pixel to belong to a projected foreign object. Segmentation is performed by grouping and post-processing pixels with a probability above a certain threshold. Next, the objects are replaced by texture inpainting.Results: The methodmore » is evaluated in experiments on 257 chest radiographs. The detection at pixel level is evaluated with receiver operating characteristic analysis on pixels within the unobscured lung fields and an A{sub z} value of 0.949 is achieved. Free response operator characteristic analysis is performed at the object level, and 95.6% of objects are detected with on average 0.25 false positive detections per image. To investigate the effect of removing the detected objects through inpainting, a texture analysis system for tuberculosis detection is applied to images with and without pathology and with and without foreign object removal. Unprocessed, the texture analysis abnormality score of normal images with foreign objects is comparable to those with pathology. After removing foreign objects, the texture score of normal images with and without foreign objects is similar, while abnormal images, whether they contain foreign objects or not, achieve on average higher scores.Conclusions: The authors conclude that removal of foreign objects from chest radiographs is feasible and beneficial for automated image analysis.« less

[Quality management in a clinical research facility: Evaluation of changes in quality in-house figures and the appraisal of in-house quality indicators].

PubMed

Aden, Bile; Allekotte, Silke; Mösges, Ralph

2016-12-01

For long-term maintenance and improvement of quality within a clinical research institute, the implementation and certification of a quality management system is suitable. Due to the implemented quality management system according to the still valid DIN EN ISO 9001:2008 desired quality objectives are achieved effectively. The evaluation of quality scores and the appraisal of in-house quality indicators make an important contribution in this regard. In order to achieve this and draw quality assurance conclusions, quality indicators as sensible and sensitive as possible are developed. For this, own key objectives, the retrospective evaluation of quality scores, a prospective follow-up and also discussions establish the basis. In the in-house clinical research institute the measures introduced by the quality management led to higher efficiency in work processes, improved staff skills, higher customer satisfaction and overall to more successful outcomes in relation to the self-defined key objectives. Copyright © 2016. Published by Elsevier GmbH.

External Validation of European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) for Risk Prioritization in an Iranian Population

PubMed Central

Atashi, Alireza; Amini, Shahram; Tashnizi, Mohammad Abbasi; Moeinipour, Ali Asghar; Aazami, Mathias Hossain; Tohidnezhad, Fariba; Ghasemi, Erfan; Eslami, Saeid

2018-01-01

Introduction The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is a prediction model which maps 18 predictors to a 30-day post-operative risk of death concentrating on accurate stratification of candidate patients for cardiac surgery. Objective The objective of this study was to determine the performance of the EuroSCORE II risk-analysis predictions among patients who underwent heart surgeries in one area of Iran. Methods A retrospective cohort study was conducted to collect the required variables for all consecutive patients who underwent heart surgeries at Emam Reza hospital, Northeast Iran between 2014 and 2015. Univariate and multivariate analysis were performed to identify covariates which significantly contribute to higher EuroSCORE II in our population. External validation was performed by comparing the real and expected mortality using area under the receiver operating characteristic curve (AUC) for discrimination assessment. Also, Brier Score and Hosmer-Lemeshow goodness-of-fit test were used to show the overall performance and calibration level, respectively. Results Two thousand five hundred eight one (59.6% males) were included. The observed mortality rate was 3.3%, but EuroSCORE II had a prediction of 4.7%. Although the overall performance was acceptable (Brier score=0.047), the model showed poor discriminatory power by AUC=0.667 (sensitivity=61.90, and specificity=66.24) and calibration (Hosmer-Lemeshow test, P<0.01). Conclusion Our study showed that the EuroSCORE II discrimination power is less than optimal for outcome prediction and less accurate for resource allocation programs. It highlights the need for recalibration of this risk stratification tool aiming to improve post cardiac surgery outcome predictions in Iran. PMID:29617500

Modified CLIP with objective liver reserve assessment retains prognosis prediction for patients with advanced hepatocellular carcinoma.

PubMed

Shao, Yu-Yun; Liu, Tsung-Hao; Lee, Ying-Hui; Hsu, Chih-Hung; Cheng, Ann-Lii

2016-07-01

The Cancer of the Liver Italian Program (CLIP) score is a commonly used staging system for hepatocellular carcinoma (HCC) helpful with predicting prognosis of advanced HCC. CLIP uses the Child-Turcotte-Pugh (CTP) score to evaluate liver reserve. A new scoring system, the albumin-bilirubin (ALBI) grade, has been proposed as they objectively evaluate liver reserve. We examined whether the modification of CLIP with ALBI retained its prognosis prediction for patients with advanced HCC. We included patients who received first-line antiangiogenic therapy for advanced HCC. Liver reserve was assessed using CTP and ALBI scores, which were then incorporated into CLIP and ALBI-CLIP, respectively. To assess their efficacies of prognostic prediction, the Cox's proportional hazard model and concordance indexes were used. A total of 142 patients were included; 137 of them were classified CTP A and 5 patients CTP B. Patients could be divided into four or five groups with different prognosis according to CLIP and ALBI-CLIP, respectively. Higher R(2) (0.249 vs 0.216) and lower Akaike information criterion (995.0 vs 1001.1) were observed for ALBI-CLIP than for CLIP in the Cox's model predicting overall survival. ALBI-CLIP remained an independent predictor for overall survival when CLIP and ALBI-CLIP were simultaneously incorporated in Cox's models allowing variable selection with adjustment for hepatitis etiology, treatment, and performance status. The concordance index was also higher for ALBI-CLIP than for CLIP (0.724 vs 0.703). Modification of CLIP scoring with ALBI, which objectively assesses liver reserve, retains and might have improved prognosis prediction for advanced HCC. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Post-Traumatic Stress Disorder, Depression, and Heart-Rate Variability among North Korean Defectors

PubMed Central

Song, Byoung-A; Yoo, So-Young; Kang, Hee-Young; Byeon, Seong-Hye; Shin, Sang-Ho; Hwang, Eun-Jeong

2011-01-01

Objective This study evaluated the symptoms of post-traumatic stress disorder (PTSD) among North Korean defectors and their level of suicidal ideation and the correlation between these and heart-rate variability (HRV) to explore the possibility of using HRV as an objective neurobiological index of signs of autonomic nervous system disorder. Methods A total of 32 North Korean defectors (nine men, 23 women) were selected as subjects, and their HRV was measured after they completed the Minnesota Multiphasic Personality Inventory-PTSD (MMPI-PTSD) scale and the Beck Depression Inventory (BDI). Results 1) Low-frequency (LF)/high-frequency (HF) ratios in the HRV index and MMPI-PTSD scores were correlated (r=0.419, p<0.05), as were BDI item 9 (suicidal ideation) and MMPI-PTSD scores (r=0.600, p<0.01). 2) A regression analysis of LF/HF ratios and MMPI-PTSD scores revealed an R-value of 13.8% (Adj. R2=0.138, F=4.695, p=0.041), and a regression analysis of BDI item 9 and MMPI-PTSD scores showed an R-value of 32.8% (Adj. R2=0.328, F=11.234, p=0.003). In other words, the LF/HF ratio (β=0.419) and BDI item 9 (β=0.600) appear to be risk factors in predicting MMPI-PTSD scores. Conclusion The LF/HF ratio, a standard index of autonomic nervous system activity, can be used as an objective neurobiological index to analyze PTSD among North Korean defectors presenting with various mental and physical symptoms, and the approximate level of suicide -ideation can act as a predicting factor for PTSD. PMID:22216038

Prospective Randomized Controlled Study on the Efficacy of Multimedia Informed Consent for Patients Scheduled to Undergo Green-Light High-Performance System Photoselective Vaporization of the Prostate

PubMed Central

Ham, Dong Yeub; Choi, Woo Suk; Song, Sang Hoon; Ahn, Young-Joon; Park, Hyoung Keun; Kim, Hyeong Gon

2016-01-01

Purpose The aim of this study was to evaluate the efficacy of a multimedia informed consent (IC) presentation on the understanding and satisfaction of patients who were scheduled to receive 120-W green-light high-performance system photoselective vaporization of the prostate (HPS-PVP). Materials and Methods A multimedia IC (M-IC) presentation for HPS-PVP was developed. Forty men with benign prostatic hyperplasia who were scheduled to undergo HPS-PVP were prospectively randomized to a conventional written IC group (W-IC group, n=20) or the M-IC group (n=20). The allocated IC was obtained by one certified urologist, followed by a 15-question test (maximum score, 15) to evaluate objective understanding, and questionnaires on subjective understanding (range, 0~10) and satisfaction (range, 0~10) using a visual analogue scale. Results Demographic characteristics, including age and the highest level of education, did not significantly differ between the two groups. No significant differences were found in scores reflecting the objective understanding of HPS-PVP (9.9±2.3 vs. 10.6±2.8, p=0.332) or in subjective understanding scores (7.5±2.1 vs. 8.6±1.7, p=0.122); however, the M-IC group showed higher satisfaction scores than the W-IC group (7.4±1.7 vs. 8.4±1.5, p=0.033). After adjusting for age and educational level, the M-IC group still had significantly higher satisfaction scores. Conclusions M-IC did not enhance the objective knowledge of patients regarding this surgical procedure. However, it improved the satisfaction of patients with the IC process itself. PMID:27169129

Objective assessment of operator performance during ultrasound-guided procedures.

PubMed

Tabriz, David M; Street, Mandie; Pilgram, Thomas K; Duncan, James R

2011-09-01

Simulation permits objective assessment of operator performance in a controlled and safe environment. Image-guided procedures often require accurate needle placement, and we designed a system to monitor how ultrasound guidance is used to monitor needle advancement toward a target. The results were correlated with other estimates of operator skill. The simulator consisted of a tissue phantom, ultrasound unit, and electromagnetic tracking system. Operators were asked to guide a needle toward a visible point target. Performance was video-recorded and synchronized with the electromagnetic tracking data. A series of algorithms based on motor control theory and human information processing were used to convert raw tracking data into different performance indices. Scoring algorithms converted the tracking data into efficiency, quality, task difficulty, and targeting scores that were aggregated to create performance indices. After initial feasibility testing, a standardized assessment was developed. Operators (N = 12) with a broad spectrum of skill and experience were enrolled and tested. Overall scores were based on performance during ten simulated procedures. Prior clinical experience was used to independently estimate operator skill. When summed, the performance indices correlated well with estimated skill. Operators with minimal or no prior experience scored markedly lower than experienced operators. The overall score tended to increase according to operator's clinical experience. Operator experience was linked to decreased variation in multiple aspects of performance. The aggregated results of multiple trials provided the best correlation between estimated skill and performance. A metric for the operator's ability to maintain the needle aimed at the target discriminated between operators with different levels of experience. This study used a highly focused task model, standardized assessment, and objective data analysis to assess performance during simulated ultrasound-guided needle placement. The performance indices were closely related to operator experience.

Lund-Mackay and modified Lund-Mackay score for sinus surgery in children with cystic fibrosis.

PubMed

Do, Bao Anh; Lands, Larry C; Mascarella, Marco A; Fanous, Amanda; Saint-Martin, Christine; Manoukian, John J; Nguyen, Lily H P

2015-08-01

Patients with cystic fibrosis (CF) frequently present with severe sinonasal disease often requiring radiologic imaging and surgical intervention. Few studies have focused on the relationship between radiologic scoring systems and the need for sinus surgery in this population. The objective of this study is to evaluate the Lund-Mackay (LM) and modified Lund-Mackay (m-LM) scoring systems in predicting the need for sinus surgery or revision surgery in patients with CF. We performed a retrospective chart review of CF patients undergoing computed tomography (CT) sinus imaging at a tertiary care pediatric hospital from 1995 to 2008. Patient scans were scored using both the LM and m-LM systems and compared to the rate of sinus surgery or revision surgery. Receiver-operator characteristics curves (ROC) were used to analyze the radiological scoring systems. A total of 41 children with CF were included in the study. The mean LM score for patients undergoing surgery was 17.3 (±3.1) compared to 11.5 (±6.2) for those treated medically (p<0.01). For the m-LM, the mean score of patients undergoing surgery was 20.3 (±3.5) and 13.5 (±7.3) for those medically treated (p<0.01). Using a ROC curve with a threshold score of 13 for the LM, the sensitivity was 89.3% (95% CI of 72-98) and specificity of 69.2% (95% CI of 39-91). At an optimal score of 19, the m-LM system produced a sensitivity of 67.7% (95% CI of 48-84) and specificity of 84.6% (95% CI of 55-98). The modified Lund-Mackay score provides a high specificity while the Lund-Mackay score a high sensitivity for CF patients who required sinus surgery. The combination of both radiologic scoring systems can potentially predict the need for surgery in this population. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Revised Tubiana’s Staging System for Assessment of Disease Severity in Dupuytren’s Disease—Preliminary Clinical Findings

PubMed Central

Hindocha, Sandip; Stanley, John K.; Watson, James Stewart

2007-01-01

There are few objective staging systems to assess severity of Dupuytren’s disease (DD). Previous methods to assess severity of DD were based primarily on the degree of contracture of an affected digit measured using a goniometer. Nonetheless, this method of assessment alone may be incomplete, and other factors should be considered. White (n = 92) patients diagnosed with DD from northwest of England were assessed for DD. Objective criteria for evaluating severity incorporated quantified variables. The revised severity stage was correlated to a known staging system of DD (Tubiana’s staging system) which measures total flexion deformity for a single affected digit. Total revised severity staging scores ranged between 4 and 53 (mean = 18.7) and revealed significant positive correlation to Tubiana’s original staging system (r2 = 0.8, p < 0.001). There was significant difference between severity staging scores in those with a positive family history compared to those without (p < 0.01). In current practice, often, the degree of contracture in an affected digit is used solely as a measure of disease severity. Additional objective clinical information may provide useful prognostic indices for disease progression as well as postoperative outcome. PMID:18780081

The system evaluation for report writing skills of summary by HGA-SVM with Ontology: Medical case study in problem based learning

NASA Astrophysics Data System (ADS)

Yenaeng, Sasikanchana; Saelee, Somkid; Samai, Wirachai

2018-01-01

The system evaluation for report writing skills of summary by Hybrid Genetic Algorithm-Support Vector Machines (HGA-SVM) with Ontology of Medical Case Study in Problem Based Learning (PBL) is a system was developed as a guideline of scoring for the facilitators or medical teacher. The essay answers come from medical student of medical education courses in the nervous system motion and Behavior I and II subject, a third year medical student 20 groups of 9-10 people, the Faculty of Medicine in Prince of Songkla University (PSU). The audit committee have the opinion that the ratings of individual facilitators are inadequate, this system to solve such problems. In this paper proposes a development of the system evaluation for report writing skills of summary by HGA-SVM with Ontology of medical case study in PBL which the mean scores of machine learning score and humans (facilitators) score were not different at the significantly level .05 all 3 essay parts contain problem essay part, hypothesis essay part and learning objective essay part. The result show that, the average score all 3 essay parts that were not significantly different from the rate at the level of significance .05.

The OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging (MRI) Scoring System: Updated Recommendations by the OMERACT MRI in Arthritis Working Group.

PubMed

Østergaard, Mikkel; Peterfy, Charles G; Bird, Paul; Gandjbakhch, Frédérique; Glinatsi, Daniel; Eshed, Iris; Haavardsholm, Espen A; Lillegraven, Siri; Bøyesen, Pernille; Ejbjerg, Bo; Foltz, Violaine; Emery, Paul; Genant, Harry K; Conaghan, Philip G

2017-11-01

The Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis (RA) Magnetic Resonance Imaging (MRI) scoring system (RAMRIS), evaluating bone erosion, bone marrow edema/osteitis, and synovitis, was introduced in 2002, and is now the standard method of objectively quantifying inflammation and damage by MRI in RA trials. The objective of this paper was to identify subsequent advances and based on them, to provide updated recommendations for the RAMRIS. MRI studies relevant for RAMRIS and technical and scientific advances were analyzed by the OMERACT MRI in Arthritis Working Group, which used these data to provide updated considerations on image acquisition, RAMRIS definitions, and scoring systems for the original and new RA pathologies. Further, a research agenda was outlined. Since 2002, longitudinal studies and clinical trials have documented RAMRIS variables to have face, construct, and criterion validity; high reliability and sensitivity to change; and the ability to discriminate between therapies. This has enabled RAMRIS to demonstrate inhibition of structural damage progression with fewer patients and shorter followup times than has been possible with conventional radiography. Technical improvements, including higher field strengths and improved pulse sequences, allow higher image resolution and contrast-to-noise ratio. These have facilitated development and validation of scoring methods of new pathologies: joint space narrowing and tenosynovitis. These have high reproducibility and moderate sensitivity to change, and can be added to RAMRIS. Combined scores of inflammation or joint damage may increase sensitivity to change and discriminative power. However, this requires further research. Updated 2016 RAMRIS recommendations and a research agenda were developed.

Semi-automatic computerized approach to radiological quantification in rheumatoid arthritis

NASA Astrophysics Data System (ADS)

Steiner, Wolfgang; Schoeffmann, Sylvia; Prommegger, Andrea; Boegl, Karl; Klinger, Thomas; Peloschek, Philipp; Kainberger, Franz

2004-04-01

Rheumatoid Arthritis (RA) is a common systemic disease predominantly involving the joints. Precise diagnosis and follow-up therapy requires objective quantification. For this purpose, radiological analyses using standardized scoring systems are considered to be the most appropriate method. The aim of our study is to develop a semi-automatic image analysis software, especially applicable for scoring of joints in rheumatic disorders. The X-Ray RheumaCoach software delivers various scoring systems (Larsen-Score and Ratingen-Rau-Score) which can be applied by the scorer. In addition to the qualitative assessment of joints performed by the radiologist, a semi-automatic image analysis for joint detection and measurements of bone diameters and swollen tissue supports the image assessment process. More than 3000 radiographs from hands and feet of more than 200 RA patients were collected, analyzed, and statistically evaluated. Radiographs were quantified using conventional paper-based Larsen score and the X-Ray RheumaCoach software. The use of the software shortened the scoring time by about 25 percent and reduced the rate of erroneous scorings in all our studies. Compared to paper-based scoring methods, the X-Ray RheumaCoach software offers several advantages: (i) Structured data analysis and input that minimizes variance by standardization, (ii) faster and more precise calculation of sum scores and indices, (iii) permanent data storing and fast access to the software"s database, (iv) the possibility of cross-calculation to other scores, (v) semi-automatic assessment of images, and (vii) reliable documentation of results in the form of graphical printouts.

Prediction of significant conduction disease through noninvasive assessment of cardiac calcification.

PubMed

Mainigi, Sumeet K; Chebrolu, Lakshmi Hima Bindu; Romero-Corral, Abel; Mehta, Vinay; Machado, Rodolfo Rozindo; Konecny, Tomas; Pressman, Gregg S

2012-10-01

Cardiac calcification is associated with coronary artery disease, arrhythmias, conduction disease, and adverse cardiac events. Recently, we have described an echocardiographic-based global cardiac calcification scoring system. The objective of this study was to evaluate the severity of cardiac calcification in patients with permanent pacemakers as based on this scoring system. Patients with a pacemaker implanted within the 2-year study period with a previous echocardiogram were identified and underwent blinded global cardiac calcium scoring. These patients were compared to matched control patients without a pacemaker who also underwent calcium scoring. The study group consisted of 49 patients with pacemaker implantation who were compared to 100 matched control patients. The mean calcium score in the pacemaker group was 3.3 ± 2.9 versus 1.8 ± 2.0 (P = 0.006) in the control group. Univariate and multivariate analysis revealed glomerular filtration rate and calcium scoring to be significant predictors of the presence of a pacemaker. Echocardiographic-based calcium scoring correlates with the presence of severe conduction disease requiring a pacemaker. © 2012, Wiley Periodicals, Inc.

Prognostic scores in oesophageal or gastric variceal bleeding.

PubMed

Ohmann, C; Stöltzing, H; Wins, L; Busch, E; Thon, K

1990-05-01

Numerous scoring systems have been developed for the prediction of outcome of variceal bleeding; however, only a few have been evaluated adequately. The object of this study was to improve the classical Child-Pugh score (CPS) and to test other scores from the literature. Patients (n = 82) with endoscopically confirmed variceal bleeding and long-term sclerotherapy were included in the study. Linear logistic regression (LR) was applied to different sets of prognostic variables with regard to 30-day mortality. In addition, scores from the literature were evaluated on the data set. Performance was measured by the accuracy and receiver-operating characteristic curves. The application of LR to all five CPS variables (accuracy, 80%) was superior to the classical CPS (70%). LR with selection from the CPS variables or from other sets of variables resulted in no improvement. Compared with CPS only three scores from the literature, mainly based on subsets of the CPS variables, showed an improved accuracy. It is concluded that CPS is still a good scoring system; however, it can be improved by statistical analysis using the same variables.

Comparison of L-system applications towards plant modelling, music rendering and score generation using visual language programming

NASA Astrophysics Data System (ADS)

Lim, Chen Kim; Tan, Kian Lam; Yusran, Hazwanni; Suppramaniam, Vicknesh

2017-10-01

Visual language or visual representation has been used in the past few years in order to express the knowledge in graphic. One of the important graphical elements is fractal and L-Systems is a mathematic-based grammatical model for modelling cell development and plant topology. From the plant model, L-Systems can be interpreted as music sound and score. In this paper, LSound which is a Visual Language Programming (VLP) framework has been developed to model plant to music sound and generate music score and vice versa. The objectives of this research has three folds: (i) To expand the grammar dictionary of L-Systems music based on visual programming, (ii) To design and produce a user-friendly and icon based visual language framework typically for L-Systems musical score generation which helps the basic learners in musical field and (iii) To generate music score from plant models and vice versa using L-Systems method. This research undergoes a four phases methodology where the plant is first modelled, then the music is interpreted, followed by the output of music sound through MIDI and finally score is generated. LSound is technically compared to other existing applications in the aspects of the capability of modelling the plant, rendering the music and generating the sound. It has been found that LSound is a flexible framework in which the plant can be easily altered through arrow-based programming and the music score can be altered through the music symbols and notes. This work encourages non-experts to understand L-Systems and music hand-in-hand.

Comparative testing of reliability and audit utility of ordinal objective calculus complexity scores. Can we make an informed choice yet?

PubMed

Jaipuria, Jiten; Suryavanshi, Manav; Sen, Tridib K

2016-12-01

To assess the reliability of the Guy's Stone Score, the Seoul National University Renal Stone Complexity (S-ReSC) score and the S.T.O.N.E. scores in percutaneous nephrolithotomy (PCNL), and assess their utility in discriminating outcomes [stone free rate (SFR), complications, need for multiple PCNL sessions, and auxiliary procedures] valid across parameters of experience of surgeon, independence from surgical approach, and variations in institution-specific instrumentation. A prospectively maintained database of two tertiary institutions was analysed (606 cases). Institutes differed in instrumentation, while the overall surgical team comprised: two trainees (experience <100 cases), two junior consultants (experience 100-200 cases), and two senior surgeons (experience >1000 cases). Scores were assigned and re-assigned after 4 months by one trainee and an expert surgeon. Inter-rater and test-retest agreement were analysed by Cohen's κ and intraclass correlation coefficient. Multivariate logistic regression models were created adjusting outcomes for the institution, comorbidity, Amplatz size, access tract location, the number of punctures, the experience level of the surgeon, and individual scoring system, and receiver operating curves were analysed for comparison. Despite some areas of inconsistencies, individually all scores had excellent inter-rater and test-retest concordance. On multivariable analyses, while the experience of the surgeon and surgical approach characteristics (such as access tract location, Amplatz size, and number of punctures) remained independently associated with different outcomes in varying combinations, calculus complexity scores were found consistently to be independently associated with all outcomes. The S-ReSC score had a superior association with SFR, the need for multiple PCNL sessions, and auxiliary procedures. Individually all scoring systems performed well. On cross comparison, the S-ReSC score consistently emerged to be more superiorly associated with all outcomes, signifying the importance of the distributional complexity of the calculus (which also indirectly amalgamates the influence of stone number, size, and anatomical location) in discriminating outcomes. Our study proves the utility of scoring systems in prognosticating multiple outcomes and also clarifies important aspects of their practical application including future roles such as benchmarking, audit, training, and objective assessment of surgical technique modifications. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

Objective, Structured Proforma to Score the Merit of Scientific Presentations.

PubMed

Agarwal, Nayan; Thawani, Rajat; Gupta, Setu; Sharma, Arun; Dhaliwal, Upreet

2015-12-01

Around 100,000 medical conferences are organized all over the world and hence, they form an integral part of a medical professional's life. Oral presentations, especially award sessions, are judged by a panel of faculty judges who score individual presentations on various aspects including content, delivery and submission. Our objective was to compare the scores given by student-judges and faculty-judges for scientific presentations using the standardized score sheet. An objective, structured score-sheet was designed using existing literature. Five presentations, all made using PowerPoint, were judged using the structured score-sheet by seven student-judges and two-faculty judges. The mean score of all the score-sheets (n = 45) was 38.5 + 5.4 (out of a maximum score of 50). There was no statistical difference between mean scores assigned by students or faculty (p = 0.2). Thus, an objective, structured score sheet like ours, when used to judge scientific presentations, gave uniform results even when judges hailed from different levels of the medical hierarchy.

A scoring system for ascertainment of incident stroke; the Risk Index Score (RISc).

PubMed

Kass-Hout, T A; Moyé, L A; Smith, M A; Morgenstern, L B

2006-01-01

The main objective of this study was to develop and validate a computer-based statistical algorithm that could be translated into a simple scoring system in order to ascertain incident stroke cases using hospital admission medical records data. The Risk Index Score (RISc) algorithm was developed using data collected prospectively by the Brain Attack Surveillance in Corpus Christi (BASIC) project, 2000. The validity of RISc was evaluated by estimating the concordance of scoring system stroke ascertainment to stroke ascertainment by physician and/or abstractor review of hospital admission records. RISc was developed on 1718 randomly selected patients (training set) and then statistically validated on an independent sample of 858 patients (validation set). A multivariable logistic model was used to develop RISc and subsequently evaluated by goodness-of-fit and receiver operating characteristic (ROC) analyses. The higher the value of RISc, the higher the patient's risk of potential stroke. The study showed RISc was well calibrated and discriminated those who had potential stroke from those that did not on initial screening. In this study we developed and validated a rapid, easy, efficient, and accurate method to ascertain incident stroke cases from routine hospital admission records for epidemiologic investigations. Validation of this scoring system was achieved statistically; however, clinical validation in a community hospital setting is warranted.

DISCO: An object-oriented system for music composition and sound design

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

Kaper, H. G.; Tipei, S.; Wright, J. M.

2000-09-05

This paper describes an object-oriented approach to music composition and sound design. The approach unifies the processes of music making and instrument building by using similar logic, objects, and procedures. The composition modules use an abstract representation of musical data, which can be easily mapped onto different synthesis languages or a traditionally notated score. An abstract base class is used to derive classes on different time scales. Objects can be related to act across time scales, as well as across an entire piece, and relationships between similar objects can replicate traditional music operations or introduce new ones. The DISCO (Digitalmore » Instrument for Sonification and Composition) system is an open-ended work in progress.« less

The intra- and inter-assessor reliability of measurement of functional outcome by lameness scoring in horses.

PubMed

Fuller, Catherine J; Bladon, Bruce M; Driver, Adam J; Barr, Alistair R S

2006-03-01

The objective of this study was to assess the reliability of lameness scoring in horses. One veterinary surgeon examined nineteen lame horses on four occasions. Gait was recorded by camcorder, and scored from 0 to 10 ranging from sound to non-weight bearing lameness. A global score of overall change in lameness during the study was also determined for each horse. To measure intra-assessor reliability of the scoring systems, one veterinary surgeon scored videotapes of the horses' gaits on two occasions. To measure inter-assessor reliability, three veterinary surgeons viewed the videotapes, assigning individual lameness scores plus global scores to each horse. Reliability of individual lameness scoring was good intra-assessor, but only just within our acceptable limit inter-assessor. However, global scoring of change in lameness throughout the study was found to be reliable overall. Since clinician scoring is commonly used to assess lameness in horses, this is an important finding, fundamental to future clinical studies.

Reliability of a Retail Food Store Survey and Development of an Accompanying Retail Scoring System to Communicate Survey Findings and Identify Vendors for Healthful Food and Marketing Initiatives

ERIC Educational Resources Information Center

Ghirardelli, Alyssa; Quinn, Valerie; Sugerman, Sharon

2011-01-01

Objective: To develop a retail grocery instrument with weighted scoring to be used as an indicator of the food environment. Participants/Setting: Twenty six retail food stores in low-income areas in California. Intervention: Observational. Main Outcome Measure(s): Inter-rater reliability for grocery store survey instrument. Description of store…

Novel Method for Analyzing Locomotor Ability after Spinal Cord Injury in Rats: Technical Note

PubMed Central

Shinozaki, Munehisa; Yasuda, Akimasa; Nori, Satoshi; Saito, Nobuhito; Toyama, Yoshiaki; Okano, Hideyuki; Nakamura, Masaya

2013-01-01

In the research for the treatment of spinal cord injury (SCI), the evaluation of motor function in model rats must be as objective, noninvasive, and ethical as possible. The maximum speed and acceleration of a mouse measured using a SCANET system were previously reported to vary significantly according to severity of SCI. In the present study, the motor performance of SCI model rats was examined with SCANET and assessed for Basso-Beattie-Bresnahan (BBB) score to determine the usefulness of the SCANET system in evaluating functional recovery after SCI. Maximum speed and acceleration within the measurement period correlated significantly with BBB scores. Furthermore, among several phased kinematic factors used in BBB scores, the capability of “plantar stepping” was associated with a drastic increase in maximum speed and acceleration after SCI. Therefore, evaluation of maximum speed and acceleration using a SCANET system is a useful method for rat models of SCI and can complement open field scoring scales. PMID:24097095

Clock Drawing as a Screen for Impaired Driving in Aging and Dementia: Is It Worth the Time?

PubMed Central

Manning, Kevin J.; Davis, Jennifer D.; Papandonatos, George D.; Ott, Brian R.

2014-01-01

Clock drawing is recommended by medical and transportation authorities as a screening test for unsafe drivers. The objective of the present study was to assess the usefulness of different clock drawing systems as screening measures of driving performance in 122 healthy and cognitively impaired older drivers. Clock drawing was measured using four different scoring systems. Driving outcomes included global ratings of safety and the error rate on a standardized on-road test. Findings revealed that clock drawing was significantly correlated with the driving score on the road test for each of the scoring systems. However, receiver operator curve analyses showed limited clinical utility for clock drawing as a screening instrument for impaired on-road driving performance with the area under the curve ranging from 0.53 to 0.61. Results from this study indicate that clock drawing has limited utility as a solitary screening measure of on-road driving, even when considering a variety of scoring approaches. PMID:24296110

Clock drawing as a screen for impaired driving in aging and dementia: is it worth the time?

PubMed

Manning, Kevin J; Davis, Jennifer D; Papandonatos, George D; Ott, Brian R

2014-02-01

Clock drawing is recommended by medical and transportation authorities as a screening test for unsafe drivers. The objective of the present study was to assess the usefulness of different clock drawing systems as screening measures of driving performance in 122 healthy and cognitively impaired older drivers. Clock drawing was measured using four different scoring systems. Driving outcomes included global ratings of safety and the error rate on a standardized on-road test. Findings revealed that clock drawing was significantly correlated with the driving score on the road test for each of the scoring systems. However, receiver operator curve analyses showed limited clinical utility for clock drawing as a screening instrument for impaired on-road driving performance with the area under the curve ranging from 0.53 to 0.61. Results from this study indicate that clock drawing has limited utility as a solitary screening measure of on-road driving, even when considering a variety of scoring approaches.

Methods and consequences of including feed intake and efficiency in genetic selection for multiple-trait merit.

PubMed

Barwick, Stephen A; Henzell, Anthony L; Walmsley, Brad J; Johnston, David J; Banks, Robert G

2018-05-04

Methods are presented for including feed intake and efficiency in genetic selection for multiple-trait merit when commercial production is from any combination of pasture or concentrates. Consequences for the production system and for individual animals are illustrated with a beef cattle example. Residual feed intake at pasture (RFI-p), residual feed intake in the feedlot (RFI-f), and cow condition score are additional traits of the breeding objective. Feed requirement change is costed in the economic values of other objective traits. Selection responses are examined when feed costs are ignored, partially or fully included in the breeding objective, and when net feed intake (NFI) EBVs are added to the index. When all feed cost was included and NFI EBVs were in the index, selection (with selection intensity, i = 1) increased production system $ net return by 6.0%, $ per unit of product by 5.2%, $ per unit of feed by 6.6%, total product by 0.7% and product per unit of feed by 1.3%. There was little change in production system total feed. When feed cost was ignored, selection decreased production system $ net return, $ per unit of product, and $ per unit of feed. At the individual trait level, when feed was fully included there were increases in weaning weight-direct (0.8 kg), feedlot entry weight (1.4 kg), dressing % (0.04%), carcass meat % (0.36%), carcase fat depth (0.12 mm), carcass marbling score (0.02 score), cow condition score (0.01 score), calving ease-direct (0.97%), calving ease-maternal (0.22%) and cow weaning rate (1.3%), and decreases in weaning weight-maternal (-0.9 kg), RFI-p (-0.09 kg DM/d), RFI-f (-0.11 kg DM/d), sale weight (-1.6 kg) and cow weight (-8.7 kg). Gains were evident over a range of feed price. Selection for $ net return also increased $ net return per unit of feed, suggesting that $ net return per unit area would increase in grazing industries. Feed cost for trait change was the source of a major genotype × environment interaction affecting animal rankings. Where industry production environments vary, and feed cost for trait change varies with the environment, we recommend that industry indexes be derived for more than one level of feed cost. Cow condition score did not decline while biological and economic efficiency of the production system and individual animal were improving, suggesting that efficiency can be improved under multiple-trait selection without compromising breeding cow welfare.

An illustrative overview of semi-quantitative MRI scoring of knee osteoarthritis: Lessons learned from longitudinal observational studies

PubMed Central

Roemer, Frank W.; Hunter, David J.; Crema, Michel D.; Kwoh, C. Kent; Ochoa-Albiztegui, Elena; Guermazi, Ali

2015-01-01

Objective To introduce the most popular magnetic resonance imaging (MRI) osteoarthritis (OA) semi-quantitative (SQ) scoring systems to a broader audience with a focus on the most commonly applied scores, i.e. the MOAKS and WORMS system and illustrate similarities and differences. Design While the main structure and methodology of each scoring system are publicly available, the core of this overview will be an illustrative imaging atlas section including image examples from multiple osteoarthritis studies applying MRI in regard to different features assessed, show specific examples of different grades and point out pitfalls and specifics of SQ assessment including artifacts, blinding to time point of acquisition and within-grade evaluation. Results Similarities and differences between different scoring systems are presented. Technical considerations are followed by a brief description of the most commonly utilized SQ scoring systems including their responsiveness and reliability. The second part is comprised of the atlas section presenting illustrative image examples. Conclusions Evidence suggests that SQ assessment of OA by expert MRI readers is valid, reliable and responsive, which helps investigators to understand the natural history of this complex disease and to evaluate potential new drugs in OA clinical trials. Researchers have to be aware of the differences and specifics of the different systems to be able to engage in imaging assessment and interpretation of imaging-based data. SQ scoring has enabled us to explain associations of structural tissue damage with clinical manifestations of the disease and with morphological alterations thought to represent disease progression. PMID:26318656

Novel and Practical Scoring Systems for the Diagnosis of Thyroid Nodules

PubMed Central

Wei, Ying; Zhou, Xinrong; Liu, Siyue; Wang, Hong; Liu, Limin; Liu, Renze; Kang, Jinsong; Hong, Kai; Wang, Daowen; Yuan, Gang

2016-01-01

Objective The clinical management of patients with thyroid nodules that are biopsied by fine-needle aspiration cytology and yield indeterminate results remains unsettled. The BRAF V600E mutation has dubious diagnostic value due to its low sensitivity. Novel strategies are urgently needed to distinguish thyroid malignancies from thyroid nodules. Design This prospective study included 504 thyroid nodules diagnosed by ultrasonography from 468 patients, and fine-needle aspiration cytology was performed under ultrasound guidance. Cytology and molecular analysis, including BRAF V600E, RET/PTC1 and RET/PTC3, were conducted simultaneously. The cytology, ultrasonography results, and mutational status were gathered and analyzed together. Predictive scoring systems were designed using a combination of diagnostic parameters for ultrasonography, cytology and genetic analysis. The utility of the scoring systems was analyzed and compared to detection using the individual methods alone or combined. Result The sensitivity of scoring systema (ultrasonography, cytology, BRAF V600E, RET/PTC) was nearly identical to that of scoring systemb (ultrasonography, cytology, BRAF V600E); these were 91.0% and 90.2%, respectively. These sensitivities were significantly higher than those obtained using FNAC, genetic analysis and US alone or combined; their sensitivities were 63.9%, 70.7% and 87.2%, respectively. Scoring systemc (ultrasonography, cytology) was slightly inferior to the former two scoring systems but still had relatively high sensitivity and specificity (80.5% and 95.1%, respectively), which were significantly superior to those of single cytology, ultrasonography or genetic analysis. In nodules with uncertainty cytology, scoring systema, scoring systemb and scoring systemc could elevate the malignancy detection rates to 69.7%, 69.7% and 63.6%, respectively. Conclusion These three scoring systems were quick for clinicians to master and could provide quantified information to predict the probability of malignant nodules. Scoring systemb is recommended for improving the detection rate among nodules of uncertain cytology. PMID:27654865

A reliable and cost effective approach for radiographic monitoring in nutritional rickets.

PubMed

Chatterjee, D; Gupta, V; Sharma, V; Sinha, B; Samanta, S

2014-04-01

Radiological scoring is particularly useful in rickets, where pre-treatment radiographical findings can reflect the disease severity and can be used to monitor the improvement. However, there is only a single radiographic scoring system for rickets developed by Thacher and, to the best of our knowledge, no study has evaluated radiographic changes in rickets based on this scoring system apart from the one done by Thacher himself. The main objective of this study is to compare and analyse the pre-treatment and post-treatment radiographic parameters in nutritional rickets with the help of Thacher's scoring technique. 176 patients with nutritional rickets were given a single intramuscular injection of vitamin D (600 000 IU) along with oral calcium (50 mg kg(-1)) and vitamin D (400 IU per day) until radiological resolution and followed for 1 year. Pre- and post-treatment radiological parameters were compared and analysed statistically based on Thacher's scoring system. Radiological resolution was complete by 6 months. Time for radiological resolution and initial radiological score were linearly associated on regression analysis. The distal ulna was the last to heal in most cases except when the initial score was 10, when distal femur was the last to heal. Thacher's scoring system can effectively monitor nutritional rickets. The formula derived through linear regression has prognostic significance. The distal femur is a better indicator in radiologically severe rickets and when resolution is delayed. Thacher's scoring is very useful for monitoring of rickets. The formula derived through linear regression can predict the expected time for radiological resolution.

The BILAG-2004 index is sensitive to change for assessment of SLE disease activity

PubMed Central

Farewell, Vernon; Isenberg, David A.; Griffiths, Bridget; Teh, Lee-Suan; Bruce, Ian N.; Ahmad, Yasmeen; Rahman, Anisur; Prabu, Athiveeraramapandian; Akil, Mohammed; McHugh, Neil; Edwards, Christopher; D’Cruz, David; Khamashta, Munther A.; Maddison, Peter; Gordon, Caroline

2009-01-01

Objective. To determine if the BILAG-2004 index is sensitive to change for assessment of SLE disease activity. Methods. This was a prospective multi-centre longitudinal study of SLE patients. At every assessment, data were collected on disease activity (BILAG-2004 index) and treatment. Analyses were performed using overall BILAG-2004 index score (as determined by the highest score achieved by any of the individual systems) and all the systems scores. Sensitivity to change was assessed by determining the relationship between change in disease activity and change in therapy between two consecutive visits. Statistical analyses were performed using multinomial logistic regression. Results. There were 1761 assessments from 347 SLE patients that contributed 1414 observations for analysis. An increase in therapy between visits occurred in 22.7% observations, while 37.3% had a decrease in therapy and in 40.0% therapy was unchanged. Increase in overall BILAG-2004 index score was associated with increase in therapy and inversely associated with decrease in therapy. Decrease in overall BILAG-2004 index score was associated with decrease in therapy and was inversely associated with increase in therapy. Changes in overall BILAG-2004 index score were differentially related to change in therapy, with greater change in score having greater predictive power. Increase in the scores of most systems was independently associated with an increase in treatment and there was no significant association between decreases in the score of any system with an increase in therapy. Conclusions. The BILAG-2004 index is sensitive to change and is suitable for use in longitudinal studies of SLE. PMID:19395542

Practical use of a uterine score system for predicting effects on interval from calving to first insemination and non-return rate 56 in Danish dairy herds.

PubMed

Elkjær, Karina; Labouriau, Rodrigo; Ancker, Marie-Louise; Gustafsson, Hans; Callesen, Henrik

2013-12-01

A detailed study of 398,237 lactations of Danish Holstein dairy cows was undertaken. The objective was to investigate the information gained by evaluating vaginal discharge in cows from 5 to 19 days post-partum (p.p.) using an ordinal scale from 0 to 9. The study focused on the interval from calving to first insemination (CFI) and the non-return rate 56 days after first insemination (NR56), adjusted for the confounders milk production and body condition score (BCS). For the analyses, BCS was evaluated on the same day that the uterine score was made. Milk production was defined as test-day milk yield in the first month p.p. The study showed that the evaluation of vaginal discharge according to this score system permitted ranking of cows according to CFI and NR56, i.e. an increasing uterine score was associated with a significantly longer time from calving to first insemination and significantly reduced the probability of success of the first insemination. Reproductive success was already affected if the uterine score had reached 4 (i.e. before the discharge smelled abnormally). The negative effect on CFI and NR56 increased as the uterine score increased, which suggested that the uterine scoring system was a useful guide to dairy producers. Copyright © 2013 Elsevier Ltd. All rights reserved.

Two-view information fusion for improvement of computer-aided detection (CAD) of breast masses on mammograms

NASA Astrophysics Data System (ADS)

Wei, Jun; Sahiner, Berkman; Hadjiiski, Lubomir M.; Chan, Heang-Ping; Helvie, Mark A.; Roubidoux, Marilyn A.; Zhou, Chuan; Ge, Jun; Zhang, Yiheng

2006-03-01

We are developing a two-view information fusion method to improve the performance of our CAD system for mass detection. Mass candidates on each mammogram were first detected with our single-view CAD system. Potential object pairs on the two-view mammograms were then identified by using the distance between the object and the nipple. Morphological features, Hessian feature, correlation coefficients between the two paired objects and texture features were used as input to train a similarity classifier that estimated a similarity scores for each pair. Finally, a linear discriminant analysis (LDA) classifier was used to fuse the score from the single-view CAD system and the similarity score. A data set of 475 patients containing 972 mammograms with 475 biopsy-proven masses was used to train and test the CAD system. All cases contained the CC view and the MLO or LM view. We randomly divided the data set into two independent sets of 243 cases and 232 cases. The training and testing were performed using the 2-fold cross validation method. The detection performance of the CAD system was assessed by free response receiver operating characteristic (FROC) analysis. The average test FROC curve was obtained from averaging the FP rates at the same sensitivity along the two corresponding test FROC curves from the 2-fold cross validation. At the case-based sensitivities of 90%, 85% and 80% on the test set, the single-view CAD system achieved an FP rate of 2.0, 1.5, and 1.2 FPs/image, respectively. With the two-view fusion system, the FP rates were reduced to 1.7, 1.3, and 1.0 FPs/image, respectively, at the corresponding sensitivities. The improvement was found to be statistically significant (p<0.05) by the AFROC method. Our results indicate that the two-view fusion scheme can improve the performance of mass detection on mammograms.

Reliability of patient specific instrumentation in total knee arthroplasty.

PubMed

Jennart, Harold; Ngo Yamben, Marie-Ange; Kyriakidis, Theofylaktos; Zorman, David

2015-12-01

The aim of this study was to compare the precision between Patient Specific Instrumentation (PSI) and Conventional Instrumentation (CI) as determined intra-operatively by a pinless navigation system. Eighty patients were included in this prospective comparative study and they were divided into two homogeneous groups. We defined an original score from 6 to 30 points to evaluate the accuracy of the position of the cutting guides. This score is based on 6 objective criteria. The analysis indicated that PSI was not superior to conventional instrumentation in the overall score (p = 0.949). Moreover, no statistically significant difference was observed for any individual criteria of our score. Level of evidence II.

Construct and face validity of the American College of Surgeons/Association of Program Directors in Surgery laparoscopic troubleshooting team training exercise.

PubMed

Arain, Nabeel A; Hogg, Deborah C; Gala, Rajiv B; Bhoja, Ravi; Tesfay, Seifu T; Webb, Erin M; Scott, Daniel J

2012-01-01

Our aim was to develop an objective scoring system and evaluate construct and face validity for a laparoscopic troubleshooting team training exercise. Surgery and gynecology novices (n = 14) and experts (n = 10) participated. Assessments included the following: time-out, scenario decision making (SDM) score (based on essential treatments rendered and completion time), operating room communication assessment (investigator developed), line operations safety audits (teamwork), and National Aeronautics and Space Administration-Task Load Index (workload). Significant differences were detected for SDM scores for scenarios 1 (192 vs 278; P = .01) and 3 (129 vs 225; P = .004), operating room communication assessment (67 vs 91; P = .002), and line operations safety audits (58 vs 87; P = .001), but not for time-out (46 vs 51) or scenario 2 SDM score (301 vs 322). Workload was similar for both groups and face validity (8.8 on a 10-point scale) was strongly supported. Objective decision-making scoring for 2 of 3 scenarios and communication and teamwork ratings showed construct validity. Face validity and participant feedback were excellent. Copyright © 2012 Elsevier Inc. All rights reserved.

A preliminary investigation of the relationship between language and gross motor skills in preschool children.

PubMed

Merriman, W J; Barnett, B E

1995-12-01

This study was undertaken to explore the relationship between language skills and gross-motor skills of 28 preschool children from two private preschools in New York City. Pearson product-moment correlation coefficients were calculated for language (revised Preschool Language Scale) and gross motor (Test of Gross Motor Development) scores. Locomotor skills were significantly related to both auditory comprehension and verbal ability while object control scores did not correlate significantly with either language score. These results were discussed in terms of previous research and with reference to dynamical systems theory. Suggestions for research were made.

REANALYZING THE MODIFIED FERRIMAN-GALLWEY SCORE: IS THERE A SIMPLER METHOD FOR ASSESSING THE EXTENT OF HIRSUTISM?

PubMed Central

Cook, Heather; Brennan, Kathleen; Azziz, Ricardo

2011-01-01

Objective To determine whether assessing the extent of terminal hair growth in a subset of the traditional 9 areas included in the modified Ferriman-Gallwey (mFG) score can serve as a simpler predictor of total body hirsutism when compared to the full scoring system, and to determine if this new model can accurately distinguish hirsute from non-hirsute women. Design Cross-sectional analysis Setting Two tertiary care academic referral centers. Patients 1951 patients presenting for symptoms of androgen excess. Interventions History and physical examination, including mFG score. Main Outcome Measures Total body hirsutism. Results A regression model using all nine body areas indicated that the combination of upper abdomen, lower abdomen and chin was the best predictor of the total full mFG score. Using this subset of three body areas is accurate in distinguishing true hirsute from non-hirsute women when defining true hirsutism as mFG>7. Conclusion Scoring terminal hair growth only on the chin and abdomen can serve as a simple, yet reliable predictor of total body hirsutism when compared to full body scoring using the traditional mFG system. PMID:21924716

Effect of a Publicly Accessible Disclosure System on Food Safety Inspection Scores in Retail and Food Service Establishments.

PubMed

Choi, Jihee; Scharff, Robert L

2017-07-01

The increased frequency with which people are dining out coupled with an increase in the publicity of foodborne disease outbreaks has led the public to an increased awareness of food safety issues associated with food service establishments. To accommodate consumer needs, local health departments have increasingly publicized food establishments' health inspection scores. The objective of this study was to estimate the effect of the color-coded inspection score disclosure system in place since 2006 in Columbus, OH, by controlling for several confounding factors. This study incorporated cross-sectional time series data from food safety inspections performed from the Columbus Public Health Department. An ordinary least squares regression was used to assess the effect of the new inspection regime. The introduction of the new color-coded food safety inspection disclosure system increased inspection scores for all types of establishments and for most types of inspections, although significant differences were found in the degree of improvement. Overall, scores increased significantly by 1.14 points (of 100 possible). An exception to the positive results was found for inspections in response to foodborne disease complaints. Scores for these inspections declined significantly by 10.2 points. These results should be useful for both food safety researchers and public health decision makers.

The effect of obesity on the rate of heparin-induced thrombocytopenia.

PubMed

Marler, Jacob L; Jones, G Morgan; Wheeler, Brian J; Alshaya, Abdulrahman; Hartmann, Jonathan L; Oliphant, Carrie S

2018-06-01

: Heparin-induced thrombocytopenia (HIT) occurs in patients receiving heparin-containing products due to the formation of platelet-activating antibodies to heparin and platelet factor 4. Diagnosis includes utilization of a scoring system known as the 4-T score, and HIT laboratory assays. Recently, obesity was identified as a potential factor associated with the development of HIT. The objective of this study was to evaluate the association of HIT with obesity in ICU and general medicine patients. We performed a chart review of adult patients within the Methodist Healthcare System, and included patients who had an ELISA and serotonin release assay laboratory tests reported within same hospital admission in which they also had documented receipt of heparin. Obese patients were compared with nonobese patients (BMI < 30) for the primary outcome of HIT occurrence, and secondary outcomes including rate of thrombosis, 4-T scores, and ELISA optical density values. We also generated a 5-T score by including one additional point for those with a BMI of 30 or more to determine the predictive value of this score in identifying HIT. Obesity was confirmed to be a risk factor for HIT, and the 5-T score model was also predictive of the development of HIT. However, the 5-T score was not statistically more predictive of HIT than the 4-T score. Predicting HIT remains challenging and novel markers of HIT are needed to improve HIT recognition. Although obesity did not improve the 4-T score, it may improve the predictability of other scoring systems, and further investigation is warranted.

The evaluation of acute physiology and chronic health evaluation II score, poisoning severity score, sequential organ failure assessment score combine with lactate to assess the prognosis of the patients with acute organophosphate pesticide poisoning.

PubMed

Yuan, Shaoxin; Gao, Yusong; Ji, Wenqing; Song, Junshuai; Mei, Xue

2018-05-01

The aim of this study was to assess the ability of acute physiology and chronic health evaluation II (APACHE II) score, poisoning severity score (PSS) as well as sequential organ failure assessment (SOFA) score combining with lactate (Lac) to predict mortality in the Emergency Department (ED) patients who were poisoned with organophosphate.A retrospective review of 59 stands-compliant patients was carried out. Receiver operating characteristic (ROC) curves were constructed based on the APACHE II score, PSS, SOFA score with or without Lac, respectively, and the areas under the ROC curve (AUCs) were determined to assess predictive value. According to SOFA-Lac (a combination of SOFA and Lac) classification standard, acute organophosphate pesticide poisoning (AOPP) patients were divided into low-risk and high-risk groups. Then mortality rates were compared between risk levels.Between survivors and non-survivors, there were significant differences in the APACHE II score, PSS, SOFA score, and Lac (all P < .05). The AUCs of the APACHE II score, PSS, and SOFA score were 0.876, 0.811, and 0.837, respectively. However, after combining with Lac, the AUCs were 0.922, 0.878, and 0.956, respectively. According to SOFA-Lac, the mortality of high-risk group was significantly higher than low-risk group (P < .05) and the patients of the non-survival group were all at high risk.These data suggest the APACHE II score, PSS, SOFA score can all predict the prognosis of AOPP patients. For its simplicity and objectivity, the SOFA score is a superior predictor. Lac significantly improved the predictive abilities of the 3 scoring systems, especially for the SOFA score. The SOFA-Lac system effectively distinguished the high-risk group from the low-risk group. Therefore, the SOFA-Lac system is significantly better at predicting mortality in AOPP patients.

Development of a Comprehensive Osteochondral Allograft MRI Scoring System (OCAMRISS) With Histopathologic, Micro–Computed Tomography, and Biomechanical Validation

PubMed Central

Pallante-Kichura, Andrea L.; Bae, Won C.; Du, Jiang; Statum, Sheronda; Wolfson, Tanya; Gamst, Anthony C.; Cory, Esther; Amiel, David; Bugbee, William D.; Sah, Robert L.; Chung, Christine B.

2014-01-01

Objective: To describe and apply a semiquantitative MRI scoring system for multifeature analysis of cartilage defect repair in the knee by osteochondral allografts and to correlate this scoring system with histopathologic, micro–computed tomography (µCT), and biomechanical reference standards using a goat repair model. Design: Fourteen adult goats had 2 osteochondral allografts implanted into each knee: one in the medial femoral condyle and one in the lateral trochlea. At 12 months, goats were euthanized and MRI was performed. Two blinded radiologists independently rated 9 primary features for each graft, including cartilage signal, fill, edge integration, surface congruity, calcified cartilage integrity, subchondral bone plate congruity, subchondral bone marrow signal, osseous integration, and presence of cystic changes. Four ancillary features of the joint were also evaluated, including opposing cartilage, meniscal tears, synovitis, and fat-pad scarring. Comparison was made with histologic and µCT reference standards as well as biomechanical measures. Interobserver agreement and agreement with reference standards was assessed. Cohen’s κ, Spearman’s correlation, and Kruskal-Wallis tests were used as appropriate. Results: There was substantial agreement (κ > 0.6, P < 0.001) for each MRI feature and with comparison against reference standards, except for cartilage edge integration (κ = 0.6). There was a strong positive correlation between MRI and reference standard scores (ρ = 0.86, P < 0.01). Osteochondral allograft MRI scoring system was sensitive to differences in outcomes between the types of allografts. Conclusions: We have described a comprehensive MRI scoring system for osteochondral allografts and have validated this scoring system with histopathologic and µCT reference standards as well as biomechanical indentation testing. PMID:24489999

Evaluation of an inflammation-based prognostic score in patients with metastatic renal cancer.

PubMed

Ramsey, Sara; Lamb, Gavin W A; Aitchison, Michael; Graham, John; McMillan, Donald C

2007-01-15

Recently, it was shown that an inflammation-based prognostic score, the Glasgow Prognostic Score (GPS), provides additional prognostic information in patients with advanced cancer. The objective of the current study was to examine the value of the GPS compared with established scoring systems in predicting cancer-specific survival in patients with metastatic renal cancer. One hundred nineteen patients who underwent immunotherapy for metastatic renal cancer were recruited. The Memorial Sloan-Kettering Cancer Center (MSKCC) score and the Metastatic Renal Carcinoma Comprehensive Prognostic System (MRCCPS) score were calculated as described previously. Patients who had both an elevated C-reactive protein level (>10 mg/L) and hypoalbuminemia (<35 g/L) were allocated a GPS of 2. Patients who had only 1 of those 2 biochemical abnormalities were allocated a GPS of 1. Patients who had neither abnormality were allocated a GPS of 0. On multivariate analysis of significant individual factors, only calcium (hazard ratio [HR], 3.21; 95% confidence interval [95% CI], 1.51-6.83; P = .002), white cell count (HR, 1.66; 95% CI, 1.17-2.35; P = .004), albumin (HR, 2.63; 95% CI, 1.38-5.03; P = .003), and C-reactive protein (HR, 2.85; 95% CI; 1.49-5.45; P = .002) were associated independently with cancer-specific survival. On multivariate analysis of the different scoring systems, the MSKCC (HR, 1.88; 95% CI, 1.22-2.88; P = .004), the MRCCPS (HR, 1.42; 95% CI, 0.97-2.09; P = .071), and the GPS (HR, 2.35; 95% CI, 1.51-3.67; P < .001) were associated independently with cancer-specific survival. An inflammation-based prognostic score (GPS) predicted survival independent of established scoring systems in patients with metastatic renal cancer.

Sex Differences in Objective and Projective Dependency Tests: A Meta-Analytic Review.

ERIC Educational Resources Information Center

Bornstein, Robert F.

1995-01-01

A meta-analysis of 97 studies published since 1950 that assessed sex differences in scores on objective and projective dependency tests indicated that women consistently obtained higher dependency scores on objective tests, and men obtained higher scores on projective tests. Findings are discussed in terms of sex role socialization. (SLD)

Developing Canadian oncology education goals and objectives for medical students: a national modified Delphi study.

PubMed

Tam, Vincent C; Ingledew, Paris-Ann; Berry, Scott; Verma, Sunil; Giuliani, Meredith E

2016-01-01

Studies have shown that there is a deficiency in focused oncology teaching during medical school in Canada. This study aimed to develop oncology education goals and objectives for medical students through consensus of oncology educators from across Canada. In 2014 we created a comprehensive list of oncology education objectives using existing resources. Experts in oncology education and undergraduate medical education from all 17 Canadian medical schools were invited to participate in a 3-round modified Delphi process. In round 1, the participants scored the objectives on a 9-point Likert scale according to the degree to which they agreed an objective should be taught to medical students. Objectives with a mean score of 7.0 or greater were retained, those with a mean score of 1.0-3.9 were excluded, and those with a mean score of 4.0-6.9 were discussed at a round 2 Web meeting. In round 3, the participants voted on inclusion and exclusion of the round 2 objectives. Thirty-four (92%) of the 37 invited oncology educators, representing 14 medical schools, participated in the study. They included oncologists, family physicians, members of undergraduate medical education curriculum committees and a psychologist. Of the 214 objectives reviewed in round 1, 146 received a mean score of 7.0 or greater, and 68 were scored 4.0-6.9; no objective received a mean score below 4.0. Nine new objectives were suggested. The main themes of participants' comments were to minimize the number of objectives and to aim objectives at the knowledge level required for family physicians. In round 2, the participants were able to combine 28 of the objectives with other existing objectives. In round 3, 7 of the 49 objectives received consensus of at least 75% for inclusion. The final Canadian Oncology Goals and Objectives for Medical Students contained 10 goals and 153 objectives. Through a systematic process, we created a comprehensive, consensus-based set of oncology goals and objectives to facilitate the design of undergraduate medical education curricula and improve oncology education for medical students.

Semiquantitative Evaluation of Extrasynovial Soft Tissue Inflammation in the Shoulders of Patients with Polymyalgia Rheumatica and Elderly-Onset Rheumatoid Arthritis by Power Doppler Ultrasound.

PubMed

Suzuki, Takeshi; Yoshida, Ryochi; Okamoto, Akiko; Seri, Yu

2017-01-01

Objectives . To develop a scoring system for evaluating the extrasynovial soft tissue inflammation of the shoulders in patients with polymyalgia rheumatica (PMR) and elderly-onset rheumatoid arthritis with PMR-like onset (pm-EORA) using ultrasound. Methods . We analyzed stored power Doppler (PD) images obtained by the pretreatment examination of 15 PMR patients and 15 pm-EORA patients. A semiquantitative scoring system for evaluating the severity of PD signals adjacent to the anterior aspect of the subscapularis tendon was designed. Results . A four-point scale scoring for the hyperemia on the subscapularis tendon was proposed as follows in brief: 0 = absent or minimal flow, 1 = single vessel dots or short linear-shape signals, 2 = long linear-shape signals or short zone-shape signals, or 3 = long zone-shape signals. This scoring system showed good intra- and interobserver reliability and good correlation to quantitative pixel-counting evaluation. By using it, we demonstrated that inflammation in PMR is dominantly localized in extrasynovial soft tissue as compared with pm-EORA. Conclusions . We proposed a reliable semiquantitative scoring system using ultrasound for the evaluation of extrasynovial soft tissue inflammation of the shoulders in patients with both PMR and pm-EORA. This system is simple to use and can be utilized in future investigations.

Clinical assessment scoring system for tracheostomy (CASST) criterion: Objective criteria to predict pre-operatively the need for a tracheostomy in head and neck malignancies.

PubMed

Gupta, Karan; Mandlik, Dushyant; Patel, Daxesh; Patel, Purvi; Shah, Bankim; Vijay, Devanhalli G; Kothari, Jagdish M; Toprani, Rajendra B; Patel, Kaustubh D

2016-09-01

Tracheostomy is a mainstay modality for airway management for patients with head-neck cancer undergoing surgery. This study aims to define factors predicting need of tracheostomy and define an effective objective criterion to predict tracheostomy need. 486 patients undergoing composite resections were studied. Factors analyzed were age, previous surgery, extent of surgery, trismus, extent of mandibular resection and reconstruction etc. Factors were divided into major and minor, using the clinical assessment scoring system for tracheostomy (CASST) criterion. Sixty seven (13.7%) patients required tracheostomy for their peri-operative management. Elective tracheostomies were done in 53 cases during surgery and post-operatively in 14 patients. All patients in whom tracheostomies were anticipated had a score of seven or more. A decision on whether or not an elective tracheotomy in head and neck surgery is necessary and can be facilitated using CASST criterion, which has a sensitivity of 95.5% and a negative predictive value (NPV) of 99.3%. It may reduce post-operative complications and contribute to safer treatment. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

A Comparison of Robotically Assisted Microsurgery versus Manual Microsurgery in Challenging Situations.

PubMed

Willems, Joost I P; Shin, Alexandra M; Shin, Delaney M; Bishop, Allen T; Shin, Alexander Y

2016-04-01

Microsurgery can be challenging secondary to orientation of the vessels, accessibility, or depth of the wound. Robotically assisted microsurgery reduces tremors and improves visualization and may improve the quality of anastomosis compared with traditional microsurgery. The purpose of this study was to compare robotically assisted microsurgery to traditional microsurgery in technically challenging situations with respect to time of anastomosis, quality of anastomosis, and Objective Structured Assessment of Technical Skills. Two investigators with no prior surgery or microsurgery experience performed 160 anastomoses on artificial microvessels after undergoing standardized traditional and robotically assisted microsurgery courses. Five different exposure groups were created with depths of 0, 10, and 20 cm and sidewall angles of 20 and 30 degrees. A comparison of 80 manual with 80 robotically assisted microsurgery anastomoses in different exposure groups was undertaken. The modified Objective Structured Assessment of Technical Skills scoring system, duration per anastomosis, and a subjective comfort scale were evaluated. In the most difficult exposure, Objective Structured Assessment of Technical Skills scores were similar in both groups (p = 0.98), the duration was higher in the manual group (p = 0.004), and the subjective comfort rating was higher in the robotically assisted microsurgery group (p < 0.001). In the easiest (0-cm depth, flat) exposure, Objective Structured Assessment of Technical Skills scores were higher in the manual group (p = 0.018) and the duration was longer in the robotically assisted microsurgery group (p = 0.008). Manual surgery was superior to robotically assisted microsurgery in technically easy exposures. In difficult exposures (greater depth and lower sidewall angles), however, robotically assisted microsurgery had a shorter surgery time and a higher comfort rating, with Objective Structured Assessment of Technical Skills scores similar to those assessing traditional microsurgery. Therapeutic, V.

A system to measure the data quality of spectral remote-sensing reflectance of aquatic environments

NASA Astrophysics Data System (ADS)

Wei, Jianwei; Lee, Zhongping; Shang, Shaoling

2016-11-01

Spectral remote-sensing reflectance (Rrs, sr-1) is the key for ocean color retrieval of water bio-optical properties. Since Rrs from in situ and satellite systems are subject to errors or artifacts, assessment of the quality of Rrs data is critical. From a large collection of high quality in situ hyperspectral Rrs data sets, we developed a novel quality assurance (QA) system that can be used to objectively evaluate the quality of an individual Rrs spectrum. This QA scheme consists of a unique Rrs spectral reference and a score metric. The reference system includes Rrs spectra of 23 optical water types ranging from purple blue to yellow waters, with an upper and a lower bound defined for each water type. The scoring system is to compare any target Rrs spectrum with the reference and a score between 0 and 1 will be assigned to the target spectrum, with 1 for perfect Rrs spectrum and 0 for unusable Rrs spectrum. The effectiveness of this QA system is evaluated with both synthetic and in situ Rrs spectra and it is found to be robust. Further testing is performed with the NOMAD data set as well as with satellite Rrs over coastal and oceanic waters, where questionable or likely erroneous Rrs spectra are shown to be well identifiable with this QA system. Our results suggest that applications of this QA system to in situ data sets can improve the development and validation of bio-optical algorithms and its application to ocean color satellite data can improve the short-term and long-term products by objectively excluding questionable Rrs data.

French adaptation of the new Knee Society Scoring System for total knee arthroplasty.

PubMed

Debette, C; Parratte, S; Maucort-Boulch, D; Blanc, G; Pauly, V; Lustig, S; Servien, E; Neyret, P; Argenson, J N

2014-09-01

In November 2011, the Knee Society published its new KSS score to evaluate objective clinical data and also patient expectations, satisfaction and knee function during various physical activities before and after total knee arthroplasty (TKA). We undertook the French cross-cultural adaptation of this scoring system according to current recommendations. The French version of the new KSS score is a consistent, feasible, reliable and discriminating score. Eighty patients with knee osteoarthritis were recruited from two centers: one group of 40 patients had a TKA indication, while the other group of 40 patients had an indication for conservative treatment. After the new KSS score was translated and back-translated, it was compared to three other validated instruments (KOOS, AMIQUAL and SF-12) to determine construct validity, discriminating power, feasibility in terms of response rate and existence of floor or ceiling effect, internal consistency with Chronbach's alpha and reliability based on reproducibility and sensitivity to change (responsiveness). Due to missing data, two cases were eliminated. We found that the score could discriminate between groups; it had a nearly 100% response rate, a ceiling effect in the "expectations" domain, satisfactory Chronbach's alpha, excellent reproducibility and good responsiveness. These results confirm that the French version of the new KSS score is reliable, feasible, discriminating, consistent and responsive. The novelty of this scoring system resides in the "expectations" and "satisfaction" domains, its availability as a self-assessment questionnaire and the evaluation of function during various activities. Level III. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Student assessment by objective structured examination in a neurology clerkship

PubMed Central

Adesoye, Taiwo; Smith, Sandy; Blood, Angela; Brorson, James R.

2012-01-01

Objectives: We evaluated the reliability and predictive ability of an objective structured clinical examination (OSCE) in the assessment of medical students at the completion of a neurology clerkship. Methods: We analyzed data from 195 third-year medical students who took the OSCE. For each student, the OSCE consisted of 2 standardized patient encounters. The scores obtained from each encounter were compared. Faculty clinical evaluations of each student for 2 clinical inpatient rotations were also compared. Hierarchical regression analysis was applied to test the ability of the averaged OSCE scores to predict standardized written examination scores and composite clinical scores. Results: Students' OSCE scores from the 2 standardized patient encounters were significantly correlated with each other (r = 0.347, p < 0.001), and the scores for all students were normally distributed. In contrast, students' faculty clinical evaluation scores from 2 different clinical inpatient rotations were uncorrelated, and scores were skewed toward the highest ratings. After accounting for clerkship order, better OSCE scores were predictive of better National Board of Medical Examiners standardized examination scores (R2Δ = 0.131, p < 0.001) and of better faculty clinical scores (R2Δ = 0.078, p < 0.001). Conclusions: Student assessment by an OSCE provides a reliable and predictive objective assessment of clinical performance in a neurology clerkship. PMID:22855865

Multiattribute health utility scoring for the computerized adaptive measure CAT-5D-QOL was developed and validated.

PubMed

Kopec, Jacek A; Sayre, Eric C; Rogers, Pamela; Davis, Aileen M; Badley, Elizabeth M; Anis, Aslam H; Abrahamowicz, Michal; Russell, Lara; Rahman, Md Mushfiqur; Esdaile, John M

2015-10-01

The CAT-5D-QOL is a previously reported item response theory (IRT)-based computerized adaptive tool to measure five domains (attributes) of health-related quality of life. The objective of this study was to develop and validate a multiattribute health utility (MAHU) scoring method for this instrument. The MAHU scoring system was developed in two stages. In phase I, we obtained standard gamble (SG) utilities for 75 hypothetical health states in which only one domain varied (15 states per domain). In phase II, we obtained SG utilities for 256 multiattribute states. We fit a multiplicative regression model to predict SG utilities from the five IRT domain scores. The prediction model was constrained using data from phase I. We validated MAHU scores by comparing them with the Health Utilities Index Mark 3 (HUI3) and directly measured utilities and by assessing between-group discrimination. MAHU scores have a theoretical range from -0.842 to 1. In the validation study, the scores were, on average, higher than HUI3 utilities and lower than directly measured SG utilities. MAHU scores correlated strongly with the HUI3 (Spearman ρ = 0.78) and discriminated well between groups expected to differ in health status. Results reported here provide initial evidence supporting the validity of the MAHU scoring system for the CAT-5D-QOL. Copyright © 2015 Elsevier Inc. All rights reserved.

Prediction of Waitlist Mortality in Adult Heart Transplant Candidates: The Candidate Risk Score.

PubMed

Jasseron, Carine; Legeai, Camille; Jacquelinet, Christian; Leprince, Pascal; Cantrelle, Christelle; Audry, Benoît; Porcher, Raphael; Bastien, Olivier; Dorent, Richard

2017-09-01

The cardiac allocation system in France is currently based on urgency and geography. Medical urgency is defined by therapies without considering objective patient mortality risk factors. This study aimed to develop a waitlist mortality risk score from commonly available candidate variables. The study included all patients, aged 16 years or older, registered on the national registry CRISTAL for first single-organ heart transplantation between January 2010 and December 2014. This population was randomly divided in a 2:1 ratio into derivation and validation cohorts. The association of variables at listing with 1-year waitlist death or delisting for worsening medical condition was assessed within the derivation cohort. The predictors were used to generate a candidate risk score (CRS). Validation of the CRS was performed in the validation cohort. Concordance probability estimation (CPE) was used to evaluate the discriminative capacity of the models. During the study period, 2333 patients were newly listed. The derivation (n =1 555) and the validation cohorts (n = 778) were similar. Short-term mechanical circulatory support, natriuretic peptide decile, glomerular filtration rate, and total bilirubin level were included in a simplified model and incorporated into the score. The Concordance probability estimation of the CRS was 0.73 in the derivation cohort and 0.71 in the validation cohort. The correlation between observed and expected 1-year waitlist mortality in the validation cohort was 0.87. The candidate risk score provides an accurate objective prediction of waitlist mortality. It is currently being used to develop a modified cardiac allocation system in France.

Hypoxia-induced changes in standing balance.

PubMed

Wagner, Linsey S; Oakley, Sarah R; Vang, Pao; Noble, Brie N; Cevette, Michael J; Stepanek, Jan P

2011-05-01

A few studies in the literature have reported postural changes with hypoxia, but none have quantified the magnitude of change. Further understanding of this condition could have implications for patients at risk for falls, individuals undergoing acute altitude exposure, and pilots and commercial passengers. The objective of this study was to evaluate the effect of different levels of hypoxia (oxygen nitrogen mixtures) on postural standing balance using the computerized dynamic posturography (CDP) system. This improves upon previous protocols by manipulating vision and standing balance with a sway-referenced visual field and/or platform. Additionally, normative data were available for comparison with the cumulative test scores and scores for each condition. Altitude hypoxia was simulated by use of admixing nitrogen to the breathing gas to achieve equivalent altitudes of 1524 m, 2438 m, and 3048 m. Subjects were evaluated using the CDP system. Subjects showed an overall trend toward decreased performance at higher simulated altitudes consistent with the initial hypothesis. Composite standing balance sway scores for the sensory organization subtest of CDP were decreased compared to baseline for simulated altitudes as low as 2438 m (mean sway scores: 81.92 at baseline; 81.85 at 1524 m; 79.15 at 2438 m; 79.15 at 3048 m). Reaction times to unexpected movements in the support surface for the motor control subtest (MCT) increased compared to baseline (mean composite scores: 133.3 at baseline; 135.9 ms at 1524 m; 138.0 ms at 2438 m; 140.9 ms at 3048 m). The CDP testing provided a reliable objective measurement of degradation of balance under hypoxic conditions.

Syntactic error modeling and scoring normalization in speech recognition

NASA Technical Reports Server (NTRS)

Olorenshaw, Lex

1991-01-01

The objective was to develop the speech recognition system to be able to detect speech which is pronounced incorrectly, given that the text of the spoken speech is known to the recognizer. Research was performed in the following areas: (1) syntactic error modeling; (2) score normalization; and (3) phoneme error modeling. The study into the types of errors that a reader makes will provide the basis for creating tests which will approximate the use of the system in the real world. NASA-Johnson will develop this technology into a 'Literacy Tutor' in order to bring innovative concepts to the task of teaching adults to read.

Age-adjusted Charlson comorbidity index score as predictor of survival of patients with digestive system cancer who have undergone surgical resection.

PubMed

Tian, Yaohua; Jian, Zhong; Xu, Beibei; Liu, Hui

2017-10-03

Comorbidities have considerable effects on survival outcomes. The primary objective of this retrospective study was to examine the association between age-adjusted Charlson comorbidity index (ACCI) score and postoperative in-hospital mortality in patients with digestive system cancer who have undergone surgical resection of their cancers. Using electronic hospitalization summary reports, we identified 315,464 patients who had undergone surgery for digestive system cancer in top-rank (Grade 3A) hospitals in China between 2013 and 2015. The Cox proportional hazard regression model was applied to evaluate the effect of ACCI score on postoperative mortality, with adjustments for sex, type of resection, anesthesia methods, and caseload of each healthcare institution. The postoperative in-hospital mortality rate in the study cohort was 1.2% (3,631/315,464). ACCI score had a positive graded association with the risk of postoperative in-hospital mortality for all cancer subtypes. The adjusted HRs for postoperative in-hospital mortality scores ≥ 6 for esophagus, stomach, colorectum, pancreas, and liver and gallbladder cancer were 2.05 (95% CI: 1.45-2.92), 2.00 (95% CI: 1.60-2.49), 2.54 (95% CI: 2.02-3.21), 2.58 (95% CI: 1.68-3.97), and 4.57 (95% CI: 3.37-6.20), respectively, compared to scores of 0-1. These findings suggested that a high ACCI score is an independent predictor of postoperative in-hospital mortality in Chinese patients with digestive system cancer who have undergone surgical resection.

Identification and Evaluation of Medical Translator Mobile Applications Using an Adapted APPLICATIONS Scoring System.

PubMed

Khander, Amrin; Farag, Sara; Chen, Katherine T

2017-12-22

With an increasing number of patients requiring translator services, many providers are turning to mobile applications (apps) for assistance. However, there have been no published reviews of medical translator apps. To identify and evaluate medical translator mobile apps using an adapted APPLICATIONS scoring system. A list of apps was identified from the Apple iTunes and Google Play stores, using the search term, "medical translator." Apps not found on two different searches, not in an English-based platform, not used for translation, or not functional after purchase, were excluded. The remaining apps were evaluated using an adapted APPLICATIONS scoring system, which included both objective and subjective criteria. App comprehensiveness was a weighted score defined by the number of non-English languages included in each app relative to the proportion of non-English speakers in the United States. The Apple iTunes and Google Play stores. Medical translator apps identified using the search term "medical translator." Main Outcomes and Measures: Compilation of medical translator apps for provider usage. A total of 524 apps were initially found. After applying the exclusion criteria, 20 (8.2%) apps from the Google Play store and 26 (9.2%) apps from the Apple iTunes store remained for evaluation. The highest scoring apps, Canopy Medical Translator, Universal Doctor Speaker, and Vocre Translate, scored 13.5 out of 18.7 possible points. A large proportion of apps initially found did not function as medical translator apps. Using the APPLICATIONS scoring system, we have identified and evaluated medical translator apps for providers who care for non-English speaking patients.

Risk Factors for Venous Thromboembolism in Pediatric Trauma Patients and Validation of a Novel Scoring System: The Risk of Clots in Kids with Trauma (ROCKIT score)

PubMed Central

Yen, Jennifer; Van Arendonk, Kyle J.; Streiff, Michael B.; McNamara, LeAnn; Stewart, F. Dylan; Conner G, Kim G; Thompson, Richard E.; Haut, Elliott R.; Takemoto, Clifford M.

2017-01-01

OBJECTIVES Identify risk factors for venous thromboembolism (VTE) and develop a VTE risk assessment model for pediatric trauma patients. DESIGN, SETTING, AND PATIENTS We performed a retrospective review of patients 21 years and younger who were hospitalized following traumatic injuries at the John Hopkins level 1 adult and pediatric trauma center (1987-2011). The clinical characteristics of patients with and without VTE were compared, and multivariable logistic regression analysis was used to identify independent risk factors for VTE. Weighted risk assessment scoring systems were developed based on these and previously identified factors from patients in the National Trauma Data Bank (NTDB 2008-2010); the scoring systems were validated in this cohort from Johns Hopkins as well as a cohort of pediatric admissions from the NTDB (2011-2012). MAIN RESULTS Forty-nine of 17,366 pediatric trauma patients (0.28%) were diagnosed with VTE after admission to our trauma center. After adjusting for potential confounders, VTE was independently associated with older age, surgery, blood transfusion, higher Injury Severity Score (ISS), and lower Glasgow Coma Scale (GCS) score. These and additional factors were identified in 402,329 pediatric patients from the NTDB from 2008-2010; independent risk factors from the logistic regression analysis of this NTDB cohort were selected and incorporated into weighted risk assessment scoring systems. Two models were developed and were cross-validated in 2 separate pediatric trauma cohorts: 1) 282,535 patients in the NTDB from 2011 to 2012 2) 17,366 patients from Johns Hopkins. The receiver operator curve using these models in the validation cohorts had area under the curves that ranged 90% to 94%. CONCLUSIONS VTE is infrequent after trauma in pediatric patients. We developed weighted scoring systems to stratify pediatric trauma patients at risk for VTE. These systems may have potential to guide risk-appropriate VTE prophylaxis in children after trauma. PMID:26963757

The ANKLe Score: An Audit of Otolaryngology Emergency Clinic Record Keeping

PubMed Central

Dexter, Sara C; Hayashi, Daichi; Tysome, James R

2008-01-01

INTRODUCTION Accurate and legible medical records are essential to good quality patient care. Guidelines from The Royal College of Surgeons of England (RCSE) state the content required to form a complete medical record, but do not address legibility. An audit of otolaryngology emergency clinic record keeping was performed using a new scoring system. PATIENTS AND METHODS The Adjusted Note Keeping and Legibility (ANKLe) score was developed as an objective and quantitative method to assess both the content and legibility of case notes, incorporating the RCSE guidelines. Twenty consecutive otolaryngology emergency clinic case notes from each of 7 senior house officers were audited against standards for legibility and content using the ANKLe score. A proforma was introduced to improve documentation and handwriting advice was given. A further set of 140 notes (20 notes for each of the 7 doctors) was audited in the same way to provide feedback. RESULTS The introduction of a proforma and advice on handwriting significantly increased the quality of case note entries in terms of content, legibility and overall ANKLe score. CONCLUSIONS Accurate note keeping can be improved by the use of a proforma. The legibility of handwriting can be improved using simple advice. The ANKLe score is an objective assessment tool of the overall quality of medical note documentation which can be adapted for use in other specialties. PMID:18430339

Corneal staining patterns in vernal keratoconjunctivitis: the new VKC-CLEK scoring scale.

PubMed

Leonardi, Andrea; Lazzarini, Daniela; La Gloria Valerio, Alvise; Scalora, Tania; Fregona, Iva

2018-01-24

To propose a new scoring system in the assessment of ocular surface epithelial damage in vernal keratoconjunctivitis (VKC). 25 consecutive patients with VKC (50 eyes) were evaluated using the Quality of Life in children with VKC (QUICK) questionnaire and objective clinical measures: fluorescein and lissamine green staining and cornea confocal microscopy (Heidelberg Retina Tomography 3). Oxford, Van Bljsterweld and a new system, the VKC-Collaborative Longitudinal Evaluation of Keratoconus study (CLEK) (VKC-CLEK) scores, were used to evaluate the epithelial damage after staining. Mean Oxford and VKC-CLEK scores were significantly different after fluorescein staining (P<0.001), but significantly correlated (P<0.001; r=0.649). The same data were obtained comparing Van Bljsterweld and VKC-CLEK after lissamine green staining (P<0.001; r=0.760). In patient with limbal VKC, a statistically significant difference was found comparing new VKC-CLEK scores and Oxford or Van Bljsterweld scores (P<0.001), but not in tarsal VKC. A statistically superior concordance was found between QUICK and VKC-CLEK scores compared with standard staining scores values (P<0.001). Oxford and Van Bijsterveld scores are not adequate for the evaluation of the epithelial damage in patients with limbal VKC because the staining patterns considered for these tests do not correspond to the staining patterns in patients with VKC. We propose a new scoring system, VKC-CLEK, to better evaluate both limbal and tarsal epithelial damage in patients with VKC. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Mapping Direct Observations From Objective Structured Clinical Examinations to the Milestones Across Specialties.

PubMed

Baker-Genaw, Kimberly; Kokas, Maria S; Ahsan, Syed F; Darnley-Fisch, Deborah; Drake, Sean; Goyal, Nikhil; Inamdar, Kedar; Moutzouros, Vasilios; Prabhakar, Deepak; Rolland, Laurie; Sangha, Roopina; Shreve, Maria; Woodward, Ann

2016-07-01

Little is known about residents' performance on the milestones at the institutional level. Our institution formed a work group to explore this using an institutional-level curriculum and residents' evaluation of the milestones. We assessed whether beginner-level milestones for interpersonal and communication skills (ICS) related to observable behaviors in ICS-focused objective structured clinical examinations (OSCEs) for postgraduate year (PGY) 1 residents across specialties. The work group compared ICS subcompetencies across 12 programs to identify common beginner-level physician-patient communication milestones. The selected ICS milestone sets were compared for common language with the ICS-OSCE assessment tool-the Kalamazoo Essential Elements of Communication Checklist-Adapted (KEECC-A). To assess whether OSCE scores related to ICS milestone scores, all PGY-1 residents from programs that were part of Next Accreditation System Phase 1 were identified; their OSCE scores from July 2013 to June 2014 and ICS subcompetency scores from December 2014 were compared. The milestones for 10 specialties and the transitional year had at least 1 ICS subcompetency that related to physician-patient communication. The language of the ICS beginner-level milestones appears similar to behaviors outlined in the KEECC-A. All 60 residents with complete data received at least a beginner-level ICS subcompetency score and at least a satisfactory score on all 3 OSCEs. The ICS-OSCE scores for PGY-1 residents appear to relate to beginner-level milestones for physician-patient communication across multiple specialties.

Utilization of a novel digital measurement tool for quantitative assessment of upper extremity motor dexterity: a controlled pilot study.

PubMed

Getachew, Ruth; Lee, Sunghoon I; Kimball, Jon A; Yew, Andrew Y; Lu, Derek S; Li, Charles H; Garst, Jordan H; Ghalehsari, Nima; Paak, Brian H; Razaghy, Mehrdad; Espinal, Marie; Ostowari, Arsha; Ghavamrezaii, Amir A; Pourtaheri, Sahar; Wu, Irene; Sarrafzadeh, Majid; Lu, Daniel C

2014-08-13

The current methods of assessing motor function rely primarily on the clinician's judgment of the patient's physical examination and the patient's self-administered surveys. Recently, computerized handgrip tools have been designed as an objective method to quantify upper-extremity motor function. This pilot study explores the use of the MediSens handgrip as a potential clinical tool for objectively assessing the motor function of the hand. Eleven patients with cervical spondylotic myelopathy (CSM) were followed for three months. Eighteen age-matched healthy participants were followed for two months. The neuromotor function and the patient-perceived motor function of these patients were assessed with the MediSens device and the Oswestry Disability Index respectively. The MediSens device utilized a target tracking test to investigate the neuromotor capacity of the participants. The mean absolute error (MAE) between the target curve and the curve tracing achieved by the participants was used as the assessment metric. The patients' adjusted MediSens MAE scores were then compared to the controls. The CSM patients were further classified as either "functional" or "nonfunctional" in order to validate the system's responsiveness. Finally, the correlation between the MediSens MAE score and the ODI score was investigated. The control participants had lower MediSens MAE scores of 8.09%±1.60%, while the cervical spinal disorder patients had greater MediSens MAE scores of 11.24%±6.29%. Following surgery, the functional CSM patients had an average MediSens MAE score of 7.13%±1.60%, while the nonfunctional CSM patients had an average score of 12.41%±6.32%. The MediSens MAE and the ODI scores showed a statistically significant correlation (r=-0.341, p<1.14×10⁻⁵). A Bland-Altman plot was then used to validate the agreement between the two scores. Furthermore, the percentage improvement of the the two scores after receiving the surgical intervention showed a significant correlation (r=-0.723, p<0.04). The MediSens handgrip device is capable of identifying patients with impaired motor function of the hand. The MediSens handgrip scores correlate with the ODI scores and may serve as an objective alternative for assessing motor function of the hand.

Discordant assessment of lupus activity between patients and their physicians: the Singapore experience.

PubMed

Leong, K P; Chong, E Y Y; Kong, K O; Chan, S P; Thong, B Y H; Lian, T Y; Chng, H H; Koh, E T; Teh, C L; Lau, T C; Law, W G; Cheng, Y K; Badsha, H; Chew, L C; Yong, W H; Howe, H S

2010-01-01

Patients with systemic lupus erythematosus often assess their disease activity differently from their physicians. We studied the factors associated with this discordance. The data provided by 534 systemic lupus erythematosus patients were analyzed. We compared the physician and patient assessments of lupus activity on a visual-assessment scale from the same visit. We collected clinical data and scores from MOS 36-Item Short-Form Health Survey, Systemic Lupus Erythematosus Quality-of-Life Questionnaire, Rheumatology Attitudes Index, Systemic Lupus Erythematosus Disease Activity Index, and revised Systemic Lupus Activity Measure. Patients tended to score their disease activity higher than do their physicians, when these factors were present: poorer general health assessment, presence of thrombocytopenia, hypertension and urinary sediments, and difficulty in carrying groceries. Physicians tended to score the disease activity higher than do the patients in these circumstances proteinuria, hemolysis, use of azathioprine or cyclophosphamide, tiredness, photosensitivity, higher revised Systemic Lupus Activity Measure score, casturia, and patient report of being more easily ill than are other patients. There was only moderate correlation between the discordance in the baseline and the subsequent visits. The physician assessment of disease activity at baseline correlated better with an objective measure of disease activity (revised Systemic Lupus Activity Measure) in the subsequent visit than the patient assessment. In conclusion, discordance in the perception of disease activity between patients and physicians may be amenable to intervention.

Proposal of a Video-recording System for the Assessment of Bell's Palsy: Methodology and Preliminary Results.

PubMed

Monini, Simonetta; Marinozzi, Franco; Atturo, Francesca; Bini, Fabiano; Marchelletta, Silvia; Barbara, Maurizio

2017-09-01

To propose a new objective video-recording procedure to assess and monitor over time the severity of facial nerve palsy. No objective methods for facial palsy (FP) assessment are universally accepted. The face of subjects presenting with different degrees of facial nerve deficit, as measured by the House-Brackmann (HB) grading system, was videotaped after positioning, at specific points, 10 gray circular markers made of a retroreflective material. Video-recording included the resting position and six ordered facial movements. Editing and data elaboration was performed using a software instructed to assess marker distances. From the differences of the marker distances between the two sides was then extracted a score. The higher the FP degree, the higher the score registered during each movement. The statistical significance differed during the various movements between the different FP degrees, being uniform when closing the eyes gently; whereas when wrinkling the nose, there was no difference between the HB grade III and IV groups and, when smiling, no difference was evidenced between the HB grade IV and V groups.The global range index, which represents the overall degree of FP, was between 6.2 and 7.9 in the normal subjects (HB grade I); between 10.6 and 18.91 in HB grade II; between 22.19 and 33.06 in HB grade III; between 38.61 and 49.75 in HB grade IV; and between 50.97 and 66.88 in HB grade V. The proposed objective methodology could provide numerical data that correspond to the different degrees of FP, as assessed by the subjective HB grading system. These data can in addition be used singularly to score selected areas of the paralyzed face when recovery occurs with a different timing in the different face regions.

Outcome after Hypospadias Repair: Evaluation Using the Hypospadias Objective Penile Evaluation Score.

PubMed

Krull, Sarah; Rissmann, Anke; Krause, Hardy; Mohnike, Klaus; Roehl, Friedrich-Wilhelm; Koehn, Andrea; Hass, Hans-Juergen

2018-06-01

 The Hypospadias Objective Penile Evaluation Score (HOPE-Score) is a concise and reproducible way to describe hypospadias severity. We classified boys undergoing primary hypospadias repair to determine the correlation between the HOPE-Score and the severity of hypospadias first and the outcome after surgery second.  Patients who underwent primary hypospadias repair from 2005 to 2014 were identified. An independent physician assessed retrospectively the HOPE-Score, using photographies of the patients before, after primary surgery, and after all necessary surgeries. The correlation between the HOPE-Score and the severity of hypospadias, on the one hand, and the outcome after surgery, on the other hand, were analyzed.  The HOPE-Score was assessed preoperatively for 79 boys, postoperatively for 66, and after all necessary surgeries for 21 patients. Mean HOPE-Score reached 30.2 ± 5.9 before surgery, 42.2 ± 6.1 after primary surgery, and 43.7 ± 3.4 after all necessary surgeries. A significant correlation between the HOPE-Score and the severity of hypospadias before surgery was observed. The boys with glanular hypospadias scored significantly higher (36.3 ± 5.4) than those with distal (29.6 ± 4.4) and proximal hypospadias (21.1 ± 3.5). Furthermore, a significant correlation between the HOPE-Score and the outcome after hypospadias repair was observed. Patients who needed no reintervention after primary hypospadias repair scored significantly higher postoperatively (45.1 ± 5.4) than those who needed a second (40.8 ± 4.2) or more than two surgeries (36.9 ± 7.4).  The HOPE-Score is a good system to assess the severity of hypospadias and the cosmetic outcome after hypospadias repair. Georg Thieme Verlag KG Stuttgart · New York.

Thromboelastometry

PubMed Central

Dumitrescu, Gabriel; Januszkiewicz, Anna; Ågren, Anna; Magnusson, Maria; Wahlin, Staffan; Wernerman, Jan

2017-01-01

Abstract The severity of liver disease is assessed by scoring systems, which include the conventional coagulation test prothrombin time-the international normalized ratio (PT-INR). However, PT-INR is not predictive of bleeding in liver disease and thromboelastometry (ROTEM) has been suggested to give a better overview of the coagulation system in these patients. It has now been suggested that coagulation as reflected by tromboelastomety may also be used for prognostic purposes. The objective of our study was to investigate whether thrombelastometry may discriminate the degree of liver insufficiency according to the scoring systems Child Pugh and Model for End-stage Liver Disease (MELD). Forty patients with chronic liver disease of different etiologies and stages were included in this observational cross-sectional study. The severity of liver disease was evaluated using the Child-Pugh score and the MELD score, and blood samples for biochemistry, conventional coagulation tests, and ROTEM were collected at the time of the final assessment for liver transplantation. Statistical comparisons for the studied parameters with scores of severity were made using Spearman correlation test and receiver-operating characteristic (ROC) curves. Spearman correlation coefficients indicated that the thromboelastometric parameters did not correlate with Child-Pugh or MELD scores. The ROC curves of the thromboelastometric parameters could not differentiate advanced stages from early stages of liver cirrhosis. Standard ROTEM cannot discriminate the stage of chronic liver disease in patients with severe chronic liver disease. PMID:28591054

An Index to Objectively Score Supraglottic Abnormalities in Refractory Asthma

PubMed Central

Good, James T.; Rollins, Donald R.; Curran-Everett, Douglas; Lommatzsch, Steven E.; Carolan, Brendan J.; Stubenrauch, Peter C.

2014-01-01

Background: Patients with refractory asthma frequently have elements of laryngopharyngeal reflux (LPR) with potential aspiration contributing to their poor control. We previously reported on a supraglottic index (SGI) scoring system that helps in the evaluation of LPR with potential aspiration. However, to further the usefulness of this SGI scoring system for bronchoscopists, a teaching system was developed that included both interobserver and intraobserver reproducibility. Methods: Five pulmonologists with expertise in fiber-optic bronchoscopy but novice to the SGI participated. A training system was developed that could be used via Internet interaction to make this learning technique widely available. Results: By the final testing, there was excellent interreader agreement (κ of at least 0.81), thus documenting reproducibility in scoring the SGI. For the measure of intrareader consistency, one reader was arbitrarily selected to rescore the final test 4 weeks later and had a κ value of 0.93, with a 95% CI of 0.79 to 1.00. Conclusions: In this study, we demonstrate that with an organized educational approach, bronchoscopists can develop skills to have highly reproducible assessment and scoring of supraglottic abnormalities. The SGI can be used to determine which patients need additional intervention to determine causes of LPR and gastroesophageal reflux. Identification of this problem in patients with refractory asthma allows for personal, individual directed therapy to improve asthma control. PMID:24202552

The Relationship between the Interactive Computer Interview System and the "Praxis II" Principles of Learning and Teaching Test

ERIC Educational Resources Information Center

Pruett, Sharon M.

2012-01-01

The objective of this study was to compare the relationships between the subtests of the Interactive Computer Interview System and the ETS "Praxis II" Principles of Learning and Teaching examination. In particular, this study compares scores on the ICIS instrument subtests to those gathered from the same classroom teachers on the…

A Study of the Construct Validity of the Interactive Computer Interview System (ICIS) Using Student Evaluations as the Outcome Measure

ERIC Educational Resources Information Center

Gardner, Robby Christopher

2009-01-01

The primary objective of this study was to compare the individual teacher interview scores from the Interactive Computer Interview System (ICIS) with their students' responses to "The Steps to Excellence Student Questionnaire". Specifically, the study examined the correlation among the teacher interviews across four themes of the ICIS ("Knowledge…

A comparison of MRI and CT imaging clarity of titanium alloy and titanium alloy with cobalt-chromium-alloy pedicle screw and rod implants in the lumbar spine.

PubMed

Trammell, Terry R; Flint, Kathy; Ramsey, Curtis J

2012-08-15

Magnetic resonance imaging (MRI) and computed tomography (CT) imaging are important postoperative diagnostic and evaluation tools, particularly in patients who have undergone spinal fusions. Advancements in materials and imaging techniques have lessened artifact and improved overall imaging results. Systems that combine titanium alloy and cobalt-chromium components have been introduced to reduce implant profile while maintaining strength. The objective of this study was to determine if there were any differences in the clarity of imaging between two types of implant materials in a lumbar spine construct model. One of two lumbar spine stabilization implant systems, titanium alloy (titanium) or titanium alloy with cobalt-chromium alloy (titanium-cobalt), was placed to simulate a four-level fusion construct in two human cadaveric spine segments, followed by MRI and CT imaging. The implant systems were then removed from each cadaver and implanted in the other cadaver. Nine physician graders from three subspecialties scored the images using a 5-point scale, with higher imaging scores indicating greater clarity of the region of interest. Physician-rated scores were compared across systems and between physician groups. There were no significant differences in the overall mean total scores on the basis of construct material. Overall mean scores were 18.16 for titanium and 17.45 for titanium-cobalt (p = 0.275). Among images of the titanium-cobalt constructs, no significant differences in mean scores were found between specimens with use of MRI (p = 0.883) or with use of CT only (p = 0.274). Among images of the titanium system, a slightly significant difference was found between specimens with use of MRI (p = 0.044) but not with CT imaging (p = 0.837). Overall image clarity scores were not significantly different between titanium and titanium-cobalt implant systems in the lumbar spine. Observation of pertinent anatomy in the regions of interest was not degraded by the presence of either system.

A New Operating System for Security Tagged Architecture Hardware in Support of Multiple Independent Levels of Security (MILS) Compliant System

DTIC Science & Technology

2014-04-01

important data structures of RTEMS are introduced. Section 3.2.2 discusses the problems we found in RTEMS that may cause security vulnerabilities...the important data structures in RTEMS: Object, which is a critical data structure in the SCORE, tasks threads. Approved for Public Release...these important system codes. The example code shows a possibility that a user can delete a system thread. Therefore, in order to protect system

Comparison of Different Scoring Systems Based on Both Donor and Recipient Characteristics for Predicting Outcome after Living Donor Liver Transplantation

PubMed Central

2015-01-01

Background and Objectives In order to provide a good match between donor and recipient in liver transplantation, four scoring systems [the product of donor age and Model for End-stage Liver Disease score (D-MELD), the score to predict survival outcomes following liver transplantation (SOFT), the balance of risk score (BAR), and the transplant risk index (TRI)] based on both donor and recipient parameters were designed. This study was conducted to evaluate the performance of the four scores in living donor liver transplantation (LDLT) and compare them with the MELD score. Patients and Methods The clinical data of 249 adult patients undergoing LDLT in our center were retrospectively evaluated. The area under the receiver operating characteristic curves (AUCs) of each score were calculated and compared at 1-, 3-, 6-month and 1-year after LDLT. Results The BAR at 1-, 3-, 6-month and 1-year after LDLT and the D-MELD and TRI at 1-, 3- and 6-month after LDLT showed acceptable performances in the prediction of survival (AUC>0.6), while the SOFT showed poor discrimination at 6-month after LDLT (AUC = 0.569). In addition, the D-MELD and BAR displayed positive correlations with the length of ICU stay (D-MELD, p = 0.025; BAR, p = 0.022). The SOFT was correlated with the time of mechanical ventilation (p = 0.022). Conclusion The D-MELD, BAR and TRI provided acceptable performance in predicting survival after LDLT. However, even though these scoring systems were based on both donor and recipient parameters, only the BAR provided better performance than the MELD in predicting 1-year survival after LDLT. PMID:26378786

Owner perceptions of their cat's quality of life when treated with a modified University of Wisconsin-Madison protocol for lymphoma.

PubMed

Thornton, Laura A; Cave, Nicholas; Bridges, Janis P; Stell, Anneliese J

2018-04-01

Objectives The objectives of this study were to assess owner perceptions of their cat's quality of life during treatment for lymphoma with a doxorubicin-containing multi-agent chemotherapy protocol, whether various health-related parameters correlated with quality of life scores, and to assess owner satisfaction with the protocol. Methods A postal questionnaire was sent to the owners of 33 treated cats. Owners retrospectively assessed their cat's quality of life using a Likert scale (1-10) before lymphoma was diagnosed, at diagnosis and during chemotherapy. Owners assigned scores to various health-related parameters previously reported to affect quality of life at the three time points, and correlations with quality of life scores were sought. Owners were asked to rate the importance of these health-related parameters. Satisfaction with the protocol was investigated. Results Twenty questionnaires were completed (61% response rate). The median quality of life score before diagnosis (10, range 5-10) was higher than at diagnosis (3, range 1-9) ( P <0.05). The median quality of life score during chemotherapy (7, range 3-9) was lower than before diagnosis ( P <0.05) and higher than at diagnosis, but this was not statistically significant. Quality of life scores did not correlate with individual health-related parameter scores consistently; however, quality of life scores did correlate with appetite scores during chemotherapy. Appetite, vomiting and diarrhoea were parameters perceived as important in affecting quality of life. Most owners (75%) were happy they had treated their cat. Conclusions and relevance The quality of life scores observed were comparable to a previous study using cyclophosphamide, vincristine and prednisolone, employing the same scoring system. Although quality of life scores during chemotherapy were not significantly improved at diagnosis, owner satisfaction with the protocol was high. The factors perceived by owners to determine quality of life in their pets may be different to those previously conjectured, but appetite during chemotherapy remains important.

Sarcopenia in the prognosis of cirrhosis: Going beyond the MELD score

PubMed Central

Kim, Hee Yeon; Jang, Jeong Won

2015-01-01

Estimating the prognosis of patients with cirrhosis remains challenging, because the natural history of cirrhosis varies according to the cause, presence of portal hypertension, liver synthetic function, and the reversibility of underlying disease. Conventional prognostic scoring systems, including the Child-Turcotte-Pugh score or model for end-stage liver diseases are widely used; however, revised models have been introduced to improve prognostic performance. Although sarcopenia is one of the most common complications related to survival of patients with cirrhosis, the newly proposed prognostic models lack a nutritional status evaluation of patients. This is reflected by the lack of an optimal index for sarcopenia in terms of objectivity, reproducibility, practicality, and prognostic performance, and of a consensus definition for sarcopenia in patients with cirrhosis in whom ascites and edema may interfere with body composition analysis. Quantifying skeletal muscle mass using cross-sectional abdominal imaging is a promising tool for assessing sarcopenia. As radiological imaging provides direct visualization of body composition, it is useful to evaluate sarcopenia in patients with cirrhosis whose body mass index, anthropometric measurements, or biochemical markers are inaccurate on a nutritional assessment. Sarcopenia defined by cross-sectional imaging-based muscular assessment is prevalent and predicts mortality in patients with cirrhosis. Sarcopenia alone or in combination with conventional prognostic systems shows promise for a cirrhosis prognosis. Including an objective assessment of sarcopenia with conventional scores to optimize the outcome prediction for patients with cirrhosis needs further research. PMID:26167066

Assessing students' performance in software requirements engineering education using scoring rubrics

NASA Astrophysics Data System (ADS)

Mkpojiogu, Emmanuel O. C.; Hussain, Azham

2017-10-01

The study investigates how helpful the use of scoring rubrics is, in the performance assessment of software requirements engineering students and whether its use can lead to students' performance improvement in the development of software requirements artifacts and models. Scoring rubrics were used by two instructors to assess the cognitive performance of a student in the design and development of software requirements artifacts. The study results indicate that the use of scoring rubrics is very helpful in objectively assessing the performance of software requirements or software engineering students. Furthermore, the results revealed that the use of scoring rubrics can also produce a good achievement assessments direction showing whether a student is either improving or not in a repeated or iterative assessment. In a nutshell, its use leads to the performance improvement of students. The results provided some insights for further investigation and will be beneficial to researchers, requirements engineers, system designers, developers and project managers.

Gross Motor Development in Children Aged 3-5 Years, United States 2012.

PubMed

Kit, Brian K; Akinbami, Lara J; Isfahani, Neda Sarafrazi; Ulrich, Dale A

2017-07-01

Objective Gross motor development in early childhood is important in fostering greater interaction with the environment. The purpose of this study is to describe gross motor skills among US children aged 3-5 years using the Test of Gross Motor Development (TGMD-2). Methods We used 2012 NHANES National Youth Fitness Survey (NNYFS) data, which included TGMD-2 scores obtained according to an established protocol. Outcome measures included locomotor and object control raw and age-standardized scores. Means and standard errors were calculated for demographic and weight status with SUDAAN using sample weights to calculate nationally representative estimates, and survey design variables to account for the complex sampling methods. Results The sample included 339 children aged 3-5 years. As expected, locomotor and object control raw scores increased with age. Overall mean standardized scores for locomotor and object control were similar to the mean value previously determined using a normative sample. Girls had a higher mean locomotor, but not mean object control, standardized score than boys (p < 0.05). However, the mean locomotor standardized scores for both boys and girls fell into the range categorized as "average." There were no other differences by age, race/Hispanic origin, weight status, or income in either of the subtest standardized scores (p > 0.05). Conclusions In a nationally representative sample of US children aged 3-5 years, TGMD-2 mean locomotor and object control standardized scores were similar to the established mean. These results suggest that standardized gross motor development among young children generally did not differ by demographic or weight status.

Assessment of the effectiveness of physical activity interventions in the Brazilian Unified Health System

PubMed Central

Ribeiro, Evelyn Helena Corgosinho; Garcia, Leandro Martin Totaro; Salvador, Emanuel Péricles; Costa, Evelyn Fabiana; Andrade, Douglas Roque; Latorre, Maria do Rosario Dias de Oliveira; Florindo, Alex Antonio

2017-01-01

ABSTRACT OBJECTIVE To assess the effect of interventions on the levels of physical activity of healthy adults, users of the Brazilian Unified Health System and attended by the Family Health Strategy. METHODS Non-randomized experimental study with 157 adults allocated in three groups: 1) physical exercise classes (n = 54), 2) health education (n = 54), 3) control (n = 49). The study lasted for18 months, with 12 months of interventions and six months of follow-up after intervention. Assessments took place at the beginning, in the 12 months, and in the 18 months of study. Physical activity has been assessed by questionnaires and accelerometry. For the analyses, we have used the intention-to-treat principle and generalized estimating equations. RESULTS After 12 months, both intervention groups have increased the minutes of weekly leisure time physical activity and annual scores of physical exercise, leisure and transport-related physical activity. The exercise class group has obtained the highest average annual physical exercises score when compared to the other groups (p < 0.001). In the follow-up period, the exercise class group reduced its annual score (average: -0.3; 95%CI -0.5–-0.1), while the health education group increased this score (average: 0.2; 95%CI 0.1–0.4). There have been no differences in the levels of physical activity measured by accelerometry. CONCLUSIONS The interventions have been effective in increasing the practice of physical activity. However, we have observed that the health education intervention was more effective for maintaining the practice of physical activity in the period after intervention. We recommend the use of both interventions to promote physical activity in the Brazilian Unified Health System, according to the local reality of professionals, facilities, and team objectives. PMID:28678906

Automated outcome scoring in a virtual reality simulator for endodontic surgery.

PubMed

Yin, Myat Su; Haddawy, Peter; Suebnukarn, Siriwan; Rhienmora, Phattanapon

2018-01-01

We address the problem of automated outcome assessment in a virtual reality (VR) simulator for endodontic surgery. Outcome assessment is an essential component of any system that provides formative feedback, which requires assessing the outcome, relating it to the procedure, and communicating in a language natural to dental students. This study takes a first step toward automated generation of such comprehensive feedback. Virtual reference templates are computed based on tooth anatomy and the outcome is assessed with a 3D score cube volume which consists of voxel-level non-linear weighted scores based on the templates. The detailed scores are transformed into standard scoring language used by dental schools. The system was evaluated on fifteen outcome samples that contained optimal results and those with errors including perforation of the walls, floor, and both, as well as various combinations of major and minor over and under drilling errors. Five endodontists who had professional training and varying levels of experiences in root canal treatment participated as raters in the experiment. Results from evaluation of our system with expert endodontists show a high degree of agreement with expert scores (information based measure of disagreement 0.04-0.21). At the same time they show some disagreement among human expert scores, reflecting the subjective nature of human outcome scoring. The discriminatory power of the AOS scores analyzed with three grade tiers (A, B, C) using the area under the receiver operating characteristic curve (AUC). The AUC values are generally highest for the {AB: C} cutoff which is cutoff at the boundary between clinically acceptable (B) and clinically unacceptable (C) grades. The objective consistency of computed scores and high degree of agreement with experts make the proposed system a promising addition to existing VR simulators. The translation of detailed level scores into terminology commonly used in dental surgery supports natural communication with students and instructors. With the reference virtual templates created automatically, the approach is robust and is applicable in scoring the outcome of any dental surgery procedure involving the act of drilling. Copyright © 2017 Elsevier B.V. All rights reserved.

How Does the Relationship Between Motor Skill Performance and Body Mass Index Impact Physical Activity in Preschool Children?

PubMed

Guo, Haixia; Schenkelberg, Michaela A; O'Neill, Jennifer R; Dowda, Marsha; Pate, Russell R

2018-05-01

To determine if weight status modifies the relationship between motor skill (MS) performance and physical activity (PA) in preschoolers. Preschoolers (N = 227, age 3-5 y) were recruited from 22 preschools. Preschoolers' MS (locomotor, object control, and total MS) were assessed with the Children's Activity and Movement in Preschool Study MS protocol. PA was measured by accelerometry. Mixed linear models were used to examine the relationship of MS performance and body mass index (BMI) z score to PA. Models were adjusted for age, race, sex, and parent education, with preschool as a random effect. There was a significant correlation between MS performance and PA (r = .14-.17, P < .05). A significant interaction was observed between BMI z score and object control, and between BMI z score and total MS score on PA (P = .03). Preschoolers with higher BMI z scores and high object control scores engaged in significantly (P = .03) more PA than preschoolers with lower BMI z scores and high object control scores (PA = 15.04 min/h and 13.54 min/h, respectively). Similarly, preschoolers with higher BMI z scores and high total MS scores spent significantly (P = .01) more time in PA compared with those with lower BMI z scores and high total MS scores (PA = 15.65 min/h and 13.91 min/h, respectively). Preschool children's MS performance is positively correlated with PA, and BMI z score modified the relationship between MS performance and PA.

Education & Agency: Muslim Women and the Tensions of Traditional & Modern Expectations

ERIC Educational Resources Information Center

Khan, Shabnam Syed

2010-01-01

This hermeneutically crafted qualitative study examines how six university-educated middle-class Pakistani Muslim women negotiate the competing expectations of traditional Muslim culture and the emancipated ethos of the university. It uses Robert Kegan's constructive-developmental theory, whose Subject-Object scoring system distinguishes a…

A NOVEL SCORING SYSTEM: PREDICTING SEPTIC SHOCK AT DIAGNOSIS EASILY IN ACUTE COMPLICATED PYELONEPHRITIS PATIENTS.

PubMed

Kubota, Masashi; Kanno, Toru; Nishiyama, Ryuichi; Okada, Takashi; Higashi, Yoshihito; Yamada, Hitoshi

2016-01-01

(Objectives) Because acute complicated pyelonephritis can easily cause sepsis and concomitant shock status, it is a potentially lethal disease. However, the predictors for the severity of pyelonephritis is not well analyzed. In this study, we aimed at clarifying the clinical characteristic risk factors associated with septic shock in patients with acute complicated pyelonephritis. (Materials and methods) From May 2009 to March 2014, 267 patients with acute complicated pyelonephritis were treated at our institution. We investigated the characteristics of the patients associated with septic shock, and assessed risk factors in these patients. By using these risk factors, we established a novel scoring system to predict septic shock. (Results) 267 patients included 145 patients with ureteral calculi and 75 patients with stent-related pyelonephritis. Septic shock occurred in 35 patients (13%), and the mortality rate was 0.75%. Multivariate analysis revealed that (P): Performance Status ≥3 (p=0.0014), (U): Presence of Ureteral calculi (p=0.043), (S): Sex of female (p=0.023), and (H): the presence of Hydronephrosis (p=0.039) were independent risk factors for septic shock. P.U.S.H. scoring system (range 0-4), which consists of these 4 factors, were positively correlated with the rate of septic shock (score 0: 0%, 1: 5.3%, 2: 3.4%, 3: 25.0%, 4: 42.3%). Importantly, patients with 3-4 P.U.S.H. scores were statistically more likely to become septic shock than those with 0-2 score (p=0.00014). (Conclusions) These results suggest that P.U.S.H. scoring system using 4 clinical factors is useful to predict the status of septic shock in patients with acute complicated pyelonephritis.

Resistance to intravenous immunoglobulin in children with Kawasaki disease

PubMed Central

Tremoulet, Adriana H.; Best, Brookie M.; Song, Sungchan; Wang, Susan; Corinaldesi, Elena; Eichenfield, Julia R.; Martin, Danielle D.; Newburger, Jane W.; Burns, Jane C.

2008-01-01

Objectives To explore the increased incidence of intravenous immunoglobulin (IVIG) resistance among San Diego County Kawasaki disease (KD) patients in 2006 and to evaluate a scoring system to predict IVIG-resistant patients with KD. Study design We performed a retrospective review of patients with KD treated within 10 days of fever onset. Using multivariate analysis, independent predictors of IVIG-resistance were combined into a scoring system. Results In 2006, 38.3 % of patients with KD in San Diego County were IVIG-resistant, a significant increase over previous years. IVIG-resistance was not associated with a particular brand or lot of IVIG. Resistant patients were diagnosed earlier, had higher % bands, and higher concentrations of C-reactive protein, alanine aminotransferase, and γ-glutamyl transferase (GGT). They also had lower platelet counts and age-adjusted hemoglobin (zHgb) concentrations and were more likely to have aneurysms (p=0.0008). A scoring system developed to predict IVIG-resistant patients using illness day, % bands, GGT, and zHgb, had a sensitivity of 73.3% and specificity of 61.9%. Conclusions An unexplained increase in IVIG-resistance was noted among patients with KD in San Diego County in 2006. Scoring systems based on demographic and laboratory data were insufficiently accurate to be clinically useful in our ethnically diverse population. PMID:18571548

Use of Laser Speckle Contrast Imaging to Assess Digital Microvascular Function in Primary Raynaud Phenomenon and Systemic Sclerosis: A Comparison Using the Raynaud Condition Score Diary.

PubMed

Pauling, John D; Shipley, Jacqueline A; Hart, Darren J; McGrogan, Anita; McHugh, Neil J

2015-07-01

Evaluate objective assessment of digital microvascular function using laser speckle contrast imaging (LSCI) in a cross-sectional study of patients with primary Raynaud phenomenon (RP) and systemic sclerosis (SSc), comparing LSCI with both infrared thermography (IRT) and subjective assessment using the Raynaud Condition Score (RCS) diary. Patients with SSc (n = 25) and primary RP (n = 18) underwent simultaneous assessment of digital perfusion using LSCI and IRT with a cold challenge on 2 occasions, 2 weeks apart. The RCS diary was completed between assessments. The relationship between objective and subjective assessments of RP was evaluated. Reproducibility of LSCI/IRT was assessed, along with differences between primary RP and SSc, and the effect of sex. There was moderate-to-good correlation between LSCI and IRT (Spearman rho 0.58-0.84, p < 0.01), but poor correlation between objective assessments and the RCS diary (p > 0.05 for all analyses). Reproducibility of IRT and LSCI was moderate at baseline (ICC 0.51-0.63) and immediately following cold challenge (ICC 0.56-0.86), but lower during reperfusion (ICC 0.3-0.7). Neither subjective nor objective assessments differentiated between primary RP and SSc. Men reported lower median daily frequency of RP attacks (0.82 vs 1.93, p = 0.03). Perfusion using LSCI/IRT was higher in men for the majority of assessments. Objective and subjective methods provide differing information on microvascular function in RP. There is good convergent validity of LSCI with IRT and acceptable reproducibility of both modalities. Neither subjective nor objective assessments could differentiate between primary RP and SSc. Influence of sex on subjective and objective assessment of RP warrants further evaluation.

Technical note on the validation of a semi-automated image analysis software application for estrogen and progesterone receptor detection in breast cancer.

PubMed

Krecsák, László; Micsik, Tamás; Kiszler, Gábor; Krenács, Tibor; Szabó, Dániel; Jónás, Viktor; Császár, Gergely; Czuni, László; Gurzó, Péter; Ficsor, Levente; Molnár, Béla

2011-01-18

The immunohistochemical detection of estrogen (ER) and progesterone (PR) receptors in breast cancer is routinely used for prognostic and predictive testing. Whole slide digitalization supported by dedicated software tools allows quantization of the image objects (e.g. cell membrane, nuclei) and an unbiased analysis of immunostaining results. Validation studies of image analysis applications for the detection of ER and PR in breast cancer specimens provided strong concordance between the pathologist's manual assessment of slides and scoring performed using different software applications. The effectiveness of two connected semi-automated image analysis software (NuclearQuant v. 1.13 application for Pannoramic™ Viewer v. 1.14) for determination of ER and PR status in formalin-fixed paraffin embedded breast cancer specimens immunostained with the automated Leica Bond Max system was studied. First the detection algorithm was calibrated to the scores provided an independent assessors (pathologist), using selected areas from 38 small digital slides (created from 16 cases) containing a mean number of 195 cells. Each cell was manually marked and scored according to the Allred-system combining frequency and intensity scores. The performance of the calibrated algorithm was tested on 16 cases (14 invasive ductal carcinoma, 2 invasive lobular carcinoma) against the pathologist's manual scoring of digital slides. The detection was calibrated to 87 percent object detection agreement and almost perfect Total Score agreement (Cohen's kappa 0.859, quadratic weighted kappa 0.986) from slight or moderate agreement at the start of the study, using the un-calibrated algorithm. The performance of the application was tested against the pathologist's manual scoring of digital slides on 53 regions of interest of 16 ER and PR slides covering all positivity ranges, and the quadratic weighted kappa provided almost perfect agreement (κ = 0.981) among the two scoring schemes. NuclearQuant v. 1.13 application for Pannoramic™ Viewer v. 1.14 software application proved to be a reliable image analysis tool for pathologists testing ER and PR status in breast cancer.

The Objective Borderline Method (OBM): A Probability-Based Model for Setting up an Objective Pass/Fail Cut-Off Score in Medical Programme Assessments

ERIC Educational Resources Information Center

Shulruf, Boaz; Turner, Rolf; Poole, Phillippa; Wilkinson, Tim

2013-01-01

The decision to pass or fail a medical student is a "high stakes" one. The aim of this study is to introduce and demonstrate the feasibility and practicality of a new objective standard-setting method for determining the pass/fail cut-off score from borderline grades. Three methods for setting up pass/fail cut-off scores were compared: the…

Which functionalities are available in the electronic health record systems used by French general practitioners? An assessment study of 15 systems.

PubMed

Darmon, David; Sauvant, Rémy; Staccini, Pascal; Letrilliart, Laurent

2014-01-01

Whereas an unprecedented effort is currently under way worldwide for the implementation of electronic health record (EHR) systems, their capabilities are poorly understood, especially in primary care. The objective of this study was to assess the main functionalities of the EHR systems used in French general practices. Among the 20 EHR systems marketed in France, we assessed the 15 systems used by more than 1500 general practitioners in the Provence-Alpes-Côte d'Azur region in the southeast part of France. Each EHR system was assessed in a general practice office, using two clinical vignettes describing virtual patient consultations. The evaluation criteria were derived from the EuroRec requirements for EHR system quality. The assessment scale included 37 criteria grouped into three sets: background data, consultation data, and exchange functionalities. The scoring system used, totalling 64 points, was based on the validation of the criteria and was adjusted based on the possibility of standardising the data. A high score indicated a good EHR system quality. The median global score was 32 points out of a possible 64 (range: 20-39). The median score was 12 points out of 22 (range: 6-15) for the background data set, 16 points out of 32 (range: 9-22) for the consultation data set, and four points out of 10 (range: 0-6) for the exchange functionalities. No association was found between the number of users and the assessment score of the EHR systems (p=0.79). One third of the EHR systems lacked a problem list and only one of them supported the episode of care. Functionalities noticeably vary among the EHR systems currently used in French primary care. Whereas these systems are globally very focused on drug prescriptions, several core functionalities are frequently lacking. They are also poorly interoperable for healthcare professionals and patients. Further research is necessary to assess their actual use. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The association between surgical complications and the POSSUM score in head and neck reconstruction: a retrospective single-center study.

PubMed

Makino, Yohjiroh; Ishida, Katsuhiro; Kishi, Keita; Kodama, Hiroki; Miyawaki, Takeshi

2018-06-01

The Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) is widely used to predict surgical complications affecting various organs. However, there are few reports about objective evaluation methods for head and neck surgery. In this study, we retrospectively examined the association between POSSUM score and actual surgical complications of head and neck reconstruction surgery. In total, 711 patients who underwent head and neck reconstruction after cancer extirpation between January 2007 and January 2015 were studied. The predicted risk of complications was calculated using the POSSUM score and compared with the actual rate of perioperative complications. Perioperative complications occurred in 178 (25%) patients, comprising systemic complications in 52 (7%) patients, surgical site infection of the head and neck area in 78 (11%) patients and failure of the free flap in 55 (8.8%) patients. When patients were divided into a perioperative complication group and a no-complication group, a significant difference between the two groups was observed in the predicted postoperative rate calculated from the POSSUM score (p < .0001, odds ratio 1.03, 95% confidence interval = 1.02-1.04). Furthermore, the cutoff value of the POSSUM score calculated from the receiver operating characteristic curve using Youden's index was 43.0%. POSSUM is a useful risk indicator for head and neck reconstruction surgery. It is possible to objectively calculate the prediction level using a standard assessment method without adding burden to any medical facility. Therefore, patients may be considered at high risk for perioperative complications when the POSSUM score is 43.0% or higher.

Automatic and Objective Assessment of Alternating Tapping Performance in Parkinson's Disease

PubMed Central

Memedi, Mevludin; Khan, Taha; Grenholm, Peter; Nyholm, Dag; Westin, Jerker

2013-01-01

This paper presents the development and evaluation of a method for enabling quantitative and automatic scoring of alternating tapping performance of patients with Parkinson's disease (PD). Ten healthy elderly subjects and 95 patients in different clinical stages of PD have utilized a touch-pad handheld computer to perform alternate tapping tests in their home environments. First, a neurologist used a web-based system to visually assess impairments in four tapping dimensions (‘speed’, ‘accuracy’, ‘fatigue’ and ‘arrhythmia’) and a global tapping severity (GTS). Second, tapping signals were processed with time series analysis and statistical methods to derive 24 quantitative parameters. Third, principal component analysis was used to reduce the dimensions of these parameters and to obtain scores for the four dimensions. Finally, a logistic regression classifier was trained using a 10-fold stratified cross-validation to map the reduced parameters to the corresponding visually assessed GTS scores. Results showed that the computed scores correlated well to visually assessed scores and were significantly different across Unified Parkinson's Disease Rating Scale scores of upper limb motor performance. In addition, they had good internal consistency, had good ability to discriminate between healthy elderly and patients in different disease stages, had good sensitivity to treatment interventions and could reflect the natural disease progression over time. In conclusion, the automatic method can be useful to objectively assess the tapping performance of PD patients and can be included in telemedicine tools for remote monitoring of tapping. PMID:24351667

Automatic and objective assessment of alternating tapping performance in Parkinson's disease.

PubMed

Memedi, Mevludin; Khan, Taha; Grenholm, Peter; Nyholm, Dag; Westin, Jerker

2013-12-09

This paper presents the development and evaluation of a method for enabling quantitative and automatic scoring of alternating tapping performance of patients with Parkinson's disease (PD). Ten healthy elderly subjects and 95 patients in different clinical stages of PD have utilized a touch-pad handheld computer to perform alternate tapping tests in their home environments. First, a neurologist used a web-based system to visually assess impairments in four tapping dimensions ('speed', 'accuracy', 'fatigue' and 'arrhythmia') and a global tapping severity (GTS). Second, tapping signals were processed with time series analysis and statistical methods to derive 24 quantitative parameters. Third, principal component analysis was used to reduce the dimensions of these parameters and to obtain scores for the four dimensions. Finally, a logistic regression classifier was trained using a 10-fold stratified cross-validation to map the reduced parameters to the corresponding visually assessed GTS scores. Results showed that the computed scores correlated well to visually assessed scores and were significantly different across Unified Parkinson's Disease Rating Scale scores of upper limb motor performance. In addition, they had good internal consistency, had good ability to discriminate between healthy elderly and patients in different disease stages, had good sensitivity to treatment interventions and could reflect the natural disease progression over time. In conclusion, the automatic method can be useful to objectively assess the tapping performance of PD patients and can be included in telemedicine tools for remote monitoring of tapping.

Contrast-detail phantom scoring methodology.

PubMed

Thomas, Jerry A; Chakrabarti, Kish; Kaczmarek, Richard; Romanyukha, Alexander

2005-03-01

Published results of medical imaging studies which make use of contrast detail mammography (CDMAM) phantom images for analysis are difficult to compare since data are often not analyzed in the same way. In order to address this situation, the concept of ideal contrast detail curves is suggested. The ideal contrast detail curves are constructed based on the requirement of having the same product of the diameter and contrast (disk thickness) of the minimal correctly determined object for every row of the CDMAM phantom image. A correlation and comparison of five different quality parameters of the CDMAM phantom image determined for obtained ideal contrast detail curves is performed. The image quality parameters compared include: (1) contrast detail curve--a graph correlation between "minimal correct reading" diameter and disk thickness; (2) correct observation ratio--the ratio of the number of correctly identified objects to the actual total number of objects multiplied by 100; (3) image quality figure--the sum of the product of the diameter of the smallest scored object and its relative contrast; (4) figure-of-merit--the zero disk diameter value obtained from extrapolation of the contrast detail curve to the origin (e.g., zero disk diameter); and (5) k-factor--the product of the thickness and the diameter of the smallest correctly identified disks. The analysis carried out showed the existence of a nonlinear relationship between the above parameters, which means that use of different parameters of CDMAM image quality potentially can cause different conclusions about changes in image quality. Construction of the ideal contrast detail curves for CDMAM phantom is an attempt to determine the quantitative limits of the CDMAM phantom as employed for image quality evaluation. These limits are determined by the relationship between certain parameters of a digital mammography system and the set of the gold disks sizes in the CDMAM phantom. Recommendations are made on selections of CDMAM phantom regions which should be used for scoring at different image quality and which scoring methodology may be most appropriate. Special attention is also paid to the use of the CDMAM phantom for image quality assessment of digital mammography systems particularly in the vicinity of the Nyquist frequency.

Implications of Changing Answers on Objective Test Items

ERIC Educational Resources Information Center

Mueller, Daniel J.; Wasser, Virginia

1977-01-01

Eighteen studies of the effects of changing initial answers to objective test items are reviewed. While students throughout the total test score range tended to gain more points than they lost, higher scoring students gain more than did lower scoring students. Suggestions for further research are made. (Author/JKS)

Early working memory as a racially and ethnically neutral measure of outcome in extremely preterm children at 18-22 months

PubMed Central

Lowe, Jean R.; Duncan, Andrea Freeman; Bann, Carla M.; Fuller, Janell; Hintz, Susan R.; Das, Abhik; Higgins, Rosemary D.; Watterberg, Kristi L.

2013-01-01

Background Difficulties with executive function has been found in preterm children, resulting in difficulties with learning and school performance. Aim This study evaluated the relationship of early working memory as measured by object permanence items to the cognitive and language scores on the Bayley Scales-III in a cohort of children born extremely preterm. Study Design Logistic regression models were conducted to compare object permanence scores derived from the Bayley Scales-III by race/ethnicity and maternal education, controlling for medical covariates. Subjects Extremely preterm toddlers (526), who were part of a Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network's multi-center study, were evaluated at 18-22 months corrected age. Outcome Measures Object permanence scores derived from the Bayley Developmental Scales were compared by race/ethnicity and maternal education, controlling for medical covariates. Results There were no significant differences in object permanence mastery and scores among the treatment groups after controlling for medical and social variables, including maternal education and race/ethnicity. Males and children with intraventricular hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia were less likely to demonstrate object permanence mastery and had lower object permanence scores. Children who attained object permanence mastery had significantly higher Bayley Scales-III cognitive and language scores after controlling for medical and socio-economic factors. Conclusions Our measure of object permanence is free of influence from race, ethnic and socio-economic factors. Adding this simple task to current clinical practice could help detect early executive function difficulties in young children. PMID:23993309

Early working memory as a racially and ethnically neutral measure of outcome in extremely preterm children at 18-22 months.

PubMed

Lowe, Jean R; Duncan, Andrea Freeman; Bann, Carla M; Fuller, Janell; Hintz, Susan R; Das, Abhik; Higgins, Rosemary D; Watterberg, Kristi L

2013-12-01

Difficulties with executive function have been found in preterm children, resulting in difficulties with learning and school performance. This study evaluated the relationship of early working memory as measured by object permanence items to the cognitive and language scores on the Bayley Scales-III in a cohort of children born extremely preterm. Logistic regression models were conducted to compare object permanence scores derived from the Bayley Scales-III by race/ethnicity and maternal education, controlling for medical covariates. Extremely preterm toddlers (526), who were part of a Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network's multi-center study, were evaluated at 18-22 months corrected age. Object permanence scores derived from the Bayley Developmental Scales were compared by race/ethnicity and maternal education, controlling for medical covariates. There were no significant differences in object permanence mastery and scores among the treatment groups after controlling for medical and social variables, including maternal education and race/ethnicity. Males and children with intraventricular hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia were less likely to demonstrate object permanence mastery and had lower object permanence scores. Children who attained object permanence mastery had significantly higher Bayley Scales-III cognitive and language scores after controlling for medical and socio-economic factors. Our measure of object permanence is free of influence from race, ethnic and socio-economic factors. Adding this simple task to current clinical practice could help detect early executive function difficulties in young children. Published by Elsevier Ireland Ltd.

A polarized light microscopy method for accurate and reliable grading of collagen organization in cartilage repair.

PubMed

Changoor, A; Tran-Khanh, N; Méthot, S; Garon, M; Hurtig, M B; Shive, M S; Buschmann, M D

2011-01-01

Collagen organization, a feature that is critical for cartilage load bearing and durability, is not adequately assessed in cartilage repair tissue by present histological scoring systems. Our objectives were to develop a new polarized light microscopy (PLM) score for collagen organization and to test its reliability. This PLM score uses an ordinal scale of 0-5 to rate the extent that collagen network organization resembles that of young adult hyaline articular cartilage (score of 5) vs a totally disorganized tissue (score of 0). Inter-reader reliability was assessed using Intraclass Correlation Coefficients (ICC) for Agreement, calculated from scores of three trained readers who independently evaluated blinded sections obtained from normal (n=4), degraded (n=2) and repair (n=22) human cartilage biopsies. The PLM score succeeded in distinguishing normal, degraded and repair cartilages, where the latter displayed greater complexity in collagen structure. Excellent inter-reader reproducibility was found with ICCs for Agreement of 0.90 [ICC(2,1)] (lower boundary of the 95% confidence interval is 0.83) and 0.96 [ICC(2,3)] (lower boundary of the 95% confidence interval is 0.94), indicating the reliability of a single reader's scores and the mean of all three readers' scores, respectively. This PLM method offers a novel means for systematically evaluating collagen organization in repair cartilage. We propose that it be used to supplement current gold standard histological scoring systems for a more complete assessment of repair tissue quality. Copyright © 2010 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Descriptive and Functional Classifications of Drug Abusers

ERIC Educational Resources Information Center

Carlin, Albert S.; Stauss, Fred F.

1977-01-01

Polydrug (non-opiate-drug) abusers have previously been classified by a variety of typologies that can be characterized as either descriptive, functional, or a combination of both. This investigation proposes two objective scoring systems that classify polydrug users on a streetwise/straight dimension and on a self-medication/recreational-use…

Understanding Variations in Medicare Consumer Assessment of Health Care Providers and Systems Scores: California as an Example

PubMed Central

Farley, Donna O; Elliott, Marc N; Haviland, Amelia M; Slaughter, Mary Ellen; Heller, Amy

2011-01-01

Objective To understand reasons why California has lower Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores than the rest of the country, including differing patterns of CAHPS scores between Medicare Advantage (MA) and fee-for-service, effects of additional demographic characteristics of beneficiaries, and variation across MA plans within California. Study Design/Data Collection Using 2008 CAHPS survey data for fee-for-service Medicare beneficiaries and MA members, we compared mean case mix adjusted Medicare CAHPS scores for California and the remainder of the nation. Principal Findings California fee-for-service Medicare had lower scores than non-California fee-for-service on 11 of 14 CAHPS measures; California MA had lower scores only for physician services measures and higher scores for other measures. Adding race/ethnicity and urbanity to risk adjustment improved California standing for all measures in both MA and fee-for-service. Within the MA plans, one large plan accounted for the positive performance in California MA; other California plans performed below national averages. Conclusions This study shows that the mix of fee-for-service and MA enrollees, demographic characteristics of populations, and plan-specific factors can all play a role in observed regional variations. Anticipating value-based payments, further study of successful MA plans could generate lessons for enhancing patient experience for the Medicare population. PMID:21644970

Critical appraisal of emergency medicine education research: the best publications of 2013.

PubMed

Farrell, Susan E; Kuhn, Gloria J; Coates, Wendy C; Shayne, Phillip H; Fisher, Jonathan; Maggio, Lauren A; Lin, Michelle

2014-11-01

The objective was to critically appraise and highlight methodologically superior medical education research articles published in 2013 whose outcomes are pertinent to teaching and education in emergency medicine (EM). A search of the English-language literature in 2013 querying Education Resources Information Center (ERIC), PsychINFO, PubMed, and Scopus identified 251 EM-related studies using hypothesis-testing or observational investigations of educational interventions. Two reviewers independently screened all of the publications and removed articles using established exclusion criteria. Six reviewers then independently scored the remaining 43 publications using either a qualitative a or quantitative scoring system, based on the research methodology of each article. Each scoring system consisted of nine criteria. Selected criteria were based on accepted educational review literature and chosen a priori. Both scoring systems used parallel scoring metrics and have been used previously within this annual review. Forty-three medical education research papers (37 quantitative and six qualitative studies) met the a priori criteria for inclusion and were reviewed. Six quantitative and one qualitative study were scored and ranked most highly by the reviewers as exemplary and are summarized in this article. This annual critical appraisal article aims to promote superior research in EM-related education, by reviewing and highlighting seven of 43 major education research studies, meeting a priori criteria, and published in 2013. Common methodologic pitfalls in the 2013 papers are noted, and current trends in medical education research in EM are discussed. © 2014 by the Society for Academic Emergency Medicine.

Assessing Arthroscopic Skills Using Wireless Elbow-Worn Motion Sensors.

PubMed

Kirby, Georgina S J; Guyver, Paul; Strickland, Louise; Alvand, Abtin; Yang, Guang-Zhong; Hargrove, Caroline; Lo, Benny P L; Rees, Jonathan L

2015-07-01

Assessment of surgical skill is a critical component of surgical training. Approaches to assessment remain predominantly subjective, although more objective measures such as Global Rating Scales are in use. This study aimed to validate the use of elbow-worn, wireless, miniaturized motion sensors to assess the technical skill of trainees performing arthroscopic procedures in a simulated environment. Thirty participants were divided into three groups on the basis of their surgical experience: novices (n = 15), intermediates (n = 10), and experts (n = 5). All participants performed three standardized tasks on an arthroscopic virtual reality simulator while wearing wireless wrist and elbow motion sensors. Video output was recorded and a validated Global Rating Scale was used to assess performance; dexterity metrics were recorded from the simulator. Finally, live motion data were recorded via Bluetooth from the wireless wrist and elbow motion sensors and custom algorithms produced an arthroscopic performance score. Construct validity was demonstrated for all tasks, with Global Rating Scale scores and virtual reality output metrics showing significant differences between novices, intermediates, and experts (p < 0.001). The correlation of the virtual reality path length to the number of hand movements calculated from the wireless sensors was very high (p < 0.001). A comparison of the arthroscopic performance score levels with virtual reality output metrics also showed highly significant differences (p < 0.01). Comparisons of the arthroscopic performance score levels with the Global Rating Scale scores showed strong and highly significant correlations (p < 0.001) for both sensor locations, but those of the elbow-worn sensors were stronger and more significant (p < 0.001) than those of the wrist-worn sensors. A new wireless assessment of surgical performance system for objective assessment of surgical skills has proven valid for assessing arthroscopic skills. The elbow-worn sensors were shown to achieve an accurate assessment of surgical dexterity and performance. The validation of an entirely objective assessment of arthroscopic skill with wireless elbow-worn motion sensors introduces, for the first time, a feasible assessment system for the live operating theater with the added potential to be applied to other surgical and interventional specialties. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Creation and validation of a novel body condition scoring method for the magellanic penguin (Spheniscus magellanicus) in the zoo setting.

PubMed

Clements, Julie; Sanchez, Jessica N

2015-11-01

This research aims to validate a novel, visual body scoring system created for the Magellanic penguin (Spheniscus magellanicus) suitable for the zoo practitioner. Magellanics go through marked seasonal fluctuations in body mass gains and losses. A standardized multi-variable visual body condition guide may provide a more sensitive and objective assessment tool compared to the previously used single variable method. Accurate body condition scores paired with seasonal weight variation measurements give veterinary and keeper staff a clearer understanding of an individual's nutritional status. San Francisco Zoo staff previously used a nine-point body condition scale based on the classic bird standard of a single point of keel palpation with the bird restrained in hand, with no standard measure of reference assigned to each scoring category. We created a novel, visual body condition scoring system that does not require restraint to assesses subcutaneous fat and muscle at seven body landmarks using illustrations and descriptive terms. The scores range from one, the least robust or under-conditioned, to five, the most robust, or over-conditioned. The ratio of body weight to wing length was used as a "gold standard" index of body condition and compared to both the novel multi-variable and previously used single-variable body condition scores. The novel multi-variable scale showed improved agreement with weight:wing ratio compared to the single-variable scale, demonstrating greater accuracy, and reliability when a trained assessor uses the multi-variable body condition scoring system. Zoo staff may use this tool to manage both the colony and the individual to assist in seasonally appropriate Magellanic penguin nutrition assessment. © 2015 Wiley Periodicals, Inc.

Virtual reality computer simulation.

PubMed

Grantcharov, T P; Rosenberg, J; Pahle, E; Funch-Jensen, P

2001-03-01

Objective assessment of psychomotor skills should be an essential component of a modern surgical training program. There are computer systems that can be used for this purpose, but their wide application is not yet generally accepted. The aim of this study was to validate the role of virtual reality computer simulation as a method for evaluating surgical laparoscopic skills. The study included 14 surgical residents. On day 1, they performed two runs of all six tasks on the Minimally Invasive Surgical Trainer, Virtual Reality (MIST VR). On day 2, they performed a laparoscopic cholecystectomy on living pigs; afterward, they were tested again on the MIST VR. A group of experienced surgeons evaluated the trainees' performance on the animal operation, giving scores for total performance error and economy of motion. During the tasks on the MIST VR, errors and noneconomy of movements for the left and right hand were also recorded. There were significant correlations between error scores in vivo and three of the six in vitro tasks (p < 0.05). In vivo economy scores correlated significantly with non-economy right-hand scores for five of the six tasks and with non-economy left-hand scores for one of the six tasks (p < 0.05). In this study, laparoscopic performance in the animal model correlated significantly with performance on the computer simulator. Thus, the computer model seems to be a promising objective method for the assessment of laparoscopic psychomotor skills.

Objective structured assessment of technical skills evaluation of theoretical compared with hands-on training of shoulder dystocia management: a randomized controlled trial.

PubMed

Buerkle, Bernd; Pueth, Julia; Hefler, Lukas A; Tempfer-Bentz, Eva-Katrin; Tempfer, Clemens B

2012-10-01

To compare the skills of performing a shoulder dystocia management algorithm after hands-on training compared with demonstration. We randomized medical students to a 30-minute hands-on (group 1) and a 30-minute demonstration (group 2) training session teaching a standardized shoulder dystocia management scheme on a pelvic training model. Participants were tested with a 22-item Objective Structured Assessment of Technical Skills scoring system after training and 72 hours thereafter. Objective Structured Assessment of Technical Skills scores were the primary outcome. Performance time, self-assessment, confidence, and global rating scale were the secondary outcomes. Statistics were performed using Mann-Whitney U test, χ test, and multiple linear regression analysis. Two hundred three participants were randomized. Objective Structured Assessment of Technical Skills scores were significantly higher in group 1 (n=103) compared with group 2 (n=100) (17.95±3.14 compared with 15.67±3.18, respectively; P<.001). The secondary outcomes global rating scale (GRS; 10.94±2.71 compared with 8.57±2.61, respectively; P<.001), self-assessment (3.15±0.94 compared with 2.72±1.01; P=.002), and confidence (3.72±0.98 compared with 3.34±0.90, respectively; P=.005), but not performance time (3:19±0:48 minutes compared with 3:31±1:05 minutes; P=.1), were also significantly different, favoring group 1. After 72 hours, Objective Structured Assessment of Technical Skills scores were still significantly higher in group 1 (n=67) compared with group 2 (n=60) (18.17±2.76 compared with 14.98±3.03, respectively; P<.001) as were GRS (10.80±2.62 compared with 8.15±2.59; P<.001) and self assessment (SA; 3.44±0.87 compared with 2.95±0.94; P=.003). In a multiple linear regression analysis, group assignment (group 1 compared with 2; P<.001) and sex (P=.002) independently influenced Objective Structured Assessment of Technical Skills scores. Hands-on training helps to achieve a significant improvement of shoulder dystocia management on a pelvic training model. www.ClinicalTrials.gov, NCT01618565. I.

On the performances of different IMRT Treatment Planning Systems for selected paediatric cases.

PubMed

Fogliata, Antonella; Nicolini, Giorgia; Alber, Markus; Asell, Mats; Clivio, Alessandro; Dobler, Barbara; Larsson, Malin; Lohr, Frank; Lorenz, Friedlieb; Muzik, Jan; Polednik, Martin; Vanetti, Eugenio; Wolff, Dirk; Wyttenbach, Rolf; Cozzi, Luca

2007-02-15

To evaluate the performance of seven different TPS (Treatment Planning Systems: Corvus, Eclipse, Hyperion, KonRad, Oncentra Masterplan, Pinnacle and PrecisePLAN) when intensity modulated (IMRT) plans are designed for paediatric tumours. Datasets (CT images and volumes of interest) of four patients were used to design IMRT plans. The tumour types were: one extraosseous, intrathoracic Ewing Sarcoma; one mediastinal Rhabdomyosarcoma; one metastatic Rhabdomyosarcoma of the anus; one Wilm's tumour of the left kidney with multiple liver metastases. Prescribed doses ranged from 18 to 54.4 Gy. To minimise variability, the same beam geometry and clinical goals were imposed on all systems for every patient. Results were analysed in terms of dose distributions and dose volume histograms. For all patients, IMRT plans lead to acceptable treatments in terms of conformal avoidance since most of the dose objectives for Organs At Risk (OARs) were met, and the Conformity Index (averaged over all TPS and patients) ranged from 1.14 to 1.58 on primary target volumes and from 1.07 to 1.37 on boost volumes. The healthy tissue involvement was measured in terms of several parameters, and the average mean dose ranged from 4.6 to 13.7 Gy. A global scoring method was developed to evaluate plans according to their degree of success in meeting dose objectives (lower scores are better than higher ones). For OARs the range of scores was between 0.75 +/- 0.15 (Eclipse) to 0.92 +/- 0.18 (Pinnacle(3) with physical optimisation). For target volumes, the score ranged from 0.05 +/- 0.05 (Pinnacle(3) with physical optimisation) to 0.16 +/- 0.07 (Corvus). A set of complex paediatric cases presented a variety of individual treatment planning challenges. Despite the large spread of results, inverse planning systems offer promising results for IMRT delivery, hence widening the treatment strategies for this very sensitive class of patients.

On the performances of different IMRT treatment planning systems for selected paediatric cases

PubMed Central

Fogliata, Antonella; Nicolini, Giorgia; Alber, Markus; Åsell, Mats; Clivio, Alessandro; Dobler, Barbara; Larsson, Malin; Lohr, Frank; Lorenz, Friedlieb; Muzik, Jan; Polednik, Martin; Vanetti, Eugenio; Wolff, Dirk; Wyttenbach, Rolf; Cozzi, Luca

2007-01-01

Background To evaluate the performance of seven different TPS (Treatment Planning Systems: Corvus, Eclipse, Hyperion, KonRad, Oncentra Masterplan, Pinnacle and PrecisePLAN) when intensity modulated (IMRT) plans are designed for paediatric tumours. Methods Datasets (CT images and volumes of interest) of four patients were used to design IMRT plans. The tumour types were: one extraosseous, intrathoracic Ewing Sarcoma; one mediastinal Rhabdomyosarcoma; one metastatic Rhabdomyosarcoma of the anus; one Wilm's tumour of the left kidney with multiple liver metastases. Prescribed doses ranged from 18 to 54.4 Gy. To minimise variability, the same beam geometry and clinical goals were imposed on all systems for every patient. Results were analysed in terms of dose distributions and dose volume histograms. Results For all patients, IMRT plans lead to acceptable treatments in terms of conformal avoidance since most of the dose objectives for Organs At Risk (OARs) were met, and the Conformity Index (averaged over all TPS and patients) ranged from 1.14 to 1.58 on primary target volumes and from 1.07 to 1.37 on boost volumes. The healthy tissue involvement was measured in terms of several parameters, and the average mean dose ranged from 4.6 to 13.7 Gy. A global scoring method was developed to evaluate plans according to their degree of success in meeting dose objectives (lower scores are better than higher ones). For OARs the range of scores was between 0.75 ± 0.15 (Eclipse) to 0.92 ± 0.18 (Pinnacle3 with physical optimisation). For target volumes, the score ranged from 0.05 ± 0.05 (Pinnacle3 with physical optimisation) to 0.16 ± 0.07 (Corvus). Conclusion A set of complex paediatric cases presented a variety of individual treatment planning challenges. Despite the large spread of results, inverse planning systems offer promising results for IMRT delivery, hence widening the treatment strategies for this very sensitive class of patients. PMID:17302972

The Objective Borderline method (OBM): a probability-based model for setting up an objective pass/fail cut-off score in medical programme assessments.

PubMed

Shulruf, Boaz; Turner, Rolf; Poole, Phillippa; Wilkinson, Tim

2013-05-01

The decision to pass or fail a medical student is a 'high stakes' one. The aim of this study is to introduce and demonstrate the feasibility and practicality of a new objective standard-setting method for determining the pass/fail cut-off score from borderline grades. Three methods for setting up pass/fail cut-off scores were compared: the Regression Method, the Borderline Group Method, and the new Objective Borderline Method (OBM). Using Year 5 students' OSCE results from one medical school we established the pass/fail cut-off scores by the abovementioned three methods. The comparison indicated that the pass/fail cut-off scores generated by the OBM were similar to those generated by the more established methods (0.840 ≤ r ≤ 0.998; p < .0001). Based on theoretical and empirical analysis, we suggest that the OBM has advantages over existing methods in that it combines objectivity, realism, robust empirical basis and, no less importantly, is simple to use.

Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities.

PubMed

Manyazewal, Tsegahun

2017-01-01

Acknowledging the health system strengthening agenda, the World Health Organization (WHO) has formulated a health systems framework that describes health systems in terms of six building blocks. This study aimed to determine the current status of the six WHO health system building blocks in public healthcare facilities in Ethiopia. A quantitative, cross-sectional study was conducted in five public hospitals in central Ethiopia which were in a post-reform period. A self-administered, structured questionnaire which covered the WHO's six health system building blocks was used to collect data on healthcare professionals who consented. Data was analyzed using IBM SPSS version 20. The overall performance of the public hospitals was 60% when weighed against the WHO building blocks which, in this procedure, needed a minimum of 80% score. For each building block, performance scores were: information 53%, health workforce 55%, medical products and technologies 58%, leadership and governance 61%, healthcare financing 62%, and service delivery 69%. There existed a significant difference in performance among the hospitals ( p  < .001). The study proved that the WHO's health system building blocks are useful for assessing the process of strengthening health systems in Ethiopia. The six blocks allow identifying different improvement opportunities in each one of the hospitals. There was no contradiction between the indicators of the WHO building blocks and the health sustainable development goal (SDG) objectives. However, such SDG objectives should not be a substitute for strategies to strengthen health systems.

Development and Use of a Traditional Mexican Diet Score in Relation to Systemic Inflammation and Insulin Resistance among Women of Mexican Descent123

PubMed Central

Santiago-Torres, Margarita; Tinker, Lesley F; Allison, Matthew A; Breymeyer, Kara L; Garcia, Lorena; Kroenke, Candyce H; Lampe, Johanna W; Shikany, James M; Van Horn, Linda; Neuhouser, Marian L

2015-01-01

Background: Women of Mexican descent are disproportionally affected by obesity, systemic inflammation, and insulin resistance (IR). Available approaches used to give scores to dietary patterns relative to dietary guidelines may not effectively capture traditional diets of Mexicans, who comprise the largest immigrant group in the United States. Objectives: We characterized an a priori traditional Mexican diet (MexD) score high in corn tortillas, beans, soups, Mexican mixed dishes (e.g., tamales), fruits, vegetables, full-fat milk, and Mexican cheeses and low in refined grains and added sugars and evaluated the association of the MexD score with systemic inflammation and IR in 493 postmenopausal participants in the Women’s Health Initiative (WHI) who are of Mexican ethnic descent. Methods: The MexD score was developed from the baseline (1993–1998) WHI food frequency questionnaire, which included Hispanic foods and was available in Spanish. Body mass index (BMI) was computed from baseline measured weight and height, and ethnicity was self-reported. Outcome variables were high sensitivity C-reactive protein (hsCRP), glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and triglyceride concentrations measured at follow-up (2012–2013). Multivariable linear and logistic regression models were used to test the associations of the MexD score with systemic inflammation and IR. Results: The mean ± SD MexD score was 5.8 ± 2.1 (12 maximum points) and was positively associated with intakes of carbohydrates, vegetable protein, and dietary fiber and inversely associated with intakes of added sugars and total fat (P < 0.01). Women with high compared with low MexD scores, consistent with a more-traditional Mexican diet, had 23% and 15% lower serum hsCRP (P < 0.05) and insulin concentrations, respectively (P < 0.05). Baseline BMI modified these associations such that lower MexD scores were associated with higher insulin and HOMA-IR in overweight/obese women (P-interaction <0.05). Conclusion: These findings suggest that greater adherence to a traditional Mexican diet could help reduce the future risk of systemic inflammation and IR in women of Mexican descent. PMID:26491126

THE IMPACT OF THE MELD SCORE ON LIVER TRANSPLANT ALLOCATION AND RESULTS: AN INTEGRATIVE REVIEW

PubMed Central

de MORAES, Ana Claudia Oliveira; de OLIVEIRA, Priscilla Caroliny; da FONSECA-NETO, Olival Cirilo Lucena

2017-01-01

ABSTRACT Introduction: Liver transplantation is intended to increase the survival of patients with chronic liver disease in terminal phase, as well as improved quality of life. Since the first transplant until today many changes have occurred in the organ allocation system. Objective: To review the literature on the Model for End-stage Liver Disease (MELD) and analyze its correlation with survival after liver transplantation. Method: An integrative literature review in Lilacs, SciELO, and Pubmed in October 2015, was realized. Were included eight studies related to the MELD score and its impact on liver transplant. Results: There was predominance of transplants in male between 45-55 y. The main indications were hepatitis C, hepatocellular carcinoma and alcoholic cirrhosis. The most important factors post-surgery were related to the MELD score, the recipient age, expanded donor criteria and hemotransfusion. Conclusion: The MELD system reduced the death rate in patients waiting for a liver transplant. However, this score by itself is not a good predictor of survival after liver transplantation. PMID:28489174

Walk Score™ As a Global Estimate of Neighborhood Walkability

PubMed Central

Carr, Lucas J.; Dunsiger, Shira I.; Marcus, Bess H.

2010-01-01

Background Walk Score™ has recently been demonstrated as a valid and reliable tool for estimating access to nearby facilities, a critical component of the physical activity environment. It has not yet been determined whether Walk Score relates to other critical components of the physical activity environment including street connectivity, access to public transit, residential density and/or crime. Purpose The aim of this study is to explore the relationship between Walk Score and objective/subjective measures of the physical activity environment. Methods Walk Scores were calculated for residential addresses of 296 participants of two RCTs (2006–2009). Street connectivity, residential density, access to public transit provisions and crime were objectively measured (GIS) and cross-referenced with Walk Scores and participant's perceptions of the environment (e.g., perceived crime, access to physical activity facilities, perceived neighborhood walkability). Pairwise Pearson correlations were calculated in March 2010 to compare Walk Score to subjective/objective measures of neighborhood walkability. Results Significant positive correlations were identified between Walk Score and several objective (e.g., street connectivity, residential density and access to public transit provisions) and subjective (e.g., summed score of the physical activity environment) measures of the physical activity environment. However, positive correlations were also observed between Walk Score and crime. Conclusions Collectively, these findings support Walk Score as a free, easy to use and quick proxy of neighborhood density and access to nearby amenities. However, positive associations between Walk Score and reported crime highlight a limitation of Walk Score and warrant caution of its use. PMID:20965384

Critical Appraisal of Emergency Medicine Education Research: The Best Publications of 2014.

PubMed

Yarris, Lalena M; Juve, Amy Miller; Coates, Wendy C; Fisher, Jonathan; Heitz, Corey; Shayne, Philip; Farrell, Susan E

2015-11-01

The objective was to critically appraise and highlight rigorous education research study articles published in 2014 whose outcomes advance the science of emergency medicine (EM) education. A search of the English language literature in 2014 querying Education Resources Information Center (ERIC), PsychINFO, PubMed, and Scopus identified 243 EM-related articles using either quantitative (hypothesis-testing or observational investigations of educational interventions) or qualitative (exploring important phenomena in EM education) methods. Two reviewers independently screened all of the publications using previously established exclusion criteria. Six reviewers then independently scored the 25 selected publications using either a qualitative or a quantitative scoring system. Each scoring system consisted of nine criteria. Selected criteria were based on accepted educational review literature and chosen a priori. Both scoring systems use parallel scoring metrics and have been used previously within this annual review. Twenty-five medical education research papers (22 quantitative, three qualitative) met the criteria for inclusion and were reviewed. Five quantitative and two qualitative studies were ranked most highly by the reviewers as exemplary and are summarized in this article. This annual critical appraisal series highlights seven excellent EM education research studies, meeting a priori criteria and published in 2014. Methodologic strengths in the 2014 papers are noted, and current trends in medical education research in EM are discussed. © 2015 by the Society for Academic Emergency Medicine.

Preliminary validation of the Knee Inflammation MRI Scoring System (KIMRISS) for grading bone marrow lesions in osteoarthritis of the knee: data from the Osteoarthritis Initiative

PubMed Central

Jeffery, Dean; Buller, M; Wichuk, Stephanie; McDougall, Dave; Lambert, Robert GW; Maksymowych, Walter P

2017-01-01

Objective Bone marrow lesions (BML) are an MRI feature of osteoarthritis (OA) offering a potential target for therapy. We developed the Knee Inflammation MRI Scoring System (KIMRISS) to semiquantitatively score BML with high sensitivity to small changes, and compared feasibility, reliability and responsiveness versus the established MRI Osteoarthritis Knee Score (MOAKS). Methods KIMRISS incorporates a web-based graphic overlay to facilitate detailed regional BML scoring. Observers scored BML by MOAKS and KIMRISS on sagittal fluid-sensitive sequences. Exercise 1 focused on interobserver reliability in Osteoarthritis Initiative observational data, with 4 readers (two experienced/two new to KIMRISS) scoring BML in 80 patients (baseline/1 year). Exercise 2 focused on responsiveness in an open-label trial of adalimumab, with 2 experienced readers scoring BML in 16 patients (baseline/12 weeks). Results Scoring time was similar for KIMRISS and MOAKS. Interobserver reliability of KIMRISS was equivalent to MOAKS for BML status (ICC=0.84 vs 0.79), but consistently better than MOAKS for change in BML: Exercise 1 (ICC 0.82 vs 0.53), Exercise 2 (ICC 0.90 vs 0.32), and in new readers (0.87–0.92 vs 0.32–0.51). KIMRISS BML was more responsive than MOAKS BML: post-treatment BML improvement in Exercise 2 reached statistical significance for KIMRISS (SRM −0.69, p=0.015), but not MOAKS (SRM −0.12, p=0.625). KIMRISS BML also more strongly correlated to WOMAC scores than MOAKS BML (r=0.80 vs 0.58, p<0.05). Conclusions KIMRISS BML scoring was highly feasible, and was more reliable for assessment of change and more responsive to change than MOAKS BML for expert and new readers. PMID:28123780

Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 2: reliability and application to multiple joints of a standardised consensus-based scoring system

PubMed Central

Terslev, Lene; Naredo, Esperanza; Aegerter, Philippe; Wakefield, Richard J; Backhaus, Marina; Balint, Peter; Bruyn, George A W; Iagnocco, Annamaria; Jousse-Joulin, Sandrine; Schmidt, Wolfgang A; Szkudlarek, Marcin; Conaghan, Philip G; Filippucci, Emilio

2017-01-01

Objectives To test the reliability of new ultrasound (US) definitions and quantification of synovial hypertrophy (SH) and power Doppler (PD) signal, separately and in combination, in a range of joints in patients with rheumatoid arthritis (RA) using the European League Against Rheumatisms–Outcomes Measures in Rheumatology (EULAR-OMERACT) combined score for PD and SH. Methods A stepwise approach was used: (1) scoring static images of metacarpophalangeal (MCP) joints in a web-based exercise and subsequently when scanning patients; (2) scoring static images of wrist, proximal interphalangeal joints, knee and metatarsophalangeal joints in a web-based exercise and subsequently when scanning patients using different acquisitions (standardised vs usual practice). For reliability, kappa coefficients (κ) were used. Results Scoring MCP joints in static images showed substantial intraobserver variability but good to excellent interobserver reliability. In patients, intraobserver reliability was the same for the two acquisition methods. Interobserver reliability for SH (κ=0.87) and PD (κ=0.79) and the EULAR-OMERACT combined score (κ=0.86) were better when using a ‘standardised’ scan. For the other joints, the intraobserver reliability was excellent in static images for all scores (κ=0.8–0.97) and the interobserver reliability marginally lower. When using standardised scanning in patients, the intraobserver was good (κ=0.64 for SH and the EULAR-OMERACT combined score, 0.66 for PD) and the interobserver reliability was also good especially for PD (κ range=0.41–0.92). Conclusion The EULAR-OMERACT score demonstrated moderate-good reliability in MCP joints using a standardised scan and is equally applicable in non-MCP joints. This scoring system should underpin improved reliability and consequently the responsiveness of US in RA clinical trials. PMID:28948984

Physical Function Does Not Predict Care Assessment Need Score in Older Veterans.

PubMed

Serra, Monica C; Addison, Odessa; Giffuni, Jamie; Paden, Lydia; Morey, Miriam C; Katzel, Leslie

2017-01-01

The Veterans Health Administration's Care Assessment Need (CAN) score is a statistical model, aimed to predict high-risk patients. We were interested in determining if a relationship existed between physical function and CAN scores. Seventy-four older (71 ± 1 years) male Veterans underwent assessment of CAN score and subjective (Short Form-36 [SF-36]) and objective (self-selected walking speed, four square step test, short physical performance battery) assessment of physical function. Approximately 25% of participants self-reported limitations performing lower intensity activities, while 70% to 90% reported limitations with more strenuous activities. When compared with cut points indicative of functional limitations, 35% to 65% of participants had limitations for each of the objective measures. Any measure of subjective or objective physical function did not predict CAN score. These data indicate that the addition of a physical function assessment may complement the CAN score in the identification of high-risk patients.

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.

Evaluation of a transvaginal mesh delivery system for the correction of pelvic organ prolapse: subjective and objective findings at least 1 year after surgery.

PubMed

Culligan, Patrick J; Littman, Paul M; Salamon, Charbel G; Priestley, Jennifer L; Shariati, Amir

2010-11-01

We sought to track objective and subjective outcomes ≥1 year after transvaginal mesh system to correct prolapse. This was a retrospective cohort study of 120 women who received a transvaginal mesh procedure (Avaulta Solo, CR Bard Inc, Covington, GA). Outcomes were pelvic organ prolapse quantification values; Pelvic Floor Distress Inventory, Short Form 20/Pelvic Floor Impact Questionnaire, Short Form 7 scores; and a surgical satisfaction survey. "Surgical failure" was defined as pelvic organ prolapse quantification point >0, and/or any reports of vaginal bulge. Of 120 patients, 116 (97%) were followed up for a mean of 14.4 months (range, 12-30). In all, 74 patients had only anterior mesh, 21 only posterior mesh, and 21 both meshes. Surgical cure rate was 81%. Surgical failure was more common if preoperative point C ≥+2 (35% vs 16%; P = .04). Mesh erosion and de novo pain occurred in 11.7% and 3.3%, respectively. Pelvic Floor Distress Inventory, Short Form 20/Pelvic Floor Impact Questionnaire, Short Form 7 scores improved (P < .01). Objective and subjective improvements occurred at ≥1 year, yet failure rates were high when preoperative point C was ≥+2. Copyright © 2010 Mosby, Inc. All rights reserved.

The effects of computer-assisted cognitive rehabilitation on Alzheimer's dementia patients memories.

PubMed

Hwang, Jung-Ha; Cha, Hyun-Gyu; Cho, Young-Seok; Kim, Tae-Sue; Cho, Hyuk-Shin

2015-09-01

[Purpose] The purpose of the present study was to conduct Computer-Assisted Cognitive Rehabilitation (COMCOG) to examine the effects of COMCOG on Alzheimer's dementia patients' memories. [Subjects] Thirty-five patients diagnosed with Alzheimer's dementia received COMCOG for 30 minutes per day, five days per week for four weeks. [Methods] Before and after the COMCOG intervention, subjects' cognitive functions were evaluated using the Cognitive Assessment Reference Diagnosis System (CARDS) and Mini-Mental State Examination-Korea (MMSE-K) test. [Results] According to the results of the evaluation, among the CARDS scores of the subjects who received COMCOG, the scores of the delayed 10-word list, delayed 10-object list, recognition 10-object, and recent memory significantly increased while the scores of recognition 10-word significantly decreased after intervention compared to before intervention. In addition, among the MMSE-K items, the orientation, registration, and recall showed significant increases. [Conclusion] Based on these results, delay in the progress of memory deterioration can be expected when COMCOG is conducted for Alzheimer's dementia patients who show declines in cognitive functions.

Development of a quantitative assessment method of pigmentary skin disease using ultraviolet optical imaging.

PubMed

Lee, Onseok; Park, Sunup; Kim, Jaeyoung; Oh, Chilhwan

2017-11-01

The visual scoring method has been used as a subjective evaluation of pigmentary skin disorders. Severity of pigmentary skin disease, especially melasma, is evaluated using a visual scoring method, the MASI (melasma area severity index). This study differentiates between epidermal and dermal pigmented disease. The study was undertaken to determine methods to quantitatively measure the severity of pigmentary skin disorders under ultraviolet illumination. The optical imaging system consists of illumination (white LED, UV-A lamp) and image acquisition (DSLR camera, air cooling CMOS CCD camera). Each camera is equipped with a polarizing filter to remove glare. To analyze images of visible and UV light, images are divided into frontal, cheek, and chin regions of melasma patients. Each image must undergo image processing. To reduce the curvature error in facial contours, a gradient mask is used. The new method of segmentation of front and lateral facial images is more objective for face-area-measurement than the MASI score. Image analysis of darkness and homogeneity is adequate to quantify the conventional MASI score. Under visible light, active lesion margins appear in both epidermal and dermal melanin, whereas melanin is found in the epidermis under UV light. This study objectively analyzes severity of melasma and attempts to develop new methods of image analysis with ultraviolet optical imaging equipment. Based on the results of this study, our optical imaging system could be used as a valuable tool to assess the severity of pigmentary skin disease. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

External validation of the simple clinical score and the HOTEL score, two scores for predicting short-term mortality after admission to an acute medical unit.

PubMed

Stræde, Mia; Brabrand, Mikkel

2014-01-01

Clinical scores can be of aid to predict early mortality after admission to a medical admission unit. A developed scoring system needs to be externally validated to minimise the risk of the discriminatory power and calibration to be falsely elevated. We performed the present study with the objective of validating the Simple Clinical Score (SCS) and the HOTEL score, two existing risk stratification systems that predict mortality for medical patients based solely on clinical information, but not only vital signs. Pre-planned prospective observational cohort study. Danish 460-bed regional teaching hospital. We included 3046 consecutive patients from 2 October 2008 until 19 February 2009. 26 (0.9%) died within one calendar day and 196 (6.4%) died within 30 days. We calculated SCS for 1080 patients. We found an AUROC of 0.960 (95% confidence interval [CI], 0.932 to 0.988) for 24-hours mortality and 0.826 (95% CI, 0.774-0.879) for 30-day mortality, and goodness-of-fit test, χ(2) = 2.68 (10 degrees of freedom), P = 0.998 and χ(2) = 4.00, P = 0.947, respectively. We included 1470 patients when calculating the HOTEL score. Discriminatory power (AUROC) was 0.931 (95% CI, 0.901-0.962) for 24-hours mortality and goodness-of-fit test, χ(2) = 5.56 (10 degrees of freedom), P = 0.234. We find that both the SCS and HOTEL scores showed an excellent to outstanding ability in identifying patients at high risk of dying with good or acceptable precision.

A comparison of health-related quality of life (HRQoL) across four systemic autoimmune rheumatic diseases (SARDs)

PubMed Central

Greenfield, Julia; Hudson, Marie; Vinet, Evelyne; Fortin, Paul R.; Bykerk, Vivian; Pineau, Christian A.; Wang, Mianbo; Bernatsky, Sasha; Baron, Murray

2017-01-01

Objectives To compare physical and mental health-related quality of life (HRQoL) across four systemic autoimmune rheumatic diseases (SARD). Methods Incident subjects enrolled in four SARD cohorts, namely systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA) and idiopathic inflammatory myopathies (IIM) were studied. The outcomes of interest were baseline Short Form Health Survey physical (PCS) and mental (MCS) component summary scores. Multivariate analysis was conducted to determine whether PCS and MCS scores differed across SARD type. Results The study included 118 SLE (93% women, mean age 36 years), 108 SSc (79% women, mean age 55), 64 RA (63% women, mean age 58) and 25 IIM (68% women, mean age 49) subjects. Mean PCS scores were 38.9 ± 12.2 in SLE, 37.1 ± 13.3 in RA, 35.0 ± 13.6 in SSc and 28.0 ± 15.4 in IIM. Mean MCS scores were 45.0 ± 13.3 in RA, 44.4 ± 14.7 in SSc, 40.1 ± 14.3 in SLE and 33.6 ± 18.7 in IIM. SARD type was an independent predictor of HRQoL with, in some cases, the magnitude of the differences reaching one standard deviation (IIM worse PCS scores compared to SLE (β -12.23 [95% CI -18.11, -6.36; p<0.001]); IIM worse MCS scores compared to SSc (β -11.05 [95% CI -17.53, -4.58; p = 0.001]) and RA (β -11.72 [95% CI -18.62, -4.81; p = 0.001]). Conclusions Cross-SARD research provides a novel approach to gain greater understanding of commonalities and differences across rheumatic diseases. The differences observed warrant further research into correlates and trajectories over time. PMID:29261752

Application of the British Food Standards Agency nutrient profiling system in a French food composition database.

PubMed

Julia, Chantal; Kesse-Guyot, Emmanuelle; Touvier, Mathilde; Méjean, Caroline; Fezeu, Léopold; Hercberg, Serge

2014-11-28

Nutrient profiling systems are powerful tools for public health initiatives, as they aim at categorising foods according to their nutritional quality. The British Food Standards Agency (FSA) nutrient profiling system (FSA score) has been validated in a British food database, but the application of the model in other contexts has not yet been evaluated. The objective of the present study was to assess the application of the British FSA score in a French food composition database. Foods from the French NutriNet-Santé study food composition table were categorised according to their FSA score using the Office of Communication (OfCom) cut-off value ('healthier' ≤ 4 for foods and ≤ 1 for beverages; 'less healthy' >4 for foods and >1 for beverages) and distribution cut-offs (quintiles for foods, quartiles for beverages). Foods were also categorised according to the food groups used for the French Programme National Nutrition Santé (PNNS) recommendations. Foods were weighted according to their relative consumption in a sample drawn from the NutriNet-Santé study (n 4225), representative of the French population. Classification of foods according to the OfCom cut-offs was consistent with food groups described in the PNNS: 97·8 % of fruit and vegetables, 90·4 % of cereals and potatoes and only 3·8 % of sugary snacks were considered as 'healthier'. Moreover, variability in the FSA score allowed for a discrimination between subcategories in the same food group, confirming the possibility of using the FSA score as a multiple category system, for example as a basis for front-of-pack nutrition labelling. Application of the FSA score in the French context would adequately complement current public health recommendations.

Development of a Diagnostic Clinical Score for Hemodynamically Significant Patent Ductus Arteriosus

PubMed Central

Kindler, Annemarie; Seipolt, Barbara; Heilmann, Antje; Range, Ursula; Rüdiger, Mario; Hofmann, Sigrun Ruth

2017-01-01

There is no consensus about the hemodynamic significance and, therefore, the need to treat a persistent ductus arteriosus in preterm newborns. Since the diagnosis of a hemodynamically significant persistent ductus arteriosus (hsPDA) is made by a summary of non-uniform echo-criteria in combination with the clinical deterioration of the preterm neonate, standardized clinical and ultrasound scoring systems are needed. The objective of this study was the development of a clinical score for the detection and follow-up of hsPDA. In this observational cohort study of 154 preterm neonates (mean gestational age 28.1 weeks), clinical signs for the development of hsPDA were recorded in a standardized score and compared to echocardiography. Analyzing the significance of single score parameters compared to the diagnosis by echocardiography, we developed a short clinical score (calculated sensitivity 84% and specificity 80%). In conclusion, this clinical diagnostic PDA score is non-invasive and quickly to implement. The continuous assessment of defined clinical parameters allows for a more precise diagnosis of hemodynamic significance of PDA and, therefore, should help to detect preterm neonates needing PDA-treatment. The score, therefore, allows a more targeted use of echocardiography in these very fragile preterm neonates. PMID:29312911

The Comparison of Iranian Normative Reference Data with Five Countries ‎Across Variables in Eight Rorschach Comprehensive System (CS) Clusters

PubMed Central

Hosseininasab, Abufazel; Mohammadi, Mohammadreza; Jouzi, Samira; Esmaeilinasab, Maryam; Delavar, Ali

2016-01-01

Objective: This study aimed to provide a normative study documenting how 114 five-seven year-old non-‎patient Iranian children respond to the Rorschach test. We compared this especial sample to ‎international normative reference values for the Comprehensive System (CS).‎ Method: One hundred fourteen 5- 7- year-old non-patient Iranian children were recruited from public ‎schools. Using five child and adolescent samples from five countries, we compared Iranian ‎Normative Reference Data- based on reference means and standard deviations for each sample.‎ Results: Findings revealed that how the scores in each sample were distributed and how the samples were ‎compared across variables in eight Rorschach Comprehensive System (CS) clusters. We reported ‎all descriptive statistics such as reference mean and standard deviation for all variables.‎ Conclusion: Iranian clinicians could rely on country specific or “local norms” when assessing children. We ‎discourage Iranian clinicians to use many CS scores to make nomothetic, score-based inferences ‎about psychopathology in children and adolescents.‎ PMID:27928247

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.

Cross-cultural adaptation and validation of Systemic Lupus Erythematosus Quality of Life questionnaire into Arabic.

PubMed

Aziz, M M; Galal, M A A; Elzohri, M H; El-Nouby, F; Leong, K P

2018-04-01

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which affects all aspects of quality of life (QoL) of the patients. Comprehensive patient assessment should include QoL measures in addition to the objective clinical measures of the disease. There is no specific Arabic instrument for assessment of QoL of SLE patients. The objective of this study was to translate and cross culturally adapt the SLEQOL questionnaire into Arabic and test its reliability and validity. The SLEQOL questionnaire was translated into Arabic based on the Guidelines for Translation and Cross-cultural Adaptation into other languages. Reliability was assessed by interviewing patients three times: two interviews on the same day by different interviewers and the third interview 14 days later by one of the first interviewers. Validity was assessed by correlating SLEQOL scores of 91 patients with 36-item Short Form Health Survey (SF-36) scores and clinical parameters of the patients. We found that the Arabic version of SLEQOL has a Cronbach's alpha of 0.936, interobserver and intraobserver correlation coefficients of 0.809 and 0.886 respectively. Strong correlations were also found between SLEQOL scores and SF-36 Physical and Mental Component summaries. In conclusion, the Arabic version of SLEQOL is a reliable and valid instrument for measuring QoL of Egyptian SLE patients.

The relationship between objective balance, perceived sense of balance, and fear of falling in stroke patients.

PubMed

Oguz, Semra; Demirbuken, Ilksan; Kavlak, Bahar; Acar, Gonul; Yurdalan, Saadet Ufuk; Polat, Mine Gulden

2017-10-01

The objective of our study was to investigate the relationship between objective balance, fear of falling, and perceived sense of balance (PSB) in stroke patients. Seventy patients aged 18-65 years with chronically developed hemiplegia or hemiparesis were enrolled in the study. Patients' objective balance scores, fear of falling, and PSB were obtained using the berg balance scale (BBS), the falls efficacy scale (FES), and a visual analog scale, respectively. The Standard Mini-Mental Examination was performed to exclude patients with mental disorders from the study. There was a moderate negative correlation between PSB and BBS scores (p = 0.001, ρ = -0.588); a strong negative correlation between BBS and FES scores (p = 0.001, ρ = -0.808); and a strong positive correlation between PSB and FES scores (p = 0.001, ρ = 0.714). We found that BBS scores had negative correlation with PBS scores in left hemiplegic patients while there was no any relationship between BBS and PBS scores in right hemiplegic patients. PSB assessment, besides the BBS, should be considered among the routine assessment methods that enable the rehabilitation team to be aware of patients' balance capacities.

Iterative User Interface Design for Automated Sequential Organ Failure Assessment Score Calculator in Sepsis Detection

PubMed Central

Herasevich, Vitaly

2017-01-01

Background The new sepsis definition has increased the need for frequent sequential organ failure assessment (SOFA) score recalculation and the clerical burden of information retrieval makes this score ideal for automated calculation. Objective The aim of this study was to (1) estimate the clerical workload of manual SOFA score calculation through a time-motion analysis and (2) describe a user-centered design process for an electronic medical record (EMR) integrated, automated SOFA score calculator with subsequent usability evaluation study. Methods First, we performed a time-motion analysis by recording time-to-task-completion for the manual calculation of 35 baseline and 35 current SOFA scores by 14 internal medicine residents over a 2-month period. Next, we used an agile development process to create a user interface for a previously developed automated SOFA score calculator. The final user interface usability was evaluated by clinician end users with the Computer Systems Usability Questionnaire. Results The overall mean (standard deviation, SD) time-to-complete manual SOFA score calculation time was 61.6 s (33). Among the 24% (12/50) usability survey respondents, our user-centered user interface design process resulted in >75% favorability of survey items in the domains of system usability, information quality, and interface quality. Conclusions Early stakeholder engagement in our agile design process resulted in a user interface for an automated SOFA score calculator that reduced clinician workload and met clinicians’ needs at the point of care. Emerging interoperable platforms may facilitate dissemination of similarly useful clinical score calculators and decision support algorithms as “apps.” A user-centered design process and usability evaluation should be considered during creation of these tools. PMID:28526675

Development and initial validation of the Bedside Paediatric Early Warning System score

PubMed Central

2009-01-01

Introduction Adverse outcomes following clinical deterioration in children admitted to hospital wards is frequently preventable. Identification of children for referral to critical care experts remains problematic. Our objective was to develop and validate a simple bedside score to quantify severity of illness in hospitalized children. Methods A case-control design was used to evaluate 11 candidate items and identify a pragmatic score for routine bedside use. Case-patients were urgently admitted to the intensive care unit (ICU). Control-patients had no 'code blue', ICU admission or care restrictions. Validation was performed using two prospectively collected datasets. Results Data from 60 case and 120 control-patients was obtained. Four out of eleven candidate-items were removed. The seven-item Bedside Paediatric Early Warning System (PEWS) score ranges from 0–26. The mean maximum scores were 10.1 in case-patients and 3.4 in control-patients. The area under the receiver operating characteristics curve was 0.91, compared with 0.84 for the retrospective nurse-rating of patient risk for near or actual cardiopulmonary arrest. At a score of 8 the sensitivity and specificity were 82% and 93%, respectively. The score increased over 24 hours preceding urgent paediatric intensive care unit (PICU) admission (P < 0.0001). In 436 urgent consultations, the Bedside PEWS score was higher in patients admitted to the ICU than patients who were not admitted (P < 0.0001). Conclusions We developed and performed the initial validation of the Bedside PEWS score. This 7-item score can quantify severity of illness in hospitalized children and identify critically ill children with at least one hours notice. Prospective validation in other populations is required before clinical application. PMID:19678924

Life quality assessment among patients with atopic eczema.

PubMed

Holm, E A; Wulf, H C; Stegmann, H; Jemec, G B E

2006-04-01

Quantification of quality of life (QoL) related to disease severity is important in patients with atopic eczema (AE), because the assessment provides additional information to the traditional objective clinical scoring systems. To measure health-related QoL (HRQoL) in patients with AE; to analyse discriminant, divergent and convergent validity by examining the association between various QoL methods; and to examine the association between disease severity assessed by an objective Severity Scoring of Atopic Dermatitis (SCORAD) and QoL. HRQoL was assessed at two visits at a 6-monthly interval in 101 patients with AE and 30 controls with one dermatology-specific questionnaire [Dermatology Life Quality Index (DLQI) or Children's DLQI (CDLQI)], one generic instrument (SF-36) and three visual analogue scales (VASs) of severity and pruritus. Objective SCORAD was used to measure disease severity. Patients with AE had significantly lower QoL than healthy controls and the general population. DLQI /CDLQI, pruritus, and patient and investigator overall assessment of eczema severity were significantly (P < 0.0001) and positively correlated with SCORAD, while the generic questionnaire showed only poor correlation. A gender difference was found for the mental component score of SF-36 (P = 0.019). AE has an impact on HRQoL. Patients' mental health, social functioning and role emotional functioning seem to be more affected than physical functioning. A simple VAS score of patients' assessment of disease severity showed the highest and most significant correlations with most of the HRQoL methods used. There is evidence to support the ability of patients with AE to make an accurate determination of their disease severity and QoL.

Influence of iterative reconstruction on coronary calcium scores at multiple heart rates: a multivendor phantom study on state-of-the-art CT systems.

PubMed

van der Werf, N R; Willemink, M J; Willems, T P; Greuter, M J W; Leiner, T

2017-12-28

The objective of this study was to evaluate the influence of iterative reconstruction on coronary calcium scores (CCS) at different heart rates for four state-of-the-art CT systems. Within an anthropomorphic chest phantom, artificial coronary arteries were translated in a water-filled compartment. The arteries contained three different calcifications with low (38 mg), medium (80 mg) and high (157 mg) mass. Linear velocities were applied, corresponding to heart rates of 0, < 60, 60-75 and > 75 bpm. Data were acquired on four state-of-the-art CT systems (CT1-CT4) with routinely used CCS protocols. Filtered back projection (FBP) and three increasing levels of iterative reconstruction (L1-L3) were used for reconstruction. CCS were quantified as Agatston score and mass score. An iterative reconstruction susceptibility (IRS) index was used to assess susceptibility of Agatston score (IRS AS ) and mass score (IRS MS ) to iterative reconstruction. IRS values were compared between CT systems and between calcification masses. For each heart rate, differences in CCS of iterative reconstructed images were evaluated with CCS of FBP images as reference, and indicated as small (< 5%), medium (5-10%) or large (> 10%). Statistical analysis was performed with repeated measures ANOVA tests. While subtle differences were found for Agatston scores of low mass calcification, medium and high mass calcifications showed increased CCS up to 77% with increasing heart rates. IRS AS of CT1-T4 were 17, 41, 130 and 22% higher than IRS MS . Not only were IRS significantly different between all CT systems, but also between calcification masses. Up to a fourfold increase in IRS was found for the low mass calcification in comparison with the high mass calcification. With increasing iterative reconstruction strength, maximum decreases of 21 and 13% for Agatston and mass score were found. In total, 21 large differences between Agatston scores from FBP and iterative reconstruction were found, while only five large differences were found between FBP and iterative reconstruction mass scores. Iterative reconstruction results in reduced CCS. The effect of iterative reconstruction on CCS is more prominent with low-density calcifications, high heart rates and increasing iterative reconstruction strength.

On Becoming Trauma-Informed: Role of the Adverse Childhood Experiences Survey in Tertiary Child and Adolescent Mental Health Services and the Association with Standard Measures of Impairment and Severity

PubMed Central

Rahman, Abdul; Perri, Andrea; Deegan, Avril; Kuntz, Jennifer; Cawthorpe, David

2018-01-01

Context There is a movement toward trauma-informed, trauma-focused psychiatric treatment. Objective To examine Adverse Childhood Experiences (ACE) survey items by sex and by total scores by sex vs clinical measures of impairment to examine the clinical utility of the ACE survey as an index of trauma in a child and adolescent mental health care setting. Design Descriptive, polychoric factor analysis and regression analyses were employed to analyze cross-sectional ACE surveys (N = 2833) and registration-linked data using past admissions (N = 10,400) collected from November 2016 to March 2017 related to clinical data (28 independent variables), taking into account multicollinearity. Results Distinct ACE items emerged for males, females, and those with self-identified sex and for ACE total scores in regression analysis. In hierarchical regression analysis, the final models consisting of standard clinical measures and demographic and system variables (eg, repeated admissions) were associated with substantial ACE total score variance for females (44%) and males (38%). Inadequate sample size foreclosed on developing a reduced multivariable model for the self-identified sex group. Conclusion The ACE scores relate to independent clinical measures and system and demographic variables. There are implications for clinical practice. For example, a child presenting with anxiety and a high ACE score likely requires treatment that is different from a child presenting with anxiety and an ACE score of zero. The ACE survey score is an important index of presenting clinical status that guides patient care planning and intervention in the progress toward a trauma-focused system of care. PMID:29401055

Mammographic image quality in relation to positioning of the breast: A multicentre international evaluation of the assessment systems currently used, to provide an evidence base for establishing a standardised method of assessment.

PubMed

Taylor, K; Parashar, D; Bouverat, G; Poulos, A; Gullien, R; Stewart, E; Aarre, R; Crystal, P; Wallis, M

2017-11-01

Optimum mammography positioning technique is necessary to maximise cancer detection. Current criteria for mammography appraisal lack reliability and validity with a need to develop a more objective system. We aimed to establish current international practice in assessing image quality (IQ), of screening mammograms then develop and validate a reproducible assessment tool. A questionnaire sent to centres in countries undertaking population screening identified practice, participants for an expert panel (EP) of radiologists/radiographers and a testing panel (TP) of radiographers. The EP developed category criteria and descriptors using a modified Delphi process to agree definitions. The EP scored 12 screening mammograms to test agreement then a main set of 178 cases. Weighted scores were derived for each descriptor enabling calculation of numerical parameters for each new category. The TP then scored the main set. Statistical analysis included ANOVA, t-tests and Kendall's coefficient. 11 centres in 8 countries responded forming an EP of 7 members and TP of 44 members. The EP showed moderate agreement when the scoring the mini test set W = 0.50 p < 0.001 and the main set W = 0.55 p < 0.001, 'posterior nipple line' being the most difficult descriptor. The weighted total scores differentiated the 4 new categories Perfect, Good, Adequate and Inadequate (p < 0.001). We have developed an assessment tool by Delphi consensus and weighted consensus criteria. We have successfully tabulated a range of numerical scores for each new category providing the first validated and reproducible mammography IQ scoring system. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Assessing team performance in the operating room: development and use of a "black-box" recorder and other tools for the intraoperative environment.

PubMed

Guerlain, Stephanie; Adams, Reid B; Turrentine, F Beth; Shin, Thomas; Guo, Hui; Collins, Stephen R; Calland, J Forrest

2005-01-01

The objective of this research was to develop a digital system to archive the complete operative environment along with the assessment tools for analysis of this data, allowing prospective studies of operative performance, intraoperative errors, team performance, and communication. Ability to study this environment will yield new insights, allowing design of systems to avoid preventable errors that contribute to perioperative complications. A multitrack, synchronized, digital audio-visual recording system (RATE tool) was developed to monitor intraoperative performance, including software to synchronize data and allow assignment of independent observational scores. Cases were scored for technical performance, participants' situational awareness (knowledge of critical information), and their comfort and satisfaction with the conduct of the procedure. Laparoscopic cholecystectomy (n = 10) was studied. Technical performance of the RATE tool was excellent. The RATE tool allowed real time, multitrack data collection of all aspects of the operative environment, while permitting digital recording of the objective assessment data in a time synchronized and annotated fashion during the procedure. The mean technical performance score was 73% +/- 28% of maximum (perfect) performance. Situational awareness varied widely among team members, with the attending surgeon typically the only team member having comprehensive knowledge of critical case information. The RATE tool allows prospective analysis of performance measures such as technical judgments, team performance, and communication patterns, offers the opportunity to conduct prospective intraoperative studies of human performance, and allows for postoperative discussion, review, and teaching. This study also suggests that gaps in situational awareness might be an underappreciated source of operative adverse events. Future uses of this system will aid teaching, failure or adverse event analysis, and intervention research.

Essential tremor quantification based on the combined use of a smartphone and a smartwatch: The NetMD study.

PubMed

López-Blanco, Roberto; Velasco, Miguel A; Méndez-Guerrero, Antonio; Romero, Juan Pablo; Del Castillo, María Dolores; Serrano, J Ignacio; Benito-León, Julián; Bermejo-Pareja, Félix; Rocon, Eduardo

2018-06-01

The use of wearable technology is an emerging field of research in movement disorders. This paper introduces a clinical study to evaluate the feasibility, clinical correlation and reliability of using a system based in smartwatches to quantify tremor in essential tremor (ET) patients and check its acceptance as clinical monitoring tool. The system is based on a commercial smartwatch and an Android smartphone. An investigational Android application controls the process of recording raw data from the smartwatch three-dimensional gyroscopes. Thirty-four ET patients were consecutively enrolled in the experiments and assessed along one year. Arm tremor was videofilmed and scored using the Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS). Tremor intensity was quantified with the root mean square of angular velocity measured in the patients' wrists. Eighty-two assessments with smartwatches were performed. Spearman's correlation coefficients (ρ) between clinical tremor (FTM-TRS) scores and smartwatch measures for tremor intensity were 0.590 at rest; ρ = 0.738 in steady posture; ρ = 0.189 in finger-to-nose maneuvers; and ρ = 0.652 in pouring water task. Smartwatch reliability was checked by intraclass realiability coefficients: 0.85, 0.95, 0.91, 0.95 respectively. Most of patients showed good acceptance of the system. This commodity hardware contributes to quantify tremor objectively in a consulting-room by customized Android smart devices as clinical monitoring tool. The NetMD system for tremor analysis is feasible, well-correlated with clinical scores, reliable and well-accepted by patients to tremor follow-up. Therefore, it could be an option to objectively quantify tremor in ET patients during their regular follow-up. Copyright © 2018 Elsevier B.V. All rights reserved.

[An objective scoring system to evaluate the credibility of health related websites].

PubMed

Horváth, Tamás; Matics, Katalin; Meskó, Bertalan

2018-04-01

The unreliable quality of online health contents poses a serious challenge to the medical profession. Evaluating websites on the basis of their credibility increases the chance for readers to access professional content of better quality. Hungary still lags behind in taking practical steps to improve the quality and reliability of online patient education. EgészségKommandó (HealthCommando) is a new Hungarian objective scoring system established to evaluate the credibility of health related websites. It uses four types of indicators: transparency, content, recommendations, references. We evaluated 122 websites with EgészségKommandó. Out of this, 22.1% qualified as credible. The same assessment using JAMA benchmarks yielded only one credible website (0.8%). The most frequent deficiencies were the absence of reference to source, the omission of the quote that "the website information does not replace the doctor-patient discussion", and the identity of the author. In 45.9% of the cases, however, the content was written by medical professionals with contact information. By applying different types of credibility and quality indicators in a scoring system, EgészségKommandó can efficiently assess the websites on health-awareness. In cases where the recognized indicators are absent multiple times from a website, it will not pass the credibility test. Thus, EgészégKommandó can act as a filter. At the same time, EgészségKommandó is also capable of assessing webpages of different sorts systemically, and can recommend a proportionately large amount of reliable Hungarian medical web resources to those interested. Orv Hetil. 2018; 159(13): 511-519.

Ecological Validity and Clinical Utility of Patient-Reported Outcomes Measurement Information System (PROMIS®) instruments for detecting premenstrual symptoms of depression, anger, and fatigue

PubMed Central

Junghaenel, Doerte U.; Schneider, Stefan; Stone, Arthur A.; Christodoulou, Christopher; Broderick, Joan E.

2014-01-01

Objective This study examined the ecological validity and clinical utility of NIH Patient Reported-Outcomes Measurement Information System (PROMIS®) instruments for anger, depression, and fatigue in women with premenstrual symptoms. Methods One-hundred women completed daily diaries and weekly PROMIS assessments over 4 weeks. Weekly assessments were administered through Computerized Adaptive Testing (CAT). Weekly CATs and corresponding daily scores were compared to evaluate ecological validity. To test clinical utility, we examined if CATs could detect changes in symptom levels, if these changes mirrored those obtained from daily scores, and if CATs could identify clinically meaningful premenstrual symptom change. Results PROMIS CAT scores were higher in the pre-menstrual than the baseline (ps < .0001) and post-menstrual (ps < .0001) weeks. The correlations between CATs and aggregated daily scores ranged from .73 to .88 supporting ecological validity. Mean CAT scores showed systematic changes in accordance with the menstrual cycle and the magnitudes of the changes were similar to those obtained from the daily scores. Finally, Receiver Operating Characteristic (ROC) analyses demonstrated the ability of the CATs to discriminate between women with and without clinically meaningful premenstrual symptom change. Conclusions PROMIS CAT instruments for anger, depression, and fatigue demonstrated validity and utility in premenstrual symptom assessment. The results provide encouraging initial evidence of the utility of PROMIS instruments for the measurement of affective premenstrual symptoms. PMID:24630180

Built environment attributes related to GPS measured active trips in mid-life and older adults with mobility disabilities.

PubMed

Gell, Nancy M; Rosenberg, Dori E; Carlson, Jordan; Kerr, Jacqueline; Belza, Basia

2015-04-01

Understanding factors which may promote walking in mid-life and older adults with mobility impairments is key given the association between physical activity and positive health outcomes. To examine the relationship between active trips and objective measures of the home neighborhood built environment. Global positioning systems (GPS) data collected on 28 adults age 50+ with mobility disabilities were analyzed for active trips from home. Objective and geographic information systems (GIS) derived measures included Walk Score, population density, street connectivity, crime rates, and slope within the home neighborhood. For this cross-sectional observational study, we conducted mean comparisons between participants who took active trips from home and those who did not for the objective measures. Effect sizes were calculated to assess the magnitude of group differences. Nine participants (32%) took active trips from home. Walking in the home neighborhood was significantly associated with GIS derived measures (Walk Score, population density, and street density; effect sizes 0.9-1.2). Participants who used the home neighborhood for active trips had less slope within 1 km of home but the difference was not significant (73.5 m ± 22 vs. 100.8 m ± 38.1, p = 0.06, d = 0.8). There were no statistically significant differences in mean scores for crime rates between those with active trips from home and those without. The findings provide preliminary evidence that more walkable environments promote active mobility among mid-life and older adults with mobility disabilities. The data suggest that this population can and does use active transportation modes when the built environment is supportive. Copyright © 2015 Elsevier Inc. All rights reserved.

Sympathetic nervous system activity measured by skin conductance quantifies the challenge of walking adaptability tasks after stroke.

PubMed

Clark, David J; Chatterjee, Sudeshna A; McGuirk, Theresa E; Porges, Eric C; Fox, Emily J; Balasubramanian, Chitralakshmi K

2018-02-01

Walking adaptability tasks are challenging for people with motor impairments. The construct of perceived challenge is typically measured by self-report assessments, which are susceptible to subjective measurement error. The development of an objective physiologically-based measure of challenge may help to improve the ability to assess this important aspect of mobility function. The objective of this study to investigate the use of sympathetic nervous system (SNS) activity measured by skin conductance to gauge the physiological stress response to challenging walking adaptability tasks in people post-stroke. Thirty adults with chronic post-stroke hemiparesis performed a battery of seventeen walking adaptability tasks. SNS activity was measured by skin conductance from the palmar surface of each hand. The primary outcome variable was the percent change in skin conductance level (ΔSCL) between the baseline resting and walking phases of each task. Task difficulty was measured by performance speed and by physical therapist scoring of performance. Walking function and balance confidence were measured by preferred walking speed and the Activities-specific Balance Confidence Scale, respectively. There was a statistically significant negative association between ΔSCL and task performance speed and between ΔSCL and clinical score, indicating that tasks with greater SNS activity had slower performance speed and poorer clinical scores. ΔSCL was significantly greater for low functioning participants versus high functioning participants, particularly during the most challenging walking adaptability tasks. This study supports the use of SNS activity measured by skin conductance as a valuable approach for objectively quantifying the perceived challenge of walking adaptability tasks in people post-stroke. Published by Elsevier B.V.

Crowdsourcing: a valid alternative to expert evaluation of robotic surgery skills.

PubMed

Polin, Michael R; Siddiqui, Nazema Y; Comstock, Bryan A; Hesham, Helai; Brown, Casey; Lendvay, Thomas S; Martino, Martin A

2016-11-01

Robotic-assisted gynecologic surgery is common, but requires unique training. A validated assessment tool for evaluating trainees' robotic surgery skills is Robotic-Objective Structured Assessments of Technical Skills. We sought to assess whether crowdsourcing can be used as an alternative to expert surgical evaluators in scoring Robotic-Objective Structured Assessments of Technical Skills. The Robotic Training Network produced the Robotic-Objective Structured Assessments of Technical Skills, which evaluate trainees across 5 dry lab robotic surgical drills. Robotic-Objective Structured Assessments of Technical Skills were previously validated in a study of 105 participants, where dry lab surgical drills were recorded, de-identified, and scored by 3 expert surgeons using the Robotic-Objective Structured Assessments of Technical Skills checklist. Our methods-comparison study uses these previously obtained recordings and expert surgeon scores. Mean scores per participant from each drill were separated into quartiles. Crowdworkers were trained and calibrated on Robotic-Objective Structured Assessments of Technical Skills scoring using a representative recording of a skilled and novice surgeon. Following this, 3 recordings from each scoring quartile for each drill were randomly selected. Crowdworkers evaluated the randomly selected recordings using Robotic-Objective Structured Assessments of Technical Skills. Linear mixed effects models were used to derive mean crowdsourced ratings for each drill. Pearson correlation coefficients were calculated to assess the correlation between crowdsourced and expert surgeons' ratings. In all, 448 crowdworkers reviewed videos from 60 dry lab drills, and completed a total of 2517 Robotic-Objective Structured Assessments of Technical Skills assessments within 16 hours. Crowdsourced Robotic-Objective Structured Assessments of Technical Skills ratings were highly correlated with expert surgeon ratings across each of the 5 dry lab drills (r ranging from 0.75-0.91). Crowdsourced assessments of recorded dry lab surgical drills using a validated assessment tool are a rapid and suitable alternative to expert surgeon evaluation. Copyright © 2016 Elsevier Inc. All rights reserved.

Objective criteria for acceptability and constancy tests of digital subtraction angiography.

PubMed

de las Heras, Hugo; Torres, Ricardo; Fernández-Soto, José Miguel; Vañó, Eliseo

2016-01-01

Demonstrate an objective procedure to quantify image quality in digital subtraction angiography (DSA) and suggest thresholds for acceptability and constancy tests. Series of images were obtained in a DSA system simulating a small (paediatric) and a large patient using the dynamic phantom described in the IEC and DIN standards for acceptance tests of DSA equipment. Image quality was quantified using measurements of contrast-to-noise ratio (CNR). Overall scores combining the CNR of 10-100 mg/ml Iodine at a vascular diameter of 1-4 mm in a homogeneous background were defined. Phantom entrance surface air kerma (Ka,e) was measured with an ionisation chamber. The visibility of a low-contrast vessel in DSA images has been identified with a CNR value of 0.50 ± 0.03. Despite using 14 times more Ka,e (8.85 vs 0.63 mGy/image), the protocol for large patients showed a decrease in the overall score CNRsum of 67% (4.21 ± 0.06 vs 2.10 ± 0.05). The uncertainty in the results of the objective method was below 5%. Objective evaluation of DSA images using CNR is feasible with dedicated phantom measurements. An objective methodology has been suggested for acceptance tests compliant with the IEC/DIN standards. The defined overall scores can serve to fix a reproducible baseline for constancy tests, as well as to study the device stability within one acquisition series and compare different imaging protocols. This work provides aspects that have not been included in the recent European guidelines on Criteria for Acceptability of Medical Radiological Equipment. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Standardized UXO Technology Demonstration Site Scoring Record NO. 934 Technology Type/Platform: EM61 MKII/Towed

DTIC Science & Technology

2009-07-01

nonferrous metallic objects. The applicability of the instrument for ordnance and explosives (OE) detection has been widely demonstrated at sites...was cleared of all metallic items. This clearing of the metallic anomalies from the 2 acre Active Response Demonstration Site was broken into three...with their Multiple Towed Array Detection System (MTADS). This system is known for its effectiveness and ability to detect metallic items. Once the

Dynamic Measurement of Disease Activity in Acute Pancreatitis: The Pancreatitis Activity Scoring System

PubMed Central

Wu, Bechien U.; Batech, Michael; Quezada, Michael; Lew, Daniel; Fujikawa, Kelly; Kung, Jonathan; Jamil, Laith H.; Chen, Wansu; Afghani, Elham; Reicher, Sonya; Buxbaum, James; Pandol, Stephen J.

2017-01-01

OBJECTIVES Acute pancreatitis has a highly variable course. Currently there is no widely accepted method to measure disease activity in patients hospitalized for acute pancreatitis. We aimed to develop a clinical activity index that incorporates routine clinical parameters to assist in the measurement, study, and management of acute pancreatitis. METHODS We used the UCLA/RAND appropriateness method to identify items for inclusion in the disease activity instrument. We conducted a systematic literature review followed by two sets of iterative modified Delphi meetings including a panel of international experts between November 2014 and November 2015. The final instrument was then applied to patient data obtained from five separate study cohorts across Southern California to assess profiles of disease activity. RESULTS From a list of 35 items comprising 6 domains, we identified 5 parameters for inclusion in the final weighted clinical activity scoring system: organ failure, systemic inflammatory response syndrome, abdominal pain, requirement for opiates and ability to tolerate oral intake. We applied the weighted scoring system across the 5 study cohorts comprising 3,123 patients. We identified several distinct patterns of disease activity: (i) overall there was an elevated score at baseline relative to discharge across all study cohorts, (ii) there were distinct patterns of disease activity related to duration of illness as well as (iii) early and persistent elevation of disease activity among patients with severe acute pancreatitis defined as persistent organ failure. CONCLUSIONS We present the development and initial validation of a clinical activity score for real-time assessment of disease activity in patients with acute pancreatitis. PMID:28462914

An online training-monitoring system to prevent nonfunctional overreaching.

PubMed

Piacentini, Maria Francesca; Meeusen, Romain

2015-05-01

This longitudinal case study evaluated the effectiveness of an online training-monitoring system to prevent nonfunctional overreaching (NFOR). A female master track and field athlete was followed by means of a daily online training diary (www.spartanova.com) and a weekly profile of mood state (POMS). The online diary consists of objective training data and subjective feelings reported on a 10-cm visual analog scale. Furthermore, parameters that quantify and summarize training and adaptation to training were calculated. The novelty consists in the inclusion of a specific measuring parameter tested to detect NFOR (OR score). During track-season preparation, the athlete was facing some major personal changes, and extra training stress factors increased. Despite the fact that training load (TL) did not increase, the OR score showed a 222% and then a 997% increase compared with baseline. POMS showed a 167% increase in fatigue, a 38% decrease in vigor, a 32% increase in depression scores, and a total mood increase of 22%, with a 1-wk shift compared with the OR score. A 41% decrease in TL restored the OR score and POMS to baseline values within 10 d. The results demonstrate that immediate feedback obtained by "warning signals" to both athletes and coaches, based on individual baseline data, seems an optimal predictor of FOR/NFOR.

Assessment of clinical outcomes of Roth and MBT bracket prescription using the American Board of Orthodontics Objective Grading System

PubMed Central

Jain, Mahesh; Varghese, Joseph; Mascarenhas, Rohan; Mogra, Subraya; Shetty, Siddarth; Dhakar, Nidhi

2013-01-01

Background: There is always a need to assess whether small changes in bracket prescription can lead to visually detectable differences in tooth positions. However, with little clinical evidence to show advantages of any of the popularly used bracket systems, orthodontists are forced to make clinical decisions with little scientific guidance. Aim: To compare the orthodontic cases finished with Roth and MBT prescription using American Board of Orthodontics-Objective Grading System (ABO-OGS). Settings and Design: Department of Orthodontics, Post-graduate dental college, retrospective cross-sectional study. Materials and Methods: Forty patients selected were divided into two groups of 20 patients each finished with straight wire appliance using Roth and MBT prescription, respectively. The examiner ability was assessed and calibrated by one of the ABO certified clinician to grade cases using the OGS. Statistical Analysis: Unpaired student t-test was used and P < 0.05 was accepted as significant. Results and Conclusions: MBT bracket group had a lower score of 2.60 points in buccolingual inclination and lower score of 1.10 points in occlusal contact category that was statistically significant when compared with Roth group. The difference in total ABO-OGS score was 2.65 points showing that the outcome for the MBT prescription was better than that of the Roth prescription, which is statistically significant, but with little or no clinical significance. It can be concluded that use of either one of the Roth and MBT bracket prescriptions have no impact to the overall clinical outcome and quality of treatment entirely depends on clinician judgment and experience. PMID:24124295

Validity and reliability of a novel immunosuppressive adverse effects scoring system in renal transplant recipients.

PubMed

Meaney, Calvin J; Arabi, Ziad; Venuto, Rocco C; Consiglio, Joseph D; Wilding, Gregory E; Tornatore, Kathleen M

2014-06-12

After renal transplantation, many patients experience adverse effects from maintenance immunosuppressive drugs. When these adverse effects occur, patient adherence with immunosuppression may be reduced and impact allograft survival. If these adverse effects could be prospectively monitored in an objective manner and possibly prevented, adherence to immunosuppressive regimens could be optimized and allograft survival improved. Prospective, standardized clinical approaches to assess immunosuppressive adverse effects by health care providers are limited. Therefore, we developed and evaluated the application, reliability and validity of a novel adverse effects scoring system in renal transplant recipients receiving calcineurin inhibitor (cyclosporine or tacrolimus) and mycophenolic acid based immunosuppressive therapy. The scoring system included 18 non-renal adverse effects organized into gastrointestinal, central nervous system and aesthetic domains developed by a multidisciplinary physician group. Nephrologists employed this standardized adverse effect evaluation in stable renal transplant patients using physical exam, review of systems, recent laboratory results, and medication adherence assessment during a clinic visit. Stable renal transplant recipients in two clinical studies were evaluated and received immunosuppressive regimens comprised of either cyclosporine or tacrolimus with mycophenolic acid. Face, content, and construct validity were assessed to document these adverse effect evaluations. Inter-rater reliability was determined using the Kappa statistic and intra-class correlation. A total of 58 renal transplant recipients were assessed using the adverse effects scoring system confirming face validity. Nephrologists (subject matter experts) rated the 18 adverse effects as: 3.1 ± 0.75 out of 4 (maximum) regarding clinical importance to verify content validity. The adverse effects scoring system distinguished 1.75-fold increased gastrointestinal adverse effects (p=0.008) in renal transplant recipients receiving tacrolimus and mycophenolic acid compared to the cyclosporine regimen. This finding demonstrated construct validity. Intra-class correlation was 0.81 (95% confidence interval: 0.65-0.90) and Kappa statistic of 0.68 ± 0.25 for all 18 adverse effects and verified substantial inter-rater reliability. This immunosuppressive adverse effects scoring system in stable renal transplant recipients was evaluated and substantiated face, content and construct validity with inter-rater reliability. The scoring system may facilitate prospective, standardized clinical monitoring of immunosuppressive adverse drug effects in stable renal transplant recipients and improve medication adherence.

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

David, Aurelien; Fini, Paul T.; Houser, Kevin W.

We have developed a two-measure system for evaluating light sources’ color rendition that builds upon conceptual progress of numerous researchers over the last two decades. The system quantifies the color fidelity and color gamut (change in object chroma) of a light source in comparison to a reference illuminant. The calculations are based on a newly developed set of reflectance data from real samples uniformly distributed in color space (thereby fairly representing all colors) and in wavelength space (thereby precluding artificial optimization of the color rendition scores by spectral engineering). The color fidelity score R f is an improved version ofmore » the CIE color rendering index. The color gamut score R g is an improved version of the Gamut Area Index. In combination, they provide two complementary assessments to guide the optimization of future light sources. This method summarizes the findings of the Color Metric Task Group of the Illuminating Engineering Society of North America (IES). It is adopted in the upcoming IES TM-30-2015, and is proposed for consideration with the International Commission on Illumination (CIE).« less

British isles lupus assessment group 2004 index is valid for assessment of disease activity in systemic lupus erythematosus

PubMed Central

Yee, Chee-Seng; Farewell, Vernon; Isenberg, David A; Rahman, Anisur; Teh, Lee-Suan; Griffiths, Bridget; Bruce, Ian N; Ahmad, Yasmeen; Prabu, Athiveeraramapandian; Akil, Mohammed; McHugh, Neil; D'Cruz, David; Khamashta, Munther A; Maddison, Peter; Gordon, Caroline

2007-01-01

Objective To determine the construct and criterion validity of the British Isles Lupus Assessment Group 2004 (BILAG-2004) index for assessing disease activity in systemic lupus erythematosus (SLE). Methods Patients with SLE were recruited into a multicenter cross-sectional study. Data on SLE disease activity (scores on the BILAG-2004 index, Classic BILAG index, and Systemic Lupus Erythematosus Disease Activity Index 2000 [SLEDAI-2K]), investigations, and therapy were collected. Overall BILAG-2004 and overall Classic BILAG scores were determined by the highest score achieved in any of the individual systems in the respective index. Erythrocyte sedimentation rates (ESRs), C3 levels, C4 levels, anti–double-stranded DNA (anti-dsDNA) levels, and SLEDAI-2K scores were used in the analysis of construct validity, and increase in therapy was used as the criterion for active disease in the analysis of criterion validity. Statistical analyses were performed using ordinal logistic regression for construct validity and logistic regression for criterion validity. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results Of the 369 patients with SLE, 92.7% were women, 59.9% were white, 18.4% were Afro-Caribbean and 18.4% were South Asian. Their mean ± SD age was 41.6 ± 13.2 years and mean disease duration was 8.8 ± 7.7 years. More than 1 assessment was obtained on 88.6% of the patients, and a total of 1,510 assessments were obtained. Increasing overall scores on the BILAG-2004 index were associated with increasing ESRs, decreasing C3 levels, decreasing C4 levels, elevated anti-dsDNA levels, and increasing SLEDAI-2K scores (all P < 0.01). Increase in therapy was observed more frequently in patients with overall BILAG-2004 scores reflecting higher disease activity. Scores indicating active disease (overall BILAG-2004 scores of A and B) were significantly associated with increase in therapy (odds ratio [OR] 19.3, P < 0.01). The BILAG-2004 and Classic BILAG indices had comparable sensitivity, specificity, PPV, and NPV. Conclusion These findings show that the BILAG-2004 index has construct and criterion validity. PMID:18050213

A core competency-based objective structured clinical examination (OSCE) can predict future resident performance.

PubMed

Wallenstein, Joshua; Heron, Sheryl; Santen, Sally; Shayne, Philip; Ander, Douglas

2010-10-01

This study evaluated the ability of an objective structured clinical examination (OSCE) administered in the first month of residency to predict future resident performance in the Accreditation Council for Graduate Medical Education (ACGME) core competencies. Eighteen Postgraduate Year 1 (PGY-1) residents completed a five-station OSCE in the first month of postgraduate training. Performance was graded in each of the ACGME core competencies. At the end of 18 months of training, faculty evaluations of resident performance in the emergency department (ED) were used to calculate a cumulative clinical evaluation score for each core competency. The correlations between OSCE scores and clinical evaluation scores at 18 months were assessed on an overall level and in each core competency. There was a statistically significant correlation between overall OSCE scores and overall clinical evaluation scores (R = 0.48, p < 0.05) and in the individual competencies of patient care (R = 0.49, p < 0.05), medical knowledge (R = 0.59, p < 0.05), and practice-based learning (R = 0.49, p < 0.05). No correlation was noted in the systems-based practice, interpersonal and communication skills, or professionalism competencies. An early-residency OSCE has the ability to predict future postgraduate performance on a global level and in specific core competencies. Used appropriately, such information can be a valuable tool for program directors in monitoring residents' progress and providing more tailored guidance. © 2010 by the Society for Academic Emergency Medicine.

Spacecraft COst REduction Team (SCORE): TQM/CI on a massive scale

NASA Technical Reports Server (NTRS)

Bullard, Jerry D.

1992-01-01

The business of building satellites and space systems has matured. Few missions require, or can afford, excellent performance at any price. The new paradigm is doing more with less, providing quality systems at lower cost--in other words, doing our job 'Faster-Better-Cheaper.' The TRW Spacecraft COst REduction (SCORE) initiative was launched in 1990 by Daniel S. Goldin, then general manager of TRW's Space & Technology Group. The SCORE mission is to apply continuous improvement (CI) techniques to effect major reductions in the cost (our primary goal) and span time (as a corollary) required for the production of spacecraft. SCORE is a multi-year initiative that is having a profound effect on both the procedural and the cultural aspects of how we do business. The objectives of this initiative are being realized. The focus of this paper is not on the results of SCORE per se, but rather on the things we have leaned about how to do continuous improvement on a massive scale, with multilevel (hierarchical) CI teams. The following sections summarize the chronology of the SCORE initiative, from team formation to development of the year-end report for 1991. Lessons learned, the core of this presentation, are discussed--with particular focus on the unique aspects of SCORE. The SCORE initiative is continuing and, as a part of our evolving culture, will never end. It has resulted in profound insights into the way we do work and (the topic at hand) how to do CI for large and complex multidisciplinary development activities.

A Pilot Study for Evaluation of Digital Systems as an Adjunct to Sphygmomanometry for Undergraduate Teaching

PubMed Central

Sharma, Renuka; Kapoor, Raj

2016-01-01

Objectives: Blood pressure estimation is a key skill for medical practitioners. It is routinely taught to undergraduate medical students using an aneroid sphygmomanometer. However, the conceptual understanding in the practical remains limited. We conducted the following study to evaluate the efficacy of digital data acquisition systems as an adjunct to the sphygmomanometer to teach blood pressure. Methods: Fifty-seven first-year medical students participated in the study. An MCQ test of 15 questions, consisting of 10 conceptual and five factual questions, was administered twice – pre- and post-demonstration of blood pressure measurement using a digital data acquisition system. In addition, qualitative feedback was also obtained. Results: Median scores were 7 (6 - 8) and 3 (1.5 - 4) in pre-test sessions for conceptual and factual questions, respectively. Post-test scores showed a significant improvement in both categories (10 (9 - 10) and 4 (4 - 4.5), respectively, Mann-Whitney U test, p < 0.0001). Student feedback also indicated that the digital system enhanced learning and student participation. Conclusions: Student feedback regarding the demonstrations was uniformly positive, which was also reflected in significantly improved post-test scores. We conclude that parallel demonstration on digital systems and the sphygmomanometer will enhance student engagement and understanding of blood pressure measurement. PMID:27660735

Objective Assessment of General Surgery Residents Followed by Remediation.

PubMed

Gas, Becca L; Buckarma, EeeLN H; Mohan, Monali; Pandian, T K; Farley, David R

Surgical training programs often lack objective assessment strategies. Complicated scheduling characteristics frequently make it difficult for surgical residents to undergo formal assessment; actually having the time and opportunity to remediate poor performance is an even greater problem. We developed a novel methodology of assessment for residents and created an efficient remediation system using a combination of simulation, online learning, and self-assessment options. Postgraduate year (PGY) 2 to 5 general surgery (GS) residents were tested in a 5 station, objective structured clinical examination style event called the Surgical X-Games. Stations were 15 minutes in length and tested both surgical knowledge and technical skills. Stations were scored on a scale of 1 to 5 (1 = Fail, 2 = Mediocre, 3 = Pass, 4 = Good, and 5 = Stellar). Station scores ≤ 2 were considered subpar and required remediation to a score ≥ 4. Five remediation sessions allowed residents the opportunity to practice the stations with staff surgeons. Videos of each skill or test of knowledge with clear instructions on how to perform at a stellar level were offered. Trainees also had the opportunity to checkout take-home task trainers to practice specific skills. Residents requiring remediation were then tested again in-person or sent in self-made videos of their performance. Academic medical center. PGY2, 3, 4, and 5 GS residents at Mayo Clinic in Rochester, MN. A total of, 35 residents participated in the Surgical X-Games in the spring of 2015. Among all, 31 (89%) had scores that were deemed subpar on at least 1 station. Overall, 18 (58%) residents attempted remediation. All 18 (100%) achieved a score ≥ 4 on the respective stations during a makeup attempt. Overall X-Games scores and those of PGY2s, 3s, and 4s were higher after remediation (p < 0.05). No PGY5s attempted remediation. Despite difficulties with training logistics and busy resident schedules, it is feasible to objectively assess most GS trainees and offer opportunities to remediate if performance is poor. Our multifaceted remediation methodology allowed 18 residents to achieve good or stellar performance on each station after deliberate practice. Enticing chief residents to participate in remediation efforts in the spring of their final year of training remains a work in progress. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The physician's quality of life: Relationship with ego defense mechanisms and object relations.

PubMed

Miranda, Benedito; Louzã, Mário Rodrigues

2015-11-01

To assess whether ego defense mechanisms and object relations (the way an individual subjectively experiences his/her relationships with others) are related to quality of life among physicians. In this cross-sectional mail survey, 602 physicians from Botucatu, SP, Brazil, were sent a socio-demographic questionnaire, the Bell Object Relations and Reality Testing Inventory-Form O (BORRTI-O), the Defense Style Questionnaire-40 (DSQ-40), and the World Health Organization Abbreviated Instrument for Quality of Life Assessment (WHOQOL-BREF). 198 questionnaires (33%) with valid responses were obtained. High BORRTI-O scores (indicative of pathology) on the alienation, egocentricity and insecure attachment subscales were associated with reduced WHOQOL-BREF scores for the psychological health and social relationship domains. Immature ego defense mechanisms were associated with lower WHOQOL-BREF scores for all domains. No significant associations of WHOQOL-BREF scores with working hours, workplace or monthly income were observed in the study population WHOQOL-BREF scores correlated with mature defense mechanisms and normal object relations, suggesting an association between psychological maturity and quality of life among physicians. Copyright © 2015 Elsevier Inc. All rights reserved.

External Validation of the Simple Clinical Score and the HOTEL Score, Two Scores for Predicting Short-Term Mortality after Admission to an Acute Medical Unit

PubMed Central

Stræde, Mia; Brabrand, Mikkel

2014-01-01

Background Clinical scores can be of aid to predict early mortality after admission to a medical admission unit. A developed scoring system needs to be externally validated to minimise the risk of the discriminatory power and calibration to be falsely elevated. We performed the present study with the objective of validating the Simple Clinical Score (SCS) and the HOTEL score, two existing risk stratification systems that predict mortality for medical patients based solely on clinical information, but not only vital signs. Methods Pre-planned prospective observational cohort study. Setting Danish 460-bed regional teaching hospital. Findings We included 3046 consecutive patients from 2 October 2008 until 19 February 2009. 26 (0.9%) died within one calendar day and 196 (6.4%) died within 30 days. We calculated SCS for 1080 patients. We found an AUROC of 0.960 (95% confidence interval [CI], 0.932 to 0.988) for 24-hours mortality and 0.826 (95% CI, 0.774–0.879) for 30-day mortality, and goodness-of-fit test, χ2 = 2.68 (10 degrees of freedom), P = 0.998 and χ2 = 4.00, P = 0.947, respectively. We included 1470 patients when calculating the HOTEL score. Discriminatory power (AUROC) was 0.931 (95% CI, 0.901–0.962) for 24-hours mortality and goodness-of-fit test, χ2 = 5.56 (10 degrees of freedom), P = 0.234. Conclusion We find that both the SCS and HOTEL scores showed an excellent to outstanding ability in identifying patients at high risk of dying with good or acceptable precision. PMID:25144186

Language and Adjustment Scales for the Thematic Apperception Test for Children 6-11 Years.

ERIC Educational Resources Information Center

Neman, Janice; And Others

The report summarizes research on the development of an objective scoring system and the formulation of scales useful in the assessment of psychological development and normal behavior using a five-card, orally administered and tape-recorded version of the Thematic Apperception Test (TAT). The TAT language scales which were developed represent…

Shock Wave-Stimulated Periosteum for Cartilage Repair

DTIC Science & Technology

2015-03-01

Abscess Hemorrhage was graded with the following scores: 0: No hemorrhage 1: 1 or more small (barely visible through 10x objective) hematomas 2...1-3 or more medium (visible through 10x objective) hematomas 3: >3 or more medium (immediately visible in 10x objective) hematomas 4: 1 or more...large (immediately visible in 10x objective) hematomas The results are shown in Table 3 Table 3. Scores for the degree of inflammation and hemorrhage

Objective assessment of MPEG-2 video quality

NASA Astrophysics Data System (ADS)

Gastaldo, Paolo; Zunino, Rodolfo; Rovetta, Stefano

2002-07-01

The increasing use of video compression standards in broadcasting television systems has required, in recent years, the development of video quality measurements that take into account artifacts specifically caused by digital compression techniques. In this paper we present a methodology for the objective quality assessment of MPEG video streams by using circular back-propagation feedforward neural networks. Mapping neural networks can render nonlinear relationships between objective features and subjective judgments, thus avoiding any simplifying assumption on the complexity of the model. The neural network processes an instantaneous set of input values, and yields an associated estimate of perceived quality. Therefore, the neural-network approach turns objective quality assessment into adaptive modeling of subjective perception. The objective features used for the estimate are chosen according to the assessed relevance to perceived quality and are continuously extracted in real time from compressed video streams. The overall system mimics perception but does not require any analytical model of the underlying physical phenomenon. The capability to process compressed video streams represents an important advantage over existing approaches, like avoiding the stream-decoding process greatly enhances real-time performance. Experimental results confirm that the system provides satisfactory, continuous-time approximations for actual scoring curves concerning real test videos.

Orthodontic treatment outcomes obtained by application of a finishing protocol

PubMed Central

Carvajal-Flórez, Alvaro; Barbosa-Lis, Diana María; Zapata-Noreña, Oscar Arturo; Marín-Velásquez, Julissa Andrea; Afanador-Bayona, Sergio Andrés

2016-01-01

ABSTRACT Objective: To evaluate the results of a finishing protocol implemented in patients treated in the Orthodontics graduate program at Universidad de Antioquia. Evaluation was carried out by means of the criteria set by the Objective Grading System (OGS) of the American Board of Orthodontics (ABO). Methods: Cast models and panoramic radiographs of 34 patients were evaluated. The intervention group (IG) consisted of 17 patients (19.88 ± 4.4 years old) treated under a finishing protocol. This protocol included training in finishing, application of a finishing guide, brackets repositioning and patient's follow-up. Results of the IG were compared to a control group of 17 patients (21.88 ± 7.0 years old) selected by stratified randomization without finishing intervention (CG). Results: The scores for both CG and IG were 38.00 ± 9.0 and 31.41 ± 9.6 (p = 0.048), respectively. The score improved significantly in the IG group, mainly regarding marginal ridges (CG: 5.59 ± 2.2; IG: 3.65 ± 1.8) (p = 0.009) and root angulation (CG: 7.59 ± 2.8; IG: 4.88 ± 2.6) (p = 0.007). Criteria that did not improve, but had the highest scores were: alignment (CG: 6.35 ± 2.7; IG: 6.82 ± 2.8) (p = 0.62) and buccolingual inclination (CG: 3.6 ± 5.88; IG: 5.29 ± 3.9) (p = 0.65). Conclusions: Standardization and implementation of a finishing protocol contributed to improve clinical performance in the Orthodontics graduate program, as expressed by occlusal outcomes. Greater emphasis should be given on the finishing phase to achieve lower scores in the ABO grading system. PMID:27275620

Perspective: NutriGrade: A Scoring System to Assess and Judge the Meta-Evidence of Randomized Controlled Trials and Cohort Studies in Nutrition Research.

PubMed

Schwingshackl, Lukas; Knüppel, Sven; Schwedhelm, Carolina; Hoffmann, Georg; Missbach, Benjamin; Stelmach-Mardas, Marta; Dietrich, Stefan; Eichelmann, Fabian; Kontopantelis, Evangelos; Iqbal, Khalid; Aleksandrova, Krasimira; Lorkowski, Stefan; Leitzmann, Michael F; Kroke, Anja; Boeing, Heiner

2016-11-01

The objective of this study was to develop a scoring system (NutriGrade) to evaluate the quality of evidence of randomized controlled trial (RCT) and cohort study meta-analyses in nutrition research, building upon previous tools and expert recommendations. NutriGrade aims to assess the meta-evidence of an association or effect between different nutrition factors and outcomes, taking into account nutrition research-specific requirements not considered by other tools. In a pretest study, 6 randomly selected meta-analyses investigating diet-disease relations were evaluated with NutriGrade by 5 independent raters. After revision, NutriGrade was applied by the same raters to 30 randomly selected meta-analyses in the same thematic area. The reliability of ratings of NutriGrade items was calculated with the use of a multirater κ, and reliability of the total (summed scores) was calculated with the use of intraclass correlation coefficients (ICCs). The following categories for meta-evidence evaluation were established: high (8-10), moderate (6-7.99), low (4-5.99), and very low (0-3.99). The NutriGrade scoring system (maximum of 10 points) comprises the following items: 1) risk of bias, study quality, and study limitations, 2) precision, 3) heterogeneity, 4) directness, 5) publication bias, 6) funding bias, 7) study design, 8) effect size, and 9) dose-response. The NutriGrade score varied between 2.9 (very low meta-evidence) and 8.8 (high meta-evidence) for meta-analyses of RCTs, and it ranged between 3.1 and 8.8 for meta-analyses of cohort studies. The κ value of the ratings for each scoring item varied from 0.32 (95% CI: 0.22, 0.42) for risk of bias for cohort studies and 0.95 (95% CI: 0.91, 0.99) for study design, with a mean κ of 0.66 (95% CI: 0.53, 0.79). The ICC of the total score was 0.81 (95% CI: 0.69, 0.90). The NutriGrade scoring system showed good agreement and reliability. The initial findings regarding the performance of this newly established scoring system need further evaluation in independent analyses. © 2016 American Society for Nutrition.

Perspective: NutriGrade: A Scoring System to Assess and Judge the Meta-Evidence of Randomized Controlled Trials and Cohort Studies in Nutrition Research123

PubMed Central

Knüppel, Sven; Schwedhelm, Carolina; Hoffmann, Georg; Missbach, Benjamin; Stelmach-Mardas, Marta; Dietrich, Stefan; Eichelmann, Fabian; Kontopanteils, Evangelos; Iqbal, Khalid; Aleksandrova, Krasimira; Lorkowski, Stefan; Leitzmann, Michael F; Kroke, Anja; Boeing, Heiner

2016-01-01

The objective of this study was to develop a scoring system (NutriGrade) to evaluate the quality of evidence of randomized controlled trial (RCT) and cohort study meta-analyses in nutrition research, building upon previous tools and expert recommendations. NutriGrade aims to assess the meta-evidence of an association or effect between different nutrition factors and outcomes, taking into account nutrition research–specific requirements not considered by other tools. In a pretest study, 6 randomly selected meta-analyses investigating diet–disease relations were evaluated with NutriGrade by 5 independent raters. After revision, NutriGrade was applied by the same raters to 30 randomly selected meta-analyses in the same thematic area. The reliability of ratings of NutriGrade items was calculated with the use of a multirater κ, and reliability of the total (summed scores) was calculated with the use of intraclass correlation coefficients (ICCs). The following categories for meta-evidence evaluation were established: high (8–10), moderate (6–7.99), low (4–5.99), and very low (0–3.99). The NutriGrade scoring system (maximum of 10 points) comprises the following items: 1) risk of bias, study quality, and study limitations, 2) precision, 3) heterogeneity, 4) directness, 5) publication bias, 6) funding bias, 7) study design, 8) effect size, and 9) dose-response. The NutriGrade score varied between 2.9 (very low meta-evidence) and 8.8 (high meta-evidence) for meta-analyses of RCTs, and it ranged between 3.1 and 8.8 for meta-analyses of cohort studies. The κ value of the ratings for each scoring item varied from 0.32 (95% CI: 0.22, 0.42) for risk of bias for cohort studies and 0.95 (95% CI: 0.91, 0.99) for study design, with a mean κ of 0.66 (95% CI: 0.53, 0.79). The ICC of the total score was 0.81 (95% CI: 0.69, 0.90). The NutriGrade scoring system showed good agreement and reliability. The initial findings regarding the performance of this newly established scoring system need further evaluation in independent analyses. PMID:28140319

The cardiovascular robustness hypothesis: Unmasking young adults' hidden risk for premature cardiovascular death.

PubMed

Kraushaar, Lutz E; Dressel, Alexander

2018-03-01

An undetected high risk for premature death of cardiovascular disease (CVD) among individuals with low-to-moderate risk factor levels is an acknowledged obstacle to CVD prevention. In this paper, we present the hypothesis that the vasculature's robustness against risk factor load will complement conventional risk factor models as a novel stratifier of risk. Figuratively speaking, mortality risk prediction without robustness scoring is akin to predicting the breaking risk of a lake's ice sheet considering load only while disregarding the sheet's bearing strength. Taking the cue from systems biology, which defines robustness as the ability to maintain function against internal and external challenges, we develop a robustness score from the physical parameters that comprehensively quantitate cardiovascular function. We derive the functional parameters using a recently introduced novel system, VascAssist 2 (iSYMED GmbH, Butzbach, Germany). VascAssist 2 (VA) applies the electronic-hydraulic analogy to a digital model of the arterial tree, replicating non-invasively acquired pule pressure waves by modulating the electronic equivalents of the physical parameters that describe in vivo arterial hemodynamics. As the latter is also subject to aging-associated degeneration which (a) progresses at inter-individually different rates, and which (b) affects the biomarker-mortality association, we express the robustness score as a correction factor to calendar age (CA), the dominant risk factor in all CVD risk factor models. We then propose a method for the validation of the score against known time-to-event data in reference populations. Our conceptualization of robustness implies that risk factor-challenged individuals with low robustness scores will face preferential elimination from the population resulting in a significant robustness-CA correlation in this strata absent in the unchallenged stratum. Hence, we also present an outline of a cross-sectional study design suitable to test this hypothesis. We finally discuss the objections that may validly be raised against our robustness hypothesis, and how available evidence encourages us to refute these objections. Copyright © 2018 Elsevier Ltd. All rights reserved.

Osm Poi Analyzer: a Platform for Assessing Position of POIs in Openstreetmap

NASA Astrophysics Data System (ADS)

Kashian, A.; Rajabifard, A.; Chen, Y.; Richter, K. F.

2017-09-01

In recent years, more and increased participation in Volunteered Geographical Information (VGI) projects provides enough data coverage for most places around the world for ordinary mapping and navigation purposes, however, the positional credibility of contributed data becomes more and more important to bring a long-term trust in VGI data. Today, it is hard to draw a definite traditional boundary between the authoritative map producers and the public map consumers and we observe that more and more volunteers are joining crowdsourcing activities for collecting geodata, which might result in higher rates of man-made mistakes in open map projects such as OpenStreetMap. While there are some methods for monitoring the accuracy and consistency of the created data, there is still a lack of advanced systems to automatically discover misplaced objects on the map. One feature type which is contributed daily to OSM is Point of Interest (POI). In order to understand how likely it is that a newly added POI represents a genuine real-world feature scientific means to calculate a probability of such a POI existing at that specific position is needed. This paper reports on a new analytic tool which dives into OSM data and finds co-existence patterns between one specific POI and its surrounding objects such as roads, parks and buildings. The platform uses a distance-based classification technique to find relationships among objects and tries to identify the high-frequency association patterns among each category of objects. Using such method, for each newly added POI, a probabilistic score would be generated, and the low scored POIs can be highlighted for editors for a manual check. The same scoring method can be used for existing registered POIs to check if they are located correctly. For a sample study, this paper reports on the evaluation of 800 pre-registered ATMs in Paris with associated scores to understand how outliers and fake entries could be detected automatically.

[Clinical application and optimization of HEAD-US quantitative ultrasound assessment scale for hemophilic arthropathy].

PubMed

Li, J; Guo, X J; Ding, X L; Lyu, B M; Xiao, J; Sun, Q L; Li, D S; Zhang, W F; Zhou, J C; Li, C P; Yang, R C

2018-02-14

Objective: To assess the feasibility of HEAD-US scale in the clinical application of hemophilic arthropathy (HA) and propose an optimized ultrasound scoring system. Methods: From July 2015 to August 2017, 1 035 joints ultrasonographic examinations were performed in 91 patients. Melchiorre, HEAD-US (Hemophilic Early Arthropathy Detection with UltraSound) and HEAD-US-C (HEAD-US in China) scale scores were used respectively to analyze the results. The correlations between three ultrasound scales and Hemophilia Joint Health Scores (HJHS) were evaluated. The sensitivity differences of the above Ultrasonic scoring systems in evaluation of HA were compared. Results: All the 91 patients were male, with median age of 16 (4-55) years old, including 86 cases of hemophilia A and 5 cases hemophilia B. The median ( P 25 , P 75 ) of Melchiorre, HEAD-US and HEAD-US-C scores of 1 035 joints were 2(0,6), 1(0,5) and 2(0,6), respectively, and the correlation coefficients compared with HJHS was 0.747, 0.762 and 0.765 respectively, with statistical significance ( P <0.001). The positive rates of Melchiorre, HEAD-US-C and HEAD-US scale score were 63.0% (95% CI 59.7%-65.9%), 59.5% (95% CI 56.5%-62.4%) and 56.6% (95% CI 53.6%-59.6%) respectively, and the difference was statistically significant ( P <0.001). Even for 336 cases of asymptomatic joints, the positive rates of Melchiorre, HEAD-US-C and HEAD-US scale score were 25.0% (95% CI 20.6%-29.6%), 17.0% (95% CI 12.6%-21.1%) and 11.9% (95% CI 8.4%-15.7%) respectively, and the difference was statistically significant ( P <0.001). There were significant changes ( P <0.05) in the ultrasonographic score of HA before and after onset of hemorrhage in 107 joints of 40 patients. The difference in variation amplitude of HEAD-US-C scores and HEAD-US scores before and after joint bleeding was statistically significant ( P <0.001). Conclusion: Compared with Melchiorre, there were similar good correlations between HEAD-US, HEAD-US-C and HJHS. HEAD-US ultrasound scoring system is quick, convenient and simple to use. The optimized HEAD-US-C scale score is more sensitive than HEAD-US, especially for patients with HA who have subclinical state, which make up for insufficiency of sensitivity in HEAD-US scoring system.

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…

Doctoral Theses from Nursing Postgraduate Programs in Brazil and their Association with the Millennium Development Goals

PubMed Central

Rodrigues, Rosalina Aparecida Partezani; Robazzi, Maria Lúcia do Carmo Cruz; Erdmann, Alacoque Lorenzini; Fernandes, Josicélia Dumet; de Barros, Alba Lucia Bottura Leite; Ramos, Flávia Regina Souza

2015-01-01

OBJECTIVES: The Millennium Development Goals are centered around combatting poverty and other social evils all over the world. Thus, this study seeks to identify the Millennium Development Goals as an object of study in theses from Postgraduate Nursing Programs in Brazil scoring 5 (national excellence) and 6 or 7 (international excellence), and evaluate the association between the score for the program and achieving the Millennium Development Goals. METHOD: Exploratory descriptive document research. Data were collected from the Notes on Indicators/Coordination for Higher Education Personnel Improvement for the 15 Postgraduate Nursing Courses scoring between 5 and 7 in the three-year-period of 2010/2012. RESULTS: of the 8 Millennium Development Objectives, 6 were dealt with in the theses. There was an association (Fisher's exact test p-value=0.0059) between the distribution of the theses and the program scores in relation to the Millennium Development Objectives (p-valor=0.0347) CONCLUSION: the doctoral theses were slightly related to the Millennium Development Objectives, covering the population's economic development, health conditions and quality of life. It is recommended that Postgraduate Programs in Nursing pay closer attention to the Millennium Development Objectives.. PMID:26312631

Patient Information Websites About Medically Induced Second-Trimester Abortions: A Descriptive Study of Quality, Suitability, and Issues

PubMed Central

Axelsson, Ove

2017-01-01

Background Patients undergoing medically induced second-trimester abortions feel insufficiently informed and use the Web for supplemental information. However, it is still unclear how people who have experience with pregnancy termination appraise the quality of patient information websites about medically induced second-trimester abortions, whether they consider the websites suitable for patients, and what issues they experience with the websites. Objective Our objective was to investigate the quality of, suitability of, and issues with patient information websites about medically induced second-trimester abortions and potential differences between websites affiliated with the health care system and private organizations. Methods We set out to answer the objective by using 4 laypeople who had experience with pregnancy termination as quality assessors. The first 50 hits of 26 systematic searches were screened (N=1300 hits) using search terms reported by the assessors. Of these hits, 48% (628/1300) were irrelevant and 51% (667/1300) led to websites about medically induced second-trimester abortions. After correcting for duplicate hits, 42 patient information websites were included, 18 of which were affiliated with the health care system and 24 with private organizations. The 4 assessors systematically assessed the websites with the DISCERN instrument (total score range 16-80), the Ensuring Quality Information for Patients (EQIP) tool (total score range 0-100), as well as questions concerning website suitability and perceived issues. Results The interrater reliability was 0.8 for DISCERN and EQIP, indicating substantial agreement between the assessors. The total mean score was 36 for DISCERN and 40 for EQIP, indicating poor overall quality. Websites from the health care system had greater total EQIP (45 vs 37, P>.05) and reliability scores (22 vs 20, P>.05). Only 1 website was recommended by all assessors and 57% (24/42) were rated as very unsuitable by at least one assessor. The most reported issues with the websites involved lack of information (76%, 32/42), and poor design (36%, 15/42). Conclusions The high number of irrelevant hits and poor quality of patient information websites are considerable issues that must be addressed and considered when consulting patients awaiting medically induced second-trimester abortions. In clinical encounters, health professionals should initiate discussions concerning websites about medically induced second-trimester abortions and inform patients about the issues and quality deficits associated with these websites. PMID:28073735

Magnetic Resonance Imaging (MRI) of the Knee as an Outcome Measure in Juvenile Idiopathic Arthritis: An OMERACT Reliability Study on MRI Scales.

PubMed

Hemke, Robert; Tzaribachev, Nikolay; Nusman, Charlotte M; van Rossum, Marion A J; Maas, Mario; Doria, Andrea S

2017-08-01

There is increasing evidence that early therapeutic intervention improves longterm joint outcome in juvenile idiopathic arthritis (JIA). Given the existence of highly effective treatments, there is an urgent need for reliable and accurate measures of disease activity and joint damage in JIA. Our objective was to assess the reliability of 2 magnetic resonance imaging (MRI) scoring methods: the Juvenile Arthritis MRI Scoring (JAMRIS) system and the International Prophylaxis Study Group (IPSG) consensus score, for evaluating disease status of the knee in patients with JIA. Four international readers independently scored an MRI dataset of 25 JIA patients with clinical knee involvement. Synovial thickening, joint effusion, bone marrow changes, cartilage lesions, bone erosions, and subchondral cysts were scored using the JAMRIS and IPSG systems. Further, synovial enhancement, infrapatellar fat pad heterogeneity, tendinopathy, and enthesopathy were scored. Interreader reliability was analyzed by using the generalized κ, ICC, and the smallest detectable difference (SDD). ICC regarding interreader reliability ranged from 0.33 (95% CI 0.12-0.52, SDD = 0.29) for enthesopathy up to 0.95 (95% CI 0.92-0.97, SDD = 3.19) for synovial thickening. Good interreader reliability was found concerning joint effusion (ICC 0.93, 95% CI 0.89-0.95, SDD = 0.51), synovial enhancement (ICC 0.90, 95% CI 0.85-0.94, SDD = 9.85), and bone marrow changes (ICC 0.87, 95% CI 0.80-0.92, SDD = 10.94). Moderate to substantial reliability was found concerning cartilage lesions and bone erosions (ICC 0.55-0.72, SDD 1.41-13.65). The preliminary results are promising for most of the scored JAMRIS and IPSG items. However, further refinement of the scoring system is warranted for unsatisfactorily reliable items such as bone erosions, cartilage lesions, and enthesopathy.

Evaluating Professionalism, Practice-Based Learning and Improvement, and Systems-Based Practice: Utilization of a Compliance Form and Correlation with Conflict Styles

PubMed Central

Ogunyemi, Dotun; Eno, Michelle; Rad, Steve; Fong, Alex; Alexander, Carolyn; Azziz, Ricardo

2010-01-01

Objective The purpose of this article was to develop and determine the utility of a compliance form in evaluating and teaching the Accreditation Council for Graduate Medical Education competencies of professionalism, practice-based learning and improvement, and systems-based practice. Methods In 2006, we introduced a 17-item compliance form in an obstetrics and gynecology residency program. The form prospectively monitored residents on attendance at required activities (5 items), accountability of required obligations (9 items), and completion of assigned projects (3 items). Scores were compared to faculty evaluations of residents, resident status as a contributor or a concerning resident, and to the residents' conflict styles, using the Thomas-Kilmann Conflict MODE Instrument. Results Our analysis of 18 residents for academic year 2007–2008 showed a mean (standard error of mean) of 577 (65.3) for postgraduate year (PGY)-1, 692 (42.4) for PGY-2, 535 (23.3) for PGY-3, and 651.6 (37.4) for PGY-4. Non-Hispanic white residents had significantly higher scores on compliance, faculty evaluations on interpersonal and communication skills, and competence in systems-based practice. Contributing residents had significantly higher scores on compliance compared with concerning residents. Senior residents had significantly higher accountability scores compared with junior residents, and junior residents had increased project completion scores. Attendance scores increased and accountability scores decreased significantly between the first and second 6 months of the academic year. There were positive correlations between compliance scores with competing and collaborating conflict styles, and significant negative correlations between compliance with avoiding and accommodating conflict styles. Conclusions Maintaining a compliance form allows residents and residency programs to focus on issues that affect performance and facilitate assessment of the ACGME competencies. Postgraduate year, behavior, and conflict styles appear to be associated with compliance. A lack of association with faculty evaluations suggests measurement of different perceptions of residents' behavior. PMID:21976093

Co Relation between PUFA Index and Oral Health Related Quality of Life of a Rural Population in India: A Cross-Sectional Study

PubMed Central

Prathibha, B.; Reddy, P. Parthasarthi; Monica, M.; Samba, Amit; Rajesh, R.

2015-01-01

Introduction: A new measuring system called PUFA index had been identified to quantify the consequences of untreated dental caries. The co relation between PUFA index and oral health related quality of life has not been documented so far in India and thereby the need for this study Design: Cross-sectional observational study. Materials and Methods: Sample size of 212 subjects, who are the residents of a town in Rangareddy district were included to be a part of this study. The subjects were interviewed for the OHIP score and the clinical examination done to record the PUFA scores. Results: The main objective of this study was to find out if there was any correlation between the OHIP scores and the study subjects and using the Pearson’ s co relation coefficient, there was a significant correlation between the OHIP and the PUFA scores.(Pearson’ s correlation= 0.31) Conclusion: The mean OHIP and PUFA scores of the study subjects were 2.21 and 0.40 respectively. There is a positive correlation between the OHIP score and the PUFA score among the study population i.e. with the PUFA scores increasing, it has a detrimental effect on the oral health related quality of life of the individual. PMID:25738084

Co Relation between PUFA Index and Oral Health Related Quality of Life of a Rural Population in India: A Cross-Sectional Study.

PubMed

Praveen, Bhoopathi Haricharan; Prathibha, B; Reddy, P Parthasarthi; Monica, M; Samba, Amit; Rajesh, R

2015-01-01

A new measuring system called PUFA index had been identified to quantify the consequences of untreated dental caries. The co relation between PUFA index and oral health related quality of life has not been documented so far in India and thereby the need for this study Design: Cross-sectional observational study. Sample size of 212 subjects, who are the residents of a town in Rangareddy district were included to be a part of this study. The subjects were interviewed for the OHIP score and the clinical examination done to record the PUFA scores. The main objective of this study was to find out if there was any correlation between the OHIP scores and the study subjects and using the Pearson' s co relation coefficient, there was a significant correlation between the OHIP and the PUFA scores.(Pearson' s correlation= 0.31) CONCLUSION: The mean OHIP and PUFA scores of the study subjects were 2.21 and 0.40 respectively. There is a positive correlation between the OHIP score and the PUFA score among the study population i.e. with the PUFA scores increasing, it has a detrimental effect on the oral health related quality of life of the individual.

Effect of high-pitch dual-source CT to compensate motion artifacts: a phantom study.

PubMed

Farshad-Amacker, Nadja A; Alkadhi, Hatem; Leschka, Sebastian; Frauenfelder, Thomas

2013-10-01

To evaluate the potential of high-pitch, dual-source computed tomography (DSCT) for compensation of motion artifacts. Motion artifacts were created using a moving chest/cardiac phantom with integrated stents at different velocities (from 0 to 4-6 cm/s) parallel (z direction), transverse (x direction), and diagonal (x and z direction combined) to the scanning direction using standard-pitch (SP) (pitch = 1) and high-pitch (HP) (pitch = 3.2) 128-detector DSCT (Siemens, Healthcare, Forchheim, Germany). The scanning parameters were (SP/HP): tube voltage, 120 kV/120 kV; effective tube current time product, 300 mAs/500 mAs; and a pitch of 1/3.2. Motion artifacts were analyzed in terms of subjective image quality and object distortion. Image quality was rated by two blinded, independent observers using a 4-point scoring system (1, excellent; 2, good with minor object distortion or blurring; 3, diagnostically partially not acceptable; and 4, diagnostically not acceptable image quality). Object distortion was assessed by the measured changes of the object's outer diameter (x) and length (z) and a corresponding calculated distortion vector (d) (d = √(x(2) + z(2))). The interobserver agreement was excellent (k = 0.91). Image quality using SP was diagnostically not acceptable with any motion in x direction (scores 3 and 4), in contrast to HP DSCT where it remained diagnostic up to 2 cm/s (scores 1 and 2). For motion in the z direction only, image quality remained diagnostic for SP and HP DSCT (scores 1 and 2). Changes of the object's diameter (x), length (z), and distortion vectors (d) were significantly greater with SP (overall: x = 1.9 cm ± 1.7 cm, z = 0.6 cm ± 0.8 cm, and d = 1.4 cm ± 1.5 cm) compared to HP DSCT (overall: x = 0.1 cm ± 0.1 cm, z = 0.0 cm ± 0.1 cm, and d = 0.1 cm ± 0.1 cm; each P < .05). High-pitch DSCT significantly decreases motion artifacts in various directions and improves image quality. Copyright © 2013 AUR. Published by Elsevier Inc. All rights reserved.

Proposed Project Selection Method for Human Support Research and Technology Development (HSR&TD)

NASA Technical Reports Server (NTRS)

Jones, Harry

2005-01-01

The purpose of HSR&TD is to deliver human support technologies to the Exploration Systems Mission Directorate (ESMD) that will be selected for future missions. This requires identifying promising candidate technologies and advancing them in technology readiness until they are acceptable. HSR&TD must select an may of technology development projects, guide them, and either terminate or continue them, so as to maximize the resulting number of usable advanced human support technologies. This paper proposes an effective project scoring methodology to support managing the HSR&TD project portfolio. Researchers strongly disagree as to what are the best technology project selection methods, or even if there are any proven ones. Technology development is risky and outstanding achievements are rare and unpredictable. There is no simple formula for success. Organizations that are satisfied with their project selection approach typically use a mix of financial, strategic, and scoring methods in an open, established, explicit, formal process. This approach helps to build consensus and develop management insight. It encourages better project proposals by clarifying the desired project attributes. We propose a project scoring technique based on a method previously used in a federal laboratory and supported by recent research. Projects are ranked by their perceived relevance, risk, and return - a new 3 R's. Relevance is the degree to which the project objective supports the HSR&TD goal of developing usable advanced human support technologies. Risk is the estimated probability that the project will achieve its specific objective. Return is the reduction in mission life cycle cost obtained if the project is successful. If the project objective technology performs a new function with no current cost, its return is the estimated cash value of performing the new function. The proposed project selection scoring method includes definitions of the criteria, a project evaluation questionnaire, and a scoring formula.

Outcomes of neuropsychiatric events in systemic lupus erythematosus based on clinical phenotypes; prospective data from the Leiden NP SLE cohort.

PubMed

Magro-Checa, C; Beaart-van de Voorde, L J J; Middelkoop, H A M; Dane, M L; van der Wee, N J; van Buchem, M A; Huizinga, T W J; Steup-Beekman, G M

2017-04-01

Objective The objective of this study was to assess whether clinical and patient's reported outcomes are associated with a different pathophysiological origin of neuropsychiatric events presenting in systemic lupus erythematosus. Methods A total of 232 neuropsychiatric events presenting in 131 systemic lupus erythematosus patients were included. Neuropsychiatric systemic lupus erythematosus diagnosis was established per event by multidisciplinary evaluation. All neuropsychiatric events were divided according to a suspected underlying pathophysiological process into one of the following: non-neuropsychiatric systemic lupus erythematosus related, inflammatory and ischaemic neuropsychiatric systemic lupus erythematosus. The clinical outcome of all neuropsychiatric events was determined by a physician-completed four-point Likert scale. Health-related quality of life was measured with the subscales of the patient-generated Short Form 36 (SF-36) health survey questionnaire. The change between scores at paired visits of all domain scores, mental component summary (SF-36 MCS) and physical component summary (SF-36 PCS) scores were retrospectively calculated and used as patient-reported outcome. The association among these outcomes and the different origin of neuropsychiatric events was obtained using multiple logistic regression analysis. Results The clinical status of 26.8% non-neuropsychiatric systemic lupus erythematosus events, 15.8% ischaemic neuropsychiatric systemic lupus erythematosus and 51.6% inflammatory neuropsychiatric systemic lupus erythematosus improved after re-assessment. Almost all SF-36 domains had a positive change at re-assessment in all groups independently of the origin of neuropsychiatric events. Neuropsychiatric systemic lupus erythematosus ( B = 0.502; p < 0.001) and especially inflammatory neuropsychiatric systemic lupus erythematosus ( B = 0.827; p < 0.001) had better clinical outcome, with change in disease activity being the only important predictor. The change in SF-36 MCS was also independently associated with neuropsychiatric systemic lupus erythematosus ( B = 5.783; p < 0.05) and inflammatory neuropsychiatric systemic lupus erythematosus ( B = 11.133; p < 0.001). Disease duration and change in disease activity were the only predictors in both cases. The change in SF-36 PCS was only negatively associated with age. Conclusion Inflammatory neuropsychiatric systemic lupus erythematosus events have better clinical outcome and meaningful improvement in SF-36 MCS than ischaemic neuropsychiatric systemic lupus erythematosus or non-neuropsychiatric systemic lupus erythematosus.

Clinical evaluation of accommodation and ocular surface stability relavant to visual asthenopia with 3D displays

PubMed Central

2014-01-01

Background To validate the association between accommodation and visual asthenopia by measuring objective accommodative amplitude with the Optical Quality Analysis System (OQAS®, Visiometrics, Terrassa, Spain), and to investigate associations among accommodation, ocular surface instability, and visual asthenopia while viewing 3D displays. Methods Fifteen normal adults without any ocular disease or surgical history watched the same 3D and 2D displays for 30 minutes. Accommodative ability, ocular protection index (OPI), and total ocular symptom scores were evaluated before and after viewing the 3D and 2D displays. Accommodative ability was evaluated by the near point of accommodation (NPA) and OQAS to ensure reliability. The OPI was calculated by dividing the tear breakup time (TBUT) by the interblink interval (IBI). The changes in accommodative ability, OPI, and total ocular symptom scores after viewing 3D and 2D displays were evaluated. Results Accommodative ability evaluated by NPA and OQAS, OPI, and total ocular symptom scores changed significantly after 3D viewing (p = 0.005, 0.003, 0.006, and 0.003, respectively), but yielded no difference after 2D viewing. The objective measurement by OQAS verified the decrease of accommodative ability while viewing 3D displays. The change of NPA, OPI, and total ocular symptom scores after 3D viewing had a significant correlation (p < 0.05), implying direct associations among these factors. Conclusions The decrease of accommodative ability after 3D viewing was validated by both subjective and objective methods in our study. Further, the deterioration of accommodative ability and ocular surface stability may be causative factors of visual asthenopia in individuals viewing 3D displays. PMID:24612686

Development and validation of an individual dietary index based on the British Food Standard Agency nutrient profiling system in a French context.

PubMed

Julia, Chantal; Touvier, Mathilde; Méjean, Caroline; Ducrot, Pauline; Péneau, Sandrine; Hercberg, Serge; Kesse-Guyot, Emmanuelle

2014-12-01

Nutrient profiling systems could be useful public health tools as a basis for front-of-package nutrition labeling, advertising regulations, or food taxes. However, their ability beyond characterization of foods to adequately characterize individual diets necessitates further investigation. The objectives of this study were 1) to calculate a score at the individual level based on the British Food Standard Agency (FSA) food-level nutrient profiling system of each food consumed, and 2) to evaluate the validity of the resulting diet-quality score against food group consumption, nutrient intake, and sociodemographic and lifestyle variables. A representative sample of the French population was selected from the NutriNet-Santé Study (n = 4225). Dietary data were collected through repeated 24-h dietary records. Sociodemographic and lifestyle data were self-reported. All foods consumed were characterized by their FSA nutrient profile, and the energy intake from each food consumed was used to compute FSA-derived aggregated scores at the individual level. A score of adherence to French nutritional recommendations [Programme National Nutrition Santé guideline score (PNNS-GS)] was computed as a comparison diet-quality score. Associations between food consumption, nutritional indicators, lifestyle and sociodemographic variables, and quartiles of aggregated scores were investigated using ANOVAs and linear regression models. Participants with more favorable scores consumed higher amounts of fruits [difference Δ = 156 g/d between quartile 1 (less favorable) and quartile 4 (most favorable), P < 0.001], vegetables (Δ = 85 g/d, P < 0.001), and fish, and lower amounts of snack foods (Δ = -72 g/d, P < 0.001 for sugary snacks); they also had higher vitamin and mineral intakes and lower intakes of saturated fat. Participants with more favorable scores also had a higher adherence to nutritional recommendations measured with the PNNS-GS (Δ = 2.13 points, P < 0.001). Women, older subjects, and higher-income subjects were more likely to have more favorable scores. Our results show adequate validity of the FSA nutrient profiling system to characterize individual diets in a French context. The NutriNet-Santé Study was registered in the European Clinical Trials Database (EudraCT) as 2013-000929-31. © 2014 American Society for Nutrition.

Selecting a pharmacy layout design using a weighted scoring system.

PubMed

McDowell, Alissa L; Huang, Yu-Li

2012-05-01

A weighted scoring system was used to select a pharmacy layout redesign. Facilities layout design techniques were applied at a local hospital pharmacy using a step-by-step design process. The process involved observing and analyzing the current situation, observing the current available space, completing activity flow charts of the pharmacy processes, completing communication and material relationship charts to detail which areas in the pharmacy were related to one another and how they were related, researching applications in other pharmacies or in scholarly works that could be beneficial, numerically defining space requirements for areas within the pharmacy, measuring the available space within the pharmacy, developing a set of preliminary designs, and modifying preliminary designs so they were all acceptable to the pharmacy staff. To select a final layout that could be implemented in the pharmacy, those layouts were compared via a weighted scoring system. The weighted aspect further allowed additional emphasis on categories based on their effect on pharmacy performance. The results produced a beneficial layout design as determined through simulated models of the pharmacy operation that more effectively allocated and strategically located space to improve transportation distances and materials handling, employee utilization, and ergonomics. Facilities layout designs for a hospital pharmacy were evaluated using a weighted scoring system to identify a design that was superior to both the current layout and alternative layouts in terms of feasibility, cost, patient safety, employee safety, flexibility, robustness, transportation distance, employee utilization, objective adherence, maintainability, usability, and environmental impact.

Can the efficiency of modified Alvarado scoring system in the diagnosis acute appendicitis be increased with tenesmus?

PubMed

Bulus, Hakan; Tas, Adnan; Morkavuk, Baris; Koklu, Seyfettin; Soy, Derya; Coskun, Ali

2013-01-01

Acute appendicitis is one of the main pathological conditions requiring emergency surgical intervention. The most widely accepted scoring system is modified Alvarado scoring system (MASS). In this study we aimed to improve the efficiency of MASS by adding a new parameter and to evaluate its efficiency in the diagnosis of acute appendicitis. This study included 158 patients who underwent acute appendectomy in Keçiören Training and Research Hospital General Surgery Department. In addition to criteria of MASS, all patients were questioned about the presence of tenesmus. The validity of MASS and MASS with additional parameter was evaluated with respect to sensitivity, specificity and positive and negative predictive values. Accuracy rates of MASS, clinical findings, ultrasonography and MASS with additional parameter in the diagnosis of acute appendicitis were 64, 76, 85 and 80 %. False positivity rates for clinical findings, MASS and MASS with additional parameter in the diagnosis of acute appendicitis were 17, 26 and 10 %, respectively. Sensitivity and specificity of clinical findings in the diagnosis of acute appendicitis were 83 and 66 %, respectively. Sensitivity and specificity of MASS in the diagnosis of acute appendicitis were 74 and 39 %, respectively, and those of MASS with additional parameter were appendicitis increased to 83 and 66 %, respectively. MASS is a simple, cheap and objective scoring system and does not require expertise. When tenesmus is added to standard MASS, rates of accuracy, sensitivity and specificity become better than those in MASS in the diagnosis of acute appendicitis.

Evaluation of temperament scoring methods for beef cattle

USDA-ARS?s Scientific Manuscript database

The objective of this study was to evaluate methods of temperament scoring. Crossbred (n=228) calves were evaluated for temperament by an individual evaluator at weaning by two methods of scoring: 1) pen score (1 to 5 scale, with higher scores indicating increasing degree of nervousness, aggressiven...

Military Emergency Medical Service System Assessment: Application of the National Park Service Needs Assessment and Program Audit to Objectively Evaluate the Military EMS System of Okinawa, Japan.

PubMed

Ross, Elliot M; Harper, Stephen A; Cunningham, Cord; Walrath, Benjamin D; DeMers, Gerard; Kharod, Chetan U

2017-03-01

As part of a Military Emergency Medical Services (EMS) system process improvement initiative, the authors sought to objectively evaluate the U.S. military EMS system for the island of Okinawa. They applied a program evaluation tool currently utilized by the U.S. National Park Service (NPS). A comprehensive needs assessment was conducted to evaluate the current Military EMS system in Okinawa, Japan. The NPS EMS Program Audit Worksheet was used to get an overall "score" of our assessment. After all the data had been collected, a joint committee of Military EMS physicians reviewed the findings and made formal recommendations. From 2011 to 2014, U.S. military EMS on Okinawa averaged 1,345 ± 137 patient transports annually. An advanced life support (ALS) provider would have been dispatched on 558 EMS runs (38%) based on chief complaint in 2014 had they been available. Over 36,000 man-hours were expended during this period to provide National Registry Emergency Medical Technician (EMT)-accredited instruction to certify 141 Navy Corpsman as EMT Basics. The NPS EMS Program Audit Worksheet was used and the program scored a total of 31, suggesting the program is well planned and operating within standards. This evaluation of the Military EMS system on Okinawa using the NPS program assessment and audit worksheet demonstrates the NPS evaluation instruments may offer a useful assessment tool for the evaluation of Military EMS systems. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

SortNet: learning to rank by a neural preference function.

PubMed

Rigutini, Leonardo; Papini, Tiziano; Maggini, Marco; Scarselli, Franco

2011-09-01

Relevance ranking consists in sorting a set of objects with respect to a given criterion. However, in personalized retrieval systems, the relevance criteria may usually vary among different users and may not be predefined. In this case, ranking algorithms that adapt their behavior from users' feedbacks must be devised. Two main approaches are proposed in the literature for learning to rank: the use of a scoring function, learned by examples, that evaluates a feature-based representation of each object yielding an absolute relevance score, a pairwise approach, where a preference function is learned to determine the object that has to be ranked first in a given pair. In this paper, we present a preference learning method for learning to rank. A neural network, the comparative neural network (CmpNN), is trained from examples to approximate the comparison function for a pair of objects. The CmpNN adopts a particular architecture designed to implement the symmetries naturally present in a preference function. The learned preference function can be embedded as the comparator into a classical sorting algorithm to provide a global ranking of a set of objects. To improve the ranking performances, an active-learning procedure is devised, that aims at selecting the most informative patterns in the training set. The proposed algorithm is evaluated on the LETOR dataset showing promising performances in comparison with other state-of-the-art algorithms.

Modified Balance Error Scoring System (M-BESS) test scores in athletes wearing protective equipment and cleats

PubMed Central

Azad, Aftab Mohammad; Al Juma, Saad; Bhatti, Junaid Ahmad; Delaney, J Scott

2016-01-01

Background Balance testing is an important part of the initial concussion assessment. There is no research on the differences in Modified Balance Error Scoring System (M-BESS) scores when tested in real world as compared to control conditions. Objective To assess the difference in M-BESS scores in athletes wearing their protective equipment and cleats on different surfaces as compared to control conditions. Methods This cross-sectional study examined university North American football and soccer athletes. Three observers independently rated athletes performing the M-BESS test in three different conditions: (1) wearing shorts and T-shirt in bare feet on firm surface (control); (2) wearing athletic equipment with cleats on FieldTurf; and (3) wearing athletic equipment with cleats on firm surface. Mean M-BESS scores were compared between conditions. Results 60 participants were recruited: 39 from football (all males) and 21 from soccer (11 males and 10 females). Average age was 21.1 years (SD=1.8). Mean M-BESS scores were significantly lower (p<0.001) for cleats on FieldTurf (mean=26.3; SD=2.0) and for cleats on firm surface (mean=26.6; SD=2.1) as compared to the control condition (mean=28.4; SD=1.5). Females had lower scores than males for cleats on FieldTurf condition (24.9 (SD=1.9) vs 27.3 (SD=1.6), p=0.005). Players who had taping or bracing on their ankles/feet had lower scores when tested with cleats on firm surface condition (24.6 (SD=1.7) vs 26.9 (SD=2.0), p=0.002). Conclusions Total M-BESS scores for athletes wearing protective equipment and cleats standing on FieldTurf or a firm surface are around two points lower than M-BESS scores performed on the same athletes under control conditions. PMID:27900181

Contribution for new genetic markers of rheumatoid arthritis activity and severity: sequencing of the tumor necrosis factor-alpha gene promoter.

PubMed

Fonseca, João Eurico; Cavaleiro, João; Teles, José; Sousa, Elsa; Andreozzi, Valeska L; Antunes, Marília; Amaral-Turkman, Maria A; Canhão, Helena; Mourão, Ana F; Lopes, Joana; Caetano-Lopes, Joana; Weinmann, Pamela; Sobral, Marta; Nero, Patrícia; Saavedra, Maria J; Malcata, Armando; Cruz, Margarida; Melo, Rui; Braña, Araceli; Miranda, Luis; Patto, José V; Barcelos, Anabela; da Silva, José Canas; Santos, Luís M; Figueiredo, Guilherme; Rodrigues, Mário; Jesus, Herberto; Quintal, Alberto; Carvalho, Teresa; da Silva, José A Pereira; Branco, Jaime; Queiroz, Mário Viana

2007-01-01

The objective of this study was to assess whether clinical measures of rheumatoid arthritis activity and severity were influenced by tumor necrosis factor-alpha (TNF-alpha) promoter genotype/haplotype markers. Each patient's disease activity was assessed by the disease activity score using 28 joint counts (DAS28) and functional capacity by the Health Assessment Questionnaire (HAQ) score. Systemic manifestations, radiological damage evaluated by the Sharp/van der Heijde (SvdH) score, disease-modifying anti-rheumatic drug use, joint surgeries, and work disability were also assessed. The promoter region of the TNF-alpha gene, between nucleotides -1,318 and +49, was sequenced using an automated platform. Five hundred fifty-four patients were evaluated and genotyped for 10 single-nucleotide polymorphism (SNP) markers, but 5 of these markers were excluded due to failure to fall within Hardy-Weinberg equilibrium or to monomorphism. Patients with more than 10 years of disease duration (DD) presented significant associations between the -857 SNP and systemic manifestations, as well as joint surgeries. Associations were also found between the -308 SNP and work disability in patients with more than 2 years of DD and radiological damage in patients with less than 10 years of DD. A borderline effect was found between the -238 SNP and HAQ score and radiological damage in patients with 2 to 10 years of DD. An association was also found between haplotypes and the SvdH score for those with more than 10 years of DD. An association was found between some TNF-alpha promoter SNPs and systemic manifestations, radiological progression, HAQ score, work disability, and joint surgeries, particularly in some classes of DD and between haplotypes and radiological progression for those with more than 10 years of DD.

Contribution for new genetic markers of rheumatoid arthritis activity and severity: sequencing of the tumor necrosis factor-alpha gene promoter

PubMed Central

Fonseca, João Eurico; Cavaleiro, João; Teles, José; Sousa, Elsa; Andreozzi, Valeska L; Antunes, Marília; Amaral-Turkman, Maria A; Canhão, Helena; Mourão, Ana F; Lopes, Joana; Caetano-Lopes, Joana; Weinmann, Pamela; Sobral, Marta; Nero, Patrícia; Saavedra, Maria J; Malcata, Armando; Cruz, Margarida; Melo, Rui; Braña, Araceli; Miranda, Luis; Patto, José V; Barcelos, Anabela; da Silva, José Canas; Santos, Luís M; Figueiredo, Guilherme; Rodrigues, Mário; Jesus, Herberto; Quintal, Alberto; Carvalho, Teresa; da Silva, José A Pereira; Branco, Jaime; Queiroz, Mário Viana

2007-01-01

The objective of this study was to assess whether clinical measures of rheumatoid arthritis activity and severity were influenced by tumor necrosis factor-alpha (TNF-α) promoter genotype/haplotype markers. Each patient's disease activity was assessed by the disease activity score using 28 joint counts (DAS28) and functional capacity by the Health Assessment Questionnaire (HAQ) score. Systemic manifestations, radiological damage evaluated by the Sharp/van der Heijde (SvdH) score, disease-modifying anti-rheumatic drug use, joint surgeries, and work disability were also assessed. The promoter region of the TNF-α gene, between nucleotides -1,318 and +49, was sequenced using an automated platform. Five hundred fifty-four patients were evaluated and genotyped for 10 single-nucleotide polymorphism (SNP) markers, but 5 of these markers were excluded due to failure to fall within Hardy-Weinberg equilibrium or to monomorphism. Patients with more than 10 years of disease duration (DD) presented significant associations between the -857 SNP and systemic manifestations, as well as joint surgeries. Associations were also found between the -308 SNP and work disability in patients with more than 2 years of DD and radiological damage in patients with less than 10 years of DD. A borderline effect was found between the -238 SNP and HAQ score and radiological damage in patients with 2 to 10 years of DD. An association was also found between haplotypes and the SvdH score for those with more than 10 years of DD. An association was found between some TNF-α promoter SNPs and systemic manifestations, radiological progression, HAQ score, work disability, and joint surgeries, particularly in some classes of DD and between haplotypes and radiological progression for those with more than 10 years of DD. PMID:17408492

A Scoring System to Predict the Severity of Hirschsprung Disease at Diagnosis and its Correlation with Molecular Genetics.

PubMed

Núñez-Ramos, Raquel; Fernández, Raquel M; González-Velasco, Miguel; Ruiz-Contreras, Jesús; Galán-Gómez, Enrique; Núñez-Núñez, Ramón; Borrego, Salud

2016-01-27

Hirschsprung disease (HSCR) has a wide range of severity. There are non-severe forms treated conservatively until surgery and severe forms that require an early stoma and prolonged hospitalization. Our objective was to establish a clinical scoring system to predict the severity of HSCR and to evaluate the possible existence of a clinical-genetic correlation. We carried out a retrospective observational study including all HSCR cases treated in our hospital. The sample was divided into severe and non-severe disease according to the number of surgical procedures, hospitalization time and episodes of enterocolitis. The proposed score was applied at diagnosis, and the sensitivity, specificity and optimal cut-point were determined. We conducted a prospective molecular study of RET, EDNRB and EDN3 on all patients, as well as SOX10 in Waardenburg Syndrome type 4 forms. Among the 42 patients treated between 1983 and 2013, 15 met the severe disease criteria. This group had a higher mean score (13.15±2.36) than the non-severe group (8.15±2.13; p<0.001). A score {greater than or equal to}11 had a sensitivity of 87% and a specificity of 81% in detecting the severe cases. Causative mutations were identified in 12 patients, 8 of them in the severe group (p=0.015). Most of these mutations (75%) were located in the RET proto-oncogene. The proposed scoring system enables the early selection of patients with severe behaviour of HSCR. A value {greater than or equal to}11 showed good sensitivity and specificity for this purpose. Causative mutations were identified in more than 50% of patients who met the criteria for severe disease.

Methylphenidate Transdermal System: A Multisite, Open-Label Study of Dermal Reactions in Pediatric Patients Diagnosed With ADHD

PubMed Central

Squires, Liza; Li, Yunfeng; Civil, Richard; Paller, Amy S.

2010-01-01

Objective: To characterize dermal reactions and examine methylphenidate (MPH) sensitization in subjects receiving methylphenidate transdermal system (MTS). Method: This multicenter, open-label, dose-optimization study utilized MTS doses of 10, 15, 20, and 30 mg in children aged 6 to 12 years, inclusive (N = 305), with a DSM-IV-TR primary diagnosis of attention-deficit/hyperactivity disorder. The study was conducted between January 8, 2007, and August 23, 2007. Subjects wore MTS on their hips for 9 hours per day, alternating sides daily for a total of 7 weeks. Assessments included the Experience of Discomfort scale, Transdermal System Adherence scale, and Dermal Response Scale (DRS; 0 = no irritation, 7 = strong reaction). On-study reevaluations were conducted to characterize DRS scores ≥ 4. Epicutaneous allergy patch testing was conducted for DRS scores ≥ 6, persistent DRS scores ≥ 4, DRS score increase following an assessment of ≥ 4, or DRS scores of 4 or 5 following elective discontinuation. Results: Approximately half of subjects experienced definite erythema at the patch site that generally dissipated within 24 hours. Four subjects experienced a DRS score of 4 (1%): erythema in 1 subject resolved on study treatment, 2 cases resolved poststudy and subjects tolerated oral MPH, and 1 subject discontinued treatment. The latter subject was referred for patch testing and was diagnosed with allergic contact sensitization to MPH. Conclusions: Few severe dermal effects were seen with MTS treatment. Dermal reactions were characterized as contact dermatitis and dissipated rapidly. On patch testing, 1 subject (0.3%) manifested sensitization to MPH. Trial Registration: clinicaltrials.gov Identifier: NCT00434213 PMID:21494336

White Matter Correlates of Neuropsychological Dysfunction in Systemic Lupus Erythematosus

PubMed Central

Jung, Rex E.; Chavez, Robert S.; Flores, Ranee A.; Qualls, Clifford; Sibbitt, Wilmer L.; Roldan, Carlos A.

2012-01-01

Patients diagnosed with Systemic Lupus Erythematosus have similar levels of neuropsychological dysfunction (i.e., 20–50%) as those with Neuropsychiatric Systemic Lupus Erythematosus (NPSLE). We hypothesized a gradient between cognition and white matter integrity, such that strongest brain-behavior relationships would emerge in NPSLE, intermediate in non-NPSLE, and minimal in controls. We studied thirty-one patients (16 non-NPSLE; 15 NPSLE), ranging in age from 18 to 59 years old (100% female), and eighteen age and gender matched healthy controls. DTI examinations were performed on a 1.5T scanner. A broad neuropsychological battery was administered, tapping attention, memory, processing speed, and executive functioning. The Total z-score consisted of the combined sum of all neuropsychological measures. In control subjects, we found no significant FA-Total z-score correlations. NPSLE, non-NPSLE, and control subjects differed significantly in terms of Total z-score (NPSLE = −2.25+/−1.77, non-NPSLE = −1.22+/−1.03, Controls = −0.10+/−.57; F = 13.2, p<.001). In non-NPSLE subjects, FA within the right external capsule was significantly correlated with Total z-score. In NPSLE subjects, the largest FA-Total z-score clusters were observed within the left anterior thalamic radiation and right superior longitudinal fasciculus. In subsequent analyses the largest number of significant voxels linked FA with the Processing Speed z-score in NPSLE. The current results reflect objective white matter correlates of neuropsychological dysfunction in both NPSLE and (to a lesser degree) in non-NPSLE. non-NPSLE and NPSLE subjects did not differ significantly in terms of depression, as measured by the GDI; thus, previous hypotheses suggesting moderating effects of depression upon neuropsychological performance do not impact the current FA results. PMID:22291880

Neural basis of functional fixedness during creative idea generation: an EEG study.

PubMed

Camarda, Anaëlle; Salvia, Émilie; Vidal, Julie; Weil, Benoit; Poirel, Nicolas; Houdé, Olivier; Borst, Grégoire; Cassotti, Mathieu

2018-03-09

Decades of problem solving and creativity research have converged to show that the ability to generate new and useful ideas can be blocked or impeded by intuitive biases leading to mental fixations. The present study aimed at investigating the neural bases of the processes involved in overcoming fixation effects during creative idea generation. Using the AU task adapted for EEG recording, we examined whether participant's ability to provide original ideas was related to alpha power changes in both the frontal and temporo-parietal regions. Critically, for half of the presented objects, the classical use of the object was primed orally, and a picture of the classical use was presented visually to increase functional fixedness (Fixation Priming condition). For the other half, only the name of the object and a picture of the object was provided to the participants (control condition). As expected, priming the classical use of an object before the generation of creative alternative uses of the object impeded participants' performances in terms of remoteness. In the control condition, while the frontal alpha synchronization was maintained across all successive time windows in participants with high remoteness scores, the frontal alpha synchronization decreased in participants with low remoteness scores. In the Fixation Priming condition, in which functional fixedness was maximal, both participants with high and low remoteness scores maintained frontal alpha synchronization throughout the period preceding their answer. Whereas participants with high remoteness scores maintained alpha synchronization in the temporo-parietal regions throughout the creative idea generation period, participants with low remoteness scores displayed alpha desynchronization in the same regions during this period. We speculate that individuals with high remoteness scores might generate more creative ideas than individuals with low remoteness scores because they rely more on internal semantic association and selection processes. Copyright © 2018. Published by Elsevier Ltd.

Systemic Review of Anatomic Single- Versus Double-Bundle Anterior Cruciate Ligament Reconstruction: Does Femoral Tunnel Drilling Technique Matter?

PubMed

Zhang, Yang; Xu, Caiqi; Dong, Shiqui; Shen, Peng; Su, Wei; Zhao, Jinzhong

2016-09-01

To provide an up-to-date assessment of the difference between anatomic double-bundle anterior cruciate ligament (ACL) reconstruction (DB-ACLR) and anatomic single-bundle ACL reconstruction (SB-ACLR). We hypothesized that anatomic SB-ACLR using independent femoral drilling technique would be able to achieve kinematic stability as with anatomic DB-ACLR. A comprehensive Internet search was performed to identify all therapeutic trials of anatomic DB-ACLR versus anatomic SB-ACLR. Only clinical studies of Level I and II evidence were included. The comparative outcomes were instrument-measured anterior laxity, Lachman test, pivot shift, clinical outcomes including objective/subjective International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner activity scale and complication rates of extension/flexion deficits, graft failure, and early osteoarthritis. Subgroup analyses were performed for femoral tunnel drilling techniques including independent drilling and transtibial (TT) drilling. Twenty-two clinical trials of 2,261 anatomically ACL-reconstructed patients were included in the meta-analysis. Via TT drilling technique, anatomic DB-ACLR led to improved instrument-measured anterior laxity with a standard mean difference (SMD) of -0.42 (95% confidence interval [CI] = -0.81 to -0.02), less rotational instability measured by pivot shift (SMD = 2.76, 95% CI = 1.24 to 6.16), and higher objective IKDC score with odds ratio (OR) of 2.28 (95% CI = 1.19 to 4.36). Via independent drilling technique, anatomic DB-ACLR yielded better pivot shift (SMD = 2.04, 95% CI = 1.36 to 3.05). Anatomic DB-ACLR also revealed statistical significance in subjective IKDC score compared with anatomic SB-ACLR (SMD = 0.27, 95% CI = 0.05 to 0.49). Anatomic DB-ACLR showed better anterior and rotational stability and higher objective IKDC score than anatomic SB-ACLR via TT drilling technique. Via independent drilling technique, however, anatomic DB-ACLR only showed superiority of rotational stability. All clinical function outcomes except subjective IKDC score were not significantly different between anatomic DB-ACLR and SB-ACLR. Level II, meta-analysis of Level I and II studies. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Qualities of dental chart recording and coding.

PubMed

Chantravekin, Yosananda; Tasananutree, Munchulika; Santaphongse, Supitcha; Aittiwarapoj, Anchisa

2013-01-01

Chart recording and coding are the important processes in the healthcare informatics system, but there were only a few reports in the dentistry field. The objectives of this study are to study the qualities of dental chart recording and coding, as well as the achievement of lecture/workshop on this topic. The study was performed by auditing the patient's charts at the TU Dental Student Clinic from July 2011-August 2012. The chart recording mean scores ranged from 51.0-55.7%, whereas the errors in the coding process were presented in the coder part more than the doctor part. The lecture/workshop could improve the scores only in some topics.

Perceived stress and reported cognitive symptoms among Georgia patients with systemic lupus erythematosus.

PubMed

Plantinga, L; Lim, S S; Bowling, C B; Drenkard, C

2017-09-01

Objective To examine associations of perceived stress with cognitive symptoms among adults with systemic lupus erythematosus (SLE). Methods Among 777 adult (≥18 years) SLE patients, the association of Perceived Stress Scale (PSS) scores with two self-reported cognitive symptoms was examined: forgetfulness (severe/moderate vs. mild/none; from the Systemic Lupus Activity Questionnaire) and difficulty concentrating (all/most vs. some/little/none of the time; from the Lupus Impact Tracker). The study used multivariable logistic regression to estimate the odds ratios (ORs) per minimal important difference (MID = 0.5*SD) of PSS score and cognitive symptoms. Results Forgetfulness and difficulty concentrating were reported by 41.7% and 29.5%, respectively. Women and those with less education and high disease activity had higher PSS scores and were more likely to report cognitive symptoms than their counterparts. With adjustment for age, race, sex, education, and disease activity, each MID increase in PSS score was associated with higher prevalence of forgetfulness (OR = 1.43, 95% CI 1.29-1.47) and difficulty concentrating (OR = 2.19, 95% CI 1.90-2.52). No substantial differences in this association by age, race, sex, or disease activity were noted. Conclusions SLE patients, particularly those with high disease activity, report a high burden of cognitive symptoms, for which stress may be a modifiable risk factor.

Development of a partial least squares-artificial neural network (PLS-ANN) hybrid model for the prediction of consumer liking scores of ready-to-drink green tea beverages.

PubMed

Yu, Peigen; Low, Mei Yin; Zhou, Weibiao

2018-01-01

In order to develop products that would be preferred by consumers, the effects of the chemical compositions of ready-to-drink green tea beverages on consumer liking were studied through regression analyses. Green tea model systems were prepared by dosing solutions of 0.1% green tea extract with differing concentrations of eight flavour keys deemed to be important for green tea aroma and taste, based on a D-optimal experimental design, before undergoing commercial sterilisation. Sensory evaluation of the green tea model system was carried out using an untrained consumer panel to obtain hedonic liking scores of the samples. Regression models were subsequently trained to objectively predict the consumer liking scores of the green tea model systems. A linear partial least squares (PLS) regression model was developed to describe the effects of the eight flavour keys on consumer liking, with a coefficient of determination (R 2 ) of 0.733, and a root-mean-square error (RMSE) of 3.53%. The PLS model was further augmented with an artificial neural network (ANN) to establish a PLS-ANN hybrid model. The established hybrid model was found to give a better prediction of consumer liking scores, based on its R 2 (0.875) and RMSE (2.41%). Copyright © 2017 Elsevier Ltd. All rights reserved.

Quantification of protein expression in cells and cellular subcompartments on immunohistochemical sections using a computer supported image analysis system.

PubMed

Braun, Martin; Kirsten, Robert; Rupp, Niels J; Moch, Holger; Fend, Falko; Wernert, Nicolas; Kristiansen, Glen; Perner, Sven

2013-05-01

Quantification of protein expression based on immunohistochemistry (IHC) is an important step for translational research and clinical routine. Several manual ('eyeballing') scoring systems are used in order to semi-quantify protein expression based on chromogenic intensities and distribution patterns. However, manual scoring systems are time-consuming and subject to significant intra- and interobserver variability. The aim of our study was to explore, whether new image analysis software proves to be sufficient as an alternative tool to quantify protein expression. For IHC experiments, one nucleus specific marker (i.e., ERG antibody), one cytoplasmic specific marker (i.e., SLC45A3 antibody), and one marker expressed in both compartments (i.e., TMPRSS2 antibody) were chosen. Stainings were applied on TMAs, containing tumor material of 630 prostate cancer patients. A pathologist visually quantified all IHC stainings in a blinded manner, applying a four-step scoring system. For digital quantification, image analysis software (Tissue Studio v.2.1, Definiens AG, Munich, Germany) was applied to obtain a continuous spectrum of average staining intensity. For each of the three antibodies we found a strong correlation of the manual protein expression score and the score of the image analysis software. Spearman's rank correlation coefficient was 0.94, 0.92, and 0.90 for ERG, SLC45A3, and TMPRSS2, respectively (p⟨0.01). Our data suggest that the image analysis software Tissue Studio is a powerful tool for quantification of protein expression in IHC stainings. Further, since the digital analysis is precise and reproducible, computer supported protein quantification might help to overcome intra- and interobserver variability and increase objectivity of IHC based protein assessment.

Reliability of the Balance Evaluation Systems Test (BESTest) and BESTest sections for adults with hemiparesis

PubMed Central

Rodrigues, Letícia C.; Marques, Aline P.; Barros, Paula B.; Michaelsen, Stella M.

2014-01-01

BACKGROUND: The Balance Evaluation Systems Test (BESTest) was recently created to allow the development of treatments according to the specific balance system affected in each patient. The Brazilian version of the BESTest has not been specifically tested after stroke. OBJECTIVE: To evaluate the intra- and inter-rater reliability and concurrent and convergent validity of the total score of the BESTest and BESTest sections for adults with hemiparesis after stroke. METHOD: The study included 16 subjects (61.1±7.5 years) with chronic hemiparesis (54.5±43.5 months after stroke). The BESTest was administered by two raters in the same week and one of the raters repeated the test after a one-week interval. Intraclass correlation coefficient (ICC) was calculated to assess intra- and interrater reliability. Concurrent validity with the Berg Balance Scale (BBS) and convergent validity with the Activities-specific Balance Confidence scale (ABC-Brazil) were assessed using Pearson's correlation coefficient. RESULTS: Both the BESTest total score (ICC=0.98) and the BESTest sections (ICC between 0.85 and 0.96) have excellent intrarater reliability. Interrater reliability for the total score was excellent (ICC=0.93) and, for the sections, it ranged between 0.71 and 0.94. The correlation coefficient between the BESTest and the BBS and ABC-Brazil were 0.78 and 0.59, respectively. CONCLUSIONS: The Brazilian version of the BESTest demonstrated adequate reliability when measured by sections and could identify what balance system was affected in patients after stroke. Concurrent validity was excellent with the BBS total score and good to excellent with the sections. The total scores but not the sections present adequate convergent validity with the ABC-Brazil. However, other psychometric properties should be further investigated. PMID:25003281

Contrast-enhanced ultrasonography for the detection of joint vascularity in arthritis--subjective grading versus computer-aided objective quantification.

PubMed

Klauser, A S; Franz, M; Bellmann Weiler, R; Gruber, J; Hartig, F; Mur, E; Wick, M C; Jaschke, W

2011-12-01

To compare joint inflammation assessment using subjective grading of power Doppler ultrasonography (PDUS) and contrast-enhanced ultrasonography (CEUS) versus computer-aided objective CEUS quantification. 37 joints of 28 patients with arthritis of different etiologies underwent B-mode ultrasonography, PDUS, and CEUS using a second-generation contrast agent. Synovial thickness, extent of vascularized pannus and intensity of vascularization were included in a 4-point PDUS and CEUS grading system. Subjective CEUS and PDUS scores were compared to computer-aided objective CEUS quantification using Qontrast® software for the calculation of the signal intensity (SI) and the ratio of SI for contrast enhancement. The interobserver agreement for subjective scoring was good to excellent (κ = 0.8 - 1.0; P < 0.0001). Computer-aided objective CEUS quantification correlated statistically significantly with subjective CEUS (P < 0.001) and PDUS grading (P < 0.05). The Qontrast® SI ratio correlated with subjective CEUS (P < 0.02) and PDUS grading (P < 0.03). Clinical activity did not correlate with vascularity or synovial thickening (P = N. S.) and no correlation between synovial thickening and vascularity extent could be found, neither using PDUS nor CEUS (P = N. S.). Both subjective CEUS grading and objective CEUS quantification are valuable for assessing joint vascularity in arthritis and computer-aided CEUS quantification may be a suitable objective tool for therapy follow-up in arthritis. © Georg Thieme Verlag KG Stuttgart · New York.

Validation of the Lupus Nephritis Clinical Indices in Childhood-Onset Systemic Lupus Erythematosus

PubMed Central

Mina, Rina; Abulaban, Khalid; Klein-Gitelman, Marisa; Eberhard, Anne; Ardoin, Stacy; Singer, Nora; Onel, Karen; Tucker, Lori; O’Neil, Kathleen; Wright, Tracey; Brooks, Elizabeth; Rouster-Stevens, Kelly; Jung, Lawrence; Imundo, Lisa; Rovin, Brad; Witte, David; Ying, Jun; Brunner, Hermine I.

2015-01-01

Objective To validate clinical indices of lupus nephritis (LN) activity and damage when used in children against the criterion standard of kidney biopsy findings. Methods In 83 children requiring kidney biopsy the SLE Disease Activity Index Renal Domain (SLEDAI-R); British Isles Lupus Assessment Group index Renal Domain (BILAG-R), Systemic Lupus International Collaborating Clinics Renal Activity (SLICC-RAS) and Damage Index Renal Domain (SDI-R) were measured. Fixed effect and logistic models were done to predict International Society of Nephrology/Renal Pathology Society (ISN/RPS) class; low/moderate vs. high LN-activity [NIH Activity Index (NIH-AI) score: ≤ 10 vs. > 10; Tubulointerstitial Activity Index (TIAI) score: ≤ 5 vs. > 5) or the absence vs. presence of LN chronicity [NIH Chronicity Index (NIH-CI) score: 0 vs. ≥ 1]. Results There were 10, 50 and 23 patients with class I/II, III/IV and V, respectively. Scores of the clinical indices did not differentiate among patients by ISN/RPS class. The SLEDAI-R and SLICC-RAS but not the BILAG-R differed with LN-activity status defined by NIH-AI scores, while only the SLEDAI-R scores differed between LN-activity status based on TIAI scores. The sensitivity and specificity of the SDI-R to capture LN chronicity was 23.5% and 91.7%, respectively. Despite designed to measure LN-activity, SLICC-RAS and SLEDAI-R scores significantly differed with LN chronicity status. Conclusion Current clinical indices of LN fail to discriminate ISN/RPS Class in children. Despite its shortcomings, the SLEDAI-R appears to best for measuring LN activity in a clinical setting. The SDI-R is a poor correlate of LN chronicity. PMID:26213987

A prognostic scoring system for arm exercise stress testing.

PubMed

Xie, Yan; Xian, Hong; Chandiramani, Pooja; Bainter, Emily; Wan, Leping; Martin, Wade H

2016-01-01

Arm exercise stress testing may be an equivalent or better predictor of mortality outcome than pharmacological stress imaging for the ≥50% for patients unable to perform leg exercise. Thus, our objective was to develop an arm exercise ECG stress test scoring system, analogous to the Duke Treadmill Score, for predicting outcome in these individuals. In this retrospective observational cohort study, arm exercise ECG stress tests were performed in 443 consecutive veterans aged 64.1 (11.1) years. (mean (SD)) between 1997 and 2002. From multivariate Cox models, arm exercise scores were developed for prediction of 5-year and 12-year all-cause and cardiovascular mortality and 5-year cardiovascular mortality or myocardial infarction (MI). Arm exercise capacity in resting metabolic equivalents (METs), 1 min heart rate recovery (HRR) and ST segment depression ≥1 mm were the stress test variables independently associated with all-cause and cardiovascular mortality by step-wise Cox analysis (all p<0.01). A score based on the relation HRR (bpm)+7.3×METs-10.5×ST depression (0=no; 1=yes) prognosticated 5-year cardiovascular mortality with a C-statistic of 0.81 before and 0.88 after adjustment for significant demographic and clinical covariates. Arm exercise scores for the other outcome end points yielded C-statistic values of 0.77-0.79 before and 0.82-0.86 after adjustment for significant covariates versus 0.64-0.72 for best fit pharmacological myocardial perfusion imaging models in a cohort of 1730 veterans who were evaluated over the same time period. Arm exercise scores, analogous to the Duke Treadmill Score, have good power for prediction of mortality or MI in patients who cannot perform leg exercise.

Non-hematologic predictors of mortality improve the prognostic value of the international prognostic scoring system for MDS in older adults†

PubMed Central

Fega, K. Rebecca; Abel, Gregory A.; Motyckova, Gabriela; Sherman, Alexander E.; DeAngelo, Daniel J.; Steensma, David P.; Galinsky, Ilene; Wadleigh, Martha; Stone, Richard M.; Driver, Jane A.

2016-01-01

Objectives The International Prognostic Scoring System (IPSS) is commonly used to predict survival and assign treatment for the myelodysplastic syndromes (MDS). We explored whether self-reported and readily available non-hematologic predictors of survival add independent prognostic information to the IPSS. Materials and Methods Retrospective cohort study of consecutive MDS patients ≥age 65 who presented to Dana-Farber Cancer Institute between 2006 and 2011 and completed a baseline quality of life questionnaire. Questions corresponding to functional status and symptoms and extracted clinical-pathologic data from medical records. Kaplan–Meier and Cox proportional hazards models were used to estimate survival. Results One hundred fourteen patients consented and were available for analysis. Median age was 73 years, and the majority of patients were White, were male, and had a Charlson comorbidity score of <2. Few patients (24%) had an IPSS score consistent with lower-risk disease and the majority received chemotherapy. In addition to IPSS score and history of prior chemotherapy or radiation, significant univariate predictors of survival included low serum albumin, Charlson score, performance status, ability to take a long walk, and interference of physical symptoms in family life. The multivariate model that best predicted mortality included low serum albumin (HR = 2.3; 95% CI: 1.06–5.14), therapy-related MDS (HR = 2.1; 95% CI: 1.16–4.24), IPSS score (HR = 1.7; 95% CI: 1.14–2.49), and ease taking a long walk (HR = 0.44; 95% CI: 0.23–0.90). Conclusions In this study of older adults with MDS, we found that low serum albumin and physical function added important prognostic information to the IPSS score. Self-reported physical function was more predictive than physician-assigned performance status. PMID:26073533

Development of the object permanence concept in cleft lip and palate and noncleft lip and palate infants.

PubMed

Pecyna, P M; Feeney-Giacoma, M E; Neiman, G S

1987-06-01

Studies of language acquisition in cleft lip and palate infants have not investigated the development of specific cognitive concepts, such as object permanence, which may be related to early linguistic skills. This study obtained comparative data on the development of the object permanence concept in cleft lip and palate and noncleft lip and palate infants to determine whether there were significant differences in rate or sequence of development. Infants were tested for the object permanence concept from 12 through 18 months of age. Results revealed significant improvement in all infants' scores with age, indicating progressive development of the concept. Further, while scores were not significantly different between the cleft lip and palate groups, scores for these groups were significantly better than scores for noncleft lip and palate infants. Superior performance of the cleft lip and palate infants may have resulted from increased environmental stimulation provided by their parents. Implications for intervention and future research in this area are presented.

How Non-Linearity and Grade-Level Differences Complicate the Validation of Observation Protocols

ERIC Educational Resources Information Center

Lazarev, Valeriy; Newman, Denis

2013-01-01

Teacher evaluation is currently a major policy issue at all levels of the K-12 system driven in large part by current US Department of Education requirements. The main objective of this study is to explore the patterns of relationship between observational scores and value-added measures of teacher performance in math classrooms and the variation…

[The Visual Association Test to study episodic memory in clinical geriatric psychology].

PubMed

Diesfeldt, Han; Prins, Marleen; Lauret, Gijs

2018-04-01

The Visual Association Test (VAT) is a brief learning task that consists of six line drawings of pairs of interacting objects (association cards). Subjects are asked to name or identify each object and later are presented with one object from the pair (the cue) and asked to name the other (the target). The VAT was administered in a consecutive sample of 174 psychogeriatric day care participants with mild to major neurocognitive disorder. Comparison of test performance with normative data from non-demented subjects revealed that 69% scored within the range of a major deficit (0-8 over two recall trials), 14% a minor, and 17% no deficit (9-10, and ≥10 respectively).VAT-scores correlated with another test of memory function, the Cognitive Screening Test (CST), based on the Short Portable Mental Status Questionnaire (r = 0.53). Tests of executive functioning (Expanded Mental Control Test, Category Fluency, Clock Drawing) did not add significantly to the explanation of variance in VAT-scores.Fifty-five participants (31.6%) were faced with initial problems in naming or identifying one or more objects on the cue cards or association cards. If necessary, naming was aided by the investigator. Initial difficulties in identifying cue objects were associated with lower VAT-scores, but this did not hold for difficulties in identifying target objects.A hierarchical multiple regression analysis was used to examine whether linear or quadratic trends best fitted VAT performance across the range of CST scores. The regression model revealed a linear but not a quadratic trend. The best fitting linear model implied that VAT scores differentiated between CST scores in the lower, as well as in the upper range, indicating the absence of floor and ceiling effects, respectively. Moreover, the VAT compares favourably to word list-learning tasks being more attractive in its presentation of interacting visual objects and cued recall based on incidental learning of the association between cues and targets.For practical purposes and based on documented sensitivity and specificity, Bayesian probability tables give predictive power of age-specific VAT cutoff scores for the presence or absence of a major neurocognitive disorder across a range of a priori probabilities or base rates.

Computerized quantitative evaluation of mammographic accreditation phantom images

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

Lee, Yongbum; Tsai, Du-Yih; Shinohara, Norimitsu

2010-12-15

Purpose: The objective was to develop and investigate an automated scoring scheme of the American College of Radiology (ACR) mammographic accreditation phantom (RMI 156, Middleton, WI) images. Methods: The developed method consisted of background subtraction, determination of region of interest, classification of fiber and mass objects by Mahalanobis distance, detection of specks by template matching, and rule-based scoring. Fifty-one phantom images were collected from 51 facilities for this study (one facility provided one image). A medical physicist and two radiologic technologists also scored the images. The human and computerized scores were compared. Results: In terms of meeting the ACR's criteria,more » the accuracies of the developed method for computerized evaluation of fiber, mass, and speck were 90%, 80%, and 98%, respectively. Contingency table analysis revealed significant association between observer and computer scores for microcalcifications (p<5%) but not for masses and fibers. Conclusions: The developed method may achieve a stable assessment of visibility for test objects in mammographic accreditation phantom image in whether the phantom image meets the ACR's criteria in the evaluation test, although there is room left for improvement in the approach for fiber and mass objects.« less

Subjective Cognitive Complaints and Objective Cognitive Impairment in Parkinson's Disease.

PubMed

Hong, Jin Yong; Lee, Yoonju; Sunwoo, Mun Kyung; Sohn, Young H; Lee, Phil Hyu

2018-01-01

Subjective cognitive complaints (SCCs) are very common in patients with Parkinson's disease (PD). However, the relationship between SCCs and objective cognitive impairment is still unclear. This study aimed to determine whether SCCs are correlated with objective cognitive performance in patients with PD. Totals of 148 cognitively normal patients, 71 patients with mild cognitive impairment (MCI), and 31 demented patients were recruited consecutively from a movement-disorders clinic. Their SCCs and cognitive performances were evaluated using the Cognitive Complaints Interview (CCI) and a comprehensive neuropsychological battery. The CCI score increased with age, duration of PD, and depression score, and was inversely correlated with cognitive performance. The association between CCI score and performance remained significant after adjustment for the depression score, age, and duration of PD. The CCI score could be used to discriminate patients with dementia from cognitively normal and MCI patients [area under the receiver operating characteristics curve (AUC) of 0.80], but not patients with MCI or dementia from cognitively normal patients (AUC of 0.67). SCCs as measured by the CCI are strongly correlated with objective cognitive performance in patients with PD. The CCI can also be used to screen for dementia in patients with PD. Copyright © 2018 Korean Neurological Association.

Predictive value of the korean academy of family medicine in-training examination for certifying examination.

PubMed

Cho, Jung-Jin; Kim, Ji-Yong

2011-09-01

In-training examination (ITE) is a cognitive examination similar to the written test, but it is different from the Clinical Practice Examination of the Korean Academy of Family Medicine (KAFM) Certification Examination (CE). The objective of this is to estimate the positive predictive value of the KAFM-ITE for identifying residents at risk for poor performance on the three types of KAFM-CE. 372 residents who completed the KAFM-CE in 2011 were included. We compared the mean KAFM-CE scores with ITE experience. We evaluated the correlation and the positive predictive value (PPV) of ITE for the multiple choice question (MCQ) scores of 1st written test & 2nd slide examination, the total clinical practice examination scores, and the total sum of 2nd test. 275 out of 372 residents completed ITE. Those who completed ITE had significantly higher MCQ scores of 1st written test than those who did not. The correlation of ITE scores with 1st written MCQ (0.627) was found to be the highest among the other kinds of CE. The PPV of the ITE score for 1st written MCQ scores was 0.672. The PPV of the ITE score ranged from 0.376 to 0.502. The score of the KAFM ITE has acceptable positive predictive value that could be used as a part of comprehensive evaluation system for residents in cognitive field.

Evaluation of colonoscopy technical skill levels by use of an objective kinematic-based system.

PubMed

Obstein, Keith L; Patil, Vaibhav D; Jayender, Jagadeesan; San José Estépar, Raúl; Spofford, Inbar S; Lengyel, Balazs I; Vosburgh, Kirby G; Thompson, Christopher C

2011-02-01

Colonoscopy requires training and experience to ensure accuracy and safety. Currently, no objective, validated process exists to determine when an endoscopist has attained technical competence. Kinematics data describing movements of laparoscopic instruments have been used in surgical skill assessment to define expert surgical technique. We have developed a novel system to record kinematics data during colonoscopy and quantitatively assess colonoscopist performance. To use kinematic analysis of colonoscopy to quantitatively assess endoscopic technical performance. Prospective cohort study. Tertiary-care academic medical center. This study involved physicians who perform colonoscopy. Application of a kinematics data collection system to colonoscopy evaluation. Kinematics data, validated task load assessment instrument, and technical difficulty visual analog scale. All 13 participants completed the colonoscopy to the terminal ileum on the standard colon model. Attending physicians reached the terminal ileum quicker than fellows (median time, 150.19 seconds vs 299.86 seconds; p<.01) with reduced path lengths for all 4 sensors, decreased flex (1.75 m vs 3.14 m; P=.03), smaller tip angulation, reduced absolute roll, and lower curvature of the endoscope. With performance of attending physicians serving as the expert reference standard, the mean kinematic score increased by 19.89 for each decrease in postgraduate year (P<.01). Overall, fellows experienced greater mental, physical, and temporal demand than did attending physicians. Small cohort size. Kinematic data and score calculation appear useful in the evaluation of colonoscopy technical skill levels. The kinematic score appears to consistently vary by year of training. Because this assessment is nonsubjective, it may be an improvement over current methods for determination of competence. Ongoing studies are establishing benchmarks and characteristic profiles of skill groups based on kinematics data. Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Disease evolution in late-onset and early-onset systemic lupus erythematosus.

PubMed

Aljohani, R; Gladman, D D; Su, J; Urowitz, M B

2017-10-01

Objective The objective of this study was to compare clinical features, disease activity, and outcome in late-onset versus early-onset systemic lupus erythematosus (SLE) over 5 years of follow up Method Patients with SLE since 1970 were followed prospectively according to standard protocol and tracked on a computerized database. Patients entering the cohort within one year of diagnosis constitute the inception cohort. Patients with late-onset (age at diagnosis ≥50) disease were identified and matched 1:2 based on gender and first clinic visit (±5) years with patients with early-onset disease (age at diagnosis 18-40 years). Results A total of 86 patients with late-onset disease (84.9% female, 81.4% Caucasian, mean age at SLE diagnosis ± SD 58.05 ± 7.30) and 169 patients with early-onset disease (86.4% female, 71% Caucasian, mean age at SLE diagnosis ± SD 27.80 ± 5.90) were identified. At enrollment, late-onset SLE patients had a lower total number of American College of Rheumatology (ACR) criteria, with less renal and neurologic manifestations. Mean SLE Disease Activity Index 2000 (SLEDAI-2K) scores were lower in late-onset SLE, especially renal features and anti-dsDNA positivity. Over 5 years, mean SLEDAI-2K scores decreased in both groups, while mean Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) scores increased more significantly in the late-onset group; they developed more cardiovascular, renal, and ocular damage, and had higher prevalence of cardiovascular risk factors. Conclusion Although the late-onset SLE group had a milder presentation and less active disease, with the evolution of disease, they developed more organ damage likely as a consequence of cardiovascular risk factors and aging.

School Teachers' Knowledge about Epilepsy in Kathmandu Metropolitan City.

PubMed

Khanal, K; Maharjan, R; Pokharel, B R; Sanjel, S

2015-01-01

Background Studies on Knowledge towards epilepsy among school teachers are very limited on developing countries especially with reference to Nepal. Level of knowledge of schoolteachers plays an important role on providing a greater educational support for epileptic child and to maintain good communication skills between epileptic and normal child. Objective Objective of this study is to assess the level of knowledge about epilepsy and its associated factors among school teachers. Method A cross sectional study was conducted from 10th June to 4th July, 2014 among 165 teachers teaching in six different schools of Kathmandu Metropolitan City. A selfadministrated questionnaire consisting of structured and multiple choice questions were designed to collect information on the teacher's socio-demographic profile and knowledge about epilepsy. A scoring system was developed for each question: each correct answer was given a score of 1, and a score of 0 for wrong answer. Total score was categorized on two categories: Good Knowledge and Poor Knowledge. Result Teacher's age did not correlate significantly with their knowledge about epilepsy but total years of teaching experiences and knowledge about epilepsy were found to be positively correlated (ρ= 0.165, p= 0.01). Academic qualification of teachers and different teaching level were associated with level of knowledge (p= 0.023, p= 0.021). Significant difference on knowledge score was found among teachers having different academic qualification (p= 0.019). Conclusion All teachers were aware about epilepsy, but their knowledge about epilepsy was not sufficient therefore, health education training program about epilepsy is needed for teachers.

A North American perspective of content and quality of websites in the English language on childhood-onset lupus erythematosus.

PubMed

Cutler, C; Peng, T; Stinson, J; Tucker, L; Boneparth, A; Klein Gitelman, M; Moorthy, L Nandini

2018-04-01

Objective The objective of this article is to examine the quality, content, and readability of information and resources in the English language and accessible on the internet by pediatric patients with systemic lupus erythematosus (SLE) and their families in North America. Methods Keywords relevant to SLE were generated by an undergraduate student, a first-year medical student, and a third-year pediatric resident, and a search was conducted across five commonly used search engines. Quality of information found was evaluated independently by an undergraduate student, a graduate student, a first-year medical student, and a third-year pediatric resident using the DISCERN tool. Two pediatric rheumatologists assessed website accuracy and completeness. Readability of websites was determined using the Flesch-Kincaid grade level and Reading Ease score. Results Out of 2000 websites generated in the search, only 34 unique websites met inclusion criteria. Only 16 of these websites had DISCERN scores above 50% (fair quality). Overall quality of website information was fair with mean ±standard deviation (SD) DISCERN quality score of 44 ± 7 (range: 30-56). Only nine websites of 34 had DISCERN scores above 50 (>66%, indicating greater quality) and were further assessed for completeness. Flesch-Kincaid grade level was 11 ± 1 (mean±SD) and reading ease score was 39 ± 10 (mean±SD, range of 11-61). Conclusion Our study highlights the need for more complete, readable information regarding the unique needs of pediatric patients with childhood-onset SLE and their families.

Tailored balance exercises on people with multiple sclerosis: A pilot randomized, controlled study.

PubMed

Brichetto, Giampaolo; Piccardo, Elisa; Pedullà, Ludovico; Battaglia, Mario Alberto; Tacchino, Andrea

2015-07-01

Altered integration of signals from visual (VIS), somatosensory (PROP) and vestibular system (VEST) lead to balance control impairments affecting the daily living activities of patients with multiple sclerosis (PwMS). As a consequence, tailored interventions could be crucial in improving efficacy of balance rehabilitation treatments. The objective of this paper is to assess the efficacy of tailored rehabilitation treatments for balance disorders based on visual, somatosensory and vestibular deficits versus traditional rehabilitation exercises. Thirty-two PwMS were assessed with the Berg Balance Scale (BBS), the composite score (CS) obtained by computerized dynamic posturography (CDP) test and the Modified Fatigue Impact Scale (MFIS). Based on CDP analysis, prevalent VIS, PROP or VEST deficits were identified and patients randomly allocated to a personalized (PRG) or traditional (TRG) rehabilitation group. BBS score showed a significant difference between pre- and post-treatment scores of 6.3 and 2.0 points respectively for PRG and TRG. CS showed a significant difference between pre- and post-treatment scores of 16.6 and 7.6 points respectively for PRG and TRG. No interaction effect was found for MFIS score. BBS and CS showed changes in the PRG group that met clinical relevant difference, underlining that tailored rehabilitation interventions based on patient-specific sensory system impairment could improve balance and postural control in PwMS. © The Author(s), 2015.

Neurosurgery certification in member societies of the World Federation of Neurosurgical Societies: Asia.

PubMed

Gasco, Jaime; Braun, Jonathan D; McCutcheon, Ian E; Black, Peter M

2011-01-01

To objectively compare the complexity and diversity of the certification process in neurological surgery in member societies of the World Federation of Neurosurgical Societies. This study centers in continental Asia. We provide here an analysis based on the responses provided to a 13-item survey. The data received were analyzed, and three Regional Complexity Scores (RCS) were designed. To compare national board experience, eligibility requirements for access to the certification process, and the obligatory nature of the examinations, an RCS-Organizational score was created (20 points maximum). To analyze the complexity of the examination, an RCS-Components score was designed (20 points maximum). The sum of both is presented in a Global RCS score. Only those countries that responded to the survey and presented nationwide homogeneity in the conduction of neurosurgery examinations could be included within the scoring system. In addition, a descriptive summary of the certification process per responding society is also provided. On the basis of the data provided by our RCS system, the highest global RCS was achieved by South Korea and Malaysia (21/40 points) followed by the joint examination of Singapore and Hong-Kong (FRCS-Ed) (20/40 points), Japan (17/40 points), the Philippines (15/40 points), and Taiwan (13 points). The experience from these leading countries should be of value to all countries within Asia. Copyright © 2011 Elsevier Inc. All rights reserved.

A chemical risk ranking and scoring method for the selection of harmful substances to be specially controlled in occupational environments.

PubMed

Shin, Saemi; Moon, Hyung-Il; Lee, Kwon Seob; Hong, Mun Ki; Byeon, Sang-Hoon

2014-11-20

This study aimed to devise a method for prioritizing hazardous chemicals for further regulatory action. To accomplish this objective, we chose appropriate indicators and algorithms. Nine indicators from the Globally Harmonized System of Classification and Labeling of Chemicals were used to identify categories to which the authors assigned numerical scores. Exposure indicators included handling volume, distribution, and exposure level. To test the method devised by this study, sixty-two harmful substances controlled by the Occupational Safety and Health Act in Korea, including acrylamide, acrylonitrile, and styrene were ranked using this proposed method. The correlation coefficients between total score and each indicator ranged from 0.160 to 0.641, and those between total score and hazard indicators ranged from 0.603 to 0.641. The latter were higher than the correlation coefficients between total score and exposure indicators, which ranged from 0.160 to 0.421. Correlations between individual indicators were low (-0.240 to 0.376), except for those between handling volume and distribution (0.613), suggesting that each indicator was not strongly correlated. The low correlations between each indicator mean that the indicators and independent and were well chosen for prioritizing harmful chemicals. This method proposed by this study can improve the cost efficiency of chemical management as utilized in occupational regulatory systems.

A robust collagen scoring method for human liver fibrosis by second harmonic microscopy.

PubMed

Guilbert, Thomas; Odin, Christophe; Le Grand, Yann; Gailhouste, Luc; Turlin, Bruno; Ezan, Frédérick; Désille, Yoann; Baffet, Georges; Guyader, Dominique

2010-12-06

Second Harmonic Generation (SHG) microscopy offers the opportunity to image collagen of type I without staining. We recently showed that a simple scoring method, based on SHG images of histological human liver biopsies, correlates well with the Metavir assessment of fibrosis level (Gailhouste et al., J. Hepatol., 2010). In this article, we present a detailed study of this new scoring method with two different objective lenses. By using measurements of the objectives point spread functions and of the photomultiplier gain, and a simple model of the SHG intensity, we show that our scoring method, applied to human liver biopsies, is robust to the objective's numerical aperture (NA) for low NA, the choice of the reference sample and laser power, and the spatial sampling rate. The simplicity and robustness of our collagen scoring method may open new opportunities in the quantification of collagen content in different organs, which is of main importance in providing diagnostic information and evaluation of therapeutic efficiency.

Face-specific and domain-general visual processing deficits in children with developmental prosopagnosia.

PubMed

Dalrymple, Kirsten A; Elison, Jed T; Duchaine, Brad

2017-02-01

Evidence suggests that face and object recognition depend on distinct neural circuitry within the visual system. Work with adults with developmental prosopagnosia (DP) demonstrates that some individuals have preserved object recognition despite severe face recognition deficits. This face selectivity in adults with DP indicates that face- and object-processing systems can develop independently, but it is unclear at what point in development these mechanisms are separable. Determining when individuals with DP first show dissociations between faces and objects is one means to address this question. In the current study, we investigated face and object processing in six children with DP (5-12-years-old). Each child was assessed with one face perception test, two different face memory tests, and two object memory tests that were matched to the face memory tests in format and difficulty. Scores from the DP children on the matched face and object tasks were compared to within-subject data from age-matched controls. Four of the six DP children, including the 5-year-old, showed evidence of face-specific deficits, while one child appeared to have more general visual-processing deficits. The remaining child had inconsistent results. The presence of face-specific deficits in children with DP suggests that face and object perception depend on dissociable processes in childhood.

Playing Around in the Solar System: Mini-games for Many Missions

NASA Astrophysics Data System (ADS)

Fisher, D. K.; Leon, N.; Fitzpatrick, A. J.; Wessen, A.

2010-12-01

Several NASA solar system missions will have major milestones during 2011, the Year of the Solar System. These events include launches, encounters, and orbit insertions. Other missions will continue the explorations already underway. The “Year of the Solar System Game” on The Space Place website (http://spaceplace.nasa.gov/en/kids/solar-system) brings all these efforts together in the context of the whole solar system. The game helps to build awareness of the characteristics of our solar system and some of the missions that are continuing to advance our knowledge and understanding. It is one of many educational tools being developed and deployed for the Year of the Solar System. The game is a “super-game” that encompasses a number of mission-related “mini-games.” The mini-games can be played individually, and they all contribute toward achievements in the super-game. The enveloping interface for all the games is an animated solar system. The player clicks on a planet or a moon, sees a close-up image, and reads a short paragraph about the object. If the object has been endowed with a mission mini-game, player can click on the tiny spacecraft, read about the mission, then play the game—or, if impatient, just immediately play the game (and read about the mission later, we hope). A score “page” keeps track of the player’s achievements and scores. Players earn achievements by reading about the planets, moons, asteroids, comets, and missions and by playing the mission mini-games. The game targets upper elementary age children, as does the entire Space Place website. Each mini-game, although simple, incorporates elements of the spacecrafts’ missions and their target objects. For example, in Cassini Commander, the player must navigate the Cassini spacecraft through gaps in Saturn’s rings and around Saturn’s moons. The super-game is designed to accommodate any number of mission mini-games, so we are hoping to continue to add missions and increase the fun factor and educational value of the Year of the Solar System game well into future years.

Histopathological grading of breast ductal carcinoma in situ: validation of a web-based survey through intra-observer reproducibility analysis.

PubMed

Schuh, Fernando; Biazús, Jorge Villanova; Resetkova, Erika; Benfica, Camila Zanella; Ventura, Alessandra de Freitas; Uchoa, Diego; Graudenz, Márcia; Edelweiss, Maria Isabel Albano

2015-07-10

Histopathological grading diagnosis of ductal carcinoma in situ (DCIS) of the breast may be very difficult even for experts, and it is important for therapeutic decisions. The challenge may be due to the inaccurate and/or subjective application of the diagnosis criteria. The aim of this study was to investigate the intra-observer agreement between a traditional method and a developed web-based questionnaire for scoring breast DCIS. A cross-sectional study was carried out to evaluate the diagnostic agreement of an electronic questionnaire and its point scoring system with the subjective reading of digital images for 3 different DCIS grading systems: Holland, Van Nuys and modified Black nuclear grade system. Three pathologists analyzed the same set of digitized images from 43 DCIS cases using two different web-based programs. In the first phase, they accessed a website with a newly created questionnaire and scoring system developed to allow the determination of the histological grade of the cases. After at least 6 months, the pathologists read again the same images, but without the help of the questionnaire, indicating subjectively the diagnoses. The intra-observer agreement analysis was employed to validate this innovative web-based survey. Overall, diagnostic reproducibility was similar for all histologic grading classification systems, with kappa values of 0.57 ± 0.10, 0.67 ± 0.09 and 0.67 ± 0.09 for Holland, Van Nuys classification and modified Black nuclear grade system respectively. Only two 2-step diagnostic disagreements were found, one for Holland and another for Van Nuys. Both cases were superestimated by the web-based survey. The diagnostic agreement between the web-based questionnaire and a traditional method, both using digital images, is moderate to good for Holland, Van Nuys and modified Black nuclear grade system. The use of a scoring point system does not appear to pose a major risk of presenting large (2-step) diagnostic disagreements. These findings indicate that the use of this point scoring system in this web-based survey to grade objectively DCIS lesions is a useful diagnostic tool.

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

Age, PaO2/FIO2, and Plateau Pressure Score: A Proposal for a Simple Outcome Score in Patients With the Acute Respiratory Distress Syndrome.

PubMed

Villar, Jesús; Ambrós, Alfonso; Soler, Juan Alfonso; Martínez, Domingo; Ferrando, Carlos; Solano, Rosario; Mosteiro, Fernando; Blanco, Jesús; Martín-Rodríguez, Carmen; Fernández, María Del Mar; López, Julia; Díaz-Domínguez, Francisco J; Andaluz-Ojeda, David; Merayo, Eleuterio; Pérez-Méndez, Lina; Fernández, Rosa Lidia; Kacmarek, Robert M

2016-07-01

Although there is general agreement on the characteristic features of the acute respiratory distress syndrome, we lack a scoring system that predicts acute respiratory distress syndrome outcome with high probability. Our objective was to develop an outcome score that clinicians could easily calculate at the bedside to predict the risk of death of acute respiratory distress syndrome patients 24 hours after diagnosis. A prospective, multicenter, observational, descriptive, and validation study. A network of multidisciplinary ICUs. Six-hundred patients meeting Berlin criteria for moderate and severe acute respiratory distress syndrome enrolled in two independent cohorts treated with lung-protective ventilation. None. Using individual demographic, pulmonary, and systemic data at 24 hours after acute respiratory distress syndrome diagnosis, we derived our prediction score in 300 acute respiratory distress syndrome patients based on stratification of variable values into tertiles, and validated in an independent cohort of 300 acute respiratory distress syndrome patients. Primary outcome was in-hospital mortality. We found that a 9-point score based on patient's age, PaO2/FIO2 ratio, and plateau pressure at 24 hours after acute respiratory distress syndrome diagnosis was associated with death. Patients with a score greater than 7 had a mortality of 83.3% (relative risk, 5.7; 95% CI, 3.0-11.0), whereas patients with scores less than 5 had a mortality of 14.5% (p < 0.0000001). We confirmed the predictive validity of the score in a validation cohort. A simple 9-point score based on the values of age, PaO2/FIO2 ratio, and plateau pressure calculated at 24 hours on protective ventilation after acute respiratory distress syndrome diagnosis could be used in real time for rating prognosis of acute respiratory distress syndrome patients with high probability.

Comparison of 3 Symptom Classification Methods to Standardize the History Component of the HEART Score.

PubMed

Marchick, Michael R; Setteducato, Michael L; Revenis, Jesse J; Robinson, Matthew A; Weeks, Emily C; Payton, Thomas F; Winchester, David E; Allen, Brandon R

2017-09-01

The History, Electrocardiography, Age, Risk factors, Troponin (HEART) score enables rapid risk stratification of emergency department patients presenting with chest pain. However, the subjectivity in scoring introduced by the history component has been criticized by some clinicians. We examined the association of 3 objective scoring models with the results of noninvasive cardiac testing. Medical records for all patients evaluated in the chest pain center of an academic medical center during a 1-year period were reviewed retrospectively. Each patient's history component score was calculated using 3 models developed by the authors. Differences in the distribution of HEART scores for each model, as well as their degree of agreement with one another, as well as the results of cardiac testing were analyzed. Seven hundred forty nine patients were studied, 58 of which had an abnormal stress test or computed tomography coronary angiography. The mean HEART scores for models 1, 2, and 3 were 2.97 (SD 1.17), 2.57 (SD 1.25), and 3.30 (SD 1.35), respectively, and were significantly different (P < 0.001). However, for each model, the likelihood of an abnormal cardiovascular test did not correlate with higher scores on the symptom component of the HEART score (P = 0.09, 0.41, and 0.86, respectively). While the objective scoring models produced different distributions of HEART scores, no model performed well with regards to identifying patients with abnormal advanced cardiac studies in this relatively low-risk cohort. Further studies in a broader cohort of patients, as well as comparison with the performance of subjective history scoring, is warranted before adoption of any of these objective models.

Student Laptop Use and Scores on Standardized Tests

ERIC Educational Resources Information Center

Kposowa, Augustine J.; Valdez, Amanda D.

2013-01-01

Objectives: The primary objective of the study was to investigate the relationship between ubiquitous laptop use and academic achievement. It was hypothesized that students with ubiquitous laptops would score on average higher on standardized tests than those without such computers. Methods: Data were obtained from two sources. First, demographic…

Validity, Reliability, and Feasibility of Durometer Measurements of Scleroderma Skin Disease in a Multicenter Treatment Trial

PubMed Central

MERKEL, PETER A.; SILLIMAN, NANCY P.; DENTON, CHRISTOPHER P.; FURST, DANIEL E.; KHANNA, DINESH; EMERY, PAUL; HSU, VIVIEN M.; STREISAND, JAMES B.; POLISSON, RICHARD P.; ÅKESSON, ANITA; COPPOCK, JOHN; van den HOOGEN, FRANK; HERRICK, ARIANE; MAYES, MAUREEN D.; VEALE, DOUGLAS; SEIBOLD, JAMES R.; BLACK, CAROL M.; KORN, JOSEPH H.

2013-01-01

Objective To determine the validity, reliability, and feasibility of durometer measurements of skin hardness as an outcome measure in clinical trials of scleroderma. Methods Skin hardness was measured during a multicenter treatment trial for scleroderma using handheld digital durometers with a continuous scale. Skin thickness was measured by modified Rodnan skin score (MRSS). Other outcome data collected included the Scleroderma Health Assessment Questionnaire. In a reliability exercise in advance of the trial, 9 investigators examined the same 5 scleroderma patients by MRSS and durometry. Results Forty-three patients with early diffuse cutaneous systemic sclerosis were studied at 11 international centers (mean age 49 years [range 24–76], median disease duration 6.4 months [range 0.3–23], and median baseline MRSS 22 [range 11–38]). The reliability of durometer measurements was excellent, with high interobserver intraclass correlation coefficients (ICCs) (0.82–0.92), and each result was greater than the corresponding skin site ICCs for MRSS (0.54–0.85). Baseline durometer scores correlated well with MRSS (r = 0.69, P < 0.0001), patient self-assessments of skin disease (r = 0.69, P < 0.0001), and Health Assessment Questionnaire (HAQ) disability scores (r = 0.34, P = 0.03). Change in durometer scores correlated with change in MRSS (r = 0.70, P < 0.0001), change in patient self-assessments of skin disease (r = 0.52, P = 0.003), and change in HAQ disability scores (r = 0.42, P = 0.017). The effect size was greater for durometry than for MRSS or patient self-assessment. Conclusion Durometer measurements of skin hardness in patients with scleroderma are reliable, simple, accurate, demonstrate good sensitivity to change compared with traditional skin scoring, and reflect patients' self-assessments of their disease. Durometer measurements are valid, objective, and scalable, and should be considered for use as a complementary outcome measure to skin scoring in clinical trials of scleroderma. PMID:18438905

Association between the Prevalence of Indigestible Foreign Objects in the Gastrointestinal Tract of Slaughtered Cattle and Body Condition Score

PubMed Central

Nongcula, Vikhaya Vincent; Zhou, Leocadia

2017-01-01

Simple Summary The South African national cattle herd has increased from 6 million head since the 1970s to 14 million and more than two-thirds of the 14 million cattle in South Africa reside in the Eastern Cape Province (ECP), yet the Province has one of the highest poverty indexes. While this improvement is commendable, there are still many challenges to efficient livestock production notably infectious and non-infectious diseases. Many non-infectious diseases of the fore-stomach, such as rumenitis, rumen parakeratosis, traumatic reticuloperitonitis and poly bezoars, are rarely reported, but are known to obstruct the digestive functions of the fore-stomach, causing a marked reduction in animal weight, reproduction, feed absorption and productivity, and death. The pathogenesis of these diseases often begins with the consumption of indigestible foreign objects (IFOs). Animal husbandry in the ECP is mostly communal, with an extensive system of rearing animals as the most popular production system. This system of rearing animals exposes them to consumption of litter, especially when there is drought. This study provides knowledge on the prevalence, type and effect of the indigestible foreign object on the body condition score of animals slaughtered in the ECP. Abstract It is estimated that South Africa’s population will be above 65 million in 2050. Thus, food production needs to triple to alleviate poverty and food insecurity. However, infectious and non-infectious diseases affect livestock productivity, thereby hampering food supply. Non-infectious disease/conditions caused by the consumption of solid waste material are rarely reported. Hence, this study investigates the occurrence and type of indigestible foreign objects (IFOs) in the stomach of slaughtered cattle in two high-throughput abattoirs (n = 4424) in the Eastern Cape Province of South Africa. The study revealed that metallic and non-metallic indigestible objects had an overall prevalence of 63% in cattle slaughtered in Queenstown abattoir (QTA, (n = 1906)) and 64.8% at the East London abattoir (ELA, (n = 2518)). Most of the IFOs were found in the rumen (64.2% and 70.8%) and reticulum (28.5% and 20.6%) at QTA and ELA respectively. The leading IFOs in the stomach of cattle at QTA were plastics (27.7%), poly bezoars (10.7%) and ropes (10.7%), while poly bezoars (19.8%), ropes (17.6%) and stones (10.7%) were the main IFOs seen in cattle at ELA. The study showed a statistical significance (p < 0.05) between body condition score and the prevalence of indigestible objects in cattle. The study concluded that litter and waste containing IFOs could pose a threat to livestock health and productivity. The practice of good animal husbandry and efficient solid waste management will mitigate the problem of animals consuming IFOs. PMID:29084136

Doctoral Theses from Nursing Postgraduate Programs in Brazil and their Association with the Millennium Development Goals.

PubMed

Rodrigues, Rosalina Aparecida Partezani; Robazzi, Maria Lúcia do Carmo Cruz; Erdmann, Alacoque Lorenzini; Fernandes, Josicélia Dumet; de Barros, Alba Lucia Bottura Leite; Ramos, Flávia Regina Souza

2015-01-01

The Millennium Development Goals are centered around combatting poverty and other social evils all over the world. Thus, this study seeks to identify the Millennium Development Goals as an object of study in theses from Postgraduate Nursing Programs in Brazil scoring 5 (national excellence) and 6 or 7 (international excellence), and evaluate the association between the score for the program and achieving the Millennium Development Goals. Exploratory descriptive document research. Data were collected from the Notes on Indicators/Coordination for Higher Education Personnel Improvement for the 15 Postgraduate Nursing Courses scoring between 5 and 7 in the three-year-period of 2010/2012. of the 8 Millennium Development Objectives, 6 were dealt with in the theses. There was an association (Fisher's exact test p-value=0.0059) between the distribution of the theses and the program scores in relation to the Millennium Development Objectives (p-valor=0.0347)CONCLUSION: the doctoral theses were slightly related to the Millennium Development Objectives, covering the population's economic development, health conditions and quality of life. It is recommended that Postgraduate Programs in Nursing pay closer attention to the Millennium Development Objectives.

Relationship between dyspnea, peak expiratory flow rate and wheeze in obstructive lung disease.

PubMed

Srisawai, P

1997-05-01

The relationship between dyspnea and airway obstruction is complex, and it is unclear to what extent measures of each correlate in patients with obstructive lung disease (OLD). Thus, the correlation between subjective assessment of dyspnea (dyspnea score using modified Borg scale) and objective assessment of dyspnea (peak expiratory flow rate using Mini Wright Peak Flow Meter and wheeze score using stethoscope) before and after bronchodilator (1 mg of turbutaline sulphate) were studied in 115 patients (62 males, 53 females) with OLD attending the chest clinic of Royal Irrigation Hospital, Nonthaburi, Thailand. The mean age of these patients was 47.4 +/- 16.4 years. Good correlations were found (r = 0.37 to 0.52; p < 0.001) but dyspnea scores were better correlated with wheeze scores than peak expiratory flow rates. The change in dyspnea scores after bronchodilator also correlated with the change in peak expiratory flow rates and the change in wheeze scores (r = 0.22; p < 0.02 and r = 0.28; p < 0.005 respectively). Analyzing a subgroup of 48 dyspneic patients (prebronchodilator dyspnea score of 2 or more) revealed the following response groups: those with either a bronchodilator or dyspnea response alone, both together, or neither. Twenty-three patients (47.92 per cent) responded both subjectively and objectively. One (2.08 per cent) had a bronchodilator response only. Twenty (41.66 per cent) had a dyspnea response only, while four (8.33 per cent) had neither measurable response. The present study suggests that the assessment of dyspnea by using dyspnea score is vital and may be specially helpful in a situation where the objective assessment cannot be performed. In some individuals the subjective assessment of response to bronchodilator may be at least as valuable as objective data.

Olfactory Cleft Endoscopy Scale correlates with olfactory metrics in patients with chronic rhinosinusitis

PubMed Central

Soler, Zachary M.; Hyer, J. Madison; Karnezis, Tom T.; Schlosser, Rodney J.

2015-01-01

Introduction Olfactory loss affects a majority of patients with chronic rhinosinusitis (CRS). Traditional objective measures of disease severity, including endoscopy scales, focus upon the paranasal sinuses and often have weak correlation to olfaction. Methods Adults with CRS were prospectively evaluated by blinded reviewers with a novel Olfactory Cleft Endoscopy Scale (OCES) that evaluated discharge, polyps, edema, crusting and scarring of the olfactory cleft. Objective olfactory function was assessed using “Sniffin’ Sticks testing, including composite threshold-discrimination-identification (TDI) scores. Olfactory-specific quality-of-life was evaluated using the short modified version of the Questionnaire of Olfactory Disorders (QOD-NS). Inter- and intra-rater reliability was assessed among 3 reviewers for OCES grading. Multivariate linear regression was then used to test associations between OCES scores and measures of olfaction, controlling for potential confounding factors. Results The OCES score was evaluated in 38 patients and had a high overall reliability (ICC=0.92; 95% CI: 0.91–0.96). The OCES significantly correlated with objective olfaction as measured by TDI score (p<0.001), with TDI score falling by 1.13 points for every 1 point increase in OCES score. Similar significant associations were found for threshold, discrimination, and identification scores (p<0.003 for all) after controlling for age, gender, race, and reviewer/review. The OCES was also highly associated with patient-reported QOD-NS scores (p=0.009). Conclusion A novel olfactory cleft endoscopy scale shows high reliability and correlates with both objective and patient-reported olfaction in patients with CRS. Further studies to determine prognostic value and responsiveness to change are warranted. PMID:26718315

Multicentre validation of the bedside paediatric early warning system score: a severity of illness score to detect evolving critical illness in hospitalised children

PubMed Central

2011-01-01

Introduction The timely provision of critical care to hospitalised patients at risk for cardiopulmonary arrest is contingent upon identification and referral by frontline providers. Current approaches require improvement. In a single-centre study, we developed the Bedside Paediatric Early Warning System (Bedside PEWS) score to identify patients at risk. The objective of this study was to validate the Bedside PEWS score in a large patient population at multiple hospitals. Methods We performed an international, multicentre, case-control study of children admitted to hospital inpatient units with no limitations on care. Case patients had experienced a clinical deterioration event involving either an immediate call to a resuscitation team or urgent admission to a paediatric intensive care unit. Control patients had no events. The scores ranged from 0 to 26 and were assessed in the 24 hours prior to the clinical deterioration event. Score performance was assessed using the area under the receiver operating characteristic (AUCROC) curve by comparison with the retrospective rating of nurses and the temporal progression of scores in case patients. Results A total of 2,074 patients were evaluated at 4 participating hospitals. The median (interquartile range) maximum Bedside PEWS scores for the 12 hours ending 1 hour before the clinical deterioration event were 8 (5 to 12) in case patients and 2 (1 to 4) in control patients (P < 0.0001). The AUCROC curve (95% confidence interval) was 0.87 (0.85 to 0.89). In case patients, mean scores were 5.3 at 20 to 24 hours and 8.4 at 0 to 4 hours before the event (P < 0.0001). The AUCROC curve (95% CI) of the retrospective nurse ratings was 0.83 (0.81 to 0.86). This was significantly lower than that of the Bedside PEWS score (P < 0.0001). Conclusions The Bedside PEWS score identified children at risk for cardiopulmonary arrest. Scores were elevated and continued to increase in the 24 hours before the clinical deterioration event. Prospective clinical evaluation is needed to determine whether this score will improve the quality of care and patient outcomes. PMID:21812993

Telemedicine in acute plastic surgical trauma and burns.

PubMed Central

Jones, S. M.; Milroy, C.; Pickford, M. A.

2004-01-01

BACKGROUND: Telemedicine is a relatively new development within the UK, but is increasingly useful in many areas of medicine including plastic surgery. Plastic surgery centres often work on a hub-and-spoke basis with many district hospitals referring to one tertiary centre. The Queen Victoria Hospital is one such centre receiving calls from more than 28 hospitals in the Southeast of England resulting in approximately 20 referrals a day. OBJECTIVE: A telemedicine system was developed to improve trauma management. This study was designed to establish whether digital images were sufficiently accurate enough to aid decision-making. A store-and-forward telemedicine system was devised and the images of 150 trauma referrals evaluated in terms of injury severity and operative priority by each member of the plastic surgical team. RESULTS: Correlation scores for assessed images were high. Accuracy of "transmitted image" in comparison to injury on examination scored > 97%. Operative priority scores tended to be higher than injury severity. CONCLUSIONS: Telemedicine is an accurate method by which to transfer information on plastic surgical trauma including burns. PMID:15239862

Development of the IES method for evaluating the color rendition of light sources

DOE PAGES

David, Aurelien; Fini, Paul T.; Houser, Kevin W.; ...

2015-06-08

We have developed a two-measure system for evaluating light sources’ color rendition that builds upon conceptual progress of numerous researchers over the last two decades. The system quantifies the color fidelity and color gamut (change in object chroma) of a light source in comparison to a reference illuminant. The calculations are based on a newly developed set of reflectance data from real samples uniformly distributed in color space (thereby fairly representing all colors) and in wavelength space (thereby precluding artificial optimization of the color rendition scores by spectral engineering). The color fidelity score R f is an improved version ofmore » the CIE color rendering index. The color gamut score R g is an improved version of the Gamut Area Index. In combination, they provide two complementary assessments to guide the optimization of future light sources. This method summarizes the findings of the Color Metric Task Group of the Illuminating Engineering Society of North America (IES). It is adopted in the upcoming IES TM-30-2015, and is proposed for consideration with the International Commission on Illumination (CIE).« less

Discrepancies between modified Medical Research Council dyspnea score and COPD assessment test score in patients with COPD

PubMed Central

Rhee, Chin Kook; Kim, Jin Woo; Hwang, Yong Il; Lee, Jin Hwa; Jung, Ki-Suck; Lee, Myung Goo; Yoo, Kwang Ha; Lee, Sang Haak; Shin, Kyeong-Cheol; Yoon, Hyoung Kyu

2015-01-01

Background and objective According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, either a modified Medical Research Council (mMRC) dyspnea score of ≥2 or a chronic obstructive pulmonary disease (COPD) assessment test (CAT) score of ≥10 is considered to represent COPD patients who are more symptomatic. We aimed to identify the ideal CAT score that exhibits minimal discrepancy with the mMRC score. Methods A receiver operating characteristic curve of the CAT score was generated for an mMRC scores of 1 and 2. A concordance analysis was applied to quantify the association between the frequencies of patients categorized into GOLD groups A–D using symptom cutoff points. A κ-coefficient was calculated. Results For an mMRC score of 2, a CAT score of 15 showed the maximum value of Youden’s index with a sensitivity and specificity of 0.70 and 0.66, respectively (area under the receiver operating characteristic curve [AUC] 0.74; 95% confidence interval [CI], 0.70–0.77). For an mMRC score of 1, a CAT score of 10 showed the maximum value of Youden’s index with a sensitivity and specificity of 0.77 and 0.65, respectively (AUC 0.77; 95% CI, 0.72–0.83). The κ value for concordance was highest between an mMRC score of 1 and a CAT score of 10 (0.66), followed by an mMRC score of 2 and a CAT score of 15 (0.56), an mMRC score of 2 and a CAT score of 10 (0.47), and an mMRC score of 1 and a CAT score of 15 (0.43). Conclusion A CAT score of 10 was most concordant with an mMRC score of 1 when classifying patients with COPD into GOLD groups A–D. However, a discrepancy remains between the CAT and mMRC scoring systems. PMID:26316736

Development and initial validation of an endoscopic part-task training box.

PubMed

Thompson, Christopher C; Jirapinyo, Pichamol; Kumar, Nitin; Ou, Amy; Camacho, Andrew; Lengyel, Balazs; Ryan, Michele B

2014-09-01

There is currently no objective and validated methodology available to assess the progress of endoscopy trainees or to determine when technical competence has been achieved. The aims of the current study were to develop an endoscopic part-task simulator and to assess scoring system validity. Fundamental endoscopic skills were determined via kinematic analysis, literature review, and expert interviews. Simulator prototypes and scoring systems were developed to reflect these skills. Validity evidence for content, internal structure, and response process was evaluated. The final training box consisted of five modules (knob control, torque, retroflexion, polypectomy, and navigation and loop reduction). A total of 5 minutes were permitted per module with extra points for early completion. Content validity index (CVI)-realism was 0.88, CVI-relevance was 1.00, and CVI-representativeness was 0.88, giving a composite CVI of 0.92. Overall, 82 % of participants considered the simulator to be capable of differentiating between ability levels, and 93 % thought the simulator should be used to assess ability prior to performing procedures in patients. Inter-item assessment revealed correlations from 0.67 to 0.93, suggesting that tasks were sufficiently correlated to assess the same underlying construct, with each task remaining independent. Each module represented 16.0 % - 26.1 % of the total score, suggesting that no module contributed disproportionately to the composite score. Average box scores were 272.6 and 284.4 (P = 0.94) when performed sequentially, and average score for all participants with proctor 1 was 297.6 and 308.1 with proctor 2 (P = 0.94), suggesting reproducibility and minimal error associated with test administration. A part-task training box and scoring system were developed to assess fundamental endoscopic skills, and validity evidence regarding content, internal structure, and response process was demonstrated. © Georg Thieme Verlag KG Stuttgart · New York.

Method Development for Clinical Comprehensive Evaluation of Pediatric Drugs Based on Multi-Criteria Decision Analysis: Application to Inhaled Corticosteroids for Children with Asthma.

PubMed

Yu, Yuncui; Jia, Lulu; Meng, Yao; Hu, Lihua; Liu, Yiwei; Nie, Xiaolu; Zhang, Meng; Zhang, Xuan; Han, Sheng; Peng, Xiaoxia; Wang, Xiaoling

2018-04-01

Establishing a comprehensive clinical evaluation system is critical in enacting national drug policy and promoting rational drug use. In China, the 'Clinical Comprehensive Evaluation System for Pediatric Drugs' (CCES-P) project, which aims to compare drugs based on clinical efficacy and cost effectiveness to help decision makers, was recently proposed; therefore, a systematic and objective method is required to guide the process. An evidence-based multi-criteria decision analysis model that involved an analytic hierarchy process (AHP) was developed, consisting of nine steps: (1) select the drugs to be reviewed; (2) establish the evaluation criterion system; (3) determine the criterion weight based on the AHP; (4) construct the evidence body for each drug under evaluation; (5) select comparative measures and calculate the original utility score; (6) place a common utility scale and calculate the standardized utility score; (7) calculate the comprehensive utility score; (8) rank the drugs; and (9) perform a sensitivity analysis. The model was applied to the evaluation of three different inhaled corticosteroids (ICSs) used for asthma management in children (a total of 16 drugs with different dosage forms and strengths or different manufacturers). By applying the drug analysis model, the 16 ICSs under review were successfully scored and evaluated. Budesonide suspension for inhalation (drug ID number: 7) ranked the highest, with comprehensive utility score of 80.23, followed by fluticasone propionate inhaled aerosol (drug ID number: 16), with a score of 79.59, and budesonide inhalation powder (drug ID number: 6), with a score of 78.98. In the sensitivity analysis, the ranking of the top five and lowest five drugs remains unchanged, suggesting this model is generally robust. An evidence-based drug evaluation model based on AHP was successfully developed. The model incorporates sufficient utility and flexibility for aiding the decision-making process, and can be a useful tool for the CCES-P.

Development of prediction models of stress and long-term disability among claimants to injury compensation systems: a cohort study

PubMed Central

Spittal, Matthew J; Grant, Genevieve; O’Donnell, Meaghan; McFarlane, Alexander C; Studdert, David M

2018-01-01

Objectives We sought to develop prognostic risk scores for compensation-related stress and long-term disability using markers collected within 3 months of a serious injury. Design Cohort study. Predictors were collected at baseline and at 3 months postinjury. Outcome data were collected at 72 months postinjury. Setting Hospitalised patients with serious injuries recruited from four major trauma hospitals in Australia. Participants 332 participants who made claims for compensation for their injuries to a transport accident scheme or a workers’ compensation scheme. Primary outcome measures 12-item WHO Disability Assessment Schedule and 6 items from the Claims Experience Survey. Results Our model for long-term disability had four predictors (unemployed at the time of injury, history of a psychiatric disorder at time of injury, post-traumatic stress disorder symptom severity at 3 months and disability at 3 months). This model had good discrimination (R2=0.37) and calibration. The disability risk score had a score range of 0–180, and at a threshold of 80 had sensitivity of 56% and specificity of 86%. Our model for compensation-related stress had five predictors (intensive care unit admission, discharged to home, number of traumatic events prior to injury, depression at 3 months and not working at 3 months). This model also had good discrimination (area under the curve=0.83) and calibration. The compensation-related stress risk score had score range of 0–220 and at a threshold of 100 had sensitivity of 74% and specificity of 75%. By combining these two scoring systems, we were able to identify the subgroup of claimants at highest risk of experiencing both outcomes. Conclusions The ability to identify at an early stage claimants at high risk of compensation-related stress and poor recovery is potentially valuable for claimants and the compensation agencies that serve them. The scoring systems we developed could be incorporated into the claims-handling processes to guide prevention-oriented interventions. PMID:29705763

Pre-breeding ovaro-uterine ultrasonography and its relationship with first service pregnancy rate in seasonal-calving dairy herds.

PubMed

Mee, J F; Buckley, F; Ryan, D; Dillon, P

2009-04-01

The objectives of the study were to characterize an ultrasound reproductive tract scoring (URTS) system to assess suitability for breeding in dairy cows, to describe the prevalence of these scores in commercial dairy herds and to examine their relationship with subsequent fertility. Ultrasound examinations (7797) were performed on 5751 Holstein-Friesian cows prior to breeding in 62 seasonally calving herds over 2 years. Data recorded from images of both ovaries and the uterus were combined into a six point scoring system and the prevalence of cows with cystic ovarian follicles and uterine abscesses and adhesions was recorded separately. The prevalence of ovulatory cows which had completed uterine involution (score 1), or had mild (2) or moderate endometritis (3) was 62.5%, 21.7% and 2.2%, respectively. The prevalence of anovulatory cows with moderate endometritis (4), ovulatory cows with pyometra (5) and anovulatory cows which had completed uterine involution (6) was 3.3%, 2.2% and 8.1%, respectively. The interval between calving and examination differed between cows with each of the scores 1, 2, 5 and 6 (61, 46, 53 and 50 days, respectively, p < 0.05) but not between cows with scores 3 and 4 (37 and 35 days, respectively). Ovulatory cows which had completed uterine involution (score 1) had a higher likelihood of pregnancy to first service than ovulatory or anovulatory cows which had not completed uterine involution (p

Integration and Validation of Hysteroscopy Simulation in the Surgical Training Curriculum.

PubMed

Elessawy, Mohamed; Skrzipczyk, Moritz; Eckmann-Scholz, Christel; Maass, Nicolai; Mettler, Liselotte; Guenther, Veronika; van Mackelenbergh, Marion; Bauerschlag, Dirk O; Alkatout, Ibrahim

The primary objective of our study was to test the construct validity of the HystSim hysteroscopic simulator to determine whether simulation training can improve the acquisition of hysteroscopic skills regardless of the previous levels of experience of the participants. The secondary objective was to analyze the performance of a selected task, using specially designed scoring charts to help reduce the learning curve for both novices and experienced surgeons. The teaching of hysteroscopic intervention has received only scant attention, focusing mainly on the development of physical models and box simulators. This encouraged our working group to search for a suitable hysteroscopic simulator module and to test its validation. We decided to use the HystSim hysteroscopic simulator, which is one of the few such simulators that has already completed a validation process, with high ratings for both realism and training capacity. As a testing tool for our study, we selected the myoma resection task. We analyzed the results using the multimetric score system suggested by HystSim, allowing a more precise interpretation of the results. Between June 2014 and May 2015, our group collected data on 57 participants of minimally invasive surgical training courses at the Kiel School of Gynecological Endoscopy, Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel. The novice group consisted of 42 medical students and residents with no prior experience in hysteroscopy, whereas the expert group consisted of 15 participants with more than 2 years of experience of advanced hysteroscopy operations. The overall results demonstrated that all participants attained significant improvements between their pretest and posttests, independent of their previous levels of experience (p < 0.002). Those in the expert group demonstrated statistically significant, superior scores in the pretest and posttests (p = 0.001, p = 0.006). Regarding visualization and ergonomics, the novices showed a better pretest value than the experts; however, the experts were able to improve significantly during the posttest. These precise findings demonstrated that the multimetric scoring system achieved several important objectives, including clinical relevance, critical relevance, and training motivation. All participants demonstrated improvements in their hysteroscopic skills, proving an adequate construct validation of the HystSim. Using the multimetric scoring system enabled a more accurate analysis of the performance of the participants independent of their levels of experience which could be an important key for streamlining the learning curve. Future studies testing the predictive validation of the simulator and frequency of the training intervals are necessary before the introduction of the simulator into the standard surgical training curriculum. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Nurses' Evaluation of Their Use and Mastery in Health Assessment Skills: Selected Iran's Hospitals

PubMed Central

Adib-Hajbaghery, Mohsen; Safa, Azade

2013-01-01

Background: Health assessment skills are of the most important skills which nurses require. The more precise assessment, the better results would be obtained and the quality of patient care would be improved. However, in Iran, few studies have investigated nurses’ assessment skills. Objectives: This study was aimed to assessnurses' evaluation of the learned skills of health assessment and their use. Materials and Methods: This cross-sectional study was conducted on 200 nurses in Isfahan province hospitals. Data was collected by a questionnaire including demographic data and 120 health assessment skills. Nurses scored their frequency of using and proficiency in skills. Statistical analysis was conducted by ANOVA, Tukey test and independent sample T-tests. Results: The highest level of using and proficiency in skills was related to taking history. Nurses received 87.25% of score in this field. The lowest level of application was in assessment of the urogenital system so that nurses received 16.37% of score in this area. Also the lowest proficiency was in assessment of the nervous system and nurses received 34.58% of score in this area. Conclusions: The level of nurses' proficiency in the health assessment skills was not satisfactory. Modifying the curriculum and cooperating of nurse managers and nursing schools can help to improve the situation. PMID:25414875

The Apgar Score and Infant Mortality

PubMed Central

Lei, Xiaoping; Zhang, Hao; Mao, Meng; Zhang, Jun

2013-01-01

Objective To evaluate if the Apgar score remains pertinent in contemporary practice after more than 50 years of wide use, and to assess the value of the Apgar score in predicting infant survival, expanding from the neonatal to the post-neonatal period. Methods The U.S. linked live birth and infant death dataset was used, which included 25,168,052 singleton births and 768,305 twin births. The outcome of interest was infant death within 1 year after birth. Cox proportional hazard-model was used to estimate risk ratio of infant mortality with different Apgar scores. Results Among births with a very low Apgar score at five minutes (1–3), the neonatal and post-neonatal mortality rates remained high until term (≥ 37 weeks). On the other hand, among births with a high Apgar score (≥7), neonatal and post-neonatal mortality rate decreased progressively with gestational age. Non-Hispanic White had a consistently higher neonatal mortality than non-Hispanic Black in both preterm and term births. However, for post-neonatal mortality, Black had significantly higher rate than White. The pattern of changes in neonatal and post-neonatal mortality by Apgar score in twin births is essentially the same as that in singleton births. Conclusions The Apgar score system has continuing value for predicting neonatal and post-neonatal adverse outcomes in term as well as preterm infants, and is applicable to twins and in various race/ethnic groups. PMID:23922681

An Examination of Potential Racial and Gender Bias in the Principal Version of the Interactive Computer Interview System

ERIC Educational Resources Information Center

DiPonio, Joseph M.

2010-01-01

The primary object of this study was to determine whether racial and/or gender bias were evidenced in the use of the ICIS-Principal. Specifically, will the use of the ICIS-Principal result in biased scores at a statistically significant level when rating current practicing administrators of varying gender and race. The study involved simulated…

[The study of establishment of the " Chinese provincial Blindness prevention technical guidance group performance evaluation system"].

PubMed

Lu, L N; He, X G; Zhu, J F; Xu, X; Zhang, R; Hu, X; Zou, H D

2016-11-11

Objective: To establish an assessment system, including indexes and scoring methods, that can be used for performance evaluation of the provincial blindness prevention technical guidance group properly and effectively . Methods: The indexes and scoring methods were set based on the core content of The " National Plan of Prevention and Treatment of Blindness (2012-2015)" , the specific requirement and target of the World Health Organization (WHO) "For the General Eye Health: Global plan of Action (2014-2019)" , and the current situation of the China's provinces and autonomous regions. These indexes should be of effectiveness, feasibility, comparability, guidance and advancing. Formed by a literature review of candidate indicators, the framework of the system is built by qualitative assessment. With the Delphi method, the system was further revised and improved. Empirical pilot study was then used to prove the feasibility, followed by the final qualitative analysis that establish the " Chinese provincial Blindness prevention technical guidance group performance evaluation system" . Results: Through the literature review and qualitative assessment, a six dimensional system framework was built, including 6 first-level indicators, 16 second-level indicators, and 29 third-level indicators through Delphi method evaluation. With the variation coefficient method, the coeffiences of the first-level index weight were calculated as: Organization and management 0.15, Development and implementation of blindness prevention plans 0.15, Implementation of blindness prevention projects 0.14, Training 0.17, Health education 0.18, and Cooperation and exchanges 0.21. The specific scoring method for this system is confirmed as: data and files check, field interview, and record interview, sampling investigation. Empirical pilot study was conducted in the Jilin, Guizhou and Gansu provinces, and the self-assessment results from local experts were consistent with the scores from the systems. Conclusion: This system established is appropriate at current time, and it can effectively evaluate the performance of the Chinese provincial Blindness prevention technical guidance group. (Chin J Ophthalmol, 2016, 52:814-824) .

Atopic Dermatitis Anti-IgE Paediatric Trial (ADAPT): the role of anti-IgE in severe paediatric eczema: study protocol for a randomised controlled trial.

PubMed

Chan, Susan; Cornelius, Victoria; Chen, Tao; Radulovic, Suzana; Wan, Mandy; Jahan, Rahi; Lack, Gideon

2017-03-22

The evidence for systemic treatments for severe childhood eczema is limited and largely based on extrapolation of data from adult studies. Current therapies are often immunosuppressant and may be associated with both short- and long-term side effects. There is increasing in vitro and murine-model evidence for the role of IgE in the immunopathogenesis of atopic eczema. The aim of the study is to assess whether anti-IgE treatment (omalizumab) improves eczema, compared to placebo. The Atopic Dermatitis Anti-IgE Paediatric Trial (ADAPT) is a randomised, double-blind, placebo-controlled study assessing the role of anti-IgE in the management of severe paediatric eczema. Children with severe atopic eczema, with an objective SCORing Atopic Dermatitis (SCORAD) score of over 40 will be recruited. These children are candidates for systemic therapy, have failed systemic therapy or have experienced side effects from systemic therapy. Sixty-two patients aged between 4 and 19 years will receive anti-IgE for 6 months. The primary outcome measure will be the validated eczema score, the objective SCORAD at 24 weeks. This study has 90% power to detect a 33% relative reduction in SCORAD between active and placebo groups, with 5% significance. IgE may have a role to play in eczema, particularly in childhood. This forms the basis for the hypothesis that anti-IgE may be an effective treatment in this patient population. This will be the largest study to evaluate the efficacy of anti-IgE (omalizumab) versus placebo in children with severe eczema. The findings will help to clarify the role of anti-IgE as a potential treatment option in patients with severe childhood eczema. European Clinical Trials Database (EudraCT) Number: 2010-020841-29 . Assigned on 14 May 2010. ISRCTN Registry, Identifier: ISRCTN15090567 . Retrospectively assigned on 3 December 2014. ClinicalTrials.gov, Identifier: NCT02300701 . First received 21 November 2014.

A controlled, randomized, head-to-head comparison of the Prolieve thermodilatation System versus the Targis System for benign prostatic hyperplasia: safety, procedural tolerability, and clinical results.

PubMed

Shore, Neal D; Sethi, Parminder S

2010-09-01

Compare safety and tolerability of the Prolieve(®) System with the Targis(®) System using objective and subjective measures. Thirty-four men with symptomatic benign prostatic hyperplasia (BPH) were randomized to a single treatment with either the Prolieve or Targis system; 30 were treated and then followed for 6 months. After post-treatment bladder fill with ≥200 mL saline, patients were catheterized if they could not void after 2 hours or had a postvoid residual >150 mL. Catheter use, visual analog scale (VAS) tolerability scores, American Urological Association scores, and safety were assessed. After treatment, 15/16 (94%) Prolieve patients remained catheter-free compared with 3/14 (21%) Targis patients (P = 0.0001). Foley catheter indwelling time was 58.8 hours for the one Prolieve patient compared with 103.9 hrs (range 54-270 h) for the Targis patients (n = 9). Targis patients' catheterization requirements were: Seven Foley only, two intermittent self-catheters only, and two needing both. Intermittent self-catheterization continued for 1 month in two Targis patients. VAS tolerability scores were 24% to 50% lower during Prolieve treatment vs Targis (P < 0.05). Mean AUA scores for Prolieve improved from 21.2 at baseline to 12.3 and 7.9 at week 2 and month 6, respectively; for Targis, AUA scores improved from 22.9 at baseline to 17.9 and 10.9, respectively (P > 0.05). Overall, the incidence of device-related adverse events was 31% (Prolieve) compared with 64% (Targis) (P > 0.05)-most prevalently, urinary retention, dysuria, and hematuria. No device-related serious adverse events occurred. Prolieve provided enhanced near-term therapeutic benefit over Targis as assessed by catheterization, tolerability, and symptom relief, which may assist physician and patient decision-making when selecting an office-based transurethral microwave therapy option for patients.

A risk scoring system for prediction of haemorrhagic stroke.

PubMed

Zodpey, S P; Tiwari, R R

2005-01-01

The present pair-matched case control study was carried out at Government Medical College Hospital, Nagpur, India, a tertiary care hospital with the objective to devise and validate a risk scoring system for prediction of hemorrhagic stroke. The study consisted of 166 hospitalized CT scan proved cases of hemorrhagic stroke (ICD 9, 431-432), and a age and sex matched control per case. The controls were selected from patients who attended the study hospital for conditions other than stroke. On conditional multiple logistic regression five risk factors- hypertension (OR = 1.9. 95% Cl = 1.5-2.5). raised scrum total cholesterol (OR = 2.3, 95% Cl = 1.1-4.9). use of anticoagulants and antiplatelet agents (OR = 3.4, 95% Cl =1.1-10.4). past history of transient ischaemic attack (OR = 8.4, 95% Cl = 2.1- 33.6) and alcohol intake (OR = 2.1, 95% Cl = 1.3-3.6) were significant. These factors were ascribed statistical weights (based on regression coefficients) of 6, 8, 12, 21 and 8 respectively. The nonsignificant factors (diabetes mellitus, physical inactivity, obesity, smoking, type A personality, history of claudication, family history of stroke, history of cardiac diseases and oral contraceptive use in females) were not included in the development of scoring system. ROC curve suggested a total score of 21 to be the best cut-off for predicting haemorrhag stroke. At this cut-off the sensitivity, specificity, positive predictivity and Cohen's kappa were 0.74, 0.74, 0.74 and 0.48 respectively. The overall predictive accuracy of this additive risk scoring system (area under ROC curve by Wilcoxon statistic) was 0.79 (95% Cl = 0.73-0.84). Thus to conclude, if substantiated by further validation, this scorincy system can be used to predict haemorrhagic stroke, thereby helping to devise effective risk factor intervention strategy.

Comparison of Self-Efficacy for Managing Chronic Disease between patients with systemic sclerosis and other chronic conditions: a systematic review.

PubMed

Thombs, Brett D; Kwakkenbos, Linda; Riehm, Kira E; Saadat, Nazanin; Fedoruk, Claire

2017-02-01

The complexity and burden of systemic sclerosis (SSc) pose challenges to developing and sustaining disease management self-efficacy. The objective of this systematic review was to compare scores on a commonly used self-efficacy measure, the Self-Efficacy for Managing Chronic Disease (SEMCD) Scale, between SSc and other diseases. Data sources included the CINAHL, EMBASE, MEDLINE, and Scopus databases, searched through January 25, 2016, and reference lists of included articles and relevant reviews. Studies in any language that reported total SEMCD scores or individual item scores in adult non-psychiatric medical patients were eligible. We identified one eligible non-intervention study of SSc patients (n = 553), 13 other non-intervention studies, and 21 studies with pre-intervention data for patients enrolled in a self-management program or a trial of a program. Of 13 non-intervention studies with published total score means in cancer, cardiovascular disease, Parkinson's disease, spinal cord injuries, organ transplant candidates and recipients, dialysis, and lupus, SEMCD scores were statistically significantly lower (poorer self-efficacy) in SSc than 6 other disease samples, not significantly different from 6, and significantly higher than lupus patients. Compared to 18 studies of patients in self-management programs or trials with published total score means, SSc patients were similar or lower than 9 samples and significantly higher than 9 samples. Compared to patients with other diseases not enrolled in programs to improve self-efficacy, SSc patients report lower self-efficacy scores than most patient groups. Rigorously tested self-care interventions designed to meet the unique needs of patients with SSc are needed.

ANTIDEPRESSANTS ARE NOT OVER-PRESCRIBED FOR MILD DEPRESSION

PubMed Central

Simon, Gregory E; Rossom, Rebecca C; Beck, Arne; Waitzfelder, Beth E; Coleman, Karen J; Stewart, Christine; Operskalski, Belinda; Penfold, Robert B; Shortreed, Susan M

2016-01-01

Objective Evaluate over-prescribing of antidepressant medication for minimal or mild depression. Method Electronic records data from four large healthcare systems identified outpatients aged 18 or older starting a new episode of antidepressant treatment with an ICD9 diagnosis of depressive disorder (296.2, 296.3, 311, or 300.4). PHQ9 depression severity scores at time of treatment initiation were used to examine the distribution of baseline severity and the association between baseline severity and patients' demographic and clinical characteristics. Results Of 19,751 adults beginning treatment in 2011, baseline PHQ9 scores were available for 7051. In those with a baseline score, 85% reported moderate or severe symptoms (PHQ9 score 10 or more), 12% reported mild symptoms (PHQ score 5 to 9), and 3% reported minimal symptoms (PHQ9 score less than 5). The proportion reporting minimal or mild symptoms when starting treatment increased with age, ranging from 11% in those under age 30 to 26% in those aged 65 and older. The proportion with minimal or mild symptoms was also moderately higher among patients living in wealthier neighborhoods and those treated by psychiatrists. Nevertheless, across all subgroups defined by sex, race/ethnicity, prescriber specialty, and treatment history, the proportions with minimal or mild symptoms did not exceed 18%. Secondary analyses, including weighting and subgroup analyses, found no evidence that estimates of baseline severity were biased by missing PHQ9 scores. Conclusions In these health systems, prescribing of antidepressant medication for minimal or mild depression is much less common than suggested by previous reports. Given that this practice may sometimes be clinically appropriate, our findings indicate that over-prescribing of antidepressants for mild depression is not a significant public health concern. PMID:26580702

Automated Grading System for Evaluation of Superficial Punctate Keratitis Associated With Dry Eye.

PubMed

Rodriguez, John D; Lane, Keith J; Ousler, George W; Angjeli, Endri; Smith, Lisa M; Abelson, Mark B

2015-04-01

To develop an automated method of grading fluorescein staining that accurately reproduces the clinical grading system currently in use. From the slit lamp photograph of the fluorescein-stained cornea, the region of interest was selected and punctate dot number calculated using software developed with the OpenCV computer vision library. Images (n = 229) were then divided into six incremental severity categories based on computed scores. The final selection of 54 photographs represented the full range of scores: nine images from each of six categories. These were then evaluated by three investigators using a clinical 0 to 4 corneal staining scale. Pearson correlations were calculated to compare investigator scores, and mean investigator and automated scores. Lin's Concordance Correlation Coefficients (CCC) and Bland-Altman plots were used to assess agreement between methods and between investigators. Pearson's correlation between investigators was 0.914; mean CCC between investigators was 0.882. Bland-Altman analysis indicated that scores assessed by investigator 3 were significantly higher than those of investigators 1 and 2 (paired t-test). The predicted grade was calculated to be: Gpred = 1.48log(Ndots) - 0.206. The two-point Pearson's correlation coefficient between the methods was 0.927 (P < 0.0001). The CCC between predicted automated score Gpred and mean investigator score was 0.929, 95% confidence interval (0.884-0.957). Bland-Altman analysis did not indicate bias. The difference in SD between clinical and automated methods was 0.398. An objective, automated analysis of corneal staining provides a quality assurance tool to be used to substantiate clinical grading of key corneal staining endpoints in multicentered clinical trials of dry eye.

Effects of interactive instructional techniques in a web-based peripheral nervous system component for human anatomy.

PubMed

Allen, Edwin B; Walls, Richard T; Reilly, Frank D

2008-02-01

This study investigated the effects of interactive instructional techniques in a web-based peripheral nervous system (PNS) component of a first year medical school human anatomy course. Existing data from 9 years of instruction involving 856 students were used to determine (1) the effect of web-based interactive instructional techniques on written exam item performance and (2) differences between student opinions of the benefit level of five different types of interactive learning objects used. The interactive learning objects included Patient Case studies, review Games, Simulated Interactive Patients (SIP), Flashcards, and unit Quizzes. Exam item analysis scores were found to be significantly higher (p < 0.05) for students receiving the instructional treatment incorporating the web-based interactive learning objects than for students not receiving this treatment. Questionnaires using a five-point Likert scale were analysed to determine student opinion ratings of the interactive learning objects. Students reported favorably on the benefit level of all learning objects. Students rated the benefit level of the Simulated Interactive Patients (SIP) highest, and this rating was significantly higher (p < 0.05) than all other learning objects. This study suggests that web-based interactive instructional techniques improve student exam performance. Students indicated a strong acceptance of Simulated Interactive Patient learning objects.

Case report: a balance training program using the Nintendo Wii Fit to reduce fall risk in an older adult with bilateral peripheral neuropathy.

PubMed

Hakim, Renée Marie; Salvo, Charles J; Balent, Anthony; Keyasko, Michael; McGlynn, Deidre

2015-02-01

A recent systematic review supported the use of strength and balance training for older adults at risk for falls, and provided preliminary evidence for those with peripheral neuropathy (PN). However, the role of gaming systems in fall risk reduction was not explored. The purpose of this case report was to describe the use of the Nintendo® Wii™ Fit gaming system to train standing balance in a community-dwelling older adult with PN and a history of recurrent near falls. A 76-year-old patient with bilateral PN participated in 1 h of Nintendo® Wii™ Fit balance training, two times a week for 6 weeks. Examination was conducted using a Computerized Dynamic Posturography system (i.e. Sensory Organization Test (SOT), Limits of Stability (LOS), Adaptation Test (ADT) and Motor Control Test (MCT) and clinical testing with the Berg Balance Scale (BBS), Timed Up and Go (TUG), Activities-specific Balance Confidence (ABC) scale and 30-s Chair Stand. Following training, sensory integration scores on the SOT were unchanged. Maximum excursion abilities improved by a range of 37-86% on the LOS test. MCT scores improved for amplitude with forward translations and ADT scores improved for downward platform rotations. Clinical scores improved on the BBS (28/56-34/56), ABC (57.5-70.6%) and TUG (14.9-10.9 s) which indicated reduced fall risk. Balance training with a gaming system showed promise as a feasible, objective and enjoyable method to improve physical performance and reduce fall risk in an individual with PN.

Improved ankle push-off power following cheilectomy for hallux rigidus: a prospective gait analysis study.

PubMed

Smith, Sheryl M; Coleman, Scott C; Bacon, Stacy A; Polo, Fabian E; Brodsky, James W

2012-06-01

There is limited objective scientific information on the functional effects of cheilectomy. The purpose of this study was to test the hypothesis that cheilectomy for hallux rigidus improves gait by increasing ankle push-off power. Seventeen patients with symptomatic Stage 1 or Stage 2 hallux rigidus were studied. Pre- and postoperative first metatarsophalangeal (MTP) range of motion and AOFAS hallux scores were recorded. A gait analysis was performed within 4 weeks prior to surgery and repeated at a minimum of 1 year after surgery. Gait analysis was done using a three-dimensional motion capture system and a force platform embedded in a 10-m walkway. Gait velocity sagittal plane ankle range of motion and peak sagittal plane ankle push-off power were analyzed. Following cheilectomy, significant increases were noted for first MTP range of motion and AOFAS hallux score. First MTP motion improved an average of 16.7 degrees, from means of 33.9 degrees preoperatively to 50.6 degrees postoperatively (p<0.001). AOFAS hallux score increased from 62 to 81 (p<0.007). As demonstrated through gait anaylsis, a significant increase in postoperative peak sagittal plane ankle push-off power from 1.71±0.92 W/kg to 2.05±0.75 W/kg (p<0.04). In addition to clinically increased range of motion and improved AOFAS Hallux score, first MTP joint cheilectomy produced objective improvement in gait, as measured by increased peak sagittal-plane ankle push-off power.

Quantitative morphometrical characterization of human pronuclear zygotes.

PubMed

Beuchat, A; Thévenaz, P; Unser, M; Ebner, T; Senn, A; Urner, F; Germond, M; Sorzano, C O S

2008-09-01

Identification of embryos with high implantation potential remains a challenge in in vitro fertilization (IVF). Subjective pronuclear (PN) zygote scoring systems have been developed for that purpose. The aim of this work was to provide a software tool that enables objective measuring of morphological characteristics of the human PN zygote. A computer program was created to analyse zygote images semi-automatically, providing precise morphological measurements. The accuracy of this approach was first validated by comparing zygotes from two different IVF centres with computer-assisted measurements or subjective scoring. Computer-assisted measurement and subjective scoring were then compared for their ability to classify zygotes with high and low implantation probability by using a linear discriminant analysis. Zygote images coming from the two IVF centres were analysed with the software, resulting in a series of precise measurements of 24 variables. Using subjective scoring, the cytoplasmic halo was the only feature which was significantly different between the two IVF centres. Computer-assisted measurements revealed significant differences between centres in PN centring, PN proximity, cytoplasmic halo and features related to nucleolar precursor bodies distribution. The zygote classification error achieved with the computer-assisted measurements (0.363) was slightly inferior to that of the subjective ones (0.393). A precise and objective characterization of the morphology of human PN zygotes can be achieved by the use of an advanced image analysis tool. This computer-assisted analysis allows for a better morphological characterization of human zygotes and can be used for classification.

Limaprost alfadex improves myelopathy symptoms in patients with cervical spinal canal stenosis.

PubMed

Sugawara, Taku; Hirano, Yoshitaka; Higashiyama, Naoki; Mizoi, Kazuo

2009-03-15

Myelopathy symptoms were prospectively studied in patients with cervical spinal canal stenosis (CSCS), using objective grading systems and stabilometry, to examine the effect of administration of prostaglandin E1 derivative limaprost alfadex (limaprost). Myelopathy scores/grades and stabilometry parameters were evaluated before, and 1 and 3 months after starting the limaprost treatment. Limaprost is a potent vasodilator and antiplatelet agent and has been used to treat the symptoms of lumbar spinal canal stenosis. The action presumably involves increased blood flow in the compressed cauda equina. Limaprost can also increase blood flow in the compressed spinal cord, but effects on myelopathy symptoms in patients with CSCS have not been established. This study examined 21 patients with mild spondylotic CSCS based on neurologic findings and compression of the cervical spinal cord on magnetic resonance imaging. Japanese Orthopedic Association score, grip and release test, and finger escape sign were measured, and stabilometry was performed by independent examiners, before, and 1 and 3 months after starting the oral limaprost treatment. Most patients experienced amelioration of the symptoms at 1 month after starting the treatment. Mean Japanese Orthopedic Association score and grip and release count were significantly improved and finger escape sign grade was higher in some patients. Stabilometry area with eyes closed and Romberg rate were also significantly improved. These improvements were maintained at 3 months. The efficacy of oral limaprost administration for patients with CSCS was confirmed by objective scoring and quantitative data.

[Controlling systems for operating room managers].

PubMed

Schüpfer, G; Bauer, M; Scherzinger, B; Schleppers, A

2005-08-01

Management means developing, shaping and controlling of complex, productive and social systems. Therefore, operating room managers also need to develop basic skills in financial and managerial accounting as a basis for operative and strategic controlling which is an essential part of their work. A good measurement system should include financial and strategic concepts for market position, innovation performance, productivity, attractiveness, liquidity/cash flow and profitability. Since hospitals need to implement a strategy to reach their business objectives, the performance measurement system has to be individually adapted to the strategy of the hospital. In this respect the navigation system developed by Gälweiler is compared to the "balanced score card" system of Kaplan and Norton.

Affective symptoms in multiple system atrophy and Parkinson's disease: response to levodopa therapy

PubMed Central

Fetoni, V; Soliveri, P; Monza, D; Testa, D; Girotti, F

1999-01-01

The objective was to determine the extent to which psychiatric disturbances (especially mood disorders) generally considered poor prognostic factors, are present in patients with striatonigral (SND) type multiple system atrophy (MSA) compared with patients with idiopathic Parkinson's disease (IPD).
The Hamilton depression scale (HAM-D), brief psychiatric rating scale (BPRS), and Unified Parkinson's disease rating scale (UPDRS) were administered to clinically probable non-demented patients with SND-type MSA and patients with IPD matched for age and motor disability, at baseline and after receiving levodopa.
At baseline total HAM-D score was greater in patients with IPD. Overall, BPRS score did not differ between the two groups; however, patients with IPD scored higher on anxiety items of the BPRS, and patients with MSA had higher scores on the item indicating blunted affect. After levodopa, both groups improved significantly in UPDRS and HAM-D total scores (just significant for patients with MSA). Patients with IPD improved significantly in total BPRS score but patients with MSA did not.
At baseline patients with IPD were more depressed and anxious than patients with MSA who, by contrast, showed blunted affect. After levodopa, depression and anxiety of patients with IPD improved significantly whereas the affective detachment of patients with MSA did not change. Major neuronal loss in the caudate and ventral striatum, which are part of the lateral orbitofrontal and limbic circuits, may be responsible for the blunted affect not responsive to levodopa therapy found in patients with MSA.

 PMID:10201434

Continuous Monitoring of Essential Tremor Using a Portable System Based on Smartwatch.

PubMed

Zheng, Xiaochen; Vieira Campos, Alba; Ordieres-Meré, Joaquín; Balseiro, Jose; Labrador Marcos, Sergio; Aladro, Yolanda

2017-01-01

Essential tremor (ET) shows amplitude fluctuations throughout the day, presenting challenges in both clinical and treatment monitoring. Tremor severity is currently evaluated by validated rating scales, which only provide a timely and subjective assessment during a clinical visit. Motor sensors have shown favorable performances in quantifying tremor objectively. A new highly portable system was used to monitor tremor continuously during daily lives. It consists of a smartwatch with a triaxial accelerometer, a smartphone, and a remote server. An experiment was conducted involving eight ET patients. The average effective data collection time per patient was 26 (±6.05) hours. Fahn-Tolosa-Marin Tremor Rating Scale (FTMTRS) was adopted as the gold standard to classify tremor and to validate the performance of the system. Quantitative analysis of tremor severity on different time scales is validated. Significant correlations were observed between neurologist's FTMTRS and patient's FTMTRS auto-assessment scores ( r  = 0.84; p  = 0.009), between the device quantitative measures and the scores from the standardized assessments of neurologists ( r  = 0.80; p  = 0.005) and patient's auto-evaluation ( r  = 0.97; p  = 0.032), and between patient's FTMTRS auto-assessment scores day-to-day ( r  = 0.87; p  < 0.001). A graphical representation of four patients with different degrees of tremor was presented, and a representative system is proposed to summarize the tremor scoring at different time scales. This study demonstrates the feasibility of prolonged and continuous monitoring of tremor severity during daily activities by a highly portable non-restrictive system, a useful tool to analyze efficacy and effectiveness of treatment.

Evaluation of the sustainability of contrasted pig farming systems: development of a market conformity tool for pork products based on technological quality traits.

PubMed

Gonzàlez, J; Gispert, M; Gil, M; Hviid, M; Dourmad, J Y; de Greef, K H; Zimmer, C; Fàbrega, E

2014-12-01

A market conformity tool, based on technological meat quality parameters, was developed within the Q-PorkChains project, to be included in a global sustainability evaluation of pig farming systems. The specific objective of the market conformity tool was to define a scoring system based on the suitability of meat to elaborate the main pork products, according to their market shares based on industry requirements, in different pig farming systems. The tool was based on carcass and meat quality parameters that are commonly used for the assessment of technological quality, which provide representative and repeatable data and are easily measurable. They were the following: cold carcass weight; lean meat percentage; minimum subcutaneous back fat depth at m. gluteus medius level, 45 postmortem and ultimate pH (measured at 24-h postmortem) in m. longissimus lumborum and semimembranosus; meat colour; drip losses and intramuscular fat content in a m. longissimus sample. Five categories of pork products produced at large scale in Europe were considered in the study: fresh meat, cooked products, dry products, specialties and other meat products. For each of the studied farming systems, the technological meat quality requirements, as well as the market shares for each product category within farming system, were obtained from the literature and personal communications from experts. The tool resulted in an overall conformity score that enabled to discriminate among systems according to the degree of matching of the achieved carcass and meat quality with the requirements of the targeted market. In order to improve feasibility, the tool was simplified by selecting ultimate pH at m. longissimus or semimembranosus, minimum fat thickness measured at the left half carcass over m. gluteus medius and intramuscular fat content in a m. longissimus sample as iceberg indicators. The overall suitability scores calculated by using both the complete and the reduced tools presented good correlation and the results obtained were similar. The tool could be considered as robust enough to discriminate among different systems, since it was tested in a wide range of them. It also can be used to detect improvement opportunities to enhance sustainability of pig farming systems. The final objective of the study was achieved, since the market suitability tool could be used in an integrated sustainability analysis of pig farming systems.

The Healthy Beverage Index Is Associated with Reduced Cardiometabolic Risk in US Adults: A Preliminary Analysis.

PubMed

Duffey, Kiyah J; Davy, Brenda M

2015-10-01

Beverage recommendations exist, but few evaluate overall beverage intake quality. Our objective was to develop a scoring algorithm for assessing beverage intake quality among US adults (aged ≥19 years), and to examine the association between overall beverage quality and cardiometabolic risk. We developed a scoring algorithm, similar to the Healthy Eating Index-2010, using recommendations for total beverage energy, meeting fluid requirements, and consuming within recommended limits for beverage subgroups (eg, low-fat milk, fruit juice). Multiple scoring systems were evaluated. The final scoring system, which consisted of 10 components, was applied to the average of 2 days of 24-hour dietary intake data for adults (aged ≥19 years) from the National Health and Nutrition Examination Survey (NHANES), 2005-2010. Poisson regression models stratified by sex and body mass index multivariables were used to examine the cross-sectional association between the Healthy Beverage Index (HBI) score and cardiometabolic outcomes. The 10-item index had a mean±standard deviation score of 63±16 from a possible 100 points. Each 10-point higher HBI score was associated with lower odds ratios for hypertension (men and women); high fasting insulin level, high fasting glucose level, and high low-density lipoprotein cholesterol level (women and overweight/obese men), low high-density lipoprotein cholesterol level (women), and high C-reactive protein level (men). We found positive associations between higher HBI scores and more favorable lipid profiles; hypertension risk; and, among men, C-reactive protein levels. These preliminary results suggest that the HBI could be a valuable tool to evaluate overall beverage intake quality in adults. More research is needed to understand whether improvements in beverage quality and, thus, HBI score, are associated with beneficial changes in health. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Real-Time Risk Prediction on the Wards: A Feasibility Study.

PubMed

Kang, Michael A; Churpek, Matthew M; Zadravecz, Frank J; Adhikari, Richa; Twu, Nicole M; Edelson, Dana P

2016-08-01

Failure to detect clinical deterioration in the hospital is common and associated with poor patient outcomes and increased healthcare costs. Our objective was to evaluate the feasibility and accuracy of real-time risk stratification using the electronic Cardiac Arrest Risk Triage score, an electronic health record-based early warning score. We conducted a prospective black-box validation study. Data were transmitted via HL7 feed in real time to an integration engine and database server wherein the scores were calculated and stored without visualization for clinical providers. The high-risk threshold was set a priori. Timing and sensitivity of electronic Cardiac Arrest Risk Triage score activation were compared with standard-of-care Rapid Response Team activation for patients who experienced a ward cardiac arrest or ICU transfer. Three general care wards at an academic medical center. A total of 3,889 adult inpatients. The system generated 5,925 segments during 5,751 admissions. The area under the receiver operating characteristic curve for electronic Cardiac Arrest Risk Triage score was 0.88 for cardiac arrest and 0.80 for ICU transfer, consistent with previously published derivation results. During the study period, eight of 10 patients with a cardiac arrest had high-risk electronic Cardiac Arrest Risk Triage scores, whereas the Rapid Response Team was activated on two of these patients (p < 0.05). Furthermore, electronic Cardiac Arrest Risk Triage score identified 52% (n = 201) of the ICU transfers compared with 34% (n = 129) by the current system (p < 0.001). Patients met the high-risk electronic Cardiac Arrest Risk Triage score threshold a median of 30 hours prior to cardiac arrest or ICU transfer versus 1.7 hours for standard Rapid Response Team activation. Electronic Cardiac Arrest Risk Triage score identified significantly more cardiac arrests and ICU transfers than standard Rapid Response Team activation and did so many hours in advance.

The evaluation system of city's smart growth success rates

NASA Astrophysics Data System (ADS)

Huang, Yifan

2018-04-01

"Smart growth" is to pursue the best integrated perform+-ance of the Economically prosperous, socially Equitable, and Environmentally Sustainable(3E). Firstly, we establish the smart growth evaluation system(SGI) and the sustainable development evaluation system(SDI). Based on the ten principles and the definition of three E's of sustainability. B y using the Z-score method and the principal component analysis method, we evaluate and quantify indexes synthetically. Then we define the success of smart growth as the ratio of the SDI to the SGI composite score growth rate (SSG). After that we select two cities — Canberra and Durres as the objects of our model in view of the model. Based on the development plans and key data of these two cities, we can figure out the success of smart growth. And according to our model, we adjust some of the growth indicators for both cities. Then observe the results before and after adjustment, and finally verify the accuracy of the model.

A description of disordered eating behaviors in Latino males

PubMed Central

Reyes-Rodríguez, Mae Lynn; Sala, Margarita; Von Holle, Ann; Unikel, Claudia; Bulik, Cynthia M.; Cámara-Fuentes, Luis; Suárez-Torres, Alba

2011-01-01

Objective To explore disordered eating and eating disorders (ED) in Latino males. Participants 722 male college students from a larger prevalence study conducted in the University of Puerto Rico (UPR) system. Method Participants were selected from a list of sections of required courses for first-year students on each campus. Self report instruments were used to explore ED symptoms (EAT-26 & BULIT-26) and depression (BDI). Results Overall, 2.26% scored above the cut-off point on the BULIT-R and 5.08% score above the cut-off point on the EAT-26. Of the males, 4.43% reported sufficient frequency and severity to approximate DSM-IV criteria for BN. Depression symptomatology was found in those who scored above the cut-off point on both instruments of ED. Conclusion College health practitioners should be aware of disordered eating in Latino males and include them in efforts to detect disordered eating behaviors in college students. PMID:21308586

Haemophilia & Exercise Project (HEP): subjective and objective physical performance in adult haemophilia patients--results of a cross-sectional study.

PubMed

Czepa, D; Von Mackensen, S; Hilberg, T

2012-01-01

Recurrent musculoskeletal haemorrhages in people with haemophilia (PWH) lead to restrictions in the locomotor system and consequently in physical performance. Patients' perceptions of their health status have gained an important role in the last few years. The assessment of subjective physical performance in PWH is a new approach. This study aimed to compare the subjective physical performance of PWH with healthy controls and to correlate the results with objective data. Subjective physical performance was assessed via the new questionnaire HEP-Test-Q, which consists of 25 items pertaining to four subscales 'mobility', 'strength & coordination', 'endurance' and 'body perception'. HEP-Test-Q subscales were compared with objective data in terms of range of motion, one-leg-stand and 12-minute walk test. Forty-eight patients (44 ± 11 years) with haemophilia A (43 severe, three moderate) or B (two severe) and 43 controls without haemophilia (42 ± 11 years) were enrolled. PWH showed an impaired subjective physical performance in all HEP-Test-Q subscales and in the total score (52 ± 20) compared with controls (77 ± 10; P ≤ 0.001). Correlation analyses for the total score of the HEP-Test-Q and objective data revealed values ranging from r = 0.403 (one-leg-stand) to r = 0.757 (12-minute walk test) (P ≤ 0.001). PWH evaluated their physical performance poorer in comparison with healthy people. As self-assessment did not always correlate highly with objective data, objective examinations of physical performance in PWH should be complemented with subjective perceptions. © 2011 Blackwell Publishing Ltd.

On improving IED object detection by exploiting scene geometry using stereo processing

NASA Astrophysics Data System (ADS)

van de Wouw, Dennis W. J. M.; Dubbelman, Gijs; de With, Peter H. N.

2015-03-01

Detecting changes in the environment with respect to an earlier data acquisition is important for several applications, such as finding Improvised Explosive Devices (IEDs). We explore and evaluate the benefit of depth sensing in the context of automatic change detection, where an existing monocular system is extended with a second camera in a fixed stereo setup. We then propose an alternative frame registration that exploits scene geometry, in particular the ground plane. Furthermore, change characterization is applied to localized depth maps to distinguish between 3D physical changes and shadows, which solves one of the main challenges of a monocular system. The proposed system is evaluated on real-world acquisitions, containing geo-tagged test objects of 18 18 9 cm up to a distance of 60 meters. The proposed extensions lead to a significant reduction of the false-alarm rate by a factor of 3, while simultaneously improving the detection score with 5%.

A Smart-Home System to Unobtrusively and Continuously Assess Loneliness in Older Adults.

PubMed

Austin, Johanna; Dodge, Hiroko H; Riley, Thomas; Jacobs, Peter G; Thielke, Stephen; Kaye, Jeffrey

2016-01-01

Loneliness is a common condition in older adults and is associated with increased morbidity and mortality, decreased sleep quality, and increased risk of cognitive decline. Assessing loneliness in older adults is challenging due to the negative desirability biases associated with being lonely. Thus, it is necessary to develop more objective techniques to assess loneliness in older adults. In this paper, we describe a system to measure loneliness by assessing in-home behavior using wireless motion and contact sensors, phone monitors, and computer software as well as algorithms developed to assess key behaviors of interest. We then present results showing the accuracy of the system in detecting loneliness in a longitudinal study of 16 older adults who agreed to have the sensor platform installed in their own homes for up to 8 months. We show that loneliness is significantly associated with both time out-of-home ([Formula: see text] and [Formula: see text]) and number of computer sessions ([Formula: see text] and [Formula: see text]). [Formula: see text] for the model was 0.35. We also show the model's ability to predict out-of-sample loneliness, demonstrating that the correlation between true loneliness and predicted out-of-sample loneliness is 0.48. When compared with the University of California at Los Angeles loneliness score, the normalized mean absolute error of the predicted loneliness scores was 0.81 and the normalized root mean squared error was 0.91. These results represent first steps toward an unobtrusive, objective method for the prediction of loneliness among older adults, and mark the first time multiple objective behavioral measures that have been related to this key health outcome.

Automated and objective action coding of facial expressions in patients with acute facial palsy.

PubMed

Haase, Daniel; Minnigerode, Laura; Volk, Gerd Fabian; Denzler, Joachim; Guntinas-Lichius, Orlando

2015-05-01

Aim of the present observational single center study was to objectively assess facial function in patients with idiopathic facial palsy with a new computer-based system that automatically recognizes action units (AUs) defined by the Facial Action Coding System (FACS). Still photographs using posed facial expressions of 28 healthy subjects and of 299 patients with acute facial palsy were automatically analyzed for bilateral AU expression profiles. All palsies were graded with the House-Brackmann (HB) grading system and with the Stennert Index (SI). Changes of the AU profiles during follow-up were analyzed for 77 patients. The initial HB grading of all patients was 3.3 ± 1.2. SI at rest was 1.86 ± 1.3 and during motion 3.79 ± 4.3. Healthy subjects showed a significant AU asymmetry score of 21 ± 11 % and there was no significant difference to patients (p = 0.128). At initial examination of patients, the number of activated AUs was significantly lower on the paralyzed side than on the healthy side (p < 0.0001). The final examination for patients took place 4 ± 6 months post baseline. The number of activated AUs and the ratio between affected and healthy side increased significantly between baseline and final examination (both p < 0.0001). The asymmetry score decreased between baseline and final examination (p < 0.0001). The number of activated AUs on the healthy side did not change significantly (p = 0.779). Radical rethinking in facial grading is worthwhile: automated FACS delivers fast and objective global and regional data on facial motor function for use in clinical routine and clinical trials.

Development and Application of a Plant-Based Diet Scoring System for Japanese Patients with Inflammatory Bowel Disease

PubMed Central

Chiba, Mitsuro; Nakane, Kunio; Takayama, Yuko; Sugawara, Kae; Ohno, Hideo; Ishii, Hajime; Tsuda, Satoko; Tsuji, Tsuyotoshi; Komatsu, Masafumi; Sugawara, Takeshi

2016-01-01

Context Plant-based diets (PBDs) are a healthy alternative to westernized diets. A semivegetarian diet, a PBD, has been shown to prevent a relapse in Crohn disease. However, there is no way to measure adherence to PBDs. Objective To develop a simple way of evaluating adherence to a PBD for Japanese patients with inflammatory bowel disease (IBD). Design PBD scores were assigned according to the frequency of consumption provided on a food-frequency questionnaire, obtained on hospitalization for 159 patients with ulcerative colitis and 70 patients with Crohn disease. Eight items considered to be preventive factors for IBD were scored positively, and 8 items considered to be IBD risk factors were scored negatively. The PBD score was calculated from the sum of plus and minus scores. Higher PBD scores indicated greater adherence to a PBD. The PBD scores were evaluated on hospitalization and 2 years after discharge for 22 patients with Crohn disease whose dietary pattern and prognosis were established. Main Outcome Measure Plant-Based Diet score. Results The PBD scores differed significantly, in descending order, by dietary type: pro-Japanese diet, mixed type, and pro-westernized diet (Wilcoxon/Kruskal-Wallis test). The PBD scores in the ulcerative colitis and Crohn disease groups were 10.9 ± 9.5 and 8.2 ± 8.2, respectively. For patients with Crohn disease, those with long-term remission and normal C-reactive protein concentration were significantly more likely to have PBD scores of 25 or greater than below 25 (χ2). Conclusion The PBD score is a valid assessment of PBD dietary adherence. PMID:27768566

PERFORMANCE OF TWO DIFFERENT CLINICAL SCORING SYSTEMS IN DIAGNOSING DISTAL SENSORY POLYNEUROPATHY IN PATIENTS WITH TYPE-2 DIABETES.

PubMed

Khan, Fehmeda Farrukh; Numan, Ahsan; Khawaja, Khadija Irfan; Atif, Ali; Fatima, Aziz; Masud, Faisal

2015-01-01

Early diagnosis of distal peripheral neuropathy (DSPN) the commonest diabetes complications, helps prevent significant morbidity. Clinical parameters are useful for detection, but subjectivity and lack of operator proficiency often results in inaccuracies. Comparative diagnostic accuracy of Diabetic Neuropathy Symptom (DNS) score and Diabetic Neuropathy Examination (DNE) score in detecting DSPN confirmed by nerve conduction studies (NCS) has not been evaluated. This study compares the performance of these scores in predicting the presence of electro physiologically proven DSPN. The objective of this, study was to compare the diagnostic accuracy of DNS and DNE scores in detecting NCS proven DSPN in type-2 diabetics, and to determine the frequency of sub-clinical DSPN among type-2 diabetics. In this cross-sectional study the DNS score and DNE score were determined in 110 diagnosed type-2 diabetic patients. NCS were carried out and amplitudes, velocities and latencies of sensory and motor nerves in lower limb were recorded. Comparison between the two clinical diagnostic modalities and NCS using Pearson's chi square test showed a significant association between NCS and DNE scores (p-value =.003, specificity 93%). The DNS score performed poorly in comparison (p-value = .068, specificity 77%). When the two scores were taken in combination the specificity in diagnosing DSPN was greater (p-value = .018, specificity 96%) than either alone. 33% of patients had subclinical neuropathy. DNE score alone and in combination with DNS score is reliable in predicting DSPN and is more specific than DNS score in evaluating DSPN. Both tests lack sensitivity. Patients without any evidence of clinical neuropathy manifest abnormalities on NCS.

Impact on house staff evaluation scores when changing from a Dreyfus- to a Milestone-based evaluation model: one internal medicine residency program's findings.

PubMed

Friedman, Karen A; Balwan, Sandy; Cacace, Frank; Katona, Kyle; Sunday, Suzanne; Chaudhry, Saima

2014-01-01

As graduate medical education (GME) moves into the Next Accreditation System (NAS), programs must take a critical look at their current models of evaluation and assess how well they align with reporting outcomes. Our objective was to assess the impact on house staff evaluation scores when transitioning from a Dreyfus-based model of evaluation to a Milestone-based model of evaluation. Milestones are a key component of the NAS. We analyzed all end of rotation evaluations of house staff completed by faculty for academic years 2010-2011 (pre-Dreyfus model) and 2011-2012 (post-Milestone model) in one large university-based internal medicine residency training program. Main measures included change in PGY-level average score; slope, range, and separation of average scores across all six Accreditation Council for Graduate Medical Education (ACGME) competencies. Transitioning from a Dreyfus-based model to a Milestone-based model resulted in a larger separation in the scores between our three post-graduate year classes, a steeper progression of scores in the PGY-1 class, a wider use of the 5-point scale on our global end of rotation evaluation form, and a downward shift in the PGY-1 scores and an upward shift in the PGY-3 scores. For faculty trained in both models of assessment, the Milestone-based model had greater discriminatory ability as evidenced by the larger separation in the scores for all the classes, in particular the PGY-1 class.

Predictive Value of the Korean Academy of Family Medicine In-Training Examination for Certifying Examination

PubMed Central

Kim, Ji-Yong

2011-01-01

Background In-training examination (ITE) is a cognitive examination similar to the written test, but it is different from the Clinical Practice Examination of the Korean Academy of Family Medicine (KAFM) Certification Examination (CE). The objective of this is to estimate the positive predictive value of the KAFM-ITE for identifying residents at risk for poor performance on the three types of KAFM-CE. Methods 372 residents who completed the KAFM-CE in 2011 were included. We compared the mean KAFM-CE scores with ITE experience. We evaluated the correlation and the positive predictive value (PPV) of ITE for the multiple choice question (MCQ) scores of 1st written test & 2nd slide examination, the total clinical practice examination scores, and the total sum of 2nd test. Results 275 out of 372 residents completed ITE. Those who completed ITE had significantly higher MCQ scores of 1st written test than those who did not. The correlation of ITE scores with 1st written MCQ (0.627) was found to be the highest among the other kinds of CE. The PPV of the ITE score for 1st written MCQ scores was 0.672. The PPV of the ITE score ranged from 0.376 to 0.502. Conclusion The score of the KAFM ITE has acceptable positive predictive value that could be used as a part of comprehensive evaluation system for residents in cognitive field. PMID:22745873

Study of the Continuous Improvement Trend for Health, Safety and Environmental Indicators, after Establishment of Integrated Management System (IMS) in a Pharmaceutical Industry in Iran.

PubMed

Mariouryad, Pegah; Golbabaei, Farideh; Nasiri, Parvin; Mohammadfam, Iraj; Marioryad, Hossein

2015-10-01

Nowadays, organizations try to improve their services and consequently adopt management systems and standards which have become key parts in various industries. One of these management systems which have been noticed in the recent years is Integrated Management System that is the combination of quality, health, safety and environment management systems. This study was conducted with the aim of evaluating the improvement trend after establishment of integrated management system for health, safety and environment indicators, in a pharmaceutical industry in Iran. First, during several inspections in different parts of the industry, indicators that should have been noted were listed and then these indicators were organized in 3 domains of health, safety and environment in the form of a questionnaire that followed Likert method of scaling. Also, the weight of each index was resulted from averaging out of 30 managers and the viewpoints of the related experts in the field. Moreover, by checking the documents and evidence of different years (5 contemplation years of this study), the score of each indicator was determined by multiplying the weight and score of the indices and were finally analysed. Over 5 years, scores of health scope indicators, increased from 161.99 to 202.23. Score in the first year after applying the integrated management system establishment was 172.37 in safety part and in the final year increased to 197.57. The changes of environmental scope rates, from the beginning of the program up to the last year increased from 49.24 to 64.27. Integrated management systems help organizations to improve programs to achieve their objectives. Although in this study all trends of health, safety and environmental indicator changes were positive, but at the same time showed to be slow. So, one can suggest that the result of an annual evaluation should be applied in planning future activities for the years ahead.

Study of the Continuous Improvement Trend for Health, Safety and Environmental Indicators, after Establishment of Integrated Management System (IMS) in a Pharmaceutical Industry in Iran

PubMed Central

Mariouryad, Pegah; Golbabaei, Farideh; Nasiri, Parvin; Mohammadfam, Iraj

2015-01-01

Background Nowadays, organizations try to improve their services and consequently adopt management systems and standards which have become key parts in various industries. One of these management systems which have been noticed in the recent years is Integrated Management System that is the combination of quality, health, safety and environment management systems. Aim This study was conducted with the aim of evaluating the improvement trend after establishment of integrated management system for health, safety and environment indicators, in a pharmaceutical industry in Iran. Materials and Methods First, during several inspections in different parts of the industry, indicators that should have been noted were listed and then these indicators were organized in 3 domains of health, safety and environment in the form of a questionnaire that followed Likert method of scaling. Also, the weight of each index was resulted from averaging out of 30 managers and the viewpoints of the related experts in the field. Moreover, by checking the documents and evidence of different years (5 contemplation years of this study), the score of each indicator was determined by multiplying the weight and score of the indices and were finally analysed. Results Over 5 years, scores of health scope indicators, increased from 161.99 to 202.23. Score in the first year after applying the integrated management system establishment was 172.37 in safety part and in the final year increased to 197.57. The changes of environmental scope rates, from the beginning of the program up to the last year increased from 49.24 to 64.27. Conclusion Integrated management systems help organizations to improve programs to achieve their objectives. Although in this study all trends of health, safety and environmental indicator changes were positive, but at the same time showed to be slow. So, one can suggest that the result of an annual evaluation should be applied in planning future activities for the years ahead. PMID:26557547

A reciprocal model of face recognition and autistic traits: evidence from an individual differences perspective.

PubMed

Halliday, Drew W R; MacDonald, Stuart W S; Scherf, K Suzanne; Sherf, Suzanne K; Tanaka, James W

2014-01-01

Although not a core symptom of the disorder, individuals with autism often exhibit selective impairments in their face processing abilities. Importantly, the reciprocal connection between autistic traits and face perception has rarely been examined within the typically developing population. In this study, university participants from the social sciences, physical sciences, and humanities completed a battery of measures that assessed face, object and emotion recognition abilities, general perceptual-cognitive style, and sub-clinical autistic traits (the Autism Quotient (AQ)). We employed separate hierarchical multiple regression analyses to evaluate which factors could predict face recognition scores and AQ scores. Gender, object recognition performance, and AQ scores predicted face recognition behaviour. Specifically, males, individuals with more autistic traits, and those with lower object recognition scores performed more poorly on the face recognition test. Conversely, university major, gender and face recognition performance reliably predicted AQ scores. Science majors, males, and individuals with poor face recognition skills showed more autistic-like traits. These results suggest that the broader autism phenotype is associated with lower face recognition abilities, even among typically developing individuals.

A Reciprocal Model of Face Recognition and Autistic Traits: Evidence from an Individual Differences Perspective

PubMed Central

Halliday, Drew W. R.; MacDonald, Stuart W. S.; Sherf, Suzanne K.; Tanaka, James W.

2014-01-01

Although not a core symptom of the disorder, individuals with autism often exhibit selective impairments in their face processing abilities. Importantly, the reciprocal connection between autistic traits and face perception has rarely been examined within the typically developing population. In this study, university participants from the social sciences, physical sciences, and humanities completed a battery of measures that assessed face, object and emotion recognition abilities, general perceptual-cognitive style, and sub-clinical autistic traits (the Autism Quotient (AQ)). We employed separate hierarchical multiple regression analyses to evaluate which factors could predict face recognition scores and AQ scores. Gender, object recognition performance, and AQ scores predicted face recognition behaviour. Specifically, males, individuals with more autistic traits, and those with lower object recognition scores performed more poorly on the face recognition test. Conversely, university major, gender and face recognition performance reliably predicted AQ scores. Science majors, males, and individuals with poor face recognition skills showed more autistic-like traits. These results suggest that the broader autism phenotype is associated with lower face recognition abilities, even among typically developing individuals. PMID:24853862

Standards for reporting randomized controlled trials in medical informatics: a systematic review of CONSORT adherence in RCTs on clinical decision support

PubMed Central

Berntsen, G; Lassen, K; Bellika, J G; Wootton, R; Lindsetmo, R O

2011-01-01

Introduction The Consolidated Standards for Reporting Trials (CONSORT) were published to standardize reporting and improve the quality of clinical trials. The objective of this study is to assess CONSORT adherence in randomized clinical trials (RCT) of disease specific clinical decision support (CDS). Methods A systematic search was conducted of the Medline, EMBASE, and Cochrane databases. RCTs on CDS were assessed against CONSORT guidelines and the Jadad score. Result 32 of 3784 papers identified in the primary search were included in the final review. 181 702 patients and 7315 physicians participated in the selected trials. Most trials were performed in primary care (22), including 897 general practitioner offices. RCTs assessing CDS for asthma (4), diabetes (4), and hyperlipidemia (3) were the most common. Thirteen CDS systems (40%) were implemented in electronic medical records, and 14 (43%) provided automatic alerts. CONSORT and Jadad scores were generally low; the mean CONSORT score was 30.75 (95% CI 27.0 to 34.5), median score 32, range 21–38. Fourteen trials (43%) did not clearly define the study objective, and 11 studies (34%) did not include a sample size calculation. Outcome measures were adequately identified and defined in 23 (71%) trials; adverse events or side effects were not reported in 20 trials (62%). Thirteen trials (40%) were of superior quality according to the Jadad score (≥3 points). Six trials (18%) reported on long-term implementation of CDS. Conclusion The overall quality of reporting RCTs was low. There is a need to develop standards for reporting RCTs in medical informatics. PMID:21803926

Hybrid recommendation methods in complex networks.

PubMed

Fiasconaro, A; Tumminello, M; Nicosia, V; Latora, V; Mantegna, R N

2015-07-01

We propose two recommendation methods, based on the appropriate normalization of already existing similarity measures, and on the convex combination of the recommendation scores derived from similarity between users and between objects. We validate the proposed measures on three data sets, and we compare the performance of our methods to other recommendation systems recently proposed in the literature. We show that the proposed similarity measures allow us to attain an improvement of performances of up to 20% with respect to existing nonparametric methods, and that the accuracy of a recommendation can vary widely from one specific bipartite network to another, which suggests that a careful choice of the most suitable method is highly relevant for an effective recommendation on a given system. Finally, we study how an increasing presence of random links in the network affects the recommendation scores, finding that one of the two recommendation algorithms introduced here can systematically outperform the others in noisy data sets.

A randomized comparison of video demonstration versus hands-on training of medical students for vacuum delivery using Objective Structured Assessment of Technical Skills (OSATS).

PubMed

Hilal, Ziad; Kumpernatz, Anne K; Rezniczek, Günther A; Cetin, Cem; Tempfer-Bentz, Eva-Katrin; Tempfer, Clemens B

2017-03-01

To compare medical students' skills for vaginal operative delivery by vacuum extraction (VE) after hands-on training versus video demonstration. We randomized medical students to an expert demonstration (group 1) or a hands-on (group 2) training using a standardized VE algorithm on a pelvic training model. Students were tested with a 40-item Objective Structured Assessment of Technical Skills (OSATS) scoring system after training and 4 days later. OSATS scores were the primary outcome. Performance time, self-assessment, confidence, and global rating scale were secondary outcomes. We assessed the constructive validity of OSATS in this VE model comparing metric scores of experts and students. In all, 137 students were randomized. OSATS scores were higher in group 2 (n = 63) compared with group 1 (n = 74) (32.89 ± 6.39 vs 27.51 ± 10.27, respectively; P < 0.0001). Global rating scale (1.49 ± 0.76 vs 2.33 ± 0.94, respectively; P < 0.0001), confidence (2.22 ± 0.75 vs 3.26 ± 0.94, respectively; P = 0.04), self-assessment (2.03 ± 0.62 vs 2.51 ± 0.77, respectively; P < 0.0001), and performance time (38.81 ± 11.58 seconds vs 47.23 ± 17.35 seconds, respectively; P = 0.001) also favored group 2. After 4 days, this effect persisted with OSATS scores still being significantly higher in group 2 (30.00 ± 6.50 vs 25.59 ± 6.09, respectively; P = 0.001). The assessed OSATS scores showed constructive validity. In a multiple linear regression analysis, group assignment independently influenced OSATS scores, whereas sex, handedness, sports activities, and type of curriculum were not independently associated with OSATS scores. Hands-on training is superior to video demonstration for teaching VE on a pelvic model.

A randomized comparison of video demonstration versus hands-on training of medical students for vacuum delivery using Objective Structured Assessment of Technical Skills (OSATS)

PubMed Central

Hilal, Ziad; Kumpernatz, Anne K.; Rezniczek, Günther A.; Cetin, Cem; Tempfer-Bentz, Eva-Katrin; Tempfer, Clemens B.

2017-01-01

Abstract Background: To compare medical students’ skills for vaginal operative delivery by vacuum extraction (VE) after hands-on training versus video demonstration. Methods: We randomized medical students to an expert demonstration (group 1) or a hands-on (group 2) training using a standardized VE algorithm on a pelvic training model. Students were tested with a 40-item Objective Structured Assessment of Technical Skills (OSATS) scoring system after training and 4 days later. OSATS scores were the primary outcome. Performance time, self-assessment, confidence, and global rating scale were secondary outcomes. We assessed the constructive validity of OSATS in this VE model comparing metric scores of experts and students. Results: In all, 137 students were randomized. OSATS scores were higher in group 2 (n = 63) compared with group 1 (n = 74) (32.89 ± 6.39 vs 27.51 ± 10.27, respectively; P < 0.0001). Global rating scale (1.49 ± 0.76 vs 2.33 ± 0.94, respectively; P < 0.0001), confidence (2.22 ± 0.75 vs 3.26 ± 0.94, respectively; P = 0.04), self-assessment (2.03 ± 0.62 vs 2.51 ± 0.77, respectively; P < 0.0001), and performance time (38.81 ± 11.58 seconds vs 47.23 ± 17.35 seconds, respectively; P = 0.001) also favored group 2. After 4 days, this effect persisted with OSATS scores still being significantly higher in group 2 (30.00 ± 6.50 vs 25.59 ± 6.09, respectively; P = 0.001). The assessed OSATS scores showed constructive validity. In a multiple linear regression analysis, group assignment independently influenced OSATS scores, whereas sex, handedness, sports activities, and type of curriculum were not independently associated with OSATS scores. Conclusions: Hands-on training is superior to video demonstration for teaching VE on a pelvic model. PMID:28296771

Development and Evaluation of Semiautomated Quantification of Lissamine Green Staining of the Bulbar Conjunctiva From Digital Images.

PubMed

Bunya, Vatinee Y; Chen, Min; Zheng, Yuanjie; Massaro-Giordano, Mina; Gee, James; Daniel, Ebenezer; O'Sullivan, Ryan; Smith, Eli; Stone, Richard A; Maguire, Maureen G

2017-10-01

Lissamine green (LG) staining of the conjunctiva is a key biomarker in evaluating ocular surface disease. The disease currently is assessed using relatively coarse subjective scales. Objective assessment would standardize comparisons over time and between clinicians. To develop a semiautomated, quantitative system to assess lissamine green staining of the bulbar conjunctiva on digital images. Using a standard photography protocol, 35 digital images of the conjunctiva of 11 patients with a diagnosis of dry eye disease based on characteristic signs and symptoms were obtained after topical administration of preservative-free LG, 1%, solution. Images were scored independently by 2 masked ophthalmologists in an academic medical center using the van Bijsterveld and National Eye Institute (NEI) scales. The region of interest was identified by manually marking 7 anatomic landmarks on the images. An objective measure was developed by segmenting the images, forming a vector of key attributes, and then performing a random forest regression. Subjective scores were correlated with the output from a computer algorithm using a cross-validation technique. The ranking of images from least to most staining was compared between the algorithm and the ophthalmologists. The study was conducted from April 26, 2012, through June 2, 2016. Correlation and level of agreement among computerized algorithm scores, van Bijsterveld scale clinical scores, and NEI scale clinical scores. The scores from the automated algorithm correlated well with the mean scores obtained from the gradings of 2 ophthalmologists for the 35 images using the van Bijsterveld scale (Spearman correlation coefficient, rs = 0.79), and moderately with the NEI scale (rs = 0.61) scores. For qualitative ranking of staining, the correlation between the automated algorithm and the 2 ophthalmologists was rs = 0.78 and rs = 0.83. The algorithm performed well when evaluating LG staining of the conjunctiva, as evidenced by good correlation with subjective gradings using 2 different grading scales. Future longitudinal studies are needed to assess the responsiveness of the algorithm to change of conjunctival staining over time.

Relating illness complexity to reimbursement in CKD patients.

PubMed

Bessette, Russell W; Carter, Randy L

2011-01-01

Despite significant investments of federal and state dollars to transition patient medical records to an all-electronic system, a chasm still exists between health care quality and payment for it. A major reason for this gap is the difficulty in evaluating health care outcomes based on claims data. Since both payers and patients may not appreciate how illness complexity impacts treatment outcomes, it is difficult to determine fair provider compensation. Chronic kidney disease (CKD) typifies these problems and is often associated with comorbidities that impact cost, health, and work productivity. Thus, the objective of this study was to evaluate an illness complexity score (ICS) based on a linear regression of select blood values that might assist in predicting average monthly reimbursements in CKD patients. A second objective was to compare the results of this ICS prediction to results obtained by prediction of average monthly reimbursement using CKD stage. A third objective was to analyze the relationship between the change in ICS, estimated glomerular filtration rate (eGFR), and CKD stage over time to average monthly reimbursement. We calculated parsimonious values for select variables associated with CKD patients and compared the ICS to ordinal staging of renal disease. Data from 177 de-identified patients over 13 months was collected, which included 15 blood chemistry observations along with complete claims data for all medical expenses. To test for the relationship between average blood chemistry values, stages of CKD, age, and average monthly reimbursement, we modeled an association through a linear regression function of age, eGFR, and the Z-scores calculated from average monthly values of phosphorus, parathyroid hormone, glucose, hemoglobin, bicarbonate, albumin, creatinine, blood urea nitrogen, potassium, calcium, sodium, alkaline phosphatase, alanine aminotransferase, and white blood cells. The results of our study demonstrated that the association between average ICS values throughout the entire study period predicted average monthly reimbursements with an R(2) value of 0.41. Comparing that value to the association between the average CKD stage and average monthly reimbursement demonstrated an R(2) value of 0.08. Thus, ICS offers five times greater sensitivity over CKD staging as a measure of illness complexity. Sorting the patient population by changes in CKD stage or ICS over the entire study period revealed significant differences between the two scoring methods. Groups scored by ICS demonstrated greater sensitivity by capturing dysfunction in other organ systems and had a better association with reimbursement than groups scored by CKD staging.

Validity and Reliability of Nintendo Wii Fit Balance Scores

PubMed Central

Wikstrom, Erik A.

2012-01-01

Context: Interactive gaming systems have the potential to help rehabilitate patients with musculoskeletal conditions. The Nintendo Wii Balance Board, which is part of the Wii Fit game, could be an effective tool to monitor progress during rehabilitation because the board and game can provide objective measures of balance. However, the validity and reliability of Wii Fit balance scores remain unknown. Objective: To determine the concurrent validity of balance scores produced by the Wii Fit game and the intrasession and intersession reliability of Wii Fit balance scores. Design: Descriptive laboratory study. Setting: Sports medicine research laboratory. Patients or Other Participants: Forty-five recreationally active participants (age  =  27.0 ± 9.8 years, height  =  170.9 ± 9.2 cm, mass  =  72.4 ± 11.8 kg) with a heterogeneous history of lower extremity injury. Intervention(s): Participants completed a single-limb–stance task on a force plate and the Star Excursion Balance Test (SEBT) during the first test session. Twelve Wii Fit balance activities were completed during 2 test sessions separated by 1 week. Main Outcome Measure(s): Postural sway in the anteroposterior (AP) and mediolateral (ML) directions and the AP, ML, and resultant center-of-pressure (COP) excursions were calculated from the single-limb stance. The normalized reach distance was recorded for the anterior, posteromedial, and posterolateral directions of the SEBT. Wii Fit balance scores that the game software generated also were recorded. Results: All 96 of the calculated correlation coefficients among Wii Fit activity outcomes and established balance outcomes were interpreted as poor (r < 0.50). Intrasession reliability for Wii Fit balance activity scores ranged from good (intraclass correlation coefficient [ICC]  =  0.80) to poor (ICC  =  0.39), with 8 activities having poor intrasession reliability. Similarly, 11 of the 12 Wii Fit balance activity scores demonstrated poor intersession reliability, with scores ranging from fair (ICC  =  0.74) to poor (ICC  =  0.29). Conclusions: Wii Fit balance activity scores had poor concurrent validity relative to COP outcomes and SEBT reach distances. In addition, the included Wii Fit balance activity scores generally had poor intrasession and intersession reliability. PMID:22892412

How well do second-year students learn physical diagnosis? Observational study of an Objective Structured Clinical Examination (OSCE).

PubMed

Hamann, Claus; Volkan, Kevin; Fishman, Mary B; Silvestri, Ronald C; Simon, Steven R; Fletcher, Suzanne W

2002-01-01

Little is known about using the Objective Structured Clinical Examination (OSCE) in physical diagnosis courses. The purpose of this study was to describe student performance on an OSCE in a physical diagnosis course. Cross-sectional study at Harvard Medical School, 1997-1999, for 489 second-year students. Average total OSCE score was 57% (range 39-75%). Among clinical skills, students scored highest on patient interaction (72%), followed by examination technique (65%), abnormality identification (62%), history-taking (60%), patient presentation (60%), physical examination knowledge (47%), and differential diagnosis (40%) (p <.0001). Among 16 OSCE stations, scores ranged from 70% for arthritis to 29% for calf pain (p <.0001). Teaching sites accounted for larger adjusted differences in station scores, up to 28%, than in skill scores (9%) (p <.0001). Students scored higher on interpersonal and technical skills than on interpretive or integrative skills. Station scores identified specific content that needs improved teaching.

How well do second-year students learn physical diagnosis? Observational study of an objective structured clinical examination (OSCE)

PubMed Central

Hamann, Claus; Volkan, Kevin; Fishman, Mary B; Silvestri, Ronald C; Simon, Steven R; Fletcher, Suzanne W

2002-01-01

Background Little is known about using the Objective Structured Clinical Examination (OSCE) in physical diagnosis courses. The purpose of this study was to describe student performance on an OSCE in a physical diagnosis course. Methods Cross-sectional study at Harvard Medical School, 1997–1999, for 489 second-year students. Results Average total OSCE score was 57% (range 39–75%). Among clinical skills, students scored highest on patient interaction (72%), followed by examination technique (65%), abnormality identification (62%), history-taking (60%), patient presentation (60%), physical examination knowledge (47%), and differential diagnosis (40%) (p < .0001). Among 16 OSCE stations, scores ranged from 70% for arthritis to 29% for calf pain (p < .0001). Teaching sites accounted for larger adjusted differences in station scores, up to 28%, than in skill scores (9%) (p < .0001). Conclusions Students scored higher on interpersonal and technical skills than on interpretive or integrative skills. Station scores identified specific content that needs improved teaching. PMID:11888484

SPIDERplan: A tool to support decision-making in radiation therapy treatment plan assessment.

PubMed

Ventura, Tiago; Lopes, Maria do Carmo; Ferreira, Brigida Costa; Khouri, Leila

2016-01-01

In this work, a graphical method for radiotherapy treatment plan assessment and comparison, named SPIDERplan, is proposed. It aims to support plan approval allowing independent and consistent comparisons of different treatment techniques, algorithms or treatment planning systems. Optimized plans from modern radiotherapy are not easy to evaluate and compare because of their inherent multicriterial nature. The clinical decision on the best treatment plan is mostly based on subjective options. SPIDERplan combines a graphical analysis with a scoring index. Customized radar plots based on the categorization of structures into groups and on the determination of individual structures scores are generated. To each group and structure, an angular amplitude is assigned expressing the clinical importance defined by the radiation oncologist. Completing the graphical evaluation, a global plan score, based on the structures score and their clinical weights, is determined. After a necessary clinical validation of the group weights, SPIDERplan efficacy, to compare and rank different plans, was tested through a planning exercise where plans had been generated for a nasal cavity case using different treatment planning systems. SPIDERplan method was applied to the dose metrics achieved by the nasal cavity test plans. The generated diagrams and scores successfully ranked the plans according to the prescribed dose objectives and constraints and the radiation oncologist priorities, after a necessary clinical validation process. SPIDERplan enables a fast and consistent evaluation of plan quality considering all targets and organs at risk.

Assessment of systems for paying health care providers in Vietnam: implications for equity, efficiency and expanding effective health coverage.

PubMed

Phuong, Nguyen Khanh; Oanh, Tran Thi Mai; Phuong, Hoang Thi; Tien, Tran Van; Cashin, Cheryl

2015-01-01

Provider payment arrangements are currently a core concern for Vietnam's health sector and a key lever for expanding effective coverage and improving the efficiency and equity of the health system. This study describes how different provider payment systems are designed and implemented in practice across a sample of provinces and districts in Vietnam. Key informant interviews were conducted with over 100 health policy-makers, purchasers and providers using a structured interview guide. The results of the different payment methods were scored by respondents and assessed against a set of health system performance criteria. Overall, the public health insurance agency, Vietnam Social Security (VSS), is focused on managing expenditures through a complicated set of reimbursement policies and caps, but the incentives for providers are unclear and do not consistently support Vietnam's health system objectives. The results of this study are being used by the Ministry of Health and VSS to reform the provider payment systems to be more consistent with international definitions and good practices and to better support Vietnam's health system objectives.

A comparison of four measures of moral reasoning.

PubMed

Wilmoth, G H; McFarland, S G

1977-08-01

Kohlberg's Moral Judgment Scale, Gilligan et al.'s Sexual Moral Judgment Scale, Maitland and Goldman's Objective Moral Judgment Scale, and Hogan's Maturity of Moral Judgment Scale, were examined for reliability and inter-scale relationships. All measures except the Objective Moral Judgment Scale had good reliabilities. The obtained relations between the Moral Judgment Scale and the Sexual Moral Judgment Scale replicated previous research. The Objective Moral Judgment Scale was not found to validly assess the Kohlberg stages. The Maturity of Moral Judgment Scale scores were strongly related to the subjects's classification on the Kohlberg stages, and the scale appears to offer a reliable, quickly scored, and valid index of mature thought, although the scale's continuous scores do not permit clear stage classification.

A multicenter study analyzing the relationship of a standardized radiographic scoring system of adolescent idiopathic scoliosis and the Scoliosis Research Society outcomes instrument.

PubMed

Wilson, Philip L; Newton, Peter O; Wenger, Dennis R; Haher, Thomas; Merola, Andrew; Lenke, Larry; Lowe, Thomas; Clements, David; Betz, Randy

2002-09-15

A multicenter study examining the association between radiographic and outcomes measures in adolescent idiopathic scoliosis. To evaluate the association between an objective radiographic scoring system and patient quality of life measures as determined by the Scoliosis Research Society outcomes instrument. Although surgical correction of scoliosis has been reported to be positively correlated with patient outcomes, studies to date have been unable to demonstrate an association between radiographic measures of deformity and outcomes measures in patients with adolescent idiopathic scoliosis. A standardized radiographic deformity scoring system and the Scoliosis Research Society outcome tool were used prospectively in seven scoliosis centers to collect data on patients with adolescent idiopathic scoliosis. A total of 354 data points for 265 patients consisting of those with nonoperative or preoperative curves >or=10 degrees, as well as those with surgically treated curves, were analyzed. Correlation analysis was performed to identify significant relationships between any of the radiographic measures, the Harms Study Group radiographic deformity scores (total, sagittal, coronal), and the seven Scoliosis Research Society outcome domains (Total Pain, General Self-Image, General Function, Activity, Postoperative Self-Image, Postoperative Function, and Satisfaction) as well as Scoliosis Research Society outcomes instrument total scores. Radiographic measures that were identified as significantly correlated with Scoliosis Research Society outcome scores were then entered into a stepwise regression analysis. The coronal measures of thoracic curve and lumbar curve magnitude were found to be significantly correlated with the Total Pain, General Self-Image, and total Scoliosis Research Society scores (P < 0.0001). The thoracic and upper thoracic curve magnitudes were also correlated with General Function (P < 0.002). The "coronal" subscore as well as the "total" score of the Harms Study Group radiographic scoring system were also significantly correlated with these Scoliosis Research Society domain and total scores. No radiographic measures taken after surgery were significantly correlated with the postoperative domains of the Scoliosis Research Society outcomes instrument. Stepwise regression analysis of these radiographic measures as predictors of Scoliosis Research Society scores resulted in adjusted R2 values of 0.03-0.07 (P < 0.0001). Although these results show that a significant association exists between the radiographic Cobb angle measure of the scoliosis and the Scoliosis Research Society outcomes scores, the low R2 values indicate that variables other than the radiographic appearance of the deformity (e.g., psychosocial, functional) must also be affecting these scores. The Cobb angle measure of the major deformity has a small, but statistically significant, correlation with the reported Total Pain, General Self-Image, and General Function as measured by the Scoliosis Research Society outcomes instrument. None of the radiographic measures in this population correlated with postoperative domain scores of the Scoliosis Research Society outcomes tool.

Identification of patient information corruption in the intensive care unit: using a scoring tool to direct quality improvements in handover.

PubMed

Pickering, Brian W; Hurley, Killian; Marsh, Brian

2009-11-01

To use a handover assessment tool for identifying patient information corruption and objectively evaluating interventions designed to reduce handover errors and improve medical decision making. The continuous monitoring, intervention, and evaluation of the patient in modern intensive care unit practice generates large quantities of information, the platform on which medical decisions are made. Information corruption, defined as errors of distortion/omission compared with the medical record, may result in medical judgment errors. Identifying these errors may lead to quality improvements in intensive care unit care delivery and safety. Handover assessment instrument development study divided into two phases by the introduction of a handover intervention. Closed, 17-bed, university-affiliated mixed surgical/medical intensive care unit. Senior and junior medical members of the intensive care unit team. Electronic handover page. Study subjects were asked to recall clinical information commonly discussed at handover on individual patients. The handover score measured the percentage of information correctly retained for each individual doctor-patient interaction. The clinical intention score, a subjective measure of medical judgment, was graded (1-5) by three blinded intensive care unit experts. A total of 137 interactions were scored. Median (interquartile range) handover scores for phases 1 and 2 were 79.07% (67.44-84.50) and 83.72% (76.16-88.37), respectively. Score variance was reduced by the handover intervention (p < .05). Increasing median handover scores, 68.60 to 83.72, were associated with increases in clinical intention scores from 1 to 5 (chi-square = 23.59, df = 4, p < .0001). When asked to recall clinical information discussed at handover, medical members of the intensive care unit team provide data that are significantly corrupted compared with the medical record. Low subjective clinical judgment scores are significant associated with low handover scores. The handover/clinical intention scores may, therefore, be useful screening tools for intensive care unit system vulnerability to medical error. Additionally, handover instruments can identify interventions that reduce system vulnerability to error and may be used to guide quality improvements in handover practice.

Computerized estimation of compatibility of stressors at work and worker's health characteristics.

PubMed

Susnik, J; Bizjak, B; Cestnik, B

1996-09-01

A system of computerized estimation of compatibility of stressors at work and worker's health characteristics is presented. Each characteristic is defined and scored on a specific scale. Incompatible workplace characteristics as related to worker's characteristics are singled out and offered to the user for an ergonomic solution. Work on the system started in 1987. This paper deals with the system's further development, which involves a larger number of topics, changes of the algorithm and presentation of an applicative case. Comparison of the system's results with those of medical experts shows that the use of the system tends to improve the thoroughness and consistency of incompatibility evaluations and consequently to make working ability assessment more objective.

Single strip lesions radiofrequency denervation for treatment of sacroiliac joint pain: two years' results.

PubMed

Bellini, Martina; Barbieri, Massimo

2016-01-01

Sacroiliac joint pain can be managed by intra-articular injections or radiofrequency of its innervation. Single strip lesions radiofrequency denervation is a new system. The objective of this study was to present one of the first utilizations of this innovative technique. 60 patients who met the diagnostic criteria for sacroiliac joint syndrome were enrolled in the study. In total, 102 single strip lesions radiofrequency denervations were performed. Pain intensity was measured with the Oswestry low back pain disability questionnaire and the Oswestry Disability Index whose scores were assessed at 1, 3, 6 and 12 months after the procedure. 91.8 % of the 102 radiofrequency treatments resulted in a reduction of more than 50% pain intensity relief at 1 month, 81.6% at 3 months and 59.16% at 6 months. In 35.7% of cases, the relief was continuative up to 1 year. No relief was observed in 12.24% of cases. The ODI scores improved significantly 1 month after the procedure, compared with the baseline scores. The ODI scores after 6 months improved very clearly compared with the baseline scores and with the 3-month scores. Single strip lesions radiofrequency denervation using the Simplicity III probe is a potential modality for intermediate term relief for patients with sacroiliac pain.

An objectively-analyzed method for measuring the useful penetration of x-ray imaging systems.

PubMed

Glover, Jack L; Hudson, Lawrence T

2016-06-01

The ability to detect wires is an important capability of the cabinet x-ray imaging systems that are used in aviation security as well as the portable x-ray systems that are used by domestic law enforcement and military bomb squads. A number of national and international standards describe methods for testing this capability using the so called useful penetration test metric, where wires are imaged behind different thicknesses of blocking material. Presently, these tests are scored based on human judgments of wire visibility, which are inherently subjective. We propose a new method in which the useful penetration capabilities of an x-ray system are objectively evaluated by an image processing algorithm operating on digital images of a standard test object. The algorithm advantageously applies the Radon transform for curve parameter detection that reduces the problem of wire detection from two dimensions to one. The sensitivity of the wire detection method is adjustable and we demonstrate how the threshold parameter can be set to give agreement with human-judged results. The method was developed to be used in technical performance standards and is currently under ballot for inclusion in a US national aviation security standard.

An objectively-analyzed method for measuring the useful penetration of x-ray imaging systems

PubMed Central

Glover, Jack L.; Hudson, Lawrence T.

2016-01-01

The ability to detect wires is an important capability of the cabinet x-ray imaging systems that are used in aviation security as well as the portable x-ray systems that are used by domestic law enforcement and military bomb squads. A number of national and international standards describe methods for testing this capability using the so called useful penetration test metric, where wires are imaged behind different thicknesses of blocking material. Presently, these tests are scored based on human judgments of wire visibility, which are inherently subjective. We propose a new method in which the useful penetration capabilities of an x-ray system are objectively evaluated by an image processing algorithm operating on digital images of a standard test object. The algorithm advantageously applies the Radon transform for curve parameter detection that reduces the problem of wire detection from two dimensions to one. The sensitivity of the wire detection method is adjustable and we demonstrate how the threshold parameter can be set to give agreement with human-judged results. The method was developed to be used in technical performance standards and is currently under ballot for inclusion in a US national aviation security standard. PMID:27499586

An objectively-analyzed method for measuring the useful penetration of x-ray imaging systems

NASA Astrophysics Data System (ADS)

Glover, Jack L.; Hudson, Lawrence T.

2016-06-01

The ability to detect wires is an important capability of the cabinet x-ray imaging systems that are used in aviation security as well as the portable x-ray systems that are used by domestic law enforcement and military bomb squads. A number of national and international standards describe methods for testing this capability using the so called useful penetration test metric, where wires are imaged behind different thicknesses of blocking material. Presently, these tests are scored based on human judgments of wire visibility, which are inherently subjective. We propose a new method in which the useful penetration capabilities of an x-ray system are objectively evaluated by an image processing algorithm operating on digital images of a standard test object. The algorithm advantageously applies the Radon transform for curve parameter detection that reduces the problem of wire detection from two dimensions to one. The sensitivity of the wire detection method is adjustable and we demonstrate how the threshold parameter can be set to give agreement with human-judged results. The method was developed to be used in technical performance standards and is currently under ballot for inclusion in an international aviation security standard.

PubMed Central

Paunic, Teodora; Parojcic, Aleksandra; Savic-Pavicevic, Dusanka; Vujnic, Milorad; Pesovic, Jovan; Basta, Ivana; Lavrnic, Dragana; Rakocevic-Stojanovic, Vidosava

2017-01-01

Myotonic dystrophy type 2 (DM2) is a multisystem disorder that affects many organs and systems, including the brain. The objective is to analyze personality patterns in myotonic dystrophy type 2 (DM2) compared to DM1 control group. The study comprised 27 consecutive genetically confirmed DM2 patients and control group of 44 DM1 patients. Personality traits were assessed with the Millon Multiaxial Clinical Inventory III (MMCI III). In DM2 group there were no scale with pathological scores, although compulsive and paranoid traits were the most prominent. DM2 patients had lower scores compared to DM1 patients in almost all scales. Pathological scores on clinical symptom scales were not observed, although anxiety scale almost approached this value. Patients with higher compulsive score had higher level of education (rho = +0.53, p < 0.01). On the other hand, higher paranoid score correlated with younger age at onset (rho = -0.34, p < 0.01) and lower educational level (rho = -0.26, p < 0.05). Our results did not show significant personality impairments in patients with DM2. However, following personality traits were predominant: compulsive (in patients with higher education) and paranoid (in patients with lower education and earlier age at onset). The most common clinical symptoms were anxiety and somatization. PMID:28690389

Cognitive function and its relationship to other psychosocial factors in lymphoma survivors.

PubMed

Krolak, Dorothy; Collins, Barbara; Weiss, Lorelle; Harris, Cheryl; Van der Jagt, Richard

2017-03-01

The purpose of this study was to estimate the prevalence of cognitive disturbance in lymphoma survivors and to explore relationships between cognitive function and other psychosocial factors. A package of standardized questionnaires was sent to 622 lymphoma patients treated at the Ottawa Hospital in the preceding 5 years. Patients with central nervous system involvement were excluded. The questionnaires addressed cognitive function, pain, insomnia, fatigue, and mood. Of the patients in the sampling frame, 54 % responded to the survey and 42 % met inclusion/exclusion criteria. Sixteen percent (99/622) agreed to undergo computerized neuropsychological testing with CNS vital signs (CNSVS). Scores on the objective and subjective cognitive measures were compared to those of a healthy female control group from a previous study. The lymphoma group scored significantly lower than the controls on a cognitive rating scale (p = .018) and on CNSVS (p = .035). The difference on the CNSVS was primarily due to poorer attention and executive function scores in the lymphoma patients. The patients also had a higher frequency of impairment on both the objective (p = .009) and subjective (p < .001) cognitive measures. Among the lymphoma survivors, fatigue and anxiety were related to subjective cognitive disturbance (p < .001 for both), whereas pain was the only psychosocial measure associated with objective cognitive performance (p < .001). These results suggest that cognitive disturbance may be a significant survivorship issue for lymphoma patients and should be more thoroughly investigated in this population.

Do the SRS-22 self-image and mental health domain scores reflect the degree of asymmetry of the back in adolescent idiopathic scoliosis?

PubMed

Cheshire, James; Gardner, Adrian; Berryman, Fiona; Pynsent, Paul

2017-01-01

Patient-reported outcomes are becoming increasingly recognised in the management of patients with adolescent idiopathic scoliosis (AIS). Integrated Shape Imaging System 2 (ISIS2) surface topography is a validated tool to assess AIS. Previous studies have failed to demonstrate strong correlations between AIS and patient-reported outcomes highlighting the need for additional objective surface parameters to define the deformities associated with AIS. The aim of this study was to examine whether the Scoliosis Research Society-22 (SRS-22) outcome questionnaire reflects the degree of measurable external asymmetry of the back in AIS and thus is a measure of patient outcome for external appearance. A total of 102 pre-operative AIS patients were identified retrospectively. Objective parameters were measured using ISIS2 surface topography. The associations between these parameters and the self-image and mental health domains of the SRS-22 questionnaire were investigated using correlation coefficients. All correlations between the parameters of asymmetry and SRS-22 self-image score were of weak strength. Similarly, all correlations between the parameters of asymmetry and SRS-22 mental health score were of weak strength. The SRS-22 mental health and self-image domains correlate poorly with external measures of deformity. This demonstrates that the assessment of mental health and self-image by the SRS-22 has little to do with external torso shape. Whilst the SRS-22 assesses the patient as a whole, it provides little information about objective measures of deformity over which a surgeon has control.

Internal Structure of Mini-CEX Scores for Internal Medicine Residents: Factor Analysis and Generalizability

ERIC Educational Resources Information Center

Cook, David A.; Beckman, Thomas J.; Mandrekar, Jayawant N.; Pankratz, V. Shane

2010-01-01

The mini-CEX is widely used to rate directly observed resident-patient encounters. Although several studies have explored the reliability of mini-CEX scores, the dimensionality of mini-CEX scores is incompletely understood. Objective: Explore the dimensionality of mini-CEX scores through factor analysis and generalizability analysis. Design:…

Personality and Examination Score Correlates of Abnormal Psychology Course Ratings.

ERIC Educational Resources Information Center

Pauker, Jerome D.

The relationship between the ratings students assigned to an evening undergraduate abnormal psychology class and their scores on objective personality tests and course examinations was investigated. Students (N=70) completed the MMPI and made global ratings of the course; these scores were correlated separately by sex with the T scores of 13 MMPI…

Attention Deficit and Hyperactivity Disorder Scores Are Elevated and Respond to N-Acetylcysteine Treatment in Patients With Systemic Lupus Erythematosus

PubMed Central

Garcia, Ricardo J.; Francis, Lisa; Dawood, Maha; Lai, Zhi-wei; Faraone, Stephen V.; Perl, Andras

2014-01-01

Objective To investigate whether attention deficit hyperactivity disorder (ADHD) may serve as a marker of neuropsychiatric disease and as a target for N-acetylcysteine (NAC) treatment in patients with systemic lupus erythematosus (SLE). Methods The ADHD Self-Report Scale (ASRS) was used to assess 49 patients with SLE and 46 matched healthy control subjects. Twenty-four of the patients with SLE were randomized to receive either placebo, NAC at a dosage of 2.4 gm/day, or NAC at a dosage of 4.8 gm/day. Disease activity was evaluated monthly using the British Isles Lupus Assessment Group (BILAG) index, the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), the Fatigue Assessment Scale (FAS), and the ASRS, before and during the 3-month treatment period and after a 1-month washout period. Results The cognitive/inattentive (ASRS part A), hyperactivity/impulsive (ASRS part B), and combined (total) ASRS scores were increased in patients with SLE compared with control subjects (mean ± SEM 17.37 ± 1.03 [P = 3 × 10−7], 14.51 ± 0.89 [P = 2 × 10−4], and 31.92 ± 1.74 [P = 8 × 10−7], respectively, versus 10.41 ± 1.02, 9.61 ± 1.21, and 20.02 ± 1.98, respectively. ASRS part A scores correlated with SLEDAI (r = 0.53, P < 0.0001) and BILAG scores (r = 0.36, P = 0.011). ASRS total scores also correlated with SLEDAI (r = 0.45, P = 0.0009) and BILAG scores (r = 0.31, P = 0.025). ASRS part A (r = 0.73, P < 0.0001), ASRS part B (r = 0.47, P = 0.0006), and ASRS total scores (r = 0.67, P < 0.0001) correlated with the FAS score. Relative to the scores in placebo-treated patients, ASRS total scores were reduced in SLE patients treated with NAC dosages of 2.4 gm/day and 4.8 gm/day combined (P = 0.037). ASRS part A scores were reduced by NAC dosages of 2.4 gm/day (P = 0.001) and 4.8 gm/day (P < 0.0001) as well as by NAC at dosages of 2.4 gm/day and 4.8 gm/day combined (P = 0.001). Conclusion In patients with SLE, elevated ASRS scores reveal previously unrecognized and clinically significant symptoms of ADHD that respond to NAC treatment. PMID:23400548

A multistage decision support framework to guide tree species management under climate change via habitat suitability and colonization models, and a knowledge-based scoring system

Treesearch

Anantha M. Prasad; Louis R. Iverson; Stephen N. Matthews; Matthew P. Peters

2016-01-01

Context. No single model can capture the complex species range dynamics under changing climates--hence the need for a combination approach that addresses management concerns. Objective. A multistage approach is illustrated to manage forested landscapes under climate change. We combine a tree species habitat model--DISTRIB II, a species colonization model--SHIFT, and...

Assessment of coronary artery calcium by chest CT compared with EKG-gated cardiac CT in the multicenter AIDS cohort study

PubMed Central

Chandra, Divay; Gupta, Aman; Leader, Joseph K.; Fitzpatrick, Meghan; Kingsley, Lawrence A.; Kleerup, Eric; Haberlen, Sabina A.; Budoff, Matthew J.; Witt, Mallory; Post, Wendy S.; Sciurba, Frank C.; Morris, Alison

2017-01-01

Rationale Individuals with HIV are at increased risk for coronary artery disease (CAD). Early detection of subclinical CAD by assessment of coronary artery calcium (CAC) may help risk stratify and prevent CAD events in these individuals. However, the current standard to quantify CAC i.e. Agatston scoring requires EKG-gated cardiac CT imaging. Objective To determine if the assessment of CAC using non-EKG-gated chest CT and the Weston scoring system is a useful surrogate for Agatston scores in HIV-infected and HIV-uninfected individuals. Methods and measurements CAC was assessed by both the Weston and Agatston score in 108 men enrolled in the Multicenter AIDS Cohort Study. Results Participants were 55.2 (IQR 50.4; 59.9) years old and 62 (57.4%) were seropositive for HIV. Inter-observer agreement (rs = 0.94, κ = 90.0%, p<0.001, n = 21) and intra-observer agreement (rs = 0.95, κ = 95.2%, p<0.001, n = 97) for category of Weston score were excellent. Weston scores were associated with similar CAD risk factors as Agatston scores (age, race, HDL cholesterol level, all p<0.05) in our cohort. There was excellent correlation (rs = 0.92, p<0.001) and agreement (κw = 0.77, p<0.001) between Weston and Agatston scores. Conclusions This study is the first to examine calcium scoring using chest CT in HIV-infected individuals and to independently validate the Weston score as a surrogate for the Agatston score. In clinical or research settings where EKG-gated cardiac CT is not feasible for the assessment of coronary calcium, Weston scoring by using chest CT should be considered. PMID:28453572

Quantifying usability: an evaluation of a diabetes mHealth system on effectiveness, efficiency, and satisfaction metrics with associated user characteristics

PubMed Central

Staggers, Nancy

2016-01-01

Objective Mobile health (mHealth) systems are becoming more common for chronic disease management, but usability studies are still needed on patients’ perspectives and mHealth interaction performance. This deficiency is addressed by our quantitative usability study of a mHealth diabetes system evaluating patients’ task performance, satisfaction, and the relationship of these measures to user characteristics. Materials and Methods We used metrics in the International Organization for Standardization (ISO) 9241-11 standard. After standardized training, 10 patients performed representative tasks and were assessed on individual task success, errors, efficiency (time on task), satisfaction (System Usability Scale [SUS]) and user characteristics. Results Tasks of exporting and correcting values proved the most difficult, had the most errors, the lowest task success rates, and consumed the longest times on task. The average SUS satisfaction score was 80.5, indicating good but not excellent system usability. Data trends showed males were more successful in task completion, and younger participants had higher performance scores. Educational level did not influence performance, but a more recent diabetes diagnosis did. Patients with more experience in information technology (IT) also had higher performance rates. Discussion Difficult task performance indicated areas for redesign. Our methods can assist others in identifying areas in need of improvement. Data about user background and IT skills also showed how user characteristics influence performance and can provide future considerations for targeted mHealth designs. Conclusion Using the ISO 9241-11 usability standard, the SUS instrument for satisfaction and measuring user characteristics provided objective measures of patients’ experienced usability. These could serve as an exemplar for standardized, quantitative methods for usability studies on mHealth systems. PMID:26377990

Effect of virtual reality versus conventional physiotherapy on upper extremity function in children with obstetric brachial plexus injury

PubMed Central

El-Shamy, Shamekh; Alsharif, Rabab

2017-01-01

Objectives: The objective was to evaluate the effects of virtual reality versus conventional physiotherapy on upper extremity function in children with obstetric brachial plexus injury. Methods: Forty children with Erb’s palsy were selected for this randomized controlled study. They were assigned randomly to either group A (conventional physiotherapy program) or group B (virtual reality program using Armeo® spring for 45 min three times/week for 12 successive weeks). Mallet system scores for shoulder function and shoulder abduction, and external rotation range of motion (ROM) were obtained; shoulder abductor, and external rotators isometric strength were evaluated pre-and post-treatment using Mallet scoring system, standard universal goniometer, and handheld dynamometer. Results: The results of this study indicate that the children in both groups showed improvement in shoulder functions post-treatment with greater improvements in group B. The abduction muscle strength after treatment was 8.53 and 11.3 Nm for group A and group B, respectively. The external rotation muscle strength after treatment was 5.88 and 7.45 Nm for group A and group B, respectively. Conclusions: The virtual reality program is a significantly more effective than conventional physiotherapy program in improving the upper extremity functions in children with obstetric brachial plexus injury. PMID:29199193

QPF verification using different radar-based analyses: a case study

NASA Astrophysics Data System (ADS)

Moré, J.; Sairouni, A.; Rigo, T.; Bravo, M.; Mercader, J.

2009-09-01

Verification of QPF in NWP models has been always challenging not only for knowing what scores are better to quantify a particular skill of a model but also for choosing the more appropriate methodology when comparing forecasts with observations. On the one hand, an objective verification technique can provide conclusions that are not in agreement with those ones obtained by the "eyeball" method. Consequently, QPF can provide valuable information to forecasters in spite of having poor scores. On the other hand, there are difficulties in knowing the "truth" so different results can be achieved depending on the procedures used to obtain the precipitation analysis. The aim of this study is to show the importance of combining different precipitation analyses and verification methodologies to obtain a better knowledge of the skills of a forecasting system. In particular, a short range precipitation forecasting system based on MM5 at 12 km coupled with LAPS is studied in a local convective precipitation event that took place in NE Iberian Peninsula on October 3rd 2008. For this purpose, a variety of verification methods (dichotomous, recalibration and object oriented methods) are used to verify this case study. At the same time, different precipitation analyses are used in the verification process obtained by interpolating radar data using different techniques.

Subjective and objective quantification of physician's workload and performance during radiation therapy planning tasks.

PubMed

Mazur, Lukasz M; Mosaly, Prithima R; Hoyle, Lesley M; Jones, Ellen L; Marks, Lawrence B

2013-01-01

To quantify, and compare, workload for several common physician-based treatment planning tasks using objective and subjective measures of workload. To assess the relationship between workload and performance to define workload levels where performance could be expected to decline. Nine physicians performed the same 3 tasks on each of 2 cases ("easy" vs "hard"). Workload was assessed objectively throughout the tasks (via monitoring of pupil size and blink rate), and subjectively at the end of each case (via National Aeronautics and Space Administration Task Load Index; NASA-TLX). NASA-TLX assesses the 6 dimensions (mental, physical, and temporal demands, frustration, effort, and performance); scores > or ≈ 50 are associated with reduced performance in other industries. Performance was measured using participants' stated willingness to approve the treatment plan. Differences in subjective and objective workload between cases, tasks, and experience were assessed using analysis of variance (ANOVA). The correlation between subjective and objective workload measures were assessed via the Pearson correlation test. The relationships between workload and performance measures were assessed using the t test. Eighteen case-wise and 54 task-wise assessments were obtained. Subjective NASA-TLX scores (P < .001), but not time-weighted averages of objective scores (P > .1), were significantly lower for the easy vs hard case. Most correlations between the subjective and objective measures were not significant, except between average blink rate and NASA-TLX scores (r = -0.34, P = .02), for task-wise assessments. Performance appeared to decline at NASA-TLX scores of ≥55. The NASA-TLX may provide a reasonable method to quantify subjective workload for broad activities, and objective physiologic eye-based measures may be useful to monitor workload for more granular tasks within activities. The subjective and objective measures, as herein quantified, do not necessarily track each other, and more work is needed to assess their utilities. From a series of controlled experiments, we found that performance appears to decline at subjective workload levels ≥55 (as measured via NASA-TLX), which is consistent with findings from other industries. Copyright © 2013 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

The PER (Preoperative Esophagectomy Risk) Score: A Simple Risk Score to Predict Short-Term and Long-Term Outcome in Patients with Surgically Treated Esophageal Cancer.

PubMed

Reeh, Matthias; Metze, Johannes; Uzunoglu, Faik G; Nentwich, Michael; Ghadban, Tarik; Wellner, Ullrich; Bockhorn, Maximilian; Kluge, Stefan; Izbicki, Jakob R; Vashist, Yogesh K

2016-02-01

Esophageal resection in patients with esophageal cancer (EC) is still associated with high mortality and morbidity rates. We aimed to develop a simple preoperative risk score for the prediction of short-term and long-term outcomes for patients with EC treated by esophageal resection. In total, 498 patients suffering from esophageal carcinoma, who underwent esophageal resection, were included in this retrospective cohort study. Three preoperative esophagectomy risk (PER) groups were defined based on preoperative functional evaluation of different organ systems by validated tools (revised cardiac risk index, model for end-stage liver disease score, and pulmonary function test). Clinicopathological parameters, morbidity, and mortality as well as disease-free survival (DFS) and overall survival (OS) were correlated to the PER score. The PER score significantly predicted the short-term outcome of patients with EC who underwent esophageal resection. PER 2 and PER 3 patients had at least double the risk of morbidity and mortality compared to PER 1 patients. Furthermore, a higher PER score was associated with shorter DFS (P < 0.001) and OS (P < 0.001). The PER score was identified as an independent predictor of tumor recurrence (hazard ratio [HR] 2.1; P < 0.001) and OS (HR 2.2; P < 0.001). The PER score allows preoperative objective allocation of patients with EC into different risk categories for morbidity, mortality, and long-term outcomes. Thus, multicenter studies are needed for independent validation of the PER score.

Validation of the M-stage scoring system for digital dermatitis on dairy cows in the milking parlor.

PubMed

Solano, L; Barkema, H W; Jacobs, C; Orsel, K

2017-02-01

A high prevalence of digital dermatitis (DD) and the benefits of early topical treatment highlight the need for simple tools for routine DD detection. The objective of this study was to determine the accuracy of scoring DD lesions using the 5 M-stage scoring system in the milking parlor compared with the trimming chute as the gold standard. Three observers inspected 3,585 cows and 6,991 hind feet from 9 farms in the milking parlor using a mirror (glued to a plastic kitchen spatula) and a headlamp, followed by inspection in a trimming chute within 5 d. Interobserver agreement for scoring DD in various settings was ≥82% (kappa >0.74; weighted kappa >0.76). At trimming chute inspections, 68% of cows had at least 1 DD lesion, 19% had 1 hind leg affected, and 49% had both hind legs affected. Within-herd DD prevalence ranged from 16 to 81% of cows affected. True within-herd prevalence was 2, 6, 0, 36, and 14% for M1, M2, M3, M4, and M4.1 lesions, respectively. At the foot level, DD prevalence was the same (58%) in the milking parlor and trimming chute inspection, but distribution of M-stages differed. Milking parlor inspection as a means of identifying the presence of DD lesions had a sensitivity of 92% and specificity of 88%, with positive and negative predictive values of 91 and 89%, respectively. Agreement between milking parlor and trimming chute inspections was 73% (kappa = 0.59, weighted kappa = 0.65) for the 5 M-stage scoring system and 90% (kappa = 0.80) if only the presence of a lesion was noted. Test characteristics varied greatly among M-stages, with the highest sensitivity for detecting M4 (82%) and M2 (62%) lesions, and the lowest for detecting M4.1 (20%), M1 (7%), and M3 (0%) lesions. In the milking parlor, 20% of M2 lesions were misclassified as M4.1, 8% of M4 lesions were misclassified as M0, and 68% of M4.1 lesions were misclassified as M4. The majority (87%) of DD lesions were located between the heel bulbs; 10 and 2% of DD lesions affected the interdigital space and the front of the foot, respectively. The sensitivity to detect the presence of a lesion when it occurred between the heel bulbs was 93%, but <67% if it occurred elsewhere on the foot. We concluded that inspection of the rear feet in the milking parlor was an inexpensive and simple method of detecting and scoring DD lesions. If the objective is to determine herd-level DD prevalence and routine monitoring, this method was adequately reliable. However, if the objective is to follow up DD in cows with history of interdigital hyperplasia or to detect M1 or M4.1 lesions, this method was not sufficiently reliable. Although DD scoring in the milking parlor as a routine practice should facilitate early detection, prompt treatment interventions, and herd monitoring, it was not sufficiently reliable to replace definitive identification of M-stages in the trimming chute. The Authors. Published by the Federation of Animal Science Societies and Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

Evaluation of Automated and Semi-Automated Scoring of Polysomnographic Recordings from a Clinical Trial Using Zolpidem in the Treatment of Insomnia

PubMed Central

Svetnik, Vladimir; Ma, Junshui; Soper, Keith A.; Doran, Scott; Renger, John J.; Deacon, Steve; Koblan, Ken S.

2007-01-01

Objective: To evaluate the performance of 2 automated systems, Morpheus and Somnolyzer24X7, with various levels of human review/editing, in scoring polysomnographic (PSG) recordings from a clinical trial using zolpidem in a model of transient insomnia. Methods: 164 all-night PSG recordings from 82 subjects collected during 2 nights of sleep, one under placebo and one under zolpidem (10 mg) treatment were used. For each recording, 6 different methods were used to provide sleep stage scores based on Rechtschaffen & Kales criteria: 1) full manual scoring, 2) automated scoring by Morpheus 3) automated scoring by Somnolyzer24X7, 4) automated scoring by Morpheus with full manual review, 5) automated scoring by Morpheus with partial manual review, 6) automated scoring by Somnolyzer24X7 with partial manual review. Ten traditional clinical efficacy measures of sleep initiation, maintenance, and architecture were calculated. Results: Pair-wise epoch-by-epoch agreements between fully automated and manual scores were in the range of intersite manual scoring agreements reported in the literature (70%-72%). Pair-wise epoch-by-epoch agreements between automated scores manually reviewed were higher (73%-76%). The direction and statistical significance of treatment effect sizes using traditional efficacy endpoints were essentially the same whichever method was used. As the degree of manual review increased, the magnitude of the effect size approached those estimated with fully manual scoring. Conclusion: Automated or semi-automated sleep PSG scoring offers valuable alternatives to costly, time consuming, and intrasite and intersite variable manual scoring, especially in large multicenter clinical trials. Reduction in scoring variability may also reduce the sample size of a clinical trial. Citation: Svetnik V; Ma J; Soper KA; Doran S; Renger JJ; Deacon S; Koblan KS. Evaluation of automated and semi-automated scoring of polysomnographic recordings from a clinical trial using zolpidem in the treatment of insomnia. SLEEP 2007;30(11):1562-1574. PMID:18041489

Temporal changes and risk factors for foot-pad dermatitis in Danish broilers.

PubMed

Kyvsgaard, Niels Chr; Jensen, Henrik Bang; Ambrosen, Thorkil; Toft, Nils

2013-01-01

Foot-pad dermatitis is a major welfare concern of broilers caused by ammonia irritation from the bedding material. In Denmark, an action plan to control the condition was implemented in 2002 with monitoring through a foot scoring system at slaughter and with predefined limits that trigger sanctions. The objective of the present study was to study time trends and to identify predisposing factors on the flock lesion scores. The analysis was carried out on a database created by merging abattoir lesion data with antemortem evaluation data, and the flock productivity database managed by the farmers' association. The database had a record for each flock and variables containing information on both flock foot-pad scores and a range of management factors. We observed a dramatic decline in flock lesion scores between the years 2002 and 2005 followed by a minimal decline hereafter. Mean flock lesion scores differed between abattoirs, and subsequent analysis was performed in a mixed effect model where abattoir was considered a random effect. The analysis showed that flock lesion scores increased when the litter quality was evaluated as poor during the on-site antemortem evaluation. Other significant risk factors were winter season as opposed to summer, low daily weight gain, straw as bedding material in contrast to wood shavings and sphagnum peat, and high age at slaughter. Stocking density was only weakly associated with flock lesion scores.

Summative Objective Structured Clinical Examination Assessment at the End of Anesthesia Residency for Perioperative Ultrasound.

PubMed

Mitchell, John D; Amir, Rabia; Montealegre-Gallegos, Mario; Mahmood, Feroze; Shnider, Marc; Mashari, Azad; Yeh, Lu; Bose, Ruma; Wong, Vanessa; Hess, Philip; Amador, Yannis; Jeganathan, Jelliffe; Jones, Stephanie B; Matyal, Robina

2018-06-01

While standardized examinations and data from simulators and phantom models can assess knowledge and manual skills for ultrasound, an Objective Structured Clinical Examination (OSCE) could assess workflow understanding. We recruited 8 experts to develop an OSCE to assess workflow understanding in perioperative ultrasound. The experts used a binary grading system to score 19 graduating anesthesia residents at 6 stations. Overall average performance was 86.2%, and 3 stations had an acceptable internal reliability (Kuder-Richardson formula 20 coefficient >0.5). After refinement, this OSCE can be combined with standardized examinations and data from simulators and phantom models to assess proficiency in ultrasound.

Training in pathology informatics: implementation at the University of Pittsburgh.

PubMed

Harrison, James H; Stewart, Jimmie

2003-08-01

Pathology informatics is generally recognized as an important component of pathology training, but the scope, form, and goals of informatics training vary substantially between pathology residency programs. The Training and Education Committee of the Association for Pathology Informatics (API TEC) has developed a standard set of knowledge and skills objectives that are recommended for inclusion in pathology informatics training and may serve to standardize and formalize training programs in this area. The University of Pittsburgh (Pittsburgh, Pa) core rotation in pathology informatics includes most of these goals and is offered as an implementation model for pathology informatics training. The core rotation in pathology informatics is a 3-week, full-time rotation including didactic sessions and hands-on laboratories. Topics include general desktop computing and the Internet, but the primary focus of the rotation is vocabulary and concepts related to enterprise and pathology information systems, pathology practice, and research. The total contact time is 63 hours, and a total of 19 faculty and staff contribute. Pretests and posttests are given at the start and end of the rotation. Performance and course evaluation data were collected for 3 years (a total of 21 residents). The rotation implements 84% of the knowledge objectives and 94% of the skills objectives recommended by the API TEC. Residents scored an average of about 20% on the pretest and about 70% on the posttest for an average increase during the course of 50%. Posttest scores did not correlate with pretest scores or self-assessed computer skill level. The size of the pretest/posttest difference correlated negatively with the pretest scores and self-assessed computing skill level. Pretest scores were generally low regardless of whether residents were familiar with desktop computing and productivity applications, indicating that even residents who are computer "savvy" have limited knowledge of pathology informatics topics. Posttest scores showed that all residents' knowledge increased substantially during the course and that residents who were computing novices were not disadvantaged. In fact, novices tended to have higher pretest/posttest differences, indicating that the rotation effectively supported initially less knowledgeable residents in "catching up" to their peers and achieving an appropriate competency level. This rotation provides a formal training model that implements the API TEC recommendations with demonstrated success.

The Relationship between Social Capital and Quality Management Systems in European Hospitals: A Quantitative Study

PubMed Central

Hammer, Antje; Arah, Onyebuchi A.; DerSarkissian, Maral; Thompson, Caroline A.; Mannion, Russell; Wagner, Cordula; Ommen, Oliver; Sunol, Rosa; Pfaff, Holger

2013-01-01

Background Strategic leadership is an important organizational capability and is essential for quality improvement in hospital settings. Furthermore, the quality of leadership depends crucially on a common set of shared values and mutual trust between hospital management board members. According to the concept of social capital, these are essential requirements for successful cooperation and coordination within groups. Objectives We assume that social capital within hospital management boards is an important factor in the development of effective organizational systems for overseeing health care quality. We hypothesized that the degree of social capital within the hospital management board is associated with the effectiveness and maturity of the quality management system in European hospitals. Methods We used a mixed-method approach to data collection and measurement in 188 hospitals in 7 European countries. For this analysis, we used responses from hospital managers. To test our hypothesis, we conducted a multilevel linear regression analysis of the association between social capital and the quality management system score at the hospital level, controlling for hospital ownership, teaching status, number of beds, number of board members, organizational culture, and country clustering. Results The average social capital score within a hospital management board was 3.3 (standard deviation: 0.5; range: 1-4) and the average hospital score for the quality management index was 19.2 (standard deviation: 4.5; range: 0-27). Higher social capital was associated with higher quality management system scores (regression coefficient: 1.41; standard error: 0.64, p=0.029). Conclusion The results suggest that a higher degree of social capital exists in hospitals that exhibit higher maturity in their quality management systems. Although uncontrolled confounding and reverse causation cannot be completely ruled out, our new findings, along with the results of previous research, could have important implications for the work of hospital managers and the design and evaluation of hospital quality management systems. PMID:24392027

Test anxiety and academic performance in chiropractic students.

PubMed

Zhang, Niu; Henderson, Charles N R

2014-01-01

Objective : We assessed the level of students' test anxiety, and the relationship between test anxiety and academic performance. Methods : We recruited 166 third-quarter students. The Test Anxiety Inventory (TAI) was administered to all participants. Total scores from written examinations and objective structured clinical examinations (OSCEs) were used as response variables. Results : Multiple regression analysis shows that there was a modest, but statistically significant negative correlation between TAI scores and written exam scores, but not OSCE scores. Worry and emotionality were the best predictive models for written exam scores. Mean total anxiety and emotionality scores for females were significantly higher than those for males, but not worry scores. Conclusion : Moderate-to-high test anxiety was observed in 85% of the chiropractic students examined. However, total test anxiety, as measured by the TAI score, was a very weak predictive model for written exam performance. Multiple regression analysis demonstrated that replacing total anxiety (TAI) with worry and emotionality (TAI subscales) produces a much more effective predictive model of written exam performance. Sex, age, highest current academic degree, and ethnicity contributed little additional predictive power in either regression model. Moreover, TAI scores were not found to be statistically significant predictors of physical exam skill performance, as measured by OSCEs.

Old boy network?

NASA Astrophysics Data System (ADS)

Friebele, Elaine

Ideally, peer review is an objective process. In reality, scientists who are male or have a connection to the reviewer receive higher peer review scores than their counterparts with equal qualifications. These findings were published in the May 22 issue of Nature, by Swedish researchers Christine Wennerås and Agnes Wold, who obtained access to peer-reviewers'scores for postdoctoral fellowship applications to the Swedish Medical Research Council in 1995. Using six independent, objective criteria of “scientific productivity,”Wennerås and Wold, of the University of Goteborg, Sweden, found that women systematically scored significantly lower in the peer review process than men for the same level of scientific productivity. Applicants who were associated with reviewers also scored consistently better than those who were not. Scores were not significantly affected by the education, nationality, field of research, or postdoctoral experience of the applicant.

Objective breast symmetry analysis with the breast analyzing tool (BAT): improved tool for clinical trials.

PubMed

Krois, Wilfried; Romar, Alexander Ken; Wild, Thomas; Dubsky, Peter; Exner, Ruth; Panhofer, Peter; Jakesz, Raimund; Gnant, Michael; Fitzal, Florian

2017-07-01

Objective cosmetic analysis is important to evaluate the cosmetic outcome after breast surgery or breast radiotherapy. For this purpose, we aimed to improve our recently developed objective scoring software, the Breast Analyzing Tool (BAT ® ). A questionnaire about important factors for breast symmetry was handed out to ten experts (surgeons) and eight non-experts (students). Using these factors, the first-generation BAT ® software formula has been modified and the breast symmetry index (BSI) from 129 women after breast surgery has been calculated by the first author with this new BAT ® formula. The resulting BSI values of these 129 breast cancer patients were then correlated with subjective symmetry scores from the 18 observers using the Harris scale. The BSI of ten images was also calculated from five observers different from the first author to calculate inter-rater reliability. In a second phase, the new BAT ® formula was validated and correlated with subjective scores of additional 50 women after breast surgery. The inter-rater reliability analysis of the objective evaluation by the BAT ® from five individuals showed an ICC of 0.992 with almost no difference between different observers. All subjective scores of 50 patients correlated with the modified BSI score with a high Pearson correlation coefficient of 0.909 (p < .001) which was better compared to the old software (r = 0.769; p < .001). The modified BAT ® software improves the correlation between subjective and objective BSI values, and may be a new standard for trials evaluating breast symmetry.

Job Involvement and Organizational Commitment of Employees of Prehospital Emergency Medical System

PubMed Central

Rahati, Alireza; Sotudeh-Arani, Hossein; Adib-Hajbaghery, Mohsen; Rostami, Majid

2015-01-01

Background: Several studies are available on organizational commitment of employees in different organizations. However, the organizational commitment and job involvement of the employees in the prehospital emergency medical system (PEMS) of Iran have largely been ignored. Objectives: This study aimed to investigate the organizational commitment and job involvement of the employees of PEMS and the relationship between these two issues. Materials and Methods: This cross-sectional study was conducted on 160 employees of Kashan PEMS who were selected through a census method in 2014. A 3-part instrument was used in this study, including a demographic questionnaire, the Allen and Miller’s organizational commitment inventory, and the Lodahl and Kejner’s job involvement inventory. We used descriptive statistics, Spearman correlation coefficient, Kruskal-Wallis, Friedman, analysis of variance, and Tukey post hoc tests to analyze the data. Results: The mean job involvement and organizational commitment scores were 61.78 ± 10.69 and 73.89 ± 13.58, respectively. The mean scores of job involvement and organizational commitment were significantly different in subjects with different work experiences (P = 0.043 and P = 0.012, respectively). However, no significant differences were observed between the mean scores of organizational commitment and job involvement in subjects with different fields of study, different levels of interest in the profession, and various educational levels. A direct significant correlation was found between the total scores of organizational commitment and job involvement of workers in Kashan PEMS (r = 0.910, P < 0.001). Conclusions: This study showed that the employees in the Kashan PEMS obtained half of the score of organizational commitment and about two-thirds of the job involvement score. Therefore, the higher level managers of the emergency medical system are advised to implement some strategies to increase the employees’ job involvement and organizational commitment. PMID:26835470

Portable handheld diffuse reflectance spectroscopy system for clinical evaluation of skin: a pilot study in psoriasis patients

PubMed Central

Tzeng, Shih-Yu; Guo, Jean-Yan; Yang, Chao-Chun; Hsu, Chao-Kai; Huang, Hung Ji; Chou, Shih-Jie; Hwang, Chi-Hung; Tseng, Sheng-Hao

2016-01-01

Diffuse reflectance spectroscopy (DRS) has been utilized to study biological tissues for a variety of applications. However, many DRS systems are not designed for handheld use and/or relatively expensive which limit the extensive clinical use of this technique. In this paper, we report a handheld, low-cost DRS system consisting of a light source, optical switch, and a spectrometer, that can precisely quantify the optical properties of tissue samples in the clinical setting. The handheld DRS system was employed to determine the skin chromophore concentrations, absorption and scattering properties of 11 patients with psoriasis. The measurement results were compared to the clinical severity of psoriasis as evaluated by dermatologist using PASI (Psoriasis Area and Severity Index) scores. Our statistical analyses indicated that the handheld DRS system could be a useful non-invasive tool for objective evaluation of the severity of psoriasis. It is expected that the handheld system can be used for the objective evaluation and monitoring of various skin diseases such as keloid and psoriasis. PMID:26977366

Using Audience Response Technology to provide formative feedback on pharmacology performance for non-medical prescribing students--a preliminary evaluation.

PubMed

Mostyn, Alison; Meade, Oonagh; Lymn, Joanne S

2012-11-13

The use of anonymous audience response technology (ART) to actively engage students in classroom learning has been evaluated positively across multiple settings. To date, however, there has been no empirical evaluation of the use of individualised ART handsets and formative feedback of ART scores. The present study investigates student perceptions of such a system and the relationship between formative feedback results and exam performance. Four successive cohorts of Non-Medical Prescribing students (n=107) had access to the individualised ART system and three of these groups (n=72) completed a questionnaire about their perceptions of using ART. Semi-structured interviews were carried out with a purposive sample of seven students who achieved a range of scores on the formative feedback. Using data from all four cohorts of students, the relationship between mean ART scores and summative pharmacology exam score was examined using a non-parametric correlation. Questionnaire and interview data suggested that the use of ART enhanced the classroom environment, motivated students and promoted learning. Questionnaire data demonstrated that students found the formative feedback helpful for identifying their learning needs (95.6%), guiding their independent study (86.8%), and as a revision tool (88.3%). Interviewees particularly valued the objectivity of the individualised feedback which helped them to self-manage their learning. Interviewees' initial anxiety about revealing their level of pharmacology knowledge to the lecturer and to themselves reduced over time as students focused on the learning benefits associated with the feedback.A significant positive correlation was found between students' formative feedback scores and their summative pharmacology exam scores (Spearman's rho = 0.71, N=107, p<.01). Despite initial anxiety about the use of individualised ART units, students rated the helpfulness of the individualised handsets and personalised formative feedback highly. The significant correlation between ART response scores and student exam scores suggests that formative feedback can provide students with a useful reference point in terms of their level of exam-readiness.

Application of the LEPS technique for Quantitative Precipitation Forecasting (QPF) in Southern Italy: a preliminary study

NASA Astrophysics Data System (ADS)

Federico, S.; Avolio, E.; Bellecci, C.; Colacino, M.; Walko, R. L.

2006-03-01

This paper reports preliminary results for a Limited area model Ensemble Prediction System (LEPS), based on RAMS (Regional Atmospheric Modelling System), for eight case studies of moderate-intense precipitation over Calabria, the southernmost tip of the Italian peninsula. LEPS aims to transfer the benefits of a probabilistic forecast from global to regional scales in countries where local orographic forcing is a key factor to force convection. To accomplish this task and to limit computational time in an operational implementation of LEPS, we perform a cluster analysis of ECMWF-EPS runs. Starting from the 51 members that form the ECMWF-EPS we generate five clusters. For each cluster a representative member is selected and used to provide initial and dynamic boundary conditions to RAMS, whose integrations generate LEPS. RAMS runs have 12-km horizontal resolution. To analyze the impact of enhanced horizontal resolution on quantitative precipitation forecasts, LEPS forecasts are compared to a full Brute Force (BF) ensemble. This ensemble is based on RAMS, has 36 km horizontal resolution and is generated by 51 members, nested in each ECMWF-EPS member. LEPS and BF results are compared subjectively and by objective scores. Subjective analysis is based on precipitation and probability maps of case studies whereas objective analysis is made by deterministic and probabilistic scores. Scores and maps are calculated by comparing ensemble precipitation forecasts against reports from the Calabria regional raingauge network. Results show that LEPS provided better rainfall predictions than BF for all case studies selected. This strongly suggests the importance of the enhanced horizontal resolution, compared to ensemble population, for Calabria for these cases. To further explore the impact of local physiographic features on QPF (Quantitative Precipitation Forecasting), LEPS results are also compared with a 6-km horizontal resolution deterministic forecast. Due to local and mesoscale forcing, the high resolution forecast (Hi-Res) has better performance compared to the ensemble mean for rainfall thresholds larger than 10mm but it tends to overestimate precipitation for lower amounts. This yields larger false alarms that have a detrimental effect on objective scores for lower thresholds. To exploit the advantages of a probabilistic forecast compared to a deterministic one, the relation between the ECMWF-EPS 700 hPa geopotential height spread and LEPS performance is analyzed. Results are promising even if additional studies are required.

Validation of "Signs of Inflammation in Children that Kill" (SICK) score for immediate non-invasive assessment of severity of illness

PubMed Central

2010-01-01

Objective To validate the SICK scoring system's ability to differentiate between individuals with higher and lower probabilities of death Method We performed a one year two-centre prospective evaluation of all children aged between one month and 12 years referred to the Paediatric team at St Stephens Hospital in Delhi and admitted to the Paediatric Department at West Middlesex University Hospital in London. We calculated SICK scores at presentation and correlated them with subsequent in-hospital mortality. We used discrimination by areas under receiver operating characteristic (ROC) curves to measure performance. Results We prospectively evaluated 3895 children in Delhi and 1473 children in London. The areas under the ROC curves were 84.8% in Delhi, 81.0% in London and 84.1% (95% CI 77.4 - 90.8%) for combined data. Hosmer-Lemeshow goodness of fit for the combined data was good (Hosmer-Lemeshow Chi-square = 2.13 (p = 0.345). Conclusions We propose the SICK score as a useful triage tool at initial presentation and highlight its particular suitability for resource poor settings. PMID:20420670

Outcome of Hip Impingement Surgery: Does Generalized Joint Hypermobility Matter?

PubMed

Naal, Florian D; Müller, Aileen; Varghese, Viju D; Wellauer, Vanessa; Impellizzeri, Franco M; Leunig, Michael

2017-05-01

Generalized joint hypermobility (JH) might negatively influence the results of surgical femoroacetabular impingement (FAI) treatment, as JH has been linked to musculoskeletal pain and injury incidence in athletes. JH may also be associated with worse outcomes of FAI surgery in thin females. To (1) determine the results of FAI surgery at a minimum 2-year follow-up by means of patient-reported outcome measures (PROMs) and failure rates, (2) assess the prevalence of JH in FAI patients and its effect on outcomes, and (3) identify other risk factors associated with treatment failure. Cohort study; Level of evidence, 3. We included 232 consecutive patients (118 females; mean age, 36 years) with 244 hips surgically treated for symptomatic FAI between 2010 and 2012. All patients completed different PROMs preoperatively and at a mean follow-up of 3.7 years. Satisfaction questions were used to define subjective failure (answering any of the 2 subjective questions with dissatisfied/ very dissatisfied and/or didn't help/ made things worse). Conversion to total hip replacement (THR) was defined as objective failure. JH was assessed using the Beighton score. All PROM values significantly ( P < .001) improved from preoperative measurement to follow-up (Oxford Hip Score: 33.8 to 42.4; University of California at Los Angeles Activity Scale: 6.3 to 7.3; EuroQol-5 Dimension Index: 0.58 to 0.80). Overall, 34% of patients scored ≥4 on the Beighton score, and 18% scored ≥6, indicating generalized JH. Eleven hips (4.7%) objectively failed and were converted to THR. Twenty-four patients (10.3%) were considered as subjective failures. No predictive risk factors were identified for subjective failure. Tönnis grade significantly ( P < .001) predicted objective failure (odds ratio, 13; 95% CI, 4-45). There was a weak inverse association ( r = -0.16 to -0.30) between Beighton scores and preoperative PROM values. There were no significant associations between Beighton scores and postoperative PROM values or subjective failure rates, but patients who objectively failed had lower Beighton scores than did nonfailures (1.6 vs 2.6; P = .049). FAI surgery yielded favorable outcomes at short- to midterm follow-up. JH as assessed by the Beighton score was not consistently associated with subjective and objective results. Joint degeneration was the most important risk factor for conversion to THR. Although statistical significance was not reached, female patients with no joint degeneration, only mild FAI deformity, and higher Oxford scores at the time of surgery seemed to be at increased risk for subjective dissatisfaction.

[Inter-observes agreement of Ishak and Metavir scores in histological evaluation of chronic viral hepatitis B and C].

PubMed

Rammeh, Soumaya; Khadra, Hajer Ben; Znaidi, Nadia Sabbegh; Romdhane, Neila Attia; Najjar, Taoufik; Bouzaidi, Slim; Zermani, Rachida

2014-01-01

Many classification systems are currently used for histological evaluation of the severity of chronic viral hepatitis, including the Ishak and Metavir scores, but there is not a consensus classification. The objective of this work was to study the intra and inter-observers agreement of these two scores in the histopathological analysis of liver biopsies in patients with chronic viral hepatitis B or C. Fifty nine patients were included in the study, 26 had chronic hepatitis C and 33 had chronic hepatitis B. To investigate the inter-observers agreement, the liver biopsies were analyzed separately by two pathologists without prior consensus reading. The two pathologists conducted then a consensual reading before reviewing all cases independently. Cohen's kappa coefficient was calculated and in case of asymmetry Spearman's rho coefficient. Before the consensus reading, the agreement was moderate for the analysis of histological activity with both scores (Metavir: kappa=0.41, Ishak: rho=0.58). For the analysis of fibrosis, the agreement was good with both scores (Metavir: kappa=0.61, Ishak: rho=0.86). The consensus reading has improved the reproducibility of the activity that has become good with both scores (Metavir: kappa=0.77, Ishak: rho=0.76). For fibrosis improvement was observed with the Ishak score which agreement became excellent (kappa=0.81). In conclusion, we recommend in routine practice, a combined score: Metavir for activity and Ishak for fibrosis and to make a double reading for each biopsy.

A new scoring model for characterization of adnexal masses based on two-dimensional gray-scale and colour Doppler sonographic features

PubMed Central

Abbas, A.M.; Zahran, K.M.; Nasr, A.; Kamel, H.S.

2014-01-01

Objective: To determine the most discriminating two-dimensional gray-scale and colour Doppler sonographic features that allow differentiation between malignant and benign adnexal masses, and to develop a scoring model that would enable more accurate diagnosis with those features. Methods: A cross sectional prospective study was conducted on patients scheduled for surgery due to presence of adnexal masses at Woman’s Health Center, Assiut University, Egypt between October 2012 and October 2013. All patients were evaluated by 2D ultrasound for morphological features of the masses combined with colour Doppler examination of their vessels. The final diagnosis, based on histopathological analysis, was used as a gold standard. Results: One hundred forty-six patients were recruited, 104 with benign masses, 42 with malignant masses. Features that allowed statistically significant discrimination of benignity from malignancy were; volume of mass, type of mass, presence and thickness of septae, presence and length of papillary projections, location of vessels at colour Doppler and colour score. A scoring model was formulated combining these features together; Assiut Scoring Model (ASM). The cut-off level with the highest accuracy in detection of malignancy, was ≥6, had a sensitivity of 93.5% and specificity of 92.2%. Conclusion: Our Scoring Model; a multiparameter scoring using four gray-scale ultrasound and two colour Doppler features, had shown a high sensitivity and specificity for prediction of malignancy in adnexal masses compared with previous scoring systems. PMID:25009729

An Update of "Implications of Changing Answers on Objective Test Items".

ERIC Educational Resources Information Center

Mercer, Maryann

In a 1977 review of the literature on test answer changing, Mueller and Wasser (EJ 163 236) cited 17 studies and concluded that students changing answers on objective tests gain more points than they lost by so doing. Higher scoring students tend to gain more than do the lower scoring students. Six additional studies not reported in the Mueller…

[Japanese learners' processing time for reading English relative clauses analyzed in relation to their English listening proficiency].

PubMed

Oyama, Yoshinori

2011-06-01

The present study examined Japanese university students' processing time for English subject and object relative clauses in relation to their English listening proficiency. In Analysis 1, the relation between English listening proficiency and reading span test scores was analyzed. The results showed that the high and low listening comprehension groups' reading span test scores do not differ. Analysis 2 investigated English listening proficiency and processing time for sentences with subject and object relative clauses. The results showed that reading the relative clause ending and the main verb section of a sentence with an object relative clause (such as "attacked" and "admitted" in the sentence "The reporter that the senator attacked admitted the error") takes less time for learners with high English listening scores than for learners with low English listening scores. In Analysis 3, English listening proficiency and comprehension accuracy for sentences with subject and object relative clauses were examined. The results showed no significant difference in comprehension accuracy between the high and low listening-comprehension groups. These results indicate that processing time for English relative clauses is related to the cognitive processes involved in listening comprehension, which requires immediate processing of syntactically complex audio information.

A formulation of multidimensional growth models for the assessment and forecast of technology attributes

NASA Astrophysics Data System (ADS)

Danner, Travis W.

Developing technology systems requires all manner of investment---engineering talent, prototypes, test facilities, and more. Even for simple design problems the investment can be substantial; for complex technology systems, the development costs can be staggering. The profitability of a corporation in a technology-driven industry is crucially dependent on maximizing the effectiveness of research and development investment. Decision-makers charged with allocation of this investment are forced to choose between the further evolution of existing technologies and the pursuit of revolutionary technologies. At risk on the one hand is excessive investment in an evolutionary technology which has only limited availability for further improvement. On the other hand, the pursuit of a revolutionary technology may mean abandoning momentum and the potential for substantial evolutionary improvement resulting from the years of accumulated knowledge. The informed answer to this question, evolutionary or revolutionary, requires knowledge of the expected rate of improvement and the potential a technology offers for further improvement. This research is dedicated to formulating the assessment and forecasting tools necessary to acquire this knowledge. The same physical laws and principles that enable the development and improvement of specific technologies also limit the ultimate capability of those technologies. Researchers have long used this concept as the foundation for modeling technological advancement through extrapolation by analogy to biological growth models. These models are employed to depict technology development as it asymptotically approaches limits established by the fundamental principles on which the technological approach is based. This has proven an effective and accurate approach to modeling and forecasting simple single-attribute technologies. With increased system complexity and the introduction of multiple system objectives, however, the usefulness of this modeling technique begins to diminish. With the introduction of multiple objectives, researchers often abandon technology growth models for scoring models and technology frontiers. While both approaches possess advantages over current growth models for the assessment of multi-objective technologies, each lacks a necessary dimension for comprehensive technology assessment. By collapsing multiple system metrics into a single, non-intuitive technology measure, scoring models provide a succinct framework for multi-objective technology assessment and forecasting. Yet, with no consideration of physical limits, scoring models provide no insight as to the feasibility of a particular combination of system capabilities. They only indicate that a given combination of system capabilities yields a particular score. Conversely, technology frontiers are constructed with the distinct objective of providing insight into the feasibility of system capability combinations. Yet again, upper limits to overall system performance are ignored. Furthermore, the data required to forecast subsequent technology frontiers is often inhibitive. In an attempt to reincorporate the fundamental nature of technology advancement as bound by physical principles, researchers have sought to normalize multi-objective systems whereby the variability of a single system objective is eliminated as a result of changes in the remaining objectives. This drastically limits the applicability of the resulting technology model because it is only applicable for a single setting of all other system attributes. Attempts to maintain the interaction between the growth curves of each technical objective of a complex system have thus far been limited to qualitative and subjective consideration. This research proposes the formulation of multidimensional growth models as an approach to simulating the advancement of multi-objective technologies towards their upper limits. Multidimensional growth models were formulated by noticing and exploiting the correlation between technology growth models and technology frontiers. Both are frontiers in actuality. The technology growth curve is a frontier between capability levels of a single attribute and time, while a technology frontier is a frontier between the capability levels of two or more attributes. Multidimensional growth models are formulated by exploiting the mathematical significance of this correlation. The result is a model that can capture both the interaction between multiple system attributes and their expected rates of improvement over time. The fundamental nature of technology development is maintained, and interdependent growth curves are generated for each system metric with minimal data requirements. Being founded on the basic nature of technology advancement, relative to physical limits, the availability for further improvement can be determined for a single metric relative to other system measures of merit. A by-product of this modeling approach is a single n-dimensional technology frontier linking all n system attributes with time. This provides an environment capable of forecasting future system capability in the form of advancing technology frontiers. The ability of a multidimensional growth model to capture the expected improvement of a specific technological approach is dependent on accurately identifying the physical limitations to each pertinent attribute. This research investigates two potential approaches to identifying those physical limits, a physics-based approach and a regression-based approach. The regression-based approach has found limited acceptance among forecasters, although it does show potential for estimating upper limits with a specified degree of uncertainty. Forecasters have long favored physics-based approaches for establishing the upper limit to unidimensional growth models. The task of accurately identifying upper limits has become increasingly difficult with the extension of growth models into multiple dimensions. A lone researcher may be able to identify the physical limitation to a single attribute of a simple system; however, as system complexity and the number of attributes increases, the attention of researchers from multiple fields of study is required. Thus, limit identification is itself an area of research and development requiring some level of investment. Whether estimated by physics or regression-based approaches, predicted limits will always have some degree of uncertainty. This research takes the approach of quantifying the impact of that uncertainty on model forecasts rather than heavily endorsing a single technique to limit identification. In addition to formulating the multidimensional growth model, this research provides a systematic procedure for applying that model to specific technology architectures. Researchers and decision-makers are able to investigate the potential for additional improvement within that technology architecture and to estimate the expected cost of each incremental improvement relative to the cost of past improvements. In this manner, multidimensional growth models provide the necessary information to set reasonable program goals for the further evolution of a particular technological approach or to establish the need for revolutionary approaches in light of the constraining limits of conventional approaches.

Finding Specification Pages from the Web

NASA Astrophysics Data System (ADS)

Yoshinaga, Naoki; Torisawa, Kentaro

This paper presents a method of finding a specification page on the Web for a given object (e.g., ``Ch. d'Yquem'') and its class label (e.g., ``wine''). A specification page for an object is a Web page which gives concise attribute-value information about the object (e.g., ``county''-``Sauternes'') in well formatted structures. A simple unsupervised method using layout and symbolic decoration cues was applied to a large number of the Web pages to acquire candidate attributes for each class (e.g., ``county'' for a class ``wine''). We then filter out irrelevant words from the putative attributes through an author-aware scoring function that we called site frequency. We used the acquired attributes to select a representative specification page for a given object from the Web pages retrieved by a normal search engine. Experimental results revealed that our system greatly outperformed the normal search engine in terms of this specification retrieval.

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

Automated Scoring of L2 Spoken English with Random Forests

ERIC Educational Resources Information Center

Kobayashi, Yuichiro; Abe, Mariko

2016-01-01

The purpose of the present study is to assess second language (L2) spoken English using automated scoring techniques. Automated scoring aims to classify a large set of learners' oral performance data into a small number of discrete oral proficiency levels. In automated scoring, objectively measurable features such as the frequencies of lexical and…

SCORE: Service Corps of Retired Executives. Counselor's Guidebook. One Part of ACTION.

ERIC Educational Resources Information Center

Small Business Administration, Washington, DC.

This guidebook, designed for the use of SCORE volunteers, is intended to familiarize new counselors with SCORE operations and to provide reference material to assist counselors in handling cases. Chapters are: (1) SCORE Purposes and Objectives; (II-A-1) Approach to Counseling; (II-A-2) Organization of the Business--legal forms, management or…

Individualizing Risk of Multidrug-Resistant Pathogens in Community-Onset Pneumonia

PubMed Central

Falcone, Marco; Russo, Alessandro; Giannella, Maddalena; Cangemi, Roberto; Scarpellini, Maria Gabriella; Bertazzoni, Giuliano; Alarcón, José Martínez; Taliani, Gloria; Palange, Paolo; Farcomeni, Alessio; Vestri, Annarita; Bouza, Emilio; Violi, Francesco; Venditti, Mario

2015-01-01

Introduction The diffusion of multidrug-resistant (MDR) bacteria has created the need to identify risk factors for acquiring resistant pathogens in patients living in the community. Objective To analyze clinical features of patients with community-onset pneumonia due to MDR pathogens, to evaluate performance of existing scoring tools and to develop a bedside risk score for an early identification of these patients in the Emergency Department. Patients and Methods This was an open, observational, prospective study of consecutive patients with pneumonia, coming from the community, from January 2011 to January 2013. The new score was validated on an external cohort of 929 patients with pneumonia admitted in internal medicine departments participating at a multicenter prospective study in Spain. Results A total of 900 patients were included in the study. The final logistic regression model consisted of four variables: 1) one risk factor for HCAP, 2) bilateral pulmonary infiltration, 3) the presence of pleural effusion, and 4) the severity of respiratory impairment calculated by use of PaO2/FiO2 ratio. A new risk score, the ARUC score, was developed; compared to Aliberti, Shorr, and Shindo scores, this point score system has a good discrimination performance (AUC 0.76, 95% CI 0.71-0.82) and calibration (Hosmer-Lemeshow, χ2 = 7.64; p = 0.469). The new score outperformed HCAP definition in predicting etiology due to MDR organism. The performance of this bedside score was confirmed in the validation cohort (AUC 0.68, 95% CI 0.60-0.77). Conclusion Physicians working in ED should adopt simple risk scores, like ARUC score, to select the most appropriate antibiotic regimens. This individualized approach may help clinicians to identify those patients who need an empirical broad-spectrum antibiotic therapy. PMID:25860142

Critical appraisal of emergency medicine education research: the best publications of 2012.

PubMed

Lin, Michelle; Fisher, Jonathan; Coates, Wendy C; Farrell, Susan E; Shayne, Philip; Maggio, Lauren; Kuhn, Gloria

2014-03-01

The objective was to critically appraise and highlight medical education research published in 2012 that was methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine (EM). A search of the English language literature in 2012 querying Education Resources Information Center (ERIC), PsychInfo, PubMed, and Scopus identified EM studies using hypothesis-testing or observational investigations of educational interventions. Two reviewers independently screened all of the publications and removed articles using established exclusion criteria. This year, publications limited to a single-site survey design that measured satisfaction or self-assessment on unvalidated instruments were not formally reviewed. Six reviewers then independently ranked all remaining publications using one of two scoring systems depending on whether the study methodology was primarily qualitative or quantitative. Each scoring system had nine criteria, including four related to methodology, that were chosen a priori, to standardize evaluation by reviewers. The quantitative study scoring system was used previously to appraise medical education published annually in 2008 through 2011, while a separate, new qualitative study scoring system was derived and implemented consisting of parallel metrics. Forty-eight medical education research papers met the a priori criteria for inclusion, and 33 (30 quantitative and three qualitative studies) were reviewed. Seven quantitative and two qualitative studies met the criteria for inclusion as exemplary and are summarized in this article. This critical appraisal series aims to promote superior education research by reviewing and highlighting nine of the 48 major education research studies with relevance to EM published in 2012. Current trends and common methodologic pitfalls in the 2012 papers are noted. © 2014 by the Society for Academic Emergency Medicine.

Validating Emergency Department Vital Signs Using a Data Quality Engine for Data Warehouse

PubMed Central

Genes, N; Chandra, D; Ellis, S; Baumlin, K

2013-01-01

Background : Vital signs in our emergency department information system were entered into free-text fields for heart rate, respiratory rate, blood pressure, temperature and oxygen saturation. Objective : We sought to convert these text entries into a more useful form, for research and QA purposes, upon entry into a data warehouse. Methods : We derived a series of rules and assigned quality scores to the transformed values, conforming to physiologic parameters for vital signs across the age range and spectrum of illness seen in the emergency department. Results : Validating these entries revealed that 98% of free-text data had perfect quality scores, conforming to established vital sign parameters. Average vital signs varied as expected by age. Degradations in quality scores were most commonly attributed logging temperature in Fahrenheit instead of Celsius; vital signs with this error could still be transformed for use. Errors occurred more frequently during periods of high triage, though error rates did not correlate with triage volume. Conclusions : In developing a method for importing free-text vital sign data from our emergency department information system, we now have a data warehouse with a broad array of quality-checked vital signs, permitting analysis and correlation with demographics and outcomes. PMID:24403981

Postoperative improvement in DASH score, clinical findings, and nerve conduction velocity in patients with cubital tunnel syndrome.

PubMed

Ido, Yoshikazu; Uchiyama, Shigeharu; Nakamura, Koichi; Itsubo, Toshiro; Hayashi, Masanori; Hata, Yukihiko; Imaeda, Toshihiko; Kato, Hiroyuki

2016-06-06

We investigated a recovery pattern in subjective and objective measures among 52 patients with cubital tunnel syndrome after anterior subcutaneous transposition of the ulnar nerve. Disabilities of the Arm, Shoulder and Hand (DASH) score (primary outcome), numbness score, grip and pinch strength, Semmes-Weinstein (SW) score, static 2-point discrimination (2PD) score, and motor conduction velocity (MCV) stage were examined preoperatively and 1, 3, 6, 12, and ≥24 months postoperatively. Statistical analyses were conducted to evaluate how each variable improved after surgery. A linear mixed-effects model was used for continuous variables (DASH score, numbness, grip and pinch strength), and a proportional odds model was used for categorical variables (SW and 2PD tests and MCV stages). DASH score significantly improved by 6 months. Significant recovery in numbness and SW test scores occurred at 1 month. Grip and pinch strength, 2PD test scores, and MCV stage improved by 3 months. DASH scores and numbness recovered regardless of age, sex, or disease severity. It was still unclear if both subjective and objective measures improved beyond 1-year postoperatively. These data are helpful for predicting postoperative recovery patterns and tend to be most important for patients prior to surgery.

Ergonomics and human factors in endoscopic surgery: a comparison of manual vs telerobotic simulation systems.

PubMed

Lee, E C; Rafiq, A; Merrell, R; Ackerman, R; Dennerlein, J T

2005-08-01

Minimally invasive surgical techniques expose surgeons to a variety of occupational hazards that may promote musculoskeletal disorders. Telerobotic systems for minimally invasive surgery may help to reduce these stressors. The objective of this study was to compare manual and telerobotic endoscopic surgery in terms of postural and mental stress. Thirteen participants with no experience as primary surgeons in endoscopic surgery performed a set of simulated surgical tasks using two different techniques--a telerobotic master--slave system and a manual endoscopic surgery system. The tasks consisted of passing a soft spherical object through a series of parallel rings, suturing along a line 5-cm long, running a 32-in ribbon, and cannulation. The Job Strain Index (JSI) and Rapid Upper Limb Assessment (RULA) were used to quantify upper extremity exposure to postural and force risk factors. Task duration was quantified in seconds. A questionnaire provided measures of the participants' intuitiveness and mental stress. The JSI and RULA scores for all four tasks were significantly lower for the telerobotic technique than for the manual one. Task duration was significantly longer for telerobotic than for manual tasks. Participants reported that the telerobotic technique was as intuitive as, and no more stressful than, the manual technique. Given identical tasks, the time to completion is longer using the telerobotic technique than its manual counterpart. For the given simulated tasks in the laboratory setting, the better scores for the upper extremity postural analysis indicate that telerobotic surgery provides a more comfortable environment for the surgeon without any additional mental stress.

Evaluation of novel scoring system named 5-5-5 exacerbation grading scale for allergic conjunctivitis disease.

PubMed

Shoji, Jun; Inada, Noriko; Sawa, Mitsuru

2009-12-01

The objective of this study is to evaluate the practical usefulness of a scoring system using the 5-5-5 exacerbation grading scale for allergic conjunctivitis disease (ACD). Subjects were 103 patients with ACD including 40 patients with vernal keratoconjunctivitis (VKC), 20 patients with atopic keratoconjunctivitis (AKC), and 43 patients with allergic conjunctivitis (AC). The 5-5-5 exacerbation grading scale consists of the following 3 graded groups of clinical observations: the 100-point-grade group (100 points for each observation) includes active giant papillae, gelatinous infiltrates of the limbus, exfoliative epithelial keratopathy, shield ulcer and papillary proliferation at lower palpebral conjunctiva; the 10-point-grade group (10 points for each observation) includes blepharitis, papillary proliferation with velvety appearance, Horner-Trantas spots, edema of bulbal conjunctiva, and superficial punctate keratopathy; and the 1-point-grade group (1 point for each observation) includes papillae at upper palpebral conjunctiva, follicular lesion at lower palpebral conjunctiva, hyperemia of palpebral conjunctiva, hyperemia of bulbal conjunctiva, and lacrimal effusion. The total points in each grade group were determined as the severity score of the 5-5-5 exacerbation grading scale. The median severity scores of the 5-5-5 exacerbation grading scale in VKC, AKC and AC were 243 (range: 12-444), 32.5 (11-344), and 13 (2-33), respectively. The severity score of each ACD disease type was significantly different (P < 0.001, Kruskal-Wallis test). The severity of each type of ACD was classified as severe, moderate, or mild according to the severity score. The 5-5-5 exacerbation grading scale is a useful clinical tool for grading the severity of each type of ACD.

Accuracy of Automatic Polysomnography Scoring Using Frontal Electrodes

PubMed Central

Younes, Magdy; Younes, Mark; Giannouli, Eleni

2016-01-01

Study Objectives: The economic cost of performing sleep monitoring at home is a major deterrent to adding sleep data during home studies for investigation of sleep apnea and to investigating non-respiratory sleep complaints. Michele Sleep Scoring System (MSS) is a validated automatic system that utilizes central electroencephalography (EEG) derivations and requires minimal editing. We wished to determine if MSS' accuracy is maintained if frontal derivations are used instead. If confirmed, home sleep monitoring would not require home setup or lengthy manual scoring by technologists. Methods: One hundred two polysomnograms (PSGs) previously recorded from patients with assorted sleep disorders were scored using MSS once with central and once with frontal derivations. Total sleep time, sleep/stage R sleep onset latencies, awake time, time in different sleep stages, arousal/awakening index and apnea-hypopnea index were compared. In addition, odds ratio product (ORP), a continuous index of sleep depth/quality (Sleep 2015;38:641–54), was generated for every 30-sec epoch in each PSG and epoch-by-epoch comparison of ORP was performed. Results: Intraclass correlation coefficients (ICCs) ranged from 0.89 to 1.0 for the various sleep variables (0.96 ± 0.03). For epoch-by-epoch comparisons of ORP, ICC was > 0.85 in 96 PSGs. Lower values in the other six PSGs were related to signal artifacts in either derivation. ICC for whole-record average ORP was 0.98. Conclusions: MSS is as accurate with frontal as with central EEG derivations. The use of frontal electrodes along with MSS should make it possible to obtain high-quality sleep data without requiring home setup or lengthy scoring time by expert technologists. Citation: Younes M, Younes M, Giannouli E. Accuracy of automatic polysomnography scoring using frontal electrodes. J Clin Sleep Med 2016;12(5):735–746. PMID:26951417

Relationship between clock and star drawing and the degree of hepatic encephalopathy.

PubMed

Edwin, Natasha; Peter, John Victor; John, George; Eapen, C E; Graham, Petra L

2011-09-01

PURPOSE OF THE STUDY Current hepatic encephalopathy grading tools are limited because of complexity or subjectivity. The degree of constructional apraxia could serve as a simple, objective and reproducible tool to grade encephalopathy. STUDY DESIGN In this cross-sectional study of patients with chronic liver disease, the degree of constructional apraxia was judged by their ability to copy a star and clock face and compared with conventional encephalopathy grading by the West Haven Criteria (WHC) and the Porto Systemic Encephalopathy Index (PSEI). Three blinded observers independently graded the figures. Sensitivity, specificity and positive predictive value (PPV) of clock and star scores (score 0 implying no encephalopathy and >0 hepatic encephalopathy) were assessed against conventional scoring systems (WHC grade >0 or PSEI ≥0.33 indicating encephalopathy). Mosaic and box plots were generated to assess if the degree of constructional apraxia correlated with the severity of encephalopathy. RESULTS 71 patients were studied between October 2008 and July 2009; 11 (15.4%) had WHC grade 0, 32 (45%) grade 1, and 28 (39.4%) grades 2 and 3 encephalopathy. The sensitivity, specificity and PPV of the clock drawing for the diagnosis of encephalopathy was 85%, 80%, and 96%, respectively, and 77%, 70%, and 94%, respectively, for the star drawing. Box plots and intervals on mean PSEI showed an increasing relationship between clock/star scores and PSEI. There was substantial agreement between WHC and clock (weighted κ 0.61) and star scores (weighted κ 0.71). Inter-observer reliability was at least 0.70 for star and at least 0.79 for the clock score. CONCLUSION Clock and star drawing may serve as reproducible, inexpensive bedside tools for diagnosing and grading the severity of hepatic encephalopathy.

Automated Measurement of Visual Acuity in Pediatric Ophthalmic Patients Using Principles of Game Design and Tablet Computers.

PubMed

Aslam, Tariq M; Tahir, Humza J; Parry, Neil R A; Murray, Ian J; Kwak, Kun; Heyes, Richard; Salleh, Mahani M; Czanner, Gabriela; Ashworth, Jane

2016-10-01

To report on the utility of a computer tablet-based method for automated testing of visual acuity in children based on the principles of game design. We describe the testing procedure and present repeatability as well as agreement of the score with accepted visual acuity measures. Reliability and validity study. Setting: Manchester Royal Eye Hospital Pediatric Ophthalmology Outpatients Department. Total of 112 sequentially recruited patients. For each patient 1 eye was tested with the Mobile Assessment of Vision by intERactIve Computer for Children (MAVERIC-C) system, consisting of a software application running on a computer tablet, housed in a bespoke viewing chamber. The application elicited touch screen responses using a game design to encourage compliance and automatically acquire visual acuity scores of participating patients. Acuity was then assessed by an examiner with a standard chart-based near ETDRS acuity test before the MAVERIC-C assessment was repeated. Reliability of MAVERIC-C near visual acuity score and agreement of MAVERIC-C score with near ETDRS chart for visual acuity. Altogether, 106 children (95%) completed the MAVERIC-C system without assistance. The vision scores demonstrated satisfactory reliability, with test-retest VA scores having a mean difference of 0.001 (SD ±0.136) and limits of agreement of 2 SD (LOA) of ±0.267. Comparison with the near EDTRS chart showed agreement with a mean difference of -0.0879 (±0.106) with LOA of ±0.208. This study demonstrates promising utility for software using a game design to enable automated testing of acuity in children with ophthalmic disease in an objective and accurate manner. Copyright © 2016 Elsevier Inc. All rights reserved.

A comparison of KABCO and AIS injury severity metrics using CODES linked data.

PubMed

Burch, Cynthia; Cook, Lawrence; Dischinger, Patricia

2014-01-01

The research objective is to compare the consistency of distributions between crash assigned (KABCO) and hospital assigned (Abbreviated Injury Scale, AIS) injury severity scoring systems for 2 states. The hypothesis is that AIS scores will be more consistent between the 2 studied states (Maryland and Utah) than KABCO. The analysis involved Crash Outcome Data Evaluation System (CODES) data from 2 states, Maryland and Utah, for years 2006-2008. Crash report and hospital inpatient data were linked probabilistically and International Classification of Diseases (CMS 2013) codes from hospital records were translated into AIS codes. KABCO scores from police crash reports were compared to those AIS scores within and between the 2 study states. Maryland appears to have the more severe crash report KABCO scoring for injured crash participants, with close to 50 percent of all injured persons being coded as a level B or worse, and Utah observes approximately 40 percent in this group. When analyzing AIS scores, some fluctuation was seen within states over time, but the distribution of MAIS is much more comparable between states. Maryland had approximately 85 percent of hospitalized injured cases coded as MAIS = 1 or minor. In Utah this percentage was close to 80 percent for all 3 years. This is quite different from the KABCO distributions, where Maryland had a smaller percentage of cases in the lowest injury severity category as compared to Utah. This analysis examines the distribution of 2 injury severity metrics different in both design and collection and found that both classifications are consistent within each state from 2006 to 2008. However, the distribution of both KABCO and Maximum Abbreviated Injury Scale (MAIS) varies between the states. MAIS was found to be more consistent between states than KABCO.

An alternative to the balance error scoring system: using a low-cost balance board to improve the validity/reliability of sports-related concussion balance testing.

PubMed

Chang, Jasper O; Levy, Susan S; Seay, Seth W; Goble, Daniel J

2014-05-01

Recent guidelines advocate sports medicine professionals to use balance tests to assess sensorimotor status in the management of concussions. The present study sought to determine whether a low-cost balance board could provide a valid, reliable, and objective means of performing this balance testing. Criterion validity testing relative to a gold standard and 7 day test-retest reliability. University biomechanics laboratory. Thirty healthy young adults. Balance ability was assessed on 2 days separated by 1 week using (1) a gold standard measure (ie, scientific grade force plate), (2) a low-cost Nintendo Wii Balance Board (WBB), and (3) the Balance Error Scoring System (BESS). Validity of the WBB center of pressure path length and BESS scores were determined relative to the force plate data. Test-retest reliability was established based on intraclass correlation coefficients. Composite scores for the WBB had excellent validity (r = 0.99) and test-retest reliability (R = 0.88). Both the validity (r = 0.10-0.52) and test-retest reliability (r = 0.61-0.78) were lower for the BESS. These findings demonstrate that a low-cost balance board can provide improved balance testing accuracy/reliability compared with the BESS. This approach provides a potentially more valid/reliable, yet affordable, means of assessing sports-related concussion compared with current methods.

Relationship between job satisfaction and performance of primary care physicians after the family physician reform of east Azerbaijan province in Northwest Iran.

PubMed

Jabbari, Hossein; Pezeshki, Mohamad Zakarria; Naghavi-Behzad, Mohammad; Asghari, Mohammad; Bakhshian, Fariba

2014-01-01

Following the implementation of family physician program in 2004 in Iranian healthcare system, the understanding in changes in physicians' practice has become important. The objective of this study was to determine the level of family physicians' job satisfaction and its relationship with their performance level. A cross-sectional study was conducted among all 367 family physicians of East Azerbaijan province in during December 2009 to May 2011 using a self-administered, anonymous questionnaire for job satisfaction. The performance scores of primary care physicians were obtained from health deputy of Tabriz Medical University. In this study, overall response rate was 64.5%. The average score of job satisfaction was 42.10 (±18.46), and performance score was 87.52 (±5.74) out of 100. There was significant relationships between working history and job satisfaction (P = 0.014), marital status (P = 0.014), and sex (P = 0.018) with performance among different personal and organizational variables. However, there was no significant relationship between job satisfaction and performance, but satisfied people had about three times better performance than their counterparts (all P < 0.05). The low scores of family physicians in performance and job satisfaction are obvious indications for more extensive research in identifying causes and finding mechanisms to improve the situation, especially in payment methods and work condition, in existing health system.

Relaxation Response–Based Yoga Improves Functioning in Young Children with Autism: A Pilot Study

PubMed Central

Rosenblatt, Lucy E.; Gorantla, Sasikanth; Torres, Jodi A.; Yarmush, Rubin S.; Rao, Surita; Park, Elyse R.; Denninger, John W.; Benson, Herbert; Fricchione, Gregory L.; Bernstein, Bruce

2011-01-01

Abstract Objectives The study objectives were to develop and objectively assess the therapeutic effect of a novel movement-based complementary and alternative medicine approach for children with an autism-spectrum disorder (ASD). Design A within-subject analysis comparing pre- to post-treatment scores on two standard measures of childhood behavioral problems was used. Settings and location The intervention and data analysis occurred at a tertiary care, medical school teaching hospital. Subjects Twenty-four (24) children aged 3–16 years with a diagnosis of an ASD comprised the study group. Intervention The efficacy of an 8-week multimodal yoga, dance, and music therapy program based on the relaxation response (RR) was developed and examined. Outcome measures The study outcome was measured using The Behavioral Assessment System for Children, Second Edition (BASC-2) and the Aberrant Behavioral Checklist (ABC). Results Robust changes were found on the BASC-2, primarily for 5–12-year-old children. Unexpectedly, the post-treatment scores on the Atypicality scale of the BASC-2, which measures some of the core features of autism, changed significantly (p=0.003). Conclusions A movement-based, modified RR program, involving yoga and dance, showed efficacy in treating behavioral and some core features of autism, particularly for latency-age children. PMID:21992466

The OARSI Histopathology Initiative - Recommendations for Histological Assessments of Osteoarthritis in the Guinea Pig

PubMed Central

Kraus, Virginia B; Huebner, Janet L.; DeGroot, Jeroen; Bendele, Alison

2010-01-01

Objective This review focuses on the criteria for assessing osteoarthritis (OA) in the guinea pig at the macroscopic and microscopic levels, and recommends particular assessment criteria to assist standardization in the conduct and reporting of preclinical trails in guinea pig models of OA. Methods A review was conducted of all OA studies from 1958 until the present that utilized the guinea pig. The PubMed database was originally searched August 1, 2006 using the following search terms: guinea pig and osteoarthritis. We continued to check the database periodically throughout the process of preparing this chapter and the final search was conducted January 7, 2009. Additional studies were found in a review of abstracts from the OsteoArthritis Research Society International (OARSI) conferences, Orthopaedic Research Society (ORS) conferences, and literature related to histology in other preclinical models of OA reviewed for relevant references. Studies that described or used systems for guinea pig joint scoring on a macroscopic, microscopic, or ultrastructural basis were included in the final comprehensive summary and review. General recommendations regarding methods of OA assessment in the guinea pig were derived on the basis of a comparison across studies and an inter-rater reliability assessment of the recommended scoring system. Results A histochemical-histological scoring system (based on one first introduced by H. Mankin) is recommended for semi-quantitative histological assessment of OA in the guinea pig, due to its already widespread adoption, ease of use, similarity to scoring systems used for OA in humans, its achievable high inter-rater reliability, and its demonstrated correlation with synovial fluid biomarker concentrations. Specific recommendations are also provided for histological scoring of synovitis and scoring of macroscopic lesions of OA. Conclusions As summarized herein, a wealth of tools exist to aid both in the semi-quantitative and quantitative assessment of OA in the guinea pig and provide a means of comprehensively characterizing the whole joint organ. In an ongoing effort at standardization, we recommend specific criteria for assessing the guinea pig model of OA as part of an OARSI initiative, termed herein the OARSI-HISTOgp recommendations. PMID:20864022

Tenascin-C Prevents Articular Cartilage Degeneration in Murine Osteoarthritis Models.

PubMed

Matsui, Yuriyo; Hasegawa, Masahiro; Iino, Takahiro; Imanaka-Yoshida, Kyoko; Yoshida, Toshimichi; Sudo, Akihiro

2018-01-01

Objective The objective of this study was to determine whether intra-articular injections of tenascin-C (TNC) could prevent cartilage damage in murine models of osteoarthritis (OA). Design Fluorescently labeled TNC was injected into knee joints and its distribution was examined at 1 day, 4 days, 1 week, 2 weeks, and 4 weeks postinjection. To investigate the effects of TNC on cartilage degeneration after surgery to knee joints, articular spaces were filled with 100 μg/mL (group I), 10 μg/mL (group II) of TNC solution, or control (group III). TNC solution of 10 μg/mL was additionally injected twice after 3 weeks (group IV) or weekly after 1 week, 2 weeks, and 3 weeks (group V). Joint tissues were histologically assessed using the Mankin score and the modified Chambers system at 2 to 8 weeks after surgery. Results Exogenous TNC was maintained in the cartilage and synovium for 1 week after administration. Histological scores in groups I and II were better than scores in group III at 4 and 6 weeks, but progressive cartilage damage was seen in all groups 8 weeks postoperatively. Sequential TNC injections (groups IV and V) showed significantly better Mankin score than single injection (group II) at 8 weeks. Conclusion TNC administered exogenously remained in the cartilage of knee joints for 1 week, and could decelerate articular cartilage degeneration in murine models of OA. We also showed that sequential administration of TNC was more effective than a single injection. TNC could be an important molecule for prevention of articular cartilage damage.

Objective assessment of facial skin aging and the associated environmental factors in Japanese monozygotic twins

PubMed Central

Ichibori, Ryoko; Fujiwara, Takashi; Tanigawa, Tomoko; Kanazawa, Shigeyuki; Shingaki, Kenta; Torii, Kosuke; Tomita, Koichi; Yano, Kenji; Sakai, Yasuo; Hosokawa, Ko

2014-01-01

Twin studies, especially those involving monozygotic (MZ) twins, facilitate the analysis of factors affecting skin aging while controlling for age, gender, and genetic susceptibility. The purpose of this study was to objectively assess various features of facial skin and analyze the effects of environmental factors on these features in MZ twins. At the Osaka Twin Research Center, 67 pairs of MZ twins underwent medical interviews and photographic assessments, using the VISIA® Complexion Analysis System. First, the average scores of the right and left cheek skin spots, wrinkles, pores, texture, and erythema were calculated; the differences between the scores were then compared in each pair of twins. Next, using the results of medical interviews and VISIA data, we investigated the effects of environmental factors on skin aging. The data were analyzed using Pearson's correlation coefficient test and the Wilcoxon signed-rank test. The intrapair differences in facial texture scores significantly increased as the age of the twins increased (P = 0.03). Among the twin pairs who provided answers to the questions regarding history differences in medical interviews, the twins who smoked or did not use skin protection showed significantly higher facial texture or wrinkle scores compared with the twins not exposed to cigarettes or protectants (P = 0.04 and 0.03, respectively). The study demonstrated that skin aging among Japanese MZ twins, especially in terms of facial texture, was significantly influenced by environmental factors. In addition, smoking and skin protectant use were important environmental factors influencing skin aging. PMID:24910280

Performance of the Hack's Impairment Index Score: A Novel Tool to Assess Impairment from Alcohol in Emergency Department Patients.

PubMed

Hack, Jason B; Goldlust, Eric J; Ferrante, Dennis; Zink, Brian J

2017-10-01

Over 35 million alcohol-impaired (AI) patients are cared for in emergency departments (EDs) annually. Emergency physicians are charged with ensuring AI patients' safety by identifying resolution of alcohol-induced impairment. The most common standard evaluation is an extemporized clinical examination, as ethanol levels are not reliable or predictive of clinical symptoms. There is no standard assessment of ED AI patients. The objective was to evaluate a novel standardized ED assessment of alcohol impairment, Hack's Impairment Index (HII score), in a busy urban ED. A retrospective chart review was performed for all AI patients seen in our busy urban ED over 24 months. Trained nurses evaluated AI patients with both "usual" and HII score every 2 hours. Patients were stratified by frequency of visits for AI during this time: high (≥ 6), medium (2-5), and low (1). Within each category, comparisons were made between HII scores, measured ethanol levels, and usual nursing assessment of AI. Changes in HII scores over time were also evaluated. A total of 8,074 visits from 3,219 unique patients were eligible for study, including 7,973 (98.7%) with ethanol levels, 5,061 (62.7%) with complete HII scores, and 3,646 (45.2%) with health care provider assessments. Correlations between HII scores and ethanol levels were poor (Pearson's R 2  = 0.09, 0.09, and 0.17 for high-, medium-, and low-frequency strata). HII scores were excellent at discriminating nursing assessment of AI, while ethanol levels were less effective. Omitting extrema, HII scores fell consistently an average 0.062 points per hour, throughout patients' visits. The HII score applied a quantitative, objective assessment of alcohol impairment. HII scores were superior to ethanol levels as an objective clinical measure of impairment. The HII declines in a reasonably predictable manner over time, with serial evaluations corresponding well with health care provider evaluations. © 2017 by the Society for Academic Emergency Medicine.

Investigating daily fatigue scores during two-week offshore day shifts.

PubMed

Riethmeister, Vanessa; Bültmann, Ute; Gordijn, Marijke; Brouwer, Sandra; de Boer, Michiel

2018-09-01

This study examined daily scores of fatigue and circadian rhythm markers over two-week offshore day shift periods. A prospective cohort study among N = 60 offshore day-shift workers working two-week offshore shifts was conducted. Offshore day shifts lasted from 07:00 - 19:00 h. Fatigue was measured objectively with pre- and post-shift scores of the 3-minute psychomotor vigilance tasks (PVT-B) parameters (reaction times, number of lapses, errors and false starts) and subjectively with pre- and post-shift Karolinska Sleepiness Scale (KSS) ratings. Evening saliva samples were collected on offshore days 2,7 and 13 to measure circadian rhythm markers such as dim-light melatonin onset times and cortisol. Generalized and linear mixed model analyses were used to examine daily fatigue scores over time. Complete data from N = 42 offshore day shift workers was analyzed. Daily parameters of objective fatigue, PVT-B scores (reaction times, average number of lapses, errors and false starts), remained stable over the course of the two-week offshore day shifts. Daily subjective post-shift fatigue scores significantly increased over the course of the two-week offshore shifts. Each day offshore was associated with an increased post-shift subjective fatigue score of 0.06 points (95%CI: .03 - .09 p < .001). No significant statistical differences in subjective pre-shift fatigue scores were found. Neither a circadian rhythm phase shift of melatonin nor an effect on the pattern and levels of evening cortisol was found. Daily parameters of objective fatigue scores remained stable over the course of the two-week offshore day shifts. Daily subjective post-shift fatigue scores significantly increased over the course of the two-week offshore shifts. No significant changes in circadian rhythm markers were found. Increased post-shift fatigue scores, especially during the last days of an offshore shift, should be considered and managed in (offshore) fatigue risk management programs and fatigue risk prediction models. Copyright © 2018 Elsevier Ltd. All rights reserved.

Impact on house staff evaluation scores when changing from a Dreyfus- to a Milestone-based evaluation model: one internal medicine residency program's findings.

PubMed

Friedman, Karen A; Balwan, Sandy; Cacace, Frank; Katona, Kyle; Sunday, Suzanne; Chaudhry, Saima

2014-01-01

Purpose As graduate medical education (GME) moves into the Next Accreditation System (NAS), programs must take a critical look at their current models of evaluation and assess how well they align with reporting outcomes. Our objective was to assess the impact on house staff evaluation scores when transitioning from a Dreyfus-based model of evaluation to a Milestone-based model of evaluation. Milestones are a key component of the NAS. Method We analyzed all end of rotation evaluations of house staff completed by faculty for academic years 2010-2011 (pre-Dreyfus model) and 2011-2012 (post-Milestone model) in one large university-based internal medicine residency training program. Main measures included change in PGY-level average score; slope, range, and separation of average scores across all six Accreditation Council for Graduate Medical Education (ACGME) competencies. Results Transitioning from a Dreyfus-based model to a Milestone-based model resulted in a larger separation in the scores between our three post-graduate year classes, a steeper progression of scores in the PGY-1 class, a wider use of the 5-point scale on our global end of rotation evaluation form, and a downward shift in the PGY-1 scores and an upward shift in the PGY-3 scores. Conclusions For faculty trained in both models of assessment, the Milestone-based model had greater discriminatory ability as evidenced by the larger separation in the scores for all the classes, in particular the PGY-1 class.

Does Residency Selection Criteria Predict Performance in Orthopaedic Surgery Residency?

PubMed

Raman, Tina; Alrabaa, Rami George; Sood, Amit; Maloof, Paul; Benevenia, Joseph; Berberian, Wayne

2016-04-01

More than 1000 candidates applied for orthopaedic residency positions in 2014, and the competition is intense; approximately one-third of the candidates failed to secure a position in the match. However, the criteria used in the selection process often are subjective and studies have differed in terms of which criteria predict either objective measures or subjective ratings of resident performance by faculty. Do preresidency selection factors serve as predictors of success in residency? Specifically, we asked which preresidency selection factors are associated or correlated with (1) objective measures of resident knowledge and performance; and (2) subjective ratings by faculty. Charts of 60 orthopaedic residents from our institution were reviewed. Preresidency selection criteria examined included United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores, Medical College Admission Test (MCAT) scores, number of clinical clerkship honors, number of letters of recommendation, number of away rotations, Alpha Omega Alpha (AOA) honor medical society membership, fourth-year subinternship at our institution, and number of publications. Resident performance was assessed using objective measures including American Board of Orthopaedic Surgery (ABOS) Part I scores and Orthopaedics In-Training Exam (OITE) scores and subjective ratings by faculty including global evaluation scores and faculty rankings of residents. We tested associations between preresidency criteria and the subsequent objective and subjective metrics using linear correlation analysis and Mann-Whitney tests when appropriate. Objective measures of resident performance namely, ABOS Part I scores, had a moderate linear correlation with the USMLE Step 2 scores (r = 0.55, p < 0.001) and number of clinical honors received in medical school (r = 0.45, p < 0.001). OITE scores had a weak linear correlation with the number of clinical honors (r = 0.35, p = 0.009) and USMLE Step 2 scores (r = 0.29, p = 0.02). With regards to subjective outcomes, AOA membership was associated with higher scores on the global evaluation (p = 0.005). AOA membership also correlated with higher global evaluation scores (r = 0.60, p = 0.005) with the strongest correlation existing between AOA membership and the "interpersonal and communication skills" subsection of the global evaluations. We found that USMLE Step 2, number of honors in medical school clerkships, and AOA membership demonstrated the strongest correlations with resident performance. Our goal in analyzing these data was to provide residency programs at large a sense of which criteria may be "high yield" in ranking applicants by analyzing data from within our own pool of residents. Similar studies across a broader scope of programs are warranted to confirm applicability of our findings. The continually emerging complexities of the field of orthopaedic surgery lend increasing importance to future work on the appropriate selection and training of orthopaedic residents.

Over-the-top ACL Reconstruction Plus Extra-articular Lateral Tenodesis With Hamstring Tendon Grafts: Prospective Evaluation With 20-Year Minimum Follow-up.

PubMed

Zaffagnini, Stefano; Marcheggiani Muccioli, Giulio Maria; Grassi, Alberto; Roberti di Sarsina, Tommaso; Raggi, Federico; Signorelli, Cecilia; Urrizola, Francisco; Spinnato, Paolo; Rimondi, Eugenio; Marcacci, Maurilio

2017-12-01

There are few published studies with very long-term follow-up of combined intra- and extra-articular anterior cruciate ligament (ACL) reconstruction. To analyze clinical and radiographic outcomes of over-the-top ACL reconstruction plus extra-articular lateral tenodesis with autologous hamstrings at minimum 20-year follow-up. Case series; Level of evidence, 4. Of 60 originally eligible patients who underwent over-the-top ACL reconstruction with double-stranded hamstring tendon (leaving intact graft tibial insertions) and extra-articular lateral plasty (performed with the remnant part of tendons), 52 were prospectively evaluated at a minimum 20-year follow-up (mean follow-up, 24 years; 41 men, 11 women; mean age at time of surgery, 25.5 ± 7.6 years). Twenty-nine patients were available for prospective evaluations: clinical (Lysholm, Tegner, and objective International Knee Documentation Committee [IKDC]), instrumented (KT-2000), and radiographic (standard, long-standing, and Merchant views). Subjective KOOS (Knee injury and Osteoarthritis Outcome Score) and objective inertial sensor pivot-shift analysis (KiRA) were carried out at final follow-up. Twenty-three patients were investigated by phone interview for subjective Tegner score and documented complications, rerupture, or revision surgery. At final follow-up, mean Lysholm score was 85.7 ± 14.6; median Tegner score, 4 (range, 3-5); sport activity resumption, 86.2%; and objective IKDC score, good or excellent in 86% of patients (31%, A; 55%, B). Only 3 of 26 patients (12%) had >5-mm manual maximum KT-2000 side-to-side difference. KiRA system documented positive pivot-shift (>0.9-m/s 2 tibial acceleration side-to-side difference) in these 3 of 26 patients (12%). Statistically significant changes were as follows: decrease in Tegner score from 7 (range, 6-8) at 5-year follow-up to 4 (range, 3-5) at 10 years ( P < .0001) and decrease in Lysholm score from 96.1 ± 7.3 at 10-year follow-up to 85.7 ± 14.6 at 20 years ( P = .0003). Radiographic evaluation demonstrated significant difference of medial joint space between injured and healthy knees in patients with concomitant medial meniscectomy (n = 8, 3.2 ± 0.6 vs 5.0 ± 1.8 mm, P = .0114). No significant differences were reported regarding lateral or patellofemoral joint space. One patient (2%) experienced rerupture, with 3 of 52 (5.8%) having a contralateral ACL injury (excluded from KT-2000 and radiographic evaluations). Overall, 4 of 29 clinical failures (objective IKDC, KT-2000) and 1 rerupture among 52 patients were registered at final follow-up. Studied surgical technique demonstrated good results in laxity control at 20-year minimum follow-up. The lateral extra-articular plasty associated with ACL reconstruction did not generate lateral knee or patellofemoral osteoarthritis. The factor increasing osteoarthritis was meniscectomy.

Correlation of psychomotor skills and didactic performance among dental students in Saudi Arabia

PubMed Central

Afify, Ahmed R; Zawawi, Khalid H; Othman, Hisham I; Al-Dharrab, Ayman A

2013-01-01

Objectives The objective of this study is to investigate the correlation between the psychomotor skills and the academic performance of dental students. Methods Didactic and preclinical scores were collected for students who graduated from the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia, in 2011. Three courses (Dental Anatomy, Removable Prosthodontic Denture, and Orthodontics) were selected. Correlations comparing didactic and practical scores were done for the total samples, then for the males and females separately. Results There was no significant correlation between the practical and didactic scores for the three courses for the total sample. There was a significant correlation between all three subjects in the didactic scores. For females, the results showed that there was only a significant correlation between the practical and didactic scores for Dental Anatomy. For males, no correlation was observed between the practical and didactic scores for all subjects. Conclusion In the present sample, didactic performance did not correlate well with the students’ psychomotor performance. PMID:24159266

Effect of nanotechnology in self-etch bonding systems on the shear bond strength of stainless steel orthodontic brackets

PubMed Central

Hammad, Shaza M.; El-Wassefy, Noha; Maher, Ahmed; Fawakerji, Shafik M.

2017-01-01

ABSTRACT Objective: To evaluate the effect of silica dioxide (SiO2) nanofillers in different bonding systems on shear bond strength (SBS) and mode of failure of orthodontic brackets at two experimental times. Methods: Ninety-six intact premolars were divided into four groups: A) Conventional acid-etch and primer Transbond XT; B) Transbond Plus self-etch primer; and two self-etch bonding systems reinforced with silica dioxide nanofiller at different concentrations: C) Futurabond DC at 1%; D) Optibond All-in-One at 7%. Each group was allocated into two subgroups (n = 12) according to experimental time (12 and 24 hours). SBS test was performed using a universal testing machine. ARI scores were determined under a stereomicroscope. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were used to determine the size and distribution of nanofillers. One-way ANOVA was used to compare SBS followed by the post-hoc Tukey test. The chi-square test was used to evaluate ARI scores. Results: Mean SBS of Futurabond DC and Optibond All-in-One were significantly lower than conventional system, and there were no significant differences between means SBS obtained with all self-etch bonding systems used in the study. Lower ARI scores were found for Futurabond DC and Optibond All-in-One. There was no significant difference of SBS and ARI obtained at either time points for all bonding systems. Relative homogeneous distribution of the fillers was observed with the bonding systems. Conclusion: Two nanofilled systems revealed the lowest bond strengths, but still clinically acceptable and less adhesive was left on enamel. It is advisable not to load the brackets immediately to the maximum. PMID:28444018

Objective structured practical examination in biochemistry: An experience in Medical College, Kolkata.

PubMed

Kundu, Dipankar; Das, H N; Sen, Gargi; Osta, Manish; Mandal, T; Gautam, Divyendu

2013-01-01

Undergraduate medical examination is undergoing extensive re evaluation with new core educational objectives being defined. Consequently, new exam systems have also been designed to test the objectives. Objective structured practical examination (OSPE) is one of them. To introduce OSPE as a method of assessment of practical skills and learning and to determine student satisfaction regarding the OSPE. Furthermore, to explore the faculty perception of OSPE as a learning and assessment tool. The first M.B.B.S students of 2011 12 batch of Medical College, Kolkata, were the subjects for the study. OSPE was organized and conducted on "Identification of Unknown Abnormal Constituents in Urine." Coefficient of reliability of questions administered was done by calculating Cronbach's alpha. A questionnaire on various components of the OSPE was administered to get the feedback. 16 students failed to achieve an average of 50% or above in the assessment. However, 49 students on an average achieved >75%, 52 students achieved between 65% and 75%, and 29 students scored between 50% and 65%. Cronbach's alpha of the questions administered showed to be having high internal consistency with a score of 0.80. Ninety nine percent of students believed that OSPE helps them to improve and 81% felt that this type of assessment fits in as both learning and evaluation tools. Faculty feedback reflected that such assessment tested objectivity, measured practical skills better, and eliminated examiner bias to a greater extent. OSPE tests different desired components of competence better and eliminated examiner bias. Student feedback reflects that such assessment helps them to improve as it is effective both as teaching and evaluation tools.

Correlation between the Modified Systemic Lupus Erythematosus Disease Activity Index 2000 and the European Consensus Lupus Activity Measurement in juvenile systemic lupus erythematosus.

PubMed

Sato, J O; Corrente, J E; Saad-Magalhães, C

2016-11-01

Objective The objective of this study was to assess Modified Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and European Consensus Lupus Activity Measurement (ECLAM) disease activity correlation in addition to their respective correlation to Pediatric Systemic Lupus International Collaborative Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (Ped-SDI), in juvenile systemic lupus erythematosus (JSLE). Methods The activity indices were scored retrospectively and summarized by adjusted means during follow-up. The Ped-SDI was scored during the last visit for those with more than six months follow-up. Pearson correlation between the Modified SLEDAI-2K and ECLAM, as well as Spearman correlations between the Modified SLEDAI-2K, ECLAM, and Ped-SDI were calculated. The receiver operating characteristic (ROC) curve was calculated for both activity indices discriminating damage measured by Ped-SDI. Results Thirty-seven patients with mean age at diagnosis 11 ± 2.9 years and mean follow-up time 3.2 ± 2.4 years were studied. The Modified SLEDAI-2K and ECLAM adjusted means were highly correlated ( r = 0.78, p < 0.001). Similarly, Spearman correlation between the activity indices was also high ( r s  > 0.7, p < 0.001), but Modified SLEDAI-2K and ECLAM correlation with Ped-SDI was only moderate. ROC analysis discriminant performance for both activity indices resulted in area under curve (AUC) of 0.74 and 0.73 for Modified SLEDAI-2K and ECLAM, respectively. Conclusion The high correlation found between the Modified SLEDAI-2K and ECLAM adjusted means indicated that both tools can be equally useful for longitudinal estimates of JSLE activity.

Efficacy of Autologous Microfat Graft on Facial Handicap in Systemic Sclerosis Patients

PubMed Central

Sautereau, Nolwenn; Daumas, Aurélie; Truillet, Romain; Jouve, Elisabeth; Magalon, Jéremy; Veran, Julie; Casanova, Dominique; Frances, Yves; Magalon, Guy

2016-01-01

Background: Autologous adipose tissue injection is used in plastic surgery for correction of localized tissue atrophy and has also been successfully offered for treatment of localized scleroderma. We aimed to evaluate whether patients with systemic sclerosis (SSc) and facial handicap could also benefit from this therapy. Methods: We included 14 patients (mean age of 53.8 ± 9.6 years) suffering from SSc with facial handicap defined by Mouth Handicap in Systemic Sclerosis Scale (MHISS) score more than or equal to 20, a Rodnan skin score on the face more than or equal to 1, and maximal mouth opening of less than 55 mm. Autologous adipose tissue injection was performed under local anesthesia using the technique of subcutaneous microinjection. The main objective of this study was an improvement of the MHISS score 6 months after the surgical treatment. Results: The procedure was well tolerated. We observed a mean decrease in the MHISS score of 10.7 points (±5.1; P < 0.0001) at 6 months (35% improvement). Secondary efficacy parameters assessing perioral skin sclerosis, maximum mouth opening, sicca syndrome, and facial pain significantly improved at 3 and 6 months postsurgery. At a 6-month follow-up, 75% of patients were satisfied or very satisfied of the adipose tissue microinjection therapy. Conclusions: Our study suggests that subcutaneous perioral microfat injection in patients with SSc is beneficial in the treatment of facial handicap, skin sclerosis, mouth opening limitation, sicca syndrome, and facial pain. Thus, this minimally invasive approach offers a new hope for face therapy for patients with SSc. PMID:27257590

Efficacy of Autologous Microfat Graft on Facial Handicap in Systemic Sclerosis Patients.

PubMed

Sautereau, Nolwenn; Daumas, Aurélie; Truillet, Romain; Jouve, Elisabeth; Magalon, Jéremy; Veran, Julie; Casanova, Dominique; Frances, Yves; Magalon, Guy; Granel, Brigitte

2016-03-01

Autologous adipose tissue injection is used in plastic surgery for correction of localized tissue atrophy and has also been successfully offered for treatment of localized scleroderma. We aimed to evaluate whether patients with systemic sclerosis (SSc) and facial handicap could also benefit from this therapy. We included 14 patients (mean age of 53.8 ± 9.6 years) suffering from SSc with facial handicap defined by Mouth Handicap in Systemic Sclerosis Scale (MHISS) score more than or equal to 20, a Rodnan skin score on the face more than or equal to 1, and maximal mouth opening of less than 55 mm. Autologous adipose tissue injection was performed under local anesthesia using the technique of subcutaneous microinjection. The main objective of this study was an improvement of the MHISS score 6 months after the surgical treatment. The procedure was well tolerated. We observed a mean decrease in the MHISS score of 10.7 points (±5.1; P < 0.0001) at 6 months (35% improvement). Secondary efficacy parameters assessing perioral skin sclerosis, maximum mouth opening, sicca syndrome, and facial pain significantly improved at 3 and 6 months postsurgery. At a 6-month follow-up, 75% of patients were satisfied or very satisfied of the adipose tissue microinjection therapy. Our study suggests that subcutaneous perioral microfat injection in patients with SSc is beneficial in the treatment of facial handicap, skin sclerosis, mouth opening limitation, sicca syndrome, and facial pain. Thus, this minimally invasive approach offers a new hope for face therapy for patients with SSc.

Identification of Extremely Premature Infants at High Risk of Rehospitalization

PubMed Central

Carlo, Waldemar A.; McDonald, Scott A.; Yao, Qing; Das, Abhik; Higgins, Rosemary D.

2011-01-01

OBJECTIVE: Extremely low birth weight infants often require rehospitalization during infancy. Our objective was to identify at the time of discharge which extremely low birth weight infants are at higher risk for rehospitalization. METHODS: Data from extremely low birth weight infants in Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers from 2002–2005 were analyzed. The primary outcome was rehospitalization by the 18- to 22-month follow-up, and secondary outcome was rehospitalization for respiratory causes in the first year. Using variables and odds ratios identified by stepwise logistic regression, scoring systems were developed with scores proportional to odds ratios. Classification and regression-tree analysis was performed by recursive partitioning and automatic selection of optimal cutoff points of variables. RESULTS: A total of 3787 infants were evaluated (mean ± SD birth weight: 787 ± 136 g; gestational age: 26 ± 2 weeks; 48% male, 42% black). Forty-five percent of the infants were rehospitalized by 18 to 22 months; 14.7% were rehospitalized for respiratory causes in the first year. Both regression models (area under the curve: 0.63) and classification and regression-tree models (mean misclassification rate: 40%–42%) were moderately accurate. Predictors for the primary outcome by regression were shunt surgery for hydrocephalus, hospital stay of >120 days for pulmonary reasons, necrotizing enterocolitis stage II or higher or spontaneous gastrointestinal perforation, higher fraction of inspired oxygen at 36 weeks, and male gender. By classification and regression-tree analysis, infants with hospital stays of >120 days for pulmonary reasons had a 66% rehospitalization rate compared with 42% without such a stay. CONCLUSIONS: The scoring systems and classification and regression-tree analysis models identified infants at higher risk of rehospitalization and might assist planning for care after discharge. PMID:22007016

Cigar Box Arthroscopy: A Randomized Controlled Trial Validates Nonanatomic Simulation Training of Novice Arthroscopy Skills.

PubMed

Sandberg, Rory P; Sherman, Nathan C; Latt, L Daniel; Hardy, Jolene C

2017-11-01

The goal of this study was to validate the cigar box arthroscopy trainer (CBAT) as a training tool and then compare its effectiveness to didactic training and to another previously validated low-fidelity but anatomic model, the anatomic knee arthroscopy trainer (AKAT). A nonanatomic knee arthroscopy training module was developed at our institution. Twenty-four medical students with no prior arthroscopic or laparoscopic experience were enrolled as subjects. Eight subjects served as controls. The remaining 16 subjects were randomized to participate in 4 hours of either the CBAT or a previously validated AKAT. Subjects' skills were assessed by 1 of 2 faculty members through repeated attempts at performing a diagnostic knee arthroscopy on a cadaveric specimen. Objective scores were given using a minimally adapted version of the Basic Arthroscopic Knee Skill Scoring System. Total cost differences were calculated. Seventy-five percent of subjects in the CBAT and AKAT groups succeeded in reaching minimum proficiency in the allotted time compared with 25% in the control group (P < .05). There was no significant difference in the number of attempts to reach proficiency between the CBAT and AKAT groups. The cost to build the CBAT was $44.12, whereas the cost was $324.33 for the AKAT. This pilot study suggests the CBAT is an effective knee arthroscopy trainer that may decrease the learning curve of residents without significant cost to a residency program. This study demonstrates the need for an agreed-upon objective scoring system to properly evaluate residents and compare the effectiveness of different training tools. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

An Assessment of the Measurement Equivalence of English and French Versions of the Center for Epidemiologic Studies Depression (CES-D) Scale in Systemic Sclerosis

PubMed Central

Delisle, Vanessa C.; Kwakkenbos, Linda; Hudson, Marie; Baron, Murray; Thombs, Brett D.

2014-01-01

Objectives Center for Epidemiologic Studies Depression (CES-D) Scale scores in English- and French-speaking Canadian systemic sclerosis (SSc) patients are commonly pooled in analyses, but no studies have evaluated the metric equivalence of the English and French CES-D. The study objective was to examine the metric equivalence of the CES-D in English- and French-speaking SSc patients. Methods The CES-D was completed by 1007 English-speaking and 248 French-speaking patients from the Canadian Scleroderma Research Group Registry. Confirmatory factor analysis (CFA) was used to assess the factor structure in both samples. The Multiple-Indicator Multiple-Cause (MIMIC) model was utilized to assess differential item functioning (DIF). Results A two-factor model (Positive and Negative affect) showed excellent fit in both samples. Statistically significant, but small-magnitude, DIF was found for 3 of 20 CES-D items, including items 3 (Blues), 10 (Fearful), and 11 (Sleep). Prior to accounting for DIF, French-speaking patients had 0.08 of a standard deviation (SD) lower latent scores for the Positive factor (95% confidence interval [CI]−0.25 to 0.08) and 0.09 SD higher scores (95% CI−0.07 to 0.24) for the Negative factor than English-speaking patients. After DIF correction, there was no change on the Positive factor and a non-significant increase of 0.04 SD on the Negative factor for French-speaking patients (difference = 0.13 SD, 95% CI−0.03 to 0.28). Conclusions The English and French versions of the CES-D, despite minor DIF on several items, are substantively equivalent and can be used in studies that combine data from English- and French-speaking Canadian SSc patients. PMID:25036894

A Novel Scoring System to Measure Radiographic Abnormalities and Related Spirometric Values in Cured Pulmonary Tuberculosis

PubMed Central

Báez-Saldaña, Renata; López-Arteaga, Yesenia; Bizarrón-Muro, Alma; Ferreira-Guerrero, Elizabeth; Ferreyra-Reyes, Leticia; Delgado-Sánchez, Guadalupe; Cruz-Hervert, Luis Pablo; Mongua-Rodríguez, Norma; García-García, Lourdes

2013-01-01

Background Despite chemotherapy, patients with cured pulmonary tuberculosis may result in lung functional impairment. Objective To evaluate a novel scoring system based on the degree of radiographic abnormalities and related spirometric values in patients with cured pulmonary tuberculosis. Methods One hundred and twenty seven patients with cured pulmonary tuberculosis were prospectively enrolled in a referral hospital specializing in respiratory diseases. Spirometry was performed and the extent of radiographic abnormalities was evaluated twice by each of two readers to generate a novel quantitative score. Scoring reproducibility was analyzed by the intra-class correlation coefficient (ICC) and the Bland-Altman method. Multiple linear regression models were performed to assess the association of the extent of radiographic abnormalities with spirometric values. Results The intra-observer agreement for scoring of radiographic abnormalities (SRA) showed an ICC of 0.81 (CI:95%, 0.67–0.95) and 0.78 (CI:95%, 0.65–0.92), for reader 1 and 2, respectively. Inter-observer reproducibility for the first measurement was 0.83 (CI:95%, 0.71–0.95), and for the second measurement was 0.74 (CI:95%, 0.58–0.90). The Bland-Altman analysis of the intra-observer agreement showed a mean bias of 0.87% and -0.55% and an inter-observer agreement of -0.35% and -1.78%, indicating a minor average systematic variability. After adjustment for age, gender, height, smoking status, pack-years of smoking, and degree of dyspnea, the scoring degree of radiographic abnormalities was significantly and negatively associated with absolute and percent predicted values of FVC: -0.07 (CI:95%, -0.01 to -0.04); -2.48 (CI:95%, -3.45 to -1.50); and FEV1 -0.07 (CI:95%, -0.10 to -0.05); -2.92 (CI:95%, -3.87 to -1.97) respectively, in the patients studied. Conclusion The extent of radiographic abnormalities, as evaluated through our novel scoring system, was inversely associated with spirometric values, and exhibited good reliability and reproducibility. As intra-observer and inter-observer agreement of the SRA varied from good to excellent, the use of SRA in this setting appears acceptable. PMID:24223865

American Diet Quality: Where it is, Where it is Heading, and What it Could Be

PubMed Central

Wilson, Magdalena M.; Reedy, Jill; Krebs-Smith, Susan M.

2015-01-01

Background Diet quality is critically important to the prevention of many types of chronic disease. The Federal government provides recommendations for optimal diet quality through the Dietary Guidelines for Americans and sets benchmarks for progress towards these recommendations through the Healthy People objectives. Objective This analysis estimated recent trends in American diet quality and compared those trends to the quality of diets that would meet the Healthy People 2020 (HP2020) objectives and the 2010 Dietary Guidelines for Americans (DGAs) in order to measure progress towards our national nutrition goals. Design This analysis used 24-hour recall data from the cross-sectional National Health and Nutrition Examination Survey, between the years of 1999–2000 and 2011–2012, to determine mean intakes of various dietary components for the United States population over time. Mean intakes were estimated using the population ratio method, and diet quality was assessed using the Healthy Eating Index-2010 (HEI-2010). Results The mean HEI-2010 total score for the U.S. population has increased from 49 in 1999–2000 to 59 in 2011–2012; continuing on that trajectory, it would reach a score of 65 by 2019–2020. A diet that meets the HP2020 objectives would receive a score of 74, and, by definition, a diet that meets the 2010 DGAs would receive a score of 100. Trends in HEI-2010 component scores vary; all HEI-2010 component scores except sodium have increased over time. Conclusions Diet quality is improving over time, but not quickly enough to meet all of the HP2020 objectives. Whole fruit and empty calories are the only HEI-2010 components on track to meet their respective HP2020 targets. Furthermore, the country falls short of the 2010 DGAs by a large margin in nearly every component of diet quality assessed by the HEI-2010. PMID:26612769

Evaluation of medium-range ensemble flood forecasting based on calibration strategies and ensemble methods in Lanjiang Basin, Southeast China

NASA Astrophysics Data System (ADS)

Liu, Li; Gao, Chao; Xuan, Weidong; Xu, Yue-Ping

2017-11-01

Ensemble flood forecasts by hydrological models using numerical weather prediction products as forcing data are becoming more commonly used in operational flood forecasting applications. In this study, a hydrological ensemble flood forecasting system comprised of an automatically calibrated Variable Infiltration Capacity model and quantitative precipitation forecasts from TIGGE dataset is constructed for Lanjiang Basin, Southeast China. The impacts of calibration strategies and ensemble methods on the performance of the system are then evaluated. The hydrological model is optimized by the parallel programmed ε-NSGA II multi-objective algorithm. According to the solutions by ε-NSGA II, two differently parameterized models are determined to simulate daily flows and peak flows at each of the three hydrological stations. Then a simple yet effective modular approach is proposed to combine these daily and peak flows at the same station into one composite series. Five ensemble methods and various evaluation metrics are adopted. The results show that ε-NSGA II can provide an objective determination on parameter estimation, and the parallel program permits a more efficient simulation. It is also demonstrated that the forecasts from ECMWF have more favorable skill scores than other Ensemble Prediction Systems. The multimodel ensembles have advantages over all the single model ensembles and the multimodel methods weighted on members and skill scores outperform other methods. Furthermore, the overall performance at three stations can be satisfactory up to ten days, however the hydrological errors can degrade the skill score by approximately 2 days, and the influence persists until a lead time of 10 days with a weakening trend. With respect to peak flows selected by the Peaks Over Threshold approach, the ensemble means from single models or multimodels are generally underestimated, indicating that the ensemble mean can bring overall improvement in forecasting of flows. For peak values taking flood forecasts from each individual member into account is more appropriate.

Walking on a user similarity network towards personalized recommendations.

PubMed

Gan, Mingxin

2014-01-01

Personalized recommender systems have been receiving more and more attention in addressing the serious problem of information overload accompanying the rapid evolution of the world-wide-web. Although traditional collaborative filtering approaches based on similarities between users have achieved remarkable success, it has been shown that the existence of popular objects may adversely influence the correct scoring of candidate objects, which lead to unreasonable recommendation results. Meanwhile, recent advances have demonstrated that approaches based on diffusion and random walk processes exhibit superior performance over collaborative filtering methods in both the recommendation accuracy and diversity. Building on these results, we adopt three strategies (power-law adjustment, nearest neighbor, and threshold filtration) to adjust a user similarity network from user similarity scores calculated on historical data, and then propose a random walk with restart model on the constructed network to achieve personalized recommendations. We perform cross-validation experiments on two real data sets (MovieLens and Netflix) and compare the performance of our method against the existing state-of-the-art methods. Results show that our method outperforms existing methods in not only recommendation accuracy and diversity, but also retrieval performance.

Scoring Method of a Situational Judgment Test: Influence on Internal Consistency Reliability, Adverse Impact and Correlation with Personality?

ERIC Educational Resources Information Center

De Leng, W. E.; Stegers-Jager, K. M.; Husbands, A.; Dowell, J. S.; Born, M. Ph.; Themmen, A. P.

2017-01-01

Situational Judgment Tests (SJTs) are increasingly used for medical school selection. Scoring an SJT is more complicated than scoring a knowledge test, because there are no objectively correct answers. The scoring method of an SJT may influence the construct and concurrent validity and the adverse impact with respect to non-traditional students.…

Prenatal maternal stress predicts autism traits in 6½ year-old children: Project Ice Storm.

PubMed

Walder, Deborah J; Laplante, David P; Sousa-Pires, Alexandra; Veru, Franz; Brunet, Alain; King, Suzanne

2014-10-30

Research implicates prenatal maternal stress (PNMS) as a risk factor for neurodevelopmental disorders; however few studies report PNMS effects on autism risk in offspring. We examined, prospectively, the degree to which objective and subjective elements of PNMS explained variance in autism-like traits among offspring, and tested moderating effects of sex and PNMS timing in utero. Subjects were 89 (46F/43M) children who were in utero during the 1998 Quebec Ice Storm. Soon after the storm, mothers completed questionnaires on objective exposure and subjective distress, and completed the Autism Spectrum Screening Questionnaire (ASSQ) for their children at age 6½. ASSQ scores were higher among boys than girls. Greater objective and subjective PNMS predicted higher ASSQ independent of potential confounds. An objective-by-subjective interaction suggested that when subjective PNMS was high, objective PNMS had little effect; whereas when subjective PNMS was low, objective PNMS strongly affected ASSQ scores. A timing-by-objective stress interaction suggested objective stress significantly affected ASSQ in first-trimester exposed children, though less so with later exposure. The final regression explained 43% of variance in ASSQ scores; the main effect of sex and the sex-by-PNMS interactions were not significant. Findings may help elucidate neurodevelopmental origins of non-clinical autism-like traits from a dimensional perspective. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Staging Sleep in Polysomnograms: Analysis of Inter-Scorer Variability

PubMed Central

Younes, Magdy; Raneri, Jill; Hanly, Patrick

2016-01-01

Study Objectives: To determine the reasons for inter-scorer variability in sleep staging of polysomnograms (PSGs). Methods: Fifty-six PSGs were scored (5-stage sleep scoring) by 2 experienced technologists, (first manual, M1). Months later, the technologists edited their own scoring (second manual, M2) based upon feedback from the investigators that highlighted differences between their scoring. The PSGs were then scored with an automatic system (Auto) and the technologists edited them, epoch-by-epoch (Edited-Auto). This resulted in 6 different manual scores for each PSG. Epochs were classified as scorer errors (one M1 score differed from the other 5 scores), scorer bias (all 3 scores of each technologist were similar, but differed from the other technologist) and equivocal (sleep scoring was inconsistent within and between technologists). Results: Percent agreement after M1 was 78.9% ± 9.0% and was unchanged after M2 (78.1% ± 9.7%) despite numerous edits (≈40/PSG) by the scorers. Agreement in Edited-Auto was higher (86.5% ± 6.4%, p < 1E−9). Scorer errors (< 2% of epochs) and scorer bias (3.5% ± 2.3% of epochs) together accounted for < 20% of M1 disagreements. A large number of epochs (92 ± 44/PSG) with scoring agreement in M1 were subsequently changed in M2 and/or Edited-Auto. Equivocal epochs, which showed scoring inconsistency, accounted for 28% ± 12% of all epochs, and up to 76% of all epochs in individual patients. Disagreements were largely between awake/NREM, N1/N2, and N2/N3 sleep. Conclusion: Inter-scorer variability is largely due to epochs that are difficult to classify. Availability of digitally identified events (e.g., spindles) or calculated variables (e.g., depth of sleep, delta wave duration) during scoring may greatly reduce scoring variability. Citation: Younes M, Raneri J, Hanly P. Staging sleep in polysomnograms: analysis of inter-scorer variability. J Clin Sleep Med 2016;12(6):885–894. PMID:27070243

R.E.N.A.L. Nephrometry Score: A Preoperative Risk Factor Predicting the Fuhrman Grade of Clear-Cell Renal Carcinoma

PubMed Central

Chen, Shao-Hao; Wu, Yu-Peng; Li, Xiao-Dong; Lin, Tian; Guo, Qing-Yong; Chen, Ye-Hui; Huang, Jin-Bei; Wei, Yong; Xue, Xue-Yi; Zheng, Qing-Shui; Xu, Ning

2017-01-01

Objective: The purpose of this study was to evaluate the efficacy and feasibility of the R.E.N.A.L. Nephrometry Score to postoperatively predict high-grade clear-cell renal carcinoma (ccRCC). Methods: The study included 288 patients diagnosed with ccRCC who had complete CT/CTA data and R.E.N.A.L. Nephrometry Scores and underwent renal surgery at our center between January 2012 and December 2015. The relationship between the pathological grade of renal masses and R.E.N.A.L. Nephrometry Score was evaluated. Results: Univariate analysis indicated that diagnostic modality, cystic necrosis, enlargement of the regional lymph node, distant metastasis, clinical T stage, TNM stage, surgical modality, tumor size, nearness of the tumor to the collecting system or sinus, total Nephrometry Score and individual anatomic descriptor components were significantly associated with postoperative tumor grade (P < 0.05). Multivariate analysis showed that tumor size, the maximal diameter (R score), exophytic/endophytic properties (E score) and the location relative to the polar lines (L score) were independent prognostic factors to preoperatively predicting ccRCC pathological grade. The areas under the ROC curve with respect to the multi-parameter regression model (0.935, 95%CI: 0.904-0.966), tumor size (0.901, 95%CI: 0.866-0.937), R score (0.868, 95%CI: 0.825-0.911), E score (0.511, 95%CI: 0.442-0.581) and L score (0.842, 95%CI: 0.791-0.892) were calculated and compared. Conclusion: Tumor size, as well as R, E, and L scores were independent prognostic factors for high-grade pathology. Lager tumor sizes and higher R, E and L scores were more likely to be associated with high-grade pathological outcomes. Thus, the R.E.N.A.L. Score is of practical significance in facilitating urologists to make therapeutic decisions. PMID:29151960

Changes in nasorespiratory function in association with maxillary distraction osteogenesis in subjects with cleft lip and palate.

PubMed

Saito, Kiyo; Ono, Takashi; Mochida, Masumi; Ohyama, Kimie

2006-01-01

The current study aimed to determine how nasorespiratory function changes in association with maxillary distraction osteogenesis (DO). Furthermore, with regard to impaired nasorespiratory function, the possibility of a relationship between the cleft side and laterality and any effect of maxillary distraction osteogenesis was investigated. In this descriptive, prospective clinical report, subjective and objective data regarding nasorespiratory function before and after maxillary distraction osteogenesis were compared. Data from 13 subjects with cleft lip and palate were used. Subjects had a severe maxillary deficiency and underwent distraction osteogenesis using a rigid external device system. The subjective measure was the score on a questionnaire regarding nasorespiratory function using a visual analog scale. The objective measure was nasal resistance. The visual analog scale score for two items significantly decreased just after distraction osteogenesis. Nasal resistance also significantly decreased 1 year after distraction osteogenesis. Moreover, nasal resistance on the cleft side was significantly greater than that on the noncleft side just before and 1 year after distraction osteogenesis. There was a significant positive correlation between changes in the visual analog scale score and nasal resistance. These results suggest that nasorespiratory function changes in association with maxillary distraction osteogenesis in subjects with cleft lip and palate. Moreover, it appears that nasal obstruction on the cleft side does not change in subjects with unilateral cleft lip and palate.

Overview of different scoring systems in Fournier’s Gangrene and assessment of prognostic factors

PubMed Central

Doluoğlu, Ömer Gökhan; Karagöz, Mehmet Ali; Kılınç, Muhammet Fatih; Karakan, Tolga; Yücetürk, Cem Nedim; Sarıcı, Haşmet; Özgür, Berat Cem; Eroğlu, Muzaffer

2016-01-01

Objective In this study we aimed to evaluate prognostic factors for the survival of patients with Fournier’s gangrene (FG), and overview different validated scoring systems for outcome prediction. Material and methods We retrospectively analyzed the data of 39 patients treated for FG in our clinic. Data were collected on medical history, symptoms, physical examination findings, vital signs, laboratory parameters at admission and at the end of treatment, timing and extent of surgical debridement, and the antibiotic treatment used. The Fournier’s Gangrene Severity Index (FGSI) and Charlson Comorbidity Index (CCI) were used to predict outcome. The data were analyzed in relation with the survival of the patients. Mann-Whitney U test, chi -square test, Wilcoxon signed rank test, and Cox regression analysis were used for the statistical analysis. Results Of 39 patients analyzed, 8 (20.5%) died and 31 (79.5%) survived. The median FGSI score on admission was 2 (0–9) for the survivors and 6 (2–14) for the non-survivors (p=0.004). The median CCI scores of the survivors and non-survivors were 2 (0–10) and 6.5 (5–11), respectively (p=0.001). Except for urea, albumin and hematocrit levels, no significant differences were found between survivors and non-survivors for other laboratory parameters on admission. Lower albumin levels and advanced age were found to be associated with mortality. Conclusion High blood urea, low albumin, and low hematocrit levels were associated with poor prognosis. High CCI and FGSI scores could be associated with a poor prognosis in patients with FG. PMID:27635295

Microbial Contamination Level Profiles Attributed to Contamination of Beef Carcasses, Personnel, and Equipment: Case of Small and Medium Enterprise Slaughterhouses.

PubMed

Wambui, Joseph; Lamuka, Peter; Karuri, Edward; Matofari, Joseph; Njage, Patrick Murigu Kamau

2018-04-01

The microbial contamination level profiles (MCLPs) attributed to contamination of beef carcasses, personnel, and equipment in five Kenyan small and medium enterprise slaughterhouses were determined. Aerobic plate counts, Enterobacteriaceae, Staphylococcus, and Salmonella were used to determine contamination at four different slaughter stages, namely, dehiding, evisceration, splitting, and dispatch. Microbiological criteria of the four microorganisms were used to score contamination levels (CLs) as poor (0), poor to average (1), average (2), or good (3). MCLPs were further assigned to carcasses, personnel, and equipment at each stage by summing up the CL scores. The CL score attributed to aerobic plate count contamination was 2 or 3 for carcasses but 0 for personnel and equipment in almost all slaughterhouses. A score of 0 on carcasses was mostly attributed to Enterobacteriaceae at evisceration and to Salmonella at dehiding and evisceration. In addition, a score of 0 was mostly attributed to Staphylococcus contamination of personnel at dehiding. A score of 3 was attributed mostly to Enterobacteriaceae on hands at splitting, whereas a score of 2 was mostly attributed to the clothes at dehiding and evisceration. A CL score of 3 was mostly attributed to Enterobacteriaceae and Salmonella contamination of equipment at dehiding and splitting, respectively. Although CLs attributed to contamination of carcasses, personnel, and equipment ranged from 0 to 3, the maximum MCLP score of 9 was only attained in carcasses from two slaughterhouses at dehiding and from one slaughterhouse at dispatch. There is, therefore, a lot of room for small and medium enterprise slaughterhouses to improve their food safety objectives by improving food safety management systems at the points characterized by low CL scores.

Cruise ship environmental hygiene and the risk of norovirus infection outbreaks: an objective assessment of 56 vessels over 3 years.

PubMed

Carling, Philip C; Bruno-Murtha, Lou Ann; Griffiths, Jeffrey K

2009-11-01

Norovirus infection outbreaks (NoVOs) occur frequently in closed populations, such as cruise ship passengers. Environmental contamination is believed to play an important role in NoVO propagation. Trained health care professionals covertly evaluated the thoroughness of disinfection cleaning (TDC) of 6 standardized objects (toilet seat, flush handle or button, toilet stall inner handhold, stall inner door handle, restroom inner door handle, and baby changing table surfaces) with high potential for fecal contamination in cruise ship public restrooms, by means of a previously validated novel targeting method. Fifty-six cruise ships (approximately 30% of 180 vessels operated by 9 large cruise lines) were evaluated from July 2005 through August 2008. Overall, 37% (range, 4%-100%; 95% confidence interval, 29.2%-45.4%) of 8344 objects in 273 randomly selected public restrooms were cleaned daily. The TDC did not differ by cruise line and did not correlate with the Centers for Disease Control and Prevention (CDC) Vessel Sanitation Program inspection scores (r(2), .002; P = .75). More than half the vessels had overall TDC scores <30%, although several of these low-scoring ships had near-perfect CDC sanitation scores. The mean TDC of the 3 ships evaluated within 4 months before a NoVO (10.3%) was substantially less than the mean TDC of the 40 ships that did not experience NoVOs (40.4%) (P < .004). An objective evaluation of public restroom environmental hygiene on 56 cruise ships found that only 37% of selected toilet area objects were cleaned on a daily basis. Low TDC scores may predict subsequent NoVO-prone vessels. Enhanced public restroom cleaning may prevent or moderate NoVOs on cruise ships.

A pilot study evaluating a new questionnaire for prostatic symptom scoring, the SPSS, and its sensitivity as constructed to objective measures of outflow obstruction.

PubMed

Yano, Masataka; Kitahara, Satoshi; Yasuda, Kosaku; Yamanishi, Tomonori; Nakai, Hideo; Yanagisawa, Ryouzo; Morozumi, Makoto; Homma, Yukio

2004-05-01

To evaluate the extent to which our newly developed questionnaire, the Saitama Prostate Symptom Score (SPSS), for prostatic symptom scoring reflects objective findings in benign prostatic hyperplasia (clinical BPH) and to compare it with the International Prostate Symptom Score (IPSS) with regard to diagnostic sensitivity in clinical BPH. In this study, both the SPSS and the IPSS were self-administered by patients. Free uroflowmetry, a pressure-flow study and the measurement of prostatic volume were carried out. There was no significant correlation between the results of the IPSS questionnaire and the urethral obstruction grade estimated by Schaefer or Abrams-Griffiths nomograms. The total score of the SPSS was correlated with these nomograms (P = 0.0487 and P = 0.0413, respectively). There was no significant correlation between the results of the IPSS questionnaire and the total volume or transition zone volume of the prostate, whereas the total score of the SPSS correlated with the total volume of the gland and transition zone volume (P = 0.0044 and P= 0.0051, respectively). This study revealed the SPSS to correlate with objective findings satisfactorily. However, there are still several aspects of the SPSS which need to be improved upon, and the questionnaire should be studied in larger numbers of patients suffering from lower urinary tract symptoms.

A Required Course in the Development, Implementation, and Evaluation of Clinical Pharmacy Services

PubMed Central

Kamal, Khalid M.; Berdine, Hildegarde J.

2008-01-01

Objective To develop, implement, and assess a required pharmacy practice course to prepare pharmacy students to develop, implement, and evaluate clinical pharmacy services using a business plan model. Design Course content centered around the process of business planning and pharmacoeconomic evaluations. Selected business planning topics included literature evaluation, mission statement development, market evaluation, policy and procedure development, and marketing strategy. Selected pharmacoeconomic topics included cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis, cost-utility analysis, and health-related quality of life (HRQoL). Assessment methods included objective examinations, student participation, performance on a group project, and peer evaluation. Assessment One hundred fifty-three students were enrolled in the course. The mean scores on the objective examinations (100 points per examination) ranged from 82 to 85 points, with 25%-35% of students in the class scoring over 90, and 40%-50% of students scoring from 80 to 89. The mean scores on the group project (200 points) and classroom participation (50 points) were 183.5 and 46.1, respectively. The mean score on the peer evaluation was 30.8, with scores ranging from 27.5 to 31.7. Conclusion The course provided pharmacy students with the framework necessary to develop and implement evidence-based disease management programs and to assure efficient, cost-effective utilization of pertinent resources in the provision of patient care. PMID:19214263

First quality score for referral letters in gastroenterology—a validation study

PubMed Central

Eskeland, Sigrun Losada; Brunborg, Cathrine; Seip, Birgitte; Wiencke, Kristine; Hovde, Øistein; Owen, Tanja; Skogestad, Erik; Huppertz-Hauss, Gert; Halvorsen, Fred-Arne; Garborg, Kjetil; Aabakken, Lars; de Lange, Thomas

2016-01-01

Objective To create and validate an objective and reliable score to assess referral quality in gastroenterology. Design An observational multicentre study. Setting and participants 25 gastroenterologists participated in selecting variables for a Thirty Point Score (TPS) for quality assessment of referrals to gastroenterology specialist healthcare for 9 common indications. From May to September 2014, 7 hospitals from the South-Eastern Norway Regional Health Authority participated in collecting and scoring 327 referrals to a gastroenterologist. Main outcome measure Correlation between the TPS and a visual analogue scale (VAS) for referral quality. Results The 327 referrals had an average TPS of 13.2 (range 1–25) and an average VAS of 4.7 (range 0.2–9.5). The reliability of the score was excellent, with an intra-rater intraclass correlation coefficient (ICC) of 0.87 and inter-rater ICC of 0.91. The overall correlation between the TPS and the VAS was moderate (r=0.42), and ranged from fair to substantial for the various indications. Mean agreement was good (ICC=0.47, 95% CI (0.34 to 0.57)), ranging from poor to good. Conclusions The TPS is reliable, objective and shows good agreement with the subjective VAS. The score may be a useful tool for assessing referral quality in gastroenterology, particularly important when evaluating the effect of interventions to improve referral quality. PMID:27855107

An objective measure of hyperactivity aspects with compressed webcam video.

PubMed

Wehrmann, Thomas; Müller, Jörg Michael

2015-01-01

Objective measures of physical activity are currently not considered in clinical guidelines for the assessment of hyperactivity in the context of Attention-Deficit/Hyperactivity Disorder (ADHD) due to low and inconsistent associations between clinical ratings, missing age-related norm data and high technical requirements. This pilot study introduces a new objective measure for physical activity using compressed webcam video footage, which should be less affected by age-related variables. A pre-test established a preliminary standard procedure for testing a clinical sample of 39 children aged 6-16 years (21 with a clinical ADHD diagnosis, 18 without). Subjects were filmed for 6 min while solving a standardized cognitive performance task. Our webcam video-based video-activity score was compared with respect to two independent video-based movement ratings by students, ratings of Inattentiveness, Hyperactivity and Impulsivity by clinicians (DCL-ADHS) giving a clinical diagnosis of ADHD and parents (FBB-ADHD) and physical features (age, weight, height, BMI) using mean scores, correlations and multiple regression. Our video-activity score showed a high agreement (r = 0.81) with video-based movement ratings, but also considerable associations with age-related physical attributes. After controlling for age-related confounders, the video-activity score showed not the expected association with clinicians' or parents' hyperactivity ratings. Our preliminary conclusion is that our video-activity score assesses physical activity but not specific information related to hyperactivity. The general problem of defining and assessing hyperactivity with objective criteria remains.

Suturing training in Augmented Reality: gaining proficiency in suturing skills faster.

PubMed

Botden, S M B I; de Hingh, I H J T; Jakimowicz, J J

2009-09-01

Providing informative feedback and setting goals tends to motivate trainees to practice more extensively. Augmented Reality simulators retain the benefit of realistic haptic feedback and additionally generate objective assessment and informative feedback during the training. This study researched the performance curve of the adapted suturing module on the ProMIS Augmented Reality simulator. Eighteen novice participants were pretrained on the MIST-VR to become acquainted with laparoscopy. Subsequently, they practiced 16 knots on the suturing module, of which the assessment scores were recorded to evaluate the gain in laparoscopic suturing skills. The scoring of the assessment method was calculated from the "time spent in the correct area" during the knot tying and the quality of the knot. Both the baseline knot and the knot at the top of the performance curve were assessed by two independent objective observers, by means of a standardized evaluation form, to objectify the gain in suturing skills. There was a statistically significant difference between the scores of the second knot (mean 72.59, standard deviation (SD) 16.28) and the top of the performance curve (mean 95.82, SD 3.05; p < 0.001, paired t-test). The scoring of the objective observers also differed significantly (mean 11.83 and 22.11, respectively; SD 3.37 and 3.89, respectively; p < 0.001) (interobserver reliability Cronbach's alpha = 0.96). The median amount of repetitions to reach the top of the performance curve was eight, which also showed significant differences between both the assessment score (mean 88.14, SD 13.53, p < 0.001) and scoring of the objective observers of the second knot (mean 20.51, SD 4.14; p < 0.001). This adapted suturing module on the ProMIS Augmented Reality laparoscopic simulator is a potent tool for gaining laparoscopic suturing skills.

A Novel Scoring Metrics for Quality Assurance of Ocean Color Observations

NASA Astrophysics Data System (ADS)

Wei, J.; Lee, Z.

2016-02-01

Interpretation of the ocean bio-optical properties from ocean color observations depends on the quality of the ocean color data, specifically the spectrum of remote sensing reflectance (Rrs). The in situ and remotely measured Rrs spectra are inevitably subject to errors induced by instrument calibration, sea-surface correction and atmospheric correction, and other environmental factors. Great efforts have been devoted to the ocean color calibration and validation. Yet, there exist no objective and consensus criteria for assessment of the ocean color data quality. In this study, the gap is filled by developing a novel metrics for such data quality assurance and quality control (QA/QC). This new QA metrics is not intended to discard "suspicious" Rrs spectra from available datasets. Rather, it takes into account the Rrs spectral shapes and amplitudes as a whole and grades each Rrs spectrum. This scoring system is developed based on a large ensemble of in situ hyperspectral remote sensing reflectance data measured from various aquatic environments and processed with robust procedures. This system is further tested with the NASA bio-Optical Marine Algorithm Data set (NOMAD), with results indicating significant improvements in the estimation of bio-optical properties when Rrs spectra marked with higher quality assurance are used. This scoring system is further verified with simulated data and satellite ocean color data in various regions, and we envision higher quality ocean color products with the implementation of such a quality screening system.

[Evaluation of the Oran university hospital information system].

PubMed

Chougrani, Saada; Ouhadj, Salah; Agag, Fouzia

2013-01-01

Oran university hospital has been operating since 2010. It is a public institution that must assess the resources required to achieve institutional goals integrated into the strategic objectives defined in the hospital development project. Implementation of this project could be supported, among other things, by a strong and efficient hospital information system. Three investigations were conducted: 1- evaluation of the hospital information system, 2- assessment of the quality of the hospital discharge summary reports, 3- assessment of the quality of medical records. The six components of the hospital information system (resources, indicators, sources, management, quality and dissemination and use of data) were clearly present but not satisfactory with a score ranging from 25 to 50% of the total score. The scores by component were as follows: 36% for resources, 37% for indicators, 42% for patient records, 19% for data management and 27% for the dissemination of information. The overall completeness of medical records was 85.2%. Completeness by group of variables gave the following results: 66% for medical information, 54% for the patient's stay and 38% for information relating to the patient's discharge. Hospital discharge summary reports were available in 59.8% of cases, but were blank in 4% of cases. The critical variable, the principal diagnosis was found in 51% of cases. The correct principal diagnosis rate was 33.3%. The deficiencies observed for content and data management raise real questions concerning data management at Oran university hospital as part of a real managerial approach.

A technology-enabled adherence enhancement system for people with bipolar disorder: results from a feasibility and patient acceptance analysis

PubMed Central

Sajatovic, Martha; Davis, Michael S; Cassidy, Kristin A; Nestor, Joseph; Sams, Johnny; Fuentes-Casiano, Edna

2015-01-01

Objective As poor medication adherence is common in bipolar disorder (BD), technology-assisted approaches may help to monitor and enhance adherence. This study evaluated preliminary feasibility, patient satisfaction and effects on adherence, BD knowledge, and BD symptoms associated with the use of a multicomponent technology-assisted adherence enhancement system. Methods This prospective study tested the system in five BD patients over a 15-day period. System components included: 1) an automated pill cap with remote monitoring sensor; 2) a multimedia adherence enhancement program; and 3) a treatment incentive program. This study evaluated system usability, patient satisfaction and effects on adherence (Morisky scale), knowledge (treatment knowledge test [TKT]), and symptoms (internal state scale [ISS]). Results Mean age of the sample was 62 years, 4/5 (80%) Caucasian, and 4/5 (80%) single/divorced or widowed. Most participants (4/5, 80%) were on a single BD medication. Participants had BD for an average of 21 years. Challenges included attaching the pill sensor to standard pharmacy bottles for individuals using very large pill containers or those with multiday pill boxes. Three of five (60%) individuals completed the full 15-day period. Usability scores were high overall. Mean Morisky scores improved. Means on all four subscales of the ISS were all in the direction of improvement. On the TKT, there was a 40% increase in mean scores. Conclusion A multicomponent technology-assisted BD adherence enhancement system is feasible. Challenges include accommodating multiple types of pill containers and monitoring multiple drugs simultaneously. The system can also generate adherence information that is potentially useful for treatment planning. PMID:26089652

Validation of the GerdQ questionnaire for the management of gastro-oesophageal reflux disease in Japan

PubMed Central

Matsuzaki, Juntaro; Okada, Sawako; Hirata, Kenro; Fukuhara, Seiichiro; Hibi, Toshifumi

2013-01-01

Background The GerdQ scoring system may be a useful tool for managing gastro-oesophageal reflux disease. However, GerdQ has not been fully validated in Asian countries. Objective To validate the Japanese version of GerdQ and to compare this version to the Carlsson-Dent questionnaire (CDQ) in both general and hospital-based populations. Methods The questionnaires, including the Japanese versions of GerdQ and CDQ, and questions designed to collect demographic information, were sent to a general population via the web, and to a hospital-based population via conventional mail. The optimal cutoff GerdQ score and the differences in the characteristics between GerdQ and CDQ were assessed. Results The answers from 863 web-responders and 303 conventional-mail responders were analysed. When a GerdQ cutoff score was set at 8, GerdQ significantly predicted the presence of reflux oesophagitis. Although the GerdQ scores were correlated with the CDQ scores, the concordance rates were poor. Multivariate analysis results indicated that, the additional use of over-the-counter medications was associated with GerdQ score ≥ 8, but not with CDQ score ≥ 6. Conclusions The GerdQ cutoff score of 8 was appropriate for the Japanese population. Compared with CDQ, GerdQ was more useful for evaluating treatment efficacy and detecting patients’ unmet medical needs. PMID:24917957

Sound System Engineering & Optimization: The effects of multiple arrivals on the intelligibility of reinforced speech

NASA Astrophysics Data System (ADS)

Ryan, Timothy James

The effects of multiple arrivals on the intelligibility of speech produced by live-sound reinforcement systems are examined. The intent is to determine if correlations exist between the manipulation of sound system optimization parameters and the subjective attribute speech intelligibility. Given the number, and wide range, of variables involved, this exploratory research project attempts to narrow the focus of further studies. Investigated variables are delay time between signals arriving from multiple elements of a loudspeaker array, array type and geometry and the two-way interactions of speech-to-noise ratio and array geometry with delay time. Intelligibility scores were obtained through subjective evaluation of binaural recordings, reproduced via headphone, using the Modified Rhyme Test. These word-score results are compared with objective measurements of Speech Transmission Index (STI). Results indicate that both variables, delay time and array geometry, have significant effects on intelligibility. Additionally, it is seen that all three of the possible two-way interactions have significant effects. Results further reveal that the STI measurement method overestimates the decrease in intelligibility due to short delay times between multiple arrivals.

What makes a great radiology review course lecture: the Ottawa radiology resident review course experience.

PubMed

Cao, Lilly; McInnes, Matthew D F; Ryan, John O

2014-02-01

Little objective evidence exists regarding what makes a good lecture. Our purpose was to determine qualities of radiology review course lectures that are associated with positive audience evaluation. 57 presentations from the Ottawa Resident Review Course (2012) were analyzed by a PGY4 radiology resident blinded to the result of audience evaluation. Objective data extracted were: slides per minute, lines of text per text slide, words per text slide, cases per minute, images per minute, images per case, number of audience laughs, number of questions posed to the audience, number of summaries, inclusion of learning objectives, ending on time, use of pre/post-test and use of special effects. Mean audience evaluation scores for each talk from daily audience evaluations (up to 60 per talk) were standardized out of 100. Correlation coefficient was calculated between continuous variables and audience evaluation scores. Student T test was performed on categorical variables and audience evaluation scores. Strongest positive association with audience evaluation scores was for image quality (r = 0.57) and number of times the audience laughed (r = 0.3). Strongest negative association was between images per case and audience scores (r = -0.25). Talks with special effects were rated better (mean score 94.3 vs. 87.1, p < 0.001). Talks with the highest image quality were rated better (mean score 94.1 vs. 87.5, p < 0.001). Talks which contained a pre/post-test were rated better (mean score 92 vs. 87.8, p = 0.004). Many factors go into making a great review course lecture. At the University of Ottawa Resident Review Course, high quality images, use of special effects, use of pre/post-test and humor were most strongly associated with high audience evaluation scores. High image volume per case may be negatively associated with audience evaluation scores.

Are Medical Students Assigning Proper Global Assessment of Functioning Scores?

ERIC Educational Resources Information Center

Warsi, Mustafa K.; Sattar, S. Pirzada; Din, Amad U.; Petty, Frederick; Padala, Prasad R.

2007-01-01

Objective: This article seeks to determine whether medical students can estimate the appropriate score for the Global Assessment of Functioning (GAF) compared with psychiatry residents and staff psychiatrists. The authors hypothesized that medical students' estimations of GAF scores for patients in clinical vignettes would differ from those…

[Study on the overall implementation status of the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases].

PubMed

Li, J J; Li, J L; Zhang, J; Jin, R R; Ma, S; Deng, G J; Su, X W; Bian, F; Qu, Y M; Hu, L L; Jiang, Y

2018-04-10

Objective: To understand the current overall status of implementation on the National Demonstration Areas of Comprehensive Prevention and Control of Non-communicable Diseases. Methods: According to the scheme design of the questionnaires, all the National Demonstration Areas were involved in this study. For each National Demonstration Areas, eight departments were selected to complete a total of 12 questionnaires. Results: Scores related to the implementation of the National Demonstration Areas accounted for 71.8% of the total 170 points. Based on the scores gathered from this study, the 23-items-index-system that represented the status of project implementation was classified into seven categories. Categories with higher percentile scores would include: monitoring (88.0%), safeguard measures (75.0%), health education and health promotion (75.0%). Categories with lower percentile scores would include: the national health lifestyle actions (67.7%), community diagnosis (66.7%), discovery and intervention of high-risk groups (64.7%), and patient management (60.9%). There were significant differences noticed among the eastern, central and western areas on items as safeguard measures, health education/promotion, discovery and intervention of high-risk groups. In all, the implementation programs in the eastern Demonstration Areas seemed better than in the central or western regions. As for the 23 items, five of the highest scores appeared on policy support, mortality surveillance, tumor registration, reporting system on cardiovascular/cerebrovascular events, and on tobacco control, respectively. However, the lowest five scores fell on healthy diet, patient self-management program, oral hygiene, setting up the demonstration units and promotion on basic public health services, respectively. The overall scores in the eastern region was higher than that in the central or the western regions. The scores in the central and western regions showed basically the same. Conclusions: The overall status of implementation on the National Demonstration Areas was satisfactory. Future attention should be focusing on patient management as well as discovery and intervention of high-risk groups, which also presented the lowest scores, in this survey.

Economic selection index development for Beefmaster cattle I: Terminal breeding objective.

PubMed

Ochsner, K P; MacNeil, M D; Lewis, R M; Spangler, M L

2017-03-01

The objective of this study was to develop an economic selection index for Beefmaster cattle in a terminal production system where bulls are mated to mature cows with all resulting progeny harvested. National average prices from 2010 to 2014 were used to establish income and expenses for the system. Phenotypic and genetic parameter values among the selection criteria and goal traits were obtained from literature. Economic values were estimated by simulating 100,000 animals and approximating the partial derivatives of the profit function by perturbing traits one at a time, by 1 unit, while holding the other traits constant at their respective means. Relative economic values (REV) for the terminal objective traits HCW, marbling score (MS), ribeye area (REA), 12th-rib fat (FAT), and feed intake (FI) were 91.29, 17.01, 8.38, -7.07, and -29.66, respectively. Consequently, improving the efficiency of beef production is expected to impact profitability greater than improving carcass merit alone. The accuracy of the index lies between 0.338 (phenotypic selection) and 0.503 (breeding values known without error). The application of this index would aid Beefmaster breeders in their sire selection decisions, facilitating genetic improvement for a terminal breeding objective.

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 evaluation.

Comparison of protocols for measuring and calculating postmortem submersion intervals for human analogs in fresh water.

PubMed

Humphreys, Michael K; Panacek, Edward; Green, William; Albers, Elizabeth

2013-03-01

Protocols for determining postmortem submersion interval (PMSI) have long been problematic for forensic investigators due to the wide variety of factors affecting the rate of decomposition of submerged carrion. Likewise, it has been equally problematic for researchers to develop standardized experimental protocols to monitor underwater decomposition without artificially affecting the decomposition rate. This study compares two experimental protocols: (i) underwater in situ evaluation with photographic documentation utilizing the Heaton et al. total aquatic decomposition (TAD) score and (ii) weighing the carrion before and after submersion. Complete forensic necropsies were performed as a control. Perinatal piglets were used as human analogs. The results of this study indicate that in order to objectively measure decomposition over time, the human analog should be examined at depth using the TAD scoring system rather than utilizing a carrion weight evaluation. The acquired TAD score can be used to calculate an approximate PMSI. © 2012 American Academy of Forensic Sciences.

The Distribution of Scaled Scores and Possible Floor Effects on the WISC-III and WAIS-III

ERIC Educational Resources Information Center

Whitaker, Simon; Wood, Christopher

2008-01-01

Objective: It has been suggested that, as the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) and the Wechsler Intelligence Scale for Children-Third Edition (WISC-III) give a scaled score of one even if a client scores a raw score of zero, these assessments may have a hidden floor effect at low IQ levels. The study looked for…

Different Sutures in the Surgical Treatment of Acute Closed Achilles Tendon Rupture.

PubMed

Ji, Yunhan; Ma, Xin; Wang, Xu; Huang, Jiazhang; Zhang, Chao; Chen, Li

2015-12-01

The aim was to compare the postoperative efficacy of the PDS II and Ethibond W4843 sutures in fresh, closed Achilles tendon rupture. With methods of random grouping (level of evidence II b), a total of 128 patients with fresh Achilles tendon rupture were operated on with PDS II or Ethibond W4843 suture. Postoperative objective examination and the American Orthopaedic Foot & Ankle Society (AOFAS) scoring system were used for the evaluation. Group A underwent 12-39 months of follow-up, for an average of 22 months. Group B underwent 12-37 months of follow-up, for an average of 23 months. The postoperative AOFAS score of group A within 3 months was 93 ± 9.6 points. One case exhibited re-rupture, five cases exhibited incision infection, one case manifested deep infection, and seven cases exhibited Achilles tendon adhesion. The postoperative AOFAS score of group B within 3 months was 97 ± 7.8 points. Eleven cases had incision infection, and 13 cases manifested Achilles tendon adhesion. Minimal differences were observed in the incision infection, re-rupture rate, and Achilles tendon adhesion in the study of the PDS II and Ethibond W4843 sutures. But, based on the AOFAS score and pain score, the Ethibond suture performed better.

Targeted assessment of lower motor neuron burden is associated with survival in amyotrophic lateral sclerosis.

PubMed

Devine, Matthew S; Ballard, Emma; O'Rourke, Peter; Kiernan, Matthew C; Mccombe, Pamela A; Henderson, Robert D

2016-01-01

Estimating survival in amyotrophic lateral sclerosis (ALS) is challenging due to heterogeneity in clinical features of disease and a lack of suitable markers that predict survival. Our aim was to determine whether scoring of upper or lower motor neuron weakness is associated with survival. With this objective, 161 ALS subjects were recruited from two tertiary referral centres. Scoring of upper (UMN) and lower motor neuron (LMN) signs was performed, in addition to a brief questionnaire. Subjects were then followed until the censorship date. Univariate analysis was performed to identify variables associated with survival to either non-invasive ventilation (NIV) or death, which were then further characterized using Cox regression. Results showed that factors associated with reduced survival included older age, bulbar and respiratory involvement and shorter diagnostic delay (all p < 0.05). Whole body LMN score was strongly associated with time to NIV or death (p ≤0.001) whereas UMN scores were poorly associated with survival. In conclusion, our results suggest that, early in disease assessment and in the context of other factors (age, bulbar, respiratory status), the burden of LMN weakness provides an accurate estimate of outcome. Such a scoring system could predict prognosis, and thereby aid in selection of patients for clinical trials.

Subjective and objective scales to assess the development of children cerebral palsy.

PubMed

Pietrzak, S; Jóźwiak, M

2001-01-01

Many scoring systems hale been constructed to assess the motor development of cerebral palsy children and to evaluate the effectiveness of treatment. According to the purposes they fulfill, these instruments may be divided into three types: discriminative, evaluative and predictive. The design and measurement methodology are the criteria that determine whether a given scale is quantitative or qualitative in nature, and whether is should be considered to be objective or subjective. The article presents the "reaching, losing and regaining" scale (constructed by the authors to assess functional development and its changes in certain periods of time), the Munich Functional Development Diagnostics, and the Gross Motor Function Measure (GMFM). Special attention is given to the GMFM, its methods, evaluation of results, and application. A comparison of subjective and objective assessment of two cerebral palsy children is included.

Association between functional alterations of senescence and senility and disorders of gait and balance

PubMed Central

Teixeira-Leite, Homero; Manhães, Alex C.

2012-01-01

OBJECTIVES: Declines in cognition and mobility are frequently observed in the elderly, and it has been suggested that the appearance of gait disorders in older individuals may constitute a marker of cognitive decline that precedes significant findings in functional performance screening tests. This study sought to evaluate the relationship between functional capacities and gait and balance in an elderly community monitored by the Preventive and Integrated Care Unit of the Hospital Adventista Silvestre in Rio de Janeiro, RJ, Brazil. METHODS: Elderly individuals (193 females and 90 males) were submitted to a broad geriatric evaluation, which included the following tests: 1) a performance-oriented mobility assessment (POMA) to evaluate gait; 2) a mini-mental state examination (MMSE); 3) the use of Katz and Lawton scales to assess functional capacity; 4) the application of the geriatric depression scale (GDS); and 5) a mini-nutritional assessment (MNA) scale. RESULTS: Reductions in MMSE, Katz and Lawton scores were associated with reductions in POMA scores, and we also observed that significant reductions in POMA scores were present in persons for whom the MMSE and Katz scores did not clearly indicate cognitive dysfunction. We also demonstrated that a decline in the scores obtained with the GDS and MNA scales was associated with a decline in the POMA scores. CONCLUSIONS: Considering that significant alterations in the POMA scores were observed prior to the identification of significant alterations in cognitive capacity using either the MMSE or the Katz systems, a prospective study seems warranted to assess the predictive capacity of POMA scores regarding the associated decline in functional capacity. PMID:22892914

Outcome in patients with bacterial meningitis presenting with a minimal Glasgow Coma Scale score

PubMed Central

Lucas, Marjolein J.; Brouwer, Matthijs C.; van der Ende, Arie

2014-01-01

Objective: In bacterial meningitis, a decreased level of consciousness is predictive for unfavorable outcome, but the clinical features and outcome in patients presenting with a minimal score on the Glasgow Coma Scale are unknown. Methods: We assessed the incidence, clinical characteristics, and outcome of patients with bacterial meningitis presenting with a minimal score on the Glasgow Coma Scale from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2012. Results: Thirty of 1,083 patients (3%) presented with a score of 3 on the Glasgow Coma Scale. In 22 of 30 patients (73%), the minimal Glasgow Coma Scale score could be explained by use of sedative medication or complications resulting from meningitis such as seizures, cerebral edema, and hydrocephalus. Systemic (86%) and neurologic (47%) complications occurred frequently, leading to a high proportion of patients with unfavorable outcome (77%). However, 12 of 30 patients (40%) survived and 7 patients (23%) had a good functional outcome, defined as a score of 5 on the Glasgow Outcome Scale. Patients presenting with a minimal Glasgow Coma Scale score on admission and bilaterally absent pupillary light responses, bilaterally absent corneal reflexes, or signs of septic shock on admission all died. Conclusions: Patients with community-acquired bacterial meningitis rarely present with a minimal score on the Glasgow Coma Scale, but this condition is associated with high rates of morbidity and mortality. However, 1 out of 5 of these severely ill patients will make a full recovery, stressing the continued need for aggressive supportive care in these patients. PMID:25340065

Naming Speed of Adolescents and Young Adults with Attention Deficit Hyperactivity Disorder: Differences in Alphanumeric Versus Color/Object Naming.

PubMed

Whipple, Brittany D; Nelson, Jason M

2016-02-01

This study investigated the performance of adolescents and young adults with Attention Deficit Hyperactivity Disorder (ADHD), Reading Disorder (RD), and ADHD/RD on measures of alphanumeric and nonalphanumeric naming speed and the relationship between naming speed and academic achievement. The sample (N = 203) included students aged 17-28 years diagnosed with ADHD (n = 83), RD (n = 71), or ADHD/RD (n = 49). Individuals with ADHD performed significantly faster on measures of alphanumeric naming compared with RD and comorbid groups and, within group, demonstrated significantly quicker naming of letters/digits compared with colors/objects. Both alphanumeric rapid naming scores and processing speed scores variably predicted academic achievement scores across groups, whereas nonalphanumeric rapid naming only predicted reading comprehension scores within the ADHD group. Results support findings that older individuals with ADHD show relative weakness in rapid naming of objects and colors. Implications of these findings in regard to assessment of older individuals for ADHD are discussed. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Are gross motor skills and sports participation related in children with intellectual disabilities?

PubMed

Westendorp, Marieke; Houwen, Suzanne; Hartman, Esther; Visscher, Chris

2011-01-01

This study compared the specific gross motor skills of 156 children with intellectual disabilities (ID) (50 ≤ IQ ≥ 79) with that of 255 typically developing children, aged 7-12 years. Additionally, the relationship between the specific gross motor skills and organized sports participation was examined in both groups. The Test of Gross Motor Development-2 and a self-report measure were used to assess children's gross motor skills and sports participation, respectively. The children with ID scored significantly lower on almost all specific motor skill items than the typically developing children. Children with mild ID scored lower on the locomotor skills than children with borderline ID. Furthermore, we found in all groups that children with higher object-control scores participated more in organized sports than children with lower object-control scores. Our results support the importance of attention for well-developed gross motor skills in children with borderline and mild ID, especially to object-control skills, which might contribute positively to their sports participation. Copyright © 2011 Elsevier Ltd. All rights reserved.

An automated machine vision system for the histological grading of cervical intraepithelial neoplasia (CIN).

PubMed

Keenan, S J; Diamond, J; McCluggage, W G; Bharucha, H; Thompson, D; Bartels, P H; Hamilton, P W

2000-11-01

The histological grading of cervical intraepithelial neoplasia (CIN) remains subjective, resulting in inter- and intra-observer variation and poor reproducibility in the grading of cervical lesions. This study has attempted to develop an objective grading system using automated machine vision. The architectural features of cervical squamous epithelium are quantitatively analysed using a combination of computerized digital image processing and Delaunay triangulation analysis; 230 images digitally captured from cases previously classified by a gynaecological pathologist included normal cervical squamous epithelium (n=30), koilocytosis (n=46), CIN 1 (n=52), CIN 2 (n=56), and CIN 3 (n=46). Intra- and inter-observer variation had kappa values of 0.502 and 0.415, respectively. A machine vision system was developed in KS400 macro programming language to segment and mark the centres of all nuclei within the epithelium. By object-oriented analysis of image components, the positional information of nuclei was used to construct a Delaunay triangulation mesh. Each mesh was analysed to compute triangle dimensions including the mean triangle area, the mean triangle edge length, and the number of triangles per unit area, giving an individual quantitative profile of measurements for each case. Discriminant analysis of the geometric data revealed the significant discriminatory variables from which a classification score was derived. The scoring system distinguished between normal and CIN 3 in 98.7% of cases and between koilocytosis and CIN 1 in 76.5% of cases, but only 62.3% of the CIN cases were classified into the correct group, with the CIN 2 group showing the highest rate of misclassification. Graphical plots of triangulation data demonstrated the continuum of morphological change from normal squamous epithelium to the highest grade of CIN, with overlapping of the groups originally defined by the pathologists. This study shows that automated location of nuclei in cervical biopsies using computerized image analysis is possible. Analysis of positional information enables quantitative evaluation of architectural features in CIN using Delaunay triangulation meshes, which is effective in the objective classification of CIN. This demonstrates the future potential of automated machine vision systems in diagnostic histopathology. Copyright 2000 John Wiley & Sons, Ltd.

An image analysis toolbox for high-throughput C. elegans assays

PubMed Central

Wählby, Carolina; Kamentsky, Lee; Liu, Zihan H.; Riklin-Raviv, Tammy; Conery, Annie L.; O’Rourke, Eyleen J.; Sokolnicki, Katherine L.; Visvikis, Orane; Ljosa, Vebjorn; Irazoqui, Javier E.; Golland, Polina; Ruvkun, Gary; Ausubel, Frederick M.; Carpenter, Anne E.

2012-01-01

We present a toolbox for high-throughput screening of image-based Caenorhabditis elegans phenotypes. The image analysis algorithms measure morphological phenotypes in individual worms and are effective for a variety of assays and imaging systems. This WormToolbox is available via the open-source CellProfiler project and enables objective scoring of whole-animal high-throughput image-based assays of C. elegans for the study of diverse biological pathways relevant to human disease. PMID:22522656

Examination of Skill Acquisition and Grader Bias in a Distal Radius Fracture Fixation Model.

PubMed

Putnam, Matthew D; Adams, Julie E; Lender, Paul; Van Heest, Ann E; Shanedling, Janet R; Nuckley, David J; Bechtold, Joan E

2018-03-01

Primary: Assess the ability of faculty graders to predict the objectively measured strength of distal radius fracture fixation. Secondary: Compare resident skill variation and retention related to other knowable training data. Residents were allowed 60 minutes to stabilize a standardized distal radius fracture using an assigned fixed-angle volar plate. Faculty observed and subjectively graded the residents without providing real-time feedback. Objective biomechanical evaluation (construct strength and stiffness) was compared to subjective grades. Resident-specific characteristics (sex, PGY, and ACGME case log) were also used to compare the objective data. A simulated operating room in our laboratory. Post-graduate year 2, 3, 4, and 5 orthopedic residents. Primary: Faculty were not successful at predicting objectively measured fixation, and their subjective scoring suggests confirmation bias as PGY increased. Secondary: Resident year-in-training alone did not predict objective measures (p = 0.53), but was predictive of subjective scores (p < 0.001). Skills learned were not always retained, as 29% of residents objectively failed subsequent to passing. Notably, resident-reported case-specific experience alone was inversely correlated with objective fixation strength. This testing model enabled the collection of objective and subjective resident skill scores. Faculty graders did not routinely predict objective measures, and their subjective assessment appears biased related to PGY. Also, in vivo case volume alone does not predict objective results. Familiar faculty teaching consistency, and resident grading by external faculty unfamiliar with tested residents, might alter these results. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Assessment of burnout in veterinary medical students using the Maslach Burnout Inventory-Educational Survey: a survey during two semesters.

PubMed

Chigerwe, Munashe; Boudreaux, Karen A; Ilkiw, Jan E

2014-11-28

Burnout among veterinary students can result from known stressors in the absence of a support system. The objectives of this study were to evaluate use of the Maslach Burnout Inventory-Educator Survey (MBI-ES) to assess burnout in veterinary students and evaluate the factors that predict the MBI-ES scores. The MBI-ES was administered to first (Class of 2016) and second year (Class of 2015) veterinary medical students during the 2012-2013 academic year in the fall and spring semesters. Factor analysis and test reliability for the survey were determined. Mean scores for the subscales determining burnout namely emotional exhaustion (EE), depersonalization (DP) and lack of personal accomplishment (PA) were calculated for both classes in the 2 semesters. Multiple regression analysis was performed to evaluate other factors that predict the MBI-ES scores. A non-probability sampling method was implemented consisting of a voluntary sample of 170 and 123 students in the fall and spring semesters, respectively. Scores for EE, DP and PA were not different between the 2 classes within the same semester. Mean ± SD scores for EE, DP and PA for the fall semester were 22.9 ± 9.6, 5.0 ± 4.8 and 32.3 ± 6.7, respectively. Mean ± SD scores for EE, DP and PA the spring semester were 27.8 ± 10.7, 6.5 ± 6.1and 31.7 ± 6.8, respectively. The EE score was higher in spring compared to fall while DP and PA scores were not different between the 2 semesters. Living arrangements specifically as to whether or not a student lived with another veterinary medical students was the only variable significantly associated with the MBI-ES scores. Students in this study had moderate levels of burnout based on the MBI-ES scores. The MBI-ES was an acceptable instrument for assessing burnout in veterinary medical students. The EE scores were higher in the spring semester as compared to the fall semester. Thus students in the first and second years of veterinary school under the current curriculum experience the greatest levels of emotional exhaustion during the spring semester. This has administrative implications for the school, when considering the allocation and use of resources for student support systems during each semester.

Feasibility Study of Non-Destructive Techniques to Measure Corrosion in SAVY Containers

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

Davenport, Matthew Nicholas

2016-07-15

Stainless Steel SAVY containers are used to transport and store nuclear material. They are prone to interior corrosion in the presence of certain chemicals and a low-oxygen environment. SAVY containers also have relatively thin walls to reduce their weight, making their structural integrity more vulnerable to the effects of corrosion. A nondestructive evaluation system that finds and monitors corrosion within containers in use would improve safety conditions and preclude hazards. Non-destructive testing can determine whether oxidation or corrosion is occurring inside the SAVY containers, and there are a variety of non-destructive testing methods that may be viable. The feasibility studymore » described will objectively decide which method best fits the requirements of the facility and the problem. To improve efficiency, the containers cannot be opened during the non-destructive examination. The chosen technique should also be user-friendly and relatively quick to apply. It must also meet facility requirements regarding wireless technology and maintenance. A feasibility study is an objective search for a new technology or product to solve a particular problem. First, the design, technical, and facility feasibility requirements are chosen and ranked in order of importance. Then each technology considered is given a score based upon a standard ranking system. The technology with the highest total score is deemed the best fit for a certain application.« less

Evaluation of microfinance projects.

PubMed

Johnson, S

1999-08-01

This paper criticizes the quick system proposed by Henk Moll for evaluating microfinance projects in the article ¿How to Pre-Evaluate Credit Projects in Ten Minutes¿. The author contended that there is a need to emphasize the objectives of the project. The procedure used by Moll, he contended, is applicable only to projects that have only two key objectives, such as credit operations, and the provision of services. Arguments are presented on the three specific questions proposed by Moll, ranging from the availability of externally audited financial reports, the performance of interest rate on loans vis-a-vis the inflation rate, and the provision of loans according to the individual requirements of the borrowers. Lastly, the author emphasizes that the overall approach is not useful and suggests that careful considerations should be observed in the use or abuse of a simple scoring system or checklist such as the one proposed by Moll.

Evaluation of oral stereognostic ability after rehabilitating patients with complete dentures: in vivo study.

PubMed

Meenakshi, S; Gujjari, Anil Kumar; Thippeswamy, H N; Raghunath, N

2014-12-01

Stereognosis has been defined as the appreciation of the form of objects by palpation. Whilst this definition holds good for the manual exploration of objects, it is possible for the shape of objects to be explored intra orally referred to as oral stereognosis. To better understand patients' relative satisfaction with complete dentures, differences in oral stereognostic perception, based on the identification of 6 edible objects was analyzed in a group of 30 edentulous individuals at 3 stages, namely, just before (pre-treatment), 30 min after (30 min post-treatment) and 1 month after (1 month post-treatment) the insertion of new dentures. The time required to identify each object was recorded and the correctness of identification of each object was scored using oral stereognostic score. Descriptive statistics, Wilcoxon signed rank test, Spearman's rank correlation test, Pearson Chi square test was used to statistically analyze the data obtained. OSA scores was significantly increased 1 month post-treatment compared to 30 min post-treatment (p < 0.05). It was found that Oral stereognostic test is reliable for measuring patients' oral stereognostic perception and may be used as one of the clinical aids in appreciating the functional limitations imposed by the prostheses.

A method for reducing misclassification in the extended Glasgow Outcome Score.

PubMed

Lu, Juan; Marmarou, Anthony; Lapane, Kate; Turf, Elizabeth; Wilson, Lindsay

2010-05-01

The eight-point extended Glasgow Outcome Scale (GOSE) is commonly used as the primary outcome measure in traumatic brain injury (TBI) clinical trials. The outcome is conventionally collected through a structured interview with the patient alone or together with a caretaker. Despite the fact that using the structured interview questionnaires helps reach agreement in GOSE assessment between raters, significant variation remains among different raters. We introduce an alternate GOSE rating system as an aid in determining GOSE scores, with the objective of reducing inter-rater variation in the primary outcome assessment in TBI trials. Forty-five trauma centers were randomly assigned to three groups to assess GOSE scores on sample cases, using the alternative GOSE rating system coupled with central quality control (Group 1), the alternative system alone (Group 2), or conventional structured interviews (Group 3). The inter-rater variation between an expert and untrained raters was assessed for each group and reported through raw agreement and with weighted kappa (kappa) statistics. Groups 2 and 3 without central review yielded inter-rater agreements of 83% (weighted kappa = 0.81; 95% CI 0.69, 0.92) and 83% (weighted kappa = 0.76, 95% CI 0.63, 0.89), respectively, in GOS scores. In GOSE, the groups had an agreement of 76% (weighted kappa = 0.79; 95% CI 0.69, 0.89), and 63% (weighted kappa = 0.70; 95% CI 0.60, 0.81), respectively. The group using the alternative rating system coupled with central monitoring yielded the highest inter-rater agreement among the three groups in rating GOS (97%; weighted kappa = 0.95; 95% CI 0.89, 1.00), and GOSE (97%; weighted kappa = 0.97; 95% CI 0.91, 1.00). The alternate system is an improved GOSE rating method that reduces inter-rater variations and provides for the first time, source documentation and structured narratives that allow a thorough central review of information. The data suggest that a collective effort can be made to minimize inter-rater variation.

Deep learning-based artificial vision for grasp classification in myoelectric hands

NASA Astrophysics Data System (ADS)

Ghazaei, Ghazal; Alameer, Ali; Degenaar, Patrick; Morgan, Graham; Nazarpour, Kianoush

2017-06-01

Objective. Computer vision-based assistive technology solutions can revolutionise the quality of care for people with sensorimotor disorders. The goal of this work was to enable trans-radial amputees to use a simple, yet efficient, computer vision system to grasp and move common household objects with a two-channel myoelectric prosthetic hand. Approach. We developed a deep learning-based artificial vision system to augment the grasp functionality of a commercial prosthesis. Our main conceptual novelty is that we classify objects with regards to the grasp pattern without explicitly identifying them or measuring their dimensions. A convolutional neural network (CNN) structure was trained with images of over 500 graspable objects. For each object, 72 images, at {{5}\\circ} intervals, were available. Objects were categorised into four grasp classes, namely: pinch, tripod, palmar wrist neutral and palmar wrist pronated. The CNN setting was first tuned and tested offline and then in realtime with objects or object views that were not included in the training set. Main results. The classification accuracy in the offline tests reached 85 % for the seen and 75 % for the novel objects; reflecting the generalisability of grasp classification. We then implemented the proposed framework in realtime on a standard laptop computer and achieved an overall score of 84 % in classifying a set of novel as well as seen but randomly-rotated objects. Finally, the system was tested with two trans-radial amputee volunteers controlling an i-limb UltraTM prosthetic hand and a motion controlTM prosthetic wrist; augmented with a webcam. After training, subjects successfully picked up and moved the target objects with an overall success of up to 88 % . In addition, we show that with training, subjects’ performance improved in terms of time required to accomplish a block of 24 trials despite a decreasing level of visual feedback. Significance. The proposed design constitutes a substantial conceptual improvement for the control of multi-functional prosthetic hands. We show for the first time that deep-learning based computer vision systems can enhance the grip functionality of myoelectric hands considerably.

Exploring cartilage damage in gout using 3-T MRI: distribution and associations with joint inflammation and tophus deposition.

PubMed

Popovich, I; Dalbeth, N; Doyle, A; Reeves, Q; McQueen, F M

2014-07-01

Few imaging studies have investigated cartilage in gout. Magnetic resonance imaging (MRI) can image cartilage damage and also reveals other features of gouty arthropathy. The objective was to develop and validate a system for quantifying cartilage damage in gout. 3-T MRI scans of the wrist were obtained in 40 gout patients. MRI cartilage damage was quantified using an adaptation of the radiographic Sharp van der Heijde score. Two readers scored cartilage loss at 7 wrist joints: 0 (normal), 1 (partial narrowing), 2 (complete narrowing) and concomitant osteoarthritis was recorded. Bone erosion, bone oedema and synovitis were scored (RAMRIS) and tophi were assessed. Correlations between radiographic and MRI cartilage scores were investigated, as was the reliability of the MRI cartilage score and its associations. The GOut MRI Cartilage Score (GOMRICS) was highly correlated with the total Sharp van der Heijde (SvdH) score and the joint space narrowing component (R = 0.8 and 0.71 respectively, p < 0.001). Reliability was high (intraobserver, interobserver ICCs = 0.87 [0.57-0.97], 0.64 [0.41-0.79] respectively), and improved on unenhanced scans; interobserver ICC = 0.82 [0.49-0.95]. Cartilage damage was predominantly focal (82% of lesions) and identified in 40 out of 280 (14%) of joints. Cartilage scores correlated with bone erosion (R = 0.57), tophus size (R = 0.52), and synovitis (R = 0.55), but not bone oedema scores. Magnetic resonance imaging can be used to investigate cartilage in gout. Cartilage damage was relatively uncommon, focal, and associated with bone erosions, tophi and synovitis, but not bone oedema. This emphasises the unique pathophysiology of gout.

[Scoring systems in intensive care medicine : principles, models, application and limits].

PubMed

Fleig, V; Brenck, F; Wolff, M; Weigand, M A

2011-10-01

Scoring systems are used in all diagnostic areas of medicine. Several parameters are evaluated and rated with points according to their value in order to simplify a complex clinical situation with a score. The application ranges from the classification of disease severity through determining the number of staff for the intensive care unit (ICU) to the evaluation of new therapies under study conditions. Since the introduction of scoring systems in the 1980's a variety of different score models has been developed. The scoring systems that are employed in intensive care and are discussed in this article can be categorized into prognostic scores, expenses scores and disease-specific scores. Since the introduction of compulsory recording of two scoring systems for accounting in the German diagnosis-related groups (DRG) system, these tools have gained more importance for all intensive care physicians. Problems remain in the valid calculation of scores and interpretation of the results.

The Spatial Pattern of Intelligence in a Small Town.

ERIC Educational Resources Information Center

Bailey, William H.

The document measures the spatial patterns of mental abilities of 94 seventh-grade students within a small town by correlating and mapping four variables--IQ test scores, achievement test scores, neighborhood quality as seen by town officials, and creativity test scores from the Torrance Tests of Creative Thinking. Objectives were to ascertain the…

Analysis of Open-Ended Statistics Questions with Many Facet Rasch Model

ERIC Educational Resources Information Center

Güler, Nese

2014-01-01

Problem Statement: The most significant disadvantage of open-ended items that allow the valid measurement of upper level cognitive behaviours, such as synthesis and evaluation, is scoring. The difficulty associated with objectively scoring the answers to the items contributes to the reduction of the reliability of the scores. Moreover, other…

The book availability study as an objective measure of performance in a health sciences library.

PubMed Central

Kolner, S J; Welch, E C

1985-01-01

In its search for an objective overall diagnostic evaluation, the University of Illinois Library of the Health Sciences' Program Evaluation Committee selected a book availability measure; it is easy to administer and repeat, results are reproducible, and comparable data exist for other academic and health sciences libraries. The study followed the standard methodology in the literature with minor modifications. Patrons searching for particular books were asked to record item(s) needed and the outcome of the search. Library staff members then determined the reasons for failures in obtaining desired items. The results of the study are five performance scores. The first four represent the percentage probability of a library's operating with ideal effectiveness; the last provides an overall performance score. The scores of the Library of the Health Sciences demonstrated no unusual availability problems. The study was easy to implement and provided meaningful, quantitative, and objective data. PMID:3995202

Assessment of postoperative outcomes of hypospadias repair with validated questionnaires.

PubMed

Liu, Mona M Y; Holland, Andrew J A; Cass, Danny T

2015-12-01

A standardized assessment for the optimal repair of hypospadias remains elusive. This study utilized validated questionnaires to assess the postoperative functional, cosmetic, and psychosocial outcomes of hypospadias repair. 172 patients who underwent hypospadias repair under the care of a single surgeon were identified. 25 agreed for follow-up using the validated questionnaires of Hypospadias Objective Scoring Evaluation (HOSE), Pediatric Penile Perception Scale (PPPS), and Pediatric Quality of Life Inventory (PedsQL™4.0). Mean follow-up was 59months postoperatively (range 7-113months). Techniques used included tubularized incised plate urethroplasty, meatal advancement and glanuloplasty, and a 2-stage repair. 23 of 25 patients achieved a HOSE score of 14 or more (maximum of 16). The PPPS scores correlated with severity of the hypospadias. Those with glanular hypospadias (mean score=10) scored higher than those with coronal (mean score=9) and penile/penoscrotal hypospadias (mean score=7). There was no correlation between PedsQL™4.0 scores and the severity of hypospadias or procedure used. Validated questionnaires revealed generally good functional, cosmetic, and early psychosocial outcomes after hypospadias repair. The use of validated questionnaires in routine follow-up sessions may facilitate objective assessment of both functional outcomes and patient satisfaction. Copyright © 2015 Elsevier Inc. All rights reserved.

Psychomotor performance measured in a virtual environment correlates with technical skills in the operating room.

PubMed

Kundhal, Pavi S; Grantcharov, Teodor P

2009-03-01

This study was conducted to validate the role of virtual reality computer simulation as an objective method for assessing laparoscopic technical skills. The authors aimed to investigate whether performance in the operating room, assessed using a modified Objective Structured Assessment of Technical Skill (OSATS), correlated with the performance parameters registered by a virtual reality laparoscopic trainer (LapSim). The study enrolled 10 surgical residents (3 females) with a median of 5.5 years (range, 2-6 years) since graduation who had similar limited experience in laparoscopic surgery (median, 5; range, 1-16 laparoscopic cholecystectomies). All the participants performed three repetitions of seven basic skills tasks on the LapSim laparoscopic trainer and one laparoscopic cholecystectomy in the operating room. The operating room procedure was video recorded and blindly assessed by two independent observers using a modified OSATS rating scale. Assessment in the operating room was based on three parameters: time used, error score, and economy of motion score. During the tasks on the LapSim, time, error (tissue damage and millimeters of tissue damage [tasks 2-6], error score [incomplete target areas, badly placed clips, and dropped clips [task 7]), and economy of movement parameters (path length and angular path) were registered. The correlation between time, economy, and error parameters during the simulated tasks and the operating room procedure was statistically assessed using Spearman's test. Significant correlations were demonstrated between the time used to complete the operating room procedure and time used for task 7 (r (s) = 0.74; p = 0.015). The error score demonstrated during the laparoscopic cholecystectomy correlated well with the tissue damage in three of the seven tasks (p < 0.05), the millimeters of tissue damage during two of the tasks, and the error score in task 7 (r (s) = 0.67; p = 0.034). Furthermore, statistically significant correlations were observed between the economy of motion score from the operative procedure and LapSim's economy parameters (path length and angular path in six of the tasks) (p < 0.05). The current study demonstrated significant correlations between operative performance in the operating room (assessed using a well-validated rating scale) and psychomotor performance in virtual environment assessed by a computer simulator. This provides strong evidence for the validity of the simulator system as an objective tool for assessing laparoscopic skills. Virtual reality simulation can be used in practice to assess technical skills relevant for minimally invasive surgery.

[Evaluation and prioritisation of the scientific research in Spain. Researchers' point of view].

PubMed

María Martín-Moreno, José; Juan Toharia, José; Gutiérrez Fuentes, José Antonio

2008-12-01

The assessment and prioritisation of research activity are essential components of any Science, Technology and Industry System. Data on researchers' perspectives in this respect are scarce. The objective of this paper was to describe Spanish scientists' point of view on the current evaluation system in Spain and how they believe this system should be functionally structured. From the sampling frame formed by established Spanish scientists, listed in the databases of CSIC and FIS (Institute of Health Carlos III), clinical, biomedical-non clinical, and physics and chemical researchers were randomly selected. Two hundred and eleven interviews were carried out by means of a computer-assisted telephone interviewing system. Researchers expressed their acknowledgement of progress in the Spanish research field but made their wish clear to progress towards better scientific scenarios. In their assessment, they gave a score of 5.4 to scientific policy, as opposed to 9.4 when speaking about the goals, reflecting the desire for a better policy definition, with clear objectives, stable strategies and better coordination of R&D activities (the current coordination received a score of 3.9, while the desirable coordination was valued as high as 9.2). There was certain agreement regarding the need for a prioritisation criteria which preserves some degree of creativity by researchers. They also stated that they would like to see an independent research structure with social prestige and influence. The interviewed researchers believe that the evaluation of scientific activities is fundamental in formulating a sound scientific policy. Prioritisation should arise from appropriate evaluation. Strategies properly coordinated among all the stakeholders (including the private sector) should be fostered. Budget sufficiency, stability, and better organization of independent researchers should be the backbone of any strategy tailored to increase their capacity to influence future scientific policies.

Pregnancy Requires Major Changes in the Quality of the Diet for Nutritional Adequacy: Simulations in the French and the United States Populations

PubMed Central

Bianchi, Clélia M.; Mariotti, François; Verger, Eric O.; Huneau, Jean-François

2016-01-01

Background Maternal nutrition is critical to the health of both mother and offspring, but there is a paucity of data on the nutritional adequacy of diets during pregnancy. Objective Our objective was to identify to what extent pregnancy reduces the nutritional adequacy of the expecting mother’s diet and if this nutritional gap can be resolved by simple quantitative or qualitative changes in the diet. Materials and Methods We evaluated the observed overall nutritional adequacy of diets of French and American women of childbearing age participating in ENNS (n = 344) and NHANES (n = 563) using the probabilistic approach of the PANDiet system, resulting in a 100-point score. Then, we simulated the changes in the PANDiet scores of women of childbearing age who would remain on their diet during pregnancy. Finally, by either increasing the quantity of consumed foods or using eleven snacks recommended during pregnancy, we simulated the effect of a 150-kcal increase in the energy intake of French women. Results Observed PANDiet scores were equal to 59.3 ± 7.0 and 58.8 ± 9.3 points respectively in France and in the US. Simulation of pregnancy for women of childbearing age led to a decrease in nutritional adequacy for key nutrients during pregnancy and resulted in reducing PANDiet scores by 3.3 ± 0.1 and 3.7 ± 0.1 points in France and in the US. Simulated 150-kcal increases in energy intake proved to be only partially effective in filling the gap both when the quantity of food consumed was increased and when recommended snacks were used. Conclusions The decrease in nutritional adequacy induced by pregnancy cannot be addressed by simply following generic dietary guidelines. PMID:26959492

The substantial burden of systemic lupus erythematosus on the productivity and careers of patients: a European patient-driven online survey

PubMed Central

Isenberg, David; Lerstrøm, Kirsten; Norton, Yvonne; Nikaï, Enkeleida; Pushparajah, Daphnee S.; Schneider, Matthias

2013-01-01

Objective. The objective of this study was to explore the burden of SLE and its effect on patients’ lives. Methods. The Lupus European Online (LEO) survey included patient-designed questions on demographics, SLE diagnosis, and the impact of SLE on careers. Three SLE-specific patient-reported outcome (PRO) questionnaires were also completed: the Lupus Quality of Life (LupusQoL), the Fatigue Severity Scale (FSS), and the Work Productivity and Activity Impairment (WPAI)-Lupus v2.0. The survey was available online in five languages from May through August 2010. All self-identified SLE participants were eligible to respond. Survey results were analysed using descriptive statistics. Multivariate linear regression explored factors contributing to impaired productivity. Results. Of the 2070 European SLE patients completing the survey, 93.1% were women, 86.7% were aged <50 years and 71.8% had a college or university education. More than two-thirds of respondents (69.5%) reported that SLE affected their careers; 27.7% changed careers within a year of diagnosis. All LupusQoL domains (score range 0–100) were impaired, with fatigue (median domain score 43.8) being the most affected and intimate relationships (median domain score 75.0) the least. Most patients (82.5%) reported fatigue (FSS score ≥4). Productivity was impaired across all WPAI domains, both at work and in general activities. Fatigue, an inability to plan and reduced physical health were significantly associated with impaired productivity. Patients whose careers were affected by SLE had worse health-related quality of life, more fatigue and worse productivity than patients whose careers were not affected. Conclusion. LEO survey respondents reported that SLE negatively affects their daily lives, productivity and career choices. PMID:24049101

Allergic Diseases and Internalizing Behaviors in Early Childhood

PubMed Central

LeMasters, Grace K.; Levin, Linda; Rothenberg, Marc E.; Assa'ad, Amal H.; Newman, Nicholas; Bernstein, David; Khurana-Hershey, Gurjit; Lockey, James E.; Ryan, Patrick H.

2016-01-01

BACKGROUND AND OBJECTIVES: The relationship between allergic diseases and internalizing disorders has not been well characterized with regard to multiple allergic diseases or longitudinal study. The objective of this study was to examine the association between multiple allergic diseases in early childhood with validated measures of internalizing disorders in the school-age years. METHODS: Children enrolled in the Cincinnati Childhood Allergy and Air Pollution Study underwent skin testing and examinations at ages 1, 2, 3, 4, and 7 years. At age 7, parents completed the Behavior Assessment System for Children, Second Edition (BASC-2), a validated measure of childhood behavior and emotion. The association between allergic diseases at age 4, including allergic rhinitis, allergic persistent wheezing, atopic dermatitis, and allergic sensitization, and BASC-2 internalizing, anxiety, and depression T scores at age 7 was examined by logistic and linear regression, adjusting for covariates. RESULTS: The cohort included 546 children with complete information on allergic disease and BASC-2 outcomes. Allergic rhinitis at age 4 was significantly associated with elevated internalizing (adjusted odds ratio [aOR]: 3.2; 95% confidence interval [CI]: 1.8–5.8), anxiety (aOR: 2.0; 95% CI: 1.2–3.6), and depressive scores (aOR: 3.2; 95% CI: 1.7–6.5) at age 7. Allergic persistent wheezing was significantly associated with elevated internalizing scores (aOR: 2.7; 95% CI: 1.2–6.3). The presence of >1 allergic disease (aOR: 3.6; 95% CI: 1.7–7.6) and allergic rhinitis with comorbid allergic disease(s) (aOR: 4.3; 95% CI: 2.0–9.2) at age 4 had dose-dependent associations with internalizing scores. CONCLUSIONS: Children with allergic rhinitis and allergic persistent wheezing at age 4 are at increased risk of internalizing behaviors at age 7. Furthermore, multiple allergic diseases had a dose-dependent association with elevated internalizing scores. PMID:26715608

Partially supervised P300 speller adaptation for eventual stimulus timing optimization: target confidence is superior to error-related potential score as an uncertain label

NASA Astrophysics Data System (ADS)

Zeyl, Timothy; Yin, Erwei; Keightley, Michelle; Chau, Tom

2016-04-01

Objective. Error-related potentials (ErrPs) have the potential to guide classifier adaptation in BCI spellers, for addressing non-stationary performance as well as for online optimization of system parameters, by providing imperfect or partial labels. However, the usefulness of ErrP-based labels for BCI adaptation has not been established in comparison to other partially supervised methods. Our objective is to make this comparison by retraining a two-step P300 speller on a subset of confident online trials using naïve labels taken from speller output, where confidence is determined either by (i) ErrP scores, (ii) posterior target scores derived from the P300 potential, or (iii) a hybrid of these scores. We further wish to evaluate the ability of partially supervised adaptation and retraining methods to adjust to a new stimulus-onset asynchrony (SOA), a necessary step towards online SOA optimization. Approach. Eleven consenting able-bodied adults attended three online spelling sessions on separate days with feedback in which SOAs were set at 160 ms (sessions 1 and 2) and 80 ms (session 3). A post hoc offline analysis and a simulated online analysis were performed on sessions two and three to compare multiple adaptation methods. Area under the curve (AUC) and symbols spelled per minute (SPM) were the primary outcome measures. Main results. Retraining using supervised labels confirmed improvements of 0.9 percentage points (session 2, p < 0.01) and 1.9 percentage points (session 3, p < 0.05) in AUC using same-day training data over using data from a previous day, which supports classifier adaptation in general. Significance. Using posterior target score alone as a confidence measure resulted in the highest SPM of the partially supervised methods, indicating that ErrPs are not necessary to boost the performance of partially supervised adaptive classification. Partial supervision significantly improved SPM at a novel SOA, showing promise for eventual online SOA optimization.

Cataract surgeons outperform medical students in Eyesi virtual reality cataract surgery: evidence for construct validity.

PubMed

Selvander, Madeleine; Asman, Peter

2013-08-01

To investigate construct validity for modules hydromaneuvers and phaco on the Eyesi surgical simulator. Seven cataract surgeons and 17 medical students performed capsulorhexis, hydromaneuvers, phaco, navigation, forceps, cracking and chopping modules in a standardized manner. Three trials were performed on each module (two on phaco) in the above order. Performance parameters as calculated by the simulator for each trial were saved. Video recordings of the second trial of the modules capsulorhexis, hydromaneuvers and phaco were evaluated with the modified Objective Structured Assessment of Surgical Skill (OSATS) and Objective Structured Assessment of Cataract Surgical Skill (OSACSS) tools. Cataract surgeons outperformed medical students with regard to overall score on capsulorhexis (p < 0.001, p = 0.035, p = 0.010 for the tree iterations, respectively), navigation (p = 0.024, p = 0.307, p = 0.007), forceps (p = 0.017, p = 0.03, p = 0.028). Less obvious differences in overall score were found for modules cracking and chopping (p = 0.266, p = 0.022, p = 0.324) and phaco (p = 0.011, p = 0.081 for the two iterations, respectively). No differences in overall score were found on hydromaneuvers (p = 0.588, p = 0.503, p = 0.773), but surgeons received better scores from the evaluations of the modified OSATS (p = 0.001) and OSACSS (capsulorhexis, p = 0.003; hydromaneuvers, p = 0.017; phaco, p = 0.001). Construct validity was found on several modules previously not investigated (phaco, hydromaneuvers, cracking and chopping, navigation), and our results confirm previously demonstrated construct validity for capsulorhexis and forceps modules. Interestingly, validation of the hydromaneuvers module required OSACSS video evaluation tool. A further development of the scoring system in the simulator for the hydromaneuvers module would be advantageous and make training and evaluation of progress more accessible and immediate. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

Normative Data for the NeuroCom Sensory Organization Test in US Military Special Operations Forces

PubMed Central

Pletcher, Erin R.; Williams, Valerie J.; Abt, John P.; Morgan, Paul M.; Parr, Jeffrey J.; Wohleber, Meleesa F.; Lovalekar, Mita; Sell, Timothy C.

2017-01-01

Context: Postural stability is the ability to control the center of mass in relation to a person's base of support and can be affected by both musculoskeletal injury and traumatic brain injury. The NeuroCom Sensory Organization Test (SOT) can be used to objectively quantify impairments to postural stability. The ability of postural stability to predict injury and be used as an acute injury-evaluation tool makes it essential to the screening and rehabilitation process. To our knowledge, no published normative data for the SOT from a healthy, highly active population are available for use as a reference for clinical decision making. Objective: To present a normative database of SOT scores from a US Military Special Operations population that can be used for future comparison. Design: Cross-sectional study. Setting: Human performance research laboratory. Patients or Other Participants: A total of 542 active military operators from Naval Special Warfare Combatant-Craft Crewmen (n = 149), Naval Special Warfare Command, Sea, Air, and Land (n = 101), US Army Special Operations Command (n = 171), and Air Force Special Operations Command (n = 121). Main Outcome Measure(s): Participants performed each of the 6 SOT conditions 3 times. Scores for each condition, total equilibrium composite score, and ratio scores for the somatosensory, visual, and vestibular systems were recorded. Results: Differences were present across all groups for SOT conditions 1 (P < .001), 2 (P = .001), 4 (P > .001), 5 (P > .001), and 6 (P = .001) and total equilibrium composite (P = .000), visual (P > .001), vestibular (P = .002), and preference (P > .001) NeuroCom scores. Conclusions: Statistical differences were evident in the distribution of postural stability across US Special Operations Forces personnel. This normative database for postural stability, as assessed by the NeuroCom SOT, can provide context when clinicians assess a Special Operations Forces population or any other groups that maintain a high level of conditioning and training. PMID:28140624

Detection of vehicle parts based on Faster R-CNN and relative position information

NASA Astrophysics Data System (ADS)

Zhang, Mingwen; Sang, Nong; Chen, Youbin; Gao, Changxin; Wang, Yongzhong

2018-03-01

Detection and recognition of vehicles are two essential tasks in intelligent transportation system (ITS). Currently, a prevalent method is to detect vehicle body, logo or license plate at first, and then recognize them. So the detection task is the most basic, but also the most important work. Besides the logo and license plate, some other parts, such as vehicle face, lamp, windshield and rearview mirror, are also key parts which can reflect the characteristics of vehicle and be used to improve the accuracy of recognition task. In this paper, the detection of vehicle parts is studied, and the work is novel. We choose Faster R-CNN as the basic algorithm, and take the local area of an image where vehicle body locates as input, then can get multiple bounding boxes with their own scores. If the box with maximum score is chosen as final result directly, it is often not the best one, especially for small objects. This paper presents a method which corrects original score with relative position information between two parts. Then we choose the box with maximum comprehensive score as the final result. Compared with original output strategy, the proposed method performs better.

Assessing the predictive value of the American Board of Family Practice In-training Examination.

PubMed

Replogle, William H; Johnson, William D

2004-03-01

The American Board of Family Practice In-training Examination (ABFP ITE) is a cognitive examination similar in content to the ABFP Certification Examination (CE). The ABFP ITE is widely used in family medicine residency programs. It was originally developed and intended to be used for assessment of groups of residents. Despite lack of empirical support, however, some residency programs are using ABFP ITE scores as individual resident performance indicators. This study's objective was to estimate the positive predictive value of the ABFP ITE for identifying residents at risk for poor performance on the ABFP CE or a subsequent ABFP ITE. We used a normal distribution model for correlated test scores and Monte Carlo simulation to investigate the effect of test reliability (measurement errors) on the positive predictive value of the ABFP ITE. The positive predictive value of the composite score was .72. The positive predictive value of the eight specialty subscales ranged from .26 to .57. Only the composite score of the ABFP ITE has acceptable positive predictive value to be used as part of a comprehension resident evaluation system. The ABFP ITE specialty subscales do not have sufficient positive predictive value or reliability to warrant use as performance indicators.

Failure mode and effects analysis drastically reduced potential risks in clinical trial conduct.

PubMed

Lee, Howard; Lee, Heechan; Baik, Jungmi; Kim, Hyunjung; Kim, Rachel

2017-01-01

Failure mode and effects analysis (FMEA) is a risk management tool to proactively identify and assess the causes and effects of potential failures in a system, thereby preventing them from happening. The objective of this study was to evaluate effectiveness of FMEA applied to an academic clinical trial center in a tertiary care setting. A multidisciplinary FMEA focus group at the Seoul National University Hospital Clinical Trials Center selected 6 core clinical trial processes, for which potential failure modes were identified and their risk priority number (RPN) was assessed. Remedial action plans for high-risk failure modes (RPN >160) were devised and a follow-up RPN scoring was conducted a year later. A total of 114 failure modes were identified with an RPN score ranging 3-378, which was mainly driven by the severity score. Fourteen failure modes were of high risk, 11 of which were addressed by remedial actions. Rescoring showed a dramatic improvement attributed to reduction in the occurrence and detection scores by >3 and >2 points, respectively. FMEA is a powerful tool to improve quality in clinical trials. The Seoul National University Hospital Clinical Trials Center is expanding its FMEA capability to other core clinical trial processes.

Prediction of drug synergy in cancer using ensemble-based machine learning techniques

NASA Astrophysics Data System (ADS)

Singh, Harpreet; Rana, Prashant Singh; Singh, Urvinder

2018-04-01

Drug synergy prediction plays a significant role in the medical field for inhibiting specific cancer agents. It can be developed as a pre-processing tool for therapeutic successes. Examination of different drug-drug interaction can be done by drug synergy score. It needs efficient regression-based machine learning approaches to minimize the prediction errors. Numerous machine learning techniques such as neural networks, support vector machines, random forests, LASSO, Elastic Nets, etc., have been used in the past to realize requirement as mentioned above. However, these techniques individually do not provide significant accuracy in drug synergy score. Therefore, the primary objective of this paper is to design a neuro-fuzzy-based ensembling approach. To achieve this, nine well-known machine learning techniques have been implemented by considering the drug synergy data. Based on the accuracy of each model, four techniques with high accuracy are selected to develop ensemble-based machine learning model. These models are Random forest, Fuzzy Rules Using Genetic Cooperative-Competitive Learning method (GFS.GCCL), Adaptive-Network-Based Fuzzy Inference System (ANFIS) and Dynamic Evolving Neural-Fuzzy Inference System method (DENFIS). Ensembling is achieved by evaluating the biased weighted aggregation (i.e. adding more weights to the model with a higher prediction score) of predicted data by selected models. The proposed and existing machine learning techniques have been evaluated on drug synergy score data. The comparative analysis reveals that the proposed method outperforms others in terms of accuracy, root mean square error and coefficient of correlation.

Neural Correlates to Food-Related Behavior in Normal-Weight and Overweight/Obese Participants

PubMed Central

Ho, Alan; Kennedy, James; Dimitropoulos, Anastasia

2012-01-01

Two thirds of US adults are either obese or overweight and this rate is rising. Although the etiology of obesity is not yet fully understood, neuroimaging studies have demonstrated that the central nervous system has a principal role in regulating eating behavior. In this study, functional magnetic resonance imaging and survey data were evaluated for correlations between food-related problem behaviors and the neural regions underlying responses to visual food cues before and after eating in normal-weight individuals and overweight/obese individuals. In normal-weight individuals, activity in the left amygdala in response to high-calorie food vs. nonfood object cues was positively correlated with impaired satiety scores during fasting, suggesting that those with impaired satiety scores may have an abnormal anticipatory reward response. In overweight/obese individuals, activity in the dorsolateral prefrontal cortex (DLPFC) in response to low-calorie food cues was negatively correlated with impaired satiety during fasting, suggesting that individuals scoring lower in satiety impairment were more likely to activate the DLPFC inhibitory system. After eating, activity in both the putamen and the amygdala was positively correlated with impaired satiety scores among obese/overweight participants. While these individuals may volitionally suggest they are full, their functional response to food cues suggests food continues to be salient. These findings suggest brain regions involved in the evaluation of visual food cues may be mediated by satiety-related problems, dependent on calorie content, state of satiation, and body mass index. PMID:23028988

Instrument Motion Metrics for Laparoscopic Skills Assessment in Virtual Reality and Augmented Reality.

PubMed

Fransson, Boel A; Chen, Chi-Ya; Noyes, Julie A; Ragle, Claude A

2016-11-01

To determine the construct and concurrent validity of instrument motion metrics for laparoscopic skills assessment in virtual reality and augmented reality simulators. Evaluation study. Veterinarian students (novice, n = 14) and veterinarians (experienced, n = 11) with no or variable laparoscopic experience. Participants' minimally invasive surgery (MIS) experience was determined by hospital records of MIS procedures performed in the Teaching Hospital. Basic laparoscopic skills were assessed by 5 tasks using a physical box trainer. Each participant completed 2 tasks for assessments in each type of simulator (virtual reality: bowel handling and cutting; augmented reality: object positioning and a pericardial window model). Motion metrics such as instrument path length, angle or drift, and economy of motion of each simulator were recorded. None of the motion metrics in a virtual reality simulator showed correlation with experience, or to the basic laparoscopic skills score. All metrics in augmented reality were significantly correlated with experience (time, instrument path, and economy of movement), except for the hand dominance metric. The basic laparoscopic skills score was correlated to all performance metrics in augmented reality. The augmented reality motion metrics differed between American College of Veterinary Surgeons diplomates and residents, whereas basic laparoscopic skills score and virtual reality metrics did not. Our results provide construct validity and concurrent validity for motion analysis metrics for an augmented reality system, whereas a virtual reality system was validated only for the time score. © Copyright 2016 by The American College of Veterinary Surgeons.

Comparison of Static and Dynamic Balance in Female Collegiate Soccer, Basketball, and Gymnastics Athletes

PubMed Central

Bressel, Eadric; Yonker, Joshua C; Kras, John; Heath, Edward M

2007-01-01

Context: How athletes from different sports perform on balance tests is not well understood. When prescribing balance exercises to athletes in different sports, it may be important to recognize performance variations. Objective: To compare static and dynamic balance among collegiate athletes competing or training in soccer, basketball, and gymnastics. Design: A quasi-experimental, between-groups design. Independent variables included limb (dominant and nondominant) and sport played. Setting: A university athletic training facility. Patients or Other Participants: Thirty-four female volunteers who competed in National Collegiate Athletic Association Division I soccer (n = 11), basketball (n = 11), or gymnastics (n = 12). Intervention(s): To assess static balance, participants performed 3 stance variations (double leg, single leg, and tandem leg) on 2 surfaces (stiff and compliant). For assessment of dynamic balance, participants performed multidirectional maximal single-leg reaches from a unilateral base of support. Main Outcome Measure(s): Errors from the Balance Error Scoring System and normalized leg reach distances from the Star Excursion Balance Test were used to assess static and dynamic balance, respectively. Results: Balance Error Scoring System error scores for the gymnastics group were 55% lower than for the basketball group (P = .01), and Star Excursion Balance Test scores were 7% higher in the soccer group than the basketball group (P = .04). Conclusions: Gymnasts and soccer players did not differ in terms of static and dynamic balance. In contrast, basketball players displayed inferior static balance compared with gymnasts and inferior dynamic balance compared with soccer players. PMID:17597942

"Alarm-corrected" ergonomic armrest use could improve learning curves of novices on robotic simulator.

PubMed

Yang, Kun; Perez, Manuela; Hossu, Gabriela; Hubert, Nicolas; Perrenot, Cyril; Hubert, Jacques

2017-01-01

In robotic surgery, the professional ergonomic habit of using an armrest reduces operator fatigue and increases the precision of motion. We designed and validated a pressure surveillance system (PSS) based on force sensors to investigate armrest use. The objective was to evaluate whether adding an alarm to the PSS system could shorten ergonomic training and improve performance. Twenty robot and simulator-naïve participants were recruited and randomized in two groups (A and B). The PSS was installed on a robotic simulator, the dV-Trainer, to detect contact with the armrest. The Group A members completed three tasks on the dV-Trainer without the alarm, making 15 attempts at each task. The Group B members practiced the first two tasks with the alarm and then completed the final tasks without the alarm. The simulator provided an overall score reflecting the trainees' performance. We used the new concept of an "armrest load" score to describe the ergonomic habit of using the armrest. Group B had a significantly higher performance score (p < 0.001) and armrest load score (p < 0.001) than Group A from the fifth attempt of the first task to the end of the experiment. Based on the conditioned reflex effect, the alarm associated with the PSS rectified ergonomic errors and accelerated professional ergonomic habit acquisition. The combination of the PSS and alarm is effective in significantly shortening the learning curve in the robotic training process.

The validation of the visual analogue scale for patient satisfaction after total hip arthroplasty.

PubMed

Brokelman, Roy B G; Haverkamp, Daniel; van Loon, Corné; Hol, Annemiek; van Kampen, Albert; Veth, Rene

2012-06-01

INTRODUCTION: Patient satisfaction becomes more important in our modern health care system. The assessment of satisfaction is difficult because it is a multifactorial item for which no golden standard exists. One of the potential methods of measuring satisfaction is by using the well-known visual analogue scale (VAS). In this study, we validated VAS for satisfaction. PATIENT AND METHODS: In this prospective study, we studied 147 patients (153 hips). The construct validity was measured using the Spearman correlation test that compares the satisfaction VAS with the Harris hip score, pain VAS at rest and during activity, Oxford hip score, Short Form 36 and Western Ontario McMaster Universities Osteoarthritis Index. The reliability was tested using the intra-class coefficient. RESULTS: The Pearson correlation test showed correlations in the range of 0.40-0.80. The satisfaction VAS had a high correlation between the pain VAS and Oxford hip score, which could mean that pain is one of the most important factors in patient satisfaction. The intra-class coefficient was 0.95. CONCLUSIONS: There is a moderate to mark degree of correlation between the satisfaction VAS and the currently available subjective and objective scoring systems. The intra-class coefficient of 0.95 indicates an excellent test-retest reliability. The VAS satisfaction is a simple instrument to quantify the satisfaction of a patient after total hip arthroplasty. In this study, we showed that the satisfaction VAS has a good validity and reliability.

Development and validation of the Pediatric Anesthesia Behavior score--an objective measure of behavior during induction of anesthesia.

PubMed

Beringer, Richard M; Greenwood, Rosemary; Kilpatrick, Nicky

2014-02-01

Measuring perioperative behavior changes requires validated objective rating scales. We developed a simple score for children's behavior during induction of anesthesia (Pediatric Anesthesia Behavior score) and assessed its reliability, concurrent validity, and predictive validity. Data were collected as part of a wider observational study of perioperative behavior changes in children undergoing general anesthesia for elective dental extractions. One-hundred and two healthy children aged 2-12 were recruited. Previously validated behavioral scales were used as follows: the modified Yale Preoperative Anxiety Scale (m-YPAS); the induction compliance checklist (ICC); the Pediatric Anesthesia Emergence Delirium scale (PAED); and the Post-Hospitalization Behavior Questionnaire (PHBQ). Pediatric Anesthesia Behavior (PAB) score was independently measured by two investigators, to allow assessment of interobserver reliability. Concurrent validity was assessed by examining the correlation between the PAB score, the m-YPAS, and the ICC. Predictive validity was assessed by examining the association between the PAB score, the PAED scale, and the PHBQ. The PAB score correlated strongly with both the m-YPAS (P < 0.001) and the ICC (P < 0.001). PAB score was significantly associated with the PAED score (P = 0.031) and with the PHBQ (P = 0.034). Two independent investigators recorded identical PAB scores for 94% of children and overall, there was close agreement between scores (Kappa coefficient of 0.886 [P < 0.001]). The PAB score is simple to use and may predict which children are at increased risk of developing postoperative behavioral disturbance. This study provides evidence for its reliability and validity. © 2013 John Wiley & Sons Ltd.

Sympathetic nervous system activity measured by skin conductance quantifies the challenge of walking adaptability tasks after stroke

PubMed Central

Clark, David J.; Chatterjee, Sudeshna A.; McGuirk, Theresa E.; Porges, Eric C.; Fox, Emily J.; Balasubramanian, Chitralakshmi K.

2018-01-01

Background Walking adaptability tasks are challenging for people with motor impairments. The construct of perceived challenge is typically measured by self-report assessments, which are susceptible to subjective measurement error. The development of an objective physiologically-based measure of challenge may help to improve the ability to assess this important aspect of mobility function. The objective of this study to investigate the use of sympathetic nervous system (SNS) activity measured by skin conductance to gauge the physiological stress response to challenging walking adaptability tasks in people post-stroke. Methods Thirty adults with chronic post-stroke hemiparesis performed a battery of seventeen walking adaptability tasks. SNS activity was measured by skin conductance from the palmar surface of each hand. The primary outcome variable was the percent change in skin conductance level (ΔSCL) between the baseline resting and walking phases of each task. Task difficulty was measured by performance speed and by physical therapist grading of performance. Walking function and balance confidence were measured by preferred walking speed and the Activities Specific Balance Confidence Scale, respectively. Results There was a statistically significant negative association between ΔSCL and task performance speed and between ΔSCL and clinical score, indicating that tasks with greater SNS activity had slower performance speed and poorer clinical scores. ΔSCL was significantly greater for low functioning participants versus high functioning participants, particularly during the most challenging walking adaptability tasks. Conclusion This study supports the use of SNS activity measured by skin conductance as a valuable approach for objectively quantifying the perceived challenge of walking adaptability tasks in people post-stroke. PMID:29216598

Prophylactic Groin Wound Vacuum-assisted Therapy in Vascular Surgery Patients at Enhanced Risk for Postoperative Wound Infection.

PubMed

Pesonen, Luke O; Halloran, Brian G; Aziz, Abdulhameed

2018-01-01

Vascular groin wounds have higher than expected surgical site infection (SSI) rates and some patients are at enhanced risk. The Wiseman et al. paper suggests an objective scoring system that identifies patients at enhanced risk of postdischarge SSI. We hypothesize that prophylactic groin wound vacuum-assisted closure (VAC) therapy in enhanced risk patients will decrease SSI and readmission and the Wiseman model provides potential evidence that enhanced risk patients can be objectively identified. A single institution, retrospective analysis was conducted from January 2013 to September 2016 utilizing procedure codes to identify patients with wound VACs placed in the operating room. Two distinct groups were identified. The first was a wound complication patient group with 15 limbs (13 patients) with a groin wound VAC placed within 45 days postoperatively for groin wound complications. Eleven of these limbs had the VAC placed at readmission. The second group was a prophylactic patient group that included 8 limbs (7 patients) who received a VAC prophylactically placed in the enhanced risk wounds. These wounds were determined to be enhanced risk based on clinical criteria judged by the operating surgeon such as a large overhanging panniculus and/or one of several ongoing medical issues. We calculated a Wiseman score for all patients, determined total cost of the readmissions, and determined 30-day postsurgical SSI incidence for the prophylactic VAC group. Per the Wiseman scores, 9 limbs with postoperative complications were high risk and 3 limbs were moderate/high risk. Eleven limbs had a VAC placed at readmission with an average readmission cost of $8876.77. For the prophylactic group, 8 limbs were high risk with no observed postdischarge SSI in the first 30 days from surgery. The Wiseman scores showed close correlation between the retrospective high and moderate/high risk groups versus the prophylactic VAC group (31.5 ± 7.3 vs. 32 ± 5.5, P = 0.87). The Wiseman scores showed objective validation in the prognosis of anticipating groin wound breakdown. Our initial results suggest that prophylactic groin wound VAC placement for enhanced risk vascular surgery patients may proactively decrease wound morbidity, decrease readmission secondary to groin wound complications, and provide some cost benefit. Copyright © 2017 Elsevier Inc. All rights reserved.

Does real-time objective feedback and competition improve performance and quality in manikin CPR training--a prospective observational study from several European EMS.

PubMed

Smart, J R; Kranz, K; Carmona, F; Lindner, T W; Newton, A

2015-10-15

Previous studies have reported that the quality of cardiopulmonary resuscitation (CPR) is important for patient survival. Real time objective feedback during manikin training has been shown to improve CPR performance. Objective measurement could facilitate competition and help motivate participants to improve their CPR performance. The aims of this study were to investigate whether real time objective feedback on manikins helps improve CPR performance and whether competition between separate European Emergency Medical Services (EMS) and between participants at each EMS helps motivation to train. Ten European EMS took part in the study and was carried out in two stages. At Stage 1, each EMS provided 20 pre-hospital professionals. A questionnaire was completed and standardised assessment scenarios were performed for adult and infant out of hospital cardiac arrest (OHCA). CPR performance was objectively measured and recorded but no feedback given. Between Stage 1 and 2, each EMS was given access to manikins for 6 months and instructed on how to use with objective real-time CPR feedback available. Stage 2 was undertaken and was a repeat of Stage 1 with a questionnaire with additional questions relating to usefulness of feedback and the competition nature of the study (using a 10 point Likert score). The EMS that improved the most from Stage 1 to Stage 2 was declared the winner. An independent samples Student t-test was used to analyse the objective CPR metrics with the significance level taken as p < 0.05. Overall mean Improvement of CPR performance from Stage 1 to Stage 2 was significant. The improvement was greater for the infant assessment. The participants thought the real-time feedback very useful (mean score of 8.5) and very easy to use (mean score of 8.2). Competition between EMS organisations recorded a mean score of 5.8 and competition between participants recorded a mean score of 6.0. The results suggest that the use of real time objective feedback can significantly help improve CPR performance. Competition, especially between participants, appeared to encourage staff to practice and this study suggests that competition might have a useful role to help motivate staff to perform CPR training.

Evaluation of modified Alvarado scoring system and RIPASA scoring system as diagnostic tools of acute appendicitis.

PubMed

Shuaib, Abdullah; Shuaib, Ali; Fakhra, Zainab; Marafi, Bader; Alsharaf, Khalid; Behbehani, Abdullah

2017-01-01

Acute appendicitis is the most common surgical condition presented in emergency departments worldwide. Clinical scoring systems, such as the Alvarado and modified Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%-10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specifically for Asian populations. The aim of this study was to compare the modified Alvarado with the RIPASA scoring system in Kuwait population. This study included 180 patients who underwent appendectomies and were documented as having "acute appendicitis" or "abdominal pain" in the operating theatre logbook (unit B) from November 2014 to March 2016. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modified Alvarado and RIPASA scoring systems were derived using SPSS statistical software. A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modified Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specificity of 56%. The PPV was 89.3% and the NPV was 42.4%. The cut-off threshold point of the RIPASA score was set at 7.5, which yielded a 94.5% sensitivity and an 88% specificity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modified Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased significantly, from 18.4% to 10.7% for the modified Alvarado, and to 2.2% for the RIPASA scoring system, which was a significant difference (P<0.001) for both scoring systems. Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specificity than the modified Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations. The RIPASA scoring system is more accurate and specific than the modified Alvarado scoring system for Kuwait population.

Automatically rating trainee skill at a pediatric laparoscopic suturing task.

PubMed

Oquendo, Yousi A; Riddle, Elijah W; Hiller, Dennis; Blinman, Thane A; Kuchenbecker, Katherine J

2018-04-01

Minimally invasive surgeons must acquire complex technical skills while minimizing patient risk, a challenge that is magnified in pediatric surgery. Trainees need realistic practice with frequent detailed feedback, but human grading is tedious and subjective. We aim to validate a novel motion-tracking system and algorithms that automatically evaluate trainee performance of a pediatric laparoscopic suturing task. Subjects (n = 32) ranging from medical students to fellows performed two trials of intracorporeal suturing in a custom pediatric laparoscopic box trainer after watching a video of ideal performance. The motions of the tools and endoscope were recorded over time using a magnetic sensing system, and both tool grip angles were recorded using handle-mounted flex sensors. An expert rated the 63 trial videos on five domains from the Objective Structured Assessment of Technical Skill (OSATS), yielding summed scores from 5 to 20. Motion data from each trial were processed to calculate 280 features. We used regularized least squares regression to identify the most predictive features from different subsets of the motion data and then built six regression tree models that predict summed OSATS score. Model accuracy was evaluated via leave-one-subject-out cross-validation. The model that used all sensor data streams performed best, achieving 71% accuracy at predicting summed scores within 2 points, 89% accuracy within 4, and a correlation of 0.85 with human ratings. 59% of the rounded average OSATS score predictions were perfect, and 100% were within 1 point. This model employed 87 features, including none based on completion time, 77 from tool tip motion, 3 from tool tip visibility, and 7 from grip angle. Our novel hardware and software automatically rated previously unseen trials with summed OSATS scores that closely match human expert ratings. Such a system facilitates more feedback-intensive surgical training and may yield insights into the fundamental components of surgical skill.

Soft Tissue Surgery for Adults With Nonfunctional, Spastic Hands Following Central Nervous System Lesions: A Retrospective Study.

PubMed

Gatin, Laure; Schnitzler, Alexis; Calé, Fabien; Genêt, Guillaume; Denormandie, Philippe; Genêt, François

2017-12-01

Soft tissue surgery for upper extremity contractures can improve hygiene, pain, and appearance in adults with central nervous system lesions. The goal of such interventions is highly individual; thus, goal attainment scaling (GAS; a method of scoring the extent to which patient's individual goals are achieved [5 levels] in the course of intervention and using T score values) is pertinent to evaluate outcome. The objective of this study was to assess the effect of soft tissue surgery for upper extremity muscle contractures in patients with central nervous system lesions using GAS. Retrospective data from 70 interventions were included (63 patients; 23 women). The mean age was 51.3 ± 16.2 years (range, 24.2-87.0 years). The primary goal was to improve hygiene (n = 58), pain (n = 10), or appearance (n = 2). The etiologies were stroke (n = 35), traumatic brain injury (n = 16), cerebral anoxia (n = 4), neurodegenerative disease (n = 6), and cerebral palsy (n = 2). The GAS score was calculated before surgery and 3 months after surgery. The T score (which took into account the weight of each goal) was 52.3 at 3 months (38.5 before surgery), corresponding to a "better than expected" outcome. The mean of the differences of the GAS score for each goal before and after surgery increased by 1.27 for hygiene, 1.06 for pain, and 1.00 for appearance. Soft tissue surgery can safely and effectively improve hygiene, pain, and appearance in adults with cerebral damage. The preoperative evaluation should be multidisciplinary. The GAS is a useful tool to assess the effectiveness of orthopedic surgery for these patients. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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.

Cue-based assertion classification for Swedish clinical text – developing a lexicon for pyConTextSwe

PubMed Central

Velupillai, Sumithra; Skeppstedt, Maria; Kvist, Maria; Mowery, Danielle; Chapman, Brian E.; Dalianis, Hercules; Chapman, Wendy W.

2014-01-01

Objective The ability of a cue-based system to accurately assert whether a disorder is affirmed, negated, or uncertain is dependent, in part, on its cue lexicon. In this paper, we continue our study of porting an assertion system (pyConTextNLP) from English to Swedish (pyConTextSwe) by creating an optimized assertion lexicon for clinical Swedish. Methods and material We integrated cues from four external lexicons, along with generated inflections and combinations. We used subsets of a clinical corpus in Swedish. We applied four assertion classes (definite existence, probable existence, probable negated existence and definite negated existence) and two binary classes (existence yes/no and uncertainty yes/no) to pyConTextSwe. We compared pyConTextSwe’s performance with and without the added cues on a development set, and improved the lexicon further after an error analysis. On a separate evaluation set, we calculated the system’s final performance. Results Following integration steps, we added 454 cues to pyConTextSwe. The optimized lexicon developed after an error analysis resulted in statistically significant improvements on the development set (83% F-score, overall). The system’s final F-scores on an evaluation set were 81% (overall). For the individual assertion classes, F-score results were 88% (definite existence), 81% (probable existence), 55% (probable negated existence), and 63% (definite negated existence). For the binary classifications existence yes/no and uncertainty yes/no, final system performance was 97%/87% and 78%/86% F-score, respectively. Conclusions We have successfully ported pyConTextNLP to Swedish (pyConTextSwe). We have created an extensive and useful assertion lexicon for Swedish clinical text, which could form a valuable resource for similar studies, and which is publicly available. PMID:24556644

Exposure to fall hazards and safety climate in the aircraft maintenance industry.

PubMed

Neitzel, Richard L; Seixas, Noah S; Harris, Michael J; Camp, Janice

2008-01-01

Falls represent a significant occupational hazard, particularly in industries with dynamic work environments. This paper describes rates of noncompliance with fall hazard prevention requirements, perceived safety climate and worker knowledge and beliefs, and the association between fall exposure and safety climate measures in commercial aircraft maintenance activities. Walkthrough observations were conducted on aircraft mechanics at two participating facilities (Sites A and B) to ascertain the degree of noncompliance. Mechanics at each site completed questionnaires concerning fall hazard knowledge, personal safety beliefs, and safety climate. Questionnaire results were summarized into safety climate and belief scores by workgroup and site. Noncompliance rates observed during walkthroughs were compared to the climate-belief scores, and were expected to be inversely associated. Important differences were seen in fall safety performance between the sites. The study provided a characterization of aircraft maintenance fall hazards, and also demonstrated the effectiveness of an objective hazard assessment methodology. Noncompliance varied by height, equipment used, location of work on the aircraft, shift, and by safety system. Although the expected relationship between safety climate and noncompliance was seen for site-average climate scores, workgroups with higher safety climate scores had greater observed noncompliance within Site A. Overall, use of engineered safety systems had a significant impact on working safely, while safety beliefs and climate also contributed, though inconsistently. The results of this study indicate that safety systems are very important in reducing noncompliance with fall protection requirements in aircraft maintenance facilities. Site-level fall safety compliance was found to be related to safety climate, although an unexpected relationship between compliance and safety climate was seen at the workgroup level within site. Finally, observed fall safety compliance was found to differ from self-reported compliance.

Performance characteristics of NuVal and the Overall Nutritional Quality Index (ONQI).

PubMed

Katz, David L; Njike, Valentine Y; Rhee, Lauren Q; Reingold, Arthur; Ayoob, Keith T

2010-04-01

Improving diets has considerable potential to improve health, but progress in this area has been limited, and advice to increase fruit and vegetable intake has largely gone unheeded. Our objective was to test the performance characteristics of the Overall Nutritional Quality Index (ONQI), a tool designed to help improve dietary patterns one well-informed choice at a time. The ONQI was developed by a multidisciplinary group of nutrition and public health scientists independent of food industry interests and is the basis for the NuVal Nutritional Guidance System. Dietary guidelines, existing nutritional scoring systems, and other pertinent scientific literature were reviewed. An algorithm incorporating >30 entries that represent both micro- and macronutrient properties of foods, as well as weighting coefficients representing epidemiologic associations between nutrients and health outcomes, was developed and subjected to consumer research and testing of performance characteristics. ONQI and expert panel rankings correlated highly (R = 0.92, P < 0.001). In consumer testing, approximately 80% of >800 study participants indicated that the ONQI would influence their purchase intent. ONQI scoring distinguished the more-healthful DASH (Dietary Approaches to Stop Hypertension) diet (mean score: 46) from the typical American diet according to the National Health and Nutrition Examination Survey (NHANES) 2003-2006 (mean score: 26.5; P < 0.01). In linear regression analysis of the NHANES 2003-2006 populations (n = 15,900), the NuVal system was significantly associated with the Healthy Eating Index 2005 (P < 0.0001). Recently generated data from ongoing studies indicate favorable effects on purchase patterns and significant correlation with health outcomes in large cohorts of men and women followed for decades. NuVal offers universally applicable nutrition guidance that is independent of food industry interests and is supported by consumer research and scientific evaluation of its performance characteristics.

Assessment of an electronic learning system for colon capsule endoscopy: a pilot study.

PubMed

Watabe, Hirotsugu; Nakamura, Tetsuya; Yamada, Atsuo; Kakugawa, Yasuo; Nouda, Sadaharu; Terano, Akira

2016-06-01

Training for colon capsule endoscopy (CCE) procedures is currently performed as a lecture and hands-on seminar. The aims of this pilot study were to assess the utility of an electronic learning system for CCE (ELCCE) designed for the Japanese Association for Capsule Endoscopy using an objective scoring engine, and to evaluate the efficacy of ELCCE on the acquisition of CCE reading competence. ELCCE is an Internet-based learning system with the following steps: step 1, introduction; step 2, CCE reading competence assessment test (CCAT), which evaluates the competence of CCE reading prior to training; step 3, learning reading theory; step 4, training with guidance; step 5, training without guidance; step 6, final assessment; and step 7, the same as step 2. The CCAT, step 5 and step 6 were scored automatically according to: lesion detection, diagnosis (location, size, shape of lesion), management recommendations, and quality of view. Ten trainee endoscopists were initially recruited (cohort 1), followed by a validating cohort of 11 trainee endoscopists (cohort 2). All but one participant finished ELCCE training within 7 weeks. In step 6, accuracy ranged from 53 to 98 % and was not impacted by step 2 pretest scores. The average CCAT scores significantly increased between step 2 pretest and step 7 in both cohorts, from 42 ± 18 % to 79 ± 15 % in cohort 1 (p = 0.0004), and from 52 ± 15 % to 79 ± 14 % in cohort 2 (p = 0.0003). ELCCE is useful and effective for improving CCE reading competence.