Item Analysis to Improve Reliability for an Internal Medicine Undergraduate OSCE

ERIC Educational Resources Information Center

Auewarakul, Chirayu; Downing, Steven M.; Praditsuwan, Rungnirand; Jaturatamrong, Uapong

2005-01-01

Utilization of objective structured clinical examinations (OSCEs) for final assessment of medical students in Internal Medicine requires a representative sample of OSCE stations. The reliability and generalizability of OSCE scores provides validity evidence for OSCE scores and supports its contribution to the final clinical grade of medical…

Neurology objective structured clinical examination reliability using generalizability theory

PubMed Central

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

2015-01-01

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

Optimizing multiple sequence alignments using a genetic algorithm based on three objectives: structural information, non-gaps percentage and totally conserved columns.

PubMed

Ortuño, Francisco M; Valenzuela, Olga; Rojas, Fernando; Pomares, Hector; Florido, Javier P; Urquiza, Jose M; Rojas, Ignacio

2013-09-01

Multiple sequence alignments (MSAs) are widely used approaches in bioinformatics to carry out other tasks such as structure predictions, biological function analyses or phylogenetic modeling. However, current tools usually provide partially optimal alignments, as each one is focused on specific biological features. Thus, the same set of sequences can produce different alignments, above all when sequences are less similar. Consequently, researchers and biologists do not agree about which is the most suitable way to evaluate MSAs. Recent evaluations tend to use more complex scores including further biological features. Among them, 3D structures are increasingly being used to evaluate alignments. Because structures are more conserved in proteins than sequences, scores with structural information are better suited to evaluate more distant relationships between sequences. The proposed multiobjective algorithm, based on the non-dominated sorting genetic algorithm, aims to jointly optimize three objectives: STRIKE score, non-gaps percentage and totally conserved columns. It was significantly assessed on the BAliBASE benchmark according to the Kruskal-Wallis test (P < 0.01). This algorithm also outperforms other aligners, such as ClustalW, Multiple Sequence Alignment Genetic Algorithm (MSA-GA), PRRP, DIALIGN, Hidden Markov Model Training (HMMT), Pattern-Induced Multi-sequence Alignment (PIMA), MULTIALIGN, Sequence Alignment Genetic Algorithm (SAGA), PILEUP, Rubber Band Technique Genetic Algorithm (RBT-GA) and Vertical Decomposition Genetic Algorithm (VDGA), according to the Wilcoxon signed-rank test (P < 0.05), whereas it shows results not significantly different to 3D-COFFEE (P > 0.05) with the advantage of being able to use less structures. Structural information is included within the objective function to evaluate more accurately the obtained alignments. The source code is available at http://www.ugr.es/~fortuno/MOSAStrE/MO-SAStrE.zip.

Tradeoff between noise reduction and inartificial visualization in a model-based iterative reconstruction algorithm on coronary computed tomography angiography.

PubMed

Hirata, Kenichiro; Utsunomiya, Daisuke; Kidoh, Masafumi; Funama, Yoshinori; Oda, Seitaro; Yuki, Hideaki; Nagayama, Yasunori; Iyama, Yuji; Nakaura, Takeshi; Sakabe, Daisuke; Tsujita, Kenichi; Yamashita, Yasuyuki

2018-05-01

We aimed to evaluate the image quality performance of coronary CT angiography (CTA) under the different settings of forward-projected model-based iterative reconstruction solutions (FIRST).Thirty patients undergoing coronary CTA were included. Each image was reconstructed using filtered back projection (FBP), adaptive iterative dose reduction 3D (AIDR-3D), and 2 model-based iterative reconstructions including FIRST-body and FIRST-cardiac sharp (CS). CT number and noise were measured in the coronary vessels and plaque. Subjective image-quality scores were obtained for noise and structure visibility.In the objective image analysis, FIRST-body produced the significantly highest contrast-to-noise ratio. Regarding subjective image quality, FIRST-CS had the highest score for structure visibility, although the image noise score was inferior to that of FIRST-body.In conclusion, FIRST provides significant improvements in objective and subjective image quality compared with FBP and AIDR-3D. FIRST-body effectively reduces image noise, but the structure visibility with FIRST-CS was superior to FIRST-body.

The Use of Propensity Scores as a Matching Strategy

ERIC Educational Resources Information Center

John, Lindsay; Wright, Robin; Duku, Eric K.; Willms, J. Douglas

2008-01-01

Objectives: This study reports on the concept and method of linear propensity scores used to obtain a comparison group from the National Longitudinal Survey of Children and Youth to assess the effects of a longitudinal, structured arts program for Canadian youth (aged 9 to 15 years) from low-income, multicultural communities. Method: This study…

Incorporating Active Learning into a Psychiatry Clerkship: Does It Make a Difference?

ERIC Educational Resources Information Center

Morreale, Mary; Arfken, Cynthia; Bridge, Patrick; Balon, Richard

2012-01-01

Objective: Medical students' satisfaction with the psychiatry clerkship, sense of preparedness for an institutional Objective Structured Clinical Exam (OSCE), expressed likelihood of choosing psychiatry as a specialty, and National Board of Medical Examiners (NBME) psychiatry shelf-examination scores were compared after a curriculum based on…

Effect of Clinically Discriminating, Evidence-Based Checklist Items on the Reliability of Scores from an Internal Medicine Residency OSCE

ERIC Educational Resources Information Center

Daniels, Vijay J.; Bordage, Georges; Gierl, Mark J.; Yudkowsky, Rachel

2014-01-01

Objective structured clinical examinations (OSCEs) are used worldwide for summative examinations but often lack acceptable reliability. Research has shown that reliability of scores increases if OSCE checklists for medical students include only clinically relevant items. Also, checklists are often missing evidence-based items that high-achieving…

Rapid Design of Knowledge-Based Scoring Potentials for Enrichment of Near-Native Geometries in Protein-Protein Docking.

PubMed

Sasse, Alexander; de Vries, Sjoerd J; Schindler, Christina E M; de Beauchêne, Isaure Chauvot; Zacharias, Martin

2017-01-01

Protein-protein docking protocols aim to predict the structures of protein-protein complexes based on the structure of individual partners. Docking protocols usually include several steps of sampling, clustering, refinement and re-scoring. The scoring step is one of the bottlenecks in the performance of many state-of-the-art protocols. The performance of scoring functions depends on the quality of the generated structures and its coupling to the sampling algorithm. A tool kit, GRADSCOPT (GRid Accelerated Directly SCoring OPTimizing), was designed to allow rapid development and optimization of different knowledge-based scoring potentials for specific objectives in protein-protein docking. Different atomistic and coarse-grained potentials can be created by a grid-accelerated directly scoring dependent Monte-Carlo annealing or by a linear regression optimization. We demonstrate that the scoring functions generated by our approach are similar to or even outperform state-of-the-art scoring functions for predicting near-native solutions. Of additional importance, we find that potentials specifically trained to identify the native bound complex perform rather poorly on identifying acceptable or medium quality (near-native) solutions. In contrast, atomistic long-range contact potentials can increase the average fraction of near-native poses by up to a factor 2.5 in the best scored 1% decoys (compared to existing scoring), emphasizing the need of specific docking potentials for different steps in the docking protocol.

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.

Does the MCAT predict medical school and PGY-1 performance?

PubMed

Saguil, Aaron; Dong, Ting; Gingerich, Robert J; Swygert, Kimberly; LaRochelle, Jeffrey S; Artino, Anthony R; Cruess, David F; Durning, Steven J

2015-04-01

The Medical College Admissions Test (MCAT) is a high-stakes test required for entry to most U. S. medical schools; admissions committees use this test to predict future accomplishment. Although there is evidence that the MCAT predicts success on multiple choice-based assessments, there is little information on whether the MCAT predicts clinical-based assessments of undergraduate and graduate medical education performance. This study looked at associations between the MCAT and medical school grade point average (GPA), Medical Licensing Examination (USMLE) scores, observed patient care encounters, and residency performance assessments. This study used data collected as part of the Long-Term Career Outcome Study to determine associations between MCAT scores, USMLE Step 1, Step 2 clinical knowledge and clinical skill, and Step 3 scores, Objective Structured Clinical Examination performance, medical school GPA, and PGY-1 program director (PD) assessment of physician performance for students graduating 2010 and 2011. MCAT data were available for all students, and the PGY PD evaluation response rate was 86.2% (N = 340). All permutations of MCAT scores (first, last, highest, average) were weakly associated with GPA, Step 2 clinical knowledge scores, and Step 3 scores. MCAT scores were weakly to moderately associated with Step 1 scores. MCAT scores were not significantly associated with Step 2 clinical skills Integrated Clinical Encounter and Communication and Interpersonal Skills subscores, Objective Structured Clinical Examination performance or PGY-1 PD evaluations. MCAT scores were weakly to moderately associated with assessments that rely on multiple choice testing. The association is somewhat stronger for assessments occurring earlier in medical school, such as USMLE Step 1. The MCAT was not able to predict assessments relying on direct clinical observation, nor was it able to predict PD assessment of PGY-1 performance. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

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.

Does Changing Examiner Stations During UK Postgraduate Surgery Objective Structured Clinical Examinations Influence Examination Reliability and Candidates' Scores?

PubMed

Brennan, Peter A; Croke, David T; Reed, Malcolm; Smith, Lee; Munro, Euan; Foulkes, John; Arnett, Richard

2016-01-01

Objective structured clinical examinations (OSCE) are widely used for summative assessment in surgery. Despite standardizing these as much as possible, variation, including examiner scoring, can occur which may affect reliability. In study of a high-stakes UK postgraduate surgical OSCE, we investigated whether examiners changing stations once during a long examining day affected marking, reliability, and overall candidates' scores compared with examiners who examined the same scenario all day. An observational study of 18,262 examiner-candidate interactions from the UK Membership of the Royal College of Surgeons examination was carried at 3 Surgical Colleges across the United Kingdom. Scores between examiners were compared using analysis of variance. Examination reliability was assessed with Cronbach's alpha, and the comparative distribution of total candidates' scores for each day was evaluated using t-tests of unit-weighted z scores. A significant difference was found in absolute scores differences awarded in the morning and afternoon sessions between examiners who changed stations at lunchtime and those who did not (p < 0.001). No significant differences were found for the main effects of either broad content area (p = 0.290) or station content area (p = 0.450). The reliability of each day was not affected by examiner switching (p = 0.280). Overall, no difference was found in z-score distribution of total candidate scores and categories of examiner switching. This large study has found that although the range of marks awarded varied when examiners change OSCE stations, examination reliability and the likely candidate outcome were not affected. These results may have implications for examination design and examiner experience in surgical OSCEs and beyond. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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

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

PubMed

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

2014-08-01

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

Standard Setting for Clinical Competence at Graduation from Medical School: A Comparison of Passing Scores across Five Medical Schools

ERIC Educational Resources Information Center

Boursicot, Katharine A. M.; Roberts, Trudie E.; Pell, Godfrey

2006-01-01

While Objective Structured Clinical Examinations (OSCEs) have become widely used to assess clinical competence at the end of undergraduate medical courses, the method of setting the passing score varies greatly, and there is no agreed best methodology. While there is an assumption that the passing standard at graduation is the same at all medical…

Evaluation of effectiveness of a paediatric simulation course in procedural skills for paediatric residents - A pilot study.

PubMed

AlShammari, Abdullah; Inayah, Aman; Afsar, Nasir Ali; Nurhussen, Akram; Siddiqui, Amna; Anwer, Muhammad Lucman; Obeidat, Sadek; Bakro, Mohammed Khaled; Abu Assale, Tawfik Samer; Almidani, Eyad; Alsonbul, Abdullah; Alhaider, Sami; Hussain, Ibrahim Bin; Khadawardi, Emad; Zafar, Muhammad

2018-02-01

To explore the effects of simulation training on paediatric residents' confidence and skills in managing advanced skills in critical care. The study was conducted at Alfaisal University, Riyadh, Saudi Arabia, from March to June 2016, and comprised junior residents in paediatrics. All paediatric residents (years 1 and 2) were recruited into two workshops, held one week apart. The first workshop covered lumbar puncture/ cerebrospinal fluid interpretation, oral intubation, bone marrow aspiration, and critical airway management. The second workshop covered chest tube insertion, pleural tap, insertion of central line, and arthrocentesis. The participants were surveyed using a 5-point Likert scale survey pre- and post-course, assessing their confidence. Their practical skills were assessed using a pre-objective structured clinical examination on the same day and post-course objective structured clinical examination a week later on selected skills. The outcome measures were: (1) pre-/post-course confidence rating, and (2) pre-/post-course objective structured clinical examination results. Data was analysed using SPSS 20. Of the 16 participants, 8(50%) were boys and 8(50%) girls. Besides, 13(81%) residents were in year-1 and 3(19%) in year-2. Median post-course confidence level ranks for all the skills were higher (p<0.05). There was no improvement in mean pre-objective structured clinical examination scores (2.31±2.66/ 7.46±3.02) and post- objective structured clinical examination scores (22.54±4.39/ 31.85±6.90) in Year 1 residents (p<0.001). Simulation course was significantly successful in improving residents' clinical skills and confidence in performing critical tasks.

How to assess communication, professionalism, collaboration and the other intrinsic CanMEDS roles in orthopedic residents: use of an objective structured clinical examination (OSCE)

PubMed Central

Dwyer, Tim; Takahashi, Susan Glover; Hynes, Melissa Kennedy; Herold, Jodi; Wasserstein, David; Nousiainen, Markku; Ferguson, Peter; Wadey, Veronica; Murnaghan, M. Lucas; Leroux, Tim; Semple, John; Hodges, Brian; Ogilvie-Harris, Darrell

2014-01-01

Background Assessing residents’ understanding and application of the 6 intrinsic CanMEDS roles (communicator, professional, manager, collaborator, health advocate, scholar) is challenging for postgraduate medical educators. We hypothesized that an objective structured clinical examination (OSCE) designed to assess multiple intrinsic CanMEDS roles would be sufficiently reliable and valid. Methods The OSCE comprised 6 10-minute stations, each testing 2 intrinsic roles using case-based scenarios (with or without the use of standardized patients). Residents were evaluated using 5-point scales and an overall performance rating at each station. Concurrent validity was sought by correlation with in-training evaluation reports (ITERs) from the last 12 months and an ordinal ranking created by program directors (PDs). Results Twenty-five residents from postgraduate years (PGY) 0, 3 and 5 participated. The interstation reliability for total test scores (percent) was 0.87, while reliability for each of the communicator, collaborator, manager and professional roles was greater than 0.8. Total test scores, individual station scores and individual CanMEDS role scores all showed a significant effect by PGY level. Analysis of the PD rankings of intrinsic roles demonstrated a high correlation with the OSCE role scores. A correlation was seen between ITER and OSCE for the communicator role, while the ITER medical expert and total scores highly correlated with the communicator, manager and professional OSCE scores. Conclusion An OSCE designed to assess the intrinsic CanMEDS roles was sufficiently valid and reliable for regular use in an orthopedic residency program. PMID:25078926

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

PubMed

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

2015-01-01

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

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

PubMed

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

2017-04-01

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

Neurology objective structured clinical examination reliability using generalizability theory.

PubMed

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

2015-11-03

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

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.

Motor competence and characteristics within the preschool environment.

PubMed

True, Larissa; Pfeiffer, Karin Allor; Dowda, Marsha; Williams, Harriet G; Brown, William H; O'Neill, Jennifer R; Pate, Russell R

2017-08-01

Environmental characteristics within preschools that influence children's motor competence are largely unknown. The purpose of the present study was to examine the contribution of various preschool environmental characteristics to children's locomotor, object control, and total gross motor scores. Cross-sectional, observational study of 3-5 year-old children (n=229) from 22 preschools in South Carolina. The Children's Activity and Movement in Preschool Study (CHAMPS) Motor Skills Protocol assessed MC. Preschool directors provided information regarding policies and practices. The research team measured playgrounds and classrooms, and the Early Childhood Environment Rating Scale-Revised assessed preschool quality. Time spent in open space and electronic media use were also assessed using direct observation. The aforementioned variables predicted children's object control, locomotor, and total gross motor scores. Classroom size/child ratio, teacher education, playground size, electronic media use, and trips to outside organizations emerged as significant predictors of locomotor score and total motor score. The object control model was non-significant. Preschools may be able to promote motor competence by allowing children more time in open spaces, structured activity experiences, and by expanding existing outdoor playground space whenever possible. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Validity and reliability of the robotic objective structured assessment of technical skills

PubMed Central

Siddiqui, Nazema Y.; Galloway, Michael L.; Geller, Elizabeth J.; Green, Isabel C.; Hur, Hye-Chun; Langston, Kyle; Pitter, Michael C.; Tarr, Megan E.; Martino, Martin A.

2015-01-01

Objective Objective structured assessments of technical skills (OSATS) have been developed to measure the skill of surgical trainees. Our aim was to develop an OSATS specifically for trainees learning robotic surgery. Study Design This is a multi-institutional study in eight academic training programs. We created an assessment form to evaluate robotic surgical skill through five inanimate exercises. Obstetrics/gynecology, general surgery, and urology residents, fellows, and faculty completed five robotic exercises on a standard training model. Study sessions were recorded and randomly assigned to three blinded judges who scored performance using the assessment form. Construct validity was evaluated by comparing scores between participants with different levels of surgical experience; inter- and intra-rater reliability were also assessed. Results We evaluated 83 residents, 9 fellows, and 13 faculty, totaling 105 participants; 88 (84%) were from obstetrics/gynecology. Our assessment form demonstrated construct validity, with faculty and fellows performing significantly better than residents (mean scores: 89 ± 8 faculty; 74 ± 17 fellows; 59 ± 22 residents, p<0.01). In addition, participants with more robotic console experience scored significantly higher than those with fewer prior console surgeries (p<0.01). R-OSATS demonstrated good inter-rater reliability across all five drills (mean Cronbach's α: 0.79 ± 0.02). Intra-rater reliability was also high (mean Spearman's correlation: 0.91 ± 0.11). Conclusions We developed an assessment form for robotic surgical skill that demonstrates construct validity, inter- and intra-rater reliability. When paired with standardized robotic skill drills this form may be useful to distinguish between levels of trainee performance. PMID:24807319

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

PubMed

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

2017-01-01

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

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

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.

Verbal Memory Decline following DBS for Parkinson’s Disease: Structural Volumetric MRI Relationships

PubMed Central

Geevarghese, Ruben; Lumsden, Daniel E.; Costello, Angela; Hulse, Natasha; Ayis, Salma; Samuel, Michael; Ashkan, Keyoumars

2016-01-01

Background Parkinson’s disease is a chronic degenerative movement disorder. The mainstay of treatment is medical. In certain patients Deep Brain Stimulation (DBS) may be offered. However, DBS has been associated with post-operative neuropsychology changes, especially in verbal memory. Objectives Firstly, to determine if pre-surgical thalamic and hippocampal volumes were related to verbal memory changes following DBS. Secondly, to determine if clinical factors such as age, duration of symptoms or motor severity (UPDRS Part III score) were related to verbal memory changes. Methods A consecutive group of 40 patients undergoing bilateral Subthalamic Nucleus (STN)-DBS for PD were selected. Brain MRI data was acquired, pre-processed and structural volumetric data was extracted using FSL. Verbal memory test scores for pre- and post-STN-DBS surgery were recorded. Linear regression was used to investigate the relationship between score change and structural volumetric data. Results A significant relationship was demonstrated between change in List Learning test score and thalamic (left, p = 0.02) and hippocampal (left, p = 0.02 and right p = 0.03) volumes. Duration of symptoms was also associated with List Learning score change (p = 0.02 to 0.03). Conclusion Verbal memory score changes appear to have a relationship to pre-surgical MRI structural volumetric data. The findings of this study provide a basis for further research into the use of pre-surgical MRI to counsel PD patients regarding post-surgical verbal memory changes. PMID:27557088

Combinatorics and synchronization in natural semiotics

NASA Astrophysics Data System (ADS)

Orsucci, Franco; Giuliani, Alessandro; Webber, Charles; Zbilut, Joseph; Fonagy, Peter; Mazza, Marianna

2006-03-01

In this study the derivation of an objective metrics to appreciate the degree of structuring of written and spoken texts is presented. The proposed metrics is based on the scoring of recurrences inside a text by means of the application of recurrence quantification analysis (RQA), a nonlinear technique widely used in other fields of sciences. The adopted approach allowed us to create a ranking of different poems strictly related to their prosodic structure and, more importantly, the possibility to recognize the same structure across different languages, to define a level of structuring typical of spoken texts and identifying the progressive synchronization of a dyadic relation between two speakers in terms of relative complexity of their speeches. These results suggest the possibility of introducing objective measurement methods into humanities studies.

The effectiveness of immediate feedback during the objective structured clinical examination.

PubMed

Hodder, R V; Rivington, R N; Calcutt, L E; Hart, I R

1989-03-01

Using eight different physical examination or technical stations, 400 examinations were conducted to evaluate the effectiveness of immediate feedback during the Objective Structured Clinical Examination (OSCE). The test group comprised 50 medical students who underwent a standard 4-minute examination followed by 2 minutes of feedback. Immediately following feedback the students repeated an identical 4-minute examination scored by the same examiners. The control group consisted of 50 students from the same class who underwent an identical testing sequence, but instead of receiving feedback, they were instructed to continue their examinations for an additional 2 minutes before repeating the stations. Simple repetition of the task did not significantly improve score (mean increase 2.0%, NS). Extending the testing period from 4 to 6 minutes resulted in a small but significant increase in score (mean 6.7%, P less than 0.001). However, there was a much larger increase in the scores obtained following 2 minutes of immediate feedback compared to pre-feedback performance (mean 26.3%, P less than 0.0001). The majority of students and examiners felt that feedback, as administered in this study, was valuable both as a learning and teaching experience. Short periods of immediate feedback during an OSCE are practical and can improve competency in the performance of criterion-based tasks, at least over the short term. In addition, such feedback provides students with valuable self-assessment that may stimulate further learning.

Comparing the Effects of Objective Structured Assessment of Technical Skills (OSATS) and Traditional Method on Learning of Students.

PubMed

Mansoorian, Mohammad Reza; Hosseiny, Marzeih Sadat; Khosravan, Shahla; Alami, Ali; Alaviani, Mehri

2015-06-01

Despite the benefits of the objective structured assessment of technical skills (OSATS) and it appropriateness for evaluating clinical abilities of nursing students , few studies are available on the application of this method in nursing education. The purpose of this study was to compare the effect of using OSATS and traditional methods on the students' learning. We also aimed to signify students' views about these two methods and their views about the scores they received in these methods in a medical emergency course. A quasi-experimental study was performed on 45 first semester students in nursing and medical emergencies passing a course on fundamentals of practice. The students were selected by a census method and evaluated by both the OSATS and traditional methods. Data collection was performed using checklists prepared based on the 'text book of nursing procedures checklists' published by Iranian nursing organization and a questionnaire containing learning rate and students' estimation of their received scores. Descriptive statistics as well as paired t-test and independent samples t-test were used in data analysis. The mean of students' score in OSATS was significantly higher than their mean score in traditional method (P = 0.01). Moreover, the mean of self-evaluation score after the traditional method was relatively the same as the score the students received in the exam. However, the mean of self-evaluation score after the OSATS was relatively lower than the scores the students received in the OSATS exam. Most students believed that OSATS can evaluate a wide range of students' knowledge and skills compared to traditional method. Results of this study indicated the better effect of OSATS on learning and its relative superiority in precise assessment of clinical skills compared with the traditional evaluation method. Therefore, we recommend using this method in evaluation of students in practical courses.

Communication Skills in Candidates for Accreditation in Rheumatology Are Correlated With Candidate's Performance in the Objective Structured Clinical Examination.

PubMed

Pascual-Ramos, Virginia; Flores-Alvarado, Diana Elsa; Portela-Hernández, Margarita; Maldonado-Velázquez, María Del Rocío; Amezcua-Guerra, Luis Manuel; López-Zepeda, Judith; Álvarez, Everardo; Rubio, Nadina; Lastra, Olga Vera; Saavedra, Miguel Ángel; Arce-Salinas, César Alejandro

2017-07-26

The Mexican Accreditation Council for Rheumatology annually certifies trainees in Rheumatology using a multiple-choice test and an objective structured clinical examination (OSCE). Since 2015, candidate's communication skills (CS) have been rated by both patients and by physician examiners and correlated with results on the OSCE. This study compared the CS from candidates to annual accreditation in Rheumatology as rated by patients and by physician examiners, and assessed whether these correlated with candidate's performance in the OSCE. From 2015 to 2017, 8areas of CS were evaluated using a Likert scale, in each OSCE station that involved a patient. Both patient and physician evaluators were trained annually and their evaluations were performed blindly. The associations were calculated using the Pearson correlation coefficient. In general, candidates were given high CS scores; the scores from patients of the candidate's CS were better than those of physician examiners; within the majority of the stations, both scores were found to correlate moderately. In addition, the scoring of CS correlated with trainee performance at the corresponding OSCE station. Interestingly, better correlations were found when the skills were rated by the patients compared to physician scores. The average CS score was correlated with the overall OSCE performance for each trainee, but not with the multiple-choice test, except in the 2017 accreditation process, when a weak correlation was found. CS assessed during a national accreditation process correlated with the candidate's performance at the station level and with the overall OSCE. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Formulary evaluation of third-generation cephalosporins using decision analysis.

PubMed

Cano, S B; Fujita, N K

1988-03-01

A structured, objective approach to formulary review of third-generation cephalosporins using the decision-analysis model is described. The pharmacy and therapeutics (P&T) committee approved the evaluation criteria for this drug class and assigned priority weights (as percentages of 100) to those drug characteristics deemed most important. Clinical data (spectrum of activity, pharmacokinetics, adverse effects, and stability) and financial data (cost of acquisition and cost of therapy per day) were used to determine ranking scores for each drug. Total scores were determined by multiplying ranking scores by the assigned priority weights for the criteria. The two highest-scoring drugs were selected for inclusion in the formulary. By this decision-analysis process, the P&T committee recommended that all current third-generation cephalosporins (cefotaxime, cefoperazone, and moxalactam) be removed from the institutions's formulary and be replaced with ceftazidime and ceftriaxone. P&T committees at other institutions may structure their criteria differently, and different recommendations may result. Using decision analysis for formulary review may promote rational drug therapy and achieve cost savings.

The use of objective structured self-assessment and peer-feedback (OSSP) for learning communication skills: evaluation using a controlled trial.

PubMed

Perera, Jennifer; Mohamadou, Galy; Kaur, Satpal

2010-05-01

Feedback is essential to guide students towards expected performance goals. The usefulness of teacher feedback on improving communication skills (CS) has been well documented. It has been proposed that self-assessment and peer-feedback has an equally important role to play in enhancing learning. This is the focus of this study. Objectively structured self-assessment and peer feedback (OSSP) was incorporated into small group CS teaching sessions of a group of semester one medical students who were learning CS for the first time, to minimise the influence of previous educational interventions. A control group matched for academic performance, gender and age was used to enable parallel evaluation of the innovation. A reflective log containing closed and open ended questions was used for OSSP. Facilitators and simulated patients provided feedback to students in both groups during CS learning as per routine practice. Student perceptions on OSSP and acceptability as a learning method were explored using a questionnaire. CS were assessed in both groups using objective structured clinical examination (OSCE) as per routine practice and assessors were blinded as to which group the student belonged. Mean total score and scores for specific areas of interview skills were significantly higher in the experimental group. Analysis of the questionnaire data showed that students gained fresh insights into specific areas such as empathy, addressing patients' concerns and interview style during OSSP which clearly corroborated the specific differences in scores. The free text comments were highly encouraging as to acceptability of OSSP, in spite of 67% being never exposed to formal self- and peer-assessment during pre-university studies. OSSP promotes effective CS learning and learner acceptability is high.

Using the EZ-Diffusion Model to Score a Single-Category Implicit Association Test of Physical Activity

PubMed Central

Rebar, Amanda L.; Ram, Nilam; Conroy, David E.

2014-01-01

Objective The Single-Category Implicit Association Test (SC-IAT) has been used as a method for assessing automatic evaluations of physical activity, but measurement artifact or consciously-held attitudes could be confounding the outcome scores of these measures. The objective of these two studies was to address these measurement concerns by testing the validity of a novel SC-IAT scoring technique. Design Study 1 was a cross-sectional study, and study 2 was a prospective study. Method In study 1, undergraduate students (N = 104) completed SC-IATs for physical activity, flowers, and sedentary behavior. In study 2, undergraduate students (N = 91) completed a SC-IAT for physical activity, self-reported affective and instrumental attitudes toward physical activity, physical activity intentions, and wore an accelerometer for two weeks. The EZ-diffusion model was used to decompose the SC-IAT into three process component scores including the information processing efficiency score. Results In study 1, a series of structural equation model comparisons revealed that the information processing score did not share variability across distinct SC-IATs, suggesting it does not represent systematic measurement artifact. In study 2, the information processing efficiency score was shown to be unrelated to self-reported affective and instrumental attitudes toward physical activity, and positively related to physical activity behavior, above and beyond the traditional D-score of the SC-IAT. Conclusions The information processing efficiency score is a valid measure of automatic evaluations of physical activity. PMID:25484621

Does an Advanced Pelvic Simulation Curriculum Improve Resident Performance on a Pediatric and Adolescent Gynecology Focused Objective Structured Clinical Examination? A Cohort Study.

PubMed

Dumont, Tania; Hakim, Julie; Black, Amanda; Fleming, Nathalie

2016-06-01

To determine the effect of an advanced pelvic simulation curriculum on resident performance on a pediatric and adolescent gynecology (PAG) focused objective structured clinical examination (OSCE). Obstetrics and gynecology residents in a single academic Canadian center participated in a PAG simulation curriculum. An OSCE on prepubertal vaginal bleeding was administered at the biannual OSCE examination 2 months before the simulation curriculum and again 3 months after the simulation curriculum. Academic half-day at the University of Ottawa Skills and Simulation Centre. Obstetrics and gynecology residents from the University of Ottawa. Participants completed 4 stations teaching PAG-appropriate history-taking, genital examination, Tanner staging, vaginal sampling and flushing, hymenectomy, vaginoscopy, laparoscopic adnexal detorsion, and approach to the child and/or adolescent. Advanced pelvic models were used for procedure-specific stations. The primary outcome measure was change in mean score on a prepubertal vaginal bleeding OSCE station. Secondary outcome measures were changes in individual component scores. Fourteen residents completed the simulation curriculum and the PAG OSCE at the 2 separate time points (before and after simulation curriculum). The mean OSCE score before the simulation curriculum was 54.6% (20.5 of 37) and mean score after the curriculum was 78.1% (28.9 of 37; P < .001). Significant score increases were found in history-taking, examination, differential diagnosis, identification of organism, surgical procedures, and identification of foreign body (P < .01 for all). This innovative PAG simulation curriculum significantly increased residents' knowledge in PAG history-taking, examination skills, operative procedures, and approach to the child and/or adolescent. Obstetrics and Gynecology Program Directors should consider incorporating PAG simulation training into their curriculum to ensure that residents meet their learning objectives and increase their knowledge and confidence, which will ultimately benefit patient care. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Comparison of the Diagnostic Image Quality of the Canine Maxillary Dentoalveolar Structures Obtained by Cone Beam Computed Tomography and 64-Multidetector Row Computed Tomography.

PubMed

Soukup, Jason W; Drees, Randi; Koenig, Lisa J; Snyder, Christopher J; Hetzel, Scott; Miles, Chanda R; Schwarz, Tobias

2015-01-01

The objective of this blinded study was to validate the use of cone beam computed tomography (C) for imaging of the canine maxillary dentoalveolar structures by comparing its diagnostic image quality with that of 64-multidetector row CT Sagittal slices of a tooth-bearing segment of the maxilla of a commercially purchased dog skull embedded in methylmethacrylate were obtained along a line parallel with the dental arch using a commercial histology diamond saw. The slice of tooth-bearing bone that best depicted the dentoalveolar structures was chosen and photographed. The maxillary segment was imaged with cone beam CT and 64-multidetector row CT. Four blinded evaluators compared the cone beam CT and 64-multidetector row CT images and image quality was scored as it related to the anatomy of dentoalveolar structures. Trabecular bone, enamel, dentin, pulp cavity, periodontal ligament space, and lamina dura were scored In addition, a score depicting the evaluators overall impression of the image was recorded. Images acquired with cone beam CT were found to be significantly superior in image quality to images acquired with 64-multidetector row CT overall, and in all scored categories. In our study setting cone beam CT was found to be a valid and clinically superior imaging modality for the canine maxillary dentoalveolar structures when compared to 64-multidetector row CT.

Comparison of the Diagnostic Image Quality of the Canine Maxillary Dentoalveolar Structures Obtained by Cone Beam Computed Tomography and 64-Multidetector Row Computed Tomography

PubMed Central

Soukup, Jason W.; Drees, Randi; Koenig, Lisa J.; Snyder, Christopher J.; Hetzel, Scott; Miles, Chanda R.; Schwarz, Tobias

2016-01-01

Summary The objective of this blinded study was to validate the use of cone beam computed tomography (CT) for imaging of the canine maxillary dentoalveolar structures by comparing its diagnostic image quality with that of 64-multidetector row CT. Sagittal slices of a tooth-bearing segment of the maxilla of a commercially purchased dog skull embedded in methyl methacrylate were obtained along a line parallel with the dental arch using a commercial histology diamond saw. The slice of tooth-bearing bone that best depicted the dentoalveolar structures was chosen and photographed. The maxilla segment was imaged with cone beam CT and 64-multidetector row CT. Four blinded evaluators compared the cone beam CT and 64-multidetector row CT images and image quality was scored as it related to the anatomy of dentoalveolar structures. Trabecular bone, enamel, dentin, pulp cavity, periodontal ligament space, and lamina dura were scored. In addition, a score depicting the evaluators overall impression of the image was recorded. Images acquired with cone beam CT were found to be significantly superior in image quality to images acquired with 64-multidetector row CT overall, and in all scored categories. In our study setting, cone beam CT was found to be a valid and clinically superior imaging modality for the canine maxillary dentoalveolar structures when compared to 64-multidetector row CT. PMID:26415384

Structural correlates of subjective and objective memory performance in multiple sclerosis.

PubMed

Pardini, Matteo; Bergamino, Maurizio; Bommarito, Giulia; Bonzano, Laura; Luigi Mancardi, Gian; Roccatagliata, Luca

2014-04-01

Subjective and objective memory deficits represent a frequent and ill-understood aspect of multiple sclerosis (MS), and a significant cause of disability and quality of life reduction. The aim of the study is to verify the role of hippocampal and temporal associative fibers' damage in MS-related memory complaints. To reach this aim, 25 patients with low disability relapsing-remitting MS and 19 healthy controls were included in the study. All subjects underwent 3D T1 structural imaging and Diffusion Tensor Imaging. Additionally, MS patients underwent neuropsychological evaluation of objective (Selective Reminding Test and Spatial Recall Test) and of subjective (Perceived Deficit Questionnaire, Retrospective and Prospective Memory Subscales) memory deficits. Normalized hippocampal volume (NHV) and mean Fractional Anisotropy (FA) for the uncinate fasciculus (UF) and for the ventral division of the cingulum bundle (VCB) were calculated for all subjects. We showed that, compared to controls, MS subjects presented with reduced right NHV and with reduced mean FA bilaterally in the UF and the VCB. In the MS group, verbal memory scores correlated with left NHV, spatial memory scores correlated with right NHV, while perceived retrospective and prospective memory deficits correlated with left VCB and left UF mean FA respectively. Our data confirm an early involvement of memory-related brain structures in MS patients. Our data suggest that verbal and nonverbal memory as well as perceived retrospective and prospective memory deficits are related to alterations of discrete anatomical structures in the low-disability phase of MS. Copyright © 2013 Wiley Periodicals, Inc.

The dialysis orders objective structured clinical examination (OSCE): a formative assessment for nephrology fellows.

PubMed

Prince, Lisa K; Campbell, Ruth C; Gao, Sam W; Kendrick, Jessica; Lebrun, Christopher J; Little, Dustin J; Mahoney, David L; Maursetter, Laura A; Nee, Robert; Saddler, Mark; Watson, Maura A; Yuan, Christina M

2018-04-01

Few quantitative nephrology-specific simulations assess fellow competency. We describe the development and initial validation of a formative objective structured clinical examination (OSCE) assessing fellow competence in ordering acute dialysis. The three test scenarios were acute continuous renal replacement therapy, chronic dialysis initiation in moderate uremia and acute dialysis in end-stage renal disease-associated hyperkalemia. The test committee included five academic nephrologists and four clinically practicing nephrologists outside of academia. There were 49 test items (58 points). A passing score was 46/58 points. No item had median relevance less than 'important'. The content validity index was 0.91. Ninety-five percent of positive-point items were easy-medium difficulty. Preliminary validation was by 10 board-certified volunteers, not test committee members, a median of 3.5 years from graduation. The mean score was 49 [95% confidence interval (CI) 46-51], κ = 0.68 (95% CI 0.59-0.77), Cronbach's α = 0.84. We subsequently administered the test to 25 fellows. The mean score was 44 (95% CI 43-45); 36% passed the test. Fellows scored significantly less than validators (P < 0.001). Of evidence-based questions, 72% were answered correctly by validators and 54% by fellows (P = 0.018). Fellows and validators scored least well on the acute hyperkalemia question. In self-assessing proficiency, 71% of fellows surveyed agreed or strongly agreed that the OSCE was useful. The OSCE may be used to formatively assess fellow proficiency in three common areas of acute dialysis practice. Further validation studies are in progress.

"Can you see me now?" An objective metric for predicting intelligibility of compressed American Sign Language video

NASA Astrophysics Data System (ADS)

Ciaramello, Francis M.; Hemami, Sheila S.

2007-02-01

For members of the Deaf Community in the United States, current communication tools include TTY/TTD services, video relay services, and text-based communication. With the growth of cellular technology, mobile sign language conversations are becoming a possibility. Proper coding techniques must be employed to compress American Sign Language (ASL) video for low-rate transmission while maintaining the quality of the conversation. In order to evaluate these techniques, an appropriate quality metric is needed. This paper demonstrates that traditional video quality metrics, such as PSNR, fail to predict subjective intelligibility scores. By considering the unique structure of ASL video, an appropriate objective metric is developed. Face and hand segmentation is performed using skin-color detection techniques. The distortions in the face and hand regions are optimally weighted and pooled across all frames to create an objective intelligibility score for a distorted sequence. The objective intelligibility metric performs significantly better than PSNR in terms of correlation with subjective responses.

The method used to set the pass mark in an objective structured clinical examination defines the performance of candidates for certification as rheumatologists.

PubMed

Pascual-Ramos, Virginia; Guilaisne Bernard-Medina, Ana; Flores-Alvarado, Diana Elsa; Portela-Hernández, Margarita; Maldonado-Velázquez, María Del Rocío; Jara-Quezada, Luis Javier; Amezcua-Guerra, Luis Manuel; Rubio-Judith López-Zepeda, Nadina E; Álvarez-Hernandez, Everardo; Saavedra, Miguel Ángel; Arce-Salinas, César Alejandro

The Mexican Accreditation Council for Rheumatology certifies trainees (TR) on an annual basis using both a multiple-choice question (MCQ) test and an objective structured clinical examination (OSCE). For 2013 and 2014, the OSCE pass mark (PM) was set by criterion referencing as ≥6 (CPM), whereas overall rating of borderline performance method (BPM) was added for 2015 and 2016 accreditations. We compared OSCE TR performance according to CPM and BPM, and examined whether correlations between MCQ and OSCE were affected by PM. Forty-three (2015) and 37 (2016) candidates underwent both tests. Altogether, OSCE were integrated by 15 validated stations; one evaluator per station scored TR performance according to a station-tailored check-list and a Likert scale (fail, borderline, above range) of overall performance. A composite OSCE score was derived for each candidate. Appropriate statistics were used. Mean (±standard derivation [SD]) MCQ test scores were 6.6±0.6 (2015) and 6.4±0.6 (2016) with 5 candidates receiving a failing score each year. Mean (±SD) OSCE scores were 7.4±0.6 (2015) and 7.3±0.6 (2016); no candidate received a failing CPM score in either 2015 or 2016 OSCE, although 21 (49%) and 19 (51%) TR, respectively, received a failing BPM score (calculated as 7.3 and 7.4, respectively). Stations for BPM ranged from 4.5 to 9.5; overall, candidates showed better performance in CPM. In all, MCQ correlated with composite OSCE, r=0.67 (2015) and r=0.53 (2016); P≤.001. Trainees with a passing BPM score in OSCE had higher MCQ scores than those with a failing score. Overall, OSCE-PM selection impacted candidates' performance but had a limited affect on correlation between clinical and practical examinations. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Do primary health centres and hospitals contribute equally towards achievement of the transversal clinical competencies of medical students? Performance on the Objective Structured Clinical Examination (OSCE) in competency acquisition.

PubMed

Soler-González, Jorge; Buti, Miquel; Boada, Jordi; Ayala, Victoria; Peñascal, Eduard; Rodriguez, Toni

2016-01-01

The adaptation of the educational programmes of European faculties of medicine to the European Higher Education Area guidelines has focused curricula design on competence acquisition. Competencies are defined as the achievements of a predetermined level of efficacy in real-world scenarios. Our objective was to assess whether performance on a common competence evaluation test, the Objective Structured Clinical Examination (OSCE), resulted in different scores for second-year students after a practical medical training course took place in a primary health centre (PHC) or in a hospital. A descriptive study was conducted during the 2010-2014 academic year of the OSCE test scores obtained by all second-year students. Faculty of Medicine at the University of Lleida (Catalonia, Spain). We performed a correlation analysis between students who completed their practical medical training at the PHC and hospitals utilising Student's t-test for comparison of means. 423 students who completed internships at the PHC and at hospitals obtained OSCE mean scores of 7.32 (SD; IC) (0.82; 7.18-7.47) points and 7.17 (0.83; 6.07-7.26) points, respectively (p=0.07). Second-year medical students acquired similar competency levels in the two analysed training scenarios. The two areas both serve their teaching purpose. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Tapping linked to function and structure in premanifest and symptomatic Huntington disease(e–Pub ahead of print)

PubMed Central

Bechtel, N.; Scahill, R.I.; Rosas, H.D.; Acharya, T.; van den Bogaard, S.J.A.; Jauffret, C.; Say, M.J.; Sturrock, A.; Johnson, H.; Onorato, C.E.; Salat, D.H.; Durr, A.; Leavitt, B.R.; Roos, R.A.C.; Landwehrmeyer, G.B.; Langbehn, D.R.; Stout, J.C.; Tabrizi, S.J.; Reilmann, R.

2010-01-01

Objective: Motor signs are functionally disabling features of Huntington disease. Characteristic motor signs define disease manifestation. Their severity and onset are assessed by the Total Motor Score of the Unified Huntington's Disease Rating Scale, a categorical scale limited by interrater variability and insensitivity in premanifest subjects. More objective, reliable, and precise measures are needed which permit clinical trials in premanifest populations. We hypothesized that motor deficits can be objectively quantified by force-transducer-based tapping and correlate with disease burden and brain atrophy. Methods: A total of 123 controls, 120 premanifest, and 123 early symptomatic gene carriers performed a speeded and a metronome tapping task in the multicenter study TRACK-HD. Total Motor Score, CAG repeat length, and MRIs were obtained. The premanifest group was subdivided into A and B, based on the proximity to estimated disease onset, the manifest group into stages 1 and 2, according to their Total Functional Capacity scores. Analyses were performed centrally and blinded. Results: Tapping variability distinguished between all groups and subgroups in both tasks and correlated with 1) disease burden, 2) clinical motor phenotype, 3) gray and white matter atrophy, and 4) cortical thinning. Speeded tapping was more sensitive to the detection of early changes. Conclusion: Tapping deficits are evident throughout manifest and premanifest stages. Deficits are more pronounced in later stages and correlate with clinical scores as well as regional brain atrophy, which implies a link between structure and function. The ability to track motor phenotype progression with force-transducer-based tapping measures will be tested prospectively in the TRACK-HD study. GLOSSARY CoV = coefficient of variation; DBS = disease burden score; Freq = frequency; HD = Huntington disease; ICV = intracranial volume; IOI = interonset interval; ΔIOI = deviation from interonset interval; IPI = interpeak interval; ΔIPI = deviation from interpeak interval; ITI = intertap interval; log = logarithmic; MT = metronome tapping; ΔMTI = deviation from midtap interval; preHD = premanifest Huntington disease; RT = reaction time; ST = speeded tapping; TD = tap duration; TF = tapping force; TFC = Total Functional Capacity; UHDRS = Unified Huntington's Disease Rating Scale; UHDRS-TMS = Unified Huntington's Disease Rating Scale-Total Motor Score; VBM = voxel-based morphometry. PMID:21068430

How does preclinical laboratory training impact physical examination skills during the first clinical year? A retrospective analysis of routinely collected objective structured clinical examination scores among the first two matriculating classes of a reformed curriculum in one Polish medical school

PubMed Central

Świerszcz, Jolanta; Stalmach-Przygoda, Agata; Kuźma, Marcin; Jabłoński, Konrad; Cegielny, Tomasz; Skrzypek, Agnieszka; Wieczorek-Surdacka, Ewa; Kruszelnicka, Olga; Chmura, Kaja; Chyrchel, Bernadeta; Surdacki, Andrzej; Nowakowski, Michał

2017-01-01

Objective As a result of a curriculum reform launched in 2012 at our institution, preclinical training was shortened to 2 years instead of the traditional 3 years, creating additional incentives to optimise teaching methods. In accordance with the new curriculum, a semester-long preclinical module of clinical skills (CS) laboratory training takes place in the second year of study, while an introductory clinical course (ie, brief introductory clerkships) is scheduled for the Fall semester of the third year. Objective structured clinical examinations (OSCEs) are carried out at the conclusion of both the preclinical module and the introductory clinical course. Our aim was to compare the scores at physical examination stations between the first and second matriculating classes of a newly reformed curriculum on preclinical second-year OSCEs and early clinical third-year OSCEs. Design Analysis of routinely collected data. Setting One Polish medical school. Participants Complete OSCE records for 462 second-year students and 445 third-year students. Outcome measures OSCE scores by matriculation year. Results In comparison to the first class of the newly reformed curriculum, significantly higher (ie, better) OSCE scores were observed for those students who matriculated in 2013, a year after implementing the reformed curriculum. This finding was consistent for both second-year and third-year cohorts. Additionally, the magnitude of the improvement in median third-year OSCE scores was proportional to the corresponding advancement in preceding second-year preclinical OSCE scores for each of two different sets of physical examination tasks. In contrast, no significant difference was noted between the academic years in the ability to interpret laboratory data or ECG — tasks which had not been included in the second-year preclinical training. Conclusion Our results suggest the importance of preclinical training in a CS laboratory to improve students’ competence in physical examination at the completion of introductory clinical clerkships during the first clinical year. PMID:28864488

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

PubMed

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

2015-10-25

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

Teaching the basics of echocardiography in the undergraduate: Students as mentors.

PubMed

Arias Felipe, A; Doménech García, J; Sánchez Los Arcos, I; Luordo, D; García Sánchez, F J; Villanueva Martínez, J; Forero de la Sotilla, A; Villena Garrido, V; Torres Macho, J; García de Casasola Sánchez, G

To analyse the ability of medical students to incorporate the practical teaching of basic echocardiography planes using a peer mentoring design. Thirty-six medical students previously trained in obtaining echocardiography planes (mentors) taught the other 5th-year students (n=126). The teaching methodology included three stages: theory (online course), basic training (three 15h sessions of practical experience in ultrasound and at least 20 echocardiographic studies per mentor) and objective structured clinical assessment (OSCA), which scored the appropriateness of the basic ultrasound planes and the correct identification of 16 cardiac structures. The students' weighted mean score in the OSCA was 8.66±1.98 points (out of 10). Only 10 students (8.4%) scored less than 5, and 15 (12.6%) scored less than 7. Fifty students (42%) scored 10 points. The most easily identified structure was the left ventricle in the short-axis parasternal plane, with 89.9% of correct answers. The most poorly identified structure was the mitral valve in the subxiphoid plane, with 69.7% of correct answers. Peer mentoring-based teaching achieves an appropriate level of training in obtaining basic echocardiography planes. The training period is relatively short. The peer mentoring system can facilitate the implementation of teaching on basic aspects of ultrasound to a large number of undergraduate students. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

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.

Bi-objective integer programming for RNA secondary structure prediction with pseudoknots.

PubMed

Legendre, Audrey; Angel, Eric; Tahi, Fariza

2018-01-15

RNA structure prediction is an important field in bioinformatics, and numerous methods and tools have been proposed. Pseudoknots are specific motifs of RNA secondary structures that are difficult to predict. Almost all existing methods are based on a single model and return one solution, often missing the real structure. An alternative approach would be to combine different models and return a (small) set of solutions, maximizing its quality and diversity in order to increase the probability that it contains the real structure. We propose here an original method for predicting RNA secondary structures with pseudoknots, based on integer programming. We developed a generic bi-objective integer programming algorithm allowing to return optimal and sub-optimal solutions optimizing simultaneously two models. This algorithm was then applied to the combination of two known models of RNA secondary structure prediction, namely MEA and MFE. The resulting tool, called BiokoP, is compared with the other methods in the literature. The results show that the best solution (structure with the highest F 1 -score) is, in most cases, given by BiokoP. Moreover, the results of BiokoP are homogeneous, regardless of the pseudoknot type or the presence or not of pseudoknots. Indeed, the F 1 -scores are always higher than 70% for any number of solutions returned. The results obtained by BiokoP show that combining the MEA and the MFE models, as well as returning several optimal and several sub-optimal solutions, allow to improve the prediction of secondary structures. One perspective of our work is to combine better mono-criterion models, in particular to combine a model based on the comparative approach with the MEA and the MFE models. This leads to develop in the future a new multi-objective algorithm to combine more than two models. BiokoP is available on the EvryRNA platform: https://EvryRNA.ibisc.univ-evry.fr .

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

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.

Estimating structural collapse fragility of generic building typologies using expert judgment

USGS Publications Warehouse

Jaiswal, Kishor; Wald, David J.; Perkins, David M.; Aspinall, Willy P.; Kiremidjian, Anne S.

2014-01-01

The structured expert elicitation process proposed by Cooke (1991), hereafter referred to as Cooke's approach, is applied for the first time in the realm of structural collapse-fragility assessment for selected generic construction types. Cooke's approach works on the principle of objective calibration scoring of judgments couple with hypothesis testing used in classical statistics. The performance-based scoring system reflects the combined measure of an expert's informativeness about variables in the problem are under consideration, and their ability to enumerate, in a statistically accurate way through expressing their true beliefs, the quantitative uncertainties associated with their assessments. We summarize the findings of an expert elicitation workshop in which a dozen earthquake-engineering professionals from around the world were engaged to estimate seismic collapse fragility for generic construction types. Development of seismic collapse fragility-functions was accomplished by combining their judgments using weights derived from Cooke's method. Although substantial effort was needed to elicit the inputs of these experts successfully, we anticipate that the elicitation strategy described here will gain momentum in a wide variety of earthquake seismology and engineering hazard and risk analyses where physical model and data limitations are inherent and objective professional judgment can fill gaps.

Estimating structural collapse fragility of generic building typologies using expert judgment

USGS Publications Warehouse

Jaiswal, Kishor S.; Wald, D.J.; Perkins, D.; Aspinall, W.P.; Kiremidjian, Anne S.; Deodatis, George; Ellingwood, Bruce R.; Frangopol, Dan M.

2014-01-01

The structured expert elicitation process proposed by Cooke (1991), hereafter referred to as Cooke’s approach, is applied for the first time in the realm of structural collapse-fragility assessment for selected generic construction types. Cooke’s approach works on the principle of objective calibration scoring of judgments coupled with hypothesis testing used in classical statistics. The performance-based scoring system reflects the combined measure of an expert’s informativeness about variables in the problem area under consideration, and their ability to enumerate, in a statistically accurate way through expressing their true beliefs, the quantitative uncertainties associated with their assessments. We summarize the findings of an expert elicitation workshop in which a dozen earthquake-engineering professionals from around the world were engaged to estimate seismic collapse fragility for generic construction types. Development of seismic collapse fragility functions was accomplished by combining their judgments using weights derived from Cooke’s method. Although substantial effort was needed to elicit the inputs of these experts successfully, we anticipate that the elicitation strategy described here will gain momentum in a wide variety of earthquake seismology and engineering hazard and risk analyses where physical model and data limitations are inherent and objective professional judgment can fill gaps.

Factor structure and convergent validity of the Derriford Appearance Scale-24 using standard scoring versus treating ‘not applicable’ responses as missing data: a Scleroderma Patient-centered Intervention Network (SPIN) cohort study

PubMed Central

Merz, Erin L; Kwakkenbos, Linda; Carrier, Marie-Eve; Gholizadeh, Shadi; Mills, Sarah D; Fox, Rina S; Jewett, Lisa R; Williamson, Heidi; Harcourt, Diana; Assassi, Shervin; Furst, Daniel E; Gottesman, Karen; Mayes, Maureen D; Moss, Tim P; Thombs, Brett D; Malcarne, Vanessa L

2018-01-01

Objective Valid measures of appearance concern are needed in systemic sclerosis (SSc), a rare, disfiguring autoimmune disease. The Derriford Appearance Scale-24 (DAS-24) assesses appearance-related distress related to visible differences. There is uncertainty regarding its factor structure, possibly due to its scoring method. Design Cross-sectional survey. Setting Participants with SSc were recruited from 27 centres in Canada, the USA and the UK. Participants who self-identified as having visible differences were recruited from community and clinical settings in the UK. Participants Two samples were analysed (n=950 participants with SSc; n=1265 participants with visible differences). Primary and secondary outcome measures The DAS-24 factor structure was evaluated using two scoring methods. Convergent validity was evaluated with measures of social interaction anxiety, depression, fear of negative evaluation, social discomfort and dissatisfaction with appearance. Results When items marked by respondents as ‘not applicable’ were scored as 0, per standard DAS-24 scoring, a one-factor model fit poorly; when treated as missing data, the one-factor model fit well. Convergent validity analyses revealed strong correlations that were similar across scoring methods. Conclusions Treating ‘not applicable’ responses as missing improved the measurement model, but did not substantively influence practical inferences that can be drawn from DAS-24 scores. Indications of item redundancy and poorly performing items suggest that the DAS-24 could be improved and potentially shortened. PMID:29511009

Food Consumption Patterns of Nigerian Adolescents and Effect on Body Weight

ERIC Educational Resources Information Center

Olumakaiye, M. F.; Atinmo, Tola; Olubayo-Fatiregun, M. A.

2010-01-01

Objective: Association between nutritional status of adolescents and food consumption pattern. Design: Data on number of meals and snacks consumed daily were collected using structured questionnaires. Nutritional status was assessed as weight-for-age body mass index score less than fifth percentile of the National Center for Health…

Improved informed consent documents for biomedical research do not increase patients’ understanding but reduce enrolment: a study in real settings

PubMed Central

Paris, Adeline; Deygas, Béatrice; Cornu, Catherine; Thalamas, Claire; Maison, Patrick; Duale, Christian; Kane, Maty; Hodaj, Enkelejda; Cracowski, Jean-Luc

2015-01-01

Aims The aim was to evaluate the comprehension of participants of an improved informed consent document (ICD). Method This was a randomized controlled French multicentre study performed in real conditions. Participants were adult patients undergoing screening for enrolment in biomedical research studies, who agreed to answer a validated questionnaire evaluating objective and subjective comprehension scored from 0 (no comprehension) to 100 (excellent comprehension). Patients were provided either the original ICD or an ICD modified in terms of structure and readability. The primary end point was the score of objective comprehension. The secondary end-points were the enrolment rate in the clinical study and patient characteristics associated with the score of objective comprehension. Results Four hundred and eighty-one patients were included, 241 patients in the original ICD group and 240 patients in the modified ICD group. There was no difference between the two groups for the score of objective comprehension (original ICD 72.7 (95% CI 71.3, 74.1) vs. modified ICD 72.5 (95% CI 71.0, 74.0); P = 0.81). However, the rate of enrolment in the clinical study was lower in the group who received the modified ICD (64.4% (95% CI 58.3, 70.5)) than for the original ICD (73.0% (95% CI 67.4, 78.7)) (P = 0.042). Only female gender and high educational level were associated with a better objective comprehension. Conclusions Improving ICDs had no effect on participants’ understanding, whereas the rate of enrolment was lower in this group. In attempts at improving potential participants’ understanding of clinical research information, efforts and future trials should focus on other ways to improve comprehension. PMID:26147763

Glasgow Coma Scale and Outcomes after Structural Traumatic Head Injury in Early Childhood

PubMed Central

Heather, Natasha L.; Derraik, José G. B.; Beca, John; Hofman, Paul L.; Dansey, Rangi; Hamill, James; Cutfield, Wayne S.

2013-01-01

Objective To assess the association of the Glasgow Coma Scale (GCS) with radiological evidence of head injury (the Abbreviated Injury Scale for the head region, AIS-HR) in young children hospitalized with traumatic head injury (THI), and the predictive value of GCS and AIS-HR scores for long-term impairment. Methods Our study involved a 10-year retrospective review of a database encompassing all patients admitted to Starship Children’s Hospital (Auckland, New Zealand, 2000–2010) with THI. Results We studied 619 children aged <5 years at the time of THI, with long-term outcome data available for 161 subjects. Both GCS and AIS-HR scores were predictive of length of intensive care unit and hospital stay (all p<0.001). GCS was correlated with AIS-HR (ρ=-0.46; p<0.001), although mild GCS scores (13–15) commonly under-estimated the severity of radiological injury: 42% of children with mild GCS scores had serious–critical THI (AIS-HR 3–5). Increasingly severe GCS or AIS-HR scores were both associated with a greater likelihood of long-term impairment (neurological disability, residual problems, and educational support). However, long-term impairment was also relatively common in children with mild GCS scores paired with structural THI more severe than a simple linear skull fracture. Conclusion Severe GCS scores will identify most cases of severe radiological injury in early childhood, and are good predictors of poor long-term outcome. However, young children admitted to hospital with structural THI and mild GCS scores have an appreciable risk of long-term disability, and also warrant long-term follow-up. PMID:24312648

Knowledge and practices towards influenza A (H1N1) among adults in three residential areas in Tampin Negeri Sembilan: a cross sectional survey.

PubMed

Zairina, A R; Nooriah, M S; Yunus, A Mohd

2011-08-01

A cross-sectional survey was conducted with the objective to explore a community's knowledge and practices towards prevention of Influenza A (H1N1) in three residential areas in Tampin. Respondents were randomly selected from a list of residences and interviewed face-to-face using a structured questionnaire. A total of 221 respondents (80.9%) were involved with the majority (64.7%) comprising female and who had attained secondary level of education (86.0%). The main source of information was from television/radio. The total score for knowledge questions was 15 and practice questions were 25. A total of 60.2% attained "adequate knowledge" and 52.0% "good practice". Mean (SD) for knowledge score was 11.6 (2.3) and practice was 18.1 (4.1). Ethnicity, education, income and practice score were identified as predictors for knowledge score. Income and knowledge scores were predictors for practice score. There was positive correlation between knowledge and practice scores.

Less Structured Movement Patterns Predict Severity of Positive Syndrome, Excitement, and Disorganization

PubMed Central

Walther, Sebastian

2014-01-01

Disorganized behavior is a key symptom of schizophrenia. The objective assessment of disorganized behavior is particularly challenging. Actigraphy has enabled the objective assessment of motor behavior in various settings. Reduced motor activity was associated with negative syndrome scores, but simple motor activity analyses were not informative on other symptom dimensions. The analysis of movement patterns, however, could be more informative for assessing schizophrenia symptom dimensions. Here, we use time series analyses on actigraphic data of 100 schizophrenia spectrum disorder patients. Actigraphy recording intervals were set at 2 s. Data from 2 defined 60-min periods were analyzed, and partial autocorrelations of the actigraphy time series indicated predictability of movements in each individual. Increased positive syndrome scores were associated with reduced predictability of movements but not with the overall amount of movement. Negative syndrome scores were associated with low activity levels but unrelated with predictability of movement. The factors disorganization and excitement were related to movement predictability but emotional distress was not. Thus, the predictability of objectively assessed motor behavior may be a marker of positive symptoms and disorganized behavior. This behavior could become relevant for translational research. PMID:23502433

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

PubMed Central

Graves, Lisa; Lalla, Leonora; Young, Meredith

2017-01-01

Abstract Objective To examine the relationship between objective assessment of performance and self-rated competence immediately before and after participation in a required summative family medicine clerkship objective structured clinical examination (OSCE). Design Learners rated their competence (on a 7-point Likert scale) before and after an OSCE along 3 dimensions: general, specific, and professional competencies relevant to family medicine. Setting McGill University in Montreal, Que. Participants All 168 third-year clinical clerks completing their mandatory family medicine rotation in 2010 to 2011 were invited to participate. Main outcome measures Self-ratings of competence and objective performance scores were compared, and were examined to determine if OSCEs could be a “corrective” tool for self-rating perceived competence (ie, if the experience of undergoing an assessment might assist learners in recalibrating their understanding of their own performance). Results A total of 140 (83%) of the third-year clinical clerks participated. Participating in an OSCE decreased learners’ ratings of perceived competence (pre-OSCE score = 4.9, post-OSCE score = 4.7; F1,3192 = 4.2; P < .05). Learners’ mean self-rated competence for all categories of behaviour (before and after) showed no relationship to OSCE performance (r < 0.12 and P > .08 for all), nor did ratings of station-relevant competence (before and after) (r < 0.19 and P > .09 for all). Ratings of competence before and after the OSCE were correlated for individual students (r > 0.40 and P < .001 for all). Conclusion After the OSCE, students’ self-ratings of perceived competence had decreased, and these ratings had little relationship to actual performance, regardless of the specificity of the rated competency. Discordance between perceived and actual competence is neither novel nor unique to family medicine. However, this discordance is an important consideration for the development of competency-based curricula. PMID:28404722

Experimental Protein Structure Verification by Scoring with a Single, Unassigned NMR Spectrum.

PubMed

Courtney, Joseph M; Ye, Qing; Nesbitt, Anna E; Tang, Ming; Tuttle, Marcus D; Watt, Eric D; Nuzzio, Kristin M; Sperling, Lindsay J; Comellas, Gemma; Peterson, Joseph R; Morrissey, James H; Rienstra, Chad M

2015-10-06

Standard methods for de novo protein structure determination by nuclear magnetic resonance (NMR) require time-consuming data collection and interpretation efforts. Here we present a qualitatively distinct and novel approach, called Comparative, Objective Measurement of Protein Architectures by Scoring Shifts (COMPASS), which identifies the best structures from a set of structural models by numerical comparison with a single, unassigned 2D (13)C-(13)C NMR spectrum containing backbone and side-chain aliphatic signals. COMPASS does not require resonance assignments. It is particularly well suited for interpretation of magic-angle spinning solid-state NMR spectra, but also applicable to solution NMR spectra. We demonstrate COMPASS with experimental data from four proteins--GB1, ubiquitin, DsbA, and the extracellular domain of human tissue factor--and with reconstructed spectra from 11 additional proteins. For all these proteins, with molecular mass up to 25 kDa, COMPASS distinguished the correct fold, most often within 1.5 Å root-mean-square deviation of the reference structure. Copyright © 2015 Elsevier Ltd. All rights reserved.

Experimental Protein Structure Verification by Scoring with a Single, Unassigned NMR Spectrum

PubMed Central

Courtney, Joseph M.; Ye, Qing; Nesbitt, Anna E.; Tang, Ming; Tuttle, Marcus D.; Watt, Eric D.; Nuzzio, Kristin M.; Sperling, Lindsay J.; Comellas, Gemma; Peterson, Joseph R.; Morrissey, James H.; Rienstra, Chad M.

2016-01-01

Standard methods for de novo protein structure determination by nuclear magnetic resonance (NMR) require time-consuming data collection and interpretation efforts. Here we present a qualitatively distinct and novel approach, called Comparative, Objective Measurement of Protein Architectures by Scoring Shifts (COMPASS), which identifies the best structures from a set of structural models by numerical comparison with a single, unassigned 2D 13C-13C NMR spectrum containing backbone and side-chain aliphatic signals. COMPASS does not require resonance assignments. It is particularly well suited for interpretation of magic-angle spinning solid-state NMR spectra, but also applicable to solution NMR spectra. We demonstrate COMPASS with experimental data from four proteins—GB1, ubiquitin, DsbA, and the extracellular domain of human tissue factor—and with reconstructed spectra from 11 additional proteins. For all these proteins, with molecular mass up to 25 kDa, COMPASS distinguished the correct fold, most often within 1.5 Å root-mean-square deviation of the reference structure. PMID:26365800

Using Objective Structured Teaching Encounters (OSTEs) to prepare chief residents to be emotionally intelligent leaders

PubMed Central

Cerrone, Sara Ann; Adelman, Patti; Akbar, Salaahuddin; Yacht, Andrew C.; Fornari, Alice

2017-01-01

ABSTRACT Background: Chief Residents must lead, manage and mentor a diverse and often large group of residents, however there is a lack of formal leadership training throughout graduate medical education. Objective: Development of a 3-part Chief Resident (CR) Program focused on leading, managing and mentoring. Design: Each participant completes an Emotional Intelligence (EI) Inventory prior to the day-long event. Participants receive their EI scores at the beginning of the program, which features interactive sessions on leadership, management, and feedback skills. The program then reinforces the application of their new knowledge about EI through a four station OSTE (Observed Structured Teaching Encounter). CRs practice feedback and coaching skills in a simulated environment where they need to provide the context of formative feedback to a standardized resident. Results: The aggregated mean pre-session EI score for all participants was 76.9 (an ideal score is >85). An independent-samples t-test compared the CRs’ leadership and feedback performance on their first and second OSTE performance within a single afternoon session. There was a significant difference between the first OSTE performance (M = 47.92, SD = 7.8) and the second OSTE performance (M = 51.22, SD = 6.9); t (68) = 1.99, p = 0.006. These results suggest that participating in multiple OSTEs positively reinforces the core interpersonal and communication skills discussed in the didactic and practiced in the interactive portions of the program. Conclusion: The low mean pre-session EI score achieved by our participants supports the idea that CRs enter their new roles with a level of EI that can be enhanced. CRs had an overall positive reaction to EI and its application to the core skills addressed in the program, highlighting the fact that similar programs could be used to train early career physicians to be more skilled and comfortable with leading, managing and mentoring. Abbreviations: CR: Chief resident; EI: Emotional intelligence; GME: Graduate medical education; OSTE: Objective structured teaching encounter PMID:28460596

Asymmetric Macular Structural Damage Is Associated With Relative Afferent Pupillary Defects in Patients With Glaucoma

PubMed Central

Gracitelli, Carolina P. B.; Tatham, Andrew J.; Zangwill, Linda M.; Weinreb, Robert N.; Abe, Ricardo Y.; Diniz-Filho, Alberto; Paranhos, Augusto; Baig, Saif; Medeiros, Felipe A.

2016-01-01

Purpose We examined the relationship between relative afferent pupillary defects (RAPDs) and macular structural damage measured by macular thickness and macular ganglion cell-inner plexiform layer (mGCIPL) thickness in patients with glaucoma. Methods A cross-sectional study was done of 106 glaucoma patients and 85 healthy individuals from the Diagnostic Innovations in Glaucoma Study. All subjects underwent standard automated perimetry (SAP) and optic nerve and macular imaging using Cirrus Spectral Domain Optical Coherence Tomography (SDOCT). Glaucoma was defined as repeatable abnormal SAP or progressive glaucomatous changes on stereo photographs. Pupil responses were assessed using an automated pupillometer, which records the magnitude of RAPD (RAPD score), with additional RAPD scores recorded for each of a series of colored stimuli (blue, red, green, and yellow). The relationship between RAPD score and intereye differences (right minus left eye) in circumpapillary retinal nerve fiber layer (cpRNFL) thickness, mGCIPL, macular thickness, and SAP mean deviation (MD), was examined using linear regression. Results There was fair correlation between RAPD score and asymmetric macular structural damage measured by intereye difference in mGCIPL thickness (R2 = 0.285, P < 0.001). The relationship between RAPD score and intereye difference in macular thickness was weaker (R2 = 0.167, P < 0.001). Intereye difference in cpRNFL thickness (R2 = 0.350, P < 0.001) and SAP MD (R2 = 0.594, P < 0.001) had stronger association with RAPD scores compared to intereye difference in mGCIPL and macular thickness. Conclusions Objective assessment of pupillary responses using a pupillometer was associated with asymmetric macular structural damage in patients with glaucoma. PMID:27064394

Evaluating Abstract Art: Relation between Term Usage, Subjective Ratings, Image Properties and Personality Traits.

PubMed

Lyssenko, Nathalie; Redies, Christoph; Hayn-Leichsenring, Gregor U

2016-01-01

One of the major challenges in experimental aesthetics is the uncertainty of the terminology used in experiments. In this study, we recorded terms that are spontaneously used by participants to describe abstract artworks and studied their relation to the second-order statistical image properties of the same artworks (Experiment 1). We found that the usage frequency of some structure-describing terms correlates with statistical image properties, such as PHOG Self-Similarity, Anisotropy and Complexity. Additionally, emotion-associated terms correlate with measured color values. Next, based on the most frequently used terms, we created five different rating scales (Experiment 2) and obtained ratings of participants for the abstract paintings on these scales. We found significant correlations between descriptive score ratings (e.g., between structure and subjective complexity), between evaluative and descriptive score ratings (e.g., between preference and subjective complexity/interest) and between descriptive score ratings and statistical image properties (e.g., between interest and PHOG Self-Similarity, Complexity and Anisotropy). Additionally, we determined the participants' personality traits as described in the 'Big Five Inventory' (Goldberg, 1990; Rammstedt and John, 2005) and correlated them with the ratings and preferences of individual participants. Participants with higher scores for Neuroticism showed preferences for objectively more complex images, as well as a different notion of the term complex when compared with participants with lower scores for Neuroticism. In conclusion, this study demonstrates an association between objectively measured image properties and the subjective terms that participants use to describe or evaluate abstract artworks. Moreover, our results suggest that the description of abstract artworks, their evaluation and the preference of participants for their low-level statistical properties are linked to personality traits.

The dialysis orders objective structured clinical examination (OSCE): a formative assessment for nephrology fellows

PubMed Central

Prince, Lisa K; Campbell, Ruth C; Gao, Sam W; Kendrick, Jessica; Lebrun, Christopher J; Little, Dustin J; Mahoney, David L; Maursetter, Laura A; Nee, Robert; Saddler, Mark; Watson, Maura A

2018-01-01

Abstract Background Few quantitative nephrology-specific simulations assess fellow competency. We describe the development and initial validation of a formative objective structured clinical examination (OSCE) assessing fellow competence in ordering acute dialysis. Methods The three test scenarios were acute continuous renal replacement therapy, chronic dialysis initiation in moderate uremia and acute dialysis in end-stage renal disease-associated hyperkalemia. The test committee included five academic nephrologists and four clinically practicing nephrologists outside of academia. There were 49 test items (58 points). A passing score was 46/58 points. No item had median relevance less than ‘important’. The content validity index was 0.91. Ninety-five percent of positive-point items were easy–medium difficulty. Preliminary validation was by 10 board-certified volunteers, not test committee members, a median of 3.5 years from graduation. The mean score was 49 [95% confidence interval (CI) 46–51], κ = 0.68 (95% CI 0.59–0.77), Cronbach’s α = 0.84. Results We subsequently administered the test to 25 fellows. The mean score was 44 (95% CI 43–45); 36% passed the test. Fellows scored significantly less than validators (P < 0.001). Of evidence-based questions, 72% were answered correctly by validators and 54% by fellows (P = 0.018). Fellows and validators scored least well on the acute hyperkalemia question. In self-assessing proficiency, 71% of fellows surveyed agreed or strongly agreed that the OSCE was useful. Conclusions The OSCE may be used to formatively assess fellow proficiency in three common areas of acute dialysis practice. Further validation studies are in progress. PMID:29644053

Evaluating Abstract Art: Relation between Term Usage, Subjective Ratings, Image Properties and Personality Traits

PubMed Central

Lyssenko, Nathalie; Redies, Christoph; Hayn-Leichsenring, Gregor U.

2016-01-01

One of the major challenges in experimental aesthetics is the uncertainty of the terminology used in experiments. In this study, we recorded terms that are spontaneously used by participants to describe abstract artworks and studied their relation to the second-order statistical image properties of the same artworks (Experiment 1). We found that the usage frequency of some structure-describing terms correlates with statistical image properties, such as PHOG Self-Similarity, Anisotropy and Complexity. Additionally, emotion-associated terms correlate with measured color values. Next, based on the most frequently used terms, we created five different rating scales (Experiment 2) and obtained ratings of participants for the abstract paintings on these scales. We found significant correlations between descriptive score ratings (e.g., between structure and subjective complexity), between evaluative and descriptive score ratings (e.g., between preference and subjective complexity/interest) and between descriptive score ratings and statistical image properties (e.g., between interest and PHOG Self-Similarity, Complexity and Anisotropy). Additionally, we determined the participants’ personality traits as described in the ‘Big Five Inventory’ (Goldberg, 1990; Rammstedt and John, 2005) and correlated them with the ratings and preferences of individual participants. Participants with higher scores for Neuroticism showed preferences for objectively more complex images, as well as a different notion of the term complex when compared with participants with lower scores for Neuroticism. In conclusion, this study demonstrates an association between objectively measured image properties and the subjective terms that participants use to describe or evaluate abstract artworks. Moreover, our results suggest that the description of abstract artworks, their evaluation and the preference of participants for their low-level statistical properties are linked to personality traits. PMID:27445933

Development and assessment of a new 3D neuroanatomy teaching tool for MRI training.

PubMed

Drapkin, Zachary A; Lindgren, Kristen A; Lopez, Michael J; Stabio, Maureen E

2015-01-01

A computerized three-dimensional (3D) neuroanatomy teaching tool was developed for training medical students to identify subcortical structures on a magnetic resonance imaging (MRI) series of the human brain. This program allows the user to transition rapidly between two-dimensional (2D) MRI slices, 3D object composites, and a combined model in which 3D objects are overlaid onto the 2D MRI slices, all while rotating the brain in any direction and advancing through coronal, sagittal, or axial planes. The efficacy of this tool was assessed by comparing scores from an MRI identification quiz and survey in two groups of first-year medical students. The first group was taught using this new 3D teaching tool, and the second group was taught the same content for the same amount of time but with traditional methods, including 2D images of brain MRI slices and 3D models from widely used textbooks and online sources. Students from the experimental group performed marginally better than the control group on overall test score (P = 0.07) and significantly better on test scores extracted from questions involving C-shaped internal brain structures (P < 0.01). Experimental participants also expressed higher confidence in their abilities to visualize the 3D structure of the brain (P = 0.02) after using this tool. Furthermore, when surveyed, 100% of the students in the experimental group recommended this tool for future students. These results suggest that this neuroanatomy teaching tool is an effective way to train medical students to read an MRI of the brain and is particularly effective for teaching C-shaped internal brain structures. © 2015 American Association of Anatomists.

Objective quality assessment for multiexposure multifocus image fusion.

PubMed

Hassen, Rania; Wang, Zhou; Salama, Magdy M A

2015-09-01

There has been a growing interest in image fusion technologies, but how to objectively evaluate the quality of fused images has not been fully understood. Here, we propose a method for objective quality assessment of multiexposure multifocus image fusion based on the evaluation of three key factors of fused image quality: 1) contrast preservation; 2) sharpness; and 3) structure preservation. Subjective experiments are conducted to create an image fusion database, based on which, performance evaluation shows that the proposed fusion quality index correlates well with subjective scores, and gives a significant improvement over the existing fusion quality measures.

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

Structural Analysis of Character Education: A Crosscultural Investigation

ERIC Educational Resources Information Center

Sivo, Stephen; Karl, Shannon; Fox, Jesse; Taub, Gordon; Robinson, Edward

2017-01-01

The primary objective of this cross-cultural investigation is to compare patterns in student responses to an empirically scrutinized character education measure administered to students in four school districts in Florida with students in a school in Kenya. In this way, the generalizability of findings for scale scores could be compared across…

A Comparison of Standard-Setting Procedures for an OSCE in Undergraduate Medical Education.

ERIC Educational Resources Information Center

Kaufman, David M.; Mann, Karen V.; Muijtjens, Arno M. M.; van der Vleuten, Cees P. M.

2000-01-01

Compared four standard-setting procedures for an objective structure clinical examination (OSCE) in medical education. Applied Angoff, borderline, relative, and holistic procedures to the data used to establish a cutoff score for a pass/fail decision. The Angoff and borderline procedures gave similar results; however, the relative and holistic…

Assessment of Romantic Perfectionism: Psychometric Properties of the Romantic Relationship Perfectionism Scale

ERIC Educational Resources Information Center

Matte, Melody; Lafontaine, Marie-France

2012-01-01

The objective of the present study was to provide validity evidence for the scores from the Romantic Relationship Perfectionism Scale. Results indicate a two-factor structure, adequate reliability, and overall good convergent, concurrent, discriminant, and incremental validity evidence. The strengths and limitations of this measure are discussed.…

[Development of an Atypical Response Scale.

ERIC Educational Resources Information Center

Mendelsohn, Mark; Linden, James

The development of an objective diagnostic scale to measure atypical behavior is discussed. The Atypical Response Scale (ARS) is a structured projective test consisting of 17 items, each weighted 1, 2, or 3, that were tested for convergence and reliability. ARS may be individually or group administered in 10-15 minutes; hand scoring requires 90…

Quality Control of an OSCE Using Generalizability Theory and Many-Faceted Rasch Measurement

ERIC Educational Resources Information Center

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

2008-01-01

An Objective Structured Clinical Examination (OSCE) is an effective method for evaluating competencies. However, scores obtained from an OSCE are vulnerable to many potential measurement errors that cases, items, or standardized patients (SPs) can introduce. Monitoring these sources of errors is an important quality control mechanism to ensure…

[Quality of the structured abstracts presented at a congress].

PubMed

dos Santos, Edilson F; Pereira, Maurício G

2007-01-01

To assess and compare quality of abstracts presented at a medical congress (XIV Congresso da Sociedade Brasileira de Infectologia, November, 2005). The hypothesis is that material of better quality is chosen for oral presentation. All the 63 abstracts selected for oral presentation were compared with a random sample (n=63) of the 664 abstracts registered as poster presentations. Quality was measured by a structured questionnaire comprised of 33 criteria, distributed in eight categories: purpose, research design, setting, subjects, intervention, measurement, results and conclusions. The questionnaire was applied by one of the authors who were not blind to the objective of the study. The final score could range from 0 (bad) to 1 (excellent). Abstracts quality was considered moderately good. The overall mean quality scores were 0.60 and 0.62 respectively, for poster and oral presentation (p = 0.086). The criteria rated poorly were: subjects, variable measurements, location and conclusion. The tested hypothesis of better quality in abstracts selected for oral presentation has not been confirmed. It is recommended that organizers of the congresses the use of objective quality criteria to select the form of presentation while improving on quality.

The use of the "Objective Structured Assessment of Technical Skills" as an Assessment Tool Among Danish Vascular Surgeons in Training.

PubMed

Lladó Grove, Gabriela; Langager Høgh, Annette; Nielsen, Judith; Sandermann, Jes

2015-01-01

The concept of the Objective Structured Assessment of Technical Skills (OSATS) is to quantify surgical skills in an objective way and, thereby, produce an additional procedure-specific assessment tool. Since 2005, a 2-day practical course for upcoming specialist registrars in vascular surgery has been obligatory. The aim of this study is to describe the results from a tailored OSATS test as a tool for the evaluation of practical skills during an intensive training session in a simple simulator box for vascular anastomoses. Between 2005 and 2013, we registered the OSATS scores of all course participants. The following data were collected from the questionnaires: years as a candidate, months in vascular surgery or in another type of surgery, and the number of vascular anastomoses performed before the course. The assessment of surgical skills was conducted with an OSATS score template specifically made for this purpose. It consists of a 12-item table with a 5-point grading scale. OSATS score (points) and time for the procedure (OSATS time in min) were registered at baseline (OSATS I) and at the end of the course (OSATS II). OSATS scores were given in both OSATS I and OSATS II for the 83 trainees, and the mean difference was 8.1 points (95% CI: 6.7; 9.5, p < 0.001). OSATS time was given for 69 trainees, and the mean difference was 2.8 minutes (95% CI: 1.4; 4.2, p < 0.001). We found no relationship between years since graduation, months in any surgical specialty, or the experience with vascular anastomoses and outcomes. OSATS is a valuable tool for evaluating the advancement of technical skills during an intensive practical course in performing vascular anastomoses. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Assessment of first-year veterinary students' communication skills using an objective structured clinical examination: the importance of context.

PubMed

Hecker, Kent G; Adams, Cindy L; Coe, Jason B

2012-01-01

Communication skills are considered to be a core clinical skill in veterinary medicine and essential for practice success, including outcomes of care for patients and clients. While veterinary schools include communication skills training in their programs, there is minimal knowledge on how best to assess communication competence throughout the undergraduate program. The purpose of this study was to further our understanding of the reliability, utility, and suitability of a communication skills Objective Structured Clinical Examination (OSCE). Specifically we wanted to (1) identify the greatest source of variability (student, rater, station, and track) within a first-year, four station OSCE using exam scores and scores from videotape review by two trained raters, and (2) determine the effect of different stations on students' communication skills performance. Reliability of the scores from both the exam data and the two expert raters was 0.50 and 0.46 respectively, with the greatest amount of variance attributable to student by station. The percentage of variance due to raters in the exam data was 16.35%, whereas the percentage of variance for the two expert raters was 0%. These results have three important implications. First, the results reinforce the need for communication educators to emphasize that use of communication skills is moderated by the context of the clinical interaction. Second, by increasing rater training the amount of error in the scores due to raters can be reduced and inter-rater reliability increases. Third, the communication assessment method (in this case the OSCE checklist) should be built purposefully, taking into consideration the context of the case.

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.

An environmental decision framework applied to marine engine control technologies.

PubMed

Corbett, James J; Chapman, David

2006-06-01

This paper develops a decision framework for considering emission control technologies on marine engines, informed by standard decision theory, with an open structure that may be adapted by operators with specific vessel and technology attributes different from those provided here. Attributes relate objectives important to choosing control technologies with specific alternatives that may meet several of the objectives differently. The transparent framework enables multiple stakeholders to understand how different subjective judgments and varying attribute properties may result in different technology choices. Standard scoring techniques ensure that attributes are not biased by subjective scoring and that weights are the primary quantitative input where subjective preferences are exercised. An expected value decision structure is adopted that considers probabilities (likelihood) that a given alternative can meet its claims; alternative decision criteria are discussed. Capital and annual costs are combined using a net present value approach. An iterative approach is advocated that allows for screening and disqualifying alternatives that do not meet minimum conditions for acceptance, such as engine warranty or U.S. Coast Guard requirements. This decision framework assists vessel operators in considering explicitly important attributes and in representing choices clearly to other stakeholders concerned about reducing air pollution from vessels. This general decision structure may also be applied similarly to other environmental controls in marine applications.

Olfactory identification and Stroop interference converge in schizophrenia.

PubMed Central

Purdon, S E

1998-01-01

OBJECTIVE: To test the discriminant validity of a model predicting a dissociation between measures of right and left frontal lobe function in people with schizophrenia. PARTICIPANTS: Twenty-one clinically stable outpatients with schizophrenia. INTERVENTIONS: Patients were administered the University of Pennsylvania Smell Identification Test (UPSIT), the Stroop Color-Word Test (Stroop), and the Positive and Negative Syndrome Scale (PANSS). OUTCOME MEASURES: Scores on these tests and relation among scores. RESULTS: There was a convergence of UPSII and Stroop interference scores consistent with a common cerebral basis for limitations in olfactory identification and inhibition of distraction. There was also a divergence of UPSIT and Stroop reading scores suggesting that the olfactory identification limitation is distinct from a general limitation of attention or a dysfunction of the left dorsolateral prefrontal cortex. Most notable was the 81% classification convergence between the UPSIT and Stroop incongruous colour naming scores compared with the near-random 57% classification convergence of the UPSIT and Stroop reading scores. CONCLUSIONS: These data are consistent with a right orbitofrontal dysfunction in a subgroup of patients with schizophrenia, although the involvement of mesial temporal structures in both tasks must be ruled out with further study. A multifactorial model depicting contributions from diverse cerebral structures is required to describe the pathophysiology of schizophrenia. Valid behavioural methods for classifying suspected subgroups of patients with particular cerebral dysfunction would be of value in the construction of this model. PMID:9595890

Photogrammetric Analysis of Attractiveness in Indian Faces

PubMed Central

Duggal, Shveta; Kapoor, DN; Verma, Santosh; Sagar, Mahesh; Lee, Yung-Seop; Moon, Hyoungjin

2016-01-01

Background The objective of this study was to assess the attractive facial features of the Indian population. We tried to evaluate subjective ratings of facial attractiveness and identify which facial aesthetic subunits were important for facial attractiveness. Methods A cross-sectional study was conducted of 150 samples (referred to as candidates). Frontal photographs were analyzed. An orthodontist, a prosthodontist, an oral surgeon, a dentist, an artist, a photographer and two laymen (estimators) subjectively evaluated candidates' faces using visual analog scale (VAS) scores. As an objective method for facial analysis, we used balanced angular proportional analysis (BAPA). Using SAS 10.1 (SAS Institute Inc.), the Turkey's studentized range test and Pearson correlation analysis were performed to detect between-group differences in VAS scores (Experiment 1), to identify correlations between VAS scores and BAPA scores (Experiment 2), and to analyze the characteristic features of facial attractiveness and gender differences (Experiment 3); the significance level was set at P=0.05. Results Experiment 1 revealed some differences in VAS scores according to professional characteristics. In Experiment 2, BAPA scores were found to behave similarly to subjective ratings of facial beauty, but showed a relatively weak correlation coefficient with the VAS scores. Experiment 3 found that the decisive factors for facial attractiveness were different for men and women. Composite images of attractive Indian male and female faces were constructed. Conclusions Our photogrammetric study, statistical analysis, and average composite faces of an Indian population provide valuable information about subjective perceptions of facial beauty and attractive facial structures in the Indian population. PMID:27019809

Establishing objective benchmarks in robotic virtual reality simulation at the level of a competent surgeon using the RobotiX Mentor simulator.

PubMed

Watkinson, William; Raison, Nicholas; Abe, Takashige; Harrison, Patrick; Khan, Shamim; Van der Poel, Henk; Dasgupta, Prokar; Ahmed, Kamran

2018-05-01

To establish objective benchmarks at the level of a competent robotic surgeon across different exercises and metrics for the RobotiX Mentor virtual reality (VR) simulator suitable for use within a robotic surgical training curriculum. This retrospective observational study analysed results from multiple data sources, all of which used the RobotiX Mentor VR simulator. 123 participants with varying experience from novice to expert completed the exercises. Competency was established as the 25th centile of the mean advanced intermediate score. Three basic skill exercises and two advanced skill exercises were used. King's College London. 84 Novice, 26 beginner intermediates, 9 advanced intermediates and 4 experts were used in this retrospective observational study. Objective benchmarks derived from the 25th centile of the mean scores of the advanced intermediates provided suitably challenging yet also achievable targets for training surgeons. The disparity in scores was greatest for the advanced exercises. Novice surgeons are able to achieve the benchmarks across all exercises in the majority of metrics. We have successfully created this proof-of-concept study, which requires validation in a larger cohort. Objective benchmarks obtained from the 25th centile of the mean scores of advanced intermediates provide clinically relevant benchmarks at the standard of a competent robotic surgeon that are challenging yet also attainable. That can be used within a VR training curriculum allowing participants to track and monitor their progress in a structured and progressional manner through five exercises. Providing clearly defined targets, ensuring that a universal training standard has been achieved across training surgeons. © 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.

Correlation of Objective Assessment Data With General Surgery Resident In-Training Evaluation Reports and Operative Volumes.

PubMed

Abdelsattar, Jad M; AlJamal, Yazan N; Ruparel, Raaj K; Rowse, Phillip G; Heller, Stephanie F; Farley, David R

2018-05-14

Faculty evaluations, ABSITE scores, and operative case volumes often tell little about true resident performance. We developed an objective structured clinical examination called the Surgical X-Games (5 rooms, 15 minutes each, 12-15 tests total, different for each postgraduate [PGY] level). We hypothesized that performance in X-Games will prove more useful in identifying areas of strength or weakness among general surgery (GS) residents than faculty evaluations, ABSITE scores, or operative cases volumes. PGY 2 to 5 GS residents (n = 35) were tested in a semiannual X-Games assessment using multiple simulation tasks: laparoscopic skills, bowel anastomosis, CT/CXR analysis, chest tube placement, etc. over 1 academic year. Resident scores were compared to their ABSITE, in-training evaluation reports, and operating room case numbers. Academic medical center. PGY-2, 3, 4, and 5 GS residents at Mayo Clinic in Rochester, MN. Results varied greatly within each class except for staff evaluations: in-training evaluation reports medians for PGY-2s were 5.3 (range: 5.0-6.0), PGY-3s 5.9 (5.5-6.3), PGY-4s 5.6 (5.0-6.0), and PGY-5s were 6.1 (5.6-6.9). Although ABSITE and operating room case volumes fluctated greatly with each PGY class, only X-Games scores (median: PGY-2 = 82, PGY-3 = 61, PGY-4 = 76, and PGY-5 = 60) correlated positively (p < 0.05) with operative case volume and negatively (p < 0.05) with staff evaluations. X-Games assessment generated wide differentiation of resident performance quickly, inexpensively, and objectively. Although "Minnesota-nice" surgical staff may feel all GS trainees are "above average," objective assessment tells us otherwise. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Clinical competency evaluation of Brazilian chiropractic interns

PubMed Central

Facchinato, Ana Paula A.; Benedicto, Camila C.; Mora, Aline G.; Cabral, Dayane M.C.; Fagundes, Djalma J.

2015-01-01

Objective This study compares the results of an objective structured clinical examination (OSCE) between 2 groups of students before an internship and after 6 months of clinical practice in an internship. Methods Seventy-two students participated, with 36 students in each cohort. The OSCEs were performed in the simulation laboratory before the participants' clinical practice internship and after 6 months of the internship. Students were tested in 9 stations for clinical skills and knowledge. The same procedures were repeated for both cohorts. The t test was used for unpaired parametric samples and Fisher's exact test was used for comparison of proportions. Results There was no difference in the mean final score between the 2 groups (p = .34 for test 1; p = .08 for test 2). The performance of the students in group 1 was not significantly different when performed before and after 6 months of clinical practice, but in group 2 there was a significant decrease in the average score after 6 months of clinical practice. Conclusions There was no difference in the cumulative average score for the 2 groups before and after 6 months of clinical practice in the internship. There were differences within the cohorts, however, with a significant decrease in the average score in group 2. Issues pertaining to test standardization and student motivation for test 2 may have influenced the scores. PMID:25588200

Evaluation of a Problem-based Learning Workshop Using Pre- and Post-test Objective Structured Clinical Examinations and Standardized Patients.

ERIC Educational Resources Information Center

Davis, Paul; Kvern, Brent; Donen, Neil; Andrews, Elaine; Nixon, Olga

2000-01-01

Pre/posttest data on 40 physicians who completed problem-based clinical scenarios on osteoporosis revealed that 39 showed improvement or modest change in postworkshop scores, especially in terms of management of male patients, determination of risk factors, and use and interpretation of bone density tests. (SK)

Maximum Likelihood Dynamic Factor Modeling for Arbitrary "N" and "T" Using SEM

ERIC Educational Resources Information Center

Voelkle, Manuel C.; Oud, Johan H. L.; von Oertzen, Timo; Lindenberger, Ulman

2012-01-01

This article has 3 objectives that build on each other. First, we demonstrate how to obtain maximum likelihood estimates for dynamic factor models (the direct autoregressive factor score model) with arbitrary "T" and "N" by means of structural equation modeling (SEM) and compare the approach to existing methods. Second, we go beyond standard time…

Using Objective Structured Teaching Encounters (OSTEs) to prepare chief residents to be emotionally intelligent leaders.

PubMed

Cerrone, Sara Ann; Adelman, Patti; Akbar, Salaahuddin; Yacht, Andrew C; Fornari, Alice

2017-01-01

Chief Residents must lead, manage and mentor a diverse and often large group of residents, however there is a lack of formal leadership training throughout graduate medical education. Development of a 3-part Chief Resident (CR) Program focused on leading, managing and mentoring. Each participant completes an Emotional Intelligence (EI) Inventory prior to the day-long event. Participants receive their EI scores at the beginning of the program, which features interactive sessions on leadership, management, and feedback skills. The program then reinforces the application of their new knowledge about EI through a four station OSTE (Observed Structured Teaching Encounter). CRs practice feedback and coaching skills in a simulated environment where they need to provide the context of formative feedback to a standardized resident. The aggregated mean pre-session EI score for all participants was 76.9 (an ideal score is >85). An independent-samples t-test compared the CRs' leadership and feedback performance on their first and second OSTE performance within a single afternoon session. There was a significant difference between the first OSTE performance (M = 47.92, SD = 7.8) and the second OSTE performance (M = 51.22, SD = 6.9); t (68) = 1.99, p = 0.006. These results suggest that participating in multiple OSTEs positively reinforces the core interpersonal and communication skills discussed in the didactic and practiced in the interactive portions of the program. The low mean pre-session EI score achieved by our participants supports the idea that CRs enter their new roles with a level of EI that can be enhanced. CRs had an overall positive reaction to EI and its application to the core skills addressed in the program, highlighting the fact that similar programs could be used to train early career physicians to be more skilled and comfortable with leading, managing and mentoring. CR: Chief resident; EI: Emotional intelligence; GME: Graduate medical education; OSTE: Objective structured teaching encounter.

Tibia and radius bone geometry and volumetric density in obese compared to non-obese adolescents.

PubMed

Leonard, Mary B; Zemel, Babette S; Wrotniak, Brian H; Klieger, Sarah B; Shults, Justine; Stallings, Virginia A; Stettler, Nicolas

2015-04-01

Childhood obesity is associated with biologic and behavioral characteristics that may impact bone mineral density (BMD) and structure. The objective was to determine the association between obesity and bone outcomes, independent of sexual and skeletal maturity, muscle area and strength, physical activity, calcium intake, biomarkers of inflammation, and vitamin D status. Tibia and radius peripheral quantitative CT scans were obtained in 91 obese (BMI>97th percentile) and 51 non-obese adolescents (BMI>5th and <85th percentiles). Results were converted to sex- and race-specific Z-scores relative to age. Cortical structure, muscle area and muscle strength (by dynamometry) Z-scores were further adjusted for bone length. Obese participants had greater height Z-scores (p<0.001), and advanced skeletal maturity (p<0.0001), compared with non-obese participants. Tibia cortical section modulus and calf muscle area Z-scores were greater in obese participants (1.07 and 1.63, respectively, both p<0.0001). Tibia and radius trabecular and cortical volumetric BMD did not differ significantly between groups. Calf muscle area and strength Z-scores, advanced skeletal maturity, and physical activity (by accelerometry) were positively associated with tibia cortical section modulus Z-scores (all p<0.01). Adjustment for muscle area Z-score attenuated differences in tibia section modulus Z-scores between obese and non-obese participants from 1.07 to 0.28. After multivariate adjustment for greater calf muscle area and strength Z-scores, advanced maturity, and less moderate to vigorous physical activity, tibia section modulus Z-scores were 0.32 (95% CI -0.18, 0.43, p=0.06) greater in obese, vs. non-obese participants. Radius cortical section modulus Z-scores were 0.45 greater (p=0.08) in obese vs. non-obese participants; this difference was attenuated to 0.14 with adjustment for advanced maturity. These findings suggest that greater tibia cortical section modulus in obese adolescents is attributable to advanced skeletal maturation and greater muscle area and strength, while less moderate to vigorous physical activities offset the positive effects of these covariates. The impact of obesity on cortical structure was greater at weight bearing sites. Copyright © 2014 Elsevier Inc. All rights reserved.

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

PubMed

Graves, Lisa; Lalla, Leonora; Young, Meredith

2017-04-01

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

Methodologies for semiquantitative evaluation of hip osteoarthritis by magnetic resonance imaging: approaches based on the whole organ and focused on active lesions.

PubMed

Jaremko, Jacob L; Lambert, Robert G W; Zubler, Veronika; Weber, Ulrich; Loeuille, Damien; Roemer, Frank W; Cibere, Jolanda; Pianta, Marcus; Gracey, David; Conaghan, Philip; Ostergaard, Mikkel; Maksymowych, Walter P

2014-02-01

As a wider variety of therapeutic options for osteoarthritis (OA) becomes available, there is an increasing need to objectively evaluate disease severity on magnetic resonance imaging (MRI). This is more technically challenging at the hip than at the knee, and as a result, few systematic scoring systems exist. The OMERACT (Outcome Measures in Rheumatology) filter of truth, discrimination, and feasibility can be used to validate image-based scoring systems. Our objective was (1) to review the imaging features relevant to the assessment of severity and progression of hip OA; and (2) to review currently used methods to grade these features in existing hip OA scoring systems. A systematic literature review was conducted. MEDLINE keyword search was performed for features of arthropathy (such as hip + bone marrow edema or lesion, synovitis, cyst, effusion, cartilage, etc.) and scoring system (hip + OA + MRI + score or grade), with a secondary manual search for additional references in the retrieved publications. Findings relevant to the severity of hip OA include imaging markers associated with inflammation (bone marrow lesion, synovitis, effusion), structural damage (cartilage loss, osteophytes, subchondral cysts, labral tears), and predisposing geometric factors (hip dysplasia, femoral-acetabular impingement). Two approaches to the semiquantitative assessment of hip OA are represented by Hip OA MRI Scoring System (HOAMS), a comprehensive whole organ assessment of nearly all findings, and the Hip Inflammation MRI Scoring System (HIMRISS), which selectively scores only active lesions (bone marrow lesion, synovitis/effusion). Validation is presently confined to limited assessment of reliability. Two methods for semiquantitative assessment of hip OA on MRI have been described and validation according to the OMERACT Filter is limited to evaluation of reliability.

PHOENIX: a scoring function for affinity prediction derived using high-resolution crystal structures and calorimetry measurements.

PubMed

Tang, Yat T; Marshall, Garland R

2011-02-28

Binding affinity prediction is one of the most critical components to computer-aided structure-based drug design. Despite advances in first-principle methods for predicting binding affinity, empirical scoring functions that are fast and only relatively accurate are still widely used in structure-based drug design. With the increasing availability of X-ray crystallographic structures in the Protein Data Bank and continuing application of biophysical methods such as isothermal titration calorimetry to measure thermodynamic parameters contributing to binding free energy, sufficient experimental data exists that scoring functions can now be derived by separating enthalpic (ΔH) and entropic (TΔS) contributions to binding free energy (ΔG). PHOENIX, a scoring function to predict binding affinities of protein-ligand complexes, utilizes the increasing availability of experimental data to improve binding affinity predictions by the following: model training and testing using high-resolution crystallographic data to minimize structural noise, independent models of enthalpic and entropic contributions fitted to thermodynamic parameters assumed to be thermodynamically biased to calculate binding free energy, use of shape and volume descriptors to better capture entropic contributions. A set of 42 descriptors and 112 protein-ligand complexes were used to derive functions using partial least-squares for change of enthalpy (ΔH) and change of entropy (TΔS) to calculate change of binding free energy (ΔG), resulting in a predictive r2 (r(pred)2) of 0.55 and a standard error (SE) of 1.34 kcal/mol. External validation using the 2009 version of the PDBbind "refined set" (n = 1612) resulted in a Pearson correlation coefficient (R(p)) of 0.575 and a mean error (ME) of 1.41 pK(d). Enthalpy and entropy predictions were of limited accuracy individually. However, their difference resulted in a relatively accurate binding free energy. While the development of an accurate and applicable scoring function was an objective of this study, the main focus was evaluation of the use of high-resolution X-ray crystal structures with high-quality thermodynamic parameters from isothermal titration calorimetry for scoring function development. With the increasing application of structure-based methods in molecular design, this study suggests that using high-resolution crystal structures, separating enthalpy and entropy contributions to binding free energy, and including descriptors to better capture entropic contributions may prove to be effective strategies toward rapid and accurate calculation of binding affinity.

The Impact of Critical Thinking on Clinical Judgment During Simulation With Senior Nursing Students.

PubMed

Cazzell, Mary; Anderson, Mindi

2016-01-01

The study examined the impact of critical thinking (CT) on clinical judgment (CJ) during a pediatric Objective Structured Clinical Evaluation (OSCE) with 160 pre-licensure nursing students. Educators are called to transform teaching strategies to develop CJ but confusion exists over definitions. A descriptive correlational design was used to examine demographics and Tower of Hanoi (TOH) and Health Science Reasoning Test (HSRT) scores. CJ was measured by scores on the Lasater Clinical Judgment Rubric (LCJR) from videotaped OSCEs. Participants were: 86 percent female, 42 percent Caucasian, median 23 years, with 49 percent having health care experience. Students averaged seven moves over minimum on the TOH. Average scores were: HSRT 25/38 and LCJR 31/44. Statistically significant predictors of CJ were gender, ethnicity, HSRT deduction, and analysis; 11 CT variables accounted for 17 percent of LCJR scores. Educators need to utilize/develop innovative teaching strategies addressing CJ predictors.

Change in Function, Pain, and Quality of Life Following Structured Nonoperative Treatment in Patients With Degenerative Cervical Myelopathy: A Systematic Review

PubMed Central

Tetreault, Lindsay A.; Rhee, John; Prather, Heidi; Kwon, Brian K.; Wilson, Jefferson R.; Martin, Allan R.; Andersson, Ian B.; Dembek, Anna H.; Pagarigan, Krystle T.; Dettori, Joseph R.

2017-01-01

Study Design: Systematic review. Objectives: The objective of this study was to conduct a systematic review to determine (1) change in function, pain, and quality of life following structured nonoperative treatment for degenerative cervical myelopathy (DCM); (2) variability of change in function, pain, and quality of life following different types of structured nonoperative treatment; (3) differences in outcomes observed between certain subgroups (eg, baseline severity score, duration of symptoms); and (4) negative outcomes and harms resulting from structured nonoperative treatment. Methods: A systematic search was conducted in Embase, PubMed, and the Cochrane Collaboration for articles published between January 1, 1950, and February 9, 2015. Studies were included if they evaluated outcomes following structured nonoperative treatment, including therapeutic exercise, manual therapy, cervical bracing, and/or traction. The quality of each study was evaluated using the Newcastle-Ottawa Scale, and strength of the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation Working Group. Results: Of the 570 retrieved citations, 8 met inclusion criteria and were summarized in this review. Based on our results, there is very low evidence to suggest that structured nonoperative treatment for DCM results in either a positive or negative change in function as evaluated by the Japanese Orthopaedic Association score. Conclusion: There is a lack of evidence to determine the role of nonoperative treatment in patients with DCM. However, in the majority of studies, patients did not achieve clinically significant gains in function following structured nonoperative treatment. Furthermore, 23% to 54% of patients managed nonoperatively subsequently underwent surgical treatment. PMID:29164032

Objective structured practical examination (OSPE) in Forensic Medicine: students' point of view.

PubMed

Menezes, Ritesh G; Nayak, Vinod C; Binu, V S; Kanchan, Tanuj; Rao, P P Jagadish; Baral, Prakash; Lobo, Stany W

2011-11-01

The purpose of this study was to assess the attitudes of undergraduate medical students towards the objective structured practical examination (OSPE) in Forensic Medicine, in a medical college in Nepal. Participants included 59 undergraduate medical students of the 7th semester. Findings indicated that the OSPE was an acceptable tool considering the conduct of practical examination in Forensic Medicine at the undergraduate level. The overall mean attitude score was towards the favourable side. Students strongly agreed that the OSPE tested a wide range of skills. They also strongly agreed that it was a good form of examination as well as a learning experience. The introduction of the OSPE replacing the conventional method of practical examination in Forensic Medicine is a step in the right direction taken to objectively assess undergraduate medical students. Copyright © 2011 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Nursing Activities Score: Cloud Computerized Structure.

PubMed

Moraes, Kátia Bottega; Martins, Fabiana Zerbieri; de Camargo, Maximiliano Dutra; Vieira, Débora Feijó; Magalhães, Ana Maria Muller; Silveira, Denise Tolfo

2016-01-01

This study objective to describe the cloud Nursing Activities Score implementation process in the Intensive Care Unit of the Post-Anesthesia Recovery Room. It is a case study. The tools used were the Google applications with high productivity interconnecting the topic knowledge on behalf of the nursing professionals and information technology professionals. As partial results, it was determined that the average nursing staff workload in the ICU/PARR during the first 24 hours, according to the score on the scale, was 91.75 ± 18.2. Each point of NAS is converted into 14.4 minutes, which is equivalent to an average of 22 working hours. Currently the instrument is implemented in the institution, reinforcing the need to update and raise awareness concerning the need to maintain the new routine.

Undesired Variance Due to Examiner Stringency/Leniency Effect in Communication Skill Scores Assessed in OSCEs

ERIC Educational Resources Information Center

Harasym, Peter H.; Woloschuk, Wayne; Cunning, Leslie

2008-01-01

Physician-patient communication is a clinical skill that can be learned and has a positive impact on patient satisfaction and health outcomes. A concerted effort at all medical schools is now directed at teaching and evaluating this core skill. Student communication skills are often assessed by an Objective Structure Clinical Examination (OSCE).…

An objective structured clinical exam to measure intrinsic CanMEDS roles.

PubMed

Kassam, Aliya; Cowan, Michèle; Donnon, Tyrone

2016-01-01

Background The CanMEDS roles provide a comprehensive framework to organize competency-based curricula; however, there is a challenge in finding feasible, valid, and reliable assessment methods to measure intrinsic roles such as Communicator and Collaborator. The objective structured clinical exam (OSCE) is more commonly used in postgraduate medical education for the assessment of clinical skills beyond medical expertise. Method We developed the CanMEDS In-Training Exam (CITE), a six-station OSCE designed to assess two different CanMEDS roles (one primary and one secondary) and general communication skills at each station. Correlation coefficients were computed for CanMEDS roles within and between stations, and for general communication, global rating, and total scores. One-way analysis of variance (ANOVA) was used to investigate differences between year of residency, sex, and the type of residency program. Results In total, 63 residents participated in the CITE; 40 residents (63%) were from internal medicine programs, whereas the remaining 23 (37%) were pursuing other specialties. There was satisfactory internal consistency for all stations, and the total scores of the stations were strongly correlated with the global scores r=0.86, p<0.05. Noninternal medicine residents scored higher in terms of the Professional competency overall, whereas internal medicine residents scored significantly higher in the Collaborator competency overall. Discussion The OSCE checklists developed for the assessment of intrinsic CanMEDS roles were functional, but the specific items within stations required more uniformity to be used between stations. More generic types of checklists may also improve correlations across stations. Conclusion An OSCE measuring intrinsic competence is feasible; however, further development of our cases and checklists is needed. We provide a model of how to develop an OSCE to measure intrinsic CanMEDS roles that educators may adopt as residency programs move into competency-based medical education.

Association of the pre-internship objective structured clinical examination in final year medical students with comprehensive written examinations.

PubMed

Eftekhar, Hasan; Labaf, Ali; Anvari, Pasha; Jamali, Arsia; Sheybaee-Moghaddam, Farshad

2012-01-01

The purpose of this study is to evaluate the association of the pre-internship Objective Structured Clinical Examination (OSCE) in final year medical students with comprehensive written examinations. SUBJECTS AND MATERIAL: All medical students of October 2004 admission who took part in the October 2010 National Comprehensive Pre-internship Examination (NCPE) and pre-internship OSCE were included in the study (n = 130). OSCE and NCPE scores and medical grade point average (GPA) were collected. GPA was highly correlated with NCPE (r = 0.76 and P<0.001) and moderately with OSCE (r = 0.68 and P < 0.001). Similarly a moderate correlation was observed between NCPE and OSCE scores(r = 0.6 and P < 0.001).Linear stepwise regression shows r(2) of a model applying GPA as predictor of OSCE score is 0.46 (β = 0.68 and P < 0.001), while addition of gender to the model increases r(2) to 0.59 (β = 0.61 and 0.36, for GPA and male gender, respectively and P < 0.001). Logistic forward regression models shows male gender and GPA are the only dependent predictors of high score in OSCE. OR of GPA and male gender for high OSCE score are 4.89 (95% CI = 2.37-10.06) and 6.95 (95% CI = 2.00-24.21), respectively (P < 0.001). Our findings indicate OSCE and examination which mainly evaluate knowledge, judged by GPA and NCPE are moderately to highly correlated. Our results illustrate the interwoven nature of knowledge and clinical skills. In other words, certain level of knowledge is crucial for appropriate clinical performance. Our findings suggest neither OSCE nor written forms of assessments can replace each other. They are complimentary and should also be combined by other evaluations to cover all attributes of clinical competence efficiently.

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.

Association of the pre-internship objective structured clinical examination in final year medical students with comprehensive written examinations

PubMed Central

Eftekhar, Hasan; Labaf, Ali; Anvari, Pasha; Jamali, Arsia; Sheybaee-Moghaddam, Farshad

2012-01-01

Aim The purpose of this study is to evaluate the association of the pre-internship Objective Structured Clinical Examination (OSCE) in final year medical students with comprehensive written examinations. Subjects and material All medical students of October 2004 admission who took part in the October 2010 National Comprehensive Pre-internship Examination (NCPE) and pre-internship OSCE were included in the study (n=130). OSCE and NCPE scores and medical grade point average (GPA) were collected. Results GPA was highly correlated with NCPE (r=0.76 and P<0.001) and moderately with OSCE (r=0.68 and P<0.001). Similarly a moderate correlation was observed between NCPE and OSCE scores(r=0.6 and P<0.001).Linear stepwise regression shows r 2 of a model applying GPA as predictor of OSCE score is 0.46 (β=0.68 and P<0.001), while addition of gender to the model increases r 2 to 0.59 (β=0.61 and 0.36, for GPA and male gender, respectively and P<0.001). Logistic forward regression models shows male gender and GPA are the only dependent predictors of high score in OSCE. OR of GPA and male gender for high OSCE score are 4.89 (95% CI=2.37–10.06) and 6.95 (95% CI=2.00–24.21), respectively (P<0.001). Discussion Our findings indicate OSCE and examination which mainly evaluate knowledge, judged by GPA and NCPE are moderately to highly correlated. Our results illustrate the interwoven nature of knowledge and clinical skills. In other words, certain level of knowledge is crucial for appropriate clinical performance. Our findings suggest neither OSCE nor written forms of assessments can replace each other. They are complimentary and should also be combined by other evaluations to cover all attributes of clinical competence efficiently. PMID:22547924

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.

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

Associations of medical student empathy with clinical competence.

PubMed

Casas, Rachel S; Xuan, Ziming; Jackson, Angela H; Stanfield, Lorraine E; Harvey, Nanette C; Chen, Daniel C

2017-04-01

Empathy is a crucial skill for medical students that can be difficult to evaluate. We examined if self-reported empathy in medical students was associated with clinical competence. This study combined cross-sectional data from four consecutive years of medical students (N=590) from the Boston University School of Medicine. We used regression analysis to evaluate if self-reported empathy (Jefferson Scale of Physician Empathy (JSPE)) predicted scores in clinical clerkships, United States Medical Licensing Examinations, and OBJECTIVE: Structured Clinical Examinations (OSCEs). We separately analyzed overall and OSCE communication scores based on interpersonal skills reported by standardized patients. We controlled for age, gender, debt, and specialty affinity. JSPE scores of medical students were positively associated with OSCE communication scores, and remained significant when controlling for demographics. We found that JSPE score was also predictive of overall OSCE scores, but this relationship was confounded by gender and age. JSPE scores were associated with performance in the Pediatrics clerkship, but not other clerkships or standardized tests. JSPE scores were positively associated with OSCE communication scores in medical students. This study supports that self-reported empathy may predict OSCE performance, but further research is needed to examine differences by gender and age. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

An SEM Assessment of the Internal Structure and Predictive Validity of the Abbreviated Early Adolescent HOME Inventory.

PubMed

Green, Samuel B; Pennar, Amy L; Bradley, Robert H

2018-05-01

The Home Observation for Measurement of the Environment (HOME) Inventory is designed to assess the quality and quantity of support, stimulation, and structure provided to children in the home environment. HOME has been widely used for research and applied purposes. We focused on an abbreviated version of the Early Adolescent HOME (EA-HOME-A) that was administered to 15-year-old adolescents and their parents ( N = 958) as part of the NICHD (National Institute of Child Health and Human Development) Study of Early Child Care and Youth Development. Our study had two objectives. First, we hypothesized and tested a bifactor model that specified a general factor in support of the use of the HOME total score and group factors for subsets of items in support of the content domain scores. Second, we applied structural equation modeling to relate the EA-HOME-A factors to outcome factors assessing maladaptive behaviors, autonomy, self-control, and cognitive-academic performance. The results supported the construct validity of the EA-HOME-A with respect to its internal structure as well as its correlates.

Quality of online information to support patient decision-making in breast cancer surgery.

PubMed

Bruce, Jordan G; Tucholka, Jennifer L; Steffens, Nicole M; Neuman, Heather B

2015-11-01

Breast cancer patients commonly use the internet as an information resource. Our objective was to evaluate the quality of online information available to support patients facing a decision for breast surgery. Breast cancer surgery-related queries were performed (Google and Bing), and reviewed for content pertinent to breast cancer surgery. The DISCERN instrument was used to evaluate websites' structural components that influence publication reliability and ability of information to support treatment decision-making. Scores of 4/5 were considered "good." 45 unique websites were identified. Websites satisfied a median 5/9 content questions. Commonly omitted topics included: having a choice between breast conservation and mastectomy (67%) and potential for 2nd surgery to obtain negative margins after breast conservation (60%). Websites had a median DISCERN score of 2.9 (range 2.0-4.5). Websites achieved higher scores on structural criteria (median 3.6 [2.1-4.7]), with 24% rated as "good." Scores on supporting decision-making questions were lower (2.6 [1.3-4.4]), with only 7% scoring "good." Although numerous breast cancer-related websites exist, most do a poor job providing women with essential information necessary to actively participate in decision-making for breast cancer surgery. Providing easily- accessible, high-quality online information has the potential to significantly improve patients' experiences with decision-making. © 2015 Wiley Periodicals, Inc.

Factor Analysis of Persistent Post-Concussive Symptoms within a Military Sample with Blast Exposure

PubMed Central

Franke, L.M.; Czarnota, J.N.; Ketchum, J.M.; Walker, W.C.

2014-01-01

Objective To determine the factor structure of persistent post-concussive syndrome (PPCS) symptoms in a blast-exposed military sample and validate factors against objective and symptom measures. Setting Veterans Affairs medical center and military bases. Participants One hundred eighty-one service members and veterans with at least one significant exposure to blast during deployment within the two years prior to study enrollment. Design Confirmatory and exploratory factor analysis of the Rivermead Post-concussion Questionnaire (RPQ). Main Measures RPQ, PTSD Symptom Checklist-Civilian, Center for Epidemiologic Studies Depression inventory, Sensory Organization Test, Paced Auditory Serial Addition Test, California Verbal Learning Test, Delis-Kaplan Executive Function System subtests. Results The three-factor structure of PPCS was not confirmed. A four-factor structure was extracted, and factors were interpreted as reflecting emotional, cognitive, visual, and vestibular functions. All factors were associated with scores on psychological symptom inventories; visual and vestibular factors were also associated with balance performance. There was no significant association between the cognitive factor and neuropsychological performance, nor between a history of mTBI and factor scores. Conclusion Persistent post-concussive symptoms observed months after blast exposure seem to be related to four distinct forms of distress, but not to mTBI per se, with vestibular and visual factors possibly related to injury of sensory organs by blast. PMID:24695267

An exploration of student nurses' thoughts and experiences of using a video-recording to assess their performance of cardiopulmonary resuscitation (CPR) during a mock objective structured clinical examination (OSCE).

PubMed

Paul, Fiona

2010-09-01

Cardiopulmonary resuscitation (CPR) is an essential skill taught within undergraduate nursing programmes. At the author's institution, students must pass the CPR objective structured clinical examination (OSCE) before progressing to second year. However, some students have difficulties developing competence in CPR and evidence suggests that resuscitation skills may only be retained for several months. This has implications for practice as nurses are required to be competent in CPR. Therefore, further opportunities for students to develop these skills are necessary. An action research project was conducted with six students who were assessed by an examiner at a video-recorded mock OSCE. Students self-assessed their skills using the video and a checklist. Semi-structured interviews were conducted to compare checklist scores, and explore students' thoughts and experiences of the OSCE. The findings indicate that students may need to repeat this exercise by comparing their previous and current performances to develop both their self-assessment and CPR skills. Although there were some differences between the examiner's and student's checklist scores, all students reported the benefits of participating in this project, e.g. discussion and identification of knowledge and skills deficits, thus emphasising the benefits of formative assessments to prepare students for summative assessments and ultimately clinical practice. (c) 2010 Elsevier Ltd. All rights reserved.

Assessment of photoselective vaporization of prostate skills during Urology Objective Structured Clinical Examinations (OSCE)

PubMed Central

Noureldin, Yasser A.; Elkoushy, Mohamed A.; Fahmy, Nader; Carrier, Serge; Elhilali, Mostafa M.; Andonian, Sero

2015-01-01

Introduction: We evaluated the use of the GreenLight Simulator (GL-SIM) (American Medical Systems, Guelph, ON) in the skill assessment of postgraduate trainees (PGTs) in photoselective vaporization of the prostate (PVP). We also sought to determine whether previous PVP experience or GL-SIM practice improved performance. Methods: PGTs in postgraduate years (PGY-3 to PGY-5) from all 4 Quebec urology training programs were recruited during 2 annual Objective Structured Clinical Examinations (OSCEs). During a 20-minute OSCE station, PGTs were asked to perform 2 exercises: (1) identification of endoscopic landmarks and (2) a PVP of a 30-g normal prostate. Grams vaporized, global scores, and number of correct anatomical landmarks were recorded and correlated with PGY level, practice on the GL-SIM, and previous PVP experience. Results: In total, 25 PGTs were recruited at each OSCE, with 13 PGTs participating in both OSCEs. When comparing scores from the first and second OSCEs, there was a significant improvement in the number of grams vaporized (2.9 vs. 4.3 g; p = 0.003) and global score (100 vs. 165; p = 0.03). There was good correlation between the number of previously performed PVPs and the global score (r = 0.4, p = 0.04). Similarly, PGTs with previous practice on the GL-SIM had significantly higher global score (100.6 vs. 162.6; p = 0.04) and grams vaporized (3.1 vs. 4.1 g; p = 0.04) when compared with those who did not practice on GL-SIM. Furthermore, there were significantly more competent PGTs among those who had previously practiced on the GL-SIM (32.7% vs. 10.2%; p = 0.009). PGY level did not significantly affect grams vaporized or global score (p > 0.05). Conclusion: Performance on the GL-SIM at OSCEs significantly correlated with previous practice on the GL-SIM and previous PVP experience rather than PGY level. Furthermore, there were significantly more competent PGTs among those who had previously practiced on the GL-SIM. PMID:25737763

Incorporating big data into treatment plan evaluation: Development of statistical DVH metrics and visualization dashboards.

PubMed

Mayo, Charles S; Yao, John; Eisbruch, Avraham; Balter, James M; Litzenberg, Dale W; Matuszak, Martha M; Kessler, Marc L; Weyburn, Grant; Anderson, Carlos J; Owen, Dawn; Jackson, William C; Haken, Randall Ten

2017-01-01

To develop statistical dose-volume histogram (DVH)-based metrics and a visualization method to quantify the comparison of treatment plans with historical experience and among different institutions. The descriptive statistical summary (ie, median, first and third quartiles, and 95% confidence intervals) of volume-normalized DVH curve sets of past experiences was visualized through the creation of statistical DVH plots. Detailed distribution parameters were calculated and stored in JavaScript Object Notation files to facilitate management, including transfer and potential multi-institutional comparisons. In the treatment plan evaluation, structure DVH curves were scored against computed statistical DVHs and weighted experience scores (WESs). Individual, clinically used, DVH-based metrics were integrated into a generalized evaluation metric (GEM) as a priority-weighted sum of normalized incomplete gamma functions. Historical treatment plans for 351 patients with head and neck cancer, 104 with prostate cancer who were treated with conventional fractionation, and 94 with liver cancer who were treated with stereotactic body radiation therapy were analyzed to demonstrate the usage of statistical DVH, WES, and GEM in a plan evaluation. A shareable dashboard plugin was created to display statistical DVHs and integrate GEM and WES scores into a clinical plan evaluation within the treatment planning system. Benchmarking with normal tissue complication probability scores was carried out to compare the behavior of GEM and WES scores. DVH curves from historical treatment plans were characterized and presented, with difficult-to-spare structures (ie, frequently compromised organs at risk) identified. Quantitative evaluations by GEM and/or WES compared favorably with the normal tissue complication probability Lyman-Kutcher-Burman model, transforming a set of discrete threshold-priority limits into a continuous model reflecting physician objectives and historical experience. Statistical DVH offers an easy-to-read, detailed, and comprehensive way to visualize the quantitative comparison with historical experiences and among institutions. WES and GEM metrics offer a flexible means of incorporating discrete threshold-prioritizations and historic context into a set of standardized scoring metrics. Together, they provide a practical approach for incorporating big data into clinical practice for treatment plan evaluations.

How does preclinical laboratory training impact physical examination skills during the first clinical year? A retrospective analysis of routinely collected objective structured clinical examination scores among the first two matriculating classes of a reformed curriculum in one Polish medical school.

PubMed

Świerszcz, Jolanta; Stalmach-Przygoda, Agata; Kuźma, Marcin; Jabłoński, Konrad; Cegielny, Tomasz; Skrzypek, Agnieszka; Wieczorek-Surdacka, Ewa; Kruszelnicka, Olga; Chmura, Kaja; Chyrchel, Bernadeta; Surdacki, Andrzej; Nowakowski, Michał

2017-09-01

As a result of a curriculum reform launched in 2012 at our institution, preclinical training was shortened to 2 years instead of the traditional 3 years, creating additional incentives to optimise teaching methods. In accordance with the new curriculum, a semester-long preclinical module of clinical skills (CS) laboratory training takes place in the second year of study, while an introductory clinical course (ie, brief introductory clerkships) is scheduled for the Fall semester of the third year. Objective structured clinical examinations (OSCEs) are carried out at the conclusion of both the preclinical module and the introductory clinical course. Our aim was to compare the scores at physical examination stations between the first and second matriculating classes of a newly reformed curriculum on preclinical second-year OSCEs and early clinical third-year OSCEs. Analysis of routinely collected data. One Polish medical school. Complete OSCE records for 462 second-year students and 445 third-year students. OSCE scores by matriculation year. In comparison to the first class of the newly reformed curriculum, significantly higher (ie, better) OSCE scores were observed for those students who matriculated in 2013, a year after implementing the reformed curriculum. This finding was consistent for both second-year and third-year cohorts. Additionally, the magnitude of the improvement in median third-year OSCE scores was proportional to the corresponding advancement in preceding second-year preclinical OSCE scores for each of two different sets of physical examination tasks. In contrast, no significant difference was noted between the academic years in the ability to interpret laboratory data or ECG - tasks which had not been included in the second-year preclinical training. Our results suggest the importance of preclinical training in a CS laboratory to improve students' competence in physical examination at the completion of introductory clinical clerkships during the first clinical year. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Support vector regression scoring of receptor-ligand complexes for rank-ordering and virtual screening of chemical libraries.

PubMed

Li, Liwei; Wang, Bo; Meroueh, Samy O

2011-09-26

The community structure-activity resource (CSAR) data sets are used to develop and test a support vector machine-based scoring function in regression mode (SVR). Two scoring functions (SVR-KB and SVR-EP) are derived with the objective of reproducing the trend of the experimental binding affinities provided within the two CSAR data sets. The features used to train SVR-KB are knowledge-based pairwise potentials, while SVR-EP is based on physicochemical properties. SVR-KB and SVR-EP were compared to seven other widely used scoring functions, including Glide, X-score, GoldScore, ChemScore, Vina, Dock, and PMF. Results showed that SVR-KB trained with features obtained from three-dimensional complexes of the PDBbind data set outperformed all other scoring functions, including best performing X-score, by nearly 0.1 using three correlation coefficients, namely Pearson, Spearman, and Kendall. It was interesting that higher performance in rank ordering did not translate into greater enrichment in virtual screening assessed using the 40 targets of the Directory of Useful Decoys (DUD). To remedy this situation, a variant of SVR-KB (SVR-KBD) was developed by following a target-specific tailoring strategy that we had previously employed to derive SVM-SP. SVR-KBD showed a much higher enrichment, outperforming all other scoring functions tested, and was comparable in performance to our previously derived scoring function SVM-SP.

Mediterranean diet score and left ventricular structure and function: the Multi-Ethnic Study of Atherosclerosis12

PubMed Central

Levitan, Emily B; Ahmed, Ali; Arnett, Donna K; Polak, Joseph F; Hundley, W Gregory; Bluemke, David A; Heckbert, Susan R; Jacobs, David R; Nettleton, Jennifer A

2016-01-01

Background: Data are limited on the relation between dietary patterns and left ventricular (LV) structure and function. Objective: We examined cross-sectional associations of a diet-score assessment of a Mediterranean dietary pattern with LV mass, volume, mass-to-volume ratio, stroke volume, and ejection fraction. Design: We measured LV variables with the use of cardiac MRI in 4497 participants in the Multi-Ethnic Study of Atherosclerosis study who were aged 45–84 y and without clinical cardiovascular disease. We calculated a Mediterranean diet score from intakes of fruit, vegetables, nuts, legumes, whole grains, fish, red meat, the monounsaturated fat:saturated fat ratio, and alcohol that were self-reported with the use of a food-frequency questionnaire. We used linear regression with adjustment for body size, physical activity, and cardiovascular disease risk factors to model associations and assess the shape of these associations (linear or quadratic). Results: The Mediterranean diet score had a slight U-shaped association with LV mass (adjusted means: 146, 145, 146, and 147 g across quartiles of diet score, respectively; P-quadratic trend = 0.04). The score was linearly associated with LV volume, stroke volume, and ejection fraction: for each +1-U difference in score, LV volume was 0.4 mL higher (95% CI: 0.0, 0.8 mL higher), the stroke volume was 0.5 mL higher (95% CI: 0.2, 0.8 mL higher), and the ejection fraction was 0.2 percentage points higher (95% CI: 0.1, 0.3 percentage points higher). The score was not associated with the mass-to-volume ratio. Conclusions: A higher Mediterranean diet score is cross-sectionally associated with a higher LV mass, which is balanced by a higher LV volume as well as a higher ejection fraction and stroke volume. Participants in this healthy, multiethnic sample whose dietary patterns most closely conformed to a Mediterranean-type pattern had a modestly better LV structure and function than did participants with less–Mediterranean-like dietary patterns. This trial was registered at clinicaltrials.gov as NCT00005487. PMID:27488238

Measuring the impact of multiple sclerosis: Enhancing the measurement performance of the Multiple Sclerosis Impact Scale (MSIS-29) using Rasch Measurement Theory (RMT)

PubMed Central

Cleanthous, Sophie; Kinter, Elizabeth; Marquis, Patrick; Petrillo, Jennifer; You, Xiaojun; Wakeford, Craig; Sabatella, Guido

2017-01-01

Background Study objectives were to evaluate the Multiple Sclerosis Impact Scale (MSIS-29) and explore an optimized scoring structure based on empirical post-hoc analyses of data from the Phase III ADVANCE clinical trial. Methods ADVANCE MSIS-29 data from six time-points were analyzed in a sample of patients with relapsing–remitting multiple sclerosis (RRMS). Rasch Measurement Theory (RMT) analysis was undertaken to examine three broad areas: sample-to-scale targeting, measurement scale properties, and sample measurement validity. Interpretation of results led to an alternative MSIS-29 scoring structure, further evaluated alongside responsiveness of the original and revised scales at Week 48. Results RMT analysis provided mixed evidence for Physical and Psychological Impact scales that were sub-optimally targeted at the lower functioning end of the scales. Their conceptual basis could also stand to improve based on item fit results. The revised MSIS-29 rescored scales improved but did not resolve the measurement scale properties and targeting of the MSIS-29. In two out of three revised scales, responsiveness analysis indicated strengthened ability to detect change. Conclusion The revised MSIS-29 provides an initial evidence-based improved patient-reported outcome (PRO) instrument for evaluating the impact of MS. Revised scoring improves conceptual clarity and interpretation of scores by refining scale structure to include Symptoms, Psychological Impact, and General Limitations. Clinical trial ADVANCE (ClinicalTrials.gov identifier NCT00906399). PMID:29104758

Improved performance in CAPRI round 37 using LZerD docking and template-based modeling with combined scoring functions.

PubMed

Peterson, Lenna X; Shin, Woong-Hee; Kim, Hyungrae; Kihara, Daisuke

2018-03-01

We report our group's performance for protein-protein complex structure prediction and scoring in Round 37 of the Critical Assessment of PRediction of Interactions (CAPRI), an objective assessment of protein-protein complex modeling. We demonstrated noticeable improvement in both prediction and scoring compared to previous rounds of CAPRI, with our human predictor group near the top of the rankings and our server scorer group at the top. This is the first time in CAPRI that a server has been the top scorer group. To predict protein-protein complex structures, we used both multi-chain template-based modeling (TBM) and our protein-protein docking program, LZerD. LZerD represents protein surfaces using 3D Zernike descriptors (3DZD), which are based on a mathematical series expansion of a 3D function. Because 3DZD are a soft representation of the protein surface, LZerD is tolerant to small conformational changes, making it well suited to docking unbound and TBM structures. The key to our improved performance in CAPRI Round 37 was to combine multi-chain TBM and docking. As opposed to our previous strategy of performing docking for all target complexes, we used TBM when multi-chain templates were available and docking otherwise. We also describe the combination of multiple scoring functions used by our server scorer group, which achieved the top rank for the scorer phase. © 2017 Wiley Periodicals, Inc.

Impact of biased scores on ranking in bipartite competition networks and inference of modular structure via generalized modularity

NASA Astrophysics Data System (ADS)

Jeon, Gyuhyeon; Park, Juyong

2017-02-01

In the common jury-contestant competition format, a jury consisting of multiple judges grade contestants on their performances to determine their ranking. Unlike in another common competition format where two contestants play a head-to-head match to produce the winner such as in football or basketball, the objectivity of judges are often called into question, potentially undermining the public's trust in the fairness of the competition. In this work we show, by modeling the jury-contestant competition format as a weighted bipartite network, how one can identify biased scores and how they impact the competition and its structure. Analyzing the prestigious International Chopin Piano Competition of 2015 as an example with a well-publicized scoring controversy, we show that the presence of even a very small fraction of biased edges can gravely distort our inference of the network structure —in the example a single biased edge is shown to lead to an incorrect “solution” that also wrongly appears to be robust exclusively, dominating other reasonable solutions— highlighting the importance of bias detection and elimination in network inference. In the process our work also presents a modified modularity measure for the one-mode projection of weighted complete bipartite networks.

Leadership and teamwork in medical emergencies: performance of nursing students and registered nurses in simulated patient scenarios.

PubMed

Endacott, Ruth; Bogossian, Fiona E; Cooper, Simon J; Forbes, Helen; Kain, Victoria J; Young, Susan C; Porter, Joanne E

2015-01-01

To examine nursing students' and registered nurses' teamwork skills whilst managing simulated deteriorating patients. Studies continue to show the lack of timely recognition of patient deterioration. Management of deteriorating patients can be influenced by education and experience. Mixed methods study conducted in two universities and a rural hospital in Victoria, and one university in Queensland, Australia. Three simulation scenarios (chest pain, hypovolaemic shock and respiratory distress) were completed in teams of three by 97 nursing students and 44 registered nurses, equating to a total of 32 student and 15 registered nurse teams. Data were obtained from (1) Objective Structured Clinical Examination rating to assess performance; (2) Team Emergency Assessment Measure scores to assess teamwork; (3) simulation video footage; (4) reflective interview during participants' review of video footage. Qualitative thematic analysis of video and interview data was undertaken. Objective structured clinical examination performance was similar across registered nurses and students (mean 54% and 49%); however, Team Emergency Assessment Measure scores differed significantly between the two groups (57% vs 38%, t = 6·841, p < 0·01). In both groups, there was a correlation between technical (Objective Structured Clinical Examination) and nontechnical (Team Emergency Assessment Measure) scores for the respiratory distress scenario (student teams: r = 0·530, p = 0·004, registered nurse teams r = 0·903, p < 0·01) and hypovolaemia scenario (student teams: r = 0·534, p = 0·02, registered nurse teams: r = 0·535, p = 0·049). Themes generated from the analysis of the combined quantitative and qualitative data were as follows: (1) leadership and followership behaviours; (2) help-seeking behaviours; (3) reliance on previous experience; (4) fixation on a single detail; and (5) team support. There is scope to improve leadership, team work and task management skills for registered nurses and nursing students. Simulation appears to be beneficial in enabling less experienced staff to assess their teamwork skills. There is a need to encourage less experienced staff to become leaders and for all staff to develop improved teamwork skills for medical emergencies. © 2014 John Wiley & Sons Ltd.

Assessment of email communication skills of rheumatology fellows: a pilot study

PubMed Central

Dhuper, Sonal; Siva, Chokkalingam; Fresen, John L; Petruc, Marius; Velázquez, Celso R

2010-01-01

Physician–patient email communication is gaining popularity. However, a formal assessment of physicians' email communication skills has not been described. We hypothesized that the email communication skills of rheumatology fellows can be measured in an objective structured clinical examination (OSCE) setting using a novel email content analysis instrument which has 18 items. During an OSCE, we asked 50 rheumatology fellows to respond to a simulated patient email. The content of the responses was assessed using our instrument. The majority of rheumatology fellows wrote appropriate responses scoring a mean (±SD) of 10.6 (±2.6) points (maximum score 18), with high inter-rater reliability (0.86). Most fellows were concise (74%) and courteous (68%) but not formal (22%). Ninety-two percent of fellows acknowledged that the patient's condition required urgent medical attention, but only 30% took active measures to contact the patient. No one encrypted their messages. The objective assessment of email communication skills is possible using simulated emails in an OSCE setting. The variable email communication scores and incidental patient safety gaps identified, suggest a need for further training and defined proficiency standards for physicians' email communication skills. PMID:20962134

Measuring subjective resilience despite adversity due to family, peers and teachers.

PubMed

Alonso-Tapia, Jesús; Nieto, Carmen; Ruíz, Miguel A

2013-01-01

The objective of this study is to develop and validate a scale of subjective resilience for students 12-17 years old. Items covered adverse situations due to parents', peers' and teachers' actions. The validation process included the analysis on the generalizability of the factor structure and of relationships of resilience scores with different kinds of protective and vulnerability factors -goal orientations and learning-oriented classroom motivational climate (CMC)-. A total of 471 students answered four questionnaires. Confirmatory factor analyses, reliability analysis and correlation and regression analyses were carried out. Results showed: (a) that factor structure was well defined; (b) that resilience scale had good reliability; (c) that scores correlated as expected with protective-vulnerability factors such as goal orientations and CMC defined by teachers' teaching-patterns, and (d) that students' attribution of perceived change in resilience to teachers' work depended on the degree in which CMC was learning oriented. Theoretical and practical implications are discussed.

DOCKSCORE: a webserver for ranking protein-protein docked poses.

PubMed

Malhotra, Sony; Mathew, Oommen K; Sowdhamini, Ramanathan

2015-04-24

Proteins interact with a variety of other molecules such as nucleic acids, small molecules and other proteins inside the cell. Structure-determination of protein-protein complexes is challenging due to several reasons such as the large molecular weights of these macromolecular complexes, their dynamic nature, difficulty in purification and sample preparation. Computational docking permits an early understanding of the feasibility and mode of protein-protein interactions. However, docking algorithms propose a number of solutions and it is a challenging task to select the native or near native pose(s) from this pool. DockScore is an objective scoring scheme that can be used to rank protein-protein docked poses. It considers several interface parameters, namely, surface area, evolutionary conservation, hydrophobicity, short contacts and spatial clustering at the interface for scoring. We have implemented DockScore in form of a webserver for its use by the scientific community. DockScore webserver can be employed, subsequent to docking, to perform scoring of the docked solutions, starting from multiple poses as inputs. The results, on scores and ranks for all the poses, can be downloaded as a csv file and graphical view of the interface of best ranking poses is possible. The webserver for DockScore is made freely available for the scientific community at: http://caps.ncbs.res.in/dockscore/ .

Should Weights and Risk Categories Be Used for Inspection Scores To Evaluate Food Safety in Restaurants?

PubMed

da Cunha, Diogo Thimoteo; de Rosso, Veridiana Vera; Stedefeldt, Elke

2016-03-01

The objective of this study was to verify the characteristics of food safety inspections, considering risk categories and binary scores. A cross-sectional study was performed with 439 restaurants in 43 Brazilian cities. A food safety checklist with 177 items was applied to the food service establishments. These items were classified into four groups (R1 to R4) according to the main factors that can cause outbreaks involving food: R1, time and temperature aspects; R2, direct contamination; R3, water conditions and raw material; and R4, indirect contamination (i.e., structures and buildings). A score adjusted for 100 was calculated for the overall violation score and the violation score for each risk category. The average violation score (standard deviation) was 18.9% (16.0), with an amplitude of 0.0 to 76.7%. Restaurants with a low overall violation score (approximately 20%) presented a high number of violations from the R1 and R2 groups, representing the most risky violations. Practical solutions to minimize this evaluation bias were discussed. Food safety evaluation should use weighted scores and be risk-based. However, some precautions must be taken by researchers, health inspectors, and health surveillance departments to develop an adequate and reliable instrument.

Positive and Negative Thinking in Tinnitus: Factor Structure of the Tinnitus Cognitions Questionnaire

PubMed Central

Hall, Deborah A.; Shorter, Gillian W.; Hoare, Derek J.

2017-01-01

Objectives: Researchers and clinicians consider thinking to be important in the development and maintenance of tinnitus distress, and altering thoughts or thinking style is an object of many forms of psychological therapy for tinnitus. Those working with people with tinnitus require a reliable, psychometrically robust means of measuring both positive and negative thinking related to it. The Tinnitus Cognitions Questionnaire (TCQ) was designed as such a measure and its authors showed it to be reliable, with good psychometric properties. However, no research teams have yet carried out independent validation. This study aimed to use the TCQ to investigate thinking amongst members of the general population with both bothersome and nonbothersome tinnitus and also to verify its factor structure. Design: Three hundred forty-two members of the public with tinnitus completed the TCQ online or on paper. They also rated their tinnitus on a scale as “not a problem,” “a small problem,” “a moderate problem,” “a big problem,” or a “very big problem.” The authors tested the original factor structure of the TCQ using confirmatory factor analysis and then calculated the mean scores for each item, comparing mean total scores across “problem categories” for the full questionnaire and for the positive and negative subscales. Results: The original two-factor structure of the TCQ was a good fit to the data when the correlation between positive and negative factors was fixed at zero (root mean square error of approximation = 0.064, 90% confidence interval = 0.058 to 0.070). Items pertaining to wishing the tinnitus would go away and despairing that it would ever get better had the highest mean scores. The mean total score for the “no problem” group (M = 31.17, SD = 16.03) was not significantly different from the mean total score for the “small problem” group (M = 34.00, SD = 12.44, p = 0.99). Differences between mean scores for all other groups were statistically significant. For the negative subscale, differences were statistically significant between all problem categories. For the positive subscale, the differences between mean scores were only statistically significant for the “no problem” group (M = 28.40, SD = 17.11) compared with the “moderate problem” group (M = 18.55, SD = 8.64, p = 0.02) and for the “moderate problem” group compared with the “very big problem” group (M = 26.79, SD = 11.66, p = 0.002). Positive and negative factors were uncorrelated (ρ = −0.03.) Conclusions: The TCQ is a valid measure of positive and negative thinking in tinnitus, and the authors recommend its use in research and therapeutic settings. Negative thinking appears to be associated with more problematic tinnitus, but positive thinking is not associated with unproblematic tinnitus, suggesting that reducing negative thinking may be more important than teaching positive thinking in therapy. PMID:27560491

IMG candidates' demographic characteristics as predictors of CEHPEA CE1 results

PubMed Central

Nayer, Marla; Rothman, Arthur

2013-01-01

Objective To assess the extent to which demographic characteristics are related to international medical graduate (IMG) candidate performance on the Centre for the Evaluation of Health Professionals Educated Abroad General Comprehensive Clinical Examination 1 (CE1). Design Retrospective study. Setting Toronto, Ont. Participants All IMG candidates who registered for and took the CE1 in 2007 (n = 430), 2008 (n = 480), and 2009 (n = 472) were included in this analysis. All candidates completed the Centre for the Evaluation of Health Professionals Educated Abroad CE1, a 12-station objective structured clinical examination. Main outcome measures Mean (SD) examination scores for groups based on demographic variables (age, region of medical training, and Medical Council of Canada Qualifying Examination Part 1 [MCCQE1] score) were calculated. Analysis of variance was done using CE1 examination total scores as the dependent variables. Results Candidates from countries where both medical education and patient care are conducted in English and those from South America and Western Europe achieved the highest scores, while candidates from the Western Pacific region and Africa achieved the lowest scores. Younger candidates achieved higher scores than older candidates. These results were consistent across the 3 years of CE1 examination administration. There was a significant relationship between MCCQE1 and CE1 scores in 2 of the 3 years: 2007 (r = 0.218, P < .001) and 2008 (r = 0.23, P < .01). Conclusion The CE1 includes an assessment of communication skills; hence it is reasonable that candidates with stronger English skills have the highest scores on the CE1. Age, as a proxy for time since graduation, also has a substantial effect on examination scores, possibly owing to those further from their training lacking some currency of knowledge or being in focused rather than general practices. It is reasonable that those who had higher scores on the written test (the MCCQE1) would also have higher scores on the clinical test (the CE1). Demographic characteristics appear to be related to performance on the CE1. PMID:23418245

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.

Structure, Process, and Outcome Quality of Surgical Site Infection Surveillance in Switzerland.

PubMed

Kuster, Stefan P; Eisenring, Marie-Christine; Sax, Hugo; Troillet, Nicolas

2017-10-01

OBJECTIVE To assess the structure and quality of surveillance activities and to validate outcome detection in the Swiss national surgical site infection (SSI) surveillance program. DESIGN Countrywide survey of SSI surveillance quality. SETTING 147 hospitals or hospital units with surgical activities in Switzerland. METHODS Site visits were conducted with on-site structured interviews and review of a random sample of 15 patient records per hospital: 10 from the entire data set and 5 from a subset of patients with originally reported infection. Process and structure were rated in 9 domains with a weighted overall validation score, and sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the identification of SSI. RESULTS Of 50 possible points, the median validation score was 35.5 (range, 16.25-48.5). Public hospitals (P<.001), hospitals in the Italian-speaking region of Switzerland (P=.021), and hospitals with longer participation in the surveillance (P=.018) had higher scores than others. Domains that contributed most to lower scores were quality of chart review and quality of data extraction. Of 49 infections, 15 (30.6%) had been overlooked in a random sample of 1,110 patient records, accounting for a sensitivity of 69.4% (95% confidence interval [CI], 54.6%-81.7%), a specificity of 99.9% (95% CI, 99.5%-100%), a positive predictive value of 97.1% (95% CI, 85.1%-99.9%), and a negative predictive value of 98.6% (95% CI, 97.7%-99.2%). CONCLUSIONS Irrespective of a well-defined surveillance methodology, there is a wide variation of SSI surveillance quality. The quality of chart review and the accuracy of data collection are the main areas for improvement. Infect Control Hosp Epidemiol 2017;38:1172-1181.

The PROMIS fatigue item bank has good measurement properties in patients with fibromyalgia and severe fatigue.

PubMed

Yost, Kathleen J; Waller, Niels G; Lee, Minji K; Vincent, Ann

2017-06-01

Efficient management of fibromyalgia (FM) requires precise measurement of FM-specific symptoms. Our objective was to assess the measurement properties of the Patient-Reported Outcome Measurement Information System (PROMIS) fatigue item bank (FIB) in people with FM. We applied classical psychometric and item response theory methods to cross-sectional PROMIS-FIB data from two samples. Data on the clinical FM sample were obtained at a tertiary medical center. Data for the U.S. general population sample were obtained from the PROMIS network. The full 95-item bank was administered to both samples. We investigated dimensionality of the item bank in both samples by separately fitting a bifactor model with two group factors; experience and impact. We assessed measurement invariance between samples, and we explored an alternate factor structure with the normative sample and subsequently confirmed that structure in the clinical sample. Finally, we assessed whether reporting FM subdomain scores added value over reporting a single total score. The item bank was dominated by a general fatigue factor. The fit of the initial bifactor model and evidence of measurement invariance indicated that the same constructs were measured across the samples. An alternative bifactor model with three group factors demonstrated slightly improved fit. Subdomain scores add value over a total score. We demonstrated that the PROMIS-FIB is appropriate for measuring fatigue in clinical samples of FM patients. The construct can be presented by a single score; however, subdomain scores for the three group factors identified in the alternative model may also be reported.

Objective structured brainstorming questions (OSBQs) in PBL tutorial sessions: Evidence based pilot study

PubMed Central

AlHoqail, Ibrahim A.; Badr, Fouad M.

2010-01-01

The fact that faculty tutors do have different backgrounds and specialty has been a concern as a factor that contributes to disparity in the delivery of brainstorming session outcomes. This paper aims to introduce a road map in the form of a set of focused objective structured questions (OSBQs) for tutors to follow in brainstorming. Methods Objectively structured questions were generated by the block planning committees. A pilot study was conducted from February 2008 – March 2009 and included groups (44 students) of second and third year undergraduate students of the Faculty of Medicine, King Fahad Medical City. Four indicators were considered to check the validity of the proposed OSBQs; (i) feed back on the perception of medical students experiencing different types of tutorial sessions, (ii) learning objectives achieved under both systems, (iii) student’s performance under the OSBQs and the unguided tutorials and (iv) proper utilization of the time allocated to brainstorming sessions. Results The student’s perception of their satisfaction of implementation of OSBQs was unanimous. Student’s performances were much better in blocks implementing OSBQs. The time allocated for brainstorming sessions was efficiently utilized with the introduction of OSBQs. Conclusion Implementation of OSBQs leads to standardization of tutorial sessions and allows more interaction between students to achieve their learning objectives and score better in their exams. Concern over the role of tutors will diminish. PMID:21475549

Objective structured brainstorming questions (OSBQs) in PBL tutorial sessions: Evidence based pilot study.

PubMed

Alhoqail, Ibrahim A; Badr, Fouad M

2010-11-01

The fact that faculty tutors do have different backgrounds and specialty has been a concern as a factor that contributes to disparity in the delivery of brainstorming session outcomes. This paper aims to introduce a road map in the form of a set of focused objective structured questions (OSBQs) for tutors to follow in brainstorming. Objectively structured questions were generated by the block planning committees. A pilot study was conducted from February 2008 - March 2009 and included groups (44 students) of second and third year undergraduate students of the Faculty of Medicine, King Fahad Medical City. Four indicators were considered to check the validity of the proposed OSBQs; (i) feed back on the perception of medical students experiencing different types of tutorial sessions, (ii) learning objectives achieved under both systems, (iii) student's performance under the OSBQs and the unguided tutorials and (iv) proper utilization of the time allocated to brainstorming sessions. The student's perception of their satisfaction of implementation of OSBQs was unanimous. Student's performances were much better in blocks implementing OSBQs. The time allocated for brainstorming sessions was efficiently utilized with the introduction of OSBQs. Implementation of OSBQs leads to standardization of tutorial sessions and allows more interaction between students to achieve their learning objectives and score better in their exams. Concern over the role of tutors will diminish.

Is chronic pain associated with somatization/hypochondriasis? An evidence-based structured review.

PubMed

Fishbain, David A; Lewis, John E; Gao, Jinrun; Cole, Brandly; Steele Rosomoff, R

2009-01-01

This is an evidence-based structured review. The objectives of this review were to answer the following questions: (1) Are somatization/hypochondriasis associated with chronic pain? (2) Is the degree of somatization/hypochondriasis related to pain levels? (3) Does pain treatment improve somatization/hypochondriasis? (4) Are some pain diagnoses differentially associated with somatization/hypochondriasis? Fifty-seven studies which fulfilled inclusion criteria and had high quality scores were sorted by the above-mentioned objectives. Agency for health care policy and research guidelines were utilized to type and characterize the strength/consistency of the study evidence within each objective. Somatization and hypochondriasis were both consistently associated with chronic pain (consistency ratings B and A, respectively). Study evidence indicated a correlation between pain intensity and presence of somatization and hypochondriasis (consistency rating A and B, respectively). Pain treatment improved somatization and hypochondriasis (consistency rating B and A, respectively). Some chronic pain diagnostic groups somatized more (consistency rating B). Somatization is commonly associated with chronic pain and may relate to pain levels.

QUASAR--scoring and ranking of sequence-structure alignments.

PubMed

Birzele, Fabian; Gewehr, Jan E; Zimmer, Ralf

2005-12-15

Sequence-structure alignments are a common means for protein structure prediction in the fields of fold recognition and homology modeling, and there is a broad variety of programs that provide such alignments based on sequence similarity, secondary structure or contact potentials. Nevertheless, finding the best sequence-structure alignment in a pool of alignments remains a difficult problem. QUASAR (quality of sequence-structure alignments ranking) provides a unifying framework for scoring sequence-structure alignments that aids finding well-performing combinations of well-known and custom-made scoring schemes. Those scoring functions can be benchmarked against widely accepted quality scores like MaxSub, TMScore, Touch and APDB, thus enabling users to test their own alignment scores against 'standard-of-truth' structure-based scores. Furthermore, individual score combinations can be optimized with respect to benchmark sets based on known structural relationships using QUASAR's in-built optimization routines.

Multiple mini-interview as a predictor of performance in the objective structured clinical examination among Physician Associates in the United Kingdom: a cohort study

PubMed Central

Kumar, Narendra; Bhardwaj, Shailaja; Rahman, Eqram

2018-01-01

Introduction Patient satisfaction and health care outcomes are directly linked to useful communication skills. Therefore, excellent interpersonal skills are imperative for health care professionals. Multiple mini-interview (MMI) is designed as a selection tool to assess the communication skills of applicants in medical schools during the admission process. However, objective structured clinical examination (OSCE) assesses students’ communication and clinical skills at the end of their academic terms. Recently, Anglia Ruskin University, Chelmsford, UK, adopted MMI in the selection process for the first cohort of MSc Physician Associate trainees for the academic year 2015–2016. This study aimed to determine the likelihood of MMI as a predictor of future performance of communication skills in the OSCE. Materials and methods The anonymous data of the average scores of communication skills attained in MMI and OSCE at the end of year 1 were collected for 30 students from the Physician Associate program team. Subsequently, Pearson’s correlation was computed to determine the relationship between the average scores of communication skills attained in MMI, and OSCE during trimester 2 and trimester 3 by the Physician Associate trainees. Results The study showed positive correlation between the scores of communication skills attained in MMI and OSCE during trimester 2 (r=0.956, n=30, p<0.001) and trimester 3 (r=0.966, n=30, p<0.001). Conclusion The study provides empirical evidence for the validity of MMI as a predictor of future performance of Physician Associate trainees’ communication skills during subsequent OSCEs. PMID:29695944

Implementing and Evaluating a National Certification Technical Skills Examination: The Colorectal Objective Structured Assessment of Technical Skill.

PubMed

de Montbrun, Sandra; Roberts, Patricia L; Satterthwaite, Lisa; MacRae, Helen

2016-07-01

To implement the Colorectal Objective Structured Assessment of Technical skill (COSATS) into American Board of Colon and Rectal Surgery (ABCRS) certification and build evidence of validity for the interpretation of the scores of this high stakes assessment tool. Currently, technical skill assessment is not a formal component of board certification. With the technical demands of surgical specialties, documenting competence in technical skill at the time of certification with a valid tool is ideal. In September 2014, the COSATS was a mandatory component of ABCRS certification. Seventy candidates took the examination, with their performance evaluated by expert colorectal surgeons using a task-specific checklist, global rating scale, and overall performance scale. Passing scores were set and compared using 2 standard setting methodologies, using a compensatory and conjunctive model. Inter-rater reliability and the reliability of the pass/fail decision were calculated using Cronbach alpha and Subkoviak methodology, respectively. Overall COSATS scores and pass/fail status were compared with results on the ABCRS oral examination. The pass rate ranged from 85.7% to 90%. Inter-rater reliability (0.85) and reliability of the pass/fail decision (0.87 and 0.84) were high. A low positive correlation (r= 0.25) was seen between the COSATS and oral examination. All individuals who failed the COSATS passed the ABCRS oral examination. COSATS is the first technical skill examination used in national surgical board certification. This study suggests that the current certification process may be failing to identify individuals who have demonstrated technical deficiencies on this standardized assessment tool.

Multiple mini-interview as a predictor of performance in the objective structured clinical examination among Physician Associates in the United Kingdom: a cohort study.

PubMed

Kumar, Narendra; Bhardwaj, Shailaja; Rahman, Eqram

2018-01-01

Patient satisfaction and health care outcomes are directly linked to useful communication skills. Therefore, excellent interpersonal skills are imperative for health care professionals. Multiple mini-interview (MMI) is designed as a selection tool to assess the communication skills of applicants in medical schools during the admission process. However, objective structured clinical examination (OSCE) assesses students' communication and clinical skills at the end of their academic terms. Recently, Anglia Ruskin University, Chelmsford, UK, adopted MMI in the selection process for the first cohort of MSc Physician Associate trainees for the academic year 2015-2016. This study aimed to determine the likelihood of MMI as a predictor of future performance of communication skills in the OSCE. The anonymous data of the average scores of communication skills attained in MMI and OSCE at the end of year 1 were collected for 30 students from the Physician Associate program team. Subsequently, Pearson's correlation was computed to determine the relationship between the average scores of communication skills attained in MMI, and OSCE during trimester 2 and trimester 3 by the Physician Associate trainees. The study showed positive correlation between the scores of communication skills attained in MMI and OSCE during trimester 2 ( r =0.956, n=30, p <0.001) and trimester 3 ( r =0.966, n=30, p <0.001). The study provides empirical evidence for the validity of MMI as a predictor of future performance of Physician Associate trainees' communication skills during subsequent OSCEs.

The Incremental Value of Troponin Biomarkers in Risk Stratification of Acute Coronary Syndromes: Is the Relationship Multiplicative?

PubMed Central

Amin, Amit P; Nathan, Sandeep; Vassallo, Patricia; Calvin, James E

2009-01-01

Structured Abstract Objective: To emphasize the importance of troponin in the context of a new score for risk stratifying acute coronary syndromes (ACS) patients. Although troponins have powerful prognostic value, current ACS scores do not fully capitalize this prognostic ability. Here, we weigh troponin status in a multiplicative manner to develop the TRACS score from previously published Rush score risk factors (RRF). Methods: 2,866 ACS patients (46.7% troponin positive) from 9 centers comprising the TRACS registry, were randomly split into derivation (n=1,422) and validation (n=1,444) cohorts. In the derivation sample, RRF sum was multiplied by 3 if troponins were positive to yield the TRACS score, which was grouped into five categories of 0-2, 3-5, 6-8, 9-11, 12-15 (multiples of 3). Predictive performance of this score to predict hospital death was ascertained in the validation sample. Results: The TRACS score had ROC AUC of 0.71 in the validation cohort. Logistic regression, Kaplan-Meier analysis, likelihood-ratio and Bayesian Information Criterion (BIC) test indicated that weighing troponin status with 3 in the TRACS score improved the prediction of mortality. Hosmer-Lemeshow test indicated sound model fit. Conclusions: We demonstrate that weighing troponin as a multiple of 3 yields robust prognostication of hospital mortality in ACS patients, when used in the context of the TRACS score. PMID:19557150

Combining Automatic Tube Current Modulation with Adaptive Statistical Iterative Reconstruction for Low-Dose Chest CT Screening

PubMed Central

Chen, Jiang-Hong; Jin, Er-Hu; He, Wen; Zhao, Li-Qin

2014-01-01

Objective To reduce radiation dose while maintaining image quality in low-dose chest computed tomography (CT) by combining adaptive statistical iterative reconstruction (ASIR) and automatic tube current modulation (ATCM). Methods Patients undergoing cancer screening (n = 200) were subjected to 64-slice multidetector chest CT scanning with ASIR and ATCM. Patients were divided into groups 1, 2, 3, and 4 (n = 50 each), with a noise index (NI) of 15, 20, 30, and 40, respectively. Each image set was reconstructed with 4 ASIR levels (0% ASIR, 30% ASIR, 50% ASIR, and 80% ASIR) in each group. Two radiologists assessed subjective image noise, image artifacts, and visibility of the anatomical structures. Objective image noise and signal-to-noise ratio (SNR) were measured, and effective dose (ED) was recorded. Results Increased NI was associated with increased subjective and objective image noise results (P<0.001), and SNR decreased with increasing NI (P<0.001). These values improved with increased ASIR levels (P<0.001). Images from all 4 groups were clinically diagnosable. Images with NI = 30 and 50% ASIR had average subjective image noise scores and nearly average anatomical structure visibility scores, with a mean objective image noise of 23.42 HU. The EDs for groups 1, 2, 3 and 4 were 2.79±1.17, 1.69±0.59, 0.74±0.29, and 0.37±0.22 mSv, respectively. Compared to group 1 (NI = 15), the ED reductions were 39.43%, 73.48%, and 86.74% for groups 2, 3, and 4, respectively. Conclusions Using NI = 30 with 50% ASIR in the chest CT protocol, we obtained average or above-average image quality but a reduced ED. PMID:24691208

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.

Personality and Perpetration: Narcissism Among College Sexual Assault Perpetrators.

PubMed

Mouilso, Emily R; Calhoun, Karen S

2016-09-01

Theory and research suggest that narcissism plays an important role in perpetration of sexual aggression. As narcissism is a multidimensional construct, our objective was to clarify the relation between perpetration and three aspects of narcissism. College men (N = 234) completed the Narcissistic Personality Inventory (NPI), Narcissistic Personality Disorder (NPD) subscale of the Structured Clinical Interview for DSM Disorders-II (SCID-N) Personality Questionnaire, and Hypersensitive Narcissism Scale (HSNS). Perpetrators had higher scores on NPD traits, which were also associated with frequent perpetration. HSNS scores were only associated with perpetration via alcohol and/or drugs. Only the maladaptive facets of NPI narcissism correlated with perpetration. Narcissism seems to have been understudied in nonincarcerated perpetrators. © The Author(s) 2015.

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.

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.

Using Objective Structured Clinical Examinations to Assess Intern Orthopaedic Physical Examination Skills: A Multimodal Didactic Comparison.

PubMed

Phillips, Donna; Pean, Christian A; Allen, Kathleen; Zuckerman, Joseph; Egol, Kenneth

Patient care is 1 of the 6 core competencies defined by the Accreditation Council for Graduate Medical Education (ACGME). The physical examination (PE) is a fundamental skill to evaluate patients and make an accurate diagnosis. The purpose of this study was to investigate 3 different methods to teach PE skills and to assess the ability to do a complete PE in a simulated patient encounter. Prospective, uncontrolled, observational. Northeastern academic medical center. A total of 32 orthopedic surgery residents participated and were divided into 3 didactic groups: Group 1 (n = 12) live interactive lectures, demonstration on standardized patients, and textbook reading; Group 2 (n = 11) video recordings of the lectures given to Group 1 and textbook reading alone; Group 3 (n = 9): 90-minute modules taught by residents to interns in near-peer format and textbook reading. The overall score for objective structured clinical examinations from the combined groups was 66%. There was a trend toward more complete PEs in Group 1 taught via live lectures and demonstrations compared to Group 2 that relied on video recording. Near-peer taught residents from Group 3 significantly outperformed Group 2 residents overall (p = 0.02), and trended toward significantly outperforming Group 1 residents as well, with significantly higher scores in the ankle (p = 0.02) and shoulder (p = 0.02) PE cases. This study found that orthopedic interns taught musculoskeletal PE skills by near-peers outperformed other groups overall. An overall score of 66% for the combined didactic groups suggests a baseline deficit in first-year resident musculoskeletal PE skills. The PE should continue to be taught and objectively assessed throughout residency to confirm that budding surgeons have mastered these fundamental skills before going into practice. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Toxicities Affecting Quality of Life After Chemo-IMRT of Oropharyngeal Cancer: Prospective Study of Patient-Reported, Observer-Rated, and Objective Outcomes

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

Hunter, Klaudia U.; Schipper, Matthew; Feng, Felix Y.

2013-03-15

Purpose: To test the hypothesis that intensity modulated radiation therapy (IMRT) aiming to spare the salivary glands and swallowing structures would reduce or eliminate the effects of xerostomia and dysphagia on quality of life (QOL). Methods and Materials: In this prospective, longitudinal study, 72 patients with stage III-IV oropharyngeal cancer were treated uniformly with definitive chemo-IMRT sparing the salivary glands and swallowing structures. Overall QOL was assessed by summary scores of the Head Neck QOL (HNQOL) and University of Washington QOL (UWQOL) questionnaires, as well as the HNQOL “Overall Bother” question. Quality of life, observer-rated toxicities (Common Toxicity Criteria Adversemore » Effects scale, version 2), and objective evaluations (videofluoroscopy assessing dysphagia and saliva flow rates assessing xerostomia) were recorded from before therapy through 2 years after therapy. Correlations between toxicities/objective evaluations and overall QOL were assessed using longitudinal repeated measures of analysis and Pearson correlations. Results: All observer-rated toxicities and QOL scores worsened 1-3 months after therapy and improved through 12 months, with minor further improvements through 24 months. At 12 months, dysphagia grades 0-1, 2, and 3, were observed in 95%, 4%, and 1% of patients, respectively. Using all posttherapy observations, observer-rated dysphagia was highly correlated with all overall QOL measures (P<.0001), whereas xerostomia and mucosal and voice toxicities were significantly correlated with some, but not all, overall QOL measures, with lower correlation coefficients than dysphagia. Late overall QOL (≥6 or ≥12 months after therapy) was primarily associated with observer-rated dysphagia, and to a lesser extent with xerostomia. Videofluoroscopy scores, but not salivary flows, were significantly correlated with some of the overall QOL measures. Conclusion: After chemo-IMRT, although late dysphagia was on average mild, it was still the major correlate of QOL. Further efforts to reduce swallowing dysfunction are likely to yield additional gains in QOL.« less

All-atom four-body knowledge-based statistical potential to distinguish native tertiary RNA structures from nonnative folds.

PubMed

Masso, Majid

2018-09-14

Scientific breakthroughs in recent decades have uncovered the capability of RNA molecules to fulfill a wide array of structural, functional, and regulatory roles in living cells, leading to a concomitantly significant increase in both the number and diversity of experimentally determined RNA three-dimensional (3D) structures. Atomic coordinates from a representative training set of solved RNA structures, displaying low sequence and structure similarity, facilitate derivation of knowledge-based energy functions. Here we develop an all-atom four-body statistical potential and evaluate its capacity to distinguish native RNA 3D structures from nonnative folds based on calculated free energy scores. Atomic four-body nearest-neighbors are objectively identified by their occurrence as tetrahedral vertices in the Delaunay tessellations of RNA structures, and rates of atomic quadruplet interactions expected by chance are obtained from a multinomial reference distribution. Our four-body energy function, referred to as RAMP (ribonucleic acids multibody potential), is subsequently derived by applying the inverted Boltzmann principle to the frequency data, yielding an energy score for each type of atomic quadruplet interaction. Several well-known benchmark datasets reveal that RAMP is comparable with, and often outperforms, existing knowledge- and physics-based energy functions. To the best of our knowledge, this is the first study detailing an RNA tertiary structure-based multibody statistical potential and its comparative evaluation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Study for the quality assessment of abstracts presented to Italian public health national conferences: a six years survey.

PubMed

Castaldi, S; Colombo, A; D'Errico, R; Bert, F; Siliquini, R; Ceruti, M; Curti, S; Gaietta, M; Garavelli, E; Legouellec, L; Lovato, E; Martinese, M; Visco, F

2013-01-01

Oral and poster presentations at congresses are essential to spread scientific knowledge among the medical community. Many scientific societies have analyzed the quality of papers presented at their meetings but no information on abstracts' evaluation has been presented in Public Health field. This study aims to examine the quality of abstracts presented at annual meetings of Italian Public Health Society (SItI) in the period 2005-2010 through a validated checklist grid, evaluating eight dimensions: Inherency, Structure, Originality, Objectives, Study design, Sources, Results, Conclusions. Each item was scored from 0 to 3 points (max score: 24) and we used the average score in our study (15) as threshold of good quality. A multivariate analysis was performed in order to investigate predictors of score of abstracts presented. A total of 4,399 abstracts (1,172 oral communications, 3,227 posters) was examined. Around 60% were submitted by Universities and around 40% were from Central Italy. The highest quality was found in the fields of Vaccines (average score 18.9), Infectious Diseases (18) and in abstracts submitted by Universities (16.4). Predictors of lower quality identified were geographical area and affiliation (p= 0.002). Abstracts containing well-written Results, Conclusions and Objectives (3 points) were more likely to be of high quality(OR=55.6, OR=41.9, and OR=157.4; p>0.001) CONCLUSIONS: This is the first European study evaluating the quality of abstracts in the public health field. A reliable evaluation tool is fundamental to offer a transparent methodology of assessment and to improve the quality of research.

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.

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.

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…

Assessment Methods of an Undergraduate Psychiatry Course at a Saudi University

PubMed Central

Amr, Mostafa; Amin, Tarek

2012-01-01

Objectives: In Arab countries there are few studies on assessment methods in the field of psychiatry. The objective of this study was to assess the outcome of different forms of psychiatric course assessment among fifth year medical students at King Faisal University, Saudi Arabia. Methods: We examined the performance of 110 fifth-year medical students through objective structured clinical examinations (OSCE), traditional oral clinical examinations (TOCE), portfolios, multiple choice questions (MCQ), and a written examination. Results: The score ranges in TOCE, OSCE, portfolio, and MCQ were 32–50, 7–15, 5–10 and 22–45, respectively. In regression analysis, there was a significant correlation between OSCE and all forms of psychiatry examinations, except for the MCQ marks. OSCE accounted for 65.1% of the variance in total clinical marks and 31.5% of the final marks (P = 0.001), while TOCE alone accounted for 74.5% of the variance in the clinical scores. Conclusions: This study demonstrates a consistency among the students’ assessment methods used in the psychiatry course, particularly the clinical component, in an integrated manner. This information would be useful for future developments in undergraduate teaching. PMID:22548141

Psychometric properties of the Brief Symptom Inventory-18 in a Spanish breast cancer sample.

PubMed

Galdón, Ma José; Durá, Estrella; Andreu, Yolanda; Ferrando, Maite; Murgui, Sergio; Pérez, Sandra; Ibañez, Elena

2008-12-01

The objective of this work was to study the psychometric and structural properties of the Brief Symptom Inventory-18 (BSI-18) in a sample of breast cancer patients (N=175). Confirmatory factor analyses were conducted. Two models were tested: the theoretical model with the original structure (three-dimensional), and the empirical model (a four-factor structure) obtained through exploratory factor analysis initially performed by the authors of the BSI-18. The eligible structure was the original proposal consisting of three dimensions: somatization, depression, and anxiety scores. These measures also showed good internal consistency. The results of this study support the reliability and structural validity of the BSI-18 as a standardized instrument for screening purposes in breast cancer patients, with the added benefits of simplicity and ease of application.

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)

Modeling the Distribution of Nursing Effort Using Structured Labor and Delivery Documentation

PubMed Central

Hall, Eric S.; Poynton, Mollie R.; Narus, Scott P.; Thornton, Sidney N.

2008-01-01

Our study objectives included the development and evaluation of models for representing the distribution of shared unit-wide nursing care resources among individual Labor and Delivery patients using quantified measurements of nursing care, referred to as Nursing Effort. The models were intended to enable discrimination between the amounts of care delivered to patient subsets defined by attributes such as patient acuity. For each of five proposed models, scores were generated using an analysis set of 686,402 computerized nurse-documented events associated with 1,093 patients at three hospitals during January and February 2006. Significant differences were detected in Nursing Effort scores according to patient acuity, care facility, and in scores generated during shift-change versus non shift-change hours. The development of nursing care quantification strategies proposed in this study supports outcomes analysis by establishing a foundation for measuring the effect of patient-level nursing care on individual patient outcomes. PMID:18495549

A comparison of VRML and animation of rotation for teaching 3-dimensional crystal lattice structures

NASA Astrophysics Data System (ADS)

Sauls, Barbara Lynn

Chemistry students often have difficulty visualizing abstract concepts of molecules and atoms, which may lead to misconceptions. The three-dimensionality of these structures presents a challenge to educators. Typical methods of teaching include text with two-dimensional graphics and structural models. Improved methods to allow visualization of 3D structures may improve learning of these concepts. This research compared the use of Virtual Reality Modeling Language (VRML) and animation of rotation for teaching three-dimensional structures. VRML allows full control of objects by altering angle, size, rotation, and provides the ability to zoom into and through objects. Animations may only be stopped, restarted and replayed. A web-based lesson teaching basic concepts of crystals, which requires comprehension of their three-dimensional structure was given to 100 freshmen chemistry students. Students were stratified by gender then randomly to one of two lessons, which were identical except for the multimedia method used to show the lattices and unit cells. One method required exploration of the structures using VRML, the other provided animations of the same structures rotating. The students worked through an examination as the lesson progressed. A Welch t' test was used to compare differences between groups. No significant difference in mean achievement was found between the two methods, between genders, or within gender. There was no significant difference in mean total SAT in the animation and VRML group. Total time on task had no significant difference nor did enjoyment of the lesson. Students, however, spent 14% less time maneuvering VRML structures than viewing the animations of rotation. Neither method proved superior for presenting three-dimensional information. The students spent less time maneuvering the VRML structures with no difference in mean score so the use of VRML may be more efficient. The investigator noted some manipulation difficulties using VRML to rotate structures. Some students had difficulty obtaining the correct angle required to properly interpret spatial relationships. This led to frustration and caused some students to quit trying before they could answer questions fully. Even though there were some difficulties, outcomes were not affected. Higher scores, however, may have been achieved had the students been proficient in VRML maneuvering.

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.

Do employers know the quality of health care benefits they provide? Use of HEDIS depression scores for health plans.

PubMed

Robst, John; Rost, Kathryn; Marshall, Donna

2013-11-01

OBJECTIVE Dissemination of health quality measures is a necessary ingredient of efforts to harness market-based forces, such as value-based purchasing by employers, to improve health care quality. This study examined reporting of Healthcare Effectiveness Data and Information Set (HEDIS) measures for depression to firms interested in improving depression care. METHODS During surveys conducted between 2009 and 2011, a sample of 325 employers that were interested in improving depression treatment were asked whether their primary health plan reports HEDIS scores for depression to the National Committee for Quality Assurance (NCQA) and if so, whether they knew the scores. Data about HEDIS reporting by the health plans were collected from the NCQA. RESULTS HEDIS depression scores were reported by the primary health plans of 154 (47%) employers, but only 7% of employers knew their plan's HEDIS scores. Because larger employers were more likely to report knowing the scores, 53% of all employees worked for employers who reported knowing the scores. A number of structural, health benefit, and need characteristics predicted knowledge of HEDIS depression scores by employers. CONCLUSIONS The study demonstrated that motivated employers did not know their depression HEDIS scores even when their plan publicly reported them. Measures of health care quality are not reaching the buyers of insurance products; however, larger employers were more likely to know the HEDIS scores for their health plan, suggesting that value-based purchasing may have some ability to affect health care quality.

Impact of a Student-Driven, Virtual Patient Application on Objective Structured Clinical Examination Performance: Observational Study.

PubMed

Bergeron, David; Champagne, Jean-Nicolas; Qi, Wen; Dion, Maxime; Thériault, Julie; Renaud, Jean-Sébastien

2018-02-22

Peer-assisted learning (PAL) refers to a learning activity whereby students of similar academic level teach and learn from one another. Groupe de perfectionnement des habiletés cliniques (Clinical Skills Improvement Group), a student organization at Université Laval, Canada, propelled PAL into the digital era by creating a collaborative virtual patient platform. Medical interviews can be completed in pairs (a student-patient and a student-doctor) through an interactive Web-based application, which generates a score (weighted for key questions) and automated feedback. The aim of the study was to measure the pedagogical impact of the application on the score at medical interview stations at the summative preclerkship Objective Structured Clinical Examination (OSCE). We measured the use of the application (cases completed, mean score) in the 2 months preceding the OSCE. We also accessed the results of medical interview stations at the preclerkship summative OSCE. We analyzed whether using the application was associated with higher scores and/or better passing grades (≥60%) at the OSCE. Finally, we produced an online form where students could comment on their appreciation of the application. Of the 206 students completing the preclerkship summative OSCE, 170 (82.5%) were registered users on the application, completing a total of 3133 cases (18 by active user in average, 7 minutes by case in average). The appreciation questionnaire was answered online by 45 students who mentioned appreciating the intuitive, easy-to-use, and interactive design, the diversity of cases, and the automated feedback. Using the application was associated with reduced reported stress, improved scores (P=.04), and improved passing rates (P=.11) at the preclerkship summative OSCE. This study suggests that PAL can go far beyond small-group teaching, showing students' potential to create helpful pedagogical tools for their peers. ©David Bergeron, Jean-Nicolas Champagne, Wen Qi, Maxime Dion, Julie Thériault, Jean-Sébastien Renaud. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 22.02.2018.

Implementing the objective structured clinical examination in a geriatrics fellowship program-a 3-year experience.

PubMed

Avelino-Silva, Thiago J; Gil, Luiz A; Suemoto, Claudia K; Kikuchi, Elina L; Lin, Sumika M; Farias, Luciana L; Jacob-Filho, Wilson

2012-07-01

The Objective Structured Clinical Examination (OSCE) appears to be an effective alternative for assessing not only medical knowledge, but also clinical skills, including effective communication and physical examination skills. The purpose of the current study was to implement an OSCE model in a geriatrics fellowship program and to compare the instrument with traditional essay examination. Seventy first- and second-year geriatric fellows were initially submitted to a traditional essay examination and scored from 0 to 10 by a faculty member. The same fellows subsequently underwent an OSCE with eight 10-minute stations covering a wide range of essential aspects of geriatric knowledge. Each OSCE station had an examiner responsible for its evaluation according to a predefined checklist. Checklist items were classified for analysis purposes as clinical knowledge items (CKI) and communication skills items (CSI); fellow responses were scored from 0 to 10.Although essay examinations took from 30 to 45 minutes to complete, 180-200 minutes were required to evaluate fellows using the proposed OSCE method. Fellows scored an average of 6.2 ± 1.2 on the traditional essay examination and 6.6 ± 1.0 on the OSCE (P < .001). Subanalyses of OSCE scores indicated that average performance on CKI was lower than the average on CSI (6.4 ± 1.1 vs. 8.4 ± 1.1; P < .001). Fellow performance on the essay examination was similar to their performance on CKI (P = .13). Second-year fellows performed better than first-year fellows on the essay examination (P < .001) and CKI (P = .05), but not on CSI (P = .25).The OSCE was successfully implemented as an educational strategy during a geriatrics fellowship program. Combining different testing modalities may provide the best assessment of competence for various domains of knowledge, skills, and behavior. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Objective Structured Assessment of Technical Skills (OSATS) evaluation of theoretical versus hands-on training of vaginal breech delivery management: a randomized trial.

PubMed

Buerkle, Bernd; Rueter, Katharina; Hefler, Lukas A; Tempfer-Bentz, Eva-Katrin; Tempfer, Clemens B

2013-12-01

To compare the skills of performing a vaginal breech (VB) delivery after hands-on training versus demonstration. We randomized medical students to a 30-min demonstration (group 1) or a 30-min hands-on (group 2) training session using a standardized VB management algorithm on a pelvic training model. Subjects were tested with a 25 item Objective Structured Assessment of Technical Skills (OSATS) scoring system immediately after training and 72 h thereafter. OSATS scores were the primary outcome. Performance time (PT), self assessment (SA), confidence (CON), and global rating scale (GRS) were the secondary outcomes. Statistics were performed using the Mann-Whitney U-test, chi-square test, and multiple linear regression analysis. 172 subjects were randomized. OSATS scores (primary outcome) were significantly higher in group 2 (n=88) compared to group 1 (n=84) (21.18±2.29 vs. 20.19±2.37, respectively; p=0.006). The secondary outcomes GRS (10.31±2.28 vs. 9.17±2.21; p=0.001), PT (214.60±57.97 s vs. 246.98±59.34 s; p<0.0001), and CON (3.14±0.89 vs. 2.85±0.90; p=0.04) were also significantly different between groups, favoring group 2. After 72 h, primary and secondary outcomes were not significantly different between groups. In a multiple linear regression analysis, group assignment (odds ratio [OR] 1.60; 95% confidence interval [CI] 1.14-2.05; p<0.0001) and gender (OR 2.91; 95% CI 2.45-3.38; p<0.0001) independently influenced OSATS scores. Hands-on training leads to a significant improvement of VB management in a pelvic training model, but this effect was only seen in the short term. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

When less is more: validating a brief scale to rate interprofessional team competencies.

PubMed

Lie, Désirée A; Richter-Lagha, Regina; Forest, Christopher P; Walsh, Anne; Lohenry, Kevin

2017-01-01

There is a need for validated and easy-to-apply behavior-based tools for assessing interprofessional team competencies in clinical settings. The seven-item observer-based Modified McMaster-Ottawa scale was developed for the Team Objective Structured Clinical Encounter (TOSCE) to assess individual and team performance in interprofessional patient encounters. We aimed to improve scale usability for clinical settings by reducing item numbers while maintaining generalizability; and to explore the minimum number of observed cases required to achieve modest generalizability for giving feedback. We administered a two-station TOSCE in April 2016 to 63 students split into 16 newly-formed teams, each consisting of four professions. The stations were of similar difficulty. We trained sixteen faculty to rate two teams each. We examined individual and team performance scores using generalizability (G) theory and principal component analysis (PCA). The seven-item scale shows modest generalizability (.75) with individual scores. PCA revealed multicollinearity and singularity among scale items and we identified three potential items for removal. Reducing items for individual scores from seven to four (measuring Collaboration, Roles, Patient/Family-centeredness, and Conflict Management) changed scale generalizability from .75 to .73. Performance assessment with two cases is associated with reasonable generalizability (.73). Students in newly-formed interprofessional teams show a learning curve after one patient encounter. Team scores from a two-station TOSCE demonstrate low generalizability whether the scale consisted of four (.53) or seven items (.55). The four-item Modified McMaster-Ottawa scale for assessing individual performance in interprofessional teams retains the generalizability and validity of the seven-item scale. Observation of students in teams interacting with two different patients provides reasonably reliable ratings for giving feedback. The four-item scale has potential for assessing individual student skills and the impact of IPE curricula in clinical practice settings. IPE: Interprofessional education; SP: Standardized patient; TOSCE: Team objective structured clinical encounter.

Are United States Medical Licensing Exam Step 1 and 2 scores valid measures for postgraduate medical residency selection decisions?

PubMed

McGaghie, William C; Cohen, Elaine R; Wayne, Diane B

2011-01-01

United States Medical Licensing Examination (USMLE) scores are frequently used by residency program directors when evaluating applicants. The objectives of this report are to study the chain of reasoning and evidence that underlies the use of USMLE Step 1 and 2 scores for postgraduate medical resident selection decisions and to evaluate the validity argument about the utility of USMLE scores for this purpose. This is a research synthesis using the critical review approach. The study first describes the chain of reasoning that underlies a validity argument about using test scores for a specific purpose. It continues by summarizing correlations of USMLE Step 1 and 2 scores and reliable measures of clinical skill acquisition drawn from nine studies involving 393 medical learners from 2005 to 2010. The integrity of the validity argument about using USMLE Step 1 and 2 scores for postgraduate residency selection decisions is tested. The research synthesis shows that USMLE Step 1 and 2 scores are not correlated with reliable measures of medical students', residents', and fellows' clinical skill acquisition. The validity argument about using USMLE Step 1 and 2 scores for postgraduate residency selection decisions is neither structured, coherent, nor evidence based. The USMLE score validity argument breaks down on grounds of extrapolation and decision/interpretation because the scores are not associated with measures of clinical skill acquisition among advanced medical students, residents, and subspecialty fellows. Continued use of USMLE Step 1 and 2 scores for postgraduate medical residency selection decisions is discouraged.

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.

Perceived crosstalk assessment on patterned retarder 3D display

NASA Astrophysics Data System (ADS)

Zou, Bochao; Liu, Yue; Huang, Yi; Wang, Yongtian

2014-03-01

CONTEXT: Nowadays, almost all stereoscopic displays suffer from crosstalk, which is one of the most dominant degradation factors of image quality and visual comfort for 3D display devices. To deal with such problems, it is worthy to quantify the amount of perceived crosstalk OBJECTIVE: Crosstalk measurements are usually based on some certain test patterns, but scene content effects are ignored. To evaluate the perceived crosstalk level for various scenes, subjective test may bring a more correct evaluation. However, it is a time consuming approach and is unsuitable for real­ time applications. Therefore, an objective metric that can reliably predict the perceived crosstalk is needed. A correct objective assessment of crosstalk for different scene contents would be beneficial to the development of crosstalk minimization and cancellation algorithms which could be used to bring a good quality of experience to viewers. METHOD: A patterned retarder 3D display is used to present 3D images in our experiment. By considering the mechanism of this kind of devices, an appropriate simulation of crosstalk is realized by image processing techniques to assign different values of crosstalk to each other between image pairs. It can be seen from the literature that the structures of scenes have a significant impact on the perceived crosstalk, so we first extract the differences of the structural information between original and distorted image pairs through Structural SIMilarity (SSIM) algorithm, which could directly evaluate the structural changes between two complex-structured signals. Then the structural changes of left view and right view are computed respectively and combined to an overall distortion map. Under 3D viewing condition, because of the added value of depth, the crosstalk of pop-out objects may be more perceptible. To model this effect, the depth map of a stereo pair is generated and the depth information is filtered by the distortion map. Moreover, human attention is one of important factors for crosstalk assessment due to the fact that when viewing 3D contents, perceptual salient regions are highly likely to be a major contributor to determining the quality of experience of 3D contents. To take this into account, perceptual significant regions are extracted, and a spatial pooling technique is used to combine structural distortion map, depth map and visual salience map together to predict the perceived crosstalk more precisely. To verify the performance of the proposed crosstalk assessment metric, subjective experiments are conducted with 24 participants viewing and rating 60 simuli (5 scenes * 4 crosstalk levels * 3 camera distances). After an outliers removal and statistical process, the correlation with subjective test is examined using Pearson and Spearman rank-order correlation coefficient. Furthermore, the proposed method is also compared with two traditional 2D metrics, PSNR and SSIM. The objective score is mapped to subjective scale using a nonlinear fitting function to directly evaluate the performance of the metric. RESULIS: After the above-mentioned processes, the evaluation results demonstrate that the proposed metric is highly correlated with the subjective score when compared with the existing approaches. Because the Pearson coefficient of the proposed metric is 90.3%, it is promising for objective evaluation of the perceived crosstalk. NOVELTY: The main goal of our paper is to introduce an objective metric for stereo crosstalk assessment. The novelty contributions are twofold. First, an appropriate simulation of crosstalk by considering the characteristics of patterned retarder 3D display is developed. Second, an objective crosstalk metric based on visual attention model is introduced.

Medication and aggressiveness in real-world schizophrenia. Results from the FACE-SZ dataset.

PubMed

Fond, G; Boyer, L; Favez, M; Brunel, L; Aouizerate, B; Berna, F; Capdevielle, D; Chereau, I; Dorey, J M; Dubertret, C; Dubreucq; Faget, C; Gabayet, F; Laouamri, H; Lancon, C; Le Strat, Y; Misdrahi, D; Rey, R; Passerieux, C; Schandrin, A; Schurhoff, F; Tronche, A M; Urbach, M; Vidalhet, P; Llorca, P M; Pelissolo, A

2016-02-01

The primary objective of this study was to determine if second-generation antipsychotic (SGA) administration was associated with lower aggressiveness scores compared to first-generation (FGA) in schizophrenia (SZ). The secondary objective was to determine if antidepressants, mood stabilizers, and benzodiazepines administration were respectively associated with lower aggressiveness scores compared to patients who were not administered these medications. Three hundred thirty-one patients with schizophrenia (N = 255) or schizoaffective disorder (N = 76) (mean age = 32.5 years, 75.5 % male gender) were systematically included in the network of FondaMental Expert Center for Schizophrenia and assessed with the structured clinical interview for DSM-IV Axis I disorders and validated scales for psychotic symptomatology, insight, and compliance. Aggressiveness was measured by the Buss-Perry Aggression Questionnaire (BPAQ) score. Ongoing psychotropic treatment was recorded. Patients who received SGA had lower BPAQ scores than patients who did not (p = 0.01). More specifically, these patients had lower physical and verbal aggression scores. On the contrary, patients who received benzodiazepines had higher BPAQ scores than patients who did not (p = 0.04). No significant difference was found between BPAQ scores of patients respectively being administered mood stabilizers (including valproate), antidepressant, and the patients who were not. These results were found independently of socio-demographical variables, psychotic symptomatology, insight, compliance into treatment, daily-administered antipsychotic dose, the way of antipsychotic administration (oral vs long acting), current alcohol disorder, and daily cannabis consumption. The results of the present study are in favor of the choice of SGA in SZ patients with aggressiveness, but these results need further investigation in longitudinal studies. Given the potent side effects of benzodiazepines (especially dependency and cognitive impairment) and the results of the present study, their long-term prescription is not recommended in patients with schizophrenia and aggressive behavior.

Rescore protein-protein docked ensembles with an interface contact statistics.

PubMed

Mezei, Mihaly

2017-02-01

The recently developed statistical measure for the type of residue-residue contact at protein complex interfaces, based on a parameter-free definition of contact, has been used to define a contact score that is correlated with the likelihood of correctness of a proposed complex structure. Comparing the proposed contact scores on the native structure and on a set of model structures the proposed measure was shown to generally favor the native structure but in itself was not able to reliably score the native structure to be the best. Adjusting the scores of redocking experiments with the contact score showed that the adjusted score was able to move up the ranking of the native-like structure among the proposed complexes when the native-like was not ranked the best by the respective program. Tests on docking of unbound proteins compared the contact scores of the complexes with the contact score of the crystal structure again showing the tendency of the contact score to favor native-like conformations. The possibility of using the contact score to improve the determination of biological dimers in a crystal structure was also explored. Proteins 2017; 85:235-241. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

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

Clinical simulation training improves the clinical performance of Chinese medical students

PubMed Central

Zhang, Ming-ya; Cheng, Xin; Xu, An-ding; Luo, Liang-ping; Yang, Xuesong

2015-01-01

Background Modern medical education promotes medical students’ clinical operating capacity rather than the mastery of theoretical knowledge. To accomplish this objective, clinical skill training using various simulations was introduced into medical education to cultivate creativity and develop the practical ability of students. However, quantitative analysis of the efficiency of clinical skill training with simulations is lacking. Methods In the present study, we compared the mean scores of medical students (Jinan University) who graduated in 2013 and 2014 on 16 stations between traditional training (control) and simulative training groups. In addition, in a clinical skill competition, the objective structured clinical examination (OSCE) scores of participating medical students trained using traditional and simulative training were compared. The data were statistically analyzed and qualitatively described. Results The results revealed that simulative training could significantly enhance the graduate score of medical students compared with the control. The OSCE scores of participating medical students in the clinical skill competition, trained using simulations, were dramatically higher than those of students trained through traditional methods, and we also observed that the OSCE marks were significantly increased for the same participant after simulative training for the clinical skill competition. Conclusions Taken together, these data indicate that clinical skill training with a variety of simulations could substantially promote the clinical performance of medical students and optimize the resources used for medical education, although a precise analysis of each specialization is needed in the future. PMID:26478142

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.

The Impact of Spirituality Before and After Treatment of Major Depressive Disorder

PubMed Central

Peselow, Eric; Pi, Sarah; Lopez, Enrique; Besada, André; IsHak, Waguih W.

2014-01-01

Objective: The authors sought to assess spirituality in depressed patients and evaluate whether the degree of initial depressive symptoms and response to pharmacotherapy treatment has a correlation with degree of spirituality and belief in God. Methods: Our participants included 84 patients who presented to a depression/anxiety clinic for naturalistic treatment of their depressive illness over the course of two years. All patients met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for major depression, as confirmed by structured interviews using the Structured Clinical Interview for DSM-IV, and were treated with selective serotonin reuptake inhibitors for eight weeks. Measurements: Patients were evaluated at baseline and after treatment using the Montgomery Asberg Depression Rating Scale, the Beck Hopelessness Scale, the Dysfunctional Attitude Scale, and the Spiritual Orientation to Life scale. Results: At baseline, patients reporting greater spirituality had significantly lower measures of hopelessness, dysfunctional attitudes, and depressive symptoms. Those who believed in God had a greater mean change score than those who did not on the Montgomery Asberg Depression Rating Scale, the Beck Hopelessness Scale, and the Dysfunctional Attitude Scale, with the Montgomery Asberg Depression Rating Scale showing the greatest mean change score. Significant correlations were detected between the Spiritual Orientation to Life scale score and the Montgomery Asberg Depression Rating Scale, the Beck Hopelessness Scale, and the Dysfunctional Attitude Scale pre-scores, post-scores, and change scores. Conclusion: The findings suggest that greater spirituality is associated with less severe depression. Moreover, the degree to which the measures of depressive symptom severity, hopelessness, and cognitive distortions improved over the course of eight weeks was significantly greater for those patients who were more spiritual. PMID:24800129

Online Object Tracking, Learning and Parsing with And-Or Graphs.

PubMed

Wu, Tianfu; Lu, Yang; Zhu, Song-Chun

2017-12-01

This paper presents a method, called AOGTracker, for simultaneously tracking, learning and parsing (TLP) of unknown objects in video sequences with a hierarchical and compositional And-Or graph (AOG) representation. The TLP method is formulated in the Bayesian framework with a spatial and a temporal dynamic programming (DP) algorithms inferring object bounding boxes on-the-fly. During online learning, the AOG is discriminatively learned using latent SVM [1] to account for appearance (e.g., lighting and partial occlusion) and structural (e.g., different poses and viewpoints) variations of a tracked object, as well as distractors (e.g., similar objects) in background. Three key issues in online inference and learning are addressed: (i) maintaining purity of positive and negative examples collected online, (ii) controling model complexity in latent structure learning, and (iii) identifying critical moments to re-learn the structure of AOG based on its intrackability. The intrackability measures uncertainty of an AOG based on its score maps in a frame. In experiments, our AOGTracker is tested on two popular tracking benchmarks with the same parameter setting: the TB-100/50/CVPR2013 benchmarks  , [3] , and the VOT benchmarks [4] -VOT 2013, 2014, 2015 and TIR2015 (thermal imagery tracking). In the former, our AOGTracker outperforms state-of-the-art tracking algorithms including two trackers based on deep convolutional network   [5] , [6] . In the latter, our AOGTracker outperforms all other trackers in VOT2013 and is comparable to the state-of-the-art methods in VOT2014, 2015 and TIR2015.

Do quality indicators for general practice teaching practices predict good outcomes for students?

PubMed

Bartlett, Maggie; Potts, Jessica; McKinley, Bob

2016-07-01

Keele medical students spend 113 days in general practices over our five-year programme. We collect practice data thought to indicate good quality teaching. We explored the relationships between these data and two outcomes for students; Objective Structured Clinical Examination (OSCE) scores and feedback regarding the placements. Though both are surrogate markers of good teaching, they are widely used. We collated practice and outcome data for one academic year. Two separate statistical analyses were carried out: (1) to determine how much of the variation seen in the OSCE scores was due to the effect of the practice and how much to the individual student. (2) to identify practice characteristics with a relationship to student feedback scores. (1) OSCE performance: 268 students in 90 practices: six quality indicators independently influenced the OSCE score, though without linear relationships and not to statistical significance. (2) Student satisfaction: 144 students in 69 practices: student feedback scores are not influenced by practice characteristics. The relationships between the quality indicators we collect for practices and outcomes for students are not clear. It may be that neither the quality indicators nor the outcome measures are reliable enough to inform decisions about practices' suitability for teaching.

Podiatry Ankle Duplex Scan: Readily Learned and Accurate in Diabetes.

PubMed

Normahani, Pasha; Powezka, Katarzyna; Aslam, Mohammed; Standfield, Nigel J; Jaffer, Usman

2018-03-01

We aimed to train podiatrists to perform a focused duplex ultrasound scan (DUS) of the tibial vessels at the ankle in diabetic patients; podiatry ankle (PodAnk) duplex scan. Thirteen podiatrists underwent an intensive 3-hour long simulation training session. Participants were then assessed performing bilateral PodAnk duplex scans of 3 diabetic patients with peripheral arterial disease. Participants were assessed using the duplex ultrasound objective structured assessment of technical skills (DUOSATS) tool and an "Imaging Score". A total of 156 vessel assessments were performed. All patients had abnormal waveforms with a loss of triphasic flow. Loss of triphasic flow was accurately detected in 145 (92.9%) vessels; the correct waveform was identified in 139 (89.1%) cases. Participants achieved excellent DUOSATS scores (median 24 [interquartile range: 23-25], max attainable score of 26) as well as "Imaging Scores" (8 [8-8], max attainable score of 8) indicating proficiency in technical skills. The mean time taken for each bilateral ankle assessment was 20.4 minutes (standard deviation ±6.7). We have demonstrated that a focused DUS for the purpose of vascular assessment of the diabetic foot is readily learned using intensive simulation training.

Relationship between personality disorder dimensions and verbal memory functioning in a community population.

PubMed

Park, Subin; Hong, Jin Pyo; Lee, Hochang B; Samuels, Jack; Bienvenu, O Joseph; Chung, Hye Yoon; Eaton, William W; Costa, Paul T; Nestadt, Gerald

2012-03-30

Based on the Baltimore Epidemiologic Catchment Area (ECA) follow-up survey, we examined relationships between dimensions of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) personality disorders and both subjective and objective memory functioning in a community population. Our study subjects consisted of 736 individuals from the ECA follow-up study of the original Baltimore ECA cohort, conducted between 1993 and 1996 and available for assessment in the Hopkins Epidemiology Study of Personality Disorders from 1997 to 1999. Subjects were assessed for DSM-IV personality disorders using a semi-structured instrument, the International Personality Disorder Examination, and were asked about a subjective appraisal of memory. Verbal memory function, including immediate recall, delayed recall, and recognition, were also evaluated. Multiple linear regression analyses were used to determine associations between personality dimensions of DSM-IV Axis II traits and subjective and objective memory functioning. Scores on schizoid and schizotypal personality dimensions were associated with subjective and objective memory dysfunction, both with and without adjustment for Axis I disorders. Borderline, antisocial, avoidant, and dependent personality disorder scores were associated with subjective memory impairment only, both with and without adjustment for Axis I disorders. This study suggests that subjective feelings of memory impairment and/or objective memory dysfunction are associated with specific personality disorder dimensions. Copyright © 2011 Elsevier Ltd. All rights reserved.

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.

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

PubMed

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

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

A Study of Soft Neurological Signs and Its Correlates in Drug-Naive Patients with First Episode Psychosis.

PubMed

Gunasekaran, Vanishree; Venkatesh, V Mathan Kumar; Asokan, T V

2016-01-01

Soft neurological signs are minor, non localizing, objective abnormalities, thought to reflect damage in cortical and sub-cortical connections or connections within different cortical regions. Regional structural grey matter anomalies have already been observed and correlated with the presence of cognitive deficits and presence of soft neurological signs in schizophrenic patients. Drug naive patients presenting with first episode of psychosis (FEP)were clinically evaluated for soft neurological signs using the Cambridge Neurological Inventory. The soft neurological signs scores were compared with scores in healthy volunteers. In the patient group, this score was also correlated with demographic and disorder variables. Of the 30 patients with FEP, 60% were women. The average age of the participant was 36.2 years. The average duration of illness was 1.55 years. More than 50% of the patients had schizophrenia. 93.3% of patients with FEP had atleast one soft neurological sign compared to 16.6% of controls. The average score on BPRS was 25.86 and on PANSS was 39.29, and BPRS, PANSS scores had a significant correlation with total soft neurological signs score. There is a significantly higher incidence of soft neurological signs in patients with FEP, particularly schizophrenia. The presence of soft signs correlated with the severity of psychosis.

Assessment of first-year post-graduate residents: usefulness of multiple tools.

PubMed

Yang, Ying-Ying; Lee, Fa-Yauh; Hsu, Hui-Chi; Huang, Chin-Chou; Chen, Jaw-Wen; Cheng, Hao-Min; Lee, Wen-Shin; Chuang, Chiao-Lin; Chang, Ching-Chih; Huang, Chia-Chang

2011-12-01

Objective Structural Clinical Examination (OSCE) usually needs a large number of stations with long test time, which usually exceeds the resources available in a medical center. We aimed to determine the reliability of a combination of Direct Observation of Procedural Skills (DOPS), Internal Medicine in-Training Examination (IM-ITE(®)) and OSCE, and to verify the correlation between the small-scale OSCE+DOPS+IM-ITE(®)-composited scores and 360-degree evaluation scores of first year post-graduate (PGY(1)) residents. Between 2007 January to 2010 January, two hundred and nine internal medicine PGY1 residents completed DOPS, IM-ITE(®) and small-scale OSCE at our hospital. Faculty members completed 12-item 360-degree evaluation for each of the PGY(1) residents regularly. The small-scale OSCE scores correlated well with the 360-degree evaluation scores (r = 0.37, p < 0.021). Interestingly, the addition of DOPS scores to small-scale OSCE scores [small-scale OSCE+DOPS-composited scores] increased it's correlation with 360-degree evaluation scores of PGY(1) residents (r = 0.72, p < 0.036). Further, combination of IM-ITE(®) score with small-scale OSCE+DOPS scores [small-scale OSCE+DOPS+IM-ITE(®)-composited scores] markedly enhanced their correlation with 360-degree evaluation scores (r = 0.85, p < 0.016). The strong correlations between 360-degree evaluation and small-scale OSCE+DOPS+IM-ITE(®)-composited scores suggested that both methods were measuring the same quality. Our results showed that the small-scale OSCE, when associated with both the DOPS and IM-ITE(®), could be an important assessment method for PGY(1) residents. Copyright © 2011. Published by Elsevier B.V.

Gender- and Race-Specific Metabolic Score and Cardiovascular Disease Mortality in Adults: A Structural Equation Modeling Approach—United States, 1988–2006

PubMed Central

Mercado, Carla I.; Yang, Quanhe; Ford, Earl S.; Gregg, Edward; Valderrama, Amy L.

2017-01-01

Objective Consider all metabolic syndrome (MetS) components [systolic (SBP) and diastolic (DBP) blood pressures, waist circumference, HDL cholesterol, triglycerides (TG), and fasting glucose] and gender/race differential risk when assessing cardiovascular disease (CVD) risk. Methods We estimated a gender- and race-specific continuous MetS score using structural equation modeling and tested its association with CVD mortality using data from National Health and Nutrition Examination Survey III linked with the National Death Index. Cox proportional hazard regression tested the association adjusted for sociodemographic and behavior characteristics. Results For men, continuous MetS components associated with CVD mortality were SBP (hazard ratio =1.50, 95% confidence interval =1.14–1.96), DBP (1.48, 1.16–1.90), and TG (1.15, 1.12–1.16). In women, SBP (1.44, 1.27–1.63) and DBP (1.24, 1.02–1.51) were associated with CVD mortality. MetS score was not significantly associated with CVD mortality in men; but significant associations were found for all women (1.34, 1.06–1.68), non-Hispanic white women (1.29, 1.01–1.64), non-Hispanic black women (2.03, 1.12–3.69), and Mexican-American women (3.57, 2.21–5.76). Goodness-of-fit and concordance were overall better for models with the MetS score than MetS (yes/no). Conclusions When assessing CVD mortality risk, MetS score provided additional information than MetS (yes/no). PMID:26308480

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.

Volunteer Functions Inventory: A systematic review.

PubMed

Chacón, Fernando; Gutiérrez, Gema; Sauto, Verónica; Vecina, María L; Pérez, Alfonso

2017-08-01

The objective of this research study was to conduct a systematic review of the research on volunteers using Clary et al.’s VFI (1998). A total of 48 research studies including 67 independent samples met eligibility criteria. The total sample of the studies analyzed ranged from 20375 to 21988 participants, depending on the motivation analyzed. The results show that the Values factor obtained the highest mean score, both overall and in each type of volunteering, whereas the lowest scores were for the Career and Enhancement factors. Studies conducted with samples with a mean age under 40 years obtain higher scores on Career and Understanding scales when compared to studies in older samples. The group of studies with less than 50% women yield higher mean scores on the Social scale than studies with more than 50% women in the sample. All the scales show reliability coefficients between .78 and .84. Only eight of the articles provide data on the reliability of the scale with a mean value of .90. Of the 26 studies that performed factor analysis, 18 confirmed the original structure of six factors.

Predicting student performance in sonographic scanning using spatial ability as an ability determinent of skill acquisition

NASA Astrophysics Data System (ADS)

Clem, Douglas Wayne

Spatial ability refers to an individual's capacity to visualize and mentally manipulate three dimensional objects. Since sonographers manually manipulate 2D and 3D sonographic images to generate multi-viewed, logical, sequential renderings of an anatomical structure, it can be assumed that spatial ability is central to the perception and interpretation of these medical images. Using Ackerman's theory of ability determinants of skilled performance as a conceptual framework, this study explored the relationship of spatial ability and learning sonographic scanning. Beginning first year sonography students from four different educational institutions were administered a spatial abilities test prior to their initial scanning lab coursework. The students' spatial test scores were compared with their scanning competency performance scores. A significant relationship between the students' spatial ability scores and their scanning performance scores was found. This result suggests that the use of spatial ability tests for admission to sonography programs may improve candidate selection, as well as assist programs in adjusting instruction and curriculum for students who demonstrate low spatial ability.

Causality Assessment in Drug-Induced Liver Injury Using a Structured Expert Opinion Process: Comparison to the Roussel-Uclaf Causality Assessment Method

PubMed Central

Rockey, Don C.; Seeff, Leonard B.; Rochon, James; Freston, James; Chalasani, Naga; Bonacini, Maurizio; Fontana, Robert J.; Hayashi, Paul H.

2011-01-01

Drug-induced liver injury (DILI) is largely a diagnosis of exclusion and is therefore challenging. The US Drug-Induced Liver Injury Network (DILIN) prospective study used two methods to assess DILI causality: a structured expert opinion process and the Roussel-Uclaf Causality Assessment Method (RUCAM). Causality assessment focused on detailed clinical and laboratory data from patients with suspected DILI. The adjudication process used standardized numerical and descriptive definitions and scored cases as definite, highly likely, probable, possible, or unlikely. Results of the structured expert opinion procedure were compared with those derived by the RUCAM approach. Among 250 patients with suspected DILI, the expert opinion adjudication process scored 78 patients (31%) as definite, 102 (41%) as highly likely, 37 (15%) as probable, 25 (10%) as possible, and 8 (3%) as unlikely. Among 187 enrollees who had received a single implicated drug, initial complete agreement was reached for 50 (27%) with the expert opinion process and for 34 (19%) with a five-category RUCAM scale (P = 0.08), and the two methods demonstrated a modest correlation with each other (Spearman's r = 0.42, P = 0.0001). Importantly, the RUCAM approach substantially shifted the causality likelihood toward lower probabilities in comparison with the DILIN expert opinion process. Conclusion The structured DILIN expert opinion process produced higher agreement rates and likelihood scores than RUCAM in assessing causality, but there was still considerable interobserver variability in both. Accordingly, a more objective, reliable, and reproducible means of assessing DILI causality is still needed. PMID:20512999

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.

Evaluating learning among undergraduate medical students in schools with traditional and problem-based curricula.

PubMed

Meo, Sultan Ayoub

2013-09-01

This study aimed to assess knowledge and skills in a respiratory physiology course in traditional versus problem-based learning (PBL) groups in two different medical schools. Two different undergraduate medical schools were selected for this study. The first medical school followed the traditional [lecture-based learning (LBL)] curriculum, and the second medical school followed the PBL curriculum. Sixty first-year male medical students (30 students from each medical school) volunteered; they were apparently healthy and of the same age, sex, nationality, and regional and cultural background. Students were taught respiratory physiology according to their curriculum for a period of 2 wk. At the completion of the study period, knowledge was measured based on a single best multiple-choice question examination, and skill was measured based on the objective structured practical examination in the lung function laboratory (respiratory physiology). A Student's t-test was applied for the analysis of the data, and the level of significance was set at P < 0.05. Students belonging to the PBL curriculum obtained a higher score in the multiple-choice question examination (P = 0.001) and objective structured practical examination (P = 0.0001) compared with traditional (LBL) students. Students in the PBL group obtained significantly higher knowledge and skill scores in the respiratory physiology course compared with students in the traditional (LBL) style of medical schools.

Comparison of rational pharmacotherapy decision-making competence of general practitioners with intern doctors.

PubMed

Akici, A; Kalaça, S; Gören, M Z; Akkan, A G; Karaalp, A; Demir, D; Uğurlu, U; Oktay, S

2004-04-01

The aim of this study was to compare rational pharmacotherapy decision-making competency of interns (final-year medical students) who had received rational pharmacotherapy education (RPE), with their classmates at another medical school and general practitioners (GPs) who had not been exposed to RPE. A written, objective, structured clinical examination (OSCE), consisting of open and structured questions, was given to all participants. The participants were expected to make a treatment plan and prescribe for simple, uncomplicated beta-hemolytic streptococcal tonsillitis and mild-to-moderate essential hypertension patients, explain their proposed treatment plans and reasons affecting their drug choice. After the OSCE, a questionnaire to assess knowledge of the rational use of drugs was given to the participants. Fifty RPE(+) interns, 54 RPE(-) interns and 53 GPs participated in the study. Mean scores of RPE(+) interns were higher than those of GPs, which were in turn found to be higher than those of RPE(-) interns for all cases. The RPE(+) interns scored the highest regarding all components of rational pharmacotherapy process for all cases of both indications. However, participants in all groups had higher scores for the structured questions compared with the corresponding open ones for both diseases. Prescription analysis also revealed better results for RPE(+) interns regarding the number of drugs/prescription and treatment costs. The present study demonstrated that the final-year medical students (interns) markedly benefited from undergraduate RPE at the medical school in developing rational prescribing skills compared with their classmates from a medical school with traditional pharmacology education. Interestingly, they got higher scores than not only RPE(-) interns, but also than the GPs participating in this study, indicating the urgent need for continuous medical education programs in this field throughout the country for practicing GPs.

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.

ADPROCLUS: a graphical user interface for fitting additive profile clustering models to object by variable data matrices.

PubMed

Wilderjans, Tom F; Ceulemans, Eva; Van Mechelen, Iven; Depril, Dirk

2011-03-01

In many areas of psychology, one is interested in disclosing the underlying structural mechanisms that generated an object by variable data set. Often, based on theoretical or empirical arguments, it may be expected that these underlying mechanisms imply that the objects are grouped into clusters that are allowed to overlap (i.e., an object may belong to more than one cluster). In such cases, analyzing the data with Mirkin's additive profile clustering model may be appropriate. In this model: (1) each object may belong to no, one or several clusters, (2) there is a specific variable profile associated with each cluster, and (3) the scores of the objects on the variables can be reconstructed by adding the cluster-specific variable profiles of the clusters the object in question belongs to. Until now, however, no software program has been publicly available to perform an additive profile clustering analysis. For this purpose, in this article, the ADPROCLUS program, steered by a graphical user interface, is presented. We further illustrate its use by means of the analysis of a patient by symptom data matrix.

Osteochondral Biopsy Analysis Demonstrates That BST-CarGel Treatment Improves Structural and Cellular Characteristics of Cartilage Repair Tissue Compared With Microfracture

PubMed Central

Méthot, Stéphane; Changoor, Adele; Tran-Khanh, Nicolas; Hoemann, Caroline D.; Stanish, William D.; Restrepo, Alberto; Shive, Matthew S.; Buschmann, Michael D.

2016-01-01

Objective The efficacy and safety of BST-CarGel, a chitosan-based medical device for cartilage repair, was compared with microfracture alone at 1 year during a multicenter randomized controlled trial (RCT) in the knee. The quality of repair tissue of osteochondral biopsies collected from a subset of patients was compared using blinded histological assessments. Methods The international RCT evaluated repair tissue quantity and quality by 3-dimensional quantitative magnetic resonance imaging as co-primary endpoints at 12 months. At an average of 13 months posttreatment, 21/41 BST-CarGel and 17/39 microfracture patients underwent elective second look arthroscopies as a tertiary endpoint, during which ICRS (International Cartilage Repair Society) macroscopic scoring was carried out, and osteochondral biopsies were collected. Stained histological sections were evaluated by blinded readers using ICRS I and II histological scoring systems. Collagen organization was evaluated using a polarized light microscopy score. Results BST-CarGel treatment resulted in significantly better ICRS macroscopic scores (P = 0.0002) compared with microfracture alone, indicating better filling, integration, and tissue appearance. Histologically, BST-CarGel resulted in a significant improvement of structural parameters—Surface Architecture (P = 0.007) and Surface/Superficial Assessment (P = 0.042)—as well as cellular parameters—Cell Viability (P = 0.006) and Cell Distribution (P = 0.032). No histological parameters were significantly better for the microfracture group. BST-CarGel treatment also resulted in a more organized repair tissue with collagen stratification more similar to native hyaline cartilage, as measured by polarized light microscopy scoring (P = 0.0003). Conclusion Multiple and independent analyses in this biopsy substudy demonstrated that BST-CarGel treatment results in improved structural and cellular characteristics of repair tissue at 1 year posttreatment compared with microfracture alone, supporting previously reported results by quantitative magnetic resonance imaging. PMID:26958314

The brain structural and cognitive basis of odor identification deficits in mild cognitive impairment and Alzheimer’s disease

PubMed Central

2014-01-01

Background The objectives of this study were to explore the relationship between olfactory impairment, cognitive measures, and brain structure volumes in healthy elderly individuals, compared to patients with amnestic mild cognitive impairment (aMCI) or early Alzheimer’s disease (AD). The primary aim was to elucidate possible differences in cognitive scores and brain structure volumes between aMCI/AD patients with relatively intact odor identification (OI) ability and those with reduced ability. Methods Twelve patients with aMCI, six with early AD, and 30 control subjects were included. OI abilities were assessed with the Brief Smell Identification Test (B-SIT) and Sniffin Sticks Identification Test (SSIT). Neuropsychological tests of executive functions and memory were performed. Brain structural volumes were obtained from T1 weighted 3D MRI at 3 Tesla. Statistical comparisons between the patients with aMCI and AD indicated no significant differences in performance on most tests. Since the groups were small and AD patients were in an early phase of disease, all patients were subsequently considered together as a single group for studying OI. Patients were subdivided into relatively intact (scores >50%) and reduced OI (≤ 50% score) on the olfactory tests. Results The aMCI/AD group with reduced OI ability, as measured by both B-SIT and SSIT, had significantly smaller hippocampal volume as compared to the patient group with OI scores > 50%. There was a significant association between OI scores and hippocampal volume in the patient (not the control) group. Similar changes with tests of executive function and memory were not found. Low OI scores on B-SIT were associated with conversion from aMCI to AD in patients. The reduced OI patient group was significantly faster on Rey complex figure copying than the fairly intact OI group. Conclusion The results from this pilot study suggest that the reduction in the size of hippocampus in connection with early AD is associated more with loss of OI ability rather than loss of memory, thus demonstrating that impaired OI is an early marker of medial temporal lobe degeneration. PMID:25154749

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.

Intensity-Modulated Chemoradiotherapy Aiming to Reduce Dysphagia in Patients With Oropharyngeal Cancer: Clinical and Functional Results

PubMed Central

Feng, Felix Y.; Kim, Hyungjin M.; Lyden, Teresa H.; Haxer, Marc J.; Worden, Francis P.; Feng, Mary; Moyer, Jeffrey S.; Prince, Mark E.; Carey, Thomas E.; Wolf, Gregory T.; Bradford, Carol R.; Chepeha, Douglas B.; Eisbruch, Avraham

2010-01-01

Purpose To assess clinical and functional results of chemoradiotherapy for oropharyngeal cancer (OPC), utilizing intensity-modulated radiotherapy (IMRT) to spare the important swallowing structures to reduce post-therapy dysphagia. Patients and Methods This was a prospective study of weekly chemotherapy (carboplatin dosed at one times the area under the curve [AUC, AUC 1] and paclitaxel 30 mg/m2) concurrent with IMRT aiming to spare noninvolved parts of the swallowing structures: pharyngeal constrictors, glottic and supraglottic larynx, and esophagus as well as the oral cavity and major salivary glands. Swallowing was assessed by patient-reported Swallowing and Eating Domain scores, observer-rated scores, and videofluoroscopy (VF) before therapy and periodically after therapy through 2 years. Results Overall, 73 patients with stages III to IV OPC participated. At a median follow-up of 36 months, 3-year disease-free and locoregional recurrence-free survivals were 88% and 96%, respectively. All measures of dysphagia worsened soon after therapy; observer-rated and patient-reported scores recovered over time, but VF scores did not. At 1 year after therapy, observer-rated dysphagia was absent or minimal (scores 0 to 1) in all patients except four: one who was feeding-tube dependent and three who required soft diet. From pretherapy to 12 months post-therapy, the Swallowing and Eating Domain scores worsened on average (± standard deviation) by 10 ± 21 and 13 ± 19, respectively (on scales of 0 to 100), and VF scores (on scale of 1 to 7) worsened from 2.9 ± 1.5 (mild dysphagia) to 4.1 ± 0.9 (mild/moderate dysphagia). Conclusion Chemoradiotherapy with IMRT aiming to reduce dysphagia can be performed safely for OPC and has high locoregional tumor control rates. On average, long-term patient-reported, observer-rated, and objective measures of swallowing were only slightly worse than pretherapy measures, representing potential improvement compared with previous studies. PMID:20421546

Effectiveness of teaching automated external defibrillators use using a traditional classroom instruction versus self-instruction video in non-critical care nurses

PubMed Central

Saiboon, Ismail M.; Qamruddin, Reza M.; BAO, MBBch; Jaafar, Johar M.; Bakar, Afliza A.; Hamzah, Faizal A.; Eng, Ho S.; Robertson, Colin E.

2016-01-01

Objectives: To evaluate the effectiveness and retention of learning automated external defibrillator (AED) usage taught through a traditional classroom instruction (TCI) method versus a novel self instructed video (SIV) technique in non-critical care nurses (NCCN). Methods: A prospective single-blind randomized study was conducted over 7 months (April-October 2014) at the Universiti Kebangsaan Malaysia Medical Center, Kuala Lampur, Malaysia. Eighty nurses were randomized into either TCI or SIV instructional techniques. We assessed knowledge, skill and confidence level at baseline, immediate and 6-months post-intervention. Knowledge and confidence were assessed via questionnaire; skill was assessed by a calibrated and blinded independent assessor using an objective structured clinical examination (OSCE) method. Results: Pre-test mean scores for knowledge in the TCI group was 10.87 ± 2.34, and for the SIV group was 10.37 ± 1.85 (maximum achievable score 20.00); 4.05 ± 2.87 in the TCI and 3.71 ± 2.66 in the SIV (maximum score 11.00) in the OSCE evaluation and 9.54 ± 3.65 in the TCI and 8.56 ± 3.47 in the SIV (maximum score 25.00) in the individual’s personal confidence level. Both methods increased the mean scores significantly during immediate post-intervention (0-month). At 6-months, the TCI group scored lower than the SIV group in all aspects 11.13 ± 2.70 versus 12.95 ± 2.26 (p=0.03) in knowledge, 7.27 ± 1.62 versus 7.68 ± 1.73 (p=0.47) in the OSCE, and 16.40 ± 2.72 versus 18.82 ± 3.40 (p=0.03) in confidence level. Conclusion: In NCCN’s, SIV is as good as TCI in providing the knowledge, competency, and confidence in performing AED defibrillation. PMID:27052286

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.

Childhood Maltreatment Histories, Alcohol and Other Drug Use Symptoms, and Sexual Risk Behavior in a Treatment Sample of Adolescents

PubMed Central

Tubman, Jonathan G.; Burnette, Mandi L.

2012-01-01

Objectives. We tested a structural model of relations among self-reported childhood maltreatment, alcohol and other drug abuse and dependence symptoms, and sexual risk behavior in a sample of adolescents receiving outpatient treatment of substance use problems. Methods. Structured interviews were administered to an ethnically diverse sample of 394 adolescents (114 girls, 280 boys; mean = 16.30 years; SD = 1.15 years; 44.9% Hispanic, 20.6% African American, 25.4% White non-Hispanic, and 9.1% other) in 2 outpatient treatment settings. Results. Path analyses yielded findings consistent with a mediation model. Alcohol abuse and dependence symptoms mediated (1) relations between emotional neglect scores and sex with co-occurring alcohol use and (2) relations between sexual abuse scores and sex with co-occurring alcohol use. Drug abuse and dependence symptoms mediated relations between (1) neglect scores and (2) sexual intercourse with co-occurring alcohol or drug use, as well as unprotected sexual intercourse. Conclusions. Efforts to treat alcohol or drug use problems among adolescents or to prevent transmission of HIV or other sexually transmitted infections among youths with substance use problems may require tailoring treatment or prevention protocols to address client histories of maltreatment. PMID:22401530

Screening and Evaluation of Deleterious SNPs in APOE Gene of Alzheimer's Disease.

PubMed

Masoodi, Tariq Ahmad; Al Shammari, Sulaiman A; Al-Muammar, May N; Alhamdan, Adel A

2012-01-01

Introduction. Apolipoprotein E (APOE) is an important risk factor for Alzheimer's disease (AD) and is present in 30-50% of patients who develop late-onset AD. Several single-nucleotide polymorphisms (SNPs) are present in APOE gene which act as the biomarkers for exploring the genetic basis of this disease. The objective of this study is to identify deleterious nsSNPs associated with APOE gene. Methods. The SNPs were retrieved from dbSNP. Using I-Mutant, protein stability change was calculated. The potentially functional nonsynonymous (ns) SNPs and their effect on protein was predicted by PolyPhen and SIFT, respectively. FASTSNP was used for functional analysis and estimation of risk score. The functional impact on the APOE protein was evaluated by using Swiss PDB viewer and NOMAD-Ref server. Results. Six nsSNPs were found to be least stable by I-Mutant 2.0 with DDG value of >-1.0. Four nsSNPs showed a highly deleterious tolerance index score of 0.00. Nine nsSNPs were found to be probably damaging with position-specific independent counts (PSICs) score of ≥2.0. Seven nsSNPs were found to be highly polymorphic with a risk score of 3-4. The total energies and root-mean-square deviation (RMSD) values were higher for three mutant-type structures compared to the native modeled structure. Conclusion. We concluded that three nsSNPs, namely, rs11542041, rs11542040, and rs11542034, to be potentially functional polymorphic.

Infliximab in active early rheumatoid arthritis

PubMed Central

Breedveld, F; Emery, P; Keystone, E; Patel, K; Furst, D; Kalden, J; St, C; Weisman, M; Smolen, J; Lipsky, P; Maini, R

2004-01-01

Objective: To examine the impact of the combination of infliximab plus methotrexate (MTX) on the progression of structural damage in patients with early rheumatoid arthritis (RA). Methods: Subanalyses were carried out on data for patients with early RA in the Anti-TNF Therapy in RA with Concomitant Therapy (ATTRACT) study, in which 428 patients with active RA despite MTX therapy received placebo with MTX (MTX-only) or infliximab 3 mg/kg or 10 mg/kg every (q) 4 or 8 weeks with MTX (infliximab plus MTX) for 102 weeks. Early RA was defined as disease duration of 3 years or less; 82 of the 428 patients (19%) met this definition. Structural damage was assessed with the modified van der Heijde-Sharp score. The changes from baseline to week 102 in total modified van der Heijde-Sharp score were compared between the infliximab plus MTX groups and the MTX-only group. Results: The erosion and joint space narrowing scores from baseline to week 102 in the cohort of patients with early RA decreased significantly in each infliximab dose regimen compared with the MTX-only regimen. Consistent benefit was seen in the joints of both hands and feet. Conclusions: Infliximab combined with MTX inhibited the progression of structural damage in patients with early RA during the 2 year period of treatment. Early intervention with infliximab in patients with active RA despite MTX therapy may provide long term benefits by preventing radiographic progression and preserving joint integrity. PMID:14722203

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.

User embracement with risk classification in an emergency care unit: an evaluative study.

PubMed

Hermida, Patrícia Madalena Vieira; Nascimento, Eliane Regina Pereira do; Echevarría-Guanilo, Maria Elena; Brüggemann, Odaléa Maria; Malfussi, Luciana Bihain Hagemann de

2018-01-01

Objective Describing the evaluation of the Structure, Process and Outcome of User Embracement with Risk Classification of an Emergency Care Unit from the perspective of physicians and nurses. Method An evaluative, descriptive, quantitative study developed in Santa Catarina. Data were collected using a validated and adapted instrument consisting of 21 items distributed in the dimensions of Structure (facilities), Process (activities and relationships in providing care) and Outcome (care effects). In the analysis, descriptive statistics and the Mean Ranking and Mean Score calculations were applied. Results The sample consisted of 37 participants. From the 21 evaluated items, 11 (52.4%) had a Mean Ranking between 3 and 4, and none of them reached the maximum ranking (5 points). "Prioritization of severe cases" and "Primary care according to the severity of the case" reached a higher Mean Ranking (4.5), while "Flowchart discussion" had the lowest Ranking (2.1). The dimensions of Structure, Process and Outcome reached mean scores of 23.9, 21.9 and 25.5, respectively, indicating a Precarious evaluation (17.5 to 26.1 points). Conclusion User Embracement with Risk Classification is precarious, especially regarding the Process which obtained a lower satisfaction level from the participants.

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

Obstetrics and gynecology clerkship for males and females: similar curriculum, different outcomes?

PubMed Central

Craig, LaTasha B.; Smith, Chad; Crow, Sheila M.; Driver, Whitney; Wallace, Michelle; Thompson, Britta M.

2013-01-01

Objective To determine if performance differences exist between male and female students on a 6-week obstetrics and gynecology (Ob/Gyn) clerkship and to evaluate potential variables that might underlie any observed variations. Study Design Final clerkship grades and component scores (clinical evaluations, objective structured clinical examination [OSCE], oral examination, and National Board of Medical Examiners [NBME] subject examination) from July 2007 to June 2010 were matched by student and analyzed by gender. Basic science grade point average (GPA) and initial United States Medical Licensing Exam (USMLE) Step 1 scores were used to establish students’ baseline medical knowledge. On a post-clerkship questionnaire, a subset of students reported the numbers of procedures they performed during the clerkship; students also completed online pre- and post-clerkship questionnaires reflecting their self-assessed confidence in women's health clinical skills. Results Scores were analyzed for 136 women and 220 men. Final clerkship grades were significantly higher for females than for males (89.05 vs. 87.34, p=0.0004, η 2=0.08). Specifically, females outscored males on the OSCE, oral, and NBME subject examination portions of the clerkship but not clinical evaluations. Males reported completing fewer breast examinations (p=0.001, η 2=0.14). Pre-clerkship, males were significantly less confident than females in women's health clinical skills (p<0.01) but reached similar levels upon completion of the clerkship. No gender differences were detected for basic science GPA and USMLE Step 1 scores. Conclusion Student gender is associated with final grades on an Ob/Gyn clerkship. Further research regarding these differences should be explored. PMID:24300748

Automated CT Scan Scores of Bronchiectasis and Air Trapping in Cystic Fibrosis

PubMed Central

Swiercz, Waldemar; Heltshe, Sonya L.; Anthony, Margaret M.; Szefler, Paul; Klein, Rebecca; Strain, John; Brody, Alan S.; Sagel, Scott D.

2014-01-01

Background: Computer analysis of high-resolution CT (HRCT) scans may improve the assessment of structural lung injury in children with cystic fibrosis (CF). The goal of this cross-sectional pilot study was to validate automated, observer-independent image analysis software to establish objective, simple criteria for bronchiectasis and air trapping. Methods: HRCT scans of the chest were performed in 35 children with CF and compared with scans from 12 disease control subjects. Automated image analysis software was developed to count visible airways on inspiratory images and to measure a low attenuation density (LAD) index on expiratory images. Among the children with CF, relationships among automated measures, Brody HRCT scanning scores, lung function, and sputum markers of inflammation were assessed. Results: The number of total, central, and peripheral airways on inspiratory images and LAD (%) on expiratory images were significantly higher in children with CF compared with control subjects. Among subjects with CF, peripheral airway counts correlated strongly with Brody bronchiectasis scores by two raters (r = 0.86, P < .0001; r = 0.91, P < .0001), correlated negatively with lung function, and were positively associated with sputum free neutrophil elastase activity. LAD (%) correlated with Brody air trapping scores (r = 0.83, P < .0001; r = 0.69, P < .0001) but did not correlate with lung function or sputum inflammatory markers. Conclusions: Quantitative airway counts and LAD (%) on HRCT scans appear to be useful surrogates for bronchiectasis and air trapping in children with CF. Our automated methodology provides objective quantitative measures of bronchiectasis and air trapping that may serve as end points in CF clinical trials. PMID:24114359

[Correlation between quality of life and morbidity of the caregivers of elderly stroke patients].

PubMed

Santos, Nilce Maria de Freitas; Tavares, Darlene Mara Dos Santos

2012-08-01

The objective of this study was to describe the sociodemographic characteristics and the quality of life of the caregivers of elderly individuals with a stroke history, and correlate morbidity with the caregivers' quality of life scores. This is a cross-sectional household survey that interviewed the caregivers of elderly individuals using the following tools: a semi-structured instrument; the World Health Organization Quality of life-BREF; and the Brazilian Multidimensional Functional Assessment Questionnaire. Descriptive analysis and Pearson's correlation (p<0.05) were performed. Most participants were female (93.5%), with a mean age of 55.4±14.17 years, married or living with a partner (58.7%), with four to eight years of education (28.3%), and an income equivalent to one minimum wage salary (34.8%). The highest quality of life score was in the social relations domain (67.57) and the lowest was in the environmental domain (54.82). The highest number of caregiver morbidities correlated with the lowest scores in all quality of life domains.

Setting Performance Standards for Technical and Nontechnical Competence in General Surgery.

PubMed

Szasz, Peter; Bonrath, Esther M; Louridas, Marisa; Fecso, Andras B; Howe, Brett; Fehr, Adam; Ott, Michael; Mack, Lloyd A; Harris, Kenneth A; Grantcharov, Teodor P

2017-07-01

The objectives of this study were to (1) create a technical and nontechnical performance standard for the laparoscopic cholecystectomy, (2) assess the classification accuracy and (3) credibility of these standards, (4) determine a trainees' ability to meet both standards concurrently, and (5) delineate factors that predict standard acquisition. Scores on performance assessments are difficult to interpret in the absence of established standards. Trained raters observed General Surgery residents performing laparoscopic cholecystectomies using the Objective Structured Assessment of Technical Skill (OSATS) and the Objective Structured Assessment of Non-Technical Skills (OSANTS) instruments, while as also providing a global competent/noncompetent decision for each performance. The global decision was used to divide the trainees into 2 contrasting groups and the OSATS or OSANTS scores were graphed per group to determine the performance standard. Parametric statistics were used to determine classification accuracy and concurrent standard acquisition, receiver operator characteristic (ROC) curves were used to delineate predictive factors. Thirty-six trainees were observed 101 times. The technical standard was an OSATS of 21.04/35.00 and the nontechnical standard an OSANTS of 22.49/35.00. Applying these standards, competent/noncompetent trainees could be discriminated in 94% of technical and 95% of nontechnical performances (P < 0.001). A 21% discordance between technically and nontechnically competent trainees was identified (P < 0.001). ROC analysis demonstrated case experience and trainee level were both able to predict achieving the standards with an area under the curve (AUC) between 0.83 and 0.96 (P < 0.001). The present study presents defensible standards for technical and nontechnical performance. Such standards are imperative to implementing summative assessments into surgical training.

Evaluation of a training curriculum for prehospital trauma ultrasound.

PubMed

Press, Gregory M; Miller, Sara K; Hassan, Iman A; Blankenship, Robert; del Junco, Deborah; Camp, Elizabeth; Holcomb, John B

2013-12-01

In the United States, ultrasound has rarely been incorporated into prehospital care, and scant descriptions of the processes used to train prehospital providers are available. Our objective was to evaluate the effectiveness of an extended focused assessment with sonography for trauma (EFAST) training curriculum that incorporated multiple educational modalities. We also aimed to determine if certain demographic factors predicted successful completion. All aeromedical prehospital providers (APPs) for a Level I trauma center took a 25-question computer-based test to ascertain baseline knowledge. Questions were categorized by content and format. Training over a 2-month period included a didactic course, a hands-on training session, proctored scanning sessions in the Emergency Department, six Internet-based training modules, pocket flashcards, a review session, and remedial training. At the conclusion of the training curriculum, the same test and an objective structured clinical examination were administered to evaluate knowledge gained. Thirty-three of 34 APPs completed training. The overall pre-test and post-test means and all content and format subsets showed significant improvement (p < 0.0001 for all). No APP passed the pre-test, and 28 of 33 passed the post-test with a mean score of 78%. No demographic variable predicted passing the post-test. Twenty-seven of 33 APPs passed the objective structured clinical examination, and the only predictive variable was passing the post-test (odds ratio 1.21, 95% confidence interval 1.00-1.25, p = 0.045). The implementation of a multifaceted EFAST prehospital training program is feasible. Significant improvement in overall and subset testing scores suggests that the test instrument was internally consistent and sufficiently sensitive to capture knowledge gained as a result of the training. Demographic variables were not predictive of test success. Copyright © 2013 Elsevier Inc. All rights reserved.

Fundamental Movement Skills Are More than Run, Throw and Catch: The Role of Stability Skills.

PubMed

Rudd, James R; Barnett, Lisa M; Butson, Michael L; Farrow, Damian; Berry, Jason; Polman, Remco C J

2015-01-01

In motor development literature fundamental movement skills are divided into three constructs: locomotive, object control and stability skills. Most fundamental movement skills research has focused on children's competency in locomotor and object control skills. The first aim of this study was to validate a test battery to assess the construct of stability skills, in children aged 6 to 10 (M age = 8.2, SD = 1.2). Secondly we assessed how the stability skills construct fitted into a model of fundamental movement skill. The Delphi method was used to select the stability skill battery. Confirmatory factor analysis (CFA) was used to assess if the skills loaded onto the same construct and a new model of FMS was developed using structural equation modelling. Three postural control tasks were selected (the log roll, rock and back support) because they had good face and content validity. These skills also demonstrated good predictive validity with gymnasts scoring significantly better than children without gymnastic training and children from a high SES school performing better than those from a mid and low SES schools and the mid SES children scored better than the low SES children (all p < .05). Inter rater reliability tests were excellent for all three skills (ICC = 0.81, 0.87, 0.87) as was test re-test reliability (ICC 0.87-0.95). CFA provided good construct validity, and structural equation modelling revealed stability skills to be an independent factor in an overall FMS model which included locomotor (r = .88), object control (r = .76) and stability skills (r = .81). This study provides a rationale for the inclusion of stability skills in FMS assessment. The stability skills could be used alongside other FMS assessment tools to provide a holistic assessment of children's fundamental movement skills.

Combining automatic tube current modulation with adaptive statistical iterative reconstruction for low-dose chest CT screening.

PubMed

Chen, Jiang-Hong; Jin, Er-Hu; He, Wen; Zhao, Li-Qin

2014-01-01

To reduce radiation dose while maintaining image quality in low-dose chest computed tomography (CT) by combining adaptive statistical iterative reconstruction (ASIR) and automatic tube current modulation (ATCM). Patients undergoing cancer screening (n = 200) were subjected to 64-slice multidetector chest CT scanning with ASIR and ATCM. Patients were divided into groups 1, 2, 3, and 4 (n = 50 each), with a noise index (NI) of 15, 20, 30, and 40, respectively. Each image set was reconstructed with 4 ASIR levels (0% ASIR, 30% ASIR, 50% ASIR, and 80% ASIR) in each group. Two radiologists assessed subjective image noise, image artifacts, and visibility of the anatomical structures. Objective image noise and signal-to-noise ratio (SNR) were measured, and effective dose (ED) was recorded. Increased NI was associated with increased subjective and objective image noise results (P<0.001), and SNR decreased with increasing NI (P<0.001). These values improved with increased ASIR levels (P<0.001). Images from all 4 groups were clinically diagnosable. Images with NI = 30 and 50% ASIR had average subjective image noise scores and nearly average anatomical structure visibility scores, with a mean objective image noise of 23.42 HU. The EDs for groups 1, 2, 3 and 4 were 2.79 ± 1.17, 1.69 ± 0.59, 0.74 ± 0.29, and 0.37 ± 0.22 mSv, respectively. Compared to group 1 (NI = 15), the ED reductions were 39.43%, 73.48%, and 86.74% for groups 2, 3, and 4, respectively. Using NI = 30 with 50% ASIR in the chest CT protocol, we obtained average or above-average image quality but a reduced ED.

Subjective versus objective evening chronotypes in bipolar disorder.

PubMed

Gershon, Anda; Kaufmann, Christopher N; Depp, Colin A; Miller, Shefali; Do, Dennis; Zeitzer, Jamie M; Ketter, Terence A

2018-01-01

Disturbed sleep timing is common in bipolar disorder (BD). However, most research is based upon self-reports. We examined relationships between subjective versus objective assessments of sleep timing in BD patients versus controls. We studied 61 individuals with bipolar I or II disorder and 61 healthy controls. Structured clinical interviews assessed psychiatric diagnoses, and clinician-administered scales assessed current mood symptom severity. For subjective chronotype, we used the Composite Scale of Morningness (CSM) questionnaire, using original and modified (1, ¾, ⅔, and ½ SD below mean CSM score) thresholds to define evening chronotype. Objective chronotype was calculated as the percentage of nights (50%, 66.7%, 75%, or 90% of all nights) with sleep interval midpoints at or before (non-evening chronotype) vs. after (evening chronotype) 04:15:00 (4:15:00a.m.), based on 25-50 days of continuous actigraph data. BD participants and controls differed significantly with respect to CSM mean scores and CSM evening chronotypes using modified, but not original, thresholds. Groups also differed significantly with respect to chronotype based on sleep interval midpoint means, and based on the threshold of 75% of sleep intervals with midpoints after 04:15:00. Subjective and objective chronotypes correlated significantly with one another. Twenty-one consecutive intervals were needed to yield an evening chronotype classification match of ≥ 95% with that made using the 75% of sleep intervals threshold. Limited sample size/generalizability. Subjective and objective chronotype measurements were correlated with one another in participants with BD. Using population-specific thresholds, participants with BD had a later chronotype than controls. Copyright © 2017 Elsevier B.V. All rights reserved.

Evaluation of trainees' ability to perform obstetrical ultrasound using simulation: challenges and opportunities.

PubMed

Chalouhi, Gihad E; Bernardi, Valeria; Gueneuc, Alexandra; Houssin, Isabelle; Stirnemann, Julien J; Ville, Yves

2016-04-01

Evaluation of trainee's ability in obstetrical ultrasound is a time-consuming process, which requires involving patients as volunteers. With the use of obstetrical ultrasound simulators, virtual reality could help in assessing competency and evaluating trainees in this field. The objective of the study was to test the validity of an obstetrical ultrasound simulator as a tool for evaluating trainees following structured training by comparing scores obtained on obstetrical ultrasound simulator with those obtained on volunteers and by assessing correlations between scores of images and of dexterity given by 2 blinded examiners. Trainees, taking the 2013 French national examination for the practice of obstetrical ultrasound were asked to obtain standardized ultrasound planes both on volunteer pregnant women and on an obstetrical ultrasound simulator. These planes included measurements of biparietal diameter, abdominal circumference, and femur length as well as reference planes for cardiac 4-chamber and outflow tracts, kidneys, stomach/diaphragm, spine, and face. Images were stored and evaluated subsequently by 2 national examiners who scored each picture according to previously established quality criteria. Dexterity was also evaluated and subjectively scored between 0 and 10. The Raghunathan's modification of Pearson, Filon's z, Spearman's rank correlation, and analysis of variance tests were used to assess correlations between the scores by the 2 examiners and scores of dexterity and also to compare the final scores between the 2 different methods. We evaluated 29 trainees. The mean dexterity scores in simulation (6.5 ± 2.0) and real examination (5.9 ± 2.3) were comparable (P = .31). Scores with an obstetrical ultrasound simulator were significantly higher than those obtained on volunteers (P = .027). Nevertheless, there was a good correlation between the scores of the 2 examiners judging on simulation (R = 0.888) and on volunteers (R = 0.873) (P = .81). An obstetrical ultrasound simulator is as good a method as volunteer-based examination for evaluating practical skills in trainees following structured training in obstetrical ultrasound. The threshold for success/failure should, however, be adapted as candidates obtain higher scores on the simulator. Advantages of the obstetrical ultrasound simulator include the absence of location and time constraints without the need to involve volunteers or to interfere with the running of ultrasound clinics. However, an obstetrical ultrasound simulator still lacks the ability to evaluate the trainees' ability to interact with patients. Copyright © 2016 Elsevier Inc. All rights reserved.

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

Using a computer simulation for teaching communication skills: A blinded multisite mixed methods randomized controlled trial

PubMed Central

Kron, Frederick W.; Fetters, Michael D.; Scerbo, Mark W.; White, Casey B.; Lypson, Monica L.; Padilla, Miguel A.; Gliva-McConvey, Gayle A.; Belfore, Lee A.; West, Temple; Wallace, Amelia M.; Guetterman, Timothy C.; Schleicher, Lauren S.; Kennedy, Rebecca A.; Mangrulkar, Rajesh S.; Cleary, James F.; Marsella, Stacy C.; Becker, Daniel M.

2016-01-01

Objectives To assess advanced communication skills among second-year medical students exposed either to a computer simulation (MPathic-VR) featuring virtual humans, or to a multimedia computer-based learning module, and to understand each group’s experiences and learning preferences. Methods A single-blinded, mixed methods, randomized, multisite trial compared MPathic-VR (N=210) to computer-based learning (N=211). Primary outcomes: communication scores during repeat interactions with MPathic-VR’s intercultural and interprofessional communication scenarios and scores on a subsequent advanced communication skills objective structured clinical examination (OSCE). Multivariate analysis of variance was used to compare outcomes. Secondary outcomes: student attitude surveys and qualitative assessments of their experiences with MPathic-VR or computer-based learning. Results MPathic-VR-trained students improved their intercultural and interprofessional communication performance between their first and second interactions with each scenario. They also achieved significantly higher composite scores on the OSCE than computer-based learning-trained students. Attitudes and experiences were more positive among students trained with MPathic-VR, who valued its providing immediate feedback, teaching nonverbal communication skills, and preparing them for emotion-charged patient encounters. Conclusions MPathic-VR was effective in training advanced communication skills and in enabling knowledge transfer into a more realistic clinical situation. Practice Implications MPathic-VR’s virtual human simulation offers an effective and engaging means of advanced communication training. PMID:27939846

The Leganés cognitive test correlates poorly with MRI evidence of global cortical atrophy in an underserved community: A population-based and nested case-control study in rural Ecuador (The Atahualpa Project)

PubMed Central

Brutto, Oscar H. Del; Mera, Robertino M; Zambrano, Mauricio; Lama, Julio

2014-01-01

Objective We aimed to evaluate whether the Leganés cognitive test (LCT) correlates with global cortical atrophy (GCA) and can be used as a surrogate for structural brain damage. Methods Atahualpa residents aged > 60 years identified during a door-to-door survey underwent MRI for grading GCA. Using multivariate generalized linear models, we evaluated whether continuous LCT scores correlated with GCA, after adjusting for demographics, education, cardiovascular health (CVH) status, depression and edentulism. In a nested case-control study, GCA severity was assessed in subjects with LCT scores below the cutoff level for dementia (< 22 points) and in matched controls without dementia. Results Out of 311 eligible subjects, 241 (78%) were enrolled. Mean age was 69.2±7.5 years, 59% were women, 83% had primary school education, 73% had poor CVH status, 12% had symptoms of depression and 43% had edentulism. Average LCT score was 26.7±3, and 23 (9.5%) subjects scored < 22 points. GCA was mild in 108, moderate in 95, and severe in 26 individuals. On the multivariate model, mean LCT score was not associated with GCA severity (β=0.06, SE=0.34, p=0.853). Severe GCA was noted in 6 / 23 case-patients and in 8 / 23 controls (OR: 0.67, 95% CI: 0.14-2.81, p=0.752, McNemar's test). Conclusion The LCT does not correlate with severity of GCA after adjusting for potential confounding variables, and should not be used as a reliable estimate of structural brain damage. PMID:29213925

A Mismatch Between Patient Education Materials About Sickle Cell Disease and the Literacy Level of Their Intended Audience.

PubMed

McClure, Elizabeth; Ng, Jared; Vitzthum, Kelly; Rudd, Rima

2016-05-12

Despite the first goal of the 2010 National Action Plan to Improve Health Literacy, the literacy demands of much health information exceeds the reading skills of most US adults. The objective of this study was to assess the health literacy level of publicly available patient education materials for people with sickle cell disease (SCD). We used 5 validated tools to evaluate 9 print and 4 online patient education materials: the simple measure of gobbledygook (SMOG) to assess reading grade level, the Peter Mosenthal and Irwin Kirsch readability formula (PMOSE/IKIRSCH) to assess structure and density, the Patient Education Materials Assessment Tool (PEMAT) to assess actionability (how well readers will know what to do after reading the material) and understandability, the Centers for Disease Control and Prevention's (CDC's) Clear Communication Index (Index) to obtain a comprehensive literacy demand score, and the Printed Cancer Education Materials for African Americans Cultural Sensitivity Assessment Tool. Materials' scores reflected high reading levels ranging from 8th grade to 12th grade, appropriate (low) structural demand, and low actionability relative to understandability. CDC suggests that an appropriate Index score should fall in or above the 90th percentile. The scores yielded by materials evaluated in this assessment ranged from the 44th to the 76th percentiles. Eight of the 13 materials scored within the acceptable range for cultural sensitivity. Reading levels of available patient education materials exceed the documented average literacy level of the US adult population. Health literacy demands should be a key consideration in the revision and development of patient education materials for people with SCD.

A Study of Soft Neurological Signs and Its Correlates in Drug-Naive Patients with First Episode Psychosis

PubMed Central

Gunasekaran, Vanishree; Venkatesh, V. Mathan Kumar; Asokan, T. V.

2016-01-01

Background: Soft neurological signs are minor, non localizing, objective abnormalities, thought to reflect damage in cortical and sub-cortical connections or connections within different cortical regions. Regional structural grey matter anomalies have already been observed and correlated with the presence of cognitive deficits and presence of soft neurological signs in schizophrenic patients. Materials and Methods: Drug naive patients presenting with first episode of psychosis (FEP)were clinically evaluated for soft neurological signs using the Cambridge Neurological Inventory. The soft neurological signs scores were compared with scores in healthy volunteers. In the patient group, this score was also correlated with demographic and disorder variables. Results: Of the 30 patients with FEP, 60% were women. The average age of the participant was 36.2 years. The average duration of illness was 1.55 years. More than 50% of the patients had schizophrenia. 93.3% of patients with FEP had atleast one soft neurological sign compared to 16.6% of controls. The average score on BPRS was 25.86 and on PANSS was 39.29, and BPRS, PANSS scores had a significant correlation with total soft neurological signs score. Conclusion: There is a significantly higher incidence of soft neurological signs in patients with FEP, particularly schizophrenia. The presence of soft signs correlated with the severity of psychosis. PMID:27833222

Nursing intensive care skills training: a nurse led, short, structured, and practical training program, developed and tested in a resource-limited setting.

PubMed

De Silva, A Pubudu; Stephens, Tim; Welch, John; Sigera, Chathurani; De Alwis, Sunil; Athapattu, Priyantha; Dharmagunawardene, Dilantha; Olupeliyawa, Asela; de Abrew, Ashwini; Peiris, Lalitha; Siriwardana, Somalatha; Karunathilake, Indika; Dondorp, Arjen; Haniffa, Rashan

2015-04-01

To assess the impact of a nurse-led, short, structured training program for intensive care unit (ICU) nurses in a resource-limited setting. A training program using a structured approach to patient assessment and management for ICU nurses was designed and delivered by local nurse tutors in partnership with overseas nurse trainers. The impact of the course was assessed using the following: pre-course and post-course self-assessment, a pre-course and post-course Multiple Choice Questionnaire (MCQ), a post-course Objective Structured Clinical Assessment station, 2 post-course Short Oral Exam (SOE) stations, and post-course feedback questionnaires. In total, 117 ICU nurses were trained. Post-MCQ scores were significantly higher when compared with pre-MCQ (P < .0001). More than 95% passed the post-course Objective Structured Clinical Assessment (patient assessment) and SOE 1 (arterial blood gas analysis), whereas 76.9% passed SOE 2 (3-lead electrocardiogram analysis). The course was highly rated by participants, with 98% believing that this was a useful experience. Nursing Intensive Care Skills Training was highly rated by participants and was effective in improving the knowledge of the participants. This sustainable short course model may be adaptable to other resource-limited settings. Copyright © 2014 Elsevier Inc. All rights reserved.

Building an automated SOAP classifier for emergency department reports.

PubMed

Mowery, Danielle; Wiebe, Janyce; Visweswaran, Shyam; Harkema, Henk; Chapman, Wendy W

2012-02-01

Information extraction applications that extract structured event and entity information from unstructured text can leverage knowledge of clinical report structure to improve performance. The Subjective, Objective, Assessment, Plan (SOAP) framework, used to structure progress notes to facilitate problem-specific, clinical decision making by physicians, is one example of a well-known, canonical structure in the medical domain. Although its applicability to structuring data is understood, its contribution to information extraction tasks has not yet been determined. The first step to evaluating the SOAP framework's usefulness for clinical information extraction is to apply the model to clinical narratives and develop an automated SOAP classifier that classifies sentences from clinical reports. In this quantitative study, we applied the SOAP framework to sentences from emergency department reports, and trained and evaluated SOAP classifiers built with various linguistic features. We found the SOAP framework can be applied manually to emergency department reports with high agreement (Cohen's kappa coefficients over 0.70). Using a variety of features, we found classifiers for each SOAP class can be created with moderate to outstanding performance with F(1) scores of 93.9 (subjective), 94.5 (objective), 75.7 (assessment), and 77.0 (plan). We look forward to expanding the framework and applying the SOAP classification to clinical information extraction tasks. Copyright © 2011. Published by Elsevier Inc.

Quality in dementia care: A cross sectional study on the Bio-Psycho-Social competencies of health care professionals

PubMed Central

De Vriendt, Patricia; Cornelis, Elise; Desmet, Valerie; Vanbosseghem, Ruben

2018-01-01

Objective Professionals in dementia-care ought to be able to work within a Bio-Psycho-Social model. The objectives were to examine whether dementia-care is delivered in a Bio-Psycho-Social way, to explore the influencing factors and to evaluate the factorial validity of the ‘Bio-Psycho-Social-Dementia-Care scale’. Design and setting 413 healthcare-professionals completed the ‘Bio-Psycho-Social-Dementia-Care scale’. Differences between groups (settings, professions, years of experience) were calculated with a student’s t-test and one-way ANOVA. The facture structure of the scale was evaluated using a confirmatory factor analysis. Results The factor-analysis confirmed the 5 subscale-structure (1) networking, (2) using the client’s expertise, (3) assessment and reporting, (4) professional knowledge and skills and (5) using the environment. (No significant differences were found between professionals in residential care and community care for the subscales ‘networking’ and ‘using the client’s expertise’. Professionals in residential care score higher than community care for ‘assessment and reporting’ (p<0,05) and ‘professional knowledge and skills’ (p<0,01) but lower for ‘using the environment’ (p<0,001). The juniors score higher for ‘professional knowledge’ compared to seniors (p<0,01) and the seniors score better for ‘professional experience’ (p<0,01). The Cure and Care disciplines and the Therapy disciplines had higher values in ‘assessment and reporting’ compared to the Social Support disciplines (p<0,001 and p<0.001). The Therapy disciplines scored higher in ‘using professional knowledge and skills’ compared to the Social Support group (p 0.021) and the Cure and Care disciplines (p<0,001). The Social Support disciplines scored higher in ‘using the environment’ compared to the Therapy disciplines (p<0.001) and the Cure and care disciplines (p<0.001). Conclusion The Bio-Psycho-Social-Dementia-scale is a valid tool and offers opportunities not only to rate, but also to improve Bio-Psycho-Social functioning in dementia-care: increase interdisciplinary collaboration, facilitate assessment, combine the strengths of the different professions and install a heterogeneous team with regard to age and experience. PMID:29389937

Effect of Video-Assisted Teaching Module (VATM) on Knowledge of ASHAs regarding RNTCP in Kuchinda Block of Sambalpur (Odisha).

PubMed

Pradhan, Malati; Dash, Bijayalakshmi

2015-05-01

Infectious disease is a major public health issue for both developed and developing countries. Among infectious diseases, tuberculosis (TB) is most prevalent in the develop- ing countries. India is the highest TB burden country in the world and accounts for nearly one fifth (20%) of global burden of tuberculosis. A pre-experimental design where pre- and post-test without control group with experimental approach was undertaken in Kuchinda block of Sambalpur district (Odisha) with the objectives to assess effectiveness of Video-assisted Teaching Module (VATM) on knowledge of Accredited Social Health Activists (ASHAs) regarding Revised National Tuberculosis Control Programme (RNTCP) Data were collected from 52 ASHAs, selected by systematic random sampling technique through structured questionnaire. The overall mean score in pre-test was 23.31±3.07 which is 58.27 percent of maximum score and good knowledge whereas it was 34.35±3.56 while post-test it was 85.87 percent of maximum score during post-test showing a difference of 27.6 percent effectiveness. Highly significant (p<0.01) differ- ence was found between pre- and post-test knowledge score and no significant (>0.05) association was found between post-test knowledge score when compared to all the demographic variables of ASHAs.

Knee osteoarthritis image registration: data from the Osteoarthritis Initiative

NASA Astrophysics Data System (ADS)

Galván-Tejada, Jorge I.; Celaya-Padilla, José M.; Treviño, Victor; Tamez-Peña, José G.

2015-03-01

Knee osteoarthritis is a very common disease, in early stages, changes in joint structures are shown, some of the most common symptoms are; formation of osteophytes, cartilage degradation and joint space reduction, among others. Based on a joint space reduction measurement, Kellgren-Lawrence grading scale, is a very extensive used tool to asses radiological OA knee x-ray images, based on information obtained from these assessments, the objective of this work is to correlate the Kellgren-Lawrence score to the bilateral asymmetry between knees. Using public data from the Osteoarthritis initiative (OAI), a set of images with different Kellgren-Lawrencescores were used to determine a relationship of Kellgren-Lawrence score and the bilateral asymmetry, in order to measure the asymmetry between the knees, the right knee was registered to match the left knee, then a series of similarity metrics, mutual information, correlation, and mean squared error where computed to correlate the deformation (mismatch) of the knees to the Kellgren-Lawrence score. Radiological information was evaluated and scored by OAI radiologist groups. The results of the study suggest an association between Radiological Kellgren-Lawrence score and image registration metrics, mutual information and correlation is higher in the early stages, and mean squared error is higher in advanced stages. This association can be helpful to develop a computer aided grading tool.

Higher heritabilities for gait components than for overall gait scores may improve mobility in ducks.

PubMed

Duggan, Brendan M; Rae, Anne M; Clements, Dylan N; Hocking, Paul M

2017-05-02

Genetic progress in selection for greater body mass and meat yield in poultry has been associated with an increase in gait problems which are detrimental to productivity and welfare. The incidence of suboptimal gait in breeding flocks is controlled through the use of a visual gait score, which is a subjective assessment of walking ability of each bird. The subjective nature of the visual gait score has led to concerns over its effectiveness in reducing the incidence of suboptimal gait in poultry through breeding. The aims of this study were to assess the reliability of the current visual gait scoring system in ducks and to develop a more objective method to select for better gait. Experienced gait scorers assessed short video clips of walking ducks to estimate the reliability of the current visual gait scoring system. Kendall's coefficients of concordance between and within observers were estimated at 0.49 and 0.75, respectively. In order to develop a more objective scoring system, gait components were visually scored on more than 4000 pedigreed Pekin ducks and genetic parameters were estimated for these components. Gait components, which are a more objective measure, had heritabilities that were as good as, or better than, those of the overall visual gait score. Measurement of gait components is simpler and therefore more objective than the standard visual gait score. The recording of gait components can potentially be automated, which may increase accuracy further and may improve heritability estimates. Genetic correlations were generally low, which suggests that it is possible to use gait components to select for an overall improvement in both economic traits and gait as part of a balanced breeding programme.

Estimation of Uncertainties in the Global Distance Test (GDT_TS) for CASP Models.

PubMed

Li, Wenlin; Schaeffer, R Dustin; Otwinowski, Zbyszek; Grishin, Nick V

2016-01-01

The Critical Assessment of techniques for protein Structure Prediction (or CASP) is a community-wide blind test experiment to reveal the best accomplishments of structure modeling. Assessors have been using the Global Distance Test (GDT_TS) measure to quantify prediction performance since CASP3 in 1998. However, identifying significant score differences between close models is difficult because of the lack of uncertainty estimations for this measure. Here, we utilized the atomic fluctuations caused by structure flexibility to estimate the uncertainty of GDT_TS scores. Structures determined by nuclear magnetic resonance are deposited as ensembles of alternative conformers that reflect the structural flexibility, whereas standard X-ray refinement produces the static structure averaged over time and space for the dynamic ensembles. To recapitulate the structural heterogeneous ensemble in the crystal lattice, we performed time-averaged refinement for X-ray datasets to generate structural ensembles for our GDT_TS uncertainty analysis. Using those generated ensembles, our study demonstrates that the time-averaged refinements produced structure ensembles with better agreement with the experimental datasets than the averaged X-ray structures with B-factors. The uncertainty of the GDT_TS scores, quantified by their standard deviations (SDs), increases for scores lower than 50 and 70, with maximum SDs of 0.3 and 1.23 for X-ray and NMR structures, respectively. We also applied our procedure to the high accuracy version of GDT-based score and produced similar results with slightly higher SDs. To facilitate score comparisons by the community, we developed a user-friendly web server that produces structure ensembles for NMR and X-ray structures and is accessible at http://prodata.swmed.edu/SEnCS. Our work helps to identify the significance of GDT_TS score differences, as well as to provide structure ensembles for estimating SDs of any scores.

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...

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.

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.

Exploration and confirmation of the latent variable structure of the Jefferson scale of empathy

PubMed Central

LaNoue, Marianna

2014-01-01

Objectives: To reaffirm the underlying components of the JSE by using exploratory factor analysis (EFA), and to confirm its latent variable structure by using confirmatory factor analysis (CFA). Methods Research participants included 2,612 medical students who entered Jefferson Medical College between 2002 and 2012. This sample was divided into two groups: Matriculants between 2002 and 2007 (n=1,380) and between 2008 and 2012 (n=1,232). Data for 2002-2007 matriculants were subjected to EFA (principal component factor extraction), and data for matriculants of 2008-2012 were used for CFA (structural equation modeling, and root mean square error for approximation). Results The EFA resulted in three factors: “perspective-taking,” “compassionate care” and “walking in patient’s shoes” replicating the 3-factor model reported in most of the previous studies. The CFA showed that the 3-factor model was an acceptable fit, thus confirming the latent variable structure emerged in the EFA. Corrected item-total score correlations for the total sample were all positive and statistically significant, ranging from 0.13 to 0.61 with a median of 0.44 (p<0.01). The item discrimination effect size indices (contrasting item mean scores for the top-third versus bottom-third JSE scorers) ranged from 0.50 to 1.4 indicating that the differences in item mean scores between top and bottom scorers on the JSE were of practical importance. Cronbach’s alpha coefficient of the JSE for the total sample was 0.80, ranging from 0.75 to 0.84 for matriculatnts of different years. Conclusions Findings provided further support for underlying constructs of the JSE, adding to its credibility. PMID:25341215

Evaluation of injury and fatality risk in rock and ice climbing.

PubMed

Schöffl, Volker; Morrison, Audry; Schwarz, Ulrich; Schöffl, Isabelle; Küpper, Thomas

2010-08-01

Rock and ice climbing are widely considered to be 'high-risk' sporting activities that are associated with a high incidence of severe injury and even death, compared with more mainstream sports. However, objective scientific data to support this perception are questionable. Accordingly, >400 sport-specific injury studies were analysed and compared by quantifying the injury incidence and objectively grading the injury severity (using the National Advisory Committee for Aeronautics score) per 1000 hours of sporting participation. Fatalities were also analysed. The analysis revealed that fatalities occurred in all sports, but it was not always clear whether the sport itself or pre-existing health conditions contributed or caused the deaths. Bouldering (ropeless climbing to low heights), sport climbing (mostly bolt protected lead climbing with little objective danger) and indoor climbing (climbing indoors on artificial rock structures), showed a small injury rate, minor injury severity and few fatalities. As more objective/external dangers exist for alpine and ice climbing, the injury rate, injury severity and fatality were all higher. Overall, climbing sports had a lower injury incidence and severity score than many popular sports, including basketball, sailing or soccer; indoor climbing ranked the lowest in terms of injuries of all sports assessed. Nevertheless, a fatality risk remains, especially in alpine and ice climbing. In the absence of a standard definition for a 'high-risk' sport, categorizing climbing as a high-risk sport was found to be either subjective or dependent on the definition used. In conclusion, this analysis showed that retrospective data on sport-specific injuries and fatalities are not reported in a standardized manner. To improve preventative injury measures for climbing sports, it is recommended that a standardized, robust and comprehensive sport-specific scoring model should be developed to report and fully evaluate the injury risk, severity of injuries and fatality risk in climbing sports.

Developing an Objective Structured Assessment of Technical Skills for Laparoscopic Suturing and Intracorporeal Knot Tying.

PubMed

Chang, Olivia H; King, Louise P; Modest, Anna M; Hur, Hye-Chun

2016-01-01

To develop a teaching and assessment tool for laparoscopic suturing and intracorporeal knot tying. We designed an Objective Structured Assessment of Technical Skills (OSATS) tool that includes a procedure-specific checklist (PSC) and global rating scale (GRS) to assess laparoscopic suturing and intracorporeal knot-tying performance. Obstetrics and Gynecology residents at our institution were videotaped while performing a laparoscopic suturing and intracorporeal knot-tying task at a surgical simulation workshop. A total of 2 expert reviewers assessed resident performance using the OSATS tool during live performance and 1 month later using the videotaped recordings. OSATS scores were analyzed using the Wilcoxon rank-sum test. Data are presented as median scores (interquartile range [IQR]). Intrarater and interrater reliabilities were assessed using a Spearman correlation and are presented as an r correlation coefficient and p value. An r ≥ 0.8 was considered as a high correlation. After testing, we received feedback from residents and faculty to improve the OSATS tool as part of an iterative design process. In all, 14 of 21 residents (66.7%) completed the study, with 9 junior residents and 5 senior residents. Junior residents had a lower score on the PSC than senior residents did; however, this was not statistically significant (median = 6.0 [IQR: 4.0-10.0] and median = 13.0 [IQR: 10.0-13.0]; p = 0.09). There was excellent intrarater reliability with our OSATS tool (for PSC component, r = 0.88 for Rater 1 and 0.93 for Rater 2, both p < 0.0001; for GRS component, r = 0.85 for Rater 1 and 0.88 for Rater 2, both p ≤ 0.0002). The PSC also has high interrater reliability during live evaluation (r = 0.92; p < 0.0001), and during the videotape scoring with r = 0.77 (p = 0.001). Our OSATS tool may be a useful assessment and teaching tool for laparoscopic suturing and intracorporeal knot-tying skills. Overall, good intrarater reliability was demonstrated, suggesting that this tool may be useful for longitudinal assessment of surgical skills. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Changing Objective Structured Clinical Examinations Stations at Lunchtime During All Day Postgraduate Surgery Examinations Improves Examiner Morale and Stress.

PubMed

Brennan, Peter A; Scrimgeour, Duncan S; Patel, Sheena; Patel, Roshnee; Griffiths, Gareth; Croke, David T; Smith, Lee; Arnett, Richard

Human factors are important causes of error, but little is known about their possible effect during objective structured clinical examinations (OSCE). We have previously identified stress and pressure in OSCE examiners in the postgraduate intercollegiate Membership of the Royal College of Surgeons (MRCS) examination. After modifying examination delivery by changing OSCE stations at lunchtime with no demonstrable effect on candidate outcome, we resurveyed examiners to ascertain whether examiner experience was improved. Examiners (n = 180) from all 4 surgical colleges in the United Kingdom and Ireland were invited to complete the previously validated human factors questionnaire used in 2014. Aggregated scores for each of 4 previously identified factors were compared with the previous data. Unit-weighted z-scores and nonparametric Kruskal-Wallis methods were used to test the hypothesis that there was no difference among the median factor z-scores for each college. Individual Mann-Whitney-Wilcoxon tests (with appropriate Bonferonni corrections) were used to determine any differences between factors and the respective colleges. 141 Completed questionnaires were evaluated (78% response rate) and compared with 108 responses (90%) from the original study. Analysis was based on 26 items common to both studies. In 2014, the college with the highest candidate numbers (England) was significantly different in 1 factor (stress and pressure), compared with Edinburgh (Mann-Whitney-Wilcoxon: W = 1524, p < 0.001) and Glasgow colleges (Mann-Whitney-Wilcoxon: W = 104, p = 0.004). No differences were found among colleges in the same factor in 2016, Kruskall-Wallis: (χ 2 (3) = 1.73, p = 0.63). Analysis of responses found inconsistency among examiners regarding mistakes or omissions made when candidates were performing well. After making changes to OSCE delivery, factor scores relating to examiner stress and pressure are now improved and consistent across the surgical colleges. Stress and pressure can occur in OSCE examiners and examination delivery should ideally minimize these issues, thereby improving morale is also likely to benefit candidates. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The Relationship Between Technical And Nontechnical Skills Within A Simulation-Based Ureteroscopy Training Environment.

PubMed

Brunckhorst, Oliver; Shahid, Shahab; Aydin, Abdullatif; Khan, Shahid; McIlhenny, Craig; Brewin, James; Sahai, Arun; Bello, Fernando; Kneebone, Roger; Shamim Khan, Muhammad; Dasgupta, Prokar; Ahmed, Kamran

2015-01-01

Little integration of technical and nontechnical skills (e.g., situational awareness, communication, decision making, teamwork, and leadership) teaching exists within surgery. We therefore aimed to (1) evaluate the relationship between these 2 skill sets within a simulation-based environment and (2) assess if certain nontechnical skill components are of particular relevance to technical performance. A prospective analysis of data acquired from a comparative study of simulation vs nonsimulation training was conducted. Half of the participants underwent training of technical and nontechnical skills within ureteroscopy, with the remaining half undergoing no training. All were assessed within a full immersion environment against both technical (time to completion, Objective Structured Assessment of Technical Skills, and task-specific checklist scores) and nontechnical parameters (Nontechnical Skills for Surgeons [NOTSS] rating scale). The data of whole and individual cohorts were analyzed using Pearson correlation coefficient. The trial took place within the Simulation and Interactive Learning Centre at Guy's Hospital, London, UK. In total, 32 novice participants with no prior practical ureteroscopy experience were included within the data analysis. A correlation was found within all outcome measures analyzed. For the whole cohort, a strong negative correlation was found between time to completion and NOTSS scores (r = -0.75, p < 0.001), with strong positive correlations identified when NOTSS scores were compared with Objective Structured Assessment of Technical Skills (r = 0.89, p < 0.001) and task-specific checklist scores (r = 0.91, p < 0.001). Similar results were observed when each cohort was analyzed separately. Finally, all individual nontechnical skill components demonstrated a strong correlation with all technical skill parameters, regardless of training. A strong correlation between technical and nontechnical performance exists, which was demonstrated to be irrespective of training received. This may suggest an inherent link between skill sets. Furthermore, all nontechnical skill sets are important in technical performance. This supports the notion that both of these skills should be trained and assessed together within 1 curriculum. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Use of an Objective Structured Assessment of Technical Skill After a Sports Medicine Rotation.

PubMed

Dwyer, Tim; Slade Shantz, Jesse; Kulasegaram, Kulamakan Mahan; Chahal, Jaskarndip; Wasserstein, David; Schachar, Rachel; Devitt, Brian; Theodoropoulos, John; Hodges, Brian; Ogilvie-Harris, Darrell

2016-12-01

The purpose of this study was to determine if the use of an Objective Structured Assessment of Technical skill (OSATS), using dry models, would be a valid method of assessing residents' ability to perform sports medicine procedures after training in a competency-based model. Over 18 months, 27 residents (19 junior [postgraduate year (PGY) 1-3] and 8 senior [PGY 4-5]) sat the OSATS after their rotation, in addition to 14 sports medicine staff and fellows. Each resident was provided a list of 10 procedures in which they were expected to show competence. At the end of the rotation, each resident undertook an OSATS composed of 6 stations sampled from the 10 procedures using dry models-faculty used the Arthroscopic Surgical Skill Evaluation Tool (ASSET), task-specific checklists, as well as an overall 5-point global rating scale (GRS) to score each resident. Each procedure was videotaped for blinded review. The overall reliability of the OSATS (0.9) and the inter-rater reliability (0.9) were both high. A significant difference by year in training was seen for the overall GRS, the total ASSET score, and the total checklist score, as well as for each technical procedure (P < .001). Further analysis revealed a significant difference in the total ASSET score between junior (mean 18.4, 95% confidence interval [CI] 16.8 to 19.9) and senior residents (24.2, 95% CI 22.7 to 25.6), senior residents and fellows (30.1, 95% CI 28.2 to 31.9), as well as between fellows and faculty (37, 95% CI 36.1 to 27.8) (P < .05). The results of this study show that an OSATS using dry models shows evidence of validity when used to assess performance of technical procedures after a sports medicine rotation. However, junior residents were not able to perform as well as senior residents, suggesting that overall surgical experience is as important as intensive teaching. As postgraduate medical training shifts to a competency-based model, methods of assessing performance of technical procedures become necessary. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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.

A system to evaluate the scientific quality of biological and restoration objectives using National Wildlife Refuge Comprehensive Conservation Plans as a case study

USGS Publications Warehouse

Schroeder, R.L.

2006-01-01

It is widely accepted that plans for restoration projects should contain specific, measurable, and science-based objectives to guide restoration efforts. The United States Fish and Wildlife Service (USFWS) is in the process of developing Comprehensive Conservation Plans (CCPs) for more than 500 units in the National Wildlife Refuge System (NWRS). These plans contain objectives for biological and ecosystem restoration efforts on the refuges. Based on USFWS policy, a system was developed to evaluate the scientific quality of such objectives based on three critical factors: (1) Is the objective specific, measurable, achievable, results-oriented, and time-fixed? (2) What is the extent of the rationale that explains the assumptions, logic, and reasoning for the objective? (3) How well was available science used in the development of the objective? The evaluation system scores each factor on a scale of 1 (poor) to 4 (excellent) according to detailed criteria. The biological and restoration objectives from CCPs published as of September 2004 (60 total) were evaluated. The overall average score for all biological and restoration objectives was 1.73. Average scores for each factor were: Factor 1-1.97; Factor 2-1.86; Factor 3-1.38. The overall scores increased from 1997 to 2004. Future restoration efforts may benefit by using this evaluation system during the process of plan development, to ensure that biological and restoration objectives are of the highest scientific quality possible prior to the implementation of restoration plans, and to allow for improved monitoring and adaptive management.

Assessment for learning with Objectively Structured Practical Examination in Biochemistry

PubMed Central

Jaswal, Shivani; Chattwal, Jugesh; Kaur, Jasbinder; Gupta, Seema; Singh, Tejinder

2015-01-01

Context: Despite a radical shift in assessment methodologies over the last decade, the majority of medical colleges still follow the Traditional Practical Examination (TPE). TPE raises concerns about examiner variability, standardization, and uniformity of assessment. To address these issues and in line with the notion of assessments as motivating what and how students learn, Objectively Structured Practical Examination (OSPE) was introduced, as an assessment modality. Despite its usefulness, awareness and motivation to use the same, still needs to be probed. Aims: To implement OSPE in the assessment of practical skills in biochemistry, and to know student and faculty perspectives regarding OSPE. Settings and Design: OSPE was introduced at the stage of formative assessment of practical skills, for 94 year one MBBS students. Subjects and Methods: Students were divided into two groups; the first group was evaluated by the traditional method and the second by OSPE. Students were crossed over on a second examination. The mean score obtained by both the methods was compared statistically. Students and faculty perspectives regarding OSPE were obtained by a questionnaire. Student performance was compared using “Bland–Altman technique,” and Student's t-test. Results: The mean scores of students was found to be significantly higher (P < 0.0001) when assessed with OSPE as compared to TPE. Number of students achieving >70% marks was also significantly higher with OSPE. Validity was supported by a significant correlation coefficient of comparison of marks by the two methods. Feedback from students and faculty indicated that they endorsed OSPE. Conclusions: This evaluation demonstrated the need for a structured approach to assessment. Going in line with the notion that assessment drives learning, introducing OSPE would help tailoring teaching-learning to optimize student satisfaction and learning. PMID:26380217

[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.

Proposing Melasma Severity Index: A New, More Practical, Office-based Scoring System for Assessing the Severity of Melasma

PubMed Central

Majid, Imran; Haq, Inaamul; Imran, Saher; Keen, Abid; Aziz, Khalid; Arif, Tasleem

2016-01-01

Background: Melasma Area and Severity Index (MASI), the scoring system in melasma, needs to be refined. Aims and Objectives: To propose a more practical scoring system, named as Melasma Severity Index (MSI), for assessing the disease severity and treatment response in melasma. Materials and Methods: Four dermatologists were trained to calculate MASI and also the proposed MSI scores. For MSI, the formula used was 0.4 (a × p2) l + 0.4 (a × p2) r + 0.2 (a × p2) n where “a” stands for area, “p” for pigmentation, “l” for left face, “r” for right face, and “n” for nose. On a single day, 30 enrolled patients were randomly examined by each trained dermatologist and their MASI and MSI scores were calculated. Next, each rater re-examined every 6th patient for repeat MASI and MSI scoring to assess intra- and inter-rater reliability of MASI and MSI scores. Validity was assessed by comparing the individual scores of each rater with objective data from mexameter and ImageJ software. Results: Inter-rater reliability, as assessed by intraclass correlation coefficient, was significantly higher for MSI (0.955) as compared to MASI (0.816). Correlation of scores with objective data by Spearman's correlation revealed higher rho values for MSI than for MASI for all raters. Limitations: Sample population belonged to a single ethnic group. Conclusions: MSI is simpler and more practical scoring system for melasma. PMID:26955093

Medical students perception of test anxiety triggered by different assessment modalities.

PubMed

Guraya, Salman Y; Guraya, Shaista S; Habib, Fawzia; AlQuiliti, Khalid W; Khoshhal, Khalid I

2018-05-06

Test anxiety is well known among medical students. However, little is known about test anxiety produced by different components of exam individually. This study aimed to stratify varying levels of test anxiety provoked by each exam modality and to explore the students perceptions about confounding factors. A self-administered questionnaire was administered to medical students. The instrument contained four main themes; lifestyle, psychological and specific factors of information needs, learning styles, and perceived difficulty level of each assessment tool. A highest test anxiety score of 5 was ranked for "not scheduling available time" and "insufficient exercise" by 28.8 and 28.3% students, respectively. For "irrational thoughts about exam" and "fear to fail", a highest test anxiety score of 5 was scored by 28.8 and 25.7% students, respectively. The highest total anxiety score of 1255 was recorded for long case exam, followed by 975 for examiner-based objective structured clinical examination. Excessive course load and course not well covered by faculty were thought to be the main confounding factors. The examiner-based assessment modalities induced high test anxiety. Faculty is urged to cover core contents within stipulated time and to rigorously reform and update existing curricula to prepare relevant course material.

A collaborative comparison of objective structured clinical examination (OSCE) standard setting methods at Australian medical schools.

PubMed

Malau-Aduli, Bunmi Sherifat; Teague, Peta-Ann; D'Souza, Karen; Heal, Clare; Turner, Richard; Garne, David L; van der Vleuten, Cees

2017-12-01

A key issue underpinning the usefulness of the OSCE assessment to medical education is standard setting, but the majority of standard-setting methods remain challenging for performance assessment because they produce varying passing marks. Several studies have compared standard-setting methods; however, most of these studies are limited by their experimental scope, or use data on examinee performance at a single OSCE station or from a single medical school. This collaborative study between 10 Australian medical schools investigated the effect of standard-setting methods on OSCE cut scores and failure rates. This research used 5256 examinee scores from seven shared OSCE stations to calculate cut scores and failure rates using two different compromise standard-setting methods, namely the Borderline Regression and Cohen's methods. The results of this study indicate that Cohen's method yields similar outcomes to the Borderline Regression method, particularly for large examinee cohort sizes. However, with lower examinee numbers on a station, the Borderline Regression method resulted in higher cut scores and larger difference margins in the failure rates. Cohen's method yields similar outcomes as the Borderline Regression method and its application for benchmarking purposes and in resource-limited settings is justifiable, particularly with large examinee numbers.

Purely Structural Protein Scoring Functions Using Support Vector Machine and Ensemble Learning.

PubMed

Mirzaei, Shokoufeh; Sidi, Tomer; Keasar, Chen; Crivelli, Silvia

2016-08-24

The function of a protein is determined by its structure, which creates a need for efficient methods of protein structure determination to advance scientific and medical research. Because current experimental structure determination methods carry a high price tag, computational predictions are highly desirable. Given a protein sequence, computational methods produce numerous 3D structures known as decoys. However, selection of the best quality decoys is challenging as the end users can handle only a few ones. Therefore, scoring functions are central to decoy selection. They combine measurable features into a single number indicator of decoy quality. Unfortunately, current scoring functions do not consistently select the best decoys. Machine learning techniques offer great potential to improve decoy scoring. This paper presents two machine-learning based scoring functions to predict the quality of proteins structures, i.e., the similarity between the predicted structure and the experimental one without knowing the latter. We use different metrics to compare these scoring functions against three state-of-the-art scores. This is a first attempt at comparing different scoring functions using the same non-redundant dataset for training and testing and the same features. The results show that adding informative features may be more significant than the method used.

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.

The CAD-score web server: contact area-based comparison of structures and interfaces of proteins, nucleic acids and their complexes.

PubMed

Olechnovič, Kliment; Venclovas, Ceslovas

2014-07-01

The Contact Area Difference score (CAD-score) web server provides a universal framework to compute and analyze discrepancies between different 3D structures of the same biological macromolecule or complex. The server accepts both single-subunit and multi-subunit structures and can handle all the major types of macromolecules (proteins, RNA, DNA and their complexes). It can perform numerical comparison of both structures and interfaces. In addition to entire structures and interfaces, the server can assess user-defined subsets. The CAD-score server performs both global and local numerical evaluations of structural differences between structures or interfaces. The results can be explored interactively using sortable tables of global scores, profiles of local errors, superimposed contact maps and 3D structure visualization. The web server could be used for tasks such as comparison of models with the native (reference) structure, comparison of X-ray structures of the same macromolecule obtained in different states (e.g. with and without a bound ligand), analysis of nuclear magnetic resonance (NMR) structural ensemble or structures obtained in the course of molecular dynamics simulation. The web server is freely accessible at: http://www.ibt.lt/bioinformatics/cad-score. © The Author(s) 2014. Published by Oxford University Press on behalf of Nucleic Acids Research.

Assessment of early and late dysphagia using videofluoroscopy and quality of life questionnaires in patients with head and neck cancer treated with radiation therapy.

PubMed

Erkal, Eda Yirmibeşoğlu; Canoğlu, Doğu; Kaya, Ahmet; Aksu, Görkem; Sarper, Binnaz; Akansel, Gür; Meydancı, Tülay; Erkal, Haldun Sükrü

2014-06-14

The aim of this study was to evaluate dysphagia in patients with head and neck cancer (HNC) undergoing three-dimensional conformal radiation therapy using objective and subjective tools simultaneously and to associate the clinical correlates of dysphagia with dosimetric parameters. Twenty patients were included in the study. The primary tumor and the involved lymph nodes (LN) were treated with 66-70 Gy, the uninvolved LN were treated with 46-50 Gy. Six swallowing structures were identified: the superior pharyngeal constrictor muscle (SPCM), the middle pharyngeal constrictor muscle (MPCM), the inferior pharyngeal constrictor muscle (IPCM), the base of tongue (BOT), the larynx and the proximal esophageal sphincter (PES). Dysphagia was evaluated using videofluoroscopy and European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaire (QLQ-C30) and supplemental EORTC QoL module for HNC (QLQ-H&N35). The evaluations were performed before treatment, at 3 months and at 6 months following treatment. On objective evaluation, the Dmax for the larynx and the sub-structures of the PCM were correlated with impaired lingual movement, BOT weakness and proximal esophageal stricture at 3 months, whereas the V65, the V70and the Dmax for the larynx was correlated with BOT weakness and the V65, the V70, the Dmax or the Dmean for the sub-structures of the PCM were correlated with impaired lingual movement, BOT weakness, reduced laryngeal elevation, reduced epiglottic inversion and aspiration at 6 months following treatment. On subjective evaluation, the V60, the Dmax and the Dmean for SPCM were correlated with QoL scores for HNSO at 3 months, whereas the V70 for SPCM were correlated with QoL scores for HNPA and the V60, the V65, the V70, the Dmax and the Dmean for SPCM were correlated with QoL scores for HNSO at 6 months following treatment. The use of multiple dysphagia-related endpoints to complement eachother rather than to overlap with one another, as well as the use of multiple evaluations over time to represent a scale of early to late findings might provide a better insight in terms of the association of the clinical correlates of dysphagia with the dose-volume data for the dysphagia-related anatomical structures.

Recognizing and managing a deteriorating patient: a randomized controlled trial investigating the effectiveness of clinical simulation in improving clinical performance in undergraduate nursing students.

PubMed

Stayt, Louise Caroline; Merriman, Clair; Ricketts, Barry; Morton, Sean; Simpson, Trevor

2015-11-01

To report the results of a randomized controlled trial which explored the effectiveness of clinical simulation in improving the clinical performance of recognizing and managing an adult deteriorating patient in hospital. There is evidence that final year undergraduate nurses may lack knowledge, clinical skills and situation awareness required to manage a deteriorating patient competently. The effectiveness of clinical simulation as a strategy to teach the skills required to recognize and manage the early signs of deterioration needs to be evaluated. This study was a two centre phase II single, randomized, controlled trial with single blinded assessments. Data were collected in July 2013. Ninety-eight first year nursing students were randomized either into a control group, where they received a traditional lecture, or an intervention group where they received simulation. Participants completed a pre- and postintervention objective structured clinical examination. General Perceived Self Efficacy and Self-Reported Competency scores were measured before and after the intervention. Student satisfaction with teaching was also surveyed. The intervention group performed significantly better in the post-objective structured clinical examination. There was no significant difference in the postintervention General Perceived Self Efficacy and Self-Reported Competency scores between the control and intervention group. The intervention group was significantly more satisfied with their teaching method. Simulation-based education may be an effective educational strategy to teach nurses the skills to effectively recognize and manage a deteriorating patient. © 2015 John Wiley & Sons Ltd.

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.

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.

The LIFE Cognition Study: design and baseline characteristics

PubMed Central

Sink, Kaycee M; Espeland, Mark A; Rushing, Julia; Castro, Cynthia M; Church, Timothy S; Cohen, Ronald; Gill, Thomas M; Henkin, Leora; Jennings, Janine M; Kerwin, Diana R; Manini, Todd M; Myers, Valerie; Pahor, Marco; Reid, Kieran F; Woolard, Nancy; Rapp, Stephen R; Williamson, Jeff D

2014-01-01

Observational studies have shown beneficial relationships between exercise and cognitive function. Some clinical trials have also demonstrated improvements in cognitive function in response to moderate–high intensity aerobic exercise; however, these have been limited by relatively small sample sizes and short durations. The Lifestyle Interventions and Independence for Elders (LIFE) Study is the largest and longest randomized controlled clinical trial of physical activity with cognitive outcomes, in older sedentary adults at increased risk for incident mobility disability. One LIFE Study objective is to evaluate the effects of a structured physical activity program on changes in cognitive function and incident all-cause mild cognitive impairment or dementia. Here, we present the design and baseline cognitive data. At baseline, participants completed the modified Mini Mental Status Examination, Hopkins Verbal Learning Test, Digit Symbol Coding, Modified Rey–Osterrieth Complex Figure, and a computerized battery, selected to be sensitive to changes in speed of processing and executive functioning. During follow up, participants completed the same battery, along with the Category Fluency for Animals, Boston Naming, and Trail Making tests. The description of the mild cognitive impairment/dementia adjudication process is presented here. Participants with worse baseline Short Physical Performance Battery scores (prespecified at ≤7) had significantly lower median cognitive test scores compared with those having scores of 8 or 9 with modified Mini Mental Status Examination score of 91 versus (vs) 93, Hopkins Verbal Learning Test delayed recall score of 7.4 vs 7.9, and Digit Symbol Coding score of 45 vs 48, respectively (all P<0.001). The LIFE Study will contribute important information on the effects of a structured physical activity program on cognitive outcomes in sedentary older adults at particular risk for mobility impairment. In addition to its importance in the area of prevention of cognitive decline, the LIFE Study will also likely serve as a model for exercise and other behavioral intervention trials in older adults. PMID:25210447

Validity evidence for the Simulated Colonoscopy Objective Performance Evaluation scoring system.

PubMed

Trinca, Kristen D; Cox, Tiffany C; Pearl, Jonathan P; Ritter, E Matthew

2014-02-01

Low-cost, objective systems to assess and train endoscopy skills are needed. The aim of this study was to evaluate the ability of Simulated Colonoscopy Objective Performance Evaluation to assess the skills required to perform endoscopy. Thirty-eight subjects were included in this study, all of whom performed 4 tasks. The scoring system measured performance by calculating precision and efficiency. Data analysis assessed the relationship between colonoscopy experience and performance on each task and the overall score. Endoscopic trainees' Simulated Colonoscopy Objective Performance Evaluation scores correlated significantly with total colonoscopy experience (r = .61, P = .003) and experience in the past 12 months (r = .63, P = .002). Significant differences were seen among practicing endoscopists, nonendoscopic surgeons, and trainees (P < .0001). When the 4 tasks were analyzed, each showed significant correlation with colonoscopy experience (scope manipulation, r = .44, P = .044; tool targeting, r = .45, P = .04; loop management, r = .47, P = .032; mucosal inspection, r = .65, P = .001) and significant differences in performance between the endoscopist groups, except for mucosal inspection (scope manipulation, P < .0001; tool targeting, P = .002; loop management, P = .0008; mucosal inspection, P = .27). Simulated Colonoscopy Objective Performance Evaluation objectively assesses the technical skills required to perform endoscopy and shows promise as a platform for proficiency-based skills training. Published by Elsevier Inc.

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

PubMed Central

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

2003-01-01

Objective To assess the effect of ethnicity on student performance in stations assessing communication skills within an objective structured clinical examination. Design Quantitative and qualitative study. Setting A final UK clinical examination consisting of a two day objective structured clinical examination with 22 stations. Participants 82 students from ethnic minorities and 97 white students. Main outcome measures Mean scores for stations (quantitative) and observations made using discourse analysis on selected communication stations (qualitative). Results Mean performance of students from ethnic minorities was significantly lower than that of white students for stations assessing communication skills on days 1 (67.0% (SD 6.8%) and 72.3% (7.6%); P=0.001) and 2 (65.2% (6.6%) and 69.5% (6.3%); P=0.003). No examples of overt discrimination were found in 309 video recordings. Transcriptions showed subtle differences in communication styles in some students from ethnic minorities who performed poorly. Examiners' assumptions about what is good communication may have contributed to differences in grading. Conclusions There was no evidence of explicit discrimination between students from ethnic minorities and white students in the objective structured clinical examination. A small group of male students from ethnic minorities used particularly poorly rated communicative styles, and some subtle problems in assessing communication skills may have introduced bias. Tests need to reflect issues of diversity to ensure that students from ethnic minorities are not disadvantaged. What is already known on this topicUK medical schools are concerned that students from ethnic minorities may perform less well than white students in examinationsIt is important to understand whether our examination system disadvantages themWhat this study addsMean performance of students from ethnic minorities was significantly lower than that of white students in a final year objective structured clinical examinationTwo possible reasons for the difference were poor communicative performance of a small group of male students from ethnic minorities and examiners' use of a textbook patient centred notion of good communicationIssues of diversity in test construction and implementation must be addressed to ensure that students from ethnic minorities are not disadvantaged PMID:12689978

Undesired variance due to examiner stringency/leniency effect in communication skill scores assessed in OSCEs.

PubMed

Harasym, Peter H; Woloschuk, Wayne; Cunning, Leslie

2008-12-01

Physician-patient communication is a clinical skill that can be learned and has a positive impact on patient satisfaction and health outcomes. A concerted effort at all medical schools is now directed at teaching and evaluating this core skill. Student communication skills are often assessed by an Objective Structure Clinical Examination (OSCE). However, it is unknown what sources of error variance are introduced into examinee communication scores by various OSCE components. This study primarily examined the effect different examiners had on the evaluation of students' communication skills assessed at the end of a family medicine clerkship rotation. The communication performance of clinical clerks from Classes 2005 and 2006 were assessed using six OSCE stations. Performance was rated at each station using the 28-item Calgary-Cambridge guide. Item Response Theory analysis using a Multifaceted Rasch model was used to partition the various sources of error variance and generate a "true" communication score where the effects of examiner, case, and items are removed. Variance and reliability of scores were as follows: communication scores (.20 and .87), examiner stringency/leniency (.86 and .91), case (.03 and .96), and item (.86 and .99), respectively. All facet scores were reliable (.87-.99). Examiner variance (.86) was more than four times the examinee variance (.20). About 11% of the clerks' outcome status shifted using "true" rather than observed/raw scores. There was large variability in examinee scores due to variation in examiner stringency/leniency behaviors that may impact pass-fail decisions. Exploring the benefits of examiner training and employing "true" scores generated using Item Response Theory analyses prior to making pass/fail decisions are recommended.

The first OSCE; does students' experience of performing in public affect their results?

PubMed

Chan, Michael; Bax, Nigel; Woodley, Caroline; Jennings, Michael; Nicolson, Rod; Chan, Philip

2015-03-26

Personal qualities have been shown to affect students' exam results. We studied the effect of experience, and level, of public performance in music, drama, dance, sport, and debate at the time of admission to medical school as a predictor of student achievement in their first objective structured clinical examination (OSCE). A single medical school cohort (n = 265) sitting their first clinical exam in 2011 as third year students were studied. Pre-admission statements made at the time of application were coded for their stated achievements in the level of public performance; participation in each activity was scored 0-3, where 0 was no record, 1 = leisure time activity, 2 = activity at school or local level, 3 = activity at district, regional or national level. These scores were correlated to OSCE results by linear regression and t-test. Comparison was made between the highest scoring students in each area, and students scoring zero by t-test. There was a bell shaped distribution in public performance score in this cohort. There was no significant linear regression relationship between OSCE results and overall performance score, or between any subgroups. There was a significant difference between students with high scores in theatre, debate and vocal music areas, grouped together as verbal performance, and students scoring zero in these areas. (p < 0.05, t-test) with an effect size of 0.4. We found modest effects from pre-admission experience of verbal performance on students' scores in the OSCE examination. As these data are taken from students' admission statements, we call into question the received wisdom that such statements are unreliable.

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…

Evaluation of objective structured clinical examination for advanced orthodontic education 12 years after introduction.

PubMed

Fields, Henry W; Kim, Do-Gyoon; Jeon, Minjeong; Firestone, Allen R; Sun, Zongyang; Shanker, Shiva; Mercado, Ana M; Deguchi, Toru; Vig, Katherine W L

2017-05-01

Advanced education programs in orthodontics must ensure student competency in clinical skills. An objective structure clinical examination has been used in 1 program for over a decade. The results were analyzed cross-sectionally and longitudinally to provide insights regarding the achievement of competency, student growth, question difficulty, question discrimination, and question predictive ability. In this study, we analyzed 218 (82 first-year, 68 second-year, and 68 third-year classes) scores of each station from 85 orthodontic students. The grades originated from 13 stations and were collected anonymously for 12 consecutive years during the first 2 decades of the 2000s. The stations tested knowledge and skills regarding dental relationships, analyzing a cephalometric tracing, performing a diagnostic skill, identifying cephalometric points, bracket placement, placing first-order and second-order bends, forming a loop, placing accentuated third-order bends, identifying problems and planning mixed dentition treatment, identifying problems and planning adolescent dentition treatment, identifying problems and planning nongrowing skeletal treatment, superimposing cephalometric tracings, and interpreting cephalometric superimpositions. Results were evaluated using multivariate analysis of variance, chi-square tests, and latent growth analysis. The multivariate analysis of variance showed that all stations except 3 (analyzing a cephalometric tracing, forming a loop, and identifying cephalometric points) had significantly lower mean scores for the first-year student class than the second- and third-year classes (P <0.028); scores between the second- and third-year student classes were not significantly different (P >0.108). The chi-square analysis of the distribution of the number of noncompetent item responses decreased from the first to the second years (P <0.0003), from the second to the third years (P <0.0042), and from the first to the third years (P <0.00003). The latent growth analysis showed a wide range of difficulty and discrimination between questions. It also showed continuous growth for some areas and the ability of 6 questions to predict competency at greater than the 80% level. Objective structure clinical examinations can provide a method of evaluating student performance and curriculum impact over time, but cross-sectional and longitudinal analyses of the results may not be complementary. Significant learning appears to occur during all years of a 3-year program. Valuable questions were both easy and difficult, discriminating and not discriminating, and came from all domains: diagnostic, technical, and evaluation/synthesis. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Neuropsychological assessment and perinatal risk: A study amongst very premature born 4- and 5-year old children.

PubMed

Sanchez-Joya, Mª Del Mar; Sanchez-Labraca, Nuria; Roldan-Tapia, Mª Dolores; Moral Rodríguez, Teresa; Ramos Lizana, Julio; Roman, Pablo

2017-10-01

Prematurity and its consequences are serious problems that can result in numerous neurosensory disabilities and cerebral cognitive dysfunctions. The Perinatal Risk Index (PERI) might provide a predictive measure of these problems. This study compared the cognitive development of prematurely born children at 4 and 5 years of age with age-matched peers born at term. The secondary objective was to determine whether a correlation exists between perinatal risk and performance on neuropsychological tests among premature children. A total of 54 children between four and five years of age were evaluated; 27 were born very premature (premature group; PG), and 27 were born at term (term group; TG). Executive function, attention, memory, language, visual perception, and spatial structuring were evaluated. Subtests from the Kaufman Assessment Battery for Children, the Rey Complex Figure Test, the McCarthy Scales of Children's Abilities, the Peabody Picture Vocabulary Test, Test A, Trails A and B, the spatial structuring questionnaire from the Child Neuropsychological Maturity Questionnaire, and the Wechsler Intelligence Scale for Children were used. A PERI score was also obtained for the PG. The PG showed significantly lower scores than the TG in all the studied cognitive domains. Visual-perceptive scores were significantly and negatively correlated with the PERI scores of the PG. The PG showed neurocognitive deficits compared with the TG. The PERI can be used to predict the development of visual-perceptive abilities in children between four and five years of age. Copyright © 2017 Elsevier Ltd. All rights reserved.

The STAR score: a method for auditing clinical records

PubMed Central

Tuffaha, H

2012-01-01

INTRODUCTION Adequate medical note keeping is critical in delivering high quality healthcare. However, there are few robust tools available for the auditing of notes. The aim of this paper was to describe the design, validation and implementation of a novel scoring tool to objectively assess surgical notes. METHODS An initial ‘path finding’ study was performed to evaluate the quality of note keeping using the CRABEL scoring tool. The findings prompted the development of the Surgical Tool for Auditing Records (STAR) as an alternative. STAR was validated using inter-rater reliability analysis. An audit cycle of surgical notes using STAR was performed. The results were analysed and a structured form for the completion of surgical notes was introduced to see if the quality improved in the next audit cycle using STAR. An education exercise was conducted and all participants said the exercise would change their practice, with 25% implementing major changes. RESULTS Statistical analysis of STAR showed that it is reliable (Cronbach’s a = 0.959). On completing the audit cycle, there was an overall increase in the STAR score from 83.344% to 97.675% (p<0.001) with significant improvements in the documentation of the initial clerking from 59.0% to 96.5% (p<0.001) and subsequent entries from 78.4% to 96.1% (p<0.001). CONCLUSIONS The authors believe in the value of STAR as an effective, reliable and reproducible tool. Coupled with the application of structured forms to note keeping, it can significantly improve the quality of surgical documentation and can be implemented universally. PMID:22613300

Volumetric brain magnetic resonance imaging predicts functioning in bipolar disorder: A machine learning approach.

PubMed

Sartori, Juliana M; Reckziegel, Ramiro; Passos, Ives Cavalcante; Czepielewski, Leticia S; Fijtman, Adam; Sodré, Leonardo A; Massuda, Raffael; Goi, Pedro D; Vianna-Sulzbach, Miréia; Cardoso, Taiane de Azevedo; Kapczinski, Flávio; Mwangi, Benson; Gama, Clarissa S

2018-08-01

Neuroimaging studies have been steadily explored in Bipolar Disorder (BD) in the last decades. Neuroanatomical changes tend to be more pronounced in patients with repeated episodes. Although the role of such changes in cognition and memory is well established, daily-life functioning impairments bulge among the consequences of the proposed progression. The objective of this study was to analyze MRI volumetric modifications in BD and healthy controls (HC) as possible predictors of daily-life functioning through a machine learning approach. Ninety-four participants (35 DSM-IV BD type I and 59 HC) underwent clinical and functioning assessments, and structural MRI. Functioning was assessed using the Functioning Assessment Short Test (FAST). The machine learning analysis was used to identify possible candidates of regional brain volumes that could predict functioning status, through a support vector regression algorithm. Patients with BD and HC did not differ in age, education and marital status. There were significant differences between groups in gender, BMI, FAST score, and employment status. There was significant correlation between observed and predicted FAST score for patients with BD, but not for controls. According to the model, the brain structures volumes that could predict FAST scores were: left superior frontal cortex, left rostral medial frontal cortex, right white matter total volume and right lateral ventricle volume. The machine learning approach demonstrated that brain volume changes in MRI were predictors of FAST score in patients with BD and could identify specific brain areas related to functioning impairment. Copyright © 2018 Elsevier Ltd. All rights reserved.

Breaking Bad News to Patients with Cancer: A Randomized Control Trial of a Brief Communication Skills Training Module Incorporating the Stories and Preferences of Actual Patients

PubMed Central

Gorniewicz, James; Floyd, Michael; Krishnan, Koyamangalath; Bishop, Thomas W.; Tudiver, Fred; Lang, Forrest

2017-01-01

Objective This study tested the effectiveness of a brief, learner-centered, breaking bad news (BBN) communication skills training module using objective evaluation measures. Methods This randomized control study (N=66) compared intervention and control groups of students (n=28) and residents' (n=38) objective structured clinical examination (OSCE) performance of communication skills using Common Ground Assessment and Breaking Bad News measures. Results Follow-up performance scores of intervention group students improved significantly regarding BBN (colon cancer (CC), p=.007, r=-.47; breast cancer (BC), p=.003, r=-.53), attention to patient responses after BBN (CC, p < .001, r=-.74; BC, p=.001, r=-.65), and addressing feelings (BC, p=.006, r=-.48). At CC follow-up assessment, performance scores of intervention group residents improved significantly regarding BBN (p=.004, r=-.43), communication related to emotions (p=.034, r=-.30), determining patient's readiness to proceed after BBN and communication preferences (p=.041, r=-.28), active listening (p=011, r=-.37), addressing feelings (p<.001, r=-.65), and global interview performance (p=.001, r=-.51). Conclusion This brief BBN training module is an effective method of improving BBN communication skills among medical students and residents. Practice Implications Implementation of this brief individualized training module within health education programs could lead to improved communication skills and patient care. PMID:27876220

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.

Alzheimer's Disease Diagnosis in Individual Subjects using Structural MR Images: Validation Studies

PubMed Central

Vemuri, Prashanthi; Gunter, Jeffrey L.; Senjem, Matthew L.; Whitwell, Jennifer L.; Kantarci, Kejal; Knopman, David S.; Boeve, Bradley F.; Petersen, Ronald C.; Jack, Clifford R.

2008-01-01

OBJECTIVE To develop and validate a tool for Alzheimer's disease (AD) diagnosis in individual subjects using support vector machine (SVM) based classification of structural MR (sMR) images. BACKGROUND Libraries of sMR scans of clinically well characterized subjects can be harnessed for the purpose of diagnosing new incoming subjects. METHODS 190 patients with probable AD were age- and gender-matched with 190 cognitively normal (CN) subjects. Three different classification models were implemented: Model I uses tissue densities obtained from sMR scans to give STructural Abnormality iNDex (STAND)-score; and Models II and III use tissue densities as well as covariates (demographics and Apolipoprotein E genotype) to give adjusted-STAND (aSTAND)-score. Data from 140 AD and 140 CN were used for training. The SVM parameter optimization and training was done by four-fold cross validation. The remaining independent sample of 50 AD and 50 CN were used to obtain a minimally biased estimate of the generalization error of the algorithm. RESULTS The CV accuracy of Model II and Model III aSTAND-scores was 88.5% and 89.3% respectively and the developed models generalized well on the independent test datasets. Anatomic patterns best differentiating the groups were consistent with the known distribution of neurofibrillary AD pathology. CONCLUSIONS This paper presents preliminary evidence that application of SVM-based classification of an individual sMR scan relative to a library of scans can provide useful information in individual subjects for diagnosis of AD. Including demographic and genetic information in the classification algorithm slightly improves diagnostic accuracy. PMID:18054253

Concordance between the original and short version of the Impulsive Behaviour Scale UPPS-P using an IRT model

PubMed Central

2018-01-01

The UPPS Impulsive Behaviour Scale (with five dimensions of impulsive behaviour) is being widely used. One of the handicaps of this instrument is its relatively long administration time. This has led to the development of a short version: SUPPS-P. There are no studies comparing the relationship between the SUPPS-P scores and the original UPPS-P scores. The objectives of this study, therefore, were to analyse the psychometric properties, concordance of person measures, and efficiency of the SUPPS-P compared to those on UPPS-P, applying an Item Response Theory Model. The UPPS-P and SUPPS-P were administered to 455 undergraduate students. Confirmatory factorial analysis replicated structures reported in previous studies: the five correlated factors structure and the model with two second-order factors (Urgency and Lack of Awareness) with Sensation Seeking dimension as a different factor. Rasch analysis show that both of the instruments presented adequate model-data fit. The results show the measurement for each dimension of UPPS-P offered more precision than SUPPS-P. The structure of items location was maintained in each dimension of SUPPS-P compared to the UPPS-P, but with better person and item separation indices of the UPPS-P dimensions. The concordance analysis reveals high correlations values between scores on both versions. From the standpoint of reducing items, it can be considered that the reduced version is more efficient. This study does not support the equivalence of items on the dimensions of Sensation Seeking and Lack of perseverance. PMID:29561902

Reliability, convergent validity and factor structure of the DASS-21 in a sample of Vietnamese adolescents

PubMed Central

Tran, Thach Duc; Holton, Sara; Nguyen, Huong Thanh; Wolfe, Rory; Fisher, Jane

2017-01-01

Objectives To assess the internal consistency, latent structure and convergent validity of the Depression, Anxiety and Stress Scale-21 (DASS-21) among adolescents in Vietnam. Method An anonymous, self-completed questionnaire was conducted among 1,745 high school students in Hanoi, Vietnam between October, 2013 and January, 2014. Confirmatory factor analyses were performed to assess the latent structure of the DASS-21. Factorial invariance between girls and boys was examined. Cronbach alphas and correlation coefficients between DASS-21 factor scores and the domain scores of the Duke Health Profile Adolescent Vietnamese validated version (ADHP-V) were calculated to assess DASS-21 internal consistency and convergent validity. Results A total of 1,606/ 1,745 (92.6%) students returned the questionnaire. Of those, 1,387 students provided complete DASS-21 data. The scale demonstrated adequate internal consistency (Cronbach α: 0.761 to 0.906). A four-factor model showed the best fit to the data. Items loaded significantly on a common general distress factor, the depression, and the anxiety factors, but few on the stress factor (p<0.05). DASS-21 convergent validity was confirmed with moderate correlation coefficients (-0.47 to -0.66) between its factor scores and the ADHP-V mental health related domains. Conclusions The DASS-21 is reliable and suitable for use to assess symptoms of common mental health problems, especially depression and anxiety among Vietnamese adolescents. However, its ability in detecting stress among these adolescents may be limited. Further research is warrant to explore these results. PMID:28723909

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

An empirical method to cluster objective nebulizer adherence data among adults with cystic fibrosis.

PubMed

Hoo, Zhe H; Campbell, Michael J; Curley, Rachael; Wildman, Martin J

2017-01-01

The purpose of using preventative inhaled treatments in cystic fibrosis is to improve health outcomes. Therefore, understanding the relationship between adherence to treatment and health outcome is crucial. Temporal variability, as well as absolute magnitude of adherence affects health outcomes, and there is likely to be a threshold effect in the relationship between adherence and outcomes. We therefore propose a pragmatic algorithm-based clustering method of objective nebulizer adherence data to better understand this relationship, and potentially, to guide clinical decisions. This clustering method consists of three related steps. The first step is to split adherence data for the previous 12 months into four 3-monthly sections. The second step is to calculate mean adherence for each section and to score the section based on mean adherence. The third step is to aggregate the individual scores to determine the final cluster ("cluster 1" = very low adherence; "cluster 2" = low adherence; "cluster 3" = moderate adherence; "cluster 4" = high adherence), and taking into account adherence trend as represented by sequential individual scores. The individual scores should be displayed along with the final cluster for clinicians to fully understand the adherence data. We present three cases to illustrate the use of the proposed clustering method. This pragmatic clustering method can deal with adherence data of variable duration (ie, can be used even if 12 months' worth of data are unavailable) and can cluster adherence data in real time. Empirical support for some of the clustering parameters is not yet available, but the suggested classifications provide a structure to investigate parameters in future prospective datasets in which there are accurate measurements of nebulizer adherence and health outcomes.

Two-Step Incision for Periarterial Sympathectomy of the Hand.

PubMed

Jeon, Seung Bae; Ahn, Hee Chang; Ahn, Yong Su; Choi, Matthew Seung Suk

2015-11-01

Surgical scars on the palmar surface of the hand may lead to functional and also aesthetic and psychological consequences. The objective of this study was to introduce a new incision technique for periarterial sympathectomy of the hand and to compare the results of the new two-step incision technique with those of a Koman incision by using an objective questionnaire. A total of 40 patients (17 men and 23 women) with intractable Raynaud's disease or syndrome underwent surgery in our hospital, conducted by a single surgeon, between January 2008 and January 2013. Patients who had undergone extended sympathectomy or vessel graft were excluded. Clinical evaluation of postoperative scars was performed in both groups one year after surgery using the patient and observer scar assessment scale (POSAS) and the Wake Forest University rating scale. The total patient score was 8.59 (range, 6-15) in the two-step incision group and 9.62 (range, 7-18) in the Koman incision group. A significant difference was found between the groups in the total PS score (P-value=0.034) but not in the total observer score. Our analysis found no significant difference in preoperative and postoperative Wake Forest University rating scale scores between the two-step and Koman incision groups. The time required for recovery prior to returning to work after surgery was shorter in the two-step incision group, with a mean of 29.48 days in the two-step incision group and 34.15 days in the Koman incision group (P=0.03). Compared to the Koman incision, the new two-step incision technique provides better aesthetic results, similar symptom improvement, and a reduction in the recovery time required before returning to work. Furthermore, this incision allows the surgeon to access a wide surgical field and a sufficient exposure of anatomical structures.

Assessment of structured physical examination skills training using a retro-pre-questionnaire.

PubMed

Piryani, Rano Mal; Shankar, P Ravi; Piryani, Suneel; Thapa, Trilok Pati; Karki, Balmansingh; Khakurel, Mahesh Prasad; Bhandary, Shital

2013-01-01

The effectiveness of physical examination skills (PES) training is very rarely assessed using the "post-then-pre" approach. In this study, a retro-pre-questionnaire was used to study the effect of structured physical examination skills training (SPEST) imparted to second-year undergraduate medical students. KIST Medical College (KISTMC) affiliated to Tribhuvan University Nepal admitted its first batch of MBBS students in November 2008. The university curriculum recommends the involvement of Medicine and Surgery Departments in PES training, but the methods for teaching and assessment are not well defined. KISTMC has made training more structured and involved the Medicine, Surgery, Gynaecology and Obstetrics, Orthopaedics, ENT, Ophthalmology, Paediatrics, and Family Medicine Departments. SPEST includes the teaching/learning of basic PES for 210 minutes once a week for 28 weeks. Self-assessment is done by using a retro-pre-questionnaire at the end of the last session of training, and these data are analysed using SPSS. Out of 100 students, 98 participated in the objective structured clinical examination (OSCE); 82 completed the retro-pre-questionnaire. Forty-six skills representing various systems were selected for inclusion in the retro-pre-questionnaire from among the many skills taught in different departments. The average perceived skills score (maximum score, 46×4=184) before training was 15.9 and increased to 116.5 after training. The increase was statistically significant upon the application of a paired t-test. The students perceived that their level of skills improved after the training. The retro-pre- instrument seems to be useful for assessing the learners' self-reported changes in PES after training if a large number of skills need to be assessed. However, it should be noted that although a retro-pre-questionnaire may reveal valuable information, it is not a substitute for an objective measure or gold standard.

A Structural Model of Stress, Motivation, and Academic Performance in Medical Students

PubMed Central

Park, Jangho; An, Hoyoung; Park, Seungjin; Lee, Chul; Kim, Seong Yoon; Lee, Jae-Dam; Kim, Ki-Soo

2012-01-01

Objective The purpose of the present study was 1) to identify factors that may influence academic stress in medical students and 2) to investigate the causal relationships among these variables with path analysis. Methods One hundred sixty medical students participated in the present study. Psychological parameters were assessed with the Medical Stress Scale, Minnesota Multiphasic Personality Inventory, Hamilton Depression Scale, Beck Depression Inventory, and Academic Motivation Scale. Linear regression and path analysis were used to examine the relationships among variables. Results Significant correlations were noted between several factors and Medical Stress scores. Specifically, Hamilton Depression Scale scores (β=0.26, p=0.03) and amotivation (β=0.20, p=0.01) and extrinsically identified regulation (β=0.27, p<0.01) response categories on the Academic Motivation Scale had independent and significant influences on Medical Stress Scale scores. A path analysis model indicated that stress, motivation, and academic performance formed a triangular feedback loop. Moreover, depression was associated with both stress and motivation, and personality was associated with motivation. Conclusion The triangular feedback-loop structure in the present study indicated that actions that promote motivation benefit from interventions against stress and depression. Moreover, stress management increases motivation in students. Therefore, strategies designed to reduce academic pressures in medical students should consider these factors. Additional studies should focus on the relationship between motivation and depression. PMID:22707964

Fundamental movement skills in preschoolers: a randomized controlled trial targeting object control proficiency.

PubMed

Donath, L; Faude, O; Hagmann, S; Roth, R; Zahner, L

2015-11-01

Adequately developed fundamental movement skills, particularly object control dimensions, are considered essential to learn more complex movement patterns and to increase the likelihood to successfully participate in organized and non-organized sports during later years. Thus, the present randomized controlled trial aimed at improving object control dimensions at an early state in a kindergarten setting. Catching, throwing, kicking, rolling and stationary dribbling were assessed via gross motor development 2 (TGMD-2) testing in 41 normally developed preschoolers. On a cluster-randomized basis [strata: age, sex and body mass index (BMI)], three kindergartens were randomly assigned to an intervention group (n = 22, INT, age: 4.6 ± 1.0 years; BMI: 16.2 ± 1.1 kg/m(2) ) and three to a control group (n = 19, CON: age: 4.5 ± 1.2 years; BMI: 16.8 ± 1.2 kg/m(2) ). Twelve structured training sessions were given within 6 weeks (12 sessions). The total training volume was 330 min. Moderate time × group interaction were observed for the total sum score (Δ+22%, P = 0.05) and dribbling (Δ+41%, P = 0.002). Adjusting for baseline differences analyses of covariance did not affect these results. Interestingly, likely to most likely practically worthwhile effects were detected for the total sum score, catching and dribbling. Object control dimensions such as dribbling and catching that apparently rely on rhythmical movement patterns and anticipatory eye-hand coordination seem to benefit from short-term object control training. These skills are considered important for successful team-sport participation and appropriate sportive motor development. © 2015 John Wiley & Sons Ltd.

Sway Area and Velocity Correlated With MobileMat Balance Error Scoring System (BESS) Scores.

PubMed

Caccese, Jaclyn B; Buckley, Thomas A; Kaminski, Thomas W

2016-08-01

The Balance Error Scoring System (BESS) is often used for sport-related concussion balance assessment. However, moderate intratester and intertester reliability may cause low initial sensitivity, suggesting that a more objective balance assessment method is needed. The MobileMat BESS was designed for objective BESS scoring, but the outcome measures must be validated with reliable balance measures. Thus, the purpose of this investigation was to compare MobileMat BESS scores to linear and nonlinear measures of balance. Eighty-eight healthy collegiate student-athletes (age: 20.0 ± 1.4 y, height: 177.7 ± 10.7 cm, mass: 74.8 ± 13.7 kg) completed the MobileMat BESS. MobileMat BESS scores were compared with 95% area, sway velocity, approximate entropy, and sample entropy. MobileMat BESS scores were significantly correlated with 95% area for single-leg (r = .332) and tandem firm (r = .474), and double-leg foam (r = .660); and with sway velocity for single-leg (r = .406) and tandem firm (r = .601), and double-leg (r = .575) and single-leg foam (r = .434). MobileMat BESS scores were not correlated with approximate or sample entropy. MobileMat BESS scores were low to moderately correlated with linear measures, suggesting the ability to identify changes in the center of mass-center of pressure relationship, but not higher-order processing associated with nonlinear measures. These results suggest that the MobileMat BESS may be a clinically-useful tool that provides objective linear balance measures.

The knowledge, attitudes and practices on influenza among medical college students in Northwest China.

PubMed

Tuohetamu, Shabiremu; Pang, Mingfan; Nuer, Xiaokelaiti; Mahemuti; Mohemaiti, Patamu; Qin, Ying; Peng, Zhibin; Zheng, Jiandong; Yu, Hongjie; Feng, Luzhao; Feng, Zijian

2017-07-03

Objective This study aimed to understand the knowledge, attitudes and practices (KAP) on seasonal influenza among medical college students in a low-income multiethnic society. Methods A cross-sectional questionnaire survey collected information of KAP related to influenza. A knowledge score was calculated according to the total number of correct points out of 9 questions. Logistic regression was used to identify factors associated with influenza vaccine uptake. Results 856 valid questionnaires were obtained. The average knowledge score was 14.8 ± 3.1 out of 22 correct points. Han Chinese got higher score than minorities (p < 0.001). Knowledge score increased with grade (p < 0.001). Students majoring in pharmacy had lower score than others. Questions on mode of transmission, symptoms, precautions, high risk groups and vaccination schedule had a correct rate lower than 50%. Hand hygiene was practiced by less than 40% of students after touching objects in public areas or sneezing. The proportion of participants received influenza vaccine in the past 3 y was 4.1%, 9.2% and 6.1% respectively. Willingness to receive free vaccine (OR = 2.49, 95% CI 1.31∼4.28), and awareness of the vaccine effectiveness (OR = 1.67, 95% CI 1.08∼2.56) were significantly associated with vaccine uptake, while the general knowledge about influenza, perceived susceptibility and severity, and demographic factors were not. The top 3 reasons for not being vaccinated were poor knowledge of the vaccine (46%), no perceived need due to good health (45%) and worry about adverse reactions (33%). Conclusion Health education is needed to improve the awareness of basic facts about influenza and vaccine, and more attention should be paid to minority groups. The coverage of seasonal influenza vaccine is quite low. Besides individual level behavior change, social and structural factors should be considered to increase the uptake of influenza vaccine.

Risk factors associated with detailed reproductive phenotypes in dairy and beef cows.

PubMed

Carthy, T R; Berry, D P; Fitzgerald, A; McParland, S; Williams, E J; Butler, S T; Cromie, A R; Ryan, D

2014-05-01

The objective of this study was to identify detailed fertility traits in dairy and beef cattle from transrectal ultrasonography records and quantify the associated risk factors. Data were available on 148 947 ultrasound observations of the reproductive tract from 75 949 cows in 843 Irish dairy and beef herds between March 2008 and October 2012. Traits generated included (1) cycling at time of examination, (2) cystic structures, (3) early ovulation, (4) embryo death and (5) uterine score; the latter was measured on a scale of 1 (good) to 4 (poor) characterising the tone of the uterine wall and fluid present in the uterus. After editing, 72,773 records from 44,415 dairy and beef cows in 643 herds remained. Factors associated with the logit of the probability of a positive outcome for each of the binary fertility traits were determined using generalised estimating equations; linear mixed model analysis was used for the analysis of uterine score. The prevalence of cycling, cystic structures, early ovulation and embryo death was 84.75%, 3.87%, 7.47% and 3.84%, respectively. The occurrence of the uterine heath score of 1, 2, 3 and 4 was 70.63%, 19.75%, 8.36% and 1.26%, respectively. Cows in beef herds had a 0.51 odds (95% CI=0.41 to 0.63, P<0.001) of cycling at the time of examination compared with cows in dairy herds; stage of lactation at the time of examination was the same in both herd types. Furthermore, cows in dairy herds had an inferior uterine score (indicating poorer tone and a greater quantity of uterine fluid present) compared with cows in beef herds. The likelihood of cycling at the time of examination increased with parity and stage of lactation, but was reduced in cows that had experienced dystocia in the previous calving. The presence of cystic structures on the ovaries increased with parity and stage of lactation. The likelihood of embryo/foetal death increased with parity and stage of lactation. Dystocia was not associated with the presence of cystic structures or embryo death. Uterine score improved with parity and stage of lactation, while cows that experienced dystocia in the previous calving had an inferior uterine score. Heterosis was the only factor associated with increased likelihood of early ovulation. The fertility traits identified, and the associated risk factors, provide useful information on the reproductive status of dairy and beef cows.

Factor analysis of persistent postconcussive symptoms within a military sample with blast exposure.

PubMed

Franke, Laura M; Czarnota, Jenna N; Ketchum, Jessica M; Walker, William C

2015-01-01

To determine the factor structure of persistent postconcussive syndrome symptoms in a blast-exposed military sample and validate factors against objective and symptom measures. Veterans Affairs medical center and military bases. One hundred eighty-one service members and veterans with at least 1 significant exposure to blast during deployment within the 2 years prior to study enrollment. Confirmatory and exploratory factor analyses of the Rivermead Postconcussion Questionnaire. Rivermead Postconcussion Questionnaire, PTSD (posttraumatic stress disorder) Symptom Checklist-Civilian, Center for Epidemiological Studies Depression scale, Sensory Organization Test, Paced Auditory Serial Addition Test, California Verbal Learning Test, and Delis-Kaplan Executive Function System subtests. The 3-factor structure of persistent postconcussive syndrome was not confirmed. A 4-factor structure was extracted, and factors were interpreted as reflecting emotional, cognitive, visual, and vestibular functions. All factors were associated with scores on psychological symptom inventories; visual and vestibular factors were also associated with balance performance. There was no significant association between the cognitive factor and neuropsychological performance or between a history of mild traumatic brain injury and factor scores. Persistent postconcussive symptoms observed months after blast exposure seem to be related to 4 distinct forms of distress, but not to mild traumatic brain injury per se, with vestibular and visual factors possibly related to injury of sensory organs by blast.

Comprehension of Written Grammar Test: Reliability and Known-Groups Validity Study With Hearing and Deaf and Hard-of-Hearing Students.

PubMed

Cannon, Joanna E; Hubley, Anita M; Millhoff, Courtney; Mazlouman, Shahla

2016-01-01

The aim of the current study was to gather validation evidence for the Comprehension of Written Grammar (CWG; Easterbrooks, 2010) receptive test of 26 grammatical structures of English print for use with children who are deaf and hard of hearing (DHH). Reliability and validity data were collected for 98 participants (49 DHH and 49 hearing) in Grades 2-6. The objectives were to: (a) examine 4-week test-retest reliability data; and (b) provide evidence of known-groups validity by examining expected differences between the groups on the CWG vocabulary pretest and main test, as well as selected structures. Results indicated excellent test-retest reliability estimates for CWG test scores. DHH participants performed statistically significantly lower on the CWG vocabulary pretest and main test than the hearing participants. Significantly lower performance by DHH participants on most expected grammatical structures (e.g., basic sentence patterns, auxiliary "be" singular/plural forms, tense, comparatives, and complementation) also provided known groups evidence. Overall, the findings of this study showed strong evidence of the reliability of scores and known group-based validity of inferences made from the CWG. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Factor structure and factorial invariance of the State-Trait Anxiety Inventory for Chinese children and adolescents.

PubMed

Cao, Yang; Liu, Zhengkui

2015-06-01

As previous research utilizing Spielberger's State-Trait Anxiety Inventory (Form Y; STAI-Y) has mostly involved adults or clinical groups, there have been relatively few reports assessing adolescents. This study is the first using data for children and adolescents in mainland China, from a large-scale cross-sectional survey in Beijing (Sample 1) and a longitudinal survey from the Wenchuan 512 earthquake (Sample 2), to clarify the factor structure and factorial invariance of the STAI-Y, Mandarin Chinese version. As a result, only in Sample 1 did a comparison of 11 confirmatory factor analysis models indicate the best goodness-of-fit indices shown by a two-factor structure for both state and trait anxiety, with both models reaching the selected cutoff criteria. These two optimal models were used in a subsequent simultaneous confirmatory factor analysis to test four conditions of factorial invariance, using eight participant groups divided on the basis of sex and school grade (fourth, fifth, sixth, and seventh to ninth). The two-factor structure state and trait anxiety models achieved the cutoff criteria for factorial invariance, with the exception of male fourth graders. Further, it was clearly shown that in comparison with the early stage of puberty, as puberty advanced the absence of state and trait anxiety gradually decreased, while scores for the presence of anxiety gradually increased. At the same time, in the case of Sample 2, which had experienced a traumatic event, as the goodness-of-fit indices for none of the 11 models reached the cutoff criteria, the factor scores showed arbitrariness and a lack of objectivity. The authors conclude that cognitive structure with regard to the STAI-Y may change with traumatic experience or the development of secondary sex characteristics at the onset of or in the stage of puberty. Also, computing the scores according to the STAI-Y manual is problematic. © 2014 The Institute of Psychology, Chinese Academy of Sciences and Wiley Publishing Asia Pty Ltd.

English Validation of the Parental Socialization Scale—ESPA29

PubMed Central

Martínez, Isabel; Cruise, Edie; García, Óscar F.; Murgui, Sergio

2017-01-01

Parenting styles have traditionally been studied following the classical two-dimensional orthogonal model of parental socialization. The Parental Socialization Scale ESPA29 is used to measure the four styles of parental socialization through the acceptance/involvement and strictness/imposition dimensions. The ESPA29 scale is a developmentally appropriate measure of parenting styles, which has been validated in several languages including Spanish, Italian, and Brazilian Portuguese. In this study, the English translation of the ESPA29 was evaluated. The objective of the work is to test the ESPA29’s structure of parenting practices with a United States sample measuring parenting practices using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The scores of fathers’ and mothers’ behavioral practices toward their children were obtained for a sample of 911 United States adolescents between 14 and 18 years of age. First, the total sample was split and a principal components analysis with varimax rotation was carried out with one of the two halves. EFA showed a two-factor structure fully congruent with the theoretical model for mothers’ and fathers’ scores. Next, a CFA was calculated on the second half by using the factor structure obtained in the previous EFA. The CFA replicated the two-factor structure with appropriate fit index. The seven parenting practices that were measured loaded appropriately on the acceptance/involvement and strictness/imposition dimensions. Then, the multigroup analysis between girls and boys showed equal loading in the factors and equal covariation between the acceptance/involvement and the strictness/imposition dimensions. Additionally, the two dimensions of the ESPA29 scale were related to self-esteem in order to obtain an external validity index. The findings confirm the invariant structure of the ESPA29 was in the United States and their equivalence in both fathers’ and mothers’ scores. These findings validate the instrument and confirm its applicability in cross-cultural research on parenting practices and child adjustment. PMID:28611711

Marginalized identities, discrimination burden, and mental health: Empirical exploration of an interpersonal-level approach to modeling intersectionality

PubMed Central

Seng, Julia S; Lopez, William D; Sperlich, Mickey; Hamama, Lydia; Meldrum, Caroline D Reed

2012-01-01

Intersectionality is a term used to describe the intersecting effects of race, class, gender, and other marginalizing characteristics that contribute to social identity and affect health. Adverse health effects are thought to occur via social processes including discrimination and structural inequalities (i.e., reduced opportunities for education and income). Although intersectionality has been well-described conceptually, approaches to modeling it in quantitative studies of health outcomes are still emerging. Strategies to date have focused on modeling demographic characteristics as proxies for structural inequality. Our objective was to extend these methodological efforts by modeling intersectionality across three levels: structural, contextual, and interpersonal, consistent with a social-ecological framework. We conducted a secondary analysis of a database that included two components of a widely used survey instrument, the Everyday Discrimination Scale. We operationalized a meso- or interpersonal-level of intersectionality using two variables, the frequency score of discrimination experiences and the sum of characteristics listed as reasons for these (i.e., the person’s race, ethnicity, gender, sexual orientation, nationality, religion, disability or pregnancy status, or physical appearance). We controlled for two structural inequality factors (low education, poverty) and three contextual factors (high crime neighborhood, racial minority status, and trauma exposures). The outcome variables we modeled were posttraumatic stress disorder symptoms and a quality of life index score. We used data from 619 women who completed the Everyday Discrimination Scale for a perinatal study in the U.S. state of Michigan. Statistical results indicated that the two interpersonal-level variables (i.e., number of marginalized identities, frequency of discrimination) explained 15% of variance in posttraumatic stress symptoms and 13% of variance in quality of life scores, improving the predictive value of the models over those using structural inequality and contextual factors alone. This study’s results point to instrument development ideas to improve the statistical modeling of intersectionality in health and social science research. PMID:23089613

Marginalized identities, discrimination burden, and mental health: empirical exploration of an interpersonal-level approach to modeling intersectionality.

PubMed

Seng, Julia S; Lopez, William D; Sperlich, Mickey; Hamama, Lydia; Reed Meldrum, Caroline D

2012-12-01

Intersectionality is a term used to describe the intersecting effects of race, class, gender, and other marginalizing characteristics that contribute to social identity and affect health. Adverse health effects are thought to occur via social processes including discrimination and structural inequalities (i.e., reduced opportunities for education and income). Although intersectionality has been well-described conceptually, approaches to modeling it in quantitative studies of health outcomes are still emerging. Strategies to date have focused on modeling demographic characteristics as proxies for structural inequality. Our objective was to extend these methodological efforts by modeling intersectionality across three levels: structural, contextual, and interpersonal, consistent with a social-ecological framework. We conducted a secondary analysis of a database that included two components of a widely used survey instrument, the Everyday Discrimination Scale. We operationalized a meso- or interpersonal-level of intersectionality using two variables, the frequency score of discrimination experiences and the sum of characteristics listed as reasons for these (i.e., the person's race, ethnicity, gender, sexual orientation, nationality, religion, disability or pregnancy status, or physical appearance). We controlled for two structural inequality factors (low education, poverty) and three contextual factors (high crime neighborhood, racial minority status, and trauma exposures). The outcome variables we modeled were posttraumatic stress disorder symptoms and a quality of life index score. We used data from 619 women who completed the Everyday Discrimination Scale for a perinatal study in the U.S. state of Michigan. Statistical results indicated that the two interpersonal-level variables (i.e., number of marginalized identities, frequency of discrimination) explained 15% of variance in posttraumatic stress symptoms and 13% of variance in quality of life scores, improving the predictive value of the models over those using structural inequality and contextual factors alone. This study's results point to instrument development ideas to improve the statistical modeling of intersectionality in health and social science research. Copyright © 2012 Elsevier Ltd. All rights reserved.

English Validation of the Parental Socialization Scale-ESPA29.

PubMed

Martínez, Isabel; Cruise, Edie; García, Óscar F; Murgui, Sergio

2017-01-01

Parenting styles have traditionally been studied following the classical two-dimensional orthogonal model of parental socialization. The Parental Socialization Scale ESPA29 is used to measure the four styles of parental socialization through the acceptance/involvement and strictness/imposition dimensions. The ESPA29 scale is a developmentally appropriate measure of parenting styles, which has been validated in several languages including Spanish, Italian, and Brazilian Portuguese. In this study, the English translation of the ESPA29 was evaluated. The objective of the work is to test the ESPA29's structure of parenting practices with a United States sample measuring parenting practices using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The scores of fathers' and mothers' behavioral practices toward their children were obtained for a sample of 911 United States adolescents between 14 and 18 years of age. First, the total sample was split and a principal components analysis with varimax rotation was carried out with one of the two halves. EFA showed a two-factor structure fully congruent with the theoretical model for mothers' and fathers' scores. Next, a CFA was calculated on the second half by using the factor structure obtained in the previous EFA. The CFA replicated the two-factor structure with appropriate fit index. The seven parenting practices that were measured loaded appropriately on the acceptance/involvement and strictness/imposition dimensions. Then, the multigroup analysis between girls and boys showed equal loading in the factors and equal covariation between the acceptance/involvement and the strictness/imposition dimensions. Additionally, the two dimensions of the ESPA29 scale were related to self-esteem in order to obtain an external validity index. The findings confirm the invariant structure of the ESPA29 was in the United States and their equivalence in both fathers' and mothers' scores. These findings validate the instrument and confirm its applicability in cross-cultural research on parenting practices and child adjustment.

Objective Structured Assessment of Technical Skills (OSATS) evaluation of hysteroscopy training: a prospective study.

PubMed

Alici, Ferizan; Buerkle, Bernd; Tempfer, Clemens B

2014-07-01

To describe the performance curve of hysteroscopy-naïve probands repeatedly working through a surgery algorithm on a hysteroscopy trainer. We prospectively recruited medical students to a 30min demonstration session teaching a standardized surgery algorithm. Subjects subsequently performed three training courses immediately after training (T1) and after 24h (T2) and 48h (T3). Skills were recorded with a 20-item Objective Structured Assessment of Technical Skills (OSATS) at T1, T2, and T3. The presence of a sustained OSATS score improvement from T1 to T3 was the primary outcome. Performance time (PT) and self assessment (SA) were secondary outcomes. Statistics were performed using paired T-test and multiple linear regression analysis. 92 subjects were included. OSATS scores significantly improved over time from T1 to T2 (15.21±1.95 vs. 16.02±2.06, respectively; p<0.0001) and from T2 to T3 (16.02±2.06 vs. 16.95±1.61, respectively; p<0.0001). The secondary outcomes PT (414±119s vs. 357±88s vs. 304±91s; p<0.0001) and SA (3.02±0.85 vs. 3.80±0.76 vs. 4.41±0.67; p<0.0001) also showed an improvement over time with quicker performance and higher confidence. SA, but not PT demonstrated construct validity. In a multiple linear regression analysis, gender (odds ratio (OR) 0.96; 95% confidence interval (CI) 0.35-2.71; p=0.9) did not independently influence the likelihood of OSATS score improvement. In a hysteroscopy-naïve population, there is a continuous and sustained improvement of surgical proficiency and confidence after multiple training courses on a hysteroscopy trainer. Serial hysteroscopy trainings may be helpful for teaching hysteroscopy skills. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Using the Oxford Foot Model to determine the association between objective measures of foot function and results of the AOFAS Ankle-Hindfoot Scale and the Foot Function Index: a prospective gait analysis study in Germany

PubMed Central

Kostuj, Tanja; Stief, Felix; Hartmann, Kirsten Anna; Schaper, Katharina; Arabmotlagh, Mohammad; Baums, Mike H; Meurer, Andrea; Krummenauer, Frank; Lieske, Sebastian

2018-01-01

Objective After cross-cultural adaption for the German translation of the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society (AOFAS-AHS) and agreement analysis with the Foot Function Index (FFI-D), the following gait analysis study using the Oxford Foot Model (OFM) was carried out to show which of the two scores better correlates with objective gait dysfunction. Design and participants Results of the AOFAS-AHS and FFI-D, as well as data from three-dimensional gait analysis were collected from 20 patients with mild to severe ankle and hindfoot pathologies. Kinematic and kinetic gait data were correlated with the results of the total AOFAS scale and FFI-D as well as the results of those items representing hindfoot function in the AOFAS-AHS assessment. With respect to the foot disorders in our patients (osteoarthritis and prearthritic conditions), we correlated the total range of motion (ROM) in the ankle and subtalar joints as identified by the OFM with values identified during clinical examination ‘translated’ into score values. Furthermore, reduced walking speed, reduced step length and reduced maximum ankle power generation during push-off were taken into account and correlated to gait abnormalities described in the scores. An analysis of correlations with CIs between the FFI-D and the AOFAS-AHS items and the gait parameters was performed by means of the Jonckheere-Terpstra test; furthermore, exploratory factor analysis was applied to identify common information structures and thereby redundancy in the FFI-D and the AOFAS-AHS items. Results Objective findings for hindfoot disorders, namely a reduced ROM, in the ankle and subtalar joints, respectively, as well as reduced ankle power generation during push-off, showed a better correlation with the AOFAS-AHS total score—as well as AOFAS-AHS items representing ROM in the ankle, subtalar joints and gait function—compared with the FFI-D score. Factor analysis, however, could not identify FFI-D items consistently related to these three indicator parameters (pain, disability and function) found in the AOFAS-AHS. Furthermore, factor analysis did not support stratification of the FFI-D into two subscales. Conclusions The AOFAS-AHS showed a good agreement with objective gait parameters and is therefore better suited to evaluate disability and functional limitations of patients suffering from foot and ankle pathologies compared with the FFI-D. PMID:29626046

Assessment of current undergraduate anesthesia course in a Saudi University

PubMed Central

Shams, Tarek; El-Masry, Ragaa; al Wadani, Hamed; Amr, Mostafa

2013-01-01

Background: The assessment of the anesthesia course in our university comprises Objective Structured Clinical Examinations (OSCEs), in conjunction with portfolio and multiple-choice questions (MCQ). The objective of this study was to evaluate the outcome of different forms of anesthesia course assessment among 5th year medical students in our university, as well as study the influence of gender on student performance in anesthesia. Methods: We examined the performance of 154, 5th year medical students through OSCE, portfolios, and MCQ. Results: The score ranges in the portfolio, OSCE, and MCQs were 16-24, 4.2-28.9, and 15.5-44.5, respectively. There was highly significant difference in scores in relation to gender in all assessments other than the written one (P=0.000 for Portfolio, OSCE, and Total exam, whereas P=0.164 for written exam). In the generated linear regression model, OSCE alone could predict 86.4% of the total mark if used alone. In addition, if the score of the written examination is added, OSCE will drop to 57.2% and the written exam will be 56.8% of the total mark. Conclusions: This study demonstrates that different clinical methods used to assess medical students during their anesthesia course were consistent and integrated. The performance of female was superior to male in OSCE and portfolio. This information is the basis for improving educational and assessment standards in anesthesiology and for introducing a platform for developing modern learning media in countries with dearth of anesthesia personnel. PMID:23956708

Assessment of current undergraduate anesthesia course in a Saudi University.

PubMed

Shams, Tarek; El-Masry, Ragaa; Al Wadani, Hamed; Amr, Mostafa

2013-04-01

The assessment of the anesthesia course in our university comprises Objective Structured Clinical Examinations (OSCEs), in conjunction with portfolio and multiple-choice questions (MCQ). The objective of this study was to evaluate the outcome of different forms of anesthesia course assessment among 5(th) year medical students in our university, as well as study the influence of gender on student performance in anesthesia. We examined the performance of 154, 5(th) year medical students through OSCE, portfolios, and MCQ. The score ranges in the portfolio, OSCE, and MCQs were 16-24, 4.2-28.9, and 15.5-44.5, respectively. There was highly significant difference in scores in relation to gender in all assessments other than the written one (P=0.000 for Portfolio, OSCE, and Total exam, whereas P=0.164 for written exam). In the generated linear regression model, OSCE alone could predict 86.4% of the total mark if used alone. In addition, if the score of the written examination is added, OSCE will drop to 57.2% and the written exam will be 56.8% of the total mark. This study demonstrates that different clinical methods used to assess medical students during their anesthesia course were consistent and integrated. The performance of female was superior to male in OSCE and portfolio. This information is the basis for improving educational and assessment standards in anesthesiology and for introducing a platform for developing modern learning media in countries with dearth of anesthesia personnel.

Positive and Negative Thinking in Tinnitus: Factor Structure of the Tinnitus Cognitions Questionnaire.

PubMed

Handscomb, Lucy E; Hall, Deborah A; Shorter, Gillian W; Hoare, Derek J

Researchers and clinicians consider thinking to be important in the development and maintenance of tinnitus distress, and altering thoughts or thinking style is an object of many forms of psychological therapy for tinnitus. Those working with people with tinnitus require a reliable, psychometrically robust means of measuring both positive and negative thinking related to it. The Tinnitus Cognitions Questionnaire (TCQ) was designed as such a measure and its authors showed it to be reliable, with good psychometric properties. However, no research teams have yet carried out independent validation. This study aimed to use the TCQ to investigate thinking amongst members of the general population with both bothersome and nonbothersome tinnitus and also to verify its factor structure. Three hundred forty-two members of the public with tinnitus completed the TCQ online or on paper. They also rated their tinnitus on a scale as "not a problem," "a small problem," "a moderate problem," "a big problem," or a "very big problem." The authors tested the original factor structure of the TCQ using confirmatory factor analysis and then calculated the mean scores for each item, comparing mean total scores across "problem categories" for the full questionnaire and for the positive and negative subscales. The original two-factor structure of the TCQ was a good fit to the data when the correlation between positive and negative factors was fixed at zero (root mean square error of approximation = 0.064, 90% confidence interval = 0.058 to 0.070). Items pertaining to wishing the tinnitus would go away and despairing that it would ever get better had the highest mean scores. The mean total score for the "no problem" group (M = 31.17, SD = 16.03) was not significantly different from the mean total score for the "small problem" group (M = 34.00, SD = 12.44, p = 0.99). Differences between mean scores for all other groups were statistically significant. For the negative subscale, differences were statistically significant between all problem categories. For the positive subscale, the differences between mean scores were only statistically significant for the "no problem" group (M = 28.40, SD = 17.11) compared with the "moderate problem" group (M = 18.55, SD = 8.64, p = 0.02) and for the "moderate problem" group compared with the "very big problem" group (M = 26.79, SD = 11.66, p = 0.002). Positive and negative factors were uncorrelated (ρ = -0.03.) CONCLUSIONS:: The TCQ is a valid measure of positive and negative thinking in tinnitus, and the authors recommend its use in research and therapeutic settings. Negative thinking appears to be associated with more problematic tinnitus, but positive thinking is not associated with unproblematic tinnitus, suggesting that reducing negative thinking may be more important than teaching positive thinking in therapy.

Ultrashort Echo-Time Magnetic Resonance Imaging Is a Sensitive Method for the Evaluation of Early Cystic Fibrosis Lung Disease

PubMed Central

Roach, David J.; Crémillieux, Yannick; Fleck, Robert J.; Brody, Alan S.; Serai, Suraj D.; Szczesniak, Rhonda D.; Kerlakian, Stephanie; Clancy, John P.

2016-01-01

Rationale: Recent advancements that have been made in magnetic resonance imaging (MRI) improve our ability to assess pulmonary structure and function in patients with cystic fibrosis (CF). A nonionizing imaging modality that can be used as a serial monitoring tool throughout life can positively affect patient care and outcomes. Objectives: To compare an ultrashort echo-time MRI method with computed tomography (CT) as a biomarker of lung structure abnormalities in young children with early CF lung disease. Methods: Eleven patients with CF (mean age, 31.8 ± 5.7 mo; median age, 33 mo; 7 male and 4 female) were imaged via CT and ultrashort echo-time MRI. Eleven healthy age-matched patients (mean age, 22.5 ± 10.2 mo; median age, 23 mo; 5 male and 6 female) were imaged via ultrashort echo-time MRI. CT scans of 13 additional patients obtained for clinical indications not affecting the heart or lungs and interpreted as normal provided a CT control group (mean age, 24.1 ± 11.7 mo; median age, 24 mo; 6 male and 7 female). Studies were scored by two experienced radiologists using a well-validated CF-specific scoring system for CF lung disease. Measurements and Main Results: Correlations between CT and ultrashort echo-time MRI scores of patients with CF were very strong, with P values ≤0.001 for bronchiectasis (r = 0.96) and overall score (r = 0.90), and moderately strong for bronchial wall thickening (r = 0.62, P = 0.043). MRI easily differentiated CF and control groups via a reader CF-specific scoring system. Conclusions: Ultrashort echo-time MRI detected structural lung disease in very young patients with CF and provided imaging data that correlated well with CT. By quantifying early CF lung disease without using ionizing radiation, ultrashort echo-time MRI appears well suited for pediatric patients requiring longitudinal imaging for clinical care or research studies. Clinical Trial registered with www.clinicaltrials.gov (NCT01832519). PMID:27551814

The Dental School Interview As a Predictor of Dental Students' OSCE Performance.

PubMed

Park, Sang E; Price, Mirissa D; Karimbux, Nadeem Y

2018-03-01

The aim of this study was to evaluate the use of the dental school admissions interview score as a noncognitive indicator of performance in predoctoral dental education, with specific attention to whether a correlation existed between the admissions interview scores and performance on the objective structured clinical examination (OSCE). The study population consisted of all 175 students in the Harvard School of Dental Medicine (HSDM) DMD Classes of 2012 through 2016. Data on students' gender and age on entering dental school were self-reported using their applications for admission to the HSDM DMD program. Data on students' OSCE scores for three examination sessions were collected from the Office of Dental Education. The results showed that the students' interview scores did not significantly correlate with OSCE performance on any of the three exams. Performance on the first and second OSCEs did, however, correlate with performance on the third OSCE (p<0.05). Age on entering dental school was not significantly associated with performance on any of the three OSCEs; however, among male students, there was a significant negative correlation (p<0.05) between entering age and performance on the second and third OSCEs. There was no significant association between gender and OSCE or interview score. These results suggest that although the admissions interview scores can serve as an important resource in student selection, with the lack of association between interview and OSCE scores, it is possible that the communication skills required for the interview do not directly overlap with those required for OSCE success.

State Effect of Traumatic Experience on Personality Structure

PubMed Central

Lee, Hong-seock; Lee, Sang-Kyu; Lee, Heung-Pyo

2012-01-01

Objective Personality is defined as the trait-like qualities of a person. However, it has been recently suggested that the state effect of a situation leads to changes in scores on personality assessments. We predicted that traumatic experiences would induce changes not only in personality scores but also in the factor structures of personality assessments. Methods MethodsaaWe conducted a cross-sectional, case-controlled study using two data sets: a traumatized adolescent sample (n=71) and a non-traumatized adolescent sample (n=296). Personality factor structures were compared between the two samples using exploratory factor analyses for 25 lower-ordered subscales of the Temperament and Character Inventory (TCI). In the non-traumatized sample, evaluation of the scree plot suggested a five-factor solution supporting TCI's original seven-factor model. Results The traumatized sample showed a three-factor structure representing a biological factor, a social factor and an existential factor. This decrease in number of personality factors was caused by strengthened correlations among personality subscales related to coping with traumatic situations. Cloninger's psychobiological model of personality (i.e., temperament-character) was adequate in capturing personality traits of non-traumatized adolescents, but the tripartite view of existential psychology (i.e., body-mind-spirit) clearly corresponded to the factor structure of the traumatized adolescents. Conclusion The three-factor solution of the present traumatized group is consistent with the tripartite model of personality (i.e., body-mind-spirit), while the five-factor solution of the non-traumatized group corresponds to Cloninger's seven-factor model. This is the first study to describe the state effects of traumatic experiences on personality structure. PMID:23251200

Knowledge-based prediction of protein backbone conformation using a structural alphabet.

PubMed

Vetrivel, Iyanar; Mahajan, Swapnil; Tyagi, Manoj; Hoffmann, Lionel; Sanejouand, Yves-Henri; Srinivasan, Narayanaswamy; de Brevern, Alexandre G; Cadet, Frédéric; Offmann, Bernard

2017-01-01

Libraries of structural prototypes that abstract protein local structures are known as structural alphabets and have proven to be very useful in various aspects of protein structure analyses and predictions. One such library, Protein Blocks, is composed of 16 standard 5-residues long structural prototypes. This form of analyzing proteins involves drafting its structure as a string of Protein Blocks. Predicting the local structure of a protein in terms of protein blocks is the general objective of this work. A new approach, PB-kPRED is proposed towards this aim. It involves (i) organizing the structural knowledge in the form of a database of pentapeptide fragments extracted from all protein structures in the PDB and (ii) applying a knowledge-based algorithm that does not rely on any secondary structure predictions and/or sequence alignment profiles, to scan this database and predict most probable backbone conformations for the protein local structures. Though PB-kPRED uses the structural information from homologues in preference, if available. The predictions were evaluated rigorously on 15,544 query proteins representing a non-redundant subset of the PDB filtered at 30% sequence identity cut-off. We have shown that the kPRED method was able to achieve mean accuracies ranging from 40.8% to 66.3% depending on the availability of homologues. The impact of the different strategies for scanning the database on the prediction was evaluated and is discussed. Our results highlight the usefulness of the method in the context of proteins without any known structural homologues. A scoring function that gives a good estimate of the accuracy of prediction was further developed. This score estimates very well the accuracy of the algorithm (R2 of 0.82). An online version of the tool is provided freely for non-commercial usage at http://www.bo-protscience.fr/kpred/.

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.

Protein-protein structure prediction by scoring molecular dynamics trajectories of putative poses.

PubMed

Sarti, Edoardo; Gladich, Ivan; Zamuner, Stefano; Correia, Bruno E; Laio, Alessandro

2016-09-01

The prediction of protein-protein interactions and their structural configuration remains a largely unsolved problem. Most of the algorithms aimed at finding the native conformation of a protein complex starting from the structure of its monomers are based on searching the structure corresponding to the global minimum of a suitable scoring function. However, protein complexes are often highly flexible, with mobile side chains and transient contacts due to thermal fluctuations. Flexibility can be neglected if one aims at finding quickly the approximate structure of the native complex, but may play a role in structure refinement, and in discriminating solutions characterized by similar scores. We here benchmark the capability of some state-of-the-art scoring functions (BACH-SixthSense, PIE/PISA and Rosetta) in discriminating finite-temperature ensembles of structures corresponding to the native state and to non-native configurations. We produce the ensembles by running thousands of molecular dynamics simulations in explicit solvent starting from poses generated by rigid docking and optimized in vacuum. We find that while Rosetta outperformed the other two scoring functions in scoring the structures in vacuum, BACH-SixthSense and PIE/PISA perform better in distinguishing near-native ensembles of structures generated by molecular dynamics in explicit solvent. Proteins 2016; 84:1312-1320. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

A sampling-based method for ranking protein structural models by integrating multiple scores and features.

PubMed

Shi, Xiaohu; Zhang, Jingfen; He, Zhiquan; Shang, Yi; Xu, Dong

2011-09-01

One of the major challenges in protein tertiary structure prediction is structure quality assessment. In many cases, protein structure prediction tools generate good structural models, but fail to select the best models from a huge number of candidates as the final output. In this study, we developed a sampling-based machine-learning method to rank protein structural models by integrating multiple scores and features. First, features such as predicted secondary structure, solvent accessibility and residue-residue contact information are integrated by two Radial Basis Function (RBF) models trained from different datasets. Then, the two RBF scores and five selected scoring functions developed by others, i.e., Opus-CA, Opus-PSP, DFIRE, RAPDF, and Cheng Score are synthesized by a sampling method. At last, another integrated RBF model ranks the structural models according to the features of sampling distribution. We tested the proposed method by using two different datasets, including the CASP server prediction models of all CASP8 targets and a set of models generated by our in-house software MUFOLD. The test result shows that our method outperforms any individual scoring function on both best model selection, and overall correlation between the predicted ranking and the actual ranking of structural quality.

Exploratory Factor Analyses of the CAHPS® Hospital Pilot Survey Responses across and within Medical, Surgical, and Obstetric Services

PubMed Central

O'Malley, A James; Zaslavsky, Alan M; Hays, Ron D; Hepner, Kimberly A; Keller, San; Cleary, Paul D

2005-01-01

Objectives To estimate the associations among hospital-level scores from the Consumer Assessments of Healthcare Providers and Systems (CAHPS®) Hospital pilot survey within and across different services (surgery, obstetrics, medical), and to evaluate differences between hospital- and patient-level analyses. Data Source CAHPS Hospital pilot survey data provided by the Centers for Medicare and Medicaid Services. Study Design Responses to 33 questionnaire items were analyzed using patient- and hospital-level exploratory factor analytic (EFA) methods to identify both a patient-level and hospital-level composite structures for the CAHPS Hospital survey. The latter EFA was corrected for patient-level sampling variability using a hierarchical model. We compared results of these analyses with each other and to separate EFAs conducted at the service level. To quantify the similarity of assessments across services, we compared correlations of different composites within the same service with those of the same composite across different services. Data Collection Cross-sectional data were collected during the summer of 2003 via mail and telephone from 19,720 patients discharged from November 2002 through January 2003 from 132 hospitals in three states. Principal Findings Six factors provided the best description of inter-item covariation at the patient level. Analyses that assessed variability across both services and hospitals suggested that three dimensions provide a parsimonious summary of inter-item covariation at the hospital level. Hospital-level factor structures also differed across services; as much variation in quality reports was explained by service as by composite. Conclusions Variability of CAHPS scores across hospitals can be reported parsimoniously using a limited number of composites. There is at least as much distinct information in composite scores from different services as in different composite scores within each service. Because items cluster slightly differently in the different services, service-specific composites may be more informative when comparing patients in a given service across hospitals. When studying individual-level variability, a more differentiated structure is probably more appropriate. PMID:16316439

Effect of concrete slats, three mat types and out-wintering pads on performance and welfare of finishing beef steers.

PubMed

Earley, Bernadette; McNamara, John D; Jerrams, Stephen J; O'Riordan, Edward G

2017-05-30

The objective was to investigate the effect of placing mats on concrete slatted floors on performance, behaviour, hoof condition, dirt scores, physiological and immunological variables of beef steers, and to compare responses with animals on out-wintering pads. Continental crossbred beef steers [n = 360; mean (±SD) initial live weight 539 kg (42.2)] were blocked by breed and live weight and randomly assigned to one of five treatments; (1) Concrete slats alone, (2) Mat 1 (Natural Rubber structure) (Durapak Rubber Products), (3) Mat 2 (Natural rubber structure) (EasyFix), (4) Mat 3 (modified ethylene vinyl acetate (EVA) foam structure) and (5) Out-wintering pads (OWP's). Animals on the OWPs had a greater (P < 0.05) live weight gain (P < 0.05) compared with the slat and Mat 2 treatments: results for Mat 1 and Mat 3 were the same (P > 0.05) as the other treatments. Animals on the OWPs had reduced lying percentage time compared with all the other treatments. Dry matter (DM) intake was greater for animals on the OWPs compared with all the other treatments. Carcass weight, kill out proportion, carcass fat score, carcass composition score, FCR and physiological responses were similar (P > 0.05) among treatments. No incidence of laminitis was observed among treatments. The number of hoof lesions was greater on all mat types (P < 0.05) compared with concrete slats and OWP treatments. Dirt scores were greater (P < 0.05) for animals on OWPs when measured on days 42, 84, 105, 126 and 150 compared with animals on slats. Under the conditions adopted for the present study, there was no evidence to suggest that animals housed on bare concrete slats were disadvantaged in respect of animal welfare compared with animals housed on other floor types. It is concluded that the welfare of steers was not adversely affected by slats compared with different mat types or OWPs.

Use of an objective structured clinical exam (OSCE) for early identification of communication skills deficits in interns.

PubMed

Goldhamer, Mary Ellen J; Cohen, Amy; Brooks, Michelle; Macklin, Eric A; Co, John Patrick T; Weinstein, Debra

2018-01-01

There is limited information about whether OSCE during GME orientation can identify trainee communication deficits before these become evident via clinical performance evaluations. Ninety-seven interns matriculating to eight residency programs in six specialties at four hospitals participated in a nine-station communication skills OSCE. Ratings were based on the "Kalamazoo, adapted" communication skills checklist. Possible association with intern performance evaluations was assessed by repeated-measures logistic regression and ROC curves were generated. The mean OSCE score was 4.08 ± 0.27 with a range of 3.3-4.6. Baseline OSCE scores were associated with subsequent communication concerns recorded by faculty, based on 1591 evaluations. A 0.1-unit decrease in the OSCE communication score was associated with an 18% higher odds of being identified with a communication concern by faculty evaluation (odds ratio 1.18, 95% CI 1.01-1.36, p = 0.034). ROC curves did not demonstrate a "cut-off" score (AUC= 0.558). Non-faculty evaluators were 3-5 times more likely than faculty evaluators to identify communication deficits, based on 1900 evaluations. Lower OSCE performance was associated with faculty communication concerns on performance evaluations; however, a "cut-off" score was not demonstrated that could identify trainees for potential early intervention. Multi-source evaluation also identified trainees with communication skills deficits.

Prevalence and associated factors of perceived stress among adolescent girls in Nawabshahi City, Pakistan.

PubMed

Parpio, Yasmin

2013-01-01

The aim of this study was to determine the prevalence and associated factors of perceived stress among female adolescent in Nawabshah City, Pakistan. This study was a sub-analysis of a parent research. Analytical cross-sectional design was used to achieve the study objectives. The study population comprised of school-going female adolescents aged 10-16 years resident of Nawabshah City. Perceived Stress Scale (PSS) and structured questionnaire were employed to measure the prevalence and associated factors of stress respectively. Multiple linear regressions were done to determine the predictors contributing to stress among female adolescents by using SPSS-17. The mean (+/- SD) of perceived stress score of the respondents was 27.84 +/- 2.84 with median 28 and the values were ranging from 19-37 scores for female participants. The final model indicated that among adolescents whose fathers are unemployed, the estimated mean score of stress was 0.734 +/- 0.493 higher than adolescents whose fathers are employed. As the number of rooms in the house increased by one, the estimated mean stress score decreases by 0.213 +/- 0.082. Among adolescents whose parents quarrelled, the estimated mean score of stress was 0.158 +/- 0.051 higher than adolescents whom parents did not quarrel. Almost every second female adolescent (58%) reported stress symptoms. The father's unemployment, number of rooms and parental quarrel is associated with risk of stress among female adolescents.

Using Educational Prescriptions to Teach Medical Students Evidence-based Medicine

PubMed Central

Umscheid, Craig A.; Maenner, Matthew J.; Mull, Nikhil; Veesenmeyer, Angela F.; Farrar, John T.; Goldfarb, Stanley; Morrison, Gail; Albanese, Mark A.; Frohna, John G.; Feldstein, David A.

2018-01-01

Purpose To evaluate feasibility and impact of evidence-based medicine (EBM) educational prescriptions (EPs) in medical student clerkships. Methods Students answered clinical questions during clerkships using EPs, which guide learners through the “four As” of EBM. Epidemiology fellows graded EPs using a rubric. Feasibility was assessed using descriptive statistics and student and fellow end-of-study questionnaires, which also measured impact. In addition, for each EP, students reported patient impact. Impact on EBM skills was assessed by change in EP scores over time and scores on an EBM objective structured clinical exam (OSCE) that were compared to controls from the prior year. Results 117 students completed 402 EPs evaluated by 24 fellows. Average score was 7.34/9.00 (SD 1.58). 69 students (59%) and 21 fellows (88%) completed questionnaires. Most students thought EPs improved “Acquiring” and “Appraising.” Almost half thought EPs improved “Asking” and “Applying.” Fellows did not value grading EPs. For 18%of EPs, students reported a “change” or “potential change” in treatment. 56% “confirmed” treatment. EP scores increased by 1.27 (95% CI: 0.81–1.72). There were no differences in OSCE scores between cohorts. Conclusions Integrating EPs into clerkships is feasible and has impact, yet OSCEs were unchanged, and research fellows had limitations as evaluators. PMID:27075864

Comorbidity Structure of Psychological Disorders in the Online e-PASS Data as Predictors of Psychosocial Adjustment Measures: Psychological Distress, Adequate Social Support, Self-Confidence, Quality of Life, and Suicidal Ideation

PubMed Central

Klein, Britt; Meyer, Denny

2014-01-01

Background A relative newcomer to the field of psychology, e-mental health has been gaining momentum and has been given considerable research attention. Although several aspects of e-mental health have been studied, 1 aspect has yet to receive attention: the structure of comorbidity of psychological disorders and their relationships with measures of psychosocial adjustment including suicidal ideation in online samples. Objective This exploratory study attempted to identify the structure of comorbidity of 21 psychological disorders assessed by an automated online electronic psychological assessment screening system (e-PASS). The resulting comorbidity factor scores were then used to assess the association between comorbidity factor scores and measures of psychosocial adjustments (ie, psychological distress, suicidal ideation, adequate social support, self-confidence in dealing with mental health issues, and quality of life). Methods A total of 13,414 participants were assessed using a complex online algorithm that resulted in primary and secondary Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) diagnoses for 21 psychological disorders on dimensional severity scales. The scores on these severity scales were used in a principal component analysis (PCA) and the resulting comorbidity factor scores were related to 4 measures of psychosocial adjustments. Results A PCA based on 17 of the 21 psychological disorders resulted in a 4-factor model of comorbidity: anxiety-depression consisting of all anxiety disorders, major depressive episode (MDE), and insomnia; substance abuse consisting of alcohol and drug abuse and dependency; body image–eating consisting of eating disorders, body dysmorphic disorder, and obsessive-compulsive disorders; depression–sleep problems consisting of MDE, insomnia, and hypersomnia. All comorbidity factor scores were significantly associated with psychosocial measures of adjustment (P<.001). They were positively related to psychological distress and suicidal ideation, but negatively related to adequate social support, self-confidence, and quality of life. Conclusions This exploratory study identified 4 comorbidity factors in the e-PASS data and these factor scores significantly predicted 5 psychosocial adjustment measures. Trial Registration Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG). PMID:25351885

Outcomes of Individualized Formative Assessments in a Pharmacy Skills Laboratory.

PubMed

Gums, Tyler Harris; Kleppinger, Erika L; Urick, Benjamin Y

2014-11-15

To determine the effectiveness of an individualized teaching method in a pharmacy skills laboratory. All third-year students enrolled in an Accreditation Council for Pharmacy Education (ACPE) accredited doctor of pharmacy program (n=150) received an individual formative assessment from clinical pharmacists on communication skills and clinical competency after the students counseled standardized mock glaucoma patients during a laboratory focused on alternative dosing formulations. Objective structured clinical examination (OSCE) scores for this station from the 2012 and 2013 classes were compared before and after the intervention. Ophthalmic OSCE station scores were higher after the individual formative feedback intervention. Students in 2013 had a mean score of 83.2 ± 8.3% compared to a mean of 74.3 ± 12.9% in 2012 for this OSCE station. The percentage of students receiving an "A" on the OSCE station increased from 8.1% to 31.3% after the intervention. Individualized formative teaching methods benefited students in both their communication skills and clinical assessment. Future research should focus on wider implementation and overcoming obstacles, such as increased facilitator needs.

[Teaching Bioethics to Students of Medicine with Problem-Based Learning (PBL)].

PubMed

Bosch-Barrera, Joaquim; Briceño García, Hugo C; Capella, Dolors; De Castro Vila, Carmen; Farrés, Ramón; Quintanas, Anna; Ramis, Josep; Roca, Rosa; Brunet, Joan

2015-01-01

We present the experience of the introduction of the subject of bioethics in a medical school in order to give to the 73 students of 5th degree skills to handle ethical conflicts in their practice. The main teaching method used was problem-based learning (PBL). Skills objectives are described. The course was structured with a theoretical seminar (2 hours of duration), a workshop (2 hours of duration), 4 cases of PBL (24 hours of duration in total) and a role playing workshop (2 hours of duration). The seminar was aimed at the acquisition of theoretical knowledge. The PBL cases provided critical appraisal, obtaining knowledge, and application. The Role Playing set out for the practical demonstration of skills acquired in a simulated environment. A continuous assessment of students was performed throughout their practice on the PBL cases (40% of the final score) and also a final evaluation of the course was carried out via exam (60% of the final score). Students completed a course and faculty evaluation anonymously, which came out with positive results (median score of 8.5/10).

Catering to millennial learners: assessing and improving fine-needle aspiration performance.

PubMed

Rowse, Phillip G; Ruparel, Raaj K; AlJamal, Yazan N; Abdelsattar, Jad M; Heller, Stephanie F; Farley, David R

2014-01-01

Fine-needle aspiration (FNA) of a palpable cervical lymph node is a straightforward procedure that should be safely performed by educated general surgery (GS) trainees. Retention of technical skill is suspect, unless sequential learning experiences are provided. However, voluntary learning experiences are no guarantee that trainees will actually use the resource. A 3-minute objective structured assessment of technical skill-type station was created to assess GS trainee performance using FNA. Objective criteria were developed and a checklist was generated (perfect score = 24). Following abysmal performance of 11 postgraduate year (PGY)-4 trainees on the FNA station of our semiannual surgical skills assessment ("X-Games"), we provided all GS residents with electronic access to a 90-second YouTube video clip demonstrating proper FNA technique. PGY-2 (n = 11) and PGY-3 (n = 10) residents subsequently were tested on FNA technique 5 and 12 days later, respectively. All 32 trainees completed the station in less than 3 minutes. Overall scores ranged from 4 to 24 (mean = 14.9). PGY-4 residents assessed before the creation of the video clip scored lowest (range: 4-18, mean = 11.4). PGY-3 residents (range: 10-22, mean = 17.8) and PGY-2 residents (range: 10-24, mean = 15.8) subsequently scored higher (p < 0.05). Ten residents admitted watching the 90-second FNA video clip and scored higher (mean = 21.7) than the 11 residents that admitted they did not watch the clip (mean = 13.1, p < 0.001). Of the 11 trainees who did not watch the video, 6 claimed they did not have time, and 5 felt it would not be useful to them. Overall performance of FNA was poor in 32 midlevel GS residents. However, a 90-second video clip demonstrating proper FNA technique viewed less than 2 weeks before the examination significantly elevated scores. Half of trainees given the chance to learn online did not take the opportunity to view the video clip. Although preemptive learning is effective, future efforts should attempt to improve self-directed learning habits of trainees and evaluate actual long-term skill retention. Copyright © 2014. Published by Elsevier Inc.

Association Between Undergraduate Performance Predictors and Academic and Clinical Performance of Osteopathic Medical Students.

PubMed

Agahi, Farshad; Speicher, Mark R; Cisek, Grace

2018-02-01

Medical schools use a variety of preadmission indices to select potential students. These indices generally include undergraduate grade point average (GPA), Medical College Admission Test (MCAT) scores, and preadmission interviews. To investigate whether the admission indices used by Midwestern University Arizona College of Osteopathic Medicine are associated with the academic and clinical performance of their students. Associations between the prematriculation variables of undergraduate science GPA, undergraduate total GPA, MCAT component scores, and interview scores and the academic and clinical variables of the first- and second-year medical school GPA, Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Level 1 and Level 2-Cognitive Evaluation (CE) total and discipline scores, scores in clinical rotations for osteopathic competencies, COMLEX-USA Level 2-Performance Evaluation passage, and match status were evaluated. Two-tailed Pearson product-moment correlations with a Bonferroni adjustment were used to examine these relationships. The traditional predictors of science and total undergraduate GPA as well as total and component MCAT scores had small to moderate associations with first- and second-year GPA, as well as COMLEX-USA Level 1 and Level 2-CE total scores. Of all predictors, only the MCAT biological sciences score had a statistically significant correlation with failure of the COMLEX-USA Level 2-Performance Evaluation examination (P=.009). Average interview scores were associated only with the osteopathic competency of medical knowledge (r=0.233; n=209; P=.001), as assessed by clerkship preceptors. No predictors were associated with scores in objective structured clinical encounters or with failing to match to a residency position. The data indicate that traditional predictors of academic performance (undergraduate GPA, undergraduate science GPA, and MCAT scores) have small to moderate association with medical school grades and performance on COMLEX-USA Level 1 and Level 2-CE. This finding requires additional research into the value of the interview in the medical school admissions process and the availability of alternatives that allow better prediction and assessment of applicant performance.

Measurement of COPD Severity Using a Survey-Based Score

PubMed Central

Omachi, Theodore A.; Katz, Patricia P.; Yelin, Edward H.; Iribarren, Carlos; Blanc, Paul D.

2010-01-01

Background: A comprehensive survey-based COPD severity score has usefulness for epidemiologic and health outcomes research. We previously developed and validated the survey-based COPD Severity Score without using lung function or other physiologic measurements. In this study, we aimed to further validate the severity score in a different COPD cohort and using a combination of patient-reported and objective physiologic measurements. Methods: Using data from the Function, Living, Outcomes, and Work cohort study of COPD, we evaluated the concurrent and predictive validity of the COPD Severity Score among 1,202 subjects. The survey instrument is a 35-point score based on symptoms, medication and oxygen use, and prior hospitalization or intubation for COPD. Subjects were systemically assessed using structured telephone survey, spirometry, and 6-min walk testing. Results: We found evidence to support concurrent validity of the score. Higher COPD Severity Score values were associated with poorer FEV1 (r = −0.38), FEV1% predicted (r = −0.40), Body mass, Obstruction, Dyspnea, Exercise Index (r = 0.57), and distance walked in 6 min (r = −0.43) (P < .0001 in all cases). Greater COPD severity was also related to poorer generic physical health status (r = −0.49) and disease-specific health-related quality of life (r = 0.57) (P < .0001). The score also demonstrated predictive validity. It was also associated with a greater prospective risk of acute exacerbation of COPD defined as ED visits (hazard ratio [HR], 1.31; 95% CI, 1.24-1.39), hospitalizations (HR, 1.59; 95% CI, 1.44-1.75), and either measure of hospital-based care for COPD (HR, 1.34; 95% CI, 1.26-1.41) (P < .0001 in all cases). Conclusion: The COPD Severity Score is a valid survey-based measure of disease-specific severity, both in terms of concurrent and predictive validity. The score is a psychometrically sound instrument for use in epidemiologic and outcomes research in COPD. PMID:20040611

Knowledge and practice of patients with diabetes mellitus in Lebanon: a cross-sectional study.

PubMed

Karaoui, Lamis R; Deeb, Mary E; Nasser, Layal; Hallit, Souheil

2018-04-20

The objective of this study was to assess the knowledge and practice of Lebanese patients living with diabetes mellitus in regards to their diabetes self- management. A cross-sectional study, conducted between January and June 2015, enrolled 207 urban adult patients with diabetes mellitus from community pharmacies while purchasing their diabetes medications. Their knowledge and self-management practices were assessed using a structured anonymous interview survey questionnaire. The mean age of the participants was 60.2 ± 15.5 years, and the Male/Female ratio was 1.38. The mean knowledge score was 2.34 ± 0.88 points (out of 6). Very few participants (17.4%) knew their current medication side effects. The mean practice score was 5.86 ± 1.77 points (out of 8). Only 15.9% of patients reported current physical activity. A multiple linear analysis showed that those with a university degree had a significantly higher knowledge (Beta = 0.448, p = 0.001) and practice score (Beta = 0.523 p = 0.047) than those with intermediate or primary schooling. Those who reported following a special diabetes diet had a higher knowledge score (Beta = 0.482, p < 0.001) than those who did not. Knowledge score and practice score were highly correlated (Beta = 0.844, p < 0.001). There was no significant differential by gender and age for knowledge and practice scores. The knowledge and practice scores of patients with diabetes mellitus were not satisfactory. Well-targeted interventions are needed, such as improving the communication between the pharmacist and people living with diabetes. The observed low adherence to physical exercise among patients with diabetes should also be addressed.

A Method for Reducing Misclassification in the Extended Glasgow Outcome Score

PubMed Central

Marmarou, Anthony; Lapane, Kate; Turf, Elizabeth; Wilson, Lindsay

2010-01-01

Abstract 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 (κ) statistics. Groups 2 and 3 without central review yielded inter-rater agreements of 83% (weighted κ = 0.81; 95% CI 0.69, 0.92) and 83% (weighted κ = 0.76, 95% CI 0.63, 0.89), respectively, in GOS scores. In GOSE, the groups had an agreement of 76% (weighted κ = 0.79; 95% CI 0.69, 0.89), and 63% (weighted κ = 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 κ = 0.95; 95% CI 0.89, 1.00), and GOSE (97%; weighted κ = 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. PMID:20334503

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

Analysis of eHealth Search Perspectives Among Female College Students in the Health Professions Using Q Methodology

PubMed Central

Hanik, Bruce; Chaney, J. Don; Tennant, Bethany

2012-01-01

Background The current “Millennial Generation” of college students majoring in the health professions has unprecedented access to the Internet. Although some research has been initiated among medical professionals to investigate the cognitive basis for health information searches on the Internet, little is known about Internet search practices among health and medical professional students. Objective To systematically identify health professional college student perspectives of personal eHealth search practices. Methods Q methodology was used to examine subjective perspectives regarding personal eHealth search practices among allied health students majoring in a health education degree program. Thirteen (n = 13) undergraduate students were interviewed about their attitudes and experiences conducting eHealth searches. From the interviews, 36 statements were used in a structured ranking task to identify clusters and determine which specific perceptions of eHealth search practices discriminated students into different groups. Scores on an objective measure of eHealth literacy were used to help categorize participant perspectives. Results Q-technique factor analysis of the rankings identified 3 clusters of respondents with differing views on eHealth searches that generally coincided with participants’ objective eHealth literacy scores. The proficient resourceful students (pattern/structure coefficient range 0.56-0.80) described themselves as using multiple resources to obtain eHealth information, as opposed to simply relying on Internet search engines. The intermediate reluctant students (pattern/structure coefficient range 0.75-0.90) reported engaging only Internet search engines to locate eHealth information, citing undeveloped evaluation skills when considering sources of information located on the Internet. Both groups of advanced students reported not knowing how to use Boolean operators to conduct Internet health searches. The basic hubristic students (pattern/structure coefficient range 0.54-0.76) described themselves as independent procrastinators when searching for eHealth information. Interestingly, basic hubristic students represented the only cluster of participants to describe themselves as (1) having received instruction on using the Internet to conduct eHealth searches, and (2) possessing relative confidence when completing a search task. Conclusions Subjective perspectives of eHealth search practices differed among students possessing different levels of eHealth literacy. These multiple perspectives present both challenges and opportunities for empowering college students in the health professions to use the Internet to obtain and appraise evidence-based health information using the Internet. PMID:22543437

Ensemble-based evaluation for protein structure models.

PubMed

Jamroz, Michal; Kolinski, Andrzej; Kihara, Daisuke

2016-06-15

Comparing protein tertiary structures is a fundamental procedure in structural biology and protein bioinformatics. Structure comparison is important particularly for evaluating computational protein structure models. Most of the model structure evaluation methods perform rigid body superimposition of a structure model to its crystal structure and measure the difference of the corresponding residue or atom positions between them. However, these methods neglect intrinsic flexibility of proteins by treating the native structure as a rigid molecule. Because different parts of proteins have different levels of flexibility, for example, exposed loop regions are usually more flexible than the core region of a protein structure, disagreement of a model to the native needs to be evaluated differently depending on the flexibility of residues in a protein. We propose a score named FlexScore for comparing protein structures that consider flexibility of each residue in the native state of proteins. Flexibility information may be extracted from experiments such as NMR or molecular dynamics simulation. FlexScore considers an ensemble of conformations of a protein described as a multivariate Gaussian distribution of atomic displacements and compares a query computational model with the ensemble. We compare FlexScore with other commonly used structure similarity scores over various examples. FlexScore agrees with experts' intuitive assessment of computational models and provides information of practical usefulness of models. https://bitbucket.org/mjamroz/flexscore dkihara@purdue.edu Supplementary data are available at Bioinformatics online. © The Author 2016. Published by Oxford University Press.

Ensemble-based evaluation for protein structure models

PubMed Central

Jamroz, Michal; Kolinski, Andrzej; Kihara, Daisuke

2016-01-01

Motivation: Comparing protein tertiary structures is a fundamental procedure in structural biology and protein bioinformatics. Structure comparison is important particularly for evaluating computational protein structure models. Most of the model structure evaluation methods perform rigid body superimposition of a structure model to its crystal structure and measure the difference of the corresponding residue or atom positions between them. However, these methods neglect intrinsic flexibility of proteins by treating the native structure as a rigid molecule. Because different parts of proteins have different levels of flexibility, for example, exposed loop regions are usually more flexible than the core region of a protein structure, disagreement of a model to the native needs to be evaluated differently depending on the flexibility of residues in a protein. Results: We propose a score named FlexScore for comparing protein structures that consider flexibility of each residue in the native state of proteins. Flexibility information may be extracted from experiments such as NMR or molecular dynamics simulation. FlexScore considers an ensemble of conformations of a protein described as a multivariate Gaussian distribution of atomic displacements and compares a query computational model with the ensemble. We compare FlexScore with other commonly used structure similarity scores over various examples. FlexScore agrees with experts’ intuitive assessment of computational models and provides information of practical usefulness of models. Availability and implementation: https://bitbucket.org/mjamroz/flexscore Contact: dkihara@purdue.edu Supplementary information: Supplementary data are available at Bioinformatics online. PMID:27307633

A robust fingerprint matching algorithm based on compatibility of star structures

NASA Astrophysics Data System (ADS)

Cao, Jia; Feng, Jufu

2009-10-01

In fingerprint verification or identification systems, most minutiae-based matching algorithms suffered from the problems of non-linear distortion and missing or faking minutiae. Local structures such as triangle or k-nearest structure are widely used to reduce the impact of non-linear distortion, but are suffered from missing and faking minutiae. In our proposed method, star structure is used to present local structure. A star structure contains various number of minutiae, thus, it is more robust with missing and faking minutiae. Our method consists of four steps: 1) Constructing star structures at minutia level; 2) Computing similarity score for each structure pair, and eliminating impostor matched pairs which have the low scores. As it is generally assumed that there is only linear distortion in local area, the similarity is defined by rotation and shifting. 3) Voting for remained matched pairs according to the compatibility between them, and eliminating impostor matched pairs which gain few votes. The concept of compatibility is first introduced by Yansong Feng [4], the original definition is only based on triangles. We define the compatibility for star structures to adjust to our proposed algorithm. 4) Computing the matching score, based on the number of matched structures and their voting scores. The score also reflects the fact that, it should get higher score if minutiae match in more intensive areas. Experiments evaluated on FVC 2004 show both effectiveness and efficiency of our methods.

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.

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…

Audiologic features of Norrie disease.

PubMed

Halpin, Chris; Owen, Grace; Gutiérrez-Espeleta, Gustavo A; Sims, Katherine; Rehm, Heidi L

2005-07-01

Norrie disease is an X-linked recessive disorder in which patients are born blind and develop sensory hearing loss in adolescence. The hearing loss associated with Norrie disease has been shown in a genetically altered knockout mouse to involve dysfunction of the stria vascularis; most other structures are preserved until the later stages of the disease. The objective of this study was to characterize the audiologic phenotype of Norrie disease for comparison with the pathophysiologic mechanism. The design combined two series of clinical audiologic evaluations, with special attention to speech intelligibility. The audiologic results for 12 affected individuals and 10 carriers show that patients with Norrie disease retain high speech intelligibility scores even when the threshold loss is severe. The cochlear mechanism-- failure of the stria vascularis-- accounts for some of the higher values in the wide distribution of speech scores in cases with similar pure tone audiograms.

Retention of drug administration skills after intensive teaching.

PubMed

Wheeler, D W; Degnan, B A; Murray, L J; Dunling, C P; Whittlestone, K D; Wood, D F; Smith, H L; Gupta, A K

2008-04-01

We have identified deficiencies in medical students' drug administration skills, and we attempted to address them with interactive online teaching modules and simulated critical incident scenarios. Short-term improvements have been evident with this intensive effort, but medium-term retention of skills has not been measured. A drug administration lecture, an online module and a simulated emergency scenario were offered to final year clinical students. None of the teaching was compulsory but participation was recorded, along with students' simulator performances and marks in an objective structured practical examination 9 months later. A poor simulator score predicted a poor performance in the later examination. Participation in the simulated scenario only significantly improved examination scores when supplemented by online teaching (p = 0.002). Intensive drug administration teaching using an online module and high fidelity simulation improves drug administration skills in the medium term. Students found simulation much more engaging than online teaching.

Versatile and declarative dynamic programming using pair algebras.

PubMed

Steffen, Peter; Giegerich, Robert

2005-09-12

Dynamic programming is a widely used programming technique in bioinformatics. In sharp contrast to the simplicity of textbook examples, implementing a dynamic programming algorithm for a novel and non-trivial application is a tedious and error prone task. The algebraic dynamic programming approach seeks to alleviate this situation by clearly separating the dynamic programming recurrences and scoring schemes. Based on this programming style, we introduce a generic product operation of scoring schemes. This leads to a remarkable variety of applications, allowing us to achieve optimizations under multiple objective functions, alternative solutions and backtracing, holistic search space analysis, ambiguity checking, and more, without additional programming effort. We demonstrate the method on several applications for RNA secondary structure prediction. The product operation as introduced here adds a significant amount of flexibility to dynamic programming. It provides a versatile testbed for the development of new algorithmic ideas, which can immediately be put to practice.

Women in surgery: a survey in Switzerland.

PubMed

Kaderli, Reto; Guller, Ulrich; Muff, Brigitte; Stefenelli, Ulrich; Businger, Adrian

2010-11-01

An increasing proportion of women work in medicine; however, only few choose surgical specialties. The objective of this study was to analyze the current situation of female surgeons and surgical residents in Switzerland concerning their personal and professional fulfillment. Of 318 female surgeons and surgical residents included in our study, 189 (59.4%) returned the anonymous questionnaire. Mentor-mentee relationships were mentioned by 110 (58.2%) of the 189 respondents. On the basis of a 7-point Likert scale, these women responded that they were moderately satisfied with their professional (mean score [SD], 2.7 [1.3]) and personal (mean score [SD], 3.0 [1.7]) lives. Of the 189 respondents, 113 (59.8%) mentioned that they felt underappreciated. The most important ways suggested for increasing the attractiveness of a surgical career for women were a reduction in workload (49 respondents [25.9%]), more flexible working hours (38 respondents [20.1%]), and better structured residency programs (23 respondents [12.2%]).

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.

Use of a formal assessment instrument for evaluation of resident operative skills in pediatric neurosurgery.

PubMed

Hadley, Caroline; Lam, Sandi K; Briceño, Valentina; Luerssen, Thomas G; Jea, Andrew

2015-08-28

OBJECT Currently there is no standardized tool for assessment of neurosurgical resident performance in the operating room. In light of enhanced requirements issued by the Accreditation Council for Graduate Medical Education's Milestone Project and the Matrix Curriculum Project from the Society of Neurological Surgeons, the implementation of such a tool seems essential for objective evaluation of resident competence. Beyond compliance with governing body guidelines, objective assessment tools may be useful to direct early intervention for trainees performing below the level of their peers so that they may be given more hands-on teaching, while strong residents can be encouraged by faculty members to progress to conducting operations more independently with passive supervision. The aims of this study were to implement a validated assessment tool for evaluation of operative skills in pediatric neurosurgery and determine its feasibility and reliability. METHODS All neurosurgery residents completing their pediatric rotation over a 6-month period from January 1, 2014, to June 30, 2014, at the authors' institution were enrolled in this study. For each procedure, residents were evaluated by means of a form, with one copy being completed by the resident and a separate copy being completed by the attending surgeon. The evaluation form was based on the validated Objective Structured Assessment of Technical Skills for Surgery (OSATS) and used a 5-point Likert-type scale with 7 categories: respect for tissue; time and motion; instrument handling; knowledge of instruments; flow of operation; use of assistants; and knowledge of specific procedure. Data were then stratified by faculty versus resident (self-) assessment; postgraduate year level; and difficulty of procedure. Descriptive statistics (means and SDs) were calculated, and the results were compared using the Wilcoxon signed-rank test and Student t-test. A p value < 0.05 was considered statistically significant. RESULTS Six faculty members, 1 fellow, and 8 residents completed evaluations for 299 procedures, including 32 ventriculoperitoneal (VP) shunt revisions, 23 VP shunt placements, 19 endoscopic third ventriculostomies, and 18 craniotomies for tumor resection. There was no significant difference between faculty and resident self-assessment scores overall or in any of the 7 domains scores for each of the involved residents. On self-assessment, senior residents scored themselves significantly higher (p < 0.02) than junior residents overall and in all domains except for "time and motion." Faculty members scored senior residents significantly higher than junior residents only for the "knowledge of instruments" domain (p = 0.05). When procedure difficulty was considered, senior residents' scores from faculty members were significantly higher (p = 0.04) than the scores given to junior residents for expert procedures only. Senior residents' self-evaluation scores were significantly higher than those of junior residents for both expert (p = 0.03) and novice (p = 0.006) procedures. CONCLUSIONS OSATS is a feasible and reliable assessment tool for the comprehensive evaluation of neurosurgery resident performance in the operating room. The authors plan to use this tool to assess resident operative skill development and to improve direct resident feedback.

Quantifying the impact of standardized assessment and symptom management tools on symptoms associated with cancer-induced anorexia cachexia syndrome.

PubMed

Andrew, Inga M; Waterfield, Kerry; Hildreth, Anthony J; Kirkpatrick, Graeme; Hawkins, Colette

2009-12-01

The objective of this study was to quantify the impact of standardized assessment and management tools on patient symptom scores in cancer-induced anorexia cachexia syndrome (ACS) using a within-group study design. Baseline assessments included the Patient Generated Subjective Global Assessment (PG-SGA) tool and an amended Symptoms and Concerns Checklist (SCC). Symptom management strategies, written for this project, were instigated. Follow-up SCC scores were collected at 2 and 4 weeks. Forty out of 79 patients referred were recruited; 29/79 (36.7%) were too unwell or had died prior to consent. At baseline, the PG-SGA tool revealed 250 active symptoms associated with ACS. Total PG-SGA score was above 9 for all patients. Predominant interventions involved simple dietary advice and prescription of artificial saliva, mouthwash and prokinetic antiemetics. Median total SCC score improved sequentially from 11 at baseline, to 7 and 4 at first and second review, respectively (visit 1 to 2, p = 0.001; visit 1 to 3, p < 0.001; and visit 2 to 3, p = 0.02). We conclude that patients with ACS are recognised late in their disease and have a considerable burden of active symptoms. A structured approach to assessment and management has a significant impact on symptom burden.

Treatment adherence in heart failure patients followed up by nurses in two specialized clinics

PubMed Central

da Silva, Andressa Freitas; Cavalcanti, Ana Carla Dantas; Malta, Mauricio; Arruda, Cristina Silva; Gandin, Thamires; da Fé, Adriana; Rabelo-Silva, Eneida Rejane

2015-01-01

Objectives: to analyze treatment adherence in heart failure (HF) patients followed up by the nursing staff at specialized clinics and its association with patients' characteristics such as number of previous appointments, family structure, and comorbidities. Methods: a cross-sectional study was conducted at two reference clinics for the treatment of HF patients (center 1 and center 2). Data were obtained using a 10-item questionnaire with scores ranging from 0 to 26 points; adherence was considered adequate if the score was ≥ 18 points, or 70% of adherence. Results: a total of 340 patients were included. Mean adherence score was 16 (±4) points. Additionally, 124 (36.5%) patients showed an adherence rate ≥ 70%. It was demonstrated that patients who lived with their family had higher adherence scores, that three or more previous nursing appointments was significantly associated with higher adherence (p<0.001), and that hypertension was associated with low adherence (p=0.023). Conclusions: treatment adherence was considered satisfactory in less than a half of the patients followed up at the two clinics specialized in HF. Living with the family and attending to a great number of nursing appointments improved adherence, while the presence of hypertension led to worse adherence. PMID:26487139

Limited Effectiveness of a Skills and Drills Intervention to Improve Emergency Obstetric and Newborn Care in Karnataka, India: A Proof-of-Concept Study.

PubMed

Varghese, Beena; Krishnamurthy, Jayanna; Correia, Blaze; Panigrahi, Ruchika; Washington, Maryann; Ponnuswamy, Vinotha; Mony, Prem

2016-12-23

The majority of the maternal and perinatal deaths are preventable through improved emergency obstetric and newborn care at facilities. However, the quality of such care in India has significant gaps in terms of provider skills and in their preparedness to handle emergencies. We tested the feasibility, acceptability, and effectiveness of a "skills and drills" intervention, implemented between July 2013 and September 2014, to improve emergency obstetric and newborn care in the state of Karnataka, India. Emergency drills through role play, conducted every 2 months, combined with supportive supervision and a 2-day skills refresher session were delivered across 4 sub-district, secondary-level government facilities by an external team of obstetric and pediatric specialists and nurses. We evaluated the intervention through a quasi-experimental design with 4 intervention and 4 comparison facilities, using delivery case sheet reviews, pre- and post-knowledge tests among providers, objective structured clinical examinations (OSCEs), and qualitative in-depth interviews. Primary outcomes consisted of improved diagnosis and management of selected maternal and newborn complications (postpartum hemorrhage, pregnancy-induced hypertension, and birth asphyxia). Secondary outcomes included knowledge and skill levels of providers and acceptability and feasibility of the intervention. Knowledge scores among providers improved significantly in the intervention facilities; in obstetrics, average scores between the pre- and post-test increased from 49% to 57% (P=.006) and in newborn care, scores increased from 48% to 56% (P=.03). Knowledge scores in the comparison facilities were similar but did not improve significantly over time. Skill levels were significantly higher among providers in intervention facilities than comparison facilities (mean objective structured clinical examination scores for obstetric skills: 55% vs. 46%, respectively; for newborn skills: 58% vs. 48%, respectively; P<.001 for both obstetric and newborn), along with their confidence in managing complications. However, this did not result in significant differences in correct diagnosis and management of complications between intervention and comparison facilities. Shortage of trained nurses and doctors along with unavailability of a consistent supply chain was cited by most providers as major health systems barriers affecting provision of care. Improvements in knowledge, skills, and confidence levels of providers as a result of the skills and drills intervention was not sufficient to translate into improved diagnosis and management of maternal and newborn complications. System-level changes including adequate in-service training may also be necessary to improve maternal and newborn outcomes. © Varghese et al.

A Comparison of Assessment Tools: Is Direct Observation an Improvement Over Objective Structured Clinical Examinations for Communications Skills Evaluation?

PubMed

Goch, Abraham M; Karia, Raj; Taormina, David; Kalet, Adina; Zuckerman, Joseph; Egol, Kenneth A; Phillips, Donna

2018-04-01

Evaluation of resident physicians' communications skills is a challenging task and is increasingly accomplished with standardized examinations. There exists a need to identify the effective, efficient methods for assessment of communications skills. We compared objective structured clinical examination (OSCE) and direct observation as approaches for assessing resident communications skills. We conducted a retrospective cohort analysis of orthopaedic surgery resident physicians at a single tertiary care academic institution, using the Institute for Healthcare Communication "4 Es" model for effective communication. Data were collected between 2011 and 2015. A total of 28 residents, each with OSCE and complete direct observation assessment checklists, were included in the analysis. Residents were included if they had 1 OSCE assessment and 2 or more complete direct observation assessments. There were 28 of a possible 59 residents (47%) included. A total of 89% (25 of 28) of residents passed the communications skills OSCE; only 54% (15 of 28) of residents passed the direct observation communications assessment. There was a positive, moderate correlation between OSCE and direct observation scores overall ( r  = 0.415, P  = .028). There was no agreement between OSCE and direct observation in categorizing residents into passing and failing scores (κ = 0.205, P  = .16), after adjusting for chance agreement. Our results suggest that OSCE and direct observation tools provide different insights into resident communications skills (simulation of rare and challenging situations versus real-life daily encounters), and may provide useful perspectives on resident communications skills in different contexts.

Teaching Cardiac Examination Skills

PubMed Central

Smith, Christopher A; Hart, Avery S; Sadowski, Laura S; Riddle, Janet; Evans, Arthur T; Clarke, Peter M; Ganschow, Pamela S; Mason, Ellen; Sequeira, Winston; Wang, Yue

2006-01-01

OBJECTIVE To determine if structured teaching of bedside cardiac examination skills improves medical residents' examination technique and their identification of key clinical findings. DESIGN Firm-based single-blinded controlled trial. SETTING Inpatient service at a university-affiliated public teaching hospital. PARTICIPANTS Eighty Internal Medicine residents. METHODS The study assessed 2 intervention groups that received 3-hour bedside teaching sessions during their 4-week rotation using either: (1) a traditional teaching method, “demonstration and practice” (DP) (n=26) or (2) an innovative method, “collaborative discovery” (CD) (n=24). The control group received their usual ward teaching sessions (n=25). The main outcome measures were scores on examination technique and correct identification of key clinical findings on an objective structured clinical examination (OSCE). RESULTS All 3 groups had similar scores for both their examination technique and identification of key findings in the preintervention OSCE. After teaching, both intervention groups significantly improved their technical examination skills compared with the control group. The increase was 10% (95% confidence interval [CI] 4% to 17%) for CD versus control and 12% (95% CI 6% to 19%) for DP versus control (both P<.005) equivalent to an additional 3 to 4 examination skills being correctly performed. Improvement in key findings was limited to a 5% (95% CI 2% to 9%) increase for the CD teaching method, CD versus control P=.046, equivalent to the identification of an additional 2 key clinical findings. CONCLUSIONS Both programs of bedside teaching increase the technical examination skills of residents but improvements in the identification of key clinical findings were modest and only demonstrated with a new method of teaching. PMID:16423116

Development and validation of surgical training tool: cystectomy assessment and surgical evaluation (CASE) for robot-assisted radical cystectomy for men.

PubMed

Hussein, Ahmed A; Sexton, Kevin J; May, Paul R; Meng, Maxwell V; Hosseini, Abolfazl; Eun, Daniel D; Daneshmand, Siamak; Bochner, Bernard H; Peabody, James O; Abaza, Ronney; Skinner, Eila C; Hautmann, Richard E; Guru, Khurshid A

2018-04-13

We aimed to develop a structured scoring tool: cystectomy assessment and surgical evaluation (CASE) that objectively measures and quantifies performance during robot-assisted radical cystectomy (RARC) for men. A multinational 10-surgeon expert panel collaborated towards development and validation of CASE. The critical steps of RARC in men were deconstructed into nine key domains, each assessed by five anchors. Content validation was done utilizing the Delphi methodology. Each anchor was assessed in terms of context, score concordance, and clarity. The content validity index (CVI) was calculated for each aspect. A CVI ≥ 0.75 represented consensus, and this statement was removed from the next round. This process was repeated until consensus was achieved for all statements. CASE was used to assess de-identified videos of RARC to determine reliability and construct validity. Linearly weighted percent agreement was used to assess inter-rater reliability (IRR). A logit model for odds ratio (OR) was used to assess construct validation. The expert panel reached consensus on CASE after four rounds. The final eight domains of the CASE included: pelvic lymph node dissection, development of the peri-ureteral space, lateral pelvic space, anterior rectal space, control of the vascular pedicle, anterior vesical space, control of the dorsal venous complex, and apical dissection. IRR > 0.6 was achieved for all eight domains. Experts outperformed trainees across all domains. We developed and validated a reliable structured, procedure-specific tool for objective evaluation of surgical performance during RARC. CASE may help differentiate novice from expert performances.

Teaching Point-of-Care Lung Ultrasound to Novice Pediatric Learners: Web-Based E-Learning Versus Traditional Classroom Didactic.

PubMed

Soon, Aun Woon; Toney, Amanda Greene; Stidham, Timothy; Kendall, John; Roosevelt, Genie

2018-04-24

To assess whether Web-based teaching is at least as effective as traditional classroom didactic in improving the proficiency of pediatric novice learners in the image acquisition and interpretation of pneumothorax and pleural effusion using point-of-care ultrasound (POCUS). We conducted a randomized controlled noninferiority study comparing the effectiveness of Web-based teaching to traditional classroom didactic. The participants were randomized to either group A (live classroom lecture) or group B (Web-based lecture) and completed a survey and knowledge test. They also received hands-on training and completed an objective structured clinical examination. The participants were invited to return 2 months later to test for retention of knowledge and skills. There were no significant differences in the mean written test scores between the classroom group and Web group for the precourse test (absolute difference, -2.5; 95% confidence interval [CI], -12 to 6.9), postcourse test (absolute difference, 2.0; 95% CI, -1.4, 5.3), and postcourse 2-month retention test (absolute difference, -0.8; 95% CI, -9.6 to 8.1). Similarly, no significant differences were noted in the mean objective structured clinical examination scores for both intervention groups in postcourse (absolute difference, 1.9; 95% CI, -4.7 to 8.5) and 2-month retention (absolute difference, -0.6; 95% CI, -10.7 to 9.5). Web-based teaching is at least as effective as traditional classroom didactic in improving the proficiency of novice learners in POCUS. The usage of Web-based tutorials allows a more efficient use of time and a wider dissemination of knowledge.

Measuring achievement goal motivation, mindsets and cognitive load: validation of three instruments' scores.

PubMed

Cook, David A; Castillo, Richmond M; Gas, Becca; Artino, Anthony R

2017-10-01

Measurement of motivation and cognitive load has potential value in health professions education. Our objective was to evaluate the validity of scores from Dweck's Implicit Theories of Intelligence Scale (ITIS), Elliot's Achievement Goal Questionnaire-Revised (AGQ-R) and Leppink's cognitive load index (CLI). This was a validity study evaluating internal structure using reliability and factor analysis, and relationships with other variables using the multitrait-multimethod matrix. Two hundred and thirty-two secondary school students participated in a medical simulation-based training activity at an academic medical center. Pre-activity ITIS (implicit theory [mindset] domains: incremental, entity) and AGQ-R (achievement goal domains: mastery-approach, mastery-avoidance, performance-approach, performance-avoidance), post-activity CLI (cognitive load domains: intrinsic, extrinsic, germane) and task persistence (self-directed repetitions on a laparoscopic surgery task) were measured. Internal consistency reliability (Cronbach's alpha) was > 0.70 for all domain scores except AGQ-R performance-avoidance (alpha 0.68) and CLI extrinsic load (alpha 0.64). Confirmatory factor analysis of ITIS and CLI scores demonstrated acceptable model fit. Confirmatory factor analysis of AGQ-R scores demonstrated borderline fit, and exploratory factor analysis suggested a three-domain model for achievement goals (mastery-approach, performance and avoidance). Correlations among scores from conceptually-related domains generally aligned with expectations, as follows: ITIS incremental and entity, r = -0.52; AGQ-R mastery-avoidance and performance-avoidance, r = 0.71; mastery-approach and performance-approach, r = 0.55; performance-approach and performance-avoidance, r = 0.43; mastery-approach and mastery-avoidance, r = 0.36; CLI germane and extrinsic, r = -0.35; ITIS incremental and AGQ-R mastery-approach, r = 0.34; ITIS incremental and CLI germane, r = 0.44; AGQ-R mastery-approach and CLI germane, r = 0.48 (all p < 0.001). We found no correlation between the number of task repetitions (i.e. persistence) and mastery-approach scores, r = -0.01. ITIS and CLI scores had appropriate internal structures and relationships with other variables. AGQ-R scores fit a three-factor (not four-factor) model that collapsed avoidance into one domain, although relationships of other variables with the original four domain scores generally aligned with expectations. Mastery goals are positively correlated with germane cognitive load. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Evaluation of 3D-Jury on CASP7 models.

PubMed

Kaján, László; Rychlewski, Leszek

2007-08-21

3D-Jury, the structure prediction consensus method publicly available in the Meta Server http://meta.bioinfo.pl/, was evaluated using models gathered in the 7th round of the Critical Assessment of Techniques for Protein Structure Prediction (CASP7). 3D-Jury is an automated expert process that generates protein structure meta-predictions from sets of models obtained from partner servers. The performance of 3D-Jury was analysed for three aspects. First, we examined the correlation between the 3D-Jury score and a model quality measure: the number of correctly predicted residues. The 3D-Jury score was shown to correlate significantly with the number of correctly predicted residues, the correlation is good enough to be used for prediction. 3D-Jury was also found to improve upon the competing servers' choice of the best structure model in most cases. The value of the 3D-Jury score as a generic reliability measure was also examined. We found that the 3D-Jury score separates bad models from good models better than the reliability score of the original server in 27 cases and falls short of it in only 5 cases out of a total of 38. We report the release of a new Meta Server feature: instant 3D-Jury scoring of uploaded user models. The 3D-Jury score continues to be a good indicator of structural model quality. It also provides a generic reliability score, especially important for models that were not assigned such by the original server. Individual structure modellers can also benefit from the 3D-Jury scoring system by testing their models in the new instant scoring feature http://meta.bioinfo.pl/compare_your_model_example.pl available in the Meta Server.

Evaluation of 3D-Jury on CASP7 models

PubMed Central

Kaján, László; Rychlewski, Leszek

2007-01-01

Background 3D-Jury, the structure prediction consensus method publicly available in the Meta Server , was evaluated using models gathered in the 7th round of the Critical Assessment of Techniques for Protein Structure Prediction (CASP7). 3D-Jury is an automated expert process that generates protein structure meta-predictions from sets of models obtained from partner servers. Results The performance of 3D-Jury was analysed for three aspects. First, we examined the correlation between the 3D-Jury score and a model quality measure: the number of correctly predicted residues. The 3D-Jury score was shown to correlate significantly with the number of correctly predicted residues, the correlation is good enough to be used for prediction. 3D-Jury was also found to improve upon the competing servers' choice of the best structure model in most cases. The value of the 3D-Jury score as a generic reliability measure was also examined. We found that the 3D-Jury score separates bad models from good models better than the reliability score of the original server in 27 cases and falls short of it in only 5 cases out of a total of 38. We report the release of a new Meta Server feature: instant 3D-Jury scoring of uploaded user models. Conclusion The 3D-Jury score continues to be a good indicator of structural model quality. It also provides a generic reliability score, especially important for models that were not assigned such by the original server. Individual structure modellers can also benefit from the 3D-Jury scoring system by testing their models in the new instant scoring feature available in the Meta Server. PMID:17711571

Quantifying Risk of Financial Incapacity and Financial Exploitation in Community-dwelling Older Adults: Utility of a Scoring System for the Lichtenberg Financial Decision-making Rating Scale.

PubMed

Lichtenberg, Peter A; Gross, Evan; Ficker, Lisa J

2018-06-08

This work examines the clinical utility of the scoring system for the Lichtenberg Financial Decision-making Rating Scale (LFDRS) and its usefulness for decision making capacity and financial exploitation. Objective 1 was to examine the clinical utility of a person centered, empirically supported, financial decision making scale. Objective 2 was to determine whether the risk-scoring system created for this rating scale is sufficiently accurate for the use of cutoff scores in cases of decisional capacity and cases of suspected financial exploitation. Objective 3 was to examine whether cognitive decline and decisional impairment predicted suspected financial exploitation. Two hundred independently living, non-demented community-dwelling older adults comprised the sample. Participants completed the rating scale and other cognitive measures. Receiver operating characteristic curves were in the good to excellent range for decisional capacity scoring, and in the fair to good range for financial exploitation. Analyses supported the conceptual link between decision making deficits and risk for exploitation, and supported the use of the risk-scoring system in a community-based population. This study adds to the empirical evidence supporting the use of the rating scale as a clinical tool assessing risk for financial decisional impairment and/or financial exploitation.

Validation of the Headache Impact Test (HIT-6) in patients with chronic migraine.

PubMed

Rendas-Baum, Regina; Yang, Min; Varon, Sepideh F; Bloudek, Lisa M; DeGryse, Ronald E; Kosinski, Mark

2014-08-01

The Headache Impact Test (HIT)-6 was developed and has been validated in patients with various types of headache. The objective of this study was to report the psychometric properties of the HIT-6 among patients with chronic migraine. Data came from two international, multicenter, randomized, double-blind, placebo-controlled clinical trials of chronic migraine patients (N = 1,384) undergoing prophylaxis therapy. Confirmatory factor analysis and differential item functioning (DIF) analysis were used to test the latent structure and cross-cultural comparability of the HIT-6. Reliability, construct validity, and responsiveness were assessed. Two sets of criterion groups were used: (1) 28-day headache frequency: <10, 10-14, and ≥15 days; (2) sample quartiles of the total cumulative hours of headache: <140, 140 to <280, 280 to <420, and ≥420 hours. Two sets of responsiveness categories were defined as reduction of <30%, 30% to <50%, or ≥50% in (1) number of headache days and (2) cumulative hours of headache. Measurement invariance tests supported the stability of the HIT-6 latent structure across studies. DIF analysis supported cross-cultural comparability. Good reliability was observed across studies (Cronbach's α: 0.75-0.92; intraclass correlation coefficient: 0.76-0.80). HIT-6 scores correlated strongly (-0.86 to -0.59) with scores of the Migraine-Specific Quality-of-Life Questionnaire. Analysis of variance indicated that HIT-6 scores discriminated across both types of criterion groups (P<0.001), across studies and time points. HIT-6 change scores were significantly higher in magnitude in groups experiencing greater improvement (P<0.001). All measurement properties were consistently verified across the two studies, supporting the validity of the HIT-6 among chronic migraine patients. NCT00156910 and NCT00168428 on www.ClinicalTrials.gov.

Psychometric Properties of the Child PTSD Checklist in a Community Sample of South African Children and Adolescents

PubMed Central

Boyes, Mark E.; Cluver, Lucie D.; Gardner, Frances

2012-01-01

Objective The current study assessed the basic psychometric properties of the Child PTSD Checklist and examined the structure of symptoms of posttraumatic stress disorder (PTSD) in a large sample of South African youth. Methodology The checklist was completed by 1025 (540 male; 485 female) South African youth (aged between 10 and 19 years). The factor structure of the scale was assessed with a combination of confirmatory and exploratory techniques. Internal consistencies for the full scale and all subscales were evaluated with Cronbach’s alpha and McDonald’s omega. Validity was assessed by comparing PTSD scores obtained by children who had and had not experienced a traumatic event, and by examining associations between total PTSD scores and known correlates of PTSD. Results Scores on the Child PTSD Checklist clearly discriminated between youth who had experienced a traumatic event and those who had not. Internal consistencies for the full scale (and all subscales) were acceptable to good and hypothesized correlations between PTSD, depression, anxiety, somatic symptoms, and age were observed. Two of the reported fit statistics for the tripartite DSM-IV-TR model of PTSD did not meet traditional criteria and further exploratory analyses revealed a four-factor structure (broadly consistent with Simms and colleagues’ Dysphoria Model of PTSD symptoms) which provided a better fit to the observed data. Conclusion Given the continued use of the Child PTSD Checklist in South Africa, findings offer an important first step in establishing the reliability and validity of the checklist for use with South African youth. However, further evaluation of the checklist in South African samples is clearly required before conclusions regarding its use as diagnostic tool in this context can be made. PMID:23056523

Do pedophiles have a weaker identity structure compared with nonsexual offenders?

PubMed

Tardi, M; Van Gijseghem, H

2001-10-01

The aim of this study was to determine whether pedophiles have a weaker identity structure compared with nonsexual offenders. The recruitment process secured the participation of 87 male adult subjects, divided into three groups: 27 pedophiles who abused male victims (X = 38.6 years), 30 pedophiles who abused female victims (X = 35.5 years), 30 nonsexual offenders (X = 29.8 years). The concept of identity was examined on the basis of two factors: body image limits and ego identity. Two objective tests, the Minnesota Multiphasic Personality Inventory (MMPI) and the Ego Identity Scale, and one projective test, the Rorschach scored according to the Fisher and Cleveland method, were used. A multivariate analysis of covariance, at a significance threshold of p < .05, indicated that pedophiles who abused female victims and pedophiles who abused male victims have more fragile body image limits, as measured by the penetration score, and present a higher level of social introversion (Si scale) than do nonsexual offenders. Moreover, pedophiles who abused male victims have a weaker ego (Es scale) than do pedophiles who abused female victims and nonsexual offenders. In other respects, no significant intergroup difference emerged in terms of body image limits as measured by the barrier score and of strength of ego identity (Ego Identity Scale). Conceptual and empirical elements related to body image and ego identity are addressed to shed light on the potential disturbances in the identity of pedophile subjects. These results imply not only that certain impairments exist at the level of the basis structures of the personality, but also that these impairments should be taken into account in formulating a program and devising a therapeutic process for pedophiles.

Environmental structure and competitive scoring advantages in team competitions.

PubMed

Merritt, Sears; Clauset, Aaron

2013-10-29

In most professional sports, playing field structure is kept neutral so that scoring imbalances may be attributed to differences in team skill. It thus remains unknown what impact environmental heterogeneities can have on scoring dynamics or competitive advantages. Applying a novel generative model of scoring dynamics to roughly 10 million team competitions drawn from an online game, we quantify the relationship between the structure within a competition and its scoring dynamics, while controlling the impact of chance. Despite wide structural variations, we observe a common three-phase pattern in the tempo of events. Tempo and balance are highly predictable from a competition's structural features alone and teams exploit environmental heterogeneities for sustained competitive advantage. Surprisingly, the most balanced competitions are associated with specific environmental heterogeneities, not from equally skilled teams. These results shed new light on the design principles of balanced competition, and illustrate the potential of online game data for investigating social dynamics and competition.

Environmental structure and competitive scoring advantages in team competitions

NASA Astrophysics Data System (ADS)

Merritt, Sears; Clauset, Aaron

2013-10-01

In most professional sports, playing field structure is kept neutral so that scoring imbalances may be attributed to differences in team skill. It thus remains unknown what impact environmental heterogeneities can have on scoring dynamics or competitive advantages. Applying a novel generative model of scoring dynamics to roughly 10 million team competitions drawn from an online game, we quantify the relationship between the structure within a competition and its scoring dynamics, while controlling the impact of chance. Despite wide structural variations, we observe a common three-phase pattern in the tempo of events. Tempo and balance are highly predictable from a competition's structural features alone and teams exploit environmental heterogeneities for sustained competitive advantage. Surprisingly, the most balanced competitions are associated with specific environmental heterogeneities, not from equally skilled teams. These results shed new light on the design principles of balanced competition, and illustrate the potential of online game data for investigating social dynamics and competition.

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.

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.

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…

Fundamental Movement Skills Are More than Run, Throw and Catch: The Role of Stability Skills

PubMed Central

Rudd, James R.; Barnett, Lisa M.; Butson, Michael L.; Farrow, Damian; Berry, Jason; Polman, Remco C. J.

2015-01-01

Introduction In motor development literature fundamental movement skills are divided into three constructs: locomotive, object control and stability skills. Most fundamental movement skills research has focused on children’s competency in locomotor and object control skills. The first aim of this study was to validate a test battery to assess the construct of stability skills, in children aged 6 to 10 (M age = 8.2, SD = 1.2). Secondly we assessed how the stability skills construct fitted into a model of fundamental movement skill. Method The Delphi method was used to select the stability skill battery. Confirmatory factor analysis (CFA) was used to assess if the skills loaded onto the same construct and a new model of FMS was developed using structural equation modelling. Results Three postural control tasks were selected (the log roll, rock and back support) because they had good face and content validity. These skills also demonstrated good predictive validity with gymnasts scoring significantly better than children without gymnastic training and children from a high SES school performing better than those from a mid and low SES schools and the mid SES children scored better than the low SES children (all p < .05). Inter rater reliability tests were excellent for all three skills (ICC = 0.81, 0.87, 0.87) as was test re-test reliability (ICC 0.87–0.95). CFA provided good construct validity, and structural equation modelling revealed stability skills to be an independent factor in an overall FMS model which included locomotor (r = .88), object control (r = .76) and stability skills (r = .81). Discussion This study provides a rationale for the inclusion of stability skills in FMS assessment. The stability skills could be used alongside other FMS assessment tools to provide a holistic assessment of children’s fundamental movement skills. PMID:26468644

[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.

Fundamental movement skills among Australian preschool children.

PubMed

Hardy, Louise L; King, Lesley; Farrell, Louise; Macniven, Rona; Howlett, Sarah

2010-09-01

Early childhood is a critical period for the development of fundamental movement skills (FMS). Children who do not master FMS are more likely to experience failure in the motor domain and less likely to participate in sport and games during childhood and adolescence. Studies among primary school aged children report low levels of FMS mastery indicating the need to implement FMS programs during the preschool years. Cross-sectional study of 425 children attending preschools in the Sydney, Australia in 2008. FMS were assessed using the Test of Gross Motor Development-2 including locomotor (run, gallop, hop, horizontal jump) and object control (strike, catch, kick overhand throw) skills. Data were analysed using linear regression and chi-squared analyses. Total locomotor score was higher among girls compared with boys (p<0.00); however only the hop was significantly different (p=0.01). Boys had higher total (p<0.00) and individual object control scores compared with girls, except the catch (p=0.6). The prevalence of mastery differed across each FMS. Girls generally had higher mastery of locomotor skills and boys had higher mastery of object control skills. These findings highlight the need to provide structured opportunities which facilitate children's acquisition of FMS, which may include providing gender separated games, equipment and spaces. That mastery of FMS is low in primary school children indicates the importance of early intervention programs in preschools. Preschools and child care centers hold promise as a key setting for implementing FMS programs.

Minefield reconnaissance and detector system

DOEpatents

Butler, M.T.; Cave, S.P.; Creager, J.D.; Johnson, C.M.; Mathes, J.B.; Smith, K.J.

1994-04-26

A multi-sensor system is described for detecting the presence of objects on the surface of the ground or buried just under the surface, such as anti-personnel or anti-tank mines or the like. A remote sensor platform has a plurality of metal detector sensors and a plurality of short pulse radar sensors. The remote sensor platform is remotely controlled from a processing and control unit and signals from the remote sensor platform are sent to the processing and control unit where they are individually evaluated in separate data analysis subprocess steps to obtain a probability score for each of the pluralities of sensors. These probability scores are combined in a fusion subprocess step by comparing score sets to a probability table which is derived based upon the historical incidence of object present conditions given that score set. A decision making rule is applied to provide an output which is optionally provided to a marker subprocess for controlling a marker device to mark the location of found objects. 7 figures.

Assessment of the Effectiveness of Protected Areas Management in Iran: Case Study in Khojir National Park

NASA Astrophysics Data System (ADS)

Kolahi, Mahdi; Sakai, Tetsuro; Moriya, Kazuyuki; Makhdoum, Majid F.; Koyama, Lina

2013-08-01

The requirement to assess the management effectiveness (ME) in protected areas (PAs) is increasing around the world to help improve management and accountability. An evaluation of ME for Khojir National Park (KNP), one of the Iran's oldest PAs, was conducted using a multi-method approach that consisted of structured interviews, open interviews, and site visits. This was the first ME evaluation in Iran. The structured interview was based on the management effectiveness tracking tool methodology. KNP received an average score of 43 %, which is lower than the global average, illustrating that its general management was in the low-intermediate level. The indices of legal status, resource inventory, planning for land and water use, regulations, and objectives received the highest average scores, whereas education and awareness, community co-management, regular work plan, boundary demarcation, visitor facilities, budget sources, staff training, protection systems, and management plan received the lowest ones. The management system of KNP was generally established, but many problems of the management still need to be resolved. To improve ME, some countermeasures should be taken, such as increasing funding, strengthening capacity building, planning, and adaptive management, and implementing community participation.

The Network Structure Underlying the Earth Observation Assessment

NASA Astrophysics Data System (ADS)

Vitkin, S.; Doane, W. E. J.; Mary, J. C.

2017-12-01

The Earth Observations Assessment (EOA 2016) is a multiyear project designed to assess the effectiveness of civil earth observation data sources (instruments, sensors, models, etc.) on societal benefit areas (SBAs) for the United States. Subject matter experts (SMEs) provided input and scored how data sources inform products, product groups, key objectives, SBA sub-areas, and SBAs in an attempt to quantify the relationships between data sources and SBAs. The resulting data were processed by Integrated Applications Incorporated (IAI) using MITRE's PALMA software to create normalized relative impact scores for each of these relationships. However, PALMA processing obscures the natural network representation of the data. Any network analysis that might identify patterns of interaction among data sources, products, and SBAs is therefore impossible. Collaborating with IAI, we cleaned and recreated a network from the original dataset. Using R and Python we explore the underlying structure of the network and apply frequent itemset mining algorithms to identify groups of data sources and products that interact. We reveal interesting patterns and relationships in the EOA dataset that were not immediately observable from the EOA 2016 report and provide a basis for further exploration of the EOA network dataset.

Evaluation of Disaster Preparedness Based on Simulation Exercises: A Comparison of Two Models.

PubMed

Rüter, Andres; Kurland, Lisa; Gryth, Dan; Murphy, Jason; Rådestad, Monica; Djalali, Ahmadreza

2016-08-01

The objective of this study was to highlight 2 models, the Hospital Incident Command System (HICS) and the Disaster Management Indicator model (DiMI), for evaluating the in-hospital management of a disaster situation through simulation exercises. Two disaster exercises, A and B, with similar scenarios were performed. Both exercises were evaluated with regard to actions, processes, and structures. After the exercises, the results were calculated and compared. In exercise A the HICS model indicated that 32% of the required positions for the immediate phase were taken under consideration with an average performance of 70%. For exercise B, the corresponding scores were 42% and 68%, respectively. According to the DiMI model, the results for exercise A were a score of 68% for management processes and 63% for management structure (staff skills). In B the results were 77% and 86%, respectively. Both models demonstrated acceptable results in relation to previous studies. More research in this area is needed to validate which of these methods best evaluates disaster preparedness based on simulation exercises or whether the methods are complementary and should therefore be used together. (Disaster Med Public Health Preparedness. 2016;10:544-548).

Factor Analysis of the Brazilian Version of UPPS Impulsive Behavior Scale.

PubMed

Sediyama, Cristina Y N; Moura, Ricardo; Garcia, Marina S; da Silva, Antonio G; Soraggi, Carolina; Neves, Fernando S; Albuquerque, Maicon R; Whiteside, Setephen P; Malloy-Diniz, Leandro F

2017-01-01

Objective: To examine the internal consistency and factor structure of the Brazilian adaptation of the UPPS Impulsive Behavior Scale. Methods: UPPS is a self-report scale composed by 40 items assessing four factors of impulsivity: (a) urgency, (b) lack of premeditation; (c) lack of perseverance; (d) sensation seeking. In the present study 384 participants (278 women and 106 men), who were recruited from schools, universities, leisure centers and workplaces fulfilled the UPPS scale. An exploratory factor analysis was performed by using Varimax factor rotation and Kaiser Normalization, and we also conducted two confirmatory analyses to test the independency of the UPPS components found in previous analysis. Results: Results showed a decrease in mean UPPS total scores with age and this analysis showed that the youngest participants (below 30 years) scored significantly higher than the other groups over 30 years. No difference in gender was found. Cronbach's alpha, results indicated satisfactory values for all subscales, with similar high values for the subscales and confirmatory factor analysis indexes also indicated a poor model fit. The results of two exploratory factor analysis were satisfactory. Conclusion: Our results showed that the Portuguese version has the same four-factor structure of the original and previous translations of the UPPS.

Using the Oxford Foot Model to determine the association between objective measures of foot function and results of the AOFAS Ankle-Hindfoot Scale and the Foot Function Index: a prospective gait analysis study in Germany.

PubMed

Kostuj, Tanja; Stief, Felix; Hartmann, Kirsten Anna; Schaper, Katharina; Arabmotlagh, Mohammad; Baums, Mike H; Meurer, Andrea; Krummenauer, Frank; Lieske, Sebastian

2018-04-05

After cross-cultural adaption for the German translation of the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society (AOFAS-AHS) and agreement analysis with the Foot Function Index (FFI-D), the following gait analysis study using the Oxford Foot Model (OFM) was carried out to show which of the two scores better correlates with objective gait dysfunction. Results of the AOFAS-AHS and FFI-D, as well as data from three-dimensional gait analysis were collected from 20 patients with mild to severe ankle and hindfoot pathologies.Kinematic and kinetic gait data were correlated with the results of the total AOFAS scale and FFI-D as well as the results of those items representing hindfoot function in the AOFAS-AHS assessment. With respect to the foot disorders in our patients (osteoarthritis and prearthritic conditions), we correlated the total range of motion (ROM) in the ankle and subtalar joints as identified by the OFM with values identified during clinical examination 'translated' into score values. Furthermore, reduced walking speed, reduced step length and reduced maximum ankle power generation during push-off were taken into account and correlated to gait abnormalities described in the scores. An analysis of correlations with CIs between the FFI-D and the AOFAS-AHS items and the gait parameters was performed by means of the Jonckheere-Terpstra test; furthermore, exploratory factor analysis was applied to identify common information structures and thereby redundancy in the FFI-D and the AOFAS-AHS items. Objective findings for hindfoot disorders, namely a reduced ROM, in the ankle and subtalar joints, respectively, as well as reduced ankle power generation during push-off, showed a better correlation with the AOFAS-AHS total score-as well as AOFAS-AHS items representing ROM in the ankle, subtalar joints and gait function-compared with the FFI-D score.Factor analysis, however, could not identify FFI-D items consistently related to these three indicator parameters (pain, disability and function) found in the AOFAS-AHS. Furthermore, factor analysis did not support stratification of the FFI-D into two subscales. The AOFAS-AHS showed a good agreement with objective gait parameters and is therefore better suited to evaluate disability and functional limitations of patients suffering from foot and ankle pathologies compared with the FFI-D. © 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.

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…

Spanish version of the Time Management Behavior Questionnaire for university students.

PubMed

García-Ros, Rafael; Pérez-González, Francisco

2012-11-01

The main objective of the study is to analyze the psychometric properties and predictive capacity on academic performance in university contexts of a Spanish adaptation of the Time Management Behavior Questionnaire. The scale was applied to 462 students newly admitted at the Universitat de València in the 2006-2007 school year. The analyses performed made it possible to reproduce the factorial structure of the original version of the questionnaire with slight modifications in the ascription of various items. The underlying factorial structure includes four interrelated dimensions (Establishing objectives and priorities, Time management tools, Perception of time control and Preference for disorganization), which present satisfactory levels of reliability and an adequate convergent validity with the Time management subscale of the Motivated Strategies for Learning Questionnaire. The scores on the dimensions of time management show significant levels of association with academic performance in the first year of university studies, especially highlighting the predictive capacity of the subscale dealing with the Establishment of objectives and priorities. These results show the reliability and validity of this adaptation of the scale for evaluating how the students manage their academic time, and predicting their performance in the year they initiate the degree program, thus aiding in the development of intervention proposals directed towards improving these skills.

MRI evidence of structural changes in the sacroiliac joints of patients with non-radiographic axial spondyloarthritis even in the absence of MRI inflammation.

PubMed

Maksymowych, Walter P; Wichuk, Stephanie; Dougados, Maxime; Jones, Heather; Szumski, Annette; Bukowski, Jack F; Marshall, Lisa; Lambert, Robert G

2017-06-06

Studies have shown that structural lesions may be present in patients with non-radiographic axial spondyloarthritis (nr-axSpA). However, the relevance of structural lesions in these patients is unclear, particularly without signs of inflammation on magnetic resonance imaging (MRI). We assessed the presence of structural lesions at baseline on MRI in the sacroiliac joints (SIJ) of patients with nr-axSpA with and without SIJ inflammation on MRI. Bone marrow edema (BME) was assessed on short tau inversion recovery (STIR) scans from 185 patients with nr-axSpA, by two independent readers at baseline using the Spondyloarthritis Research Consortium of Canada (SPARCC) score. Structural lesions were evaluated on T1 weighted spin echo scans, with readers blinded to STIR scans, using the SPARCC MRI SIJ structural score. Disease characteristics and structural lesions were compared in patients with SIJ BME (score ≥2) and without SIJ BME (score <2). Both SIJ BME and structural lesions scores were available for 183 patients; 128/183 (69.9%) patients had SIJ BME scores ≥2 and 55/183 (30.1%) had scores <2. Frequencies of MRI structural lesions in patients with vs without SIJ BME were: erosions (45.3% vs 10.9%, P < 0.001), backfill (20.3% vs 0%, P < 0.001), fat metaplasia (10.9% vs 1.8%, P = 0.04), and ankylosis (2.3% vs 1.8%, P = ns). Significantly more patients with both SIJ BME and structural lesions were male and/or HLA-B27 positive than patients with only SIJ BME. Mean (SD) spinal scores (23 discovertebral units) were significantly higher in patients with SIJ structural lesions than without: 6.5 (11.5) vs 3.3 (5.1), respectively, P = 0.01. In patients with nr-axSpA, SIJ structural lesions, particularly erosions, may be present on MRI when radiographs are normal or inconclusive, even in patients negative for MRI SIJ inflammation. They may reflect more severe disease with greater spinal inflammation. ClinicalTrials.gov, NCT01258738 . Registered on 9 December 2010.

Improvement of the Mair scoring system using structural equations modeling for classifying the diagnostic adequacy of cytology material from thyroid lesions.

PubMed

Kulkarni, H R; Kamal, M M; Arjune, D G

1999-12-01

The scoring system developed by Mair et al. (Acta Cytol 1989;33:809-813) is frequently used to grade the quality of cytology smears. Using a one-factor analytic structural equations model, we demonstrate that the errors in measurement of the parameters used in the Mair scoring system are highly and significantly correlated. We recommend the use of either a multiplicative scoring system, using linear scores, or an additive scoring system, using exponential scores, to correct for the correlated errors. We suggest that the 0, 1, and 2 points used in the Mair scoring system be replaced by 1, 2, and 4, respectively. Using data on fine-needle biopsies of 200 thyroid lesions by both fine-needle aspiration (FNA) and fine-needle capillary sampling (FNC), we demonstrate that our modification of the Mair scoring system is more sensitive and more consistent with the structural equations model. Therefore, we recommend that the modified Mair scoring system be used for classifying the diagnostic adequacy of cytology smears. Diagn. Cytopathol. 1999;21:387-393. Copyright 1999 Wiley-Liss, Inc.

Neuropsychiatry and White Matter Microstructure in Huntington’s Disease

PubMed Central

Gregory, Sarah; Scahill, Rachael I.; Seunarine, Kiran K.; Stopford, Cheryl; Zhang, Hui; Zhang, Jiaying; Orth, Michael; Durr, Alexandra; Roos, Raymund A.C.; Langbehn, Douglas R.; Long, Jeffrey D.; Johnson, Hans; Rees, Geraint; Tabrizi, Sarah J.; Craufurd, David

2015-01-01

Abstract Background: Neuropsychiatric symptoms in Huntington’s disease (HD) are often evident prior to clinical diagnosis. Apathy is highly correlated with disease progression, while depression and irritability occur at different stages of the disease, both before and after clinical onset. Little is understood about the neural bases of these neuropsychiatric symptoms and to what extent those neural bases are analogous to neuropsychiatric disorders in the general population. Objective: We used Diffusion Tensor Imaging (DTI) to investigate structural connectivity between brain regions and any putative microstructural changes associated with depression, apathy and irritability in HD. Methods: DTI data were collected from 39 premanifest and 45 early-HD participants in the Track-HD study and analysed using whole-brain Tract-Based Spatial Statistics. We used regression analyses to identify white matter tracts whose structural integrity (as measured by fractional anisotropy, FA) was correlated with HADS-depression, PBA-apathy or PBA-irritability scores in gene-carriers and related to cumulative probability to onset (CPO). Results: For those with the highest CPO, we found significant correlations between depression scores and reduced FA in the splenium of the corpus callosum. In contrast, those with lowest CPO demonstrated significant correlations between irritability scores and widespread FA reductions. There was no significant relationship between apathy and FA throughout the whole brain. Conclusions: We demonstrate that white matter changes associated with both depression and irritability in HD occur at different stages of disease progression concomitant with their clinical presentation. PMID:26443926

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.

The comparison of the efficiency of traditional lectures to video-supported lectures within the training of the Emergency Medicine residents.

PubMed

Sarıhan, Aydın; Oray, Neşe Colak; Güllüpınar, Birdal; Yanturali, Sedat; Atilla, Ridvan; Musal, Berna

2016-09-01

Recent developments in computer and video technology, multimedia resources enter quickest way possible into medical education and have started to gain popularity. The aim of this study is to evaluate the impact of video-supported lectures on leaning, with comparison to traditional lectures. According to lecture techniques, two separate groups; one is the traditional lectures group (TLG) and the other is video-supported lectures group (VSLG), are formed. While the TLG is offered a traditional lecture the VSLG is offered a video-supported lecture with imbedded videos which are related to the topics in the traditional lecture. Both study groups take pretest and posttest with MCQs (multiple choice questions) and OSCEs (objective structured clinical examination). The study includes 30 volunteer residents in Dokuz Eylul University School of Medicine Department of Emergency Medicine. No difference is observed between TGL and VSLG in pretest and posttest scores (p = 0.949, p = 0.580). And additionally, comparing the scores of both groups, we cannot observe any difference between the pretest OSCE scores of each group (p = 0.300), however posttest OSCE scores shows a dramatic odd in-between (p = 0.010). When pretest MCQs and posttest MCQs mean scores are compared, both tests (TLG, VSLG) has not any significant difference (p=0.949, p = 0.580). Nevertheless, after comparing OSCEs pretest and posttest mean scores, we can see significant difference in mean scores of both (TLG, VSLG), (p = 0.011, p = 0.001). Taken into consideration, the findings of this study shows possibility of improving educational techniques to acquire clinical skills by using local resources and low-cost technology.

A supplemental video teaching tool enhances splinting skills.

PubMed

Mehrpour, Saeed Reza; Aghamirsalim, Mohamadreza; Motamedi, Seyed Mohammad Kalantar; Ardeshir Larijani, Fatemeh; Sorbi, Reza

2013-02-01

The ability to apply casts and splints is a technical skill that requires practice and understanding of basic principles of musculoskeletal medicine. A video in which a given procedure is simulated on a dummy can represent reality under controlled conditions. A decrease in physician competency in musculoskeletal medicine is the result of educational deficiencies at the medical school level. We asked whether (1) a supplemental video educational program enhances performance of medical students' musculoskeletal clinical skills and (2) factors such as the proportion of orthopaedic professors to students, sex, age, and previous scores of medical students affected the clinical skills of medical students. We allocated 474 medical students into one of two groups: all participants received 90 minutes of lecture instruction on how to splint and cast but one group viewed the supplemental instructional video and the other did not. There were no differences in terms of sex, age, basic science exam scores, or grade point average of the groups. Thirteen specific skills in splinting an injured limb were evaluated. We recorded grade point averages. We developed a 10-point scoring system and graded each student on their splinting skills 6 months after the lectures. The medical students who watched the video had an average score of 7.6, whereas the control group's average score was 2.0. We observed a positive association between watching the educational video and clinical exam score. A higher professor-to-student ratio was associated with lower student Objective Structured Clinical Examination score. Our observations suggest a supplemental video instructional program improved the performance of musculoskeletal clinical skills in comparison to only a traditional lecture series.

Self-regulated learning strategies used in surgical clerkship and the relationship with clinical achievement.

PubMed

Turan, Sevgi; Konan, Ali

2012-01-01

Self-regulated learning indicates students' skills in controlling their own learning. Self-regulated learning, which a context-specific process, emphasizes autonomy and control. Students gain more autonomy with respect to learning in the clinical years. Examining the self-regulated learning skills of students in this period will provide important clues about the level at which students are ready to use these skills in real-life conditions. The self-regulated learning strategies used by medical students in surgical clerkship were investigated in this study and their relation with clinical achievement was analyzed. The study was conducted during the surgery clerkship of medical students. The participation rate was 94% (309 students). Motivated Strategies for Learning Questionnaire (MSLQ), a case-based examination, Objective Structured Clinical Examination (OSCE), and tutor evaluations for assessing achievement were used. The relationship between the Motivated Strategies for Learning Questionnaire scores of the students and clinical achievement was analyzed with multilinear regression analysis. The findings showed that students use self-regulated learning skills at medium levels during their surgery clerkship. A relationship between these skills and OSCE scores and tutor evaluations was determined. OSCE scores of the students were observed to increase in conjunction with increased self-efficacy levels. However, as students' beliefs regarding control over learning increased, OSCE scores decreased. No significant relationship was defined between self-regulated learning skills and case-based examination scores. We observed that a greater self-efficacy for learning resulted in higher OSCE scores. Conversely, students who believe that learning is a result of their own effort had lower OSCE scores. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Medical ethical standards in dermatology: an analytical study of knowledge, attitudes and practices.

PubMed

Mostafa, W Z; Abdel Hay, R M; El Lawindi, M I

2015-01-01

Dermatology practice has not been ethically justified at all times. The objective of the study was to find out dermatologists' knowledge about medical ethics, their attitudes towards regulatory measures and their practices, and to study the different factors influencing the knowledge, the attitude and the practices of dermatologists. This is a cross-sectional comparative study conducted among 214 dermatologists, from five Academic Universities and from participants in two conferences. A 54 items structured anonymous questionnaire was designed to describe the demographical characteristics of the study group as well as their knowledge, attitude and practices regarding the medical ethics standards in clinical and research settings. Five scoring indices were estimated regarding knowledge, attitude and practice. Inferential statistics were used to test differences between groups as indicated. The Student's t-test and analysis of variance were carried out for quantitative variables. The chi-squared test was conducted for qualitative variables. The results were considered statistically significant at a P > 0.05. Analysis of the possible factors having impact on the overall scores revealed that the highest knowledge scores were among dermatologists who practice in an academic setting plus an additional place; however, this difference was statistically non-significant (P = 0.060). Female dermatologists showed a higher attitude score compared to males (P = 0.028). The highest significant attitude score (P = 0.019) regarding clinical practice was recorded among those practicing cosmetic dermatology. The different studied groups of dermatologists revealed a significant impact on the attitude score (P = 0.049), and the evidence-practice score (P < 0.001). Ethical practices will improve the quality and integrity of dermatology research. © 2014 European Academy of Dermatology and Venereology.

Hand-assisted laparoscopic sigmoid colectomy skills acquisition: augmented reality simulator versus human cadaver training models.

PubMed

Leblanc, Fabien; Senagore, Anthony J; Ellis, Clyde N; Champagne, Bradley J; Augestad, Knut M; Neary, Paul C; Delaney, Conor P

2010-01-01

The aim of this study was to compare a simulator with the human cadaver model for hand-assisted laparoscopic colorectal skills acquisition training. An observational prospective comparative study was conducted to compare the laparoscopic surgery training models. The study took place during the laparoscopic colectomy training course performed at the annual scientific meeting of the American Society of Colon and Rectal Surgeons. Thirty four practicing surgeons performed hand-assisted laparoscopic sigmoid colectomy on human cadavers (n = 7) and on an augmented reality simulator (n = 27). Prior laparoscopic colorectal experience was assessed. Trainers and trainees completed independently objective structured assessment forms. Training models were compared by trainees' technical skills scores, events scores, and satisfaction. Prior laparoscopic experience was similar in both surgeon groups. Generic and specific skills scores were similar on both training models. Generic events scores were significantly better on the cadaver model. The 2 most frequent generic events occurring on the simulator were poor hand-eye coordination and inefficient use of retraction. Specific events were scored better on the simulator and reached the significance limit (p = 0.051) for trainers. The specific events occurring on the cadaver were intestinal perforation and left ureter identification difficulties. Overall satisfaction was better for the cadaver than for the simulator model (p = 0.009). With regard to skills scores, the augmented reality simulator had adequate qualities for the hand-assisted laparoscopic colectomy training. Nevertheless, events scores highlighted weaknesses of the anatomical replication on the simulator. Although improvements likely will be required to incorporate the simulator more routinely into the colorectal training, it may be useful in its current form for more junior trainees or those early on their learning curve. Copyright 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The video-based test of communication skills: description, development, and preliminary findings.

PubMed

Mazor, Kathleen M; Haley, Heather-Lyn; Sullivan, Kate; Quirk, Mark E

2007-01-01

The importance of assessing physician-patient communication skills is widely recognized, but assessment methods are limited. Objective structured clinical examinations are time-consuming and resource intensive. For practicing physicians, patient surveys may be useful, but these also require substantial resources. Clearly, it would be advantageous to develop alternative or supplemental methods for assessing communication skills of medical students, residents, and physicians. The Video-based Test of Communication Skills (VTCS) is an innovative, computer-administered test, consisting of 20 very short video vignettes. In each vignette, a patient makes a statement or asks a question. The examinee responds verbally, as if it was a real encounter and he or she were the physician. Responses are recorded for later scoring. Test administration takes approximately 1 h. Generalizability studies were conducted, and scores for two groups of physicians predicted to differ in their communication skills were compared. Preliminary results are encouraging; the estimated g coefficient for the communication score for 20-vignette test (scored by five raters) is 0.79; g for the personal/affective score under the same conditions is 0.62. Differences between physicians were in the predicted direction, with physicians considered "at risk" for communication difficulties scoring lower than those not so identified. The VTCS is a short, portable test of communication skills. Results reported here suggest that scores reflect differences in skill levels and are generalizable. However, these findings are based on very small sample sizes and must be considered preliminary. Additional work is required before it will be possible to argue confidently that this test in particular, and this approach to testing communication skills in general, is valuable and likely to make a substantial contribution to assessment in medical education.

Success of a Faculty Development Program for Teachers at the Mayo Clinic

PubMed Central

Lee, Staci M.; Lee, Mark C.; Reed, Darcy A.; Halvorsen, Andrew J.; Berbari, Elie F.; McDonald, Furman S.; Beckman, Thomas J.

2014-01-01

Background There has been limited research on the improvement of underperforming clinical teachers. Objective To determine whether a faculty development program could improve the evaluations of clinical teachers in an internal medicine residency program. Methods A total of 123 teachers completed faculty development at the Mayo Clinic from 2009 to 2012. The faculty enhancement and education development program (FEED) consists of 6 interactive, small group, 2-hour sessions taught by experienced Mayo Clinic faculty over 1 year. These sessions address the following competencies: asking questions, diagnosing learners, giving feedback, using teaching frameworks, recognizing learning styles, and providing clinical supervision. Resident-of-faculty Mayo teaching effectiveness (MTE) scores have previously demonstrated content, internal structure, and criterion validity. Teachers were grouped into the top 80% or the bottom 20%, according to baseline MTE scores. Mixed linear models were used to compare these groups regarding changes in MTE scores after completion of FEED. Results were adjusted for teacher age, sex, medical specialty, academic rank, and teaching awards. Results For all participants combined, the adjusted MTE scores (mean; standard error) improved from baseline (3.80; 0.04) to completion of FEED (3.93; 0.04; P < .001). However, the bottom 20% had a significantly greater improvement in scores than the top 80% (score-change difference  =  0.166, P < .001). Conclusions We describe a low-intensity faculty development intervention that benefited all clinical teachers, but was particularly effective for underperforming teachers in internal medicine. The approach may be suitable for adoption or adaptation in other graduate medical education programs. PMID:26140122

Impact of Asynchronous Training on Radiology Learning Curve among Emergency Medicine Residents and Clerkship Students

PubMed Central

Pourmand, Ali; Woodward, Christina; Shokoohi, Hamid; King, Jordan B; Taheri, M Reza; King, Jackson; Lawrence, Christopher

2018-01-01

Context Web-based learning (WBL) modules are effectively used to improve medical education curriculum; however, they have not been evaluated to improve head computed tomography (CT) scan interpretation in an emergency medicine (EM) setting. Objective To evaluate the effectiveness of a WBL module to aid identification of cranial structures on CT and to improve ability to distinguish between normal and abnormal findings. Design Prospective, before-and-after trial in the Emergency Department of an academic center. Baseline head CT knowledge was assessed via a standardized test containing ten head CT scans, including normal scans and those showing hemorrhagic stroke, trauma, and infection (abscess). All trainees then participated in a WBL intervention. Three weeks later, they were given the same ten CT scans to evaluate in a standardized posttest. Main Outcome Measures Improvement in test scores. Results A total of 131 EM clerkship students and 32 EM residents were enrolled. Pretest scores correlated with stage of training, with students and first-year residents demonstrating the lowest scores. Overall, there was a significant improvement in percentage of correctly classified CT images after the training intervention from a mean pretest score of 32% ± 12% to posttest score of 67% ± 13% (mean improvement = 35% ± 13%, p < 0.001). Among subsets by training level, all subgroups except first-year residents demonstrated a statistically significant increase in scores after the training. Conclusion Incorporating asynchronous WBL modules into EM clerkship and residency curriculum provides early radiographic exposure in their clinical training and can enhance diagnostic head CT scan interpretation. PMID:29272248

Assessment of nonscholastic abilities and its associated factors among medical students: An exploratory study

PubMed Central

Kumar, S. Ganesh; Sarkar, Sonali

2017-01-01

Background: Nonscholastic abilities among medical students are an important area of concern for the health professionals. Very few studies had been conducted in the past with regard to it. Objective: This study was an exploratory study aimed to assess the nonscholastic abilities among medical students in a medical institution in coastal South India. Materials and Methods: This study assessed three broad domains of nonscholastic abilities namely personal qualities, interpersonal activities, and communication skills among 106 medical students using a structured questionnaire (27 questions with a total score of 27). The data were analyzed by independent t-test and linear regression model. Results: About 41.5% (44) of the subjects were males and 52.8% (56) of them were belonged to 18–19 years age group. Overall mean score of nonscholastic abilities was found to be 19.40 (standard deviation = 3.27). Percentile distribution of subjects is at score 17 (25th percentile), 20 (50th percentile), and 22 (75th percentile). Mean personal quality domain score was found to be proportionately lesser than other domains of nonscholastic abilities. Nonscholastic ability score was significantly associated with marks obtained in the previous examination (P = 0.006). However, linear regression analysis revealed that the presence of family problems (P = 0.005) and alcohol use (P = 0.026) were associated with low nonscholastic ability score among medical students. Conclusion: Nonscholastic abilities are still a required need in medical student's career. Further analytical studies will help in identifying the in-depth evaluation of factors associated with it. PMID:28546968

Web-based education for placental complications of pregnancy.

PubMed

Walker, Melissa G; Windrim, Catherine; Ellul, Katie N; Kingdom, John C P

2013-04-01

The objective of this study was to determine whether a web-based education strategy could improve maternal knowledge of placental complications of pregnancy and reduce maternal anxiety in high risk-pregnancies. Prospective study in the Placenta Clinic at Mount Sinai Hospital, Toronto, Ontario. Maternal demographics and Internet usage were recorded at the patient's baseline appointment. Placental knowledge was determined using structured verbal and illustrative assessments. The six-item State-Trait Anxiety Inventory (STAI) was administered to assess baseline maternal anxiety. Women were asked to visit the Placenta Clinic website for a minimum of 15 minutes before their follow-up appointment, at which time their placental knowledge and STAI assessments were repeated. Eighteen women were included in the study. Patient knowledge at the baseline appointment was generally poor (median score 10.5 out of a maximum score of 27, range 1 to 22), with major deficits in basic placental knowledge, placenta previa/increta, and preeclampsia. At the follow-up appointment, placental knowledge was significantly improved (median score 23, range 10 to 27; P < 0.001). Educational status (high school or less vs. college or more) had no effect on either baseline knowledge or knowledge improvement. Maternal anxiety at baseline (median score 12 out of a maximum score of 24, range 6 to 23) was significantly reduced at the follow-up appointment (median score 8.5, range 6 to 20; P = 0.005). Deficits in maternal knowledge of placental complications of pregnancy in high-risk pregnant women were substantial but easily rectified with a disease-targeted web-based educational resource. This intervention significantly improved patient knowledge and significantly reduced maternal anxiety.

Construct Validity of Fresh Frozen Human Cadaver as a Training Model in Minimal Access Surgery

PubMed Central

Macafee, David; Pranesh, Nagarajan; Horgan, Alan F.

2012-01-01

Background: The construct validity of fresh human cadaver as a training tool has not been established previously. The aims of this study were to investigate the construct validity of fresh frozen human cadaver as a method of training in minimal access surgery and determine if novices can be rapidly trained using this model to a safe level of performance. Methods: Junior surgical trainees, novices (<3 laparoscopic procedure performed) in laparoscopic surgery, performed 10 repetitions of a set of structured laparoscopic tasks on fresh frozen cadavers. Expert laparoscopists (>100 laparoscopic procedures) performed 3 repetitions of identical tasks. Performances were scored using a validated, objective Global Operative Assessment of Laparoscopic Skills scale. Scores for 3 consecutive repetitions were compared between experts and novices to determine construct validity. Furthermore, to determine if the novices reached a safe level, a trimmed mean of the experts score was used to define a benchmark. Mann-Whitney U test was used for construct validity analysis and 1-sample t test to compare performances of the novice group with the benchmark safe score. Results: Ten novices and 2 experts were recruited. Four out of 5 tasks (nondominant to dominant hand transfer; simulated appendicectomy; intracorporeal and extracorporeal knot tying) showed construct validity. Novices’ scores became comparable to benchmark scores between the eighth and tenth repetition. Conclusion: Minimal access surgical training using fresh frozen human cadavers appears to have construct validity. The laparoscopic skills of novices can be accelerated through to a safe level within 8 to 10 repetitions. PMID:23318058

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.

PF2fit: Polar Fast Fourier Matched Alignment of Atomistic Structures with 3D Electron Microscopy Maps.

PubMed

Bettadapura, Radhakrishna; Rasheed, Muhibur; Vollrath, Antje; Bajaj, Chandrajit

2015-10-01

There continue to be increasing occurrences of both atomistic structure models in the PDB (possibly reconstructed from X-ray diffraction or NMR data), and 3D reconstructed cryo-electron microscopy (3D EM) maps (albeit at coarser resolution) of the same or homologous molecule or molecular assembly, deposited in the EMDB. To obtain the best possible structural model of the molecule at the best achievable resolution, and without any missing gaps, one typically aligns (match and fits) the atomistic structure model with the 3D EM map. We discuss a new algorithm and generalized framework, named PF(2) fit (Polar Fast Fourier Fitting) for the best possible structural alignment of atomistic structures with 3D EM. While PF(2) fit enables only a rigid, six dimensional (6D) alignment method, it augments prior work on 6D X-ray structure and 3D EM alignment in multiple ways: Scoring. PF(2) fit includes a new scoring scheme that, in addition to rewarding overlaps between the volumes occupied by the atomistic structure and 3D EM map, rewards overlaps between the volumes complementary to them. We quantitatively demonstrate how this new complementary scoring scheme improves upon existing approaches. PF(2) fit also includes two scoring functions, the non-uniform exterior penalty and the skeleton-secondary structure score, and implements the scattering potential score as an alternative to traditional Gaussian blurring. Search. PF(2) fit utilizes a fast polar Fourier search scheme, whose main advantage is the ability to search over uniformly and adaptively sampled subsets of the space of rigid-body motions. PF(2) fit also implements a new reranking search and scoring methodology that considerably improves alignment metrics in results obtained from the initial search.

PF2 fit: Polar Fast Fourier Matched Alignment of Atomistic Structures with 3D Electron Microscopy Maps

PubMed Central

Bettadapura, Radhakrishna; Rasheed, Muhibur; Vollrath, Antje; Bajaj, Chandrajit

2015-01-01

There continue to be increasing occurrences of both atomistic structure models in the PDB (possibly reconstructed from X-ray diffraction or NMR data), and 3D reconstructed cryo-electron microscopy (3D EM) maps (albeit at coarser resolution) of the same or homologous molecule or molecular assembly, deposited in the EMDB. To obtain the best possible structural model of the molecule at the best achievable resolution, and without any missing gaps, one typically aligns (match and fits) the atomistic structure model with the 3D EM map. We discuss a new algorithm and generalized framework, named PF2 fit (Polar Fast Fourier Fitting) for the best possible structural alignment of atomistic structures with 3D EM. While PF2 fit enables only a rigid, six dimensional (6D) alignment method, it augments prior work on 6D X-ray structure and 3D EM alignment in multiple ways: Scoring. PF2 fit includes a new scoring scheme that, in addition to rewarding overlaps between the volumes occupied by the atomistic structure and 3D EM map, rewards overlaps between the volumes complementary to them. We quantitatively demonstrate how this new complementary scoring scheme improves upon existing approaches. PF2 fit also includes two scoring functions, the non-uniform exterior penalty and the skeleton-secondary structure score, and implements the scattering potential score as an alternative to traditional Gaussian blurring. Search. PF2 fit utilizes a fast polar Fourier search scheme, whose main advantage is the ability to search over uniformly and adaptively sampled subsets of the space of rigid-body motions. PF2 fit also implements a new reranking search and scoring methodology that considerably improves alignment metrics in results obtained from the initial search. PMID:26469938

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.

Amplitude spectrum distance: measuring the global shape divergence of protein fragments.

PubMed

Galiez, Clovis; Coste, François

2015-08-14

In structural bioinformatics, there is an increasing interest in identifying and understanding the evolution of local protein structures regarded as key structural or functional protein building blocks. A central need is then to compare these, possibly short, fragments by measuring efficiently and accurately their (dis)similarity. Progress towards this goal has given rise to scores enabling to assess the strong similarity of fragments. Yet, there is still a lack of more progressive scores, with meaningful intermediate values, for the comparison, retrieval or clustering of distantly related fragments. We introduce here the Amplitude Spectrum Distance (ASD), a novel way of comparing protein fragments based on the discrete Fourier transform of their C(α) distance matrix. Defined as the distance between their amplitude spectra, ASD can be computed efficiently and provides a parameter-free measure of the global shape dissimilarity of two fragments. ASD inherits from nice theoretical properties, making it tolerant to shifts, insertions, deletions, circular permutations or sequence reversals while satisfying the triangle inequality. The practical interest of ASD with respect to RMSD, RMSDd, BC and TM scores is illustrated through zinc finger retrieval experiments and concrete structure examples. The benefits of ASD are also illustrated by two additional clustering experiments: domain linkers fragments and complementarity-determining regions of antibodies. Taking advantage of the Fourier transform to compare fragments at a global shape level, ASD is an objective and progressive measure taking into account the whole fragments. Its practical computation time and its properties make ASD particularly relevant for applications requiring meaningful measures on distantly related protein fragments, such as similar fragments retrieval asking for high recalls as shown in the experiments, or for any application taking also advantage of triangle inequality, such as fragments clustering. ASD program and source code are freely available at: http://www.irisa.fr/dyliss/public/ASD/.

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

A cross-sectional study to investigate long-term cognitive function in people with treated pituitary Cushing's disease.

PubMed

Heald, A; Parr, C; Gibson, C; O'driscoll, K; Fowler, H

2006-10-01

It has been proposed that exposure to high levels of endogenous steroids in untreated pituitary Cushing's disease damages hippocampal structures leading to impairment in learning and memory processes. We hypothesised that patients with treated pituitary Cushing's disease would perform significantly worse on tests of cognitive ability than those with nonfunctioning pituitary adenomas. Sixteen adults with pituitary Cushing's disease (PCD) and 16 adults with non-functioning pituitary adenomas (NFA) undertook the following comprehensive neuropsychological assessments: National Adult Reading Test (NART: premorbid abilities), California Verbal Learning Test (CVLT 2 UK: learning and recall), Stroop (executive functioning), Trail-Making Test (TMT: executive functioning and attention), Adult Memory and Information Processing Battery (AMIPB: Information Processing Speed and Story Recall subtests). There was no significant difference in premorbid IQ scores (NFA mean=101 SD=13; PCD mean=102, SD=13), in verbal learning nor any significant difference in the percentage of verbal material retained in story recall (AMIPB). Performance on higher executive tasks Stroop and TMT and on measures of information processing was similar. However, there were significant decrements between some mean scores for both groups and published normative data with a clear association between higher HADS depression scores and impaired objective memory and attention which was not specific to PCD. We found no difference in cognitive function between patients with PCD and NFA. The results suggest a discrepancy between patients' subjective perception of functional cognitive impairments and objective findings on psychometric testing and point to the influence of affective symptoms on cognitive performance, particularly in Cushing's disease.

Quality measurement and benchmarking of HPV vaccination services: a new approach.

PubMed

Maurici, Massimo; Paulon, Luca; Campolongo, Alessandra; Meleleo, Cristina; Carlino, Cristiana; Giordani, Alessandro; Perrelli, Fabrizio; Sgricia, Stefano; Ferrante, Maurizio; Franco, Elisabetta

2014-01-01

A new measurement process based upon a well-defined mathematical model was applied to evaluate the quality of human papillomavirus (HPV) vaccination centers in 3 of 12 Local Health Units (ASLs) within the Lazio Region of Italy. The quality aspects considered for evaluation were communicational efficiency, organizational efficiency and comfort. The overall maximum achievable value was 86.10%, while the HPV vaccination quality scores for ASL1, ASL2 and ASL3 were 73.07%, 71.08%, and 67.21%, respectively. With this new approach it is possible to represent the probabilistic reasoning of a stakeholder who evaluates the quality of a healthcare provider. All ASLs had margins for improvements and optimal quality results can be assessed in terms of better performance conditions, confirming the relationship between the resulting quality scores and HPV vaccination coverage. The measurement process was structured into three steps and involved four stakeholder categories: doctors, nurses, parents and vaccinated women. In Step 1, questionnaires were administered to collect different stakeholders' points of view (i.e., subjective data) that were elaborated to obtain the best and worst performance conditions when delivering a healthcare service. Step 2 of the process involved the gathering of performance data during the service delivery (i.e., objective data collection). Step 3 of the process involved the elaboration of all data: subjective data from step 1 are used to define a "standard" to test objective data from step 2. This entire process led to the creation of a set of scorecards. Benchmarking is presented as a result of the probabilistic meaning of the evaluated scores.

The Fear-Avoidance Components Scale (FACS): Responsiveness to Functional Restoration Treatment in a Chronic Musculoskeletal Pain Disorder (CMPD) Population.

PubMed

Neblett, Randy; Mayer, Tom G; Williams, Mark J; Asih, Sali; Cuesta-Vargas, Antonio I; Hartzell, Meredith M; Gatchel, Robert J

2017-12-01

To assess the clinical validity and factor structure of the Fear-Avoidance Components Scale (FACS), a new fear-avoidance measure. In this study, 426 chronic musculoskeletal pain disorder patients were admitted to a Functional Restoration Program (FRP). They were categorized into 5 FACS severity levels, from subclinical to extreme, at admission, and again at discharge. Associations with objective lifting performance and other patient-reported psychosocial measures were determined at admission and discharge, and objective work outcomes for this predominantly disabled cohort, were assessed 1 year later. Those patients in the severe and extreme FACS severity groups at admission were more likely to "drop out" of treatment than those in the lower severity groups (P=0.05). At both admission and discharge, the FACS severity groups were highly and inversely correlated with objective lifting performance and patient-reported fear-avoidance-related psychosocial variables, including kinesiophobia, pain intensity, depressive symptoms, perceived disability, perceived injustice, and insomnia (Ps<0.001). All variables showed improvement at FRP discharge. Patients in the extreme FACS severity group at discharge were less likely to return to, or retain, work 1 year later (P≤0.02). A factor analysis identified a 2-factor solution. Strong associations were found among FACS scores and other patient-reported psychosocial and objective lifting performance variables at both admission and discharge. High discharge-FACS scores were associated with worse work outcomes 1 year after discharge. The FACS seems to be a valid and clinically useful measure for predicting attendance, physical performance, distress, and relevant work outcomes in FRP treatment of chronic musculoskeletal pain disorder patients.

Multiple graph regularized protein domain ranking.

PubMed

Wang, Jim Jing-Yan; Bensmail, Halima; Gao, Xin

2012-11-19

Protein domain ranking is a fundamental task in structural biology. Most protein domain ranking methods rely on the pairwise comparison of protein domains while neglecting the global manifold structure of the protein domain database. Recently, graph regularized ranking that exploits the global structure of the graph defined by the pairwise similarities has been proposed. However, the existing graph regularized ranking methods are very sensitive to the choice of the graph model and parameters, and this remains a difficult problem for most of the protein domain ranking methods. To tackle this problem, we have developed the Multiple Graph regularized Ranking algorithm, MultiG-Rank. Instead of using a single graph to regularize the ranking scores, MultiG-Rank approximates the intrinsic manifold of protein domain distribution by combining multiple initial graphs for the regularization. Graph weights are learned with ranking scores jointly and automatically, by alternately minimizing an objective function in an iterative algorithm. Experimental results on a subset of the ASTRAL SCOP protein domain database demonstrate that MultiG-Rank achieves a better ranking performance than single graph regularized ranking methods and pairwise similarity based ranking methods. The problem of graph model and parameter selection in graph regularized protein domain ranking can be solved effectively by combining multiple graphs. This aspect of generalization introduces a new frontier in applying multiple graphs to solving protein domain ranking applications.

Obstructive Sleep Apnea, Posttraumatic Stress Disorder, and Health in Immigrants

PubMed Central

Arnetz, Bengt B.; Templin, Thomas; Saudi, Waleed; Jamil, Hikmet

2013-01-01

Objective To determine whether obstructive sleep apnea mediates the relationship between posttraumatic stress disorder (PTSD) and psychosomatic and somatic disorders and its implications for self-rated health (SRH) among Iraqi immigrants in the United States. Methods A random sample of immigrants who had left Iraq before the 1991 Gulf War (n = 145) or after (n = 205) and are residing in metropolitan Detroit responded to a structured interview covering questions on sociodemographics, premigration trauma, SRH, physician-diagnosed and -treated obstructive sleep apnea, somatic disorders, and psychosomatic disorders. Structural equation modeling was used to evaluate the relationship between premigration trauma scores and health, as well as to explore mediating pathways between PTSD, obstructive sleep apnea, and health. Results The prevalence of obstructive sleep apnea among post-Gulf War immigrants (30.2%) was significantly higher than among pre-Gulf War immigrants (0.7%; p < .001). Premigration trauma scores were positively associated with depression and PTSD. Structural equation modeling supported a model in which obstructive sleep apnea mediated the relationship between PTSD and psychosomatic and somatic disorders. Premigration trauma also related directly to SRH. Conclusions Part of the PTSD-associated adverse health effects observed in Iraqi immigrants is mediated by obstructive sleep apnea. Because sleep apnea in the current study is based on medical history and current treatment, there is a need for future confirmatory polysomnographic studies. PMID:23023679

Comparative Performance of Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale for Screening Antepartum Depression

PubMed Central

Zhong, Qiuyue; Gelaye, Bizu; Rondon, Marta; Sánchez, Sixto E; García, Pedro J; Sánchez, Elena; Barrios, Yasmin V; Simon, Gregory E.; Henderson, David C.; Cripe, Swee May; Williams, Michelle A

2014-01-01

Objective We sought to evaluate the psychometric properties of two widely used screening scales: the Patient Health Questionnaire (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) among pregnant Peruvian women. Methods This cross-sectional study included 1,517 women receiving prenatal care from February 2012 to March 2013. A structured interview was used to collect data using PHQ-9 and EPDS. We examined reliability, construct and concurrent validity between two scales using internal consistency indices, factor structures, correlations, and Cohen’s kappa. Results Both scales had good internal consistency (Cronbach’s alpha > 0.8). Correlation between PHQ-9 and EPDS scores was fair (rho=0.52). Based on exploratory factor analysis (EFA), both scales yielded a two-factor structure. EFA including all items from PHQ-9 and EPDS yielded four factors, namely, “somatization”, “depression and suicidal ideation”, “anxiety and depression”, and “anhedonia”. The agreement between the two scales was generally fair at different cutoff scores with the highest Cohen’s kappa being 0.46. Conclusions Both the PHQ-9 and EPDS are reliable and valid scales for antepartum depression assessment. The PHQ-9 captures somatic symptoms, while EPDS detects depressive symptoms comorbid with anxiety during early pregnancy. Our findings suggest simultaneous administration of both scales may improve identification of antepartum depressive disorders in clinical settings. PMID:24766996

Multiple graph regularized protein domain ranking

PubMed Central

2012-01-01

Background Protein domain ranking is a fundamental task in structural biology. Most protein domain ranking methods rely on the pairwise comparison of protein domains while neglecting the global manifold structure of the protein domain database. Recently, graph regularized ranking that exploits the global structure of the graph defined by the pairwise similarities has been proposed. However, the existing graph regularized ranking methods are very sensitive to the choice of the graph model and parameters, and this remains a difficult problem for most of the protein domain ranking methods. Results To tackle this problem, we have developed the Multiple Graph regularized Ranking algorithm, MultiG-Rank. Instead of using a single graph to regularize the ranking scores, MultiG-Rank approximates the intrinsic manifold of protein domain distribution by combining multiple initial graphs for the regularization. Graph weights are learned with ranking scores jointly and automatically, by alternately minimizing an objective function in an iterative algorithm. Experimental results on a subset of the ASTRAL SCOP protein domain database demonstrate that MultiG-Rank achieves a better ranking performance than single graph regularized ranking methods and pairwise similarity based ranking methods. Conclusion The problem of graph model and parameter selection in graph regularized protein domain ranking can be solved effectively by combining multiple graphs. This aspect of generalization introduces a new frontier in applying multiple graphs to solving protein domain ranking applications. PMID:23157331

Scoring functions for protein-protein interactions.

PubMed

Moal, Iain H; Moretti, Rocco; Baker, David; Fernández-Recio, Juan

2013-12-01

The computational evaluation of protein-protein interactions will play an important role in organising the wealth of data being generated by high-throughput initiatives. Here we discuss future applications, report recent developments and identify areas requiring further investigation. Many functions have been developed to quantify the structural and energetic properties of interacting proteins, finding use in interrelated challenges revolving around the relationship between sequence, structure and binding free energy. These include loop modelling, side-chain refinement, docking, multimer assembly, affinity prediction, affinity change upon mutation, hotspots location and interface design. Information derived from models optimised for one of these challenges can be used to benefit the others, and can be unified within the theoretical frameworks of multi-task learning and Pareto-optimal multi-objective learning. Copyright © 2013 Elsevier Ltd. All rights reserved.

Separating the Signal from the Noise: An Examination of Student and Teacher Scores Based on Student Learning Objectives (SLOs) in One State

ERIC Educational Resources Information Center

Buckley, Katie Hills

2015-01-01

Despite the prevalence of student learning objectives (SLOs) in teacher evaluation systems throughout the United States, research on the validity of student and teacher SLO scores used for high-stakes decisions is lacking. For this reason, this dissertation is comprised of two chapters that examine student and teacher-level SLO performance data…

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

Continued Validation of the O-SCORE (Ottawa Surgical Competency Operating Room Evaluation): Use in the Simulated Environment.

PubMed

MacEwan, Matthew J; Dudek, Nancy L; Wood, Timothy J; Gofton, Wade T

2016-01-01

CONSTRUCT: The Ottawa Surgical Competency Operating Room Evaluation (O-SCORE) is a 9-item surgical evaluation tool designed to assess technical competence in surgical trainees using behavioral anchors. The initial development of the O-SCORE produced evidence for valid results. Further work is required to determine if the use of a single surgeon or an unblinded rater introduces bias. In addition, the relationship of the O-SCORE to other currently used technical assessment tools should be explored to provide validity evidence related to the relationship to other measures. We have designed this project to provide continued validity evidence for the O-SCORE related to these two issues. Nineteen residents and 2 staff Orthopedic Surgeons from the University of Ottawa volunteered to participate in a 2-part OSCE style station. Participants completed a written questionnaire followed by a videotaped 10-minute simulated open reduction and internal fixation of a midshaft radius fracture. Videos were rated individually by 2 blinded staff orthopedic surgeons using an Objective Structured Assessment of Technical Skills (OSATS) global rating scale, an OSATS checklist, and the O-SCORE in random order. O-SCORE results appeared sensitive to surgical training level even when raters were blinded. In addition, strong agreement between two independent observers using the O-SCORE suggests that the measure captures a performance easily recognized by surgical observers. Ratings on the O-SCORE also were strongly associated with global ratings on the currently most validated technical evaluation tool (OSATS). Collectively, these results suggest that the O-SCORE generates accurate, reproducible, and meaningful results when used in a randomized and blinded fashion, providing continued validity evidence for using this tool to evaluate surgical trainee competence. The O-SCORE was able to differentiate surgical trainee level using blinded raters providing further evidence of validity for the O-SCORE. There was strong agreement between two independent observers using the O-SCORE. Ratings on the O-SCORE also demonstrated equivalence to scores on the most validated technical evaluation tool (OSATS). These results suggest that the O-SCORE demonstrates accurate and reproducible results when used in a randomized and blinded fashion providing continued validity evidence for this tool in the evaluation of surgical competence in the trainees.

Stigma towards mental illness: A hospital-based cross-sectional study among caregivers in West Bengal.

PubMed

Mukherjee, Shrabani; Mukhopadhyay, Dipta Kanti

2018-01-01

Stigma among caregivers of people with mental illness has a serious impact on the disease outcome and lives of people with mental illness as well as other family members. The objectives of this study were (i) To determine the level of self-perceived stigma toward mental illness, (ii) To measure perception to it among caregivers of people with mental illness, and (iii) To identify the factors associated with self-perceived stigma of caregivers. In this cross-sectional study, a structured interview was conducted among 200 caregivers of people with mental illness in the psychiatry outpatient department of a tertiary care hospital in West Bengal, India. Stigma and perception regarding mental illness were assessed with a validated 12-item Explanatory Model Interview Catalogue and 20-item perception scale, respectively. Information on their sociodemographic characteristics was also collected. Average stigma score (53.3 ± 13.2) was higher than 50% of maximum attainable score. Caregivers of higher age, female gender, low income, higher education, manual job, rural residence, and those who are single or widowed scored higher in stigma scale. Caregivers with female gender (P = 0.007) and rural residence (P = 0.01) were more likely to have stigma while the perception score was negatively associated (P < 0.001) with stigma score. The study highlighted that health-care providers can play a pivotal role to address caregivers' stigma in order to alleviate its effect on the course of illness and improve family life.

Training Malaysian Pharmacy Undergraduates with Knowledge and Skills on Smoking Cessation

PubMed Central

Brewster, Joan M.; Nik Mohamed, Mohamad Haniki

2015-01-01

Objective. To evaluate the feasibility of an online training module, Certified Smoking Cessation Service Provider (CSCSP), developed for practicing pharmacists to equip pharmacy students with knowledge necessary for smoking cessation counseling and to assess the changes in student knowledge and skills regarding smoking cessation following training. Design. Sixty third-year and 80 fourth-year pharmacy undergraduates (N=140) were given access to an online module, the main intervention in the study. Two linkable questionnaires were administered to assess students’ preintervention and postintervention knowledge. For the third-year students, an additional role-play training component was incorporated, and student skills were assessed during week 14 with an Objective Structured Clinical Examination (OSCE). Assessment. Preintervention and postintervention knowledge assessments were completed by 130 (92.8%) students. Sixty-six students scored above 50% for the knowledge component postintervention, compared to 13 at preintervention, demonstrating significant improvement (x2(1, N=130)=32, p=0.003). All third-year students completed the intervention, and 66.7% were able to counsel excellently for smoking cessation, scoring more than 80%. Conclusion. The CSCSP online module developed for practicing professionals was found suitable for equipping pharmacy undergraduates with knowledge on smoking cessation topics. The module, along with role-play training, also equipped students with knowledge and skills to provide smoking cessation counseling. PMID:26246620

Are reflective models appropriate for very short scales? Proofs of concept of formative models using the Ten-Item Personality Inventory.

PubMed

Myszkowski, Nils; Storme, Martin; Tavani, Jean-Louis

2018-04-27

Because of their length and objective of broad content coverage, very short scales can show limited internal consistency and structural validity. We argue that it is because their objectives may be better aligned with formative investigations than with reflective measurement methods that capitalize on content overlap. As proofs of concept of formative investigations of short scales, we investigate the Ten Item Personality Inventory (TIPI). In Study 1, we administered the TIPI and the Big Five Inventory (BFI) to 938 adults, and fitted a formative Multiple Indicator Multiple Causes model, which consisted of the TIPI items forming 5 latent variables, which in turn predicted the 5 BFI scores. These results were replicated in Study 2, on a sample of 759 adults, with, this time, the Revised NEO Personality Inventory (NEO-PI-R) as the external criterion. The models fit the data adequately, and moderate to strong significant effects (.37<|β|<.69, all p<.001) of all 5 latent formative variables on their corresponding BFI and NEOPI-R scores were observed. This study presents a formative approach that we propose to be more consistent with the aims of scales with broad content and short length like the TIPI. This article is protected by copyright. All rights reserved. © 2018 Wiley Periodicals, Inc.

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.…

Factor Scores, Structure Coefficients, and Communality Coefficients

ERIC Educational Resources Information Center

Goodwyn, Fara

2012-01-01

This paper presents heuristic explanations of factor scores, structure coefficients, and communality coefficients. Common misconceptions regarding these topics are clarified. In addition, (a) the regression (b) Bartlett, (c) Anderson-Rubin, and (d) Thompson methods for calculating factor scores are reviewed. Syntax necessary to execute all four…

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.

Airport Flight Departure Delay Model on Improved BN Structure Learning

NASA Astrophysics Data System (ADS)

Cao, Weidong; Fang, Xiangnong

An high score prior genetic simulated annealing Bayesian network structure learning algorithm (HSPGSA) by combining genetic algorithm(GA) with simulated annealing algorithm(SAA) is developed. The new algorithm provides not only with strong global search capability of GA, but also with strong local hill climb search capability of SAA. The structure with the highest score is prior selected. In the mean time, structures with lower score are also could be choice. It can avoid efficiently prematurity problem by higher score individual wrong direct growing population. Algorithm is applied to flight departure delays analysis in a large hub airport. Based on the flight data a BN model is created. Experiments show that parameters learning can reflect departure delay.

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.

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.

UAV-based urban structural damage assessment using object-based image analysis and semantic reasoning

NASA Astrophysics Data System (ADS)

Fernandez Galarreta, J.; Kerle, N.; Gerke, M.

2015-06-01

Structural damage assessment is critical after disasters but remains a challenge. Many studies have explored the potential of remote sensing data, but limitations of vertical data persist. Oblique imagery has been identified as more useful, though the multi-angle imagery also adds a new dimension of complexity. This paper addresses damage assessment based on multi-perspective, overlapping, very high resolution oblique images obtained with unmanned aerial vehicles (UAVs). 3-D point-cloud assessment for the entire building is combined with detailed object-based image analysis (OBIA) of façades and roofs. This research focuses not on automatic damage assessment, but on creating a methodology that supports the often ambiguous classification of intermediate damage levels, aiming at producing comprehensive per-building damage scores. We identify completely damaged structures in the 3-D point cloud, and for all other cases provide the OBIA-based damage indicators to be used as auxiliary information by damage analysts. The results demonstrate the usability of the 3-D point-cloud data to identify major damage features. Also the UAV-derived and OBIA-processed oblique images are shown to be a suitable basis for the identification of detailed damage features on façades and roofs. Finally, we also demonstrate the possibility of aggregating the multi-perspective damage information at building level.

A dysmorphology score system for assessing embryo abnormalities in rat whole embryo culture.

PubMed

Zhang, Cindy X; Danberry, Tracy; Jacobs, Mary Ann; Augustine-Rauch, Karen

2010-12-01

The rodent whole embryo culture (WEC) system is a well-established model for characterizing developmental toxicity of test compounds and conducting mechanistic studies. Laboratories have taken various approaches in describing type and severity of developmental findings of organogenesis-stage rodent embryos, but the Brown and Fabro morphological score system is commonly used as a quantitative approach. The associated score criteria is based upon developmental stage and growth parameters, where a series of embryonic structures are assessed and assigned respective scores relative to their gestational stage, with a Total Morphological Score (TMS) assigned to the embryo. This score system is beneficial because it assesses a series of stage-specific anatomical landmarks, facilitating harmonized evaluation across laboratories. Although the TMS provides a quantitative approach to assess growth and determine developmental delay, it is limited to its ability to identify and/or delineate subtle or structure-specific abnormalities. Because of this, the TMS may not be sufficiently sensitive for identifying compounds that induce structure or organ-selective effects. This study describes a distinct morphological score system called the "Dysmorphology Score System (DMS system)" that has been developed for assessing gestation day 11 (approximately 20-26 somite stage) rat embryos using numerical scores to differentiate normal from abnormal morphology and define the respective severity of dysmorphology of specific embryonic structures and organ systems. This method can also be used in scoring mouse embryos of the equivalent developmental stage. The DMS system enhances capabilities to rank-order compounds based upon teratogenic potency, conduct structure- relationships of chemicals, and develop statistical prediction models to support abbreviated developmental toxicity screens. © 2010 Wiley-Liss, Inc.

Detecting overlapping instances in microscopy images using extremal region trees.

PubMed

Arteta, Carlos; Lempitsky, Victor; Noble, J Alison; Zisserman, Andrew

2016-01-01

In many microscopy applications the images may contain both regions of low and high cell densities corresponding to different tissues or colonies at different stages of growth. This poses a challenge to most previously developed automated cell detection and counting methods, which are designed to handle either the low-density scenario (through cell detection) or the high-density scenario (through density estimation or texture analysis). The objective of this work is to detect all the instances of an object of interest in microscopy images. The instances may be partially overlapping and clustered. To this end we introduce a tree-structured discrete graphical model that is used to select and label a set of non-overlapping regions in the image by a global optimization of a classification score. Each region is labeled with the number of instances it contains - for example regions can be selected that contain two or three object instances, by defining separate classes for tuples of objects in the detection process. We show that this formulation can be learned within the structured output SVM framework and that the inference in such a model can be accomplished using dynamic programming on a tree structured region graph. Furthermore, the learning only requires weak annotations - a dot on each instance. The candidate regions for the selection are obtained as extremal region of a surface computed from the microscopy image, and we show that the performance of the model can be improved by considering a proxy problem for learning the surface that allows better selection of the extremal regions. Furthermore, we consider a number of variations for the loss function used in the structured output learning. The model is applied and evaluated over six quite disparate data sets of images covering: fluorescence microscopy, weak-fluorescence molecular images, phase contrast microscopy and histopathology images, and is shown to exceed the state of the art in performance. Copyright © 2015 Elsevier B.V. All rights reserved.

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…

A novel approach to assess clinical competence of postgraduate year 1 surgery residents

PubMed Central

Qi, Xin; Ding, Lian; Zhai, Wei; Li, Qiang; Li, Yan; Li, Haichao; Wen, Bing

2017-01-01

ABSTRACT Background: An increased demand for accountability and transparency in medicine have initiated a shift toward a more objective and standardized approach for postgraduate medical training. Objective: To develop and evaluate an objective method to assess clinical competence of postgraduate year 1 surgery residents. Design: Thirty-one postgraduate year 1 surgery residents, who had been trained in the Surgical School of Peking University First Hospital for one year, participated in an objective structured clinical examination as a final assessment of their clinical competence. A test station of irregular wound repair (debridement and suture) was specially designed to test the residents’ surgical integrative competence in a complex-trauma treatment procedure. A modified global rating scale, in combination with wound area measurement, was applied to evaluate residents’ surgical performance. The validity of the subjective global rating scale was evaluated by the objective measurement results from the software. Results: The global rating scale score had no obvious correlation with the area of the removed tissue and the residual wound area after the suture. There was significant difference in the debridement time and the residual wound area between 0–3 and >3 total stitches. There were significant differences in the area of the removed tissue between 0 and 1–2 grey stitches and 0 and 3–4 grey stitches, and in the residual wound area after suture between 0 and 3–4 grey stitches and 1–2 and 3–4 grey stitches. Conclusions: An irregular wound repair procedure could be an effective method to assess the integrative competence of surgery residents. The training for surgical thinking in the early stage of junior residents needs to be strengthened. The entire measurement process was more complex and time-consuming than expected. The possibility of measurement by simply counting the numbers of the key spots might be explored in the future. Abbreviations: ACS/APDS American College of Surgeons/Association of Program Directors in Surgery; GRS Global rating scale; LSD-T Least significant difference-test; OSATS Objective structured assessment of technical skills; OSCE Objective structured clinical examination; PBT Proficiency based training; PGY1 Postgraduate Year 1 PMID:28670976

Label-free characterization of vitrification-induced morphology changes in single-cell embryos with full-field optical coherence tomography

NASA Astrophysics Data System (ADS)

Zarnescu, Livia; Leung, Michael C.; Abeyta, Michael; Sudkamp, Helge; Baer, Thomas; Behr, Barry; Ellerbee, Audrey K.

2015-09-01

Vitrification is an increasingly popular method of embryo cryopreservation that is used in assisted reproductive technology. Although vitrification has high post-thaw survival rates compared to other freezing techniques, its long-term effects on embryo development are still poorly understood. We demonstrate an application of full-field optical coherence tomography (FF-OCT) to visualize the effects of vitrification on live single-cell (2 pronuclear) mouse embryos without harmful labels. Using FF-OCT, we observed that vitrification causes a significant increase in the aggregation of structures within the embryo cytoplasm, consistent with reports in literature based on fluorescence techniques. We quantify the degree of aggregation with an objective metric, the cytoplasmic aggregation (CA) score, and observe a high degree of correlation between the CA scores of FF-OCT images of embryos and of fluorescence images of their mitochondria. Our results indicate that FF-OCT shows promise as a label-free assessment of the effects of vitrification on embryo mitochondria distribution. The CA score provides a quantitative metric to describe the degree to which embryos have been affected by vitrification and could aid clinicians in selecting embryos for transfer.

Emotional Intelligence Components in Alcohol Dependent and Mentally Healthy Individuals

PubMed Central

Mohagheghi, Arash; Amiri, Shahrokh; Mousavi Rizi, Seyedreza; Safikhanlou, Salman

2015-01-01

Objective. Emotional intelligence might play an important role in the onset and persistence of different psychopathologies. This study investigated the relationship between emotional intelligence and alcohol dependence. Methods. In this case-control study, participants included alcohol dependent individuals and mentally healthy inpatients. Each group consisted of 40 individuals (male/female: 1). The diagnosis was based on the criteria of the DSM-IV-TR using the Structured Clinical Interview for DSM-IV (SCID-IV). All the participants completed Bar-On emotional intelligence test. Results. 20 males and 20 females were included in each group. Mean age of alcohol dependent participants and controls was 31.28 ± 7.82 and 34.93 ± 9.83 years in that order. The analyses showed that the alcohol dependent individuals had a significant difference compared with the control group and received lower scores in empathy, responsibility, impulse control, self-esteem, optimism, emotional consciousness, stress tolerance, autonomy, problem-solving, and total score of emotional intelligence components. Conclusion. Patients with alcohol dependence have deficits in components of emotional intelligence. Identifying and targeted training of the individuals with lower scores in components of emotional intelligence may be effective in prevention of alcohol dependence. PMID:25893214

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…

Validation of the Perceived Stigmatization Questionnaire for Brazilian adult burn patients.

PubMed

Freitas, Noélle de Oliveira; Forero, Carlos García; Caltran, Marina Paes; Alonso, Jordi; Dantas, Rosana A Spadoti; Piccolo, Monica Sarto; Farina, Jayme Adriano; Lawrence, John W; Rossi, Lidia A

2018-01-01

Currently, there is no questionnaire to assess perceived stigmatization among people with visible differences in Brazil. The Perceived Stigmatization Questionnaire (PSQ), developed in the United States, is a valid instrument to assess the perception of stigmatizing behaviours among burn survivors. The objective of this cross-sectional and multicentre study was to assess the factor structure, reliability and validity of the Brazilian Portuguese version of the PSQ in burn patients. A Brazilian version of the 21-item PSQ was answered by 240 adult burn patients, undergoing rehabilitation in two burns units in Brazil. We tested its construct validity by correlating PSQ scores with depression (Beck Depression Index-BDI) and self-esteem (Rosenberg Self-Esteem Scale-RSE), as well as with two domains of the Revised Burn Specific Health Scale-BSHS-R: affect and body image, and interpersonal relationships. We used Confirmatory Item Factor Analysis (CIFA) to test whether the data fit a measurement model involving a three-factor structure (absence of friendly behaviour; confusing/staring behaviour; and hostile behaviour). We conducted Exploratory Factor Analyses (EFA) of the subscale in a 50% random sample of individuals (training split), treating items as ordinal categorical using unweighted least squares estimation. To assess discriminant validity of the Brazilian version of the PSQ we correlated PSQ scores with known groups (sex, total body surface area burned, and visibility of the scars) and assessed its reliability by means of Cronbach's alpha and using test-retest. Goodness-of-fit indices for confirmatory factor analysis were satisfactory for the PSQ, but not for the hostile behaviour subscale, which was modified to improve fit by eliminating 3 items. Cronbach's alphas for the PSQ refined version (PSQ-R) ranged from 0.65 to 0.88, with test-retest reliability 0.87 for the total score. The PSQ-R scores correlated strongly with depression (0.63; p < 0.001), self-esteem (-0.57; p < 0.001), body image (-0.63; p < 0.001), and interpersonal relationships (-0.55; p < 0.001). PSQ-R total scores were significantly lower for patients with visible scars (effect size = 0.51, p = 0.029). The PSQ-R showed reliability and validity comparable to the original version. However, the cross-cultural structure of the subscale "hostile behaviour" and sensitivity to change of the PSQ should be further evaluated.

Validation of the Perceived Stigmatization Questionnaire for Brazilian adult burn patients

PubMed Central

Forero, Carlos García; Caltran, Marina Paes; Alonso, Jordi; Dantas, Rosana A. Spadoti; Piccolo, Monica Sarto; Farina, Jayme Adriano; Lawrence, John W.; Rossi, Lidia A.

2018-01-01

Currently, there is no questionnaire to assess perceived stigmatization among people with visible differences in Brazil. The Perceived Stigmatization Questionnaire (PSQ), developed in the United States, is a valid instrument to assess the perception of stigmatizing behaviours among burn survivors. The objective of this cross-sectional and multicentre study was to assess the factor structure, reliability and validity of the Brazilian Portuguese version of the PSQ in burn patients. A Brazilian version of the 21-item PSQ was answered by 240 adult burn patients, undergoing rehabilitation in two burns units in Brazil. We tested its construct validity by correlating PSQ scores with depression (Beck Depression Index-BDI) and self-esteem (Rosenberg Self-Esteem Scale-RSE), as well as with two domains of the Revised Burn Specific Health Scale—BSHS-R: affect and body image, and interpersonal relationships. We used Confirmatory Item Factor Analysis (CIFA) to test whether the data fit a measurement model involving a three-factor structure (absence of friendly behaviour; confusing/staring behaviour; and hostile behaviour). We conducted Exploratory Factor Analyses (EFA) of the subscale in a 50% random sample of individuals (training split), treating items as ordinal categorical using unweighted least squares estimation. To assess discriminant validity of the Brazilian version of the PSQ we correlated PSQ scores with known groups (sex, total body surface area burned, and visibility of the scars) and assessed its reliability by means of Cronbach's alpha and using test-retest. Goodness-of-fit indices for confirmatory factor analysis were satisfactory for the PSQ, but not for the hostile behaviour subscale, which was modified to improve fit by eliminating 3 items. Cronbach’s alphas for the PSQ refined version (PSQ-R) ranged from 0.65 to 0.88, with test-retest reliability 0.87 for the total score. The PSQ-R scores correlated strongly with depression (0.63; p < 0.001), self-esteem (-0.57; p < 0.001), body image (-0.63; p < 0.001), and interpersonal relationships (-0.55; p < 0.001). PSQ-R total scores were significantly lower for patients with visible scars (effect size = 0.51, p = 0.029). The PSQ-R showed reliability and validity comparable to the original version. However, the cross-cultural structure of the subscale “hostile behaviour” and sensitivity to change of the PSQ should be further evaluated. PMID:29381711

[Associative visual agnosia. The less visible consequences of a cerebral infarction].

PubMed

Diesfeldt, H F A

2011-02-01

After a cerebral infarction, some patients acutely demonstrate contralateral hemiplegia, or aphasia. Those are the obvious symptoms of a cerebral infarction. However, less visible but burdensome consequences may go unnoticed without closer investigation. The importance of a thorough clinical examination is exemplified by a single case study of a 72-year-old, right-handed male. Two years before he had suffered from an ischemic stroke in the territory of the left posterior cerebral artery, with right homonymous hemianopia and global alexia (i.e., impairment in letter recognition and profound impairment of reading) without agraphia. Naming was impaired on visual presentation (20%-39% correct), but improved significantly after tactile presentation (87% correct) or verbal definition (89%). Pre-semantic visual processing was normal (correct matching of different views of the same object), as was his access to structural knowledge from vision (he reliably distinguished real objects from non-objects). On a colour decision task he reliably indicated which of two items was coloured correctly. Though he was unable to mime how visually presented objects were used, he more reliably matched pictures of objects with pictures of a mime artist gesturing the use of the object. He obtained normal scores on word definition (WAIS-III), synonym judgment and word-picture matching tasks with perceptual and semantic distractors. He however failed when he had to match physically dissimilar specimens of the same object or when he had to decide which two of five objects were related associatively (Pyramids and Palm Trees Test). The patient thus showed a striking contrast in his intact ability to access knowledge of object shape or colour from vision and impaired functional and associative knowledge. As a result, he could not access a complete semantic representation, required for activating phonological representations to name visually presented objects. The pattern of impairments and preserved abilities is considered to be a specific difficulty to access a full semantic representation from an intact structural representation of visually presented objects, i.e., a form of visual object agnosia.

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.

Minefield reconnaissance and detector system

DOEpatents

Butler, Millard T.; Cave, Steven P.; Creager, James D.; Johnson, Charles M.; Mathes, John B.; Smith, Kirk J.

1994-01-01

A multi-sensor system (10) for detecting the presence of objects on the surface of the ground or buried just under the surface, such as anti-personnel or anti-tank mines or the like. A remote sensor platform (12) has a plurality of metal detector sensors (22) and a plurality of short pulse radar sensors (24). The remote sensor platform (12) is remotely controlled from a processing and control unit (14) and signals from the remote sensor platform (12) are sent to the processing and control unit (14) where they are individually evaluated in separate data analysis subprocess steps (34, 36) to obtain a probability "score" for each of the pluralities of sensors (22, 24). These probability scores are combined in a fusion subprocess step (38) by comparing score sets to a probability table (130) which is derived based upon the historical incidence of object present conditions given that score set. A decision making rule is applied to provide an output which is optionally provided to a marker subprocess (40) for controlling a marker device (76) to mark the location of found objects.

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.

Psychometric properties of a German organizational justice questionnaire (G-OJQ) and its association with self-rated health: findings from the Mannheim Industrial Cohort Studies (MICS).

PubMed

Herr, Raphael M; Li, Jian; Bosch, Jos A; Schmidt, Burkhard; DeJoy, David M; Fischer, Joachim E; Loerbroks, Adrian

2014-01-01

The objective of the present study was to validate a German 11-item organizational justice questionnaire (G-OJQ) that consists of two subscales, referred to as "procedural justice" (PJ) and "interactional justice" (IJ) adapted from Moorman's organizational justice (OJ) questionnaire. A second objective was to determine associations of the G-OJQ with self-rated health. This study used cross-sectional data from an occupational cohort of 1518 factory workers from Germany (87.7 % male; mean age = 38.8 with SD = 11.9). After splitting the sample in two random subsamples, we assessed structural validity by exploratory factor analyses in one subsample and by confirmatory factor analysis in the other subsample. Internal validity was assessed by Cronbach's α. Associations with self-reported poor health were estimated by logistic regression. The full scale and its subscales yielded Cronbach's α's of ≥0.9, and item-total correlations were ≥0.5. Factor analyses confirmed the expected 2-factor structure, labeled "interactional justice" (IJ, 4 items, λ 0.43-0.94) and "procedural justice" (PJ, 7 items, λ 0.46-0.83), respectively, and showed an acceptable fit to the data (χ (2) = 61; p = .001; CFI = 0.995; RMSEA = 0.037). The OJ total score as well as subscale scores in the lowest quartile, when compared to the highest quartile, was associated with an ≥2.3 increased odds of reporting poor health. The G-OJQ seems to be a valid and useful tool for observational and intervention studies in occupational settings. Future studies may additionally explore longitudinal associations and test the generalizability of the present findings to other populations and health outcomes.

Psychometric properties of the Sexual Adjustment Questionnaire (SAQ) in the Iranian population with spinal cord injury

PubMed Central

Merghati-Khoei, E; Maasoumi, R; Rahdari, F; Bayat, A; Hajmirzaei, S; Lotfi, S; Hajiaghababaei, M; Emami-Razavi, SH; Korte, JE; Atoof, F

2016-01-01

Study design This is a cross-sectional study Objectives The objective of this study was to examine the psychometric properties of the Sexual Adjustment Questionnaire (SAQ) for Iranian people with spinal cord injury Setting This study was conducted in the brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran Methods We assessed the psychometric properties of the SAQ, with 200 participants (men = 146, women = 54) completing the scale. An evaluation of its test–retest reliability was performed over a 2-weeks period, on a subsample of 30 patients recruited from the overall group. Cronbach’s α-coefficient was computed for assessment of internal consistency reliability. In addition, content and face validity were examined by an expert committee. Construct validity was assessed by examining convergent and discriminant validity. Finally, exploratory factor analysis was used to extract the factor structure of the questionnaire. Results The Cronbach’s α and intraclass correlation coefficient were 0.77 and 0.72 retrospectively. With regard to construct validity, there was a significant (P = 0.009) negative correlation (r = − 0.28) between the SAQ score and age. Those with lower levels of educations scored significantly lower on the SAQ (P = 0.04). The exploratory factor analysis indicated a four-factor structure for the questionnaire, accounting for 68.9% of the observed variance. The expert committee approved the face and content validity of the developed measure. Conclusion The SAQ is a valid measure for assessing sexual adjustment in people with spinal cord injury. The evaluation of sexual well-being may be useful in clinical trials and practical settings. PMID:25917953

Microsurgery Workout: A Novel Simulation Training Curriculum Based on Nonliving Models.

PubMed

Rodriguez, Jose R; Yañez, Ricardo; Cifuentes, Ignacio; Varas, Julian; Dagnino, Bruno

2016-10-01

Currently, there are no valid training programs based solely on nonliving models. The authors aimed to develop and validate a microsurgery training program based on nonliving models and assess the transfer of skills to a live rat model. Postgraduate year-3 general surgery residents were assessed in a 17-session program, performing arterial and venous end-to-end anastomosis on ex vivo chicken models. Procedures were recorded and rated by two blinded experts using validated global and specific scales (objective structured assessment of technical skills) and a validated checklist. Operating times and patency rates were assessed. Hand-motion analysis was used to measure economy of movements. After training, residents performed an arterial and venous end-to-end anastomosis on live rats. Results were compared to six experienced surgeons in the same models. Values of p < 0.05 were considered statistically significant. Learning curves were achieved. Ten residents improved their median global and specific objective structured assessment of technical skills scores for artery [10 (range, 8 to 10) versus 28 (range, 27 to 29), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 28), p < 0.05] and vein [8 (range, 8 to 11) versus 28 (range, 27 to 28), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 29), p < 0.05]. Checklist scores also improved for both procedures (p < 0.05). Trainees were slower and less efficient than experienced surgeons (p < 0.05). In the living rat, patency rates at 30 minutes were 100 percent and 50 percent for artery and vein, respectively. Significant acquisition of microsurgical skills was achieved by trainees to a level similar to that of experienced surgeons. Acquired skills were transferred to a more complex live model.

Sequential Objective Structured Clinical Examination based on item response theory in Iran.

PubMed

Hejri, Sara Mortaz; Jalili, Mohammad

2017-01-01

In a sequential objective structured clinical examination (OSCE), all students initially take a short screening OSCE. Examinees who pass are excused from further testing, but an additional OSCE is administered to the remaining examinees. Previous investigations of sequential OSCE were based on classical test theory. We aimed to design and evaluate screening OSCEs based on item response theory (IRT). We carried out a retrospective observational study. At each station of a 10-station OSCE, the students' performance was graded on a Likert-type scale. Since the data were polytomous, the difficulty parameters, discrimination parameters, and students' ability were calculated using a graded response model. To design several screening OSCEs, we identified the 5 most difficult stations and the 5 most discriminative ones. For each test, 5, 4, or 3 stations were selected. Normal and stringent cut-scores were defined for each test. We compared the results of each of the 12 screening OSCEs to the main OSCE and calculated the positive and negative predictive values (PPV and NPV), as well as the exam cost. A total of 253 students (95.1%) passed the main OSCE, while 72.6% to 94.4% of examinees passed the screening tests. The PPV values ranged from 0.98 to 1.00, and the NPV values ranged from 0.18 to 0.59. Two tests effectively predicted the results of the main exam, resulting in financial savings of 34% to 40%. If stations with the highest IRT-based discrimination values and stringent cut-scores are utilized in the screening test, sequential OSCE can be an efficient and convenient way to conduct an OSCE.

[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.

Two approaches to incorporate clinical data uncertainty into multiple criteria decision analysis for benefit-risk assessment of medicinal products.

PubMed

Wen, Shihua; Zhang, Lanju; Yang, Bo

2014-07-01

The Problem formulation, Objectives, Alternatives, Consequences, Trade-offs, Uncertainties, Risk attitude, and Linked decisions (PrOACT-URL) framework and multiple criteria decision analysis (MCDA) have been recommended by the European Medicines Agency for structured benefit-risk assessment of medicinal products undergoing regulatory review. The objective of this article was to provide solutions to incorporate the uncertainty from clinical data into the MCDA model when evaluating the overall benefit-risk profiles among different treatment options. Two statistical approaches, the δ-method approach and the Monte-Carlo approach, were proposed to construct the confidence interval of the overall benefit-risk score from the MCDA model as well as other probabilistic measures for comparing the benefit-risk profiles between treatment options. Both approaches can incorporate the correlation structure between clinical parameters (criteria) in the MCDA model and are straightforward to implement. The two proposed approaches were applied to a case study to evaluate the benefit-risk profile of an add-on therapy for rheumatoid arthritis (drug X) relative to placebo. It demonstrated a straightforward way to quantify the impact of the uncertainty from clinical data to the benefit-risk assessment and enabled statistical inference on evaluating the overall benefit-risk profiles among different treatment options. The δ-method approach provides a closed form to quantify the variability of the overall benefit-risk score in the MCDA model, whereas the Monte-Carlo approach is more computationally intensive but can yield its true sampling distribution for statistical inference. The obtained confidence intervals and other probabilistic measures from the two approaches enhance the benefit-risk decision making of medicinal products. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Gender differences in memory for objects and their locations: a study on automatic versus controlled encoding and retrieval contexts.

PubMed

De Goede, Maartje; Postma, Albert

2008-04-01

Object-location memory is the only spatial task where female subjects have been shown to outperform males. This result is not consistent across all studies, and may be due to the combination of the multi-component structure of object location memory with the conditions under which different studies were done. Possible gender differences in object location memory and its component object identity memory were assessed in the present study. In order to disentangle these two components, an object location memory task (in which objects had to be relocated in daily environments), and a separate object identity recognition task were carried out. This study also focused on the conditions under which object locations were encoded and retrieved. Only half of the participants were aware of the fact that object locations had to be retrieved later on. Moreover, by applying the 'process dissociation procedure' to the object location memory assessments and the 'remember-know' paradigm to the object identity measure, the amount of explicit (conscious) and implicit (unconscious) retrieval was estimated for each component. In general, females performed better than males on the object location memory task. However, when controlled for object identity memory, females no longer outperformed males, whereas they did not obtain a higher general object identity memory score, nor did they have more explicit or implicit recollection of the object identities. These complicated effects might stem from a difference between males and females, in the way locations or associations between objects and locations are retrieved. In general, participants had more explicit (conscious) recollection than implicit (unconscious) recollection. No effect of encoding context was found, nor any interaction effect of gender, encoding and retrieval context.

The development of the learning video for the flipped classroom model on student of open university on human skeletal system and muscles

NASA Astrophysics Data System (ADS)

Andrini, V. S.

2018-05-01

The objectives of the research are to develop the learning video for the flipped classroom model for Open University’s student and to know the effectiveness of the video. The development of the video used Research and Development ADDIE design (Analyses, Design, Development, Implementation, Evaluation). The sampling used purposive sampling was 28 students in Open University of Nganjuk. The techniques of data collection were the observation data to know the problems of the students, and learning facilities, the test (pre-test and post-test) to know a knowledge aspect, a questionnaire to know advisability of video learning, a structured interview to confirm their answer. The result of the expert of matter and media showed that the average product score was 3.75 of 4 or very good, the small-scale test showed that the average score was 3.60 of 4 and the large-scale test showed that the average score was 3.80 of 4, it had a very good category. The t-test with paired sample test showed that sig. (2-tailed) < 0.05. The N-gain score of pre and post test was 0.55, it had the medium category. It can be concluded that the development of the learning video for flipped classroom was effective to be implemented.

The objective structured clinical examination revisited for postgraduate trainees in general practice.

PubMed

Schoenmakers, Birgitte; Wens, Johan

2014-03-04

To investigate if the psychometric qualities of an OSCE consisting of more complex simulated patient encounters remain valid and reliable in the assessment of postgraduate trainees in general practice. In this intervention study without control group, the traditional OSCE was formally replaced by the new, complex version. The study population was composed by all postgraduate trainees (second and third phase) in general practice during the ongoing academic year. Data were handled and collected as part of the formal assessment program. Univariate analyses, the variance of scores and multivariate analyses were performed to assess the test qualities. A total of 340 students participated. Average final scores were slightly higher for third-phase students (t-test, p =0.05). Overall test scores were equally distributed on station level, circuit level and phase level. A multiple regression analysis revealed that test scores were dependent on the stations and circuits, but not on the master phase. In a changing learning environment, assessment and evaluation strategies require reorientation. The reliability and validity of the OSCE remain subject to discussion. In particular, when it comes to content and design, the traditional OSCE might underestimate the performance level of postgraduate trainees in general practice. A reshaping of this OSCE to a more sophisticated design with more complex patient encounters appears to restore the validity of the test results.

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.

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.

To what extent does the Health Professions Admission Test-Ireland predict performance in early undergraduate tests of communication and clinical skills? An observational cohort study.

PubMed

Kelly, Maureen E; Regan, Daniel; Dunne, Fidelma; Henn, Patrick; Newell, John; O'Flynn, Siun

2013-05-10

Internationally, tests of general mental ability are used in the selection of medical students. Examples include the Medical College Admission Test, Undergraduate Medicine and Health Sciences Admission Test and the UK Clinical Aptitude Test. The most widely used measure of their efficacy is predictive validity.A new tool, the Health Professions Admission Test- Ireland (HPAT-Ireland), was introduced in 2009. Traditionally, selection to Irish undergraduate medical schools relied on academic achievement. Since 2009, Irish and EU applicants are selected on a combination of their secondary school academic record (measured predominately by the Leaving Certificate Examination) and HPAT-Ireland score. This is the first study to report on the predictive validity of the HPAT-Ireland for early undergraduate assessments of communication and clinical skills. Students enrolled at two Irish medical schools in 2009 were followed up for two years. Data collected were gender, HPAT-Ireland total and subsection scores; Leaving Certificate Examination plus HPAT-Ireland combined score, Year 1 Objective Structured Clinical Examination (OSCE) scores (Total score, communication and clinical subtest scores), Year 1 Multiple Choice Questions and Year 2 OSCE and subset scores. We report descriptive statistics, Pearson correlation coefficients and Multiple linear regression models. Data were available for 312 students. In Year 1 none of the selection criteria were significantly related to student OSCE performance. The Leaving Certificate Examination and Leaving Certificate plus HPAT-Ireland combined scores correlated with MCQ marks.In Year 2 a series of significant correlations emerged between the HPAT-Ireland and subsections thereof with OSCE Communication Z-scores; OSCE Clinical Z-scores; and Total OSCE Z-scores. However on multiple regression only the relationship between Total OSCE Score and the Total HPAT-Ireland score remained significant; albeit the predictive power was modest. We found that none of our selection criteria strongly predict clinical and communication skills. The HPAT- Ireland appears to measures ability in domains different to those assessed by the Leaving Certificate Examination. While some significant associations did emerge in Year 2 between HPAT Ireland and total OSCE scores further evaluation is required to establish if this pattern continues during the senior years of the medical course.

To what extent does the Health Professions Admission Test-Ireland predict performance in early undergraduate tests of communication and clinical skills? – An observational cohort study

PubMed Central

2013-01-01

Background Internationally, tests of general mental ability are used in the selection of medical students. Examples include the Medical College Admission Test, Undergraduate Medicine and Health Sciences Admission Test and the UK Clinical Aptitude Test. The most widely used measure of their efficacy is predictive validity. A new tool, the Health Professions Admission Test- Ireland (HPAT-Ireland), was introduced in 2009. Traditionally, selection to Irish undergraduate medical schools relied on academic achievement. Since 2009, Irish and EU applicants are selected on a combination of their secondary school academic record (measured predominately by the Leaving Certificate Examination) and HPAT-Ireland score. This is the first study to report on the predictive validity of the HPAT-Ireland for early undergraduate assessments of communication and clinical skills. Method Students enrolled at two Irish medical schools in 2009 were followed up for two years. Data collected were gender, HPAT-Ireland total and subsection scores; Leaving Certificate Examination plus HPAT-Ireland combined score, Year 1 Objective Structured Clinical Examination (OSCE) scores (Total score, communication and clinical subtest scores), Year 1 Multiple Choice Questions and Year 2 OSCE and subset scores. We report descriptive statistics, Pearson correlation coefficients and Multiple linear regression models. Results Data were available for 312 students. In Year 1 none of the selection criteria were significantly related to student OSCE performance. The Leaving Certificate Examination and Leaving Certificate plus HPAT-Ireland combined scores correlated with MCQ marks. In Year 2 a series of significant correlations emerged between the HPAT-Ireland and subsections thereof with OSCE Communication Z-scores; OSCE Clinical Z-scores; and Total OSCE Z-scores. However on multiple regression only the relationship between Total OSCE Score and the Total HPAT-Ireland score remained significant; albeit the predictive power was modest. Conclusion We found that none of our selection criteria strongly predict clinical and communication skills. The HPAT- Ireland appears to measures ability in domains different to those assessed by the Leaving Certificate Examination. While some significant associations did emerge in Year 2 between HPAT Ireland and total OSCE scores further evaluation is required to establish if this pattern continues during the senior years of the medical course. PMID:23663266

A Structured Educational Curriculum Including Online Training Positively Impacts American Board of Surgery In-Training Examination Scores.

PubMed

Kelly, Dympna M; London, Daniel A; Siperstein, Allan; Fung, John J; Walsh, Matthew R

2015-01-01

To assess the effect of a structured postgraduate year 1 educational curriculum, including online surgical training, on American Board of Surgery In-Training Examination (ABSITE) scores. This was a retrospective cohort study. The study was performed in an academic surgical residency program in a tertiary care hospital, Cleveland Clinic Foundation, Cleveland, Ohio. The participants were 140 surgical postgraduate year 1 residents from 2000 to 2009. Interns from 2000 to 2004 were grouped together and completed a self-directed learning curriculum. Interns from 2005 to 2009 participated in a structured educational curriculum that included lectures and the use of an online program. Lectures were based on the American College of Surgeons curriculum. The online program consisted of 8 to 12 hours of assigned tutorials and quizzes that corresponded to the lectures and 3 multiple-choice (MC) examinations. Use of a structured educational curriculum led to improved ABSITE scores (66 ± 9%) compared with that of those who had no curriculum (55 ± 10%, p < 0.001). Several variables positively correlated with the ABSITE score: United States Medical Licensing Examination step 1 score (p < 0.001), monthly quiz scores (p = 0.003), average MC examination scores (p = 0.005), lecture attendance (p = 0.02), and time spent online (p = 0.04). Multivariable analysis demonstrated that the step 1 United States Medical Licensing Examination score, time spent online, and MC examination score are predictive of total the ABSITE score. When ABSITE subscores (basic science and clinical science) were compared, the online curriculum had a greater effect on basic science subscores, whereas lectures had a greater effect on clinical science subscores. Providing surgery residents a structured curriculum with lectures and an online component positively impacts ABSITE scores. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Factor structure of the functional movement screen in marine officer candidates.

PubMed

Kazman, Josh B; Galecki, Jeffrey M; Lisman, Peter; Deuster, Patricia A; OʼConnor, Francis G

2014-03-01

Functional movement screening (FMS) is a musculoskeletal assessment that is intended to fill a gap between preparticipation examinations and performance tests. Functional movement screening consists of 7 standardized movements involving multiple muscle groups that are rated 0-3 during performance; scores are combined into a final score, which is intended to predict injury risk. This use of a sum-score in this manner assumes that the items are unidimensional and scores are internally consistent, which are measures of internal reliability. Despite research into the FMS' predictive value and interrater reliability, research has not assessed its psychometric properties. The present study is a standard psychometric analysis of the FMS and is the first to assess the internal consistency and factor structure of the FMS, using Cronbach's alpha and exploratory factor analysis (EFA). Using a cohort of 877 male and 57 female Marine officer candidates who performed the FMS, EFA of polychoric correlations with varimax rotation was conducted to explore the structure of the FMS. Tests were repeated on the original scores, which integrated feelings of pain during movement (0-3), and then on scores discounting the pain instruction and based only on the performance (1-3), to determine whether pain ratings affected the factor structure. The average FMS score was 16.7 ± 1.8. Cronbach's alpha was 0.39. Exploratory factor analysis availed 2 components accounting for 21 and 17% and consisting of separate individual movements (shoulder mobility and deep squat, respectively). Analysis on scores discounting pain showed similar results. The factor structures were not interpretable, and the low Cronbach's alpha suggests a lack of internal consistency in FMS sum scores. Results do not offer support for validity of the FMS sum score as a unidimensional construct. In the absence of additional psychometric research, caution is warranted when using the FMS sum score.

A Critical Assessment of the Performance of Protein-ligand Scoring Functions Based on NMR Chemical Shift Perturbations

PubMed Central

Wang, Bing; Westerhoff, Lance M.; Merz, Kenneth M.

2008-01-01

We have generated docking poses for the FKBP-GPI complex using eight docking programs, and compared their scoring functions with scoring based on NMR chemical shift perturbations (NMRScore). Because the chemical shift perturbation (CSP) is exquisitely sensitive on the orientation of ligand inside the binding pocket, NMRScore offers an accurate and straightforward approach to score different poses. All scoring functions were inspected by their abilities to highly rank the native-like structures and separate them from decoy poses generated for a protein-ligand complex. The overall performance of NMRScore is much better than that of energy-based scoring functions associated with docking programs in both aspects. In summary, we find that the combination of docking programs with NMRScore results in an approach that can robustly determine the binding site structure for a protein-ligand complex, thereby, providing a new tool facilitating the structure-based drug discovery process. PMID:17867664

Evaluation of the psychometric properties of the Nighttime Symptoms of COPD Instrument.

PubMed

Mocarski, Michelle; Zaiser, Erica; Trundell, Dylan; Make, Barry J; Hareendran, Asha

2015-01-01

Nighttime symptoms can negatively impact the quality of life of patients with chronic obstructive pulmonary disease (COPD). The Nighttime Symptoms of COPD Instrument (NiSCI) was designed to measure the occurrence and severity of nighttime symptoms in patients with COPD, the impact of symptoms on nighttime awakenings, and rescue medication use. The objective of this study was to explore item reduction, inform scoring recommendations, and evaluate the psychometric properties of the NiSCI. COPD patients participating in a Phase III clinical trial completed the NiSCI daily. Item analyses were conducted using weekly mean and single day scores. Descriptive statistics (including percentage of respondents at floor/ceiling and inter-item correlations), factor analyses, and Rasch model analyses were conducted to examine item performance and scoring. Test-retest reliability was assessed for the final instrument using the intraclass correlation coefficient (ICC). Correlations with assessments conducted during study visits were used to evaluate convergent and known-groups validity. Data from 1,663 COPD patients aged 40-93 years were analyzed. Item analyses supported the generation of four scores. A one-factor structure was confirmed with factor analysis and Rasch analysis for the symptom severity score. Test-retest reliability was confirmed for the six-item symptom severity (ICC, 0.85), number of nighttime awakenings (ICC, 0.82), and rescue medication (ICC, 0.68) scores. Convergent validity was supported by significant correlations between the NiSCI, St George's Respiratory Questionnaire, and Exacerbations of Chronic Obstructive Pulmonary Disease Tool-Respiratory Symptoms scores. The results suggest that the NiSCI can be used to determine the severity of nighttime COPD symptoms, the number of nighttime awakenings due to COPD symptoms, and the nighttime use of rescue medication. The NiSCI is a reliable and valid instrument to evaluate these concepts in COPD patients in clinical trials and clinical practice. Scoring recommendations and steps for further research are discussed.

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.

SU-F-P-06: Moving From Computed Radiography to Digital Radiography: A Collaborative Approach to Improve Image Quality

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

Sandoval, D; Mlady, G; Selwyn, R

Purpose: To bring together radiologists, technologists, and physicists to utilize post-processing techniques in digital radiography (DR) in order to optimize image acquisition and improve image quality. Methods: Sub-optimal images acquired on a new General Electric (GE) DR system were flagged for follow-up by radiologists and reviewed by technologists and medical physicists. Various exam types from adult musculoskeletal (n=35), adult chest (n=4), and pediatric (n=7) were chosen for review. 673 total images were reviewed. These images were processed using five customized algorithms provided by GE. An image score sheet was created allowing the radiologist to assign a numeric score to eachmore » of the processed images, this allowed for objective comparison to the original images. Each image was scored based on seven properties: 1) overall image look, 2) soft tissue contrast, 3) high contrast, 4) latitude, 5) tissue equalization, 6) edge enhancement, 7) visualization of structures. Additional space allowed for additional comments not captured in scoring categories. Radiologists scored the images from 1 – 10 with 1 being non-diagnostic quality and 10 being superior diagnostic quality. Scores for each custom algorithm for each image set were summed. The algorithm with the highest score for each image set was then set as the default processing. Results: Images placed into the PACS “QC folder” for image processing reasons decreased. Feedback from radiologists was, overall, that image quality for these studies had improved. All default processing for these image types was changed to the new algorithm. Conclusion: This work is an example of the collaboration between radiologists, technologists, and physicists at the University of New Mexico to add value to the radiology department. The significant amount of work required to prepare the processing algorithms, reprocessing and scoring of the images was eagerly taken on by all team members in order to produce better quality images and improve patient care.« less

Has the UK Clinical Aptitude Test improved medical student selection?

PubMed

Wright, Sarah R; Bradley, Philip M

2010-11-01

In 2006, the United Kingdom Clinical Aptitude Test (UKCAT) was introduced as a new medical school admissions tool. The aim of this cohort study was to determine whether the UKCAT has made any improvements to the way medical students are selected. Regression analysis was performed in order to study the ability of previous school type and gender to predict UKCAT, personal statement or interview scores in two cohorts of accepted students. The ability of admissions scores and demographic data to predict performance on knowledge and skills examinations was also studied. Previous school type was not a significant predictor of either interview or UKCAT scores amongst students who had been accepted onto the programme (n = 307). However, it was a significant predictor of personal statement score, with students from independent and grammar schools performing better than students from state-maintained schools. Previous school type, personal statements and interviews were not significant predictors of knowledge examination performance. UKCAT scores were significant predictors of knowledge examination performance for all but one examination administered in the first 2 years of medical school. Admissions data explained very little about performance on skills (objective structured clinical examinations [OSCEs]) assessments. The use of personal statements as a basis for selection results in a bias towards students from independent and grammar schools. However, no evidence was found to suggest that students accepted from these schools perform any better than students from maintained schools on Year 1 and 2 medical school examinations. Previous school type did not predict interview or UKCAT scores of accepted students. UKCAT scores are predictive of Year 1 and 2 examination performance at this medical school, whereas interview scores are not. The results of this study challenge claims made by other authors that aptitude tests do not have a place in medical school selection in the UK. © Blackwell Publishing Ltd 2010.

Scoring of Side-Chain Packings: An Analysis of Weight Factors and Molecular Dynamics Structures.

PubMed

Colbes, Jose; Aguila, Sergio A; Brizuela, Carlos A

2018-02-26

The protein side-chain packing problem (PSCPP) is a central task in computational protein design. The problem is usually modeled as a combinatorial optimization problem, which consists of searching for a set of rotamers, from a given rotamer library, that minimizes a scoring function (SF). The SF is a weighted sum of terms, that can be decomposed in physics-based and knowledge-based terms. Although there are many methods to obtain approximate solutions for this problem, all of them have similar performances and there has not been a significant improvement in recent years. Studies on protein structure prediction and protein design revealed the limitations of current SFs to achieve further improvements for these two problems. In the same line, a recent work reported a similar result for the PSCPP. In this work, we ask whether or not this negative result regarding further improvements in performance is due to (i) an incorrect weighting of the SFs terms or (ii) the constrained conformation resulting from the protein crystallization process. To analyze these questions, we (i) model the PSCPP as a bi-objective combinatorial optimization problem, optimizing, at the same time, the two most important terms of two SFs of state-of-the-art algorithms and (ii) performed a preprocessing relaxation of the crystal structure through molecular dynamics to simulate the protein in the solvent and evaluated the performance of these two state-of-the-art SFs under these conditions. Our results indicate that (i) no matter what combination of weight factors we use the current SFs will not lead to better performances and (ii) the evaluated SFs will not be able to improve performance on relaxed structures. Furthermore, the experiments revealed that the SFs and the methods are biased toward crystallized structures.

Intensity-Modulated Radiotherapy of Head and Neck Cancer Aiming to Reduce Dysphagia: Early Dose-Effect Relationships for the Swallowing Structures

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

Feng, Felix Y.; Kim, Hyungjin M.; Lyden, Teresa H.

2007-08-01

Purpose: To present initial results of a clinical trial of intensity-modulated radiotherapy (IMRT) aiming to spare the swallowing structures whose dysfunction after chemoradiation is a likely cause of dysphagia and aspiration, without compromising target doses. Methods and Materials: This was a prospective, longitudinal study of 36 patients with Stage III-IV oropharyngeal (31) or nasopharyngeal (5) cancer. Definitive chemo-IMRT spared salivary glands and swallowing structures: pharyngeal constrictors (PC), glottic and supraglottic larynx (GSL), and esophagus. Lateral but not medial retropharyngeal nodes were considered at risk. Dysphagia endpoints included objective swallowing dysfunction (videofluoroscopy), and both patient-reported and observer-rated scores. Correlations between dosesmore » and changes in these endpoints from pre-therapy to 3 months after therapy were assessed. Results: Significant correlations were observed between videofluoroscopy-based aspirations and the mean doses to the PC and GSL, as well as the partial volumes of these structures receiving 50-65 Gy; the highest correlations were associated with doses to the superior PC (p = 0.005). All patients with aspirations received mean PC doses >60 Gy or PC V{sub 65} >50%, and GSL V{sub 50} >50%. Reduced laryngeal elevation and epiglottic inversion were correlated with mean PC and GSL doses (p < 0.01). All 3 patients with strictures had PC V{sub 70} >50%. Worsening patient-reported liquid swallowing was correlated with mean PC (p = 0.05) and esophageal (p 0.02) doses. Only mean PC doses were correlated with worsening patient-reported solid swallowing (p = 0.04) and observer-rated swallowing scores (p = 0.04). Conclusions: These dose-volume-effect relationships provide initial IMRT optimization goals and motivate further efforts to reduce swallowing structures doses to reduce dysphagia and aspiration.« less

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.

Effect of clinically discriminating, evidence-based checklist items on the reliability of scores from an Internal Medicine residency OSCE.

PubMed

Daniels, Vijay J; Bordage, Georges; Gierl, Mark J; Yudkowsky, Rachel

2014-10-01

Objective structured clinical examinations (OSCEs) are used worldwide for summative examinations but often lack acceptable reliability. Research has shown that reliability of scores increases if OSCE checklists for medical students include only clinically relevant items. Also, checklists are often missing evidence-based items that high-achieving learners are more likely to use. The purpose of this study was to determine if limiting checklist items to clinically discriminating items and/or adding missing evidence-based items improved score reliability in an Internal Medicine residency OSCE. Six internists reviewed the traditional checklists of four OSCE stations classifying items as clinically discriminating or non-discriminating. Two independent reviewers augmented checklists with missing evidence-based items. We used generalizability theory to calculate overall reliability of faculty observer checklist scores from 45 first and second-year residents and predict how many 10-item stations would be required to reach a Phi coefficient of 0.8. Removing clinically non-discriminating items from the traditional checklist did not affect the number of stations (15) required to reach a Phi of 0.8 with 10 items. Focusing the checklist on only evidence-based clinically discriminating items increased test score reliability, needing 11 stations instead of 15 to reach 0.8; adding missing evidence-based clinically discriminating items to the traditional checklist modestly improved reliability (needing 14 instead of 15 stations). Checklists composed of evidence-based clinically discriminating items improved the reliability of checklist scores and reduced the number of stations needed for acceptable reliability. Educators should give preference to evidence-based items over non-evidence-based items when developing OSCE checklists.

Semi-automated scoring of triple-probe FISH in human sperm using confocal microscopy.

PubMed

Branch, Francesca; Nguyen, GiaLinh; Porter, Nicholas; Young, Heather A; Martenies, Sheena E; McCray, Nathan; Deloid, Glen; Popratiloff, Anastas; Perry, Melissa J

2017-09-01

Structural and numerical sperm chromosomal aberrations result from abnormal meiosis and are directly linked to infertility. Any live births that arise from aneuploid conceptuses can result in syndromes such as Kleinfelter, Turners, XYY and Edwards. Multi-probe fluorescence in situ hybridization (FISH) is commonly used to study sperm aneuploidy, however manual FISH scoring in sperm samples is labor-intensive and introduces errors. Automated scoring methods are continuously evolving. One challenging aspect for optimizing automated sperm FISH scoring has been the overlap in excitation and emission of the fluorescent probes used to enumerate the chromosomes of interest. Our objective was to demonstrate the feasibility of combining confocal microscopy and spectral imaging with high-throughput methods for accurately measuring sperm aneuploidy. Our approach used confocal microscopy to analyze numerical chromosomal abnormalities in human sperm using enhanced slide preparation and rigorous semi-automated scoring methods. FISH for chromosomes X, Y, and 18 was conducted to determine sex chromosome disomy in sperm nuclei. Application of online spectral linear unmixing was used for effective separation of four fluorochromes while decreasing data acquisition time. Semi-automated image processing, segmentation, classification, and scoring were performed on 10 slides using custom image processing and analysis software and results were compared with manual methods. No significant differences in disomy frequencies were seen between the semi automated and manual methods. Samples treated with pepsin were observed to have reduced background autofluorescence and more uniform distribution of cells. These results demonstrate that semi-automated methods using spectral imaging on a confocal platform are a feasible approach for analyzing numerical chromosomal aberrations in sperm, and are comparable to manual methods. © 2017 International Society for Advancement of Cytometry. © 2017 International Society for Advancement of Cytometry.

German version of the intuitive eating scale: Psychometric evaluation and application to an eating disordered population.

PubMed

van Dyck, Zoé; Herbert, Beate M; Happ, Christian; Kleveman, Gillian V; Vögele, Claus

2016-10-01

Intuitive eating has been described to represent an adaptive eating behaviour that is characterised by eating in response to physiological hunger and satiety cues, rather than situational and emotional stimuli. The Intuitive Eating Scale-2 (IES-2) has been developed to measure such attitudes and behaviours on four subscales: unconditional permission to eat (UPE), eating for physical rather than emotional reasons (EPR), reliance on internal hunger and satiety cues (RHSC), and body-food choice congruence (B-FCC). The present study aimed at validating the psychometric properties of the German translation of the IES-2 in a large German-speaking sample. A second objective was to assess levels of intuitive eating in participants with an eating disorder diagnosis (anorexia nervosa, bulimia nervosa, or binge eating disorder). The proposed factor structure of the IES-2 could be confirmed for the German translation of the questionnaire. The total score and most subscale scores were negatively related to eating disorder symptomatology, problems in appetite and emotional awareness, body dissatisfaction, and self-objectification. Women with eating disorders had significantly lower values on all IES-2 subscale scores and the total score than women without an eating disorder diagnosis. Women with a binge eating disorder (BED) diagnosis had higher scores on the UPE subscale compared to participants with anorexia nervosa (AN) or bulimia nervosa (BN), and those diagnosed with AN had higher scores on the EPR subscale than individuals with BN or BED. We conclude that the German IES-2 constitutes a useful self-report instrument for the assessment of intuitive eating in German-speaking samples. Further studies are warranted to evaluate psychometric properties of the IES-2 in different samples, and to investigate its application in a clinical setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

Novel, customizable scoring functions, parameterized using N-PLS, for structure-based drug discovery.

PubMed

Catana, Cornel; Stouten, Pieter F W

2007-01-01

The ability to accurately predict biological affinity on the basis of in silico docking to a protein target remains a challenging goal in the CADD arena. Typically, "standard" scoring functions have been employed that use the calculated docking result and a set of empirical parameters to calculate a predicted binding affinity. To improve on this, we are exploring novel strategies for rapidly developing and tuning "customized" scoring functions tailored to a specific need. In the present work, three such customized scoring functions were developed using a set of 129 high-resolution protein-ligand crystal structures with measured Ki values. The functions were parametrized using N-PLS (N-way partial least squares), a multivariate technique well-known in the 3D quantitative structure-activity relationship field. A modest correlation between observed and calculated pKi values using a standard scoring function (r2 = 0.5) could be improved to 0.8 when a customized scoring function was applied. To mimic a more realistic scenario, a second scoring function was developed, not based on crystal structures but exclusively on several binding poses generated with the Flo+ docking program. Finally, a validation study was conducted by generating a third scoring function with 99 randomly selected complexes from the 129 as a training set and predicting pKi values for a test set that comprised the remaining 30 complexes. Training and test set r2 values were 0.77 and 0.78, respectively. These results indicate that, even without direct structural information, predictive customized scoring functions can be developed using N-PLS, and this approach holds significant potential as a general procedure for predicting binding affinity on the basis of in silico docking.

Semantic representation in the white matter pathway

PubMed Central

Fang, Yuxing; Wang, Xiaosha; Zhong, Suyu; Song, Luping; Han, Zaizhu; Gong, Gaolang

2018-01-01

Object conceptual processing has been localized to distributed cortical regions that represent specific attributes. A challenging question is how object semantic space is formed. We tested a novel framework of representing semantic space in the pattern of white matter (WM) connections by extending the representational similarity analysis (RSA) to structural lesion pattern and behavioral data in 80 brain-damaged patients. For each WM connection, a neural representational dissimilarity matrix (RDM) was computed by first building machine-learning models with the voxel-wise WM lesion patterns as features to predict naming performance of a particular item and then computing the correlation between the predicted naming score and the actual naming score of another item in the testing patients. This correlation was used to build the neural RDM based on the assumption that if the connection pattern contains certain aspects of information shared by the naming processes of these two items, models trained with one item should also predict naming accuracy of the other. Correlating the neural RDM with various cognitive RDMs revealed that neural patterns in several WM connections that connect left occipital/middle temporal regions and anterior temporal regions associated with the object semantic space. Such associations were not attributable to modality-specific attributes (shape, manipulation, color, and motion), to peripheral picture-naming processes (picture visual similarity, phonological similarity), to broad semantic categories, or to the properties of the cortical regions that they connected, which tended to represent multiple modality-specific attributes. That is, the semantic space could be represented through WM connection patterns across cortical regions representing modality-specific attributes. PMID:29624578

Risk factors associated with moderate and serious injuries attributable to the 1994 Northridge Earthquake, Los Angeles, California.

PubMed

Mahue-Giangreco, M; Mack, W; Seligson, H; Bourque, L B

2001-07-01

The purpose of this study was to use emergency department data to estimate levels of morbidity and risk factors due to earthquake-related mechanisms of injury subsequent to an urban night-time earthquake. Data were abstracted from 4190 medical records for the month of January, 1994. Injuries attributable to the earthquake were identified through emergency department and medical records. These injuries were: (a) categorized by mechanism of injury; (b) assigned an injury severity score; and (c) linked to structural and geologic data. Proportional polytomous and dichotomous logistic regression were used to estimate risk of more severe injury associated with demographic characteristics, injury characteristics, structural characteristics, and geologic factors. More severe earthquake-related injuries (serious versus moderate and moderate versus minor) were statistically significantly associated with patient age (> or = 60 years old), upper extremities, falling, multi-family structures, pre-1960 housing, and the 50th percentile of Peak Ground Acceleration, after adjusting for all other available demographic, injury, structural, and geologic characteristics. The current recommendation of 'duck, cover, and hold' might not be optimal during a nighttime earthquake, particularly if individuals are in the padded environment of the bed. Actions such as reaching for or catching objects, bracing, or holding onto perceived stable objects may increase risk for more serious injury. Alternate responses include assuming a tucked position (as in airline crashes) or staying in bed for non-ambulating people. Structural damage and structure size were not associated with more serious injuries, but structure use and age were, leading the authors to suspect that unmeasured socioeconomic factors might impact risk factors. The importance of including population demographic characteristics in hazard modeling is emphasized.

Teaching Communication Skills to Medical and Pharmacy Students Through a Blended Learning Course.

PubMed

Hess, Rick; Hagemeier, Nicholas E; Blackwelder, Reid; Rose, Daniel; Ansari, Nasar; Branham, Tandy

2016-05-25

Objective. To evaluate the impact of an interprofessional blended learning course on medical and pharmacy students' patient-centered interpersonal communication skills and to compare precourse and postcourse communication skills across first-year medical and second-year pharmacy student cohorts. Methods. Students completed ten 1-hour online modules and participated in five 3-hour group sessions over one semester. Objective structured clinical examinations (OSCEs) were administered before and after the course and were evaluated using the validated Common Ground Instrument. Nonparametric statistical tests were used to examine pre/postcourse domain scores within and across professions. Results. Performance in all communication skill domains increased significantly for all students. No additional significant pre/postcourse differences were noted across disciplines. Conclusion. Students' patient-centered interpersonal communication skills improved across multiple domains using a blended learning educational platform. Interview abilities were embodied similarly between medical and pharmacy students postcourse, suggesting both groups respond well to this form of instruction.

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.

Objective structured assessment of nontechnical skills: Reliability of a global rating scale for the in-training assessment in the operating room.

PubMed

Dedy, Nicolas J; Szasz, Peter; Louridas, Marisa; Bonrath, Esther M; Husslein, Heinrich; Grantcharov, Teodor P

2015-06-01

Nontechnical skills are critical for patient safety in the operating room (OR). As a result, regulatory bodies for accreditation and certification have mandated the integration of these competencies into postgraduate education. A generally accepted approach to the in-training assessment of nontechnical skills, however, is lacking. The goal of the present study was to develop an evidence-based and reliable tool for the in-training assessment of residents' nontechnical performance in the OR. The Objective Structured Assessment of Nontechnical Skills tool was designed as a 5-point global rating scale with descriptive anchors for each item, based on existing evidence-based frameworks of nontechnical skills, as well as resident training requirements. The tool was piloted on scripted videos and refined in an iterative process. The final version was used to rate residents' performance in recorded OR crisis simulations and during live observations in the OR. A total of 37 simulations and 10 live procedures were rated. Interrater agreement was good for total mean scores, both in simulation and in the real OR, with intraclass correlation coefficients >0.90 in all settings for average and single measures. Internal consistency of the scale was high (Cronbach's alpha = 0.80). The Objective Structured Assessment of Nontechnical Skills global rating scale was developed as an evidence-based tool for the in-training assessment of residents' nontechnical performance in the OR. Unique descriptive anchors allow for a criterion-referenced assessment of performance. Good reliability was demonstrated in different settings, supporting applications in research and education. 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.

Health status, quality of life and medical care in adult women with Turner syndrome

PubMed Central

Diana-Alexandra, Ertl; Andreas, Gleiss; Katharina, Schubert; Caroline, Culen; Peer, Hauck; Johannes, Ott; Alois, Gessl; Gabriele, Haeusler

2018-01-01

Background Previous studies have shown that only a minority of patients with Turner syndrome (TS) have adequate medical care after transfer to adult care. Aim of this study To assess the status of medical follow-up and quality of life (QoL) in adult women diagnosed with TS and followed up until transfer. To compare the subjective and objective view of the medical care quality and initiate improvements based on patients’ experiences and current recommendations. Methods 39 adult women with TS out of 64 patients contacted were seen for a clinical and laboratory check, cardiac ultrasound, standardized and structured questionnaires (SF-36v2 and Beck depression inventory). Results 7/39 of the patients were not being followed medically at all. Only 2/39 consulted all the specialists recommended. Comorbidities were newly diagnosed in 27/39 patients; of these, 11 related to the cardiovascular system. Patients in our cohort scored as high as the mean reference population for SF-36v2 in both mental and physical compartments. Obese participants had lower scores in the physical function section, whereas higher education was related to higher physical QoL scores. Adult height slightly correlated positively with physical health. Conclusion Medical follow-up was inadequate in our study cohort of adults with TS. Even though their medical follow-up was insufficient, these women felt adequately treated, leaving them vulnerable for premature illness. Initiatives in health autonomy and a structured transfer process as well as closer collaborations within specialities are urgently needed. PMID:29514898

The Polish version of Skindex-29: psychometric properties of an instrument to measure quality of life in dermatology.

PubMed

Janowski, Konrad; Steuden, Stanisława; Bereza, Bernarda

2014-02-01

Skin conditions have a negative impact on quality of life and it is necessary to quantify this impact. Skindex-29 is a self-report questionnaire developed to measure dermatology-specific quality of life. The objective of this study is to adapt this questionnaire to Polish conditions. The adaptation procedure involved the works on the linguistic content of the items and testing psychometric properties of the Polish version of Skindex-29, including item characteristics, factorial structure, aspects of reliability and validity. Two-hundred and ninety patients (63.4% women and 35.2% men) suffering from a range of skin conditions were recruited from several dermatological out-patient and in-patient clinics in Poland. Quality of life was measured using Skindex-29 and appropriate clinical data were collected. The global score of Skindex-29 showed the normal distribution. Cronbach's α reliability coefficients were found to be high to very high for all Skindex-29 indexes. Factor analysis yielded four factors, in contrast to the original version of the questionnaire, for which a three-factor solution had been reported. Skindex-29 validity was demonstrated by showing the differences in the quality of life scores across different diagnostic categories, and between in-patients and out-patients. Skindex-29 global scores were found to be significantly predicted by the localization of the skin lesions on legs, anogenital areas and palms. The findings of this study support reliability and validity of the Polish version of Skindex-29, but they also raise questions to its three-factor structure.

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.

[Visual and motor functions in schizophrenic patients].

PubMed

Del Vecchio, S; Gargiulo, P A

1992-12-01

In the present work, visual and motor functions have been explored in 26 chronic schizophrenic patients, and 7 acute schizophrenic patients, compared with 26 normal controls, by means of the Bender-Gestalt Test. Parameters under consideration were: Form distortion, rotation, integration, perseveration, use of space, subtle motricity, score (global parameter), and time employed. As regards distortion and rotation there have been highly significant differences between chronic patients and control group. Among acute patients, it was observed that perseveration was also highly significant. Conversely, integration and use of space did not differ significantly among the three groups involved. The global score, resulting from all the above mentioned parameters showed important differences between both patient groups on the one hand, and control group on the other hand. Taking into account that patients were being administered neuroleptic drugs, it can safely be said, however, that the Bender-Gestalt Test allows to recognize alteration in perceptual closure consistent with a loss of the objective structure of perceived phenomena, in both chronic and acute patients.

Functional region prediction with a set of appropriate homologous sequences-an index for sequence selection by integrating structure and sequence information with spatial statistics

PubMed Central

2012-01-01

Background The detection of conserved residue clusters on a protein structure is one of the effective strategies for the prediction of functional protein regions. Various methods, such as Evolutionary Trace, have been developed based on this strategy. In such approaches, the conserved residues are identified through comparisons of homologous amino acid sequences. Therefore, the selection of homologous sequences is a critical step. It is empirically known that a certain degree of sequence divergence in the set of homologous sequences is required for the identification of conserved residues. However, the development of a method to select homologous sequences appropriate for the identification of conserved residues has not been sufficiently addressed. An objective and general method to select appropriate homologous sequences is desired for the efficient prediction of functional regions. Results We have developed a novel index to select the sequences appropriate for the identification of conserved residues, and implemented the index within our method to predict the functional regions of a protein. The implementation of the index improved the performance of the functional region prediction. The index represents the degree of conserved residue clustering on the tertiary structure of the protein. For this purpose, the structure and sequence information were integrated within the index by the application of spatial statistics. Spatial statistics is a field of statistics in which not only the attributes but also the geometrical coordinates of the data are considered simultaneously. Higher degrees of clustering generate larger index scores. We adopted the set of homologous sequences with the highest index score, under the assumption that the best prediction accuracy is obtained when the degree of clustering is the maximum. The set of sequences selected by the index led to higher functional region prediction performance than the sets of sequences selected by other sequence-based methods. Conclusions Appropriate homologous sequences are selected automatically and objectively by the index. Such sequence selection improved the performance of functional region prediction. As far as we know, this is the first approach in which spatial statistics have been applied to protein analyses. Such integration of structure and sequence information would be useful for other bioinformatics problems. PMID:22643026

Influence of sleep disturbance, fatigue, vitality on oral health and academic performance in indian dental students

PubMed Central

ASAWA, KAILASH; SEN, NANDINI; BHAT, NAGESH; TAK, MRIDULA; SULTANE, PRATIBHA; MANDAL, ARITRA

2017-01-01

Background Oral health and academic performance are important contributing factors for a student’s professional life. Countless factors affect both, among which sleep, vitality and fatigue are less explored areas that also have a strong impact. Objective The objective of the study was to assess the association of sleep disturbances, fatigue and vitality with self reported oral health status, oral hygiene habits and academic performance of dental students of Udaipur. Methods A descriptive cross-sectional study was conducted among undergraduate and postgraduate dental students of Udaipur. Self-administered structured questionnaire was used to assess the psychological factors, vitality, sleep quality, fatigue, self reported oral health status, habits and academic performance. Analysis of variance and stepwise multiple linear regression were utilized for statistical analysis with 95% confidence level and 5% level of significance. Results Of the 230 participants, 180 (78.3%) were undergraduates and 50 (21.7%) were postgraduates. Among them, females showed higher scores in disturbed sleep index (2.69±2.14) as compared to males (2.45±1.91). Respondents who had “Poor” dental health, scored more in disturbed sleep index (3.15±1.64) and fatigue scale (20.00±4.88). Subjects who flossed “everyday”, were found to have good sleep and more energy (p=0.01) and those who assessed themselves as excellent students scored more in the Vitality Scale (p=0.01) and less in the Sleep index (p=0.01). Conclusion The present study confirms that disturbed sleep, aliveness and fatigue, all are interlinked with each other and are imperative factors having the potential to alter the oral health status, habits and academics of dental students. PMID:28781530

A year-long caregiver training program to improve neurocognition in preschool Ugandan HIV-exposed children.

PubMed

Boivin, Michael J; Bangirana, Paul; Nakasujja, Noeline; Page, Connie F; Shohet, Cilly; Givon, Deborah; Bass, Judith K; Opoka, Robert O; Klein, Pnina S

2013-05-01

Mediational intervention for sensitizing caregivers (MISC) is a structured program enabling caregivers to enhance their child's cognitive and emotional development through daily interactions. The principal aim was to evaluate if a year-long MISC caregiver training program produced greater improvement in child cognitive and emotional development compared with a control program. One hundred and nineteen uninfected HIV-exposed preschool children and their caregivers were randomly assigned to 1 of 2 treatment arms: biweekly MISC training alternating between home and clinic for 1 year or a health and nutrition curriculum. All children were evaluated at baseline, 6 months, and 1 year with the Mullen Early Learning Scales, Color-Object Association Test for memory, and Achenbach Child Behavior Checklist for psychiatric symptoms. Caregivers were evaluated on the same schedule with the Hopkins Symptoms Checklist-25 for depression and anxiety. The treatment arms were compared using repeated-measures analysis of covariance with child age, gender, weight, socioeconomic status, caregiving quality, caregiver anxiety, and caregiver education as covariates. The MISC children had significantly greater gains compared to controls on the Mullen Receptive and Expressive Language development, and on the Mullen composite score of cognitive ability. Color-Object Association Test total memory for MISC children was marginally better than controls. No Achenbach Child Behavior Checklist differences between the groups were noted. Caldwell Home Observation for Measurement of the Environment scores and observed mediational interaction scores from videotapes measuring caregiving quality also improved significantly more for the MISC group. The MISC enhanced cognitive performance, especially in language development. These benefits were possibly mediated by improved caregiving and positive emotional benefit to the caregiver.

Evaluation of PCMH Model Adoption on Teamwork and Impact on Patient Access and Safety

PubMed Central

Khanna, Niharika; Shaya, Fadia T.; Gaitonde, Priyanka; Abiamiri, Andrea; Steffen, Ben; Sharp, David

2016-01-01

Purpose: Each of the participating patient-centered medical home (PCMH) received coaching and participated in learning collaborative for improving teamwork. The objective of the study was to assess the impact of trainings on patient-centered teamwork. Methods: The Teamwork Perception Questionnaire (TPQ) was administered once in spring 2014 and then in fall 2015. The TPQ consists of 35 questions across 5 domains: mutual support, situation monitoring, communication, team structure, and leadership. Based on our objective we compared the frequencies of strongly agree/agree by domain. The difference was tested using chi-square test. We compared the scores on each domain (strongly agree/agree = 1; maximum score = 7) via Wilcoxon rank sum test. Results: The response rate for this survey was n = 29 (80.6%) in spring 2014, and n = 31 (86.1%) in fall 2015. We found that the practice members significantly (P < .05) strongly agreed/agreed more in fall 2015 than spring 2014 for characteristics—“staff relay relevant information in a timely manner” (64.5% vs 83.9%) and “staff follow a standardized method of sharing information when handing off patients” (67.7% vs 90.3%) under communication domain and for characteristic—“staff within my practice share information that enables timely decision making” (74.2% vs 90.3%). However, there was no statistical significant difference observed in the scores for the overall TPQ at the 2 time points. Conclusion: Despite the statistical insignificance, the observations in PCMHs across the spectrum of practices participating in the Maryland Multi-Payer Program demonstrated enhanced teamwork specifically in communication and in leadership. This we believe will continue to result in enhanced patient access to care and safety. PMID:27838621

Evaluation of PCMH Model Adoption on Teamwork and Impact on Patient Access and Safety.

PubMed

Khanna, Niharika; Shaya, Fadia T; Gaitonde, Priyanka; Abiamiri, Andrea; Steffen, Ben; Sharp, David

2017-04-01

Each of the participating patient-centered medical home (PCMH) received coaching and participated in learning collaborative for improving teamwork. The objective of the study was to assess the impact of trainings on patient-centered teamwork. The Teamwork Perception Questionnaire (TPQ) was administered once in spring 2014 and then in fall 2015. The TPQ consists of 35 questions across 5 domains: mutual support, situation monitoring, communication, team structure, and leadership. Based on our objective we compared the frequencies of strongly agree/agree by domain. The difference was tested using chi-square test. We compared the scores on each domain (strongly agree/agree = 1; maximum score = 7) via Wilcoxon rank sum test. The response rate for this survey was n = 29 (80.6%) in spring 2014, and n = 31 (86.1%) in fall 2015. We found that the practice members significantly ( P < .05) strongly agreed/agreed more in fall 2015 than spring 2014 for characteristics-"staff relay relevant information in a timely manner" (64.5% vs 83.9%) and "staff follow a standardized method of sharing information when handing off patients" (67.7% vs 90.3%) under communication domain and for characteristic-"staff within my practice share information that enables timely decision making" (74.2% vs 90.3%). However, there was no statistical significant difference observed in the scores for the overall TPQ at the 2 time points. Despite the statistical insignificance, the observations in PCMHs across the spectrum of practices participating in the Maryland Multi-Payer Program demonstrated enhanced teamwork specifically in communication and in leadership. This we believe will continue to result in enhanced patient access to care and safety.

The costs of heparin-induced thrombocytopenia: a patient-based cost of illness analysis.

PubMed

Wilke, T; Tesch, S; Scholz, A; Kohlmann, T; Greinacher, A

2009-05-01

SUMMARY BACKGROUND AND OBJECTIVES: Due to the complexity of heparin-induced thrombocytopenia (HIT), currently available cost analyses are rough estimates. The objectives of this study were quantification of costs involved in HIT and identification of main cost drivers based on a patient-oriented approach. Patients diagnosed with HIT (1995-2004, University-hospital Greifswald, Germany) based on a positive functional assay (HIPA test) were retrieved from the laboratory records and scored (4T-score) by two medical experts using the patient file. For cost of illness analysis, predefined HIT-relevant cost parameters (medication costs, prolonged in-hospital stay, diagnostic and therapeutic interventions, laboratory tests, blood transfusions) were retrieved from the patient files. The data were analysed by linear regression estimates with the log of costs and a gamma regression model. Mean length of stay data of non-HIT patients were obtained from the German Federal Statistical Office, adjusted for patient characteristics, comorbidities and year of treatment. Hospital costs were provided by the controlling department. One hundred and thirty HIT cases with a 4T-score >or=4 and a positive HIPA test were analyzed. Mean additional costs of a HIT case were 9008 euro. The main cost drivers were prolonged in-hospital stay (70.3%) and costs of alternative anticoagulants (19.7%). HIT was more costly in surgical patients compared with medical patients and in patients with thrombosis. Early start of alternative anticoagulation did not increase HIT costs despite the high medication costs indicating prevention of costly complications. An HIT cost calculator is provided, allowing online calculation of HIT costs based on local cost structures and different currencies.

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

Screening Internet websites for educational potential in undergraduate medical education.

PubMed

Burd, Andrew; Chiu, Tor; McNaught, Carmel

2004-01-01

This paper addresses the difficulty of finding suitable websites to support undergraduate medical students in learning key concepts and skills in plastic surgery in particular, and other areas of undergraduate medical education in general. Based on a model of the pedagogical elements contained in educational websites, the authors developed a short objective scoring system with five criteria. Pre-university students were used to find websites in plastic surgery. One hundred and fifty of those that were still in place after a year were evaluated using the objective scoring system. Sixty of these were then selected and were subjectively evaluated by final year medical students in terms of their perceived educational potential. There was only a moderate correlation between the objective and subjective scores. Our conclusion is that it does not seem possible to construct any objective system of medical website evaluation. The discussion of the results of this study focuses on the issues involved in finding suitable web-based material and the diversity between students. New strategies such as formally organized consortia involving agreements between medical schools may evolve.

Genetic parameters for type classification of Nelore cattle on central performance tests at pasture in Brazil.

PubMed

Lima, Paulo Ricardo Martins; Paiva, Samuel Rezende; Cobuci, Jaime Araujo; Braccini Neto, José; Machado, Carlos Henrique Cavallari; McManus, Concepta

2013-10-01

The objective of this study was to characterize Nelore cattle on central performance tests in pasture, ranked by the visual classification method EPMURAS (structure, precocity, muscle, navel, breed, posture, and sexual characteristics), and to estimate genetic and phenotypic correlations between these parameters, including visual as well as production traits (initial and final weight on test, weight gain, and weight corrected for 550 days). The information used in the study was obtained on 21,032 Nelore bulls which were participants in the central performance test at pasture of the Brazilian Association for Zebu Breeders (ABCZ). Heritabilities obtained were from 0.19 to 0.50. Phenotypic correlations were positive from 0.70 to 0.97 between the weight traits, from 0.65 to 0.74 between visual characteristics, and from 0.29 to 0.47 between visual characteristics and weight traits. The genetic correlations were positive ranging from 0.80 to 0.98 between the characteristics of structure, precocity and musculature, from 0.13 to 0.64 between the growth characteristics, and from 0.41 to 0.97 between visual scores and weight gains. Heritability and genetic correlations indicate that the use of visual scores, along with the selection for growth characteristics, can bring positive results in selection of beef cattle for rearing on pasture.

Factor Analysis of the Brazilian Version of UPPS Impulsive Behavior Scale

PubMed Central

Sediyama, Cristina Y. N.; Moura, Ricardo; Garcia, Marina S.; da Silva, Antonio G.; Soraggi, Carolina; Neves, Fernando S.; Albuquerque, Maicon R.; Whiteside, Setephen P.; Malloy-Diniz, Leandro F.

2017-01-01

Objective: To examine the internal consistency and factor structure of the Brazilian adaptation of the UPPS Impulsive Behavior Scale. Methods: UPPS is a self-report scale composed by 40 items assessing four factors of impulsivity: (a) urgency, (b) lack of premeditation; (c) lack of perseverance; (d) sensation seeking. In the present study 384 participants (278 women and 106 men), who were recruited from schools, universities, leisure centers and workplaces fulfilled the UPPS scale. An exploratory factor analysis was performed by using Varimax factor rotation and Kaiser Normalization, and we also conducted two confirmatory analyses to test the independency of the UPPS components found in previous analysis. Results: Results showed a decrease in mean UPPS total scores with age and this analysis showed that the youngest participants (below 30 years) scored significantly higher than the other groups over 30 years. No difference in gender was found. Cronbach’s alpha, results indicated satisfactory values for all subscales, with similar high values for the subscales and confirmatory factor analysis indexes also indicated a poor model fit. The results of two exploratory factor analysis were satisfactory. Conclusion: Our results showed that the Portuguese version has the same four-factor structure of the original and previous translations of the UPPS. PMID:28484414

Behavioral activation system modulation on brain activation during appetitive and aversive stimulus processing.

PubMed

Barrós-Loscertales, Alfonso; Ventura-Campos, Noelia; Sanjuán-Tomás, Ana; Belloch, Vicente; Parcet, Maria-Antònia; Avila, César

2010-03-01

The reinforcement sensitivity theory (RST) proposed the behavioral activation system (BAS) as a neurobehavioral system that is dependent on dopamine-irrigated structures and that mediates the individual differences in sensitivity and reactivity to appetitive stimuli associated with BAS-related personality traits. Theoretical developments propose that high BAS sensitivity is associated with both enhanced appetitive stimuli processing and the diminished processing of aversive stimuli. The objective of this study was to analyze how individual differences in BAS functioning were associated with brain activation during erotic and aversive picture processing while subjects were involved in a simple goal-directed task. Forty-five male participants took part in this study. The task activation results confirm the activation of the reward and punishment brain-related structures while viewing erotic and aversive pictures, respectively. The SR scores show a positive correlation with activation of the left lateral prefrontal cortex, the mesial prefrontal cortex and the right occipital cortex while viewing erotic pictures, and a negative correlation with the right lateral prefrontal cortex and the left occipital cortex while viewing aversive pictures. In summary, the SR scores modulate the activity of the cortical areas in the prefrontal and the occipital cortices that are proposed to modulate the BAS and the BIS-FFFS.

Structural Zeros and Their Implications with Log-Linear Bivariate Presmoothing under the Internal-Anchor Design

ERIC Educational Resources Information Center

Kim, Hyung Jin; Brennan, Robert L.; Lee, Won-Chan

2017-01-01

In equating, when common items are internal and scoring is conducted in terms of the number of correct items, some pairs of total scores ("X") and common-item scores ("V") can never be observed in a bivariate distribution of "X" and "V"; these pairs are called "structural zeros." This simulation…

Factor Structure of Child Behavior Scale Scores in Peruvian Preschoolers

ERIC Educational Resources Information Center

Meyer, Erin L.; Schaefer, Barbara A.; Soto, Cesar Merino; Simmons, Crystal S.; Anguiano, Rebecca; Brett, Jeremy; Holman, Alea; Martin, Justin F.; Hata, Heidi K.; Roberts, Kimberly J.; Mello, Zena R.; Worrell, Frank C.

2011-01-01

Behavior rating scales aid in the identification of problem behaviors, as well as the development of interventions to reduce such behavior. Although scores on many behavior rating scales have been validated in the United States, there have been few such studies in other cultural contexts. In this study, the structural validity of scores on a…

Reliability of Summed Item Scores Using Structural Equation Modeling: An Alternative to Coefficient Alpha

ERIC Educational Resources Information Center

Green, Samuel B.; Yang, Yanyun

2009-01-01

A method is presented for estimating reliability using structural equation modeling (SEM) that allows for nonlinearity between factors and item scores. Assuming the focus is on consistency of summed item scores, this method for estimating reliability is preferred to those based on linear SEM models and to the most commonly reported estimate of…

A Computer-Based Approach for Deriving and Measuring Individual and Team Knowledge Structure from Essay Questions

ERIC Educational Resources Information Center

Clariana, Roy B.; Wallace, Patricia

2007-01-01

This proof-of-concept investigation describes a computer-based approach for deriving the knowledge structure of individuals and of groups from their written essays, and considers the convergent criterion-related validity of the computer-based scores relative to human rater essay scores and multiple-choice test scores. After completing a…

Standard Errors of Estimated Latent Variable Scores with Estimated Structural Parameters

ERIC Educational Resources Information Center

Hoshino, Takahiro; Shigemasu, Kazuo

2008-01-01

The authors propose a concise formula to evaluate the standard error of the estimated latent variable score when the true values of the structural parameters are not known and must be estimated. The formula can be applied to factor scores in factor analysis or ability parameters in item response theory, without bootstrap or Markov chain Monte…

The Factor Structure and Dimensional Scoring of the Generalized Anxiety Disorder Questionnaire for "DSM-IV"

ERIC Educational Resources Information Center

Rodebaugh, Thomas L.; Holaway, Robert M.; Heimberg, Richard G.

2008-01-01

Despite favorable psychometric properties, the Generalized Anxiety Disorder Questionnaire for the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.) (GAD-Q-IV) does not have a known factor structure, which calls into question use of its original weighted scoring system (usually referred to as the dimensional score).…

Translation and validation of the new version of the Knee Society Score - The 2011 KS Score - into Brazilian Portuguese.

PubMed

Silva, Adriana Lucia Pastore E; Croci, Alberto Tesconi; Gobbi, Riccardo Gomes; Hinckel, Betina Bremer; Pecora, José Ricardo; Demange, Marco Kawamura

2017-01-01

Translation, cultural adaptation, and validation of the new version of the Knee Society Score - The 2011 KS Score - into Brazilian Portuguese and verification of its measurement properties, reproducibility, and validity. In 2012, the new version of the Knee Society Score was developed and validated. This scale comprises four separate subscales: (a) objective knee score (seven items: 100 points); (b) patient satisfaction score (five items: 40 points); (c) patient expectations score (three items: 15 points); and (d) functional activity score (19 items: 100 points). A total of 90 patients aged 55-85 years were evaluated in a clinical cross-sectional study. The pre-operative translated version was applied to patients with TKA referral, and the post-operative translated version was applied to patients who underwent TKA. Each patient answered the same questionnaire twice and was evaluated by two experts in orthopedic knee surgery. Evaluations were performed pre-operatively and three, six, or 12 months post-operatively. The reliability of the questionnaire was evaluated using the intraclass correlation coefficient (ICC) between the two applications. Internal consistency was evaluated using Cronbach's alpha. The ICC found no difference between the means of the pre-operative, three-month, and six-month post-operative evaluations between sub-scale items. The Brazilian Portuguese version of The 2011 KS Score is a valid and reliable instrument for objective and subjective evaluation of the functionality of Brazilian patients who undergo TKA and revision TKA.

Criteria for evaluating programme theory diagrams in quality improvement initiatives: a structured method for appraisal.

PubMed

Issen, Laurel; Woodcock, Thomas; McNicholas, Christopher; Lennox, Laura; Reed, Julie E

2018-04-09

Despite criticisms that many quality improvement (QI) initiatives fail due to incomplete programme theory, there is no defined way to evaluate how programme theory has been articulated. The objective of this research was to develop, and assess the usability and reliability of scoring criteria to evaluate programme theory diagrams. Criteria development was informed by published literature and QI experts. Inter-rater reliability was tested between two evaluators. About 63 programme theory diagrams (42 driver diagrams and 21 action-effect diagrams) were reviewed to establish whether the criteria could support comparative analysis of different approaches to constructing diagrams. Components of the scoring criteria include: assessment of overall aim, logical overview, clarity of components, cause-effect relationships, evidence and measurement. Independent reviewers had 78% inter-rater reliability. Scoring enabled direct comparison of different approaches to developing programme theory; action-effect diagrams were found to have had a statistically significant but moderate improvement in programme theory quality over driver diagrams; no significant differences were observed based on the setting in which driver diagrams were developed. The scoring criteria summarise the necessary components of programme theory that are thought to contribute to successful QI projects. The viability of the scoring criteria for practical application was demonstrated. Future uses include assessment of individual programme theory diagrams and comparison of different approaches (e.g. methodological, teaching or other QI support) to produce programme theory. The criteria can be used as a tool to guide the production of better programme theory diagrams, and also highlights where additional support for QI teams could be needed.

Risk and Protective Factors for Suicidality at 6-Month Follow-up in Adolescent Inpatients Who Attempted Suicide: An Exploratory Model

PubMed Central

Consoli, Angèle; Cohen, David; Bodeau, Nicolas; Guilé, Jean-Marc; Mirkovic, Bojan; Knafo, Alexandra; Mahé, Vincent; Laurent, Claudine; Renaud, Johanne; Labelle, Réal; Breton, Jean-Jacques; Gérardin, Priscille

2015-01-01

Objective: To assess risk and protective factors for suicidality at 6-month follow-up in adolescent inpatients after a suicide attempt. Methods: One hundred seven adolescents from 5 inpatient units who had a suicide attempt were seen at 6-month follow-up. Baseline measures included sociodemographics, mood and suicidality, dependence, borderline symptomatology, temperament and character inventory (TCI), reasons for living, spirituality, and coping scores. Results: At 6-month follow-up, 41 (38%) subjects relapsed from suicidal behaviours. Among them, 15 (14%) had repeated a suicide attempt. Higher depression and hopelessness scores, the occurrence of a new suicide attempt, or a new hospitalization belonged to the same factorial dimension (suicidality). Derived from the best-fit structural equation modelling for suicidality as an outcome measure at 6-month follow-up, risk factors among the baseline variables included: major depressive disorder, high depression scores, and high scores for TCI self-transcendence. Only one protective factor emerged: coping–hard work and achievement. Conclusion: In this very high-risk population, some established risk factors (for example, a history of suicide attempts) may not predict suicidality. Our results suggest that adolescents who retain high scores for depression or hopelessness, who remain depressed, or who express a low value for life or an abnormally high connection with the universe are at higher risk for suicidality and should be targeted for more intense intervention. Improving adolescent motivation in school and in work may be protective. Given the sample size, the model should be regarded as exploratory. PMID:25886668

Correlating Cognitive Decline with White Matter Lesion and Brain Atrophy MRI Measurements in Alzheimer’s Disease

PubMed Central

Bilello, Michel; Doshi, Jimit; Nabavizadeh, S. Ali; Toledo, Jon B.; Erus, Guray; Xie, Sharon X.; Trojanowski, John Q.; Han, Xiaoyan; Davatzikos, Christos

2015-01-01

Background Vascular risk factors are increasingly recognized as risks factors for Alzheimer’s disease (AD) and early conversion from mild cognitive impairment (MCI) to dementia. While neuroimaging research in AD has focused on brain atrophy, metabolic function or amyloid deposition, little attention has been paid to the effect of cerebrovascular disease to cognitive decline. Objective To investigate the correlation of brain atrophy and white matter lesions with cognitive decline in AD, MCI, and control subjects. Methods Patients with AD and MCI, and healthy subjects were included in this study. Subjects had a baseline MRI scan, and baseline and follow-up neuropsychological battery (CERAD). Regional volumes were measured, and white matter lesion segmentation was performed. Correlations between rate of CERAD score decline and white matter lesion load and brain structure volume were evaluated. In addition, voxel-based correlations between baseline CERAD scores and atrophy and white matter lesion measures were computed. Results CERAD rate of decline was most significantly associated with lesion loads located in the fornices. Several temporal lobe ROI volumes were significantly associated with CERAD decline. Voxel-based analysis demonstrated strong correlation between baseline CERAD scores and atrophy measures in the anterior temporal lobes. Correlation of baseline CERAD scores with white matter lesion volumes achieved significance in multilobar subcortical white matter. Conclusion Both baseline and declines in CERAD scores correlate with white matter lesion load and gray matter atrophy. Results of this study highlight the dominant effect of volume loss, and underscore the importance of small vessel disease as a contributor to cognitive decline in the elderly. PMID:26402108

Assessing Technical Performance and Determining the Learning Curve in Cleft Palate Surgery Using a High-Fidelity Cleft Palate Simulator.

PubMed

Podolsky, Dale J; Fisher, David M; Wong Riff, Karen W; Szasz, Peter; Looi, Thomas; Drake, James M; Forrest, Christopher R

2018-06-01

This study assessed technical performance in cleft palate repair using a newly developed assessment tool and high-fidelity cleft palate simulator through a longitudinal simulation training exercise. Three residents performed five and one resident performed nine consecutive endoscopically recorded cleft palate repairs using a cleft palate simulator. Two fellows in pediatric plastic surgery and two expert cleft surgeons also performed recorded simulated repairs. The Cleft Palate Objective Structured Assessment of Technical Skill (CLOSATS) and end-product scales were developed to assess performance. Two blinded cleft surgeons assessed the recordings and the final repairs using the CLOSATS, end-product scale, and a previously developed global rating scale. The average procedure-specific (CLOSATS), global rating, and end-product scores increased logarithmically after each successive simulation session for the residents. Reliability of the CLOSATS (average item intraclass correlation coefficient (ICC), 0.85 ± 0.093) and global ratings (average item ICC, 0.91 ± 0.02) among the raters was high. Reliability of the end-product assessments was lower (average item ICC, 0.66 ± 0.15). Standard setting linear regression using an overall cutoff score of 7 of 10 corresponded to a pass score for the CLOSATS and the global score of 44 (maximum, 60) and 23 (maximum, 30), respectively. Using logarithmic best-fit curves, 6.3 simulation sessions are required to reach the minimum standard. A high-fidelity cleft palate simulator has been developed that improves technical performance in cleft palate repair. The simulator and technical assessment scores can be used to determine performance before operating on patients.

Structure refinement of membrane proteins via molecular dynamics simulations.

PubMed

Dutagaci, Bercem; Heo, Lim; Feig, Michael

2018-07-01

A refinement protocol based on physics-based techniques established for water soluble proteins is tested for membrane protein structures. Initial structures were generated by homology modeling and sampled via molecular dynamics simulations in explicit lipid bilayer and aqueous solvent systems. Snapshots from the simulations were selected based on scoring with either knowledge-based or implicit membrane-based scoring functions and averaged to obtain refined models. The protocol resulted in consistent and significant refinement of the membrane protein structures similar to the performance of refinement methods for soluble proteins. Refinement success was similar between sampling in the presence of lipid bilayers and aqueous solvent but the presence of lipid bilayers may benefit the improvement of lipid-facing residues. Scoring with knowledge-based functions (DFIRE and RWplus) was found to be as good as scoring using implicit membrane-based scoring functions suggesting that differences in internal packing is more important than orientations relative to the membrane during the refinement of membrane protein homology models. © 2018 Wiley Periodicals, Inc.

Effectiveness of Structured Education in Reduction of Postpartum Depression Scores: A Quasi-Experimental Study.

PubMed

Top, Ekin Dila; Karaçam, Zekiye

2016-06-01

The aim of this study was to evaluate effectiveness of structured education in reduction of postpartum depression scores among women. This was a quasi-experimental study with a pre-post tests and a control group. Non-random sampling was used and the study included a total of 103 Turkish women, 52 of whom were in the intervention group and 51 were in the control group. The women in the intervention group were offered structured education for postpartum depression and given structured education material. Effectiveness of the education given was evaluated by comparing scores for Edinburg Postpartum Depression Scale obtained before and after delivery between the intervention and the control groups. Before education, median score (8.0±4.8) for Edinburg Postpartum Depression Scale of the intervention group were significantly higher the than the control group (6.0±6.0, p=0.010), but the groups were statistically similar in terms of having depression (intervention: 17.3%, control: 11.8%, p=0.425). After education, the median score for Edinburg Postpartum Depression Scale and the ratio of the women having depression in the intervention group were significantly lower than in the control group (respectively intervention: 4.0±3.0, control: 10.0±4.0, p=0.000; intervention: 7.7%, control: 25.5%, p=0.015). Besides, the median score (8.0±4.8) of the intervention group before education were significantly higher than the score (4.0±3.0) obtained after education (p=0.000), while the median score (6.0±6.0) of the control group before education were lower than the score (10.0±4.0) obtained after education (p=0.000). This study revealed that structured education offered to women by nurses was effective in reducing the postpartum depression scores and the numbers of women having depression. Copyright © 2015 Elsevier Inc. All rights reserved.

Using Empirical Data to Set Cutoff Scores.

ERIC Educational Resources Information Center

Hills, John R.

Six experimental approaches to the problems of setting cutoff scores and choosing proper test length are briefly mentioned. Most of these methods share the premise that a test is a random sample of items, from a domain associated with a carefully specified objective. Each item is independent and is scored zero or one, with no provision for…

Validating Automated Essay Scoring: A (Modest) Refinement of the "Gold Standard"

ERIC Educational Resources Information Center

Powers, Donald E.; Escoffery, David S.; Duchnowski, Matthew P.

2015-01-01

By far, the most frequently used method of validating (the interpretation and use of) automated essay scores has been to compare them with scores awarded by human raters. Although this practice is questionable, human-machine agreement is still often regarded as the "gold standard." Our objective was to refine this model and apply it to…

Algorithm improvement program nuclide identification algorithm scoring criteria and scoring application.

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

Enghauser, Michael

2016-02-01

The goal of the Domestic Nuclear Detection Office (DNDO) Algorithm Improvement Program (AIP) is to facilitate gamma-radiation detector nuclide identification algorithm development, improvement, and validation. Accordingly, scoring criteria have been developed to objectively assess the performance of nuclide identification algorithms. In addition, a Microsoft Excel spreadsheet application for automated nuclide identification scoring has been developed. This report provides an overview of the equations, nuclide weighting factors, nuclide equivalencies, and configuration weighting factors used by the application for scoring nuclide identification algorithm performance. Furthermore, this report presents a general overview of the nuclide identification algorithm scoring application including illustrative examples.

An investigation of the development of the topological spatial structures in elementary school students

NASA Astrophysics Data System (ADS)

Everett, Susan Ann

1999-09-01

In this study the relationships among the topological spatial structures were examined in students in kindergarten, second, and fourth grades. These topological spatial structures are part of the three major types of spatial thinking: topological, projective, and Euclidean (as defined by Jean Piaget and associates). According to Piaget's model of spatial thinking, the spatial structures enable humans to think about spatial relationships at a conceptual or representational level rather than only at a simpler, perceptual level. The clinical interview technique was used to interact individually with 72 children to assess the presence of each of the different topological spatial structures. This was accomplished through the use of seven task protocols and simple objects which are familiar to young children. These task protocols allowed the investigator to interact with each child in a consistent manner. The results showed that most of the children in this study (97.2%) had not developed all of the topological spatial structures. The task scores, were analyzed using non-parametric statistical tests due to the ordinal nature of the data. From the data the following results were obtained: (1) the spatial structures did not develop in random order based on the task scores but developed in the sequence expected from Piaget's model, (2) task performance improved with grade level with fourth grade students outperforming second graders and kindergartners on each of the seven tasks, and (3) no significant differences on task performance due to gender were found. Based on these results, young elementary children are beginning to develop topological spatial thinking. This is critical since it provides the foundation for the other types of spatial thinking, projective and Euclidean. Since spatial thinking is not a "gift" but can be developed, educators need to provide more opportunities for students to increase their level of spatial thinking since it is necessary for conceptual understanding of many different topics in math and science.