WorldWideScience

Sample records for external validity evidence

  1. Identifying and Evaluating External Validity Evidence for Passing Scores

    Science.gov (United States)

    Davis-Becker, Susan L.; Buckendahl, Chad W.

    2013-01-01

    A critical component of the standard setting process is collecting evidence to evaluate the recommended cut scores and their use for making decisions and classifying students based on test performance. Kane (1994, 2001) proposed a framework by which practitioners can identify and evaluate evidence of the results of the standard setting from (1)…

  2. Checklists for external validity

    DEFF Research Database (Denmark)

    Dyrvig, Anne-Kirstine; Kidholm, Kristian; Gerke, Oke

    2014-01-01

    to an implementation setting. In this paper, currently available checklists on external validity are identified, assessed and used as a basis for proposing a new improved instrument. METHOD: A systematic literature review was carried out in Pubmed, Embase and Cinahl on English-language papers without time restrictions....... The retrieved checklist items were assessed for (i) the methodology used in primary literature, justifying inclusion of each item; and (ii) the number of times each item appeared in checklists. RESULTS: Fifteen papers were identified, presenting a total of 21 checklists for external validity, yielding a total...... of 38 checklist items. Empirical support was considered the most valid methodology for item inclusion. Assessment of methodological justification showed that none of the items were supported empirically. Other kinds of literature justified the inclusion of 22 of the items, and 17 items were included...

  3. Examining Evidence for External and Consequential Validity of the First Term General Chemistry Exam from the ACS Examinations Institute

    Science.gov (United States)

    Lewis, Scott E.

    2014-01-01

    Validity of educational research instruments and student assessments has appropriately become a growing interest in the chemistry education research community. Of particular concern is an attention to the consequences to students that result from the interpretation of assessment scores and whether those consequences are swayed by invalidity within…

  4. International External Validation Study of the 2014 European Society of Cardiology Guidelines on Sudden Cardiac Death Prevention in Hypertrophic Cardiomyopathy (EVIDENCE-HCM).

    Science.gov (United States)

    O'Mahony, Constantinos; Jichi, Fatima; Ommen, Steve R; Christiaans, Imke; Arbustini, Eloisa; Garcia-Pavia, Pablo; Cecchi, Franco; Olivotto, Iacopo; Kitaoka, Hiroaki; Gotsman, Israel; Carr-White, Gerald; Mogensen, Jens; Antoniades, Loizos; Mohiddin, Saidi A; Maurer, Mathew S; Tang, Hak Chiaw; Geske, Jeffrey B; Siontis, Konstantinos C; Mahmoud, Karim D; Vermeer, Alexa; Wilde, Arthur; Favalli, Valentina; Guttmann, Oliver P; Gallego-Delgado, Maria; Dominguez, Fernando; Tanini, Ilaria; Kubo, Toru; Keren, Andre; Bueser, Teofila; Waters, Sarah; Issa, Issa F; Malcolmson, James; Burns, Tom; Sekhri, Neha; Hoeger, Christopher W; Omar, Rumana Z; Elliott, Perry M

    2018-03-06

    Identification of people with hypertrophic cardiomyopathy (HCM) who are at risk of sudden cardiac death (SCD) and require a prophylactic implantable cardioverter defibrillator is challenging. In 2014, the European Society of Cardiology proposed a new risk stratification method based on a risk prediction model (HCM Risk-SCD) that estimates the 5-year risk of SCD. The aim was to externally validate the 2014 European Society of Cardiology recommendations in a geographically diverse cohort of patients recruited from the United States, Europe, the Middle East, and Asia. This was an observational, retrospective, longitudinal cohort study. The cohort consisted of 3703 patients. Seventy three (2%) patients reached the SCD end point within 5 years of follow-up (5-year incidence, 2.4% [95% confidence interval {CI}, 1.9-3.0]). The validation study revealed a calibration slope of 1.02 (95% CI, 0.93-1.12), C-index of 0.70 (95% CI, 0.68-0.72), and D-statistic of 1.17 (95% CI, 1.05-1.29). In a complete case analysis (n= 2147; 44 SCD end points at 5 years), patients with a predicted 5-year risk of <4% (n=1524; 71%) had an observed 5-year SCD incidence of 1.4% (95% CI, 0.8-2.2); patients with a predicted risk of ≥6% (n=297; 14%) had an observed SCD incidence of 8.9% (95% CI, 5.96-13.1) at 5 years. For every 13 (297/23) implantable cardioverter defibrillator implantations in patients with an estimated 5-year SCD risk ≥6%, 1 patient can potentially be saved from SCD. This study confirms that the HCM Risk-SCD model provides accurate prognostic information that can be used to target implantable cardioverter defibrillator therapy in patients at the highest risk of SCD. © 2017 American Heart Association, Inc.

  5. Geochemistry Model Validation Report: External Accumulation Model

    International Nuclear Information System (INIS)

    Zarrabi, K.

    2001-01-01

    The purpose of this Analysis and Modeling Report (AMR) is to validate the External Accumulation Model that predicts accumulation of fissile materials in fractures and lithophysae in the rock beneath a degrading waste package (WP) in the potential monitored geologic repository at Yucca Mountain. (Lithophysae are voids in the rock having concentric shells of finely crystalline alkali feldspar, quartz, and other materials that were formed due to entrapped gas that later escaped, DOE 1998, p. A-25.) The intended use of this model is to estimate the quantities of external accumulation of fissile material for use in external criticality risk assessments for different types of degrading WPs: U.S. Department of Energy (DOE) Spent Nuclear Fuel (SNF) codisposed with High Level Waste (HLW) glass, commercial SNF, and Immobilized Plutonium Ceramic (Pu-ceramic) codisposed with HLW glass. The scope of the model validation is to (1) describe the model and the parameters used to develop the model, (2) provide rationale for selection of the parameters by comparisons with measured values, and (3) demonstrate that the parameters chosen are the most conservative selection for external criticality risk calculations. To demonstrate the applicability of the model, a Pu-ceramic WP is used as an example. The model begins with a source term from separately documented EQ6 calculations; where the source term is defined as the composition versus time of the water flowing out of a breached waste package (WP). Next, PHREEQC, is used to simulate the transport and interaction of the source term with the resident water and fractured tuff below the repository. In these simulations the primary mechanism for accumulation is mixing of the high pH, actinide-laden source term with resident water; thus lowering the pH values sufficiently for fissile minerals to become insoluble and precipitate. In the final section of the model, the outputs from PHREEQC, are processed to produce mass of accumulation

  6. Convergent validity test, construct validity test and external validity test of the David Liberman algorithm

    Directory of Open Access Journals (Sweden)

    David Maldavsky

    2013-08-01

    Full Text Available The author first exposes a complement of a previous test about convergent validity, then a construct validity test and finally an external validity test of the David Liberman algorithm.  The first part of the paper focused on a complementary aspect, the differential sensitivity of the DLA 1 in an external comparison (to other methods, and 2 in an internal comparison (between two ways of using the same method, the DLA.  The construct validity test exposes the concepts underlined to DLA, their operationalization and some corrections emerging from several empirical studies we carried out.  The external validity test examines the possibility of using the investigation of a single case and its relation with the investigation of a more extended sample.

  7. Review of external validity reporting in childhood obesity prevention research.

    Science.gov (United States)

    Klesges, Lisa M; Dzewaltowski, David A; Glasgow, Russell E

    2008-03-01

    The translation and dissemination of prevention intervention evidence into practice is needed to address significant public health issues such as childhood obesity. Increased attention to and reporting of external validity information in research publications would allow for better understanding of generalizability issues relevant to successful translation. To demonstrate this potential, recent reports of childhood obesity prevention interventions were evaluated on the extent to which external validity dimensions were reported. Childhood obesity prevention studies that were controlled, long-term research trials published between 1980 and 2004 that reported a behavioral target of physical activity and/or healthy eating along with at least one anthropometric outcome were identified in 2005. Studies were summarized between 2005 and 2006 using review criteria developed by Green and Glasgow in 2006. Nineteen publications met selection criteria. In general, all studies lacked full reporting on potential generalizability and dissemination elements. Median reporting over all elements was 34.5%; the mode was 0% with a range of 0% to 100%. Most infrequent were reports of setting level selection criteria and representativeness, characteristics regarding intervention staff, implementation of intervention content, costs, and program sustainability. The evidence base for future prevention interventions can be improved by enhancing the reporting of contextual and generalizability elements central to translational research. Such efforts face practical hurdles but could provide additional explanation for variability in intervention outcomes, insights into successful adaptations of interventions, and help guide policy decisions.

  8. Reconceptualising the external validity of discrete choice experiments.

    Science.gov (United States)

    Lancsar, Emily; Swait, Joffre

    2014-10-01

    External validity is a crucial but under-researched topic when considering using discrete choice experiment (DCE) results to inform decision making in clinical, commercial or policy contexts. We present the theory and tests traditionally used to explore external validity that focus on a comparison of final outcomes and review how this traditional definition has been empirically tested in health economics and other sectors (such as transport, environment and marketing) in which DCE methods are applied. While an important component, we argue that the investigation of external validity should be much broader than a comparison of final outcomes. In doing so, we introduce a new and more comprehensive conceptualisation of external validity, closely linked to process validity, that moves us from the simple characterisation of a model as being or not being externally valid on the basis of predictive performance, to the concept that external validity should be an objective pursued from the initial conceptualisation and design of any DCE. We discuss how such a broader definition of external validity can be fruitfully used and suggest innovative ways in which it can be explored in practice.

  9. EXTERNAL EVIDENCE IN THE VALIDATION OF MENTALISTIC ...

    African Journals Online (AJOL)

    rical nature of his mentalistic theories, grammatical as well as general linguistic. The obvious way .... process of language acquisition or growth the cognitive system character- ized by the general ... then, abstract in a dual sense: in the sense of ...

  10. External Validation of a Prediction Model for Successful External Cephalic Version

    NARCIS (Netherlands)

    de Hundt, Marcella; Vlemmix, Floortje; Kok, Marjolein; van der Steeg, Jan W.; Bais, Joke M.; Mol, Ben W.; van der Post, Joris A.

    2012-01-01

    We sought external validation of a prediction model for the probability of a successful external cephalic version (ECV). We evaluated the performance of the prediction model with calibration and discrimination. For clinical practice, we developed a score chart to calculate the probability of a

  11. External validation of EPIWIN biodegradation models.

    Science.gov (United States)

    Posthumus, R; Traas, T P; Peijnenburg, W J G M; Hulzebos, E M

    2005-01-01

    The BIOWIN biodegradation models were evaluated for their suitability for regulatory purposes. BIOWIN includes the linear and non-linear BIODEG and MITI models for estimating the probability of rapid aerobic biodegradation and an expert survey model for primary and ultimate biodegradation estimation. Experimental biodegradation data for 110 newly notified substances were compared with the estimations of the different models. The models were applied separately and in combinations to determine which model(s) showed the best performance. The results of this study were compared with the results of other validation studies and other biodegradation models. The BIOWIN models predict not-readily biodegradable substances with high accuracy in contrast to ready biodegradability. In view of the high environmental concern of persistent chemicals and in view of the large number of not-readily biodegradable chemicals compared to the readily ones, a model is preferred that gives a minimum of false positives without a corresponding high percentage false negatives. A combination of the BIOWIN models (BIOWIN2 or BIOWIN6) showed the highest predictive value for not-readily biodegradability. However, the highest score for overall predictivity with lowest percentage false predictions was achieved by applying BIOWIN3 (pass level 2.75) and BIOWIN6.

  12. Assessing Discriminative Performance at External Validation of Clinical Prediction Models.

    Directory of Open Access Journals (Sweden)

    Daan Nieboer

    Full Text Available External validation studies are essential to study the generalizability of prediction models. Recently a permutation test, focusing on discrimination as quantified by the c-statistic, was proposed to judge whether a prediction model is transportable to a new setting. We aimed to evaluate this test and compare it to previously proposed procedures to judge any changes in c-statistic from development to external validation setting.We compared the use of the permutation test to the use of benchmark values of the c-statistic following from a previously proposed framework to judge transportability of a prediction model. In a simulation study we developed a prediction model with logistic regression on a development set and validated them in the validation set. We concentrated on two scenarios: 1 the case-mix was more heterogeneous and predictor effects were weaker in the validation set compared to the development set, and 2 the case-mix was less heterogeneous in the validation set and predictor effects were identical in the validation and development set. Furthermore we illustrated the methods in a case study using 15 datasets of patients suffering from traumatic brain injury.The permutation test indicated that the validation and development set were homogenous in scenario 1 (in almost all simulated samples and heterogeneous in scenario 2 (in 17%-39% of simulated samples. Previously proposed benchmark values of the c-statistic and the standard deviation of the linear predictors correctly pointed at the more heterogeneous case-mix in scenario 1 and the less heterogeneous case-mix in scenario 2.The recently proposed permutation test may provide misleading results when externally validating prediction models in the presence of case-mix differences between the development and validation population. To correctly interpret the c-statistic found at external validation it is crucial to disentangle case-mix differences from incorrect regression coefficients.

  13. Internal and external validation of an ESTRO delineation guideline

    DEFF Research Database (Denmark)

    Eldesoky, Ahmed R.; Yates, Esben Svitzer; Nyeng, Tine B

    2016-01-01

    Background and purpose To internally and externally validate an atlas based automated segmentation (ABAS) in loco-regional radiation therapy of breast cancer. Materials and methods Structures of 60 patients delineated according to the ESTRO consensus guideline were included in four categorized...... and axillary nodal levels and poor agreement for interpectoral, internal mammary nodal regions and LADCA. Correcting ABAS significantly improved all the results. External validation of ABAS showed comparable results. Conclusions ABAS is a clinically useful tool for segmenting structures in breast cancer loco...

  14. Development and external validation of a new PTA assessment scale

    NARCIS (Netherlands)

    Jacobs, B.; van Ekert, J.; Vernooy, L.P.; Dieperink, P.; Andriessen, T.M.J.C.; Hendriks, M.P.; van Vugt, A.B.; Emons, M.A.; Borm, G.F.; Vos, P.E.

    2012-01-01

    BACKGROUND: Post-traumatic amnesia (PTA) is a key symptom of traumatic brain injury (TBI). Accurate assessment of PTA is imperative in guiding clinical decision making. Our aim was to develop and externally validate a short, examiner independent and practical PTA scale, by selecting the most

  15. Development and external validation of a new PTA assessment scale

    Directory of Open Access Journals (Sweden)

    Jacobs Bram

    2012-08-01

    Full Text Available Abstract Background Post-traumatic amnesia (PTA is a key symptom of traumatic brain injury (TBI. Accurate assessment of PTA is imperative in guiding clinical decision making. Our aim was to develop and externally validate a short, examiner independent and practical PTA scale, by selecting the most discriminative items from existing scales and using a three-word memory test. Methods Mild, moderate and severe TBI patients and control subjects were assessed in two separate cohorts, one for derivation and one for validation, using a questionnaire comprised of items from existing PTA scales. We tested which individual items best discriminated between TBI patients and controls, represented by sensitivity and specificity. We then created our PTA scale based on these results. This new scale was externally evaluated for its discriminative value using Receiver Operating Characteristic (ROC analysis and compared to existing PTA scales. Results The derivation cohort included 126 TBI patients and 31 control subjects; the validation cohort consisted of 132 patients and 30 controls. A set of seven items was eventually selected to comprise the new PTA scale: age, name of hospital, time, day of week, month, mode of transport and recall of three words. This scale demonstrated adequate discriminative values compared to existing PTA scales on three consecutive administrations in the validation cohort. Conclusion We introduce a valid, practical and examiner independent PTA scale, which is suitable for mild TBI patients at the emergency department and yet still valuable for the follow-up of more severely injured TBI patients.

  16. Validity evidence based on test content.

    Science.gov (United States)

    Sireci, Stephen; Faulkner-Bond, Molly

    2014-01-01

    Validity evidence based on test content is one of the five forms of validity evidence stipulated in the Standards for Educational and Psychological Testing developed by the American Educational Research Association, American Psychological Association, and National Council on Measurement in Education. In this paper, we describe the logic and theory underlying such evidence and describe traditional and modern methods for gathering and analyzing content validity data. A comprehensive review of the literature and of the aforementioned Standards is presented. For educational tests and other assessments targeting knowledge and skill possessed by examinees, validity evidence based on test content is necessary for building a validity argument to support the use of a test for a particular purpose. By following the methods described in this article, practitioners have a wide arsenal of tools available for determining how well the content of an assessment is congruent with and appropriate for the specific testing purposes.

  17. Validation of a scenario-based assessment of critical thinking using an externally validated tool.

    Science.gov (United States)

    Buur, Jennifer L; Schmidt, Peggy; Smylie, Dean; Irizarry, Kris; Crocker, Carlos; Tyler, John; Barr, Margaret

    2012-01-01

    With medical education transitioning from knowledge-based curricula to competency-based curricula, critical thinking skills have emerged as a major competency. While there are validated external instruments for assessing critical thinking, many educators have created their own custom assessments of critical thinking. However, the face validity of these assessments has not been challenged. The purpose of this study was to compare results from a custom assessment of critical thinking with the results from a validated external instrument of critical thinking. Students from the College of Veterinary Medicine at Western University of Health Sciences were administered a custom assessment of critical thinking (ACT) examination and the externally validated instrument, California Critical Thinking Skills Test (CCTST), in the spring of 2011. Total scores and sub-scores from each exam were analyzed for significant correlations using Pearson correlation coefficients. Significant correlations between ACT Blooms 2 and deductive reasoning and total ACT score and deductive reasoning were demonstrated with correlation coefficients of 0.24 and 0.22, respectively. No other statistically significant correlations were found. The lack of significant correlation between the two examinations illustrates the need in medical education to externally validate internal custom assessments. Ultimately, the development and validation of custom assessments of non-knowledge-based competencies will produce higher quality medical professionals.

  18. External validity of post-stroke interventional gait rehabilitation studies.

    Science.gov (United States)

    Kafri, Michal; Dickstein, Ruth

    2017-01-01

    Gait rehabilitation is a major component of stroke rehabilitation, and is supported by extensive research. The objective of this review was to examine the external validity of intervention studies aimed at improving gait in individuals post-stroke. To that end, two aspects of these studies were assessed: subjects' exclusion criteria and the ecological validity of the intervention, as manifested by the intervention's technological complexity and delivery setting. Additionally, we examined whether the target population as inferred from the titles/abstracts is broader than the population actually represented by the reported samples. We systematically researched PubMed for intervention studies to improve gait post-stroke, working backwards from the beginning of 2014. Exclusion criteria, the technological complexity of the intervention (defined as either elaborate or simple), setting, and description of the target population in the titles/abstracts were recorded. Fifty-two studies were reviewed. The samples were exclusive, with recurrent stroke, co-morbidities, cognitive status, walking level, and residency being major reasons for exclusion. In one half of the studies, the intervention was elaborate. Descriptions of participants in the title/abstract in almost one half of the studies included only the diagnosis (stroke or comparable terms) and its stage (acute, subacute, and chronic). The external validity of a substantial number of intervention studies about rehabilitation of gait post-stroke appears to be limited by exclusivity of the samples as well as by deficiencies in ecological validity of the interventions. These limitations are not accurately reflected in the titles or abstracts of the studies.

  19. External Validity and Model Validity: A Conceptual Approach for Systematic Review Methodology

    Directory of Open Access Journals (Sweden)

    Raheleh Khorsan

    2014-01-01

    Full Text Available Background. Evidence rankings do not consider equally internal (IV, external (EV, and model validity (MV for clinical studies including complementary and alternative medicine/integrative health care (CAM/IHC research. This paper describe this model and offers an EV assessment tool (EVAT© for weighing studies according to EV and MV in addition to IV. Methods. An abbreviated systematic review methodology was employed to search, assemble, and evaluate the literature that has been published on EV/MV criteria. Standard databases were searched for keywords relating to EV, MV, and bias-scoring from inception to Jan 2013. Tools identified and concepts described were pooled to assemble a robust tool for evaluating these quality criteria. Results. This study assembled a streamlined, objective tool to incorporate for the evaluation of quality of EV/MV research that is more sensitive to CAM/IHC research. Conclusion. Improved reporting on EV can help produce and provide information that will help guide policy makers, public health researchers, and other scientists in their selection, development, and improvement in their research-tested intervention. Overall, clinical studies with high EV have the potential to provide the most useful information about “real-world” consequences of health interventions. It is hoped that this novel tool which considers IV, EV, and MV on equal footing will better guide clinical decision making.

  20. Validade de construto da versão brasileira do Inventário Espectral de Externalização: evidências a partir de uma amostra de estudantes universitários Construct validity of the Brazilian version of the Externalizing Spectrum Inventory: evidence from a university student sample

    Directory of Open Access Journals (Sweden)

    Hudson Wander de Carvalho

    2010-01-01

    Full Text Available CONTEXTO: Externalização é uma dimensão das diferenças individuais que dá substrato e unifica traços impulsivos e agressivos de personalidade a transtornos mentais relacionados ao uso de substância e à conduta antissocial. OBJETIVOS: O presente estudo objetivou apresentar indicadores de validade de construto da versão brasileira do Inventário Espectral de Externalização. MÉTODO: Trata-se de um estudo psicométrico de orientação correlacional. Foram utilizadas duas técnicas clássicas de representação de construto: análise exploratória de fatores comuns e análise de consistência interna. A amostra consistiu de 258 participantes de ambos os sexos, provenientes de diferentes cursos universitários de duas instituições públicas do estado de Minas Gerais. RESULTADOS: A análise fatorial resultou em um modelo de um fator de segunda ordem (Externalização com três fatores de primeira ordem (dimensões de agressão, de uso de substância e de impulsividade/alienação. Os coeficientes alfa mostraram-se bastante elevados, com índices acima de 0,9 tanto para os três fatores de primeira ordem quanto para o fator geral. CONCLUSÃO: Combinados, os resultados trazem evidências de validade e de fidedignidade para a versão brasileira do Inventário Espectral de Externalização no que tange à sua aplicabilidade a estudantes universitários.BACKGROUND: Externalizing is a dimension of individual differences that undergirds and unites aggressive and impulsive personality traits to psychopathological disorders related to substance use and antisocial behavior. OBJECTIVES: The present study aims to establish parameters of construct validity for the Brazilian version of the Externalizing Spectrum Inventory. METHOD: This is a psychometrical correlacional study design. Two classical techniques of construct representation were implemented: unweighted least squares exploratory factor analysis and internal consistency analysis. The sample

  1. External Validation of the HERNIAscore: An Observational Study.

    Science.gov (United States)

    Cherla, Deepa V; Moses, Maya L; Mueck, Krislynn M; Hannon, Craig; Ko, Tien C; Kao, Lillian S; Liang, Mike K

    2017-09-01

    The HERNIAscore is a ventral incisional hernia (VIH) risk assessment tool that uses only preoperative variables and predictable intraoperative variables. The aim of this study was to validate and modify, if needed, the HERNIAscore in an external dataset. This was a retrospective observational study of all patients undergoing resection for gastrointestinal malignancy from 2011 through 2015 at a safety-net hospital. The primary end point was clinical postoperative VIH. Patients were stratified into low-risk, medium-risk, and high-risk groups based on HERNIAscore. A revised HERNIAscore was calculated with the addition of earlier abdominal operation as a categorical variable. Cox regression of incisional hernia with stratification by risk class was performed. Incidence rates of clinical VIH formation within each risk class were also calculated. Two hundred and forty-seven patents were enrolled. On Cox regression, in addition to the 3 variables of the HERNIAscore (BMI, COPD, and incision length), earlier abdominal operation was also predictive of VIH. The revised HERNIAscore demonstrated improved predictive accuracy for clinical VIH. Although the original HERNIAscore effectively stratified the risk of an incisional radiographic VIH developing, the revised HERNIAscore provided a statistically significant stratification for both clinical and radiographic VIHs in this patient cohort. We have externally validated and improved the HERNIAscore. The revised HERNIAscore uses BMI, incision length, COPD, and earlier abdominal operation to predict risk of postoperative incisional hernia. Future research should assess methods to prevent incisional hernias in moderate-to-high risk patients. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Evidence of Construct Validity for Work Values

    Science.gov (United States)

    Leuty, Melanie E.; Hansen, Jo-Ida C.

    2011-01-01

    Despite the importance of work values in the process of career adjustment (Dawis, 2002), little empirical research has focused on articulating the domains represented within the construct of work values and the examination of evidence of validity for the construct has been limited. Furthermore, the larger number of work values measures has made it…

  3. AN APPROACH TO THE EXTERNAL ASSESSMENT THROUGH EMPIRICAL EVIDENCE

    Directory of Open Access Journals (Sweden)

    Ismael Sanz Labrador

    2015-06-01

    Full Text Available This article presents the empiral evidences of standardized evaluations and explores the aspects of such evaluations more interesting to the educational community, and investigates the effects in implementing those exams on the performance of students. Furthermore, it is analyzed the relationship between external evaluations and teaching to the test , it is seen how it affects the introduction of these evaluations in student learning and their performance in international assessments of different characteristics, and the effect it produces in schools located in disadvantaged areas.

  4. Achieving external validity in home advantage research: generalizing crowd noise effects

    Directory of Open Access Journals (Sweden)

    Tony D Myers

    2014-06-01

    Full Text Available Different factors have been postulated to explain the home advantage phenomenon in sport. One plausible explanation investigated has been the influence of a partisan home crowd on sports officials’ decisions. Different types of studies have tested the crowd influence hypothesis including purposefully designed experiments. However, while experimental studies investigating crowd influences have high levels of internal validity, they suffer from a lack of external validity; decision-making in a laboratory setting bearing little resemblance to decision-making in live sports settings. This focused review initially considers threats to external validity in applied and theoretical experimental research. Discussing how such threats can be addressed using representative design by focusing on a recently published study that arguably provides the first experimental evidence of the impact of live crowd noise on officials in sport. The findings of this controlled experiment conducted in a real tournament setting offer some confirmation of the validity of laboratory experimental studies in the area. Finally directions for future research and the future conduct of crowd noise studies are discussed.

  5. EXTERNAL VALIDATION OF THE DIABETES EARLY READMISSION RISK INDICATOR (DERRI™).

    Science.gov (United States)

    Rubin, Daniel J; Recco, Dominic; Turchin, Alexander; Zhao, Huaqing; Golden, Sherita Hill

    2018-04-06

    The Diabetes Early Readmission Risk Indicator (DERRI ™ ) was previously developed and internally validated as a tool to predict the risk of all-cause readmission within 30 days of discharge (30-d readmission) of hospitalized patients with diabetes. In this study, the predictive performance of the DERRI ™ with and without additional predictors was assessed in an external sample. We conducted a retrospective cohort study of adult patients with diabetes discharged from 2 academic medical centers between 1/1/2000 and 12/31/2014. We applied the previously developed DERRI ™ , which includes admission laboratory results, sociodemographics, a diagnosis of certain comorbidities, and recent discharge information, and evaluated the effect of adding metabolic indicators on predictive performance using multivariable logistic regression. Total cholesterol and A1c were selected based on clinical relevance and univariate association with 30-d readmission. Among 105,974 discharges, 19,032 (18.0%) were followed by 30-d readmission for any cause. The DERRI ™ had a C-statistic of 0.634 for 30-d readmission. Total cholesterol (TC) was the lipid parameter most strongly associated with 30-d readmission. The DERRI ™ predictors, A1c, and TC were significantly associated with 30-d readmission; however, their addition to the DERRI ™ did not significantly change model performance (C-statistic 0.643 [95% CI, 0.638-0.647], p=0.92). Performance of the DERRI ™ in this external cohort was modest but comparable to other readmission prediction models. Addition of A1c and TC to the DERRI ™ did not significantly improve performance. Although the DERRI ™ may be useful to direct resources toward diabetes patients at higher risk, better prediction is needed. DERRI = Diabetes Early Readmission Risk Indicator; TC = Total cholesterol; A1c = hemoglobin A1c; HDL-C = high-density lipoprotein cholesterol; LDL-C = low-density lipoprotein cholesterol; DKA = diabetic ketoacidosis; HHS

  6. Achieving external validity in home advantage research: generalizing crowd noise effects.

    Science.gov (United States)

    Myers, Tony D

    2014-01-01

    Different factors have been postulated to explain the home advantage phenomenon in sport. One plausible explanation investigated has been the influence of a partisan home crowd on sports officials' decisions. Different types of studies have tested the crowd influence hypothesis including purposefully designed experiments. However, while experimental studies investigating crowd influences have high levels of internal validity, they suffer from a lack of external validity; decision-making in a laboratory setting bearing little resemblance to decision-making in live sports settings. This focused review initially considers threats to external validity in applied and theoretical experimental research. Discussing how such threats can be addressed using representative design by focusing on a recently published study that arguably provides the first experimental evidence of the impact of live crowd noise on officials in sport. The findings of this controlled experiment conducted in a real tournament setting offer a level of confirmation of the findings of laboratory studies in the area. Finally directions for future research and the future conduct of crowd noise studies are discussed.

  7. Adapting social neuroscience measures for schizophrenia clinical trials, part 3: fathoming external validity.

    Science.gov (United States)

    Olbert, Charles M; Penn, David L; Kern, Robert S; Lee, Junghee; Horan, William P; Reise, Steven P; Ochsner, Kevin N; Marder, Stephen R; Green, Michael F

    2013-11-01

    It is unknown whether measures adapted from social neuroscience linked to specific neural systems will demonstrate relationships to external variables. Four paradigms adapted from social neuroscience were administered to 173 clinically stable outpatients with schizophrenia to determine their relationships to functionally meaningful variables and to investigate their incremental validity beyond standard measures of social and nonsocial cognition. The 4 paradigms included 2 that assess perception of nonverbal social and action cues (basic biological motion and emotion in biological motion) and 2 that involve higher level inferences about self and others' mental states (self-referential memory and empathic accuracy). Overall, social neuroscience paradigms showed significant relationships to functional capacity but weak relationships to community functioning; the paradigms also showed weak correlations to clinical symptoms. Evidence for incremental validity beyond standard measures of social and nonsocial cognition was mixed with additional predictive power shown for functional capacity but not community functioning. Of the newly adapted paradigms, the empathic accuracy task had the broadest external validity. These results underscore the difficulty of translating developments from neuroscience into clinically useful tasks with functional significance.

  8. Experimental validation of a radio frequency photogun as external electron

    NARCIS (Netherlands)

    Stragier, X.F.D.; Luiten, O.J.; Geer, van der S.B.; Wiel, van der M.J.

    2011-01-01

    A purpose-built RF-photogun as external electron injector for a laser wakefield accelerator has been thoroughly tested. Different properties of the RF-photogun have been measured such as energy, energy spread and transverse emittance. The focus of this study is the investigation of the smallest

  9. External Validity in the Study of Human Development: Theoretical and Methodological Issues

    Science.gov (United States)

    Hultsch, David F.; Hickey, Tom

    1978-01-01

    An examination of the concept of external validity from two theoretical perspectives: a traditional mechanistic approach and a dialectical organismic approach. Examines the theoretical and methodological implications of these perspectives. (BD)

  10. External review and validation of the Swedish national inpatient register

    Directory of Open Access Journals (Sweden)

    Kim Jeong-Lim

    2011-06-01

    Full Text Available Abstract Background The Swedish National Inpatient Register (IPR, also called the Hospital Discharge Register, is a principal source of data for numerous research projects. The IPR is part of the National Patient Register. The Swedish IPR was launched in 1964 (psychiatric diagnoses from 1973 but complete coverage did not begin until 1987. Currently, more than 99% of all somatic (including surgery and psychiatric hospital discharges are registered in the IPR. A previous validation of the IPR by the National Board of Health and Welfare showed that 85-95% of all diagnoses in the IPR are valid. The current paper describes the history, structure, coverage and quality of the Swedish IPR. Methods and results In January 2010, we searched the medical databases, Medline and HighWire, using the search algorithm "validat* (inpatient or hospital discharge Sweden". We also contacted 218 members of the Swedish Society of Epidemiology and an additional 201 medical researchers to identify papers that had validated the IPR. In total, 132 papers were reviewed. The positive predictive value (PPV was found to differ between diagnoses in the IPR, but is generally 85-95%. Conclusions In conclusion, the validity of the Swedish IPR is high for many but not all diagnoses. The long follow-up makes the register particularly suitable for large-scale population-based research, but for certain research areas the use of other health registers, such as the Swedish Cancer Register, may be more suitable.

  11. External validation of the NUn score for predicting anastomotic leakage after oesophageal resection.

    Science.gov (United States)

    Paireder, Matthias; Jomrich, Gerd; Asari, Reza; Kristo, Ivan; Gleiss, Andreas; Preusser, Matthias; Schoppmann, Sebastian F

    2017-08-29

    Early detection of anastomotic leakage (AL) after oesophageal resection for malignancy is crucial. This retrospective study validates a risk score, predicting AL, which includes C-reactive protein, albumin and white cell count in patients undergoing oesophageal resection between 2003 and 2014. For validation of the NUn score a receiver operating characteristic (ROC) curve is estimated. Area under the ROC curve (AUC) is reported with 95% confidence interval (CI). Among 258 patients (79.5% male) 32 patients showed signs of anastomotic leakage (12.4%). NUn score in our data has a median of 9.3 (range 6.2-17.6). The odds ratio for AL was 1.31 (CI 1.03-1.67; p = 0.028). AUC for AL was 0.59 (CI 0.47-0.72). Using the original cutoff value of 10, the sensitivity was 45.2% an the specificity was 73.8%. This results in a positive predictive value of 19.4% and a negative predictive value of 90.6%. The proportion of variation in AL occurrence, which is explained by the NUn score, was 2.5% (PEV = 0.025). This study provides evidence for an external validation of a simple risk score for AL after oesophageal resection. In this cohort, the NUn score is not useful due to its poor discrimination.

  12. External validation of a clinical scoring system for the risk of gestational diabetes mellitus

    NARCIS (Netherlands)

    van Leeuwen, M.; Opmeer, B. C.; Zweers, E. J. K.; van Ballegooie, E.; ter Brugge, H. G.; de Valk, H. W.; Visser, G. H. A.; Mol, B. W. J.

    Aim: A prediction rule for gestational diabetes mellitus (GDM) could be helpful in early detection and increased efficiency of screening. A prediction rule by means of a clinical scoring system is available, but has never been validated externally. The aim of this study was to validate the scoring

  13. Pragmatic controlled clinical trials in primary care: the struggle between external and internal validity

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    Birtwhistle Richard

    2003-12-01

    Full Text Available Abstract Background Controlled clinical trials of health care interventions are either explanatory or pragmatic. Explanatory trials test whether an intervention is efficacious; that is, whether it can have a beneficial effect in an ideal situation. Pragmatic trials measure effectiveness; they measure the degree of beneficial effect in real clinical practice. In pragmatic trials, a balance between external validity (generalizability of the results and internal validity (reliability or accuracy of the results needs to be achieved. The explanatory trial seeks to maximize the internal validity by assuring rigorous control of all variables other than the intervention. The pragmatic trial seeks to maximize external validity to ensure that the results can be generalized. However the danger of pragmatic trials is that internal validity may be overly compromised in the effort to ensure generalizability. We are conducting two pragmatic randomized controlled trials on interventions in the management of hypertension in primary care. We describe the design of the trials and the steps taken to deal with the competing demands of external and internal validity. Discussion External validity is maximized by having few exclusion criteria and by allowing flexibility in the interpretation of the intervention and in management decisions. Internal validity is maximized by decreasing contamination bias through cluster randomization, and decreasing observer and assessment bias, in these non-blinded trials, through baseline data collection prior to randomization, automating the outcomes assessment with 24 hour ambulatory blood pressure monitors, and blinding the data analysis. Summary Clinical trials conducted in community practices present investigators with difficult methodological choices related to maintaining a balance between internal validity (reliability of the results and external validity (generalizability. The attempt to achieve methodological purity can

  14. Scanning the business external environment for information: evidence from Greece

    Directory of Open Access Journals (Sweden)

    L. Kourteli

    2005-01-01

    Full Text Available Introduction. This paper examines the business external environment scanning theory for information in the context of Greece. Method. A questionnaire was developed to explore the relationships between general and task business environment, perceived uncertainty, scanning strategy, and sources of information with respect to type of environment, size and industry.The research was based on a sample of 144 private organizations operating in North Greece. Analysis. Data collected were analysed using SPSS. The statistical procedures of chi-squared homogeneity test, ANOVA, Duncan's test of homogeneity of means, and related samples t-test were followed for testing the hypotheses developed. Results. The results show that perceived uncertainty of the general and task business external environment factors depend on the type of the environment, size of organization, and industry where the organizations operate; organizations adapt their scanning strategy to the complexity of the environment; personal sources of information seem to be more important than impersonal sources; external sources of information are equally important with internal sources; and higher levels of environmental uncertainty are associated with higher levels of scanning the various sources. Conclusion. Business external environment scanning of information is influenced by the characteristics of the organizations themselves and by the characteristics of the external environment within which the organizations operate. The study contributes to both environmental scanning theory and has important messages for practitioners.

  15. External validation and comparison of three pediatric clinical dehydration scales.

    Directory of Open Access Journals (Sweden)

    Joshua Jauregui

    Full Text Available OBJECTIVE: To prospectively validate three popular clinical dehydration scales and overall physician gestalt in children with vomiting or diarrhea relative to the criterion standard of percent weight change with rehydration. METHODS: We prospectively enrolled a non-consecutive cohort of children ≤ 18 years of age with an acute episode of diarrhea or vomiting. Patient weight, clinical scale variables and physician clinical impression, or gestalt, were recorded before and after fluid resuscitation in the emergency department and upon hospital discharge. The percent weight change from presentation to discharge was used to calculate the degree of dehydration, with a weight change of ≥ 5% considered significant dehydration. Receiver operating characteristics (ROC curves were constructed for each of the three clinical scales and physician gestalt. Sensitivity and specificity were calculated based on the best cut-points of the ROC curve. RESULTS: We approached 209 patients, and of those, 148 were enrolled and 113 patients had complete data for analysis. Of these, 10.6% had significant dehydration based on our criterion standard. The Clinical Dehydration Scale (CDS and Gorelick scales both had an area under the ROC curve (AUC statistically different from the reference line with AUCs of 0.72 (95% CI 0.60, 0.84 and 0.71 (95% CI 0.57, 0.85 respectively. The World Health Organization (WHO scale and physician gestalt had AUCs of 0.61 (95% CI 0.45, 0.77 and 0.61 (0.44, 0.78 respectively, which were not statistically significant. CONCLUSION: The Gorelick scale and Clinical Dehydration Scale were fair predictors of dehydration in children with diarrhea or vomiting. The World Health Organization scale and physician gestalt were not helpful predictors of dehydration in our cohort.

  16. External validation and comparison of three pediatric clinical dehydration scales.

    Science.gov (United States)

    Jauregui, Joshua; Nelson, Daniel; Choo, Esther; Stearns, Branden; Levine, Adam C; Liebmann, Otto; Shah, Sachita P

    2014-01-01

    To prospectively validate three popular clinical dehydration scales and overall physician gestalt in children with vomiting or diarrhea relative to the criterion standard of percent weight change with rehydration. We prospectively enrolled a non-consecutive cohort of children ≤ 18 years of age with an acute episode of diarrhea or vomiting. Patient weight, clinical scale variables and physician clinical impression, or gestalt, were recorded before and after fluid resuscitation in the emergency department and upon hospital discharge. The percent weight change from presentation to discharge was used to calculate the degree of dehydration, with a weight change of ≥ 5% considered significant dehydration. Receiver operating characteristics (ROC) curves were constructed for each of the three clinical scales and physician gestalt. Sensitivity and specificity were calculated based on the best cut-points of the ROC curve. We approached 209 patients, and of those, 148 were enrolled and 113 patients had complete data for analysis. Of these, 10.6% had significant dehydration based on our criterion standard. The Clinical Dehydration Scale (CDS) and Gorelick scales both had an area under the ROC curve (AUC) statistically different from the reference line with AUCs of 0.72 (95% CI 0.60, 0.84) and 0.71 (95% CI 0.57, 0.85) respectively. The World Health Organization (WHO) scale and physician gestalt had AUCs of 0.61 (95% CI 0.45, 0.77) and 0.61 (0.44, 0.78) respectively, which were not statistically significant. The Gorelick scale and Clinical Dehydration Scale were fair predictors of dehydration in children with diarrhea or vomiting. The World Health Organization scale and physician gestalt were not helpful predictors of dehydration in our cohort.

  17. Testing the role of external debt in environmental degradation: empirical evidence from Turkey.

    Science.gov (United States)

    Katircioglu, Salih; Celebi, Aysem

    2018-03-01

    This study investigates the role of external debt stock in Turkey, which has suffered from heavy (external and domestic) debt stock for many years. Annual data from 1960 to 2013 was analyzed using time series analysis in order to study this. The results confirm the validity of the conventional environmental Kuznets curve (EKC) in the case of Turkey. However, this study also found that Turkey's external debt stock did not influence the Turkish economy's long-term EKC behavior. Fortunately, the results suggest that there are important interactions among external debt stock, CO 2 emissions, energy consumption, and real income; that is, changes in external debt volume precede changes in these aggregates' volumes.

  18. Scanning the Business External Environment for Information: Evidence from Greece

    Science.gov (United States)

    Kourteli, Liana

    2005-01-01

    Introduction: This paper examines the business external environment scanning theory for information in the context of Greece. Method. A questionnaire was developed to explore the relationships between general and task business environment, perceived uncertainty, scanning strategy, and sources of information with respect to type of environment,…

  19. Psychological capital: Internal and external validity of the Psychological Capital Questionnaire (PCQ-24 on a South African sample

    Directory of Open Access Journals (Sweden)

    Gina Görgens-Ekermans

    2013-10-01

    Research purpose: The objectives of this study were to investigate the internal validity (construct and discriminant validity, reliability and external validity (relationship with theoretically relevant variables, namely stress, burnout and work engagement of the PCQ-24. Motivation for the study: Multiple studies have underscored the value of PsyCap within the workplace. In order to harness the full potential of the construct in the South African environment, sound measurement thereof, evidenced by a psychometrically sound instrument, is needed. Research design, approach and method: A cross-sectional survey design was used. The sample consisted of employees at managerial and non-managerial levels, from a medium-sized construction company in the Western Cape, South Africa. In addition to PsyCap, perceived stress, work-related burnout and work engagement were measured. Main findings: The results provided preliminary evidence of construct and discriminant validity, reliability and significant relations with external theoretically relevant variables. Practical/managerial implications: Researchers may confidently use the PCQ-24 to measure the construct of PsyCap and investigate relations with workplace outcomes in the South African environment, informing human relations practices. Contribution/value-add: Preliminary evidence of the psychometric properties of the PCQ-24, which measures the construct of PsyCap (consisting of hope, self-efficacy, resilience and optimism on a South African sample, was provided in this study.

  20. The Internal, External, and Diagnostic Validity of Sluggish Cognitive Tempo: A Meta-Analysis and Critical Review

    Science.gov (United States)

    Becker, Stephen P.; Leopold, Daniel R.; Burns, G. Leonard; Jarrett, Matthew A.; Langberg, Joshua M.; Marshall, Stephen A.; McBurnett, Keith; Waschbusch, Daniel A.; Willcutt, Erik G.

    2015-01-01

    , although there is initial support for SCT being associated with processing speed, sustained attention, and metacognitive deficits. Conclusion This meta-analytic review provides strong support for the internal validity of SCT and preliminary support for the external validity of SCT. In terms of diagnostic validity, there is not currently enough evidence to describe SCT in diagnostic terms. Key directions for future research are discussed, including evaluating the conceptualization of SCT as a transdiagnostic construct and the need for longitudinal research. PMID:26903250

  1. External validation of the ability of the DRAGON score to predict outcome after thrombolysis treatment

    DEFF Research Database (Denmark)

    Ovesen, Christian Aavang; Christensen, Anders; Nielsen, J K

    2013-01-01

    Easy-to-perform and valid assessment scales for the effect of thrombolysis are essential in hyperacute stroke settings. Because of this we performed an external validation of the DRAGON scale proposed by Strbian et al. in a Danish cohort. All patients treated with intravenous recombinant plasmino......Easy-to-perform and valid assessment scales for the effect of thrombolysis are essential in hyperacute stroke settings. Because of this we performed an external validation of the DRAGON scale proposed by Strbian et al. in a Danish cohort. All patients treated with intravenous recombinant...... and their modified Rankin Scale (mRS) was assessed after 3 months. Three hundred and three patients were included in the analysis. The DRAGON scale proved to have a good discriminative ability for predicting highly unfavourable outcome (mRS 5-6) (area under the curve-receiver operating characteristic [AUC-ROC]: 0...

  2. External validation of the NOBLADS score, a risk scoring system for severe acute lower gastrointestinal bleeding.

    Directory of Open Access Journals (Sweden)

    Tomonori Aoki

    Full Text Available We aimed to evaluate the generalizability of NOBLADS, a severe lower gastrointestinal bleeding (LGIB prediction model which we had previously derived when working at a different institution, using an external validation cohort. NOBLADS comprises the following factors: non-steroidal anti-inflammatory drug use, no diarrhea, no abdominal tenderness, blood pressure ≤ 100 mmHg, antiplatelet drug use, albumin < 3.0 g/dL, disease score ≥ 2, and syncope.We retrospectively analyzed 511 patients emergently hospitalized for acute LGIB at the University of Tokyo Hospital, from January 2009 to August 2016. The areas under the receiver operating characteristic curves (ROCs-AUCs for severe bleeding (continuous and/or recurrent bleeding were compared between the original derivation cohort and the external validation cohort.Severe LGIB occurred in 44% of patients. Several clinical factors were significantly different between the external and derivation cohorts (p < 0.05, including background, laboratory data, NOBLADS scores, and diagnosis. The NOBLADS score predicted the severity of LGIB with an AUC value of 0.74 in the external validation cohort and one of 0.77 in the derivation cohort. In the external validation cohort, the score predicted the risk for blood transfusion need (AUC, 0.71, but was not adequate for predicting intervention need (AUC, 0.54. The in-hospital mortality rate was higher in patients with a score ≥ 5 than in those with a score < 5 (AUC, 0.83.Although the external validation cohort clinically differed from the derivation cohort in many ways, we confirmed the moderately high generalizability of NOBLADS, a clinical risk score for severe LGIB. Appropriate triage using this score may support early decision-making in various hospitals.

  3. External Debt and Economic Growth: Evidence from Nigeria

    Directory of Open Access Journals (Sweden)

    Lawal Isola Adedoyin

    2016-12-01

    Full Text Available The study examined the impact of external debt on economic growth in Nigeria for the period 1981-2014 based on annual data sourced from the Central Bank of Nigeria (CBN Statistical Bulletin (various issues and abstract of National Bureau of Statistics (NBS. The researcher examined the existence of Co-integration among the underlying variables using Auto-regressive Distributed Lag (ARDL model after conducting preliminary statistical test to ascertain the normality of the variables as well as stationary of the data set using descriptive and unit root tests. The result of the ARDL test shows that a significant relationship exists between external debt and economic growth both at the long and short run. The study also examined the causality among the variables using Granger causality test and observed that no causality exist among the variables. The study therefore recommends that government should ensure that loans obtained are used to finance profitable projects that would generate reasonable amount of revenue to service the debts and also adequate record of debt payment obligations should be kept and debt should not be allowed to exceed a maximum limit in order to prevent debt overhang.

  4. The Main Concept Analysis in Cantonese Aphasic Oral Discourse: External Validation and Monitoring Chronic Aphasia

    Science.gov (United States)

    Kong, Anthony Pak-Hin

    2011-01-01

    Purpose: The 1st aim of this study was to further establish the external validity of the main concept (MC) analysis by examining its relationship with the Cantonese Linguistic Communication Measure (CLCM; Kong, 2006; Kong & Law, 2004)--an established quantitative system for narrative production--and the Cantonese version of the Western Aphasia…

  5. Evaluating health inequity interventions: applying a contextual (external) validity framework to programs funded by the Canadian Health Services Research Foundation.

    Science.gov (United States)

    Phillips, Kaye; Müller-Clemm, Werner; Ysselstein, Margaretha; Sachs, Jonathan

    2013-02-01

    Including context in the measurement and evaluation of health in equity interventions is critical to understanding how events that occur in an intervention's environment might contribute to or impede its success. This study adapted and piloted a contextual validity assessment framework on a selection of health inequity-related programs funded by the Canadian Health Services Research Foundation (CHSRF) between 1998 and 2006. The two overarching objectives of this study were (1) to determine the relative amount and quality of attention given to conceptualizing, measuring and validating context within CHSRF funded research final reports related to health-inequity; and (2) to contribute evaluative evidence towards the incorporation of context into the assessment and measurement of health inequity interventions. The study found that of the 42/146 CHSRF programs and projects, judged to be related to health inequity 20 adequately reported on the conceptualization, measurement and validation of context. Amongst these health-inequity related project reports, greatest emphasis was placed on describing the socio-political and economical context over actually measuring and validating contextual evidence. Applying a contextual validity assessment framework was useful for distinguishing between the descriptive (conceptual) versus empirical (measurement and validation) inclusion of documented contextual evidence. Although contextual validity measurement frameworks needs further development, this study contributes insight into identifying funded research related to health inequities and preliminary criteria for assessing interventions targeted at specific populations and jurisdictions. This study also feeds a larger critical dialogue (albeit beyond the scope of this study) regarding the relevance and utility of using evaluative techniques for understanding how specific external conditions support or impede the successful implementation of health inequity interventions. Copyright

  6. Analysis of internal and external validity criteria for a computerized visual search task: A pilot study.

    Science.gov (United States)

    Richard's, María M; Introzzi, Isabel; Zamora, Eliana; Vernucci, Santiago

    2017-01-01

    Inhibition is one of the main executive functions, because of its fundamental role in cognitive and social development. Given the importance of reliable and computerized measurements to assessment inhibitory performance, this research intends to analyze the internal and external criteria of validity of a computerized conjunction search task, to evaluate the role of perceptual inhibition. A sample of 41 children (21 females and 20 males), aged between 6 and 11 years old (M = 8.49, SD = 1.47), intentionally selected from a private management school of Mar del Plata (Argentina), middle socio-economic level were assessed. The Conjunction Search Task from the TAC Battery, Coding and Symbol Search tasks from Wechsler Intelligence Scale for Children were used. Overall, results allow us to confirm that the perceptual inhibition task form TAC presents solid rates of internal and external validity that make a valid measurement instrument of this process.

  7. Prediction of prostate cancer in unscreened men: external validation of a risk calculator.

    Science.gov (United States)

    van Vugt, Heidi A; Roobol, Monique J; Kranse, Ries; Määttänen, Liisa; Finne, Patrik; Hugosson, Jonas; Bangma, Chris H; Schröder, Fritz H; Steyerberg, Ewout W

    2011-04-01

    Prediction models need external validation to assess their value beyond the setting where the model was derived from. To assess the external validity of the European Randomized study of Screening for Prostate Cancer (ERSPC) risk calculator (www.prostatecancer-riskcalculator.com) for the probability of having a positive prostate biopsy (P(posb)). The ERSPC risk calculator was based on data of the initial screening round of the ERSPC section Rotterdam and validated in 1825 and 531 men biopsied at the initial screening round in the Finnish and Swedish sections of the ERSPC respectively. P(posb) was calculated using serum prostate specific antigen (PSA), outcome of digital rectal examination (DRE), transrectal ultrasound and ultrasound assessed prostate volume. The external validity was assessed for the presence of cancer at biopsy by calibration (agreement between observed and predicted outcomes), discrimination (separation of those with and without cancer), and decision curves (for clinical usefulness). Prostate cancer was detected in 469 men (26%) of the Finnish cohort and in 124 men (23%) of the Swedish cohort. Systematic miscalibration was present in both cohorts (mean predicted probability 34% versus 26% observed, and 29% versus 23% observed, both pscreened men, but overestimated the risk of a positive biopsy. Further research is necessary to assess the performance and applicability of the ERSPC risk calculator when a clinical setting is considered rather than a screening setting. Copyright © 2010 Elsevier Ltd. All rights reserved.

  8. External validation of the Cairns Prediction Model (CPM) to predict conversion from laparoscopic to open cholecystectomy.

    Science.gov (United States)

    Hu, Alan Shiun Yew; Donohue, Peter O'; Gunnarsson, Ronny K; de Costa, Alan

    2018-03-14

    Valid and user-friendly prediction models for conversion to open cholecystectomy allow for proper planning prior to surgery. The Cairns Prediction Model (CPM) has been in use clinically in the original study site for the past three years, but has not been tested at other sites. A retrospective, single-centred study collected ultrasonic measurements and clinical variables alongside with conversion status from consecutive patients who underwent laparoscopic cholecystectomy from 2013 to 2016 in The Townsville Hospital, North Queensland, Australia. An area under the curve (AUC) was calculated to externally validate of the CPM. Conversion was necessary in 43 (4.2%) out of 1035 patients. External validation showed an area under the curve of 0.87 (95% CI 0.82-0.93, p = 1.1 × 10 -14 ). In comparison with most previously published models, which have an AUC of approximately 0.80 or less, the CPM has the highest AUC of all published prediction models both for internal and external validation. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

  9. External validation of multivariable prediction models: a systematic review of methodological conduct and reporting

    Science.gov (United States)

    2014-01-01

    Background Before considering whether to use a multivariable (diagnostic or prognostic) prediction model, it is essential that its performance be evaluated in data that were not used to develop the model (referred to as external validation). We critically appraised the methodological conduct and reporting of external validation studies of multivariable prediction models. Methods We conducted a systematic review of articles describing some form of external validation of one or more multivariable prediction models indexed in PubMed core clinical journals published in 2010. Study data were extracted in duplicate on design, sample size, handling of missing data, reference to the original study developing the prediction models and predictive performance measures. Results 11,826 articles were identified and 78 were included for full review, which described the evaluation of 120 prediction models. in participant data that were not used to develop the model. Thirty-three articles described both the development of a prediction model and an evaluation of its performance on a separate dataset, and 45 articles described only the evaluation of an existing published prediction model on another dataset. Fifty-seven percent of the prediction models were presented and evaluated as simplified scoring systems. Sixteen percent of articles failed to report the number of outcome events in the validation datasets. Fifty-four percent of studies made no explicit mention of missing data. Sixty-seven percent did not report evaluating model calibration whilst most studies evaluated model discrimination. It was often unclear whether the reported performance measures were for the full regression model or for the simplified models. Conclusions The vast majority of studies describing some form of external validation of a multivariable prediction model were poorly reported with key details frequently not presented. The validation studies were characterised by poor design, inappropriate handling

  10. Large-scale external validation and comparison of prognostic models: an application to chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    Guerra, Beniamino; Haile, Sarah R.; Lamprecht, Bernd; Ramírez, Ana S.; Martinez-Camblor, Pablo; Kaiser, Bernhard; Alfageme, Inmaculada; Almagro, Pere; Casanova, Ciro; Esteban-González, Cristóbal; Soler-Cataluña, Juan J.; de-Torres, Juan P.; Miravitlles, Marc; Celli, Bartolome R.; Marin, Jose M.; ter Riet, Gerben; Sobradillo, Patricia; Lange, Peter; Garcia-Aymerich, Judith; Antó, Josep M.; Turner, Alice M.; Han, MeiLan K.; Langhammer, Arnulf; Leivseth, Linda; Bakke, Per; Johannessen, Ane; Oga, Toru; Cosio, Borja; Ancochea-Bermúdez, Julio; Echazarreta, Andres; Roche, Nicolas; Burgel, Pierre-Régis; Sin, Don D.; Soriano, Joan B.; Puhan, Milo A.

    2018-01-01

    External validations and comparisons of prognostic models or scores are a prerequisite for their use in routine clinical care but are lacking in most medical fields including chronic obstructive pulmonary disease (COPD). Our aim was to externally validate and concurrently compare prognostic scores

  11. Estimating mortality from external causes using data from retrospective surveys: A validation study in Niakhar (Senegal

    Directory of Open Access Journals (Sweden)

    Gilles Pison

    2018-03-01

    Full Text Available Background: In low- and middle-income countries (LMICs, data on causes of death is often inaccurate or incomplete. In this paper, we test whether adding a few questions about injuries and accidents to mortality questionnaires used in representative household surveys would yield accurate estimates of the extent of mortality due to external causes (accidents, homicides, or suicides. Methods: We conduct a validation study in Niakhar (Senegal, during which we compare reported survey data to high-quality prospective records of deaths collected by a health and demographic surveillance system (HDSS. Results: Survey respondents more frequently list the deaths of their adult siblings who die of external causes than the deaths of those who die from other causes. The specificity of survey data is high, but sensitivity is low. Among reported deaths, less than 60Š of the deaths classified as due to external causes by the HDSS are also classified as such by survey respondents. Survey respondents better report deaths due to road-traffic accidents than deaths from suicides and homicides. Conclusions: Asking questions about deaths resulting from injuries and accidents during surveys might help measure mortality from external causes in LMICs, but the resulting data displays systematic bias in a rural population of Senegal. Future studies should 1 investigate whether similar biases also apply in other settings and 2 test new methods to further improve the accuracy of survey data on mortality from external causes. Contribution: This study helps strengthen the monitoring of sustainable development targets in LMICs by validating a simple approach for the measurement of mortality from external causes.

  12. External Validation of the Acoustic Voice Quality Index Version 03.01 With Extended Representativity.

    Science.gov (United States)

    Barsties, Ben; Maryn, Youri

    2016-07-01

    The Acoustic Voice Quality Index (AVQI) is an objective method to quantify the severity of overall voice quality in concatenated continuous speech and sustained phonation segments. Recently, AVQI was successfully modified to be more representative and ecologically valid because the internal consistency of AVQI was balanced out through equal proportion of the 2 speech types. The present investigation aims to explore its external validation in a large data set. An expert panel of 12 speech-language therapists rated the voice quality of 1058 concatenated voice samples varying from normophonia to severe dysphonia. The Spearman rank-order correlation coefficients (r) were used to measure concurrent validity. The AVQI's diagnostic accuracy was evaluated with several estimates of its receiver operating characteristics (ROC). Finally, 8 of the 12 experts were chosen because of reliability criteria. A strong correlation was identified between AVQI and auditoryperceptual rating (r = 0.815, P = .000). It indicated that 66.4% of the auditory-perceptual rating's variation was explained by AVQI. Additionally, the ROC results showed again the best diagnostic outcome at a threshold of AVQI = 2.43. This study highlights external validation and diagnostic precision of the AVQI version 03.01 as a robust and ecologically valid measurement to objectify voice quality. © The Author(s) 2016.

  13. External Validation of Prediction Models for Pneumonia in Primary Care Patients with Lower Respiratory Tract Infection

    DEFF Research Database (Denmark)

    Schierenberg, Alwin; Minnaard, Margaretha C; Hopstaken, Rogier M

    2016-01-01

    BACKGROUND: Pneumonia remains difficult to diagnose in primary care. Prediction models based on signs and symptoms (S&S) serve to minimize the diagnostic uncertainty. External validation of these models is essential before implementation into routine practice. In this study all published S&S mode...... discriminative accuracy coupled with reasonable to good calibration across the IPD of different study populations. This model is therefore the main candidate for primary care use....

  14. Review and evaluation of performance measures for survival prediction models in external validation settings

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    M. Shafiqur Rahman

    2017-04-01

    Full Text Available Abstract Background When developing a prediction model for survival data it is essential to validate its performance in external validation settings using appropriate performance measures. Although a number of such measures have been proposed, there is only limited guidance regarding their use in the context of model validation. This paper reviewed and evaluated a wide range of performance measures to provide some guidelines for their use in practice. Methods An extensive simulation study based on two clinical datasets was conducted to investigate the performance of the measures in external validation settings. Measures were selected from categories that assess the overall performance, discrimination and calibration of a survival prediction model. Some of these have been modified to allow their use with validation data, and a case study is provided to describe how these measures can be estimated in practice. The measures were evaluated with respect to their robustness to censoring and ease of interpretation. All measures are implemented, or are straightforward to implement, in statistical software. Results Most of the performance measures were reasonably robust to moderate levels of censoring. One exception was Harrell’s concordance measure which tended to increase as censoring increased. Conclusions We recommend that Uno’s concordance measure is used to quantify concordance when there are moderate levels of censoring. Alternatively, Gönen and Heller’s measure could be considered, especially if censoring is very high, but we suggest that the prediction model is re-calibrated first. We also recommend that Royston’s D is routinely reported to assess discrimination since it has an appealing interpretation. The calibration slope is useful for both internal and external validation settings and recommended to report routinely. Our recommendation would be to use any of the predictive accuracy measures and provide the corresponding predictive

  15. 20 CFR 219.33 - Evidence of a deemed valid marriage.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Evidence of a deemed valid marriage. 219.33... EVIDENCE REQUIRED FOR PAYMENT Evidence of Relationship § 219.33 Evidence of a deemed valid marriage. (a) Preferred evidence. Preferred evidence of a deemed valid marriage is— (1) Evidence of a ceremonial marriage...

  16. The impact of crowd noise on officiating in Muay Thai: achieving external validity in an experimental setting

    Directory of Open Access Journals (Sweden)

    Tony D Myers

    2012-09-01

    Full Text Available Numerous factors have been proposed to explain the home advantage in sport. Several authors have suggested that a partisan home crowd enhances home advantage and that this is at least in part a consequence of their influence on officiating. However, while experimental studies examining this phenomenon have high levels of internal validity (since only the ‘crowd noise’ intervention is allowed to vary, they suffer from a lack of external validity, with decision-making in a laboratory setting typically bearing little resemblance to decision-making in live sports settings. Conversely, observational and quasi-experimental studies with high levels of external validity suffer from low levels of internal validity as countless factors besides crowd noise vary. The present study provides a unique opportunity to address these criticisms, by conducting a controlled experiment on the impact of crowd noise on officiating in a live tournament setting. Seventeen qualified judges officiated on thirty Thai boxing bouts in a live international tournament setting featuring ‘home’ and ‘away’ boxers. In each bout, judges were randomised into a ‘noise’ (live sound or ‘no crowd noise’ (noise cancelling headphones and white noise condition, resulting in 59 judgements in the ‘no crowd noise’ and 61 in the ‘crowd noise’ condition. The results provide the first experimental evidence of the impact of live crowd noise on officials in sport. A cross-classified statistical model indicated that crowd noise had a statistically significant impact, equating to just over half a point per bout (in the context of five round bouts with the ‘ten point must’ scoring system shared with professional boxing. The practical significance of the findings, their implications for officiating and for the future conduct of crowd noise studies are discussed.

  17. The impact of crowd noise on officiating in muay thai: achieving external validity in an experimental setting.

    Science.gov (United States)

    Myers, Tony; Balmer, Nigel

    2012-01-01

    Numerous factors have been proposed to explain the home advantage in sport. Several authors have suggested that a partisan home crowd enhances home advantage and that this is at least in part a consequence of their influence on officiating. However, while experimental studies examining this phenomenon have high levels of internal validity (since only the "crowd noise" intervention is allowed to vary), they suffer from a lack of external validity, with decision-making in a laboratory setting typically bearing little resemblance to decision-making in live sports settings. Conversely, observational and quasi-experimental studies with high levels of external validity suffer from low levels of internal validity as countless factors besides crowd noise vary. The present study provides a unique opportunity to address these criticisms, by conducting a controlled experiment on the impact of crowd noise on officiating in a live tournament setting. Seventeen qualified judges officiated on thirty Thai boxing bouts in a live international tournament setting featuring "home" and "away" boxers. In each bout, judges were randomized into a "noise" (live sound) or "no crowd noise" (noise-canceling headphones and white noise) condition, resulting in 59 judgments in the "no crowd noise" and 61 in the "crowd noise" condition. The results provide the first experimental evidence of the impact of live crowd noise on officials in sport. A cross-classified statistical model indicated that crowd noise had a statistically significant impact, equating to just over half a point per bout (in the context of five round bouts with the "10-point must" scoring system shared with professional boxing). The practical significance of the findings, their implications for officiating and for the future conduct of crowd noise studies are discussed.

  18. Multicentre validation of IMRT pre-treatment verification: Comparison of in-house and external audit

    International Nuclear Information System (INIS)

    Jornet, Núria; Carrasco, Pablo; Beltrán, Mercè; Calvo, Juan Francisco; Escudé, Lluís; Hernández, Victor; Quera, Jaume; Sáez, Jordi

    2014-01-01

    Background and purpose: We performed a multicentre intercomparison of IMRT optimisation and dose planning and IMRT pre-treatment verification methods and results. The aims were to check consistency between dose plans and to validate whether in-house pre-treatment verification results agreed with those of an external audit. Materials and methods: Participating centres used two mock cases (prostate and head and neck) for the intercomparison and audit. Compliance to dosimetric goals and total number of MU per plan were collected. A simple quality index to compare the different plans was proposed. We compared gamma index pass rates using the centre’s equipment and methodology to those of an external audit. Results: While for the prostate case, all centres fulfilled the dosimetric goals and plan quality was homogeneous, that was not the case for the head and neck case. The number of MU did not correlate with the plan quality index. Pre-treatment verifications results of the external audit did not agree with those of the in-house measurements for two centres: being within tolerance for in-house measurements and unacceptable for the audit or the other way round. Conclusions: Although all plans fulfilled dosimetric constraints, plan quality is highly dependent on the planner expertise. External audits are an excellent tool to detect errors in IMRT implementation and cannot be replaced by intercomparison using results obtained by centres

  19. Development and external validation of a prognostic nomogram for metastatic uveal melanoma.

    Directory of Open Access Journals (Sweden)

    Sara Valpione

    Full Text Available Approximately 50% of patients with uveal melanoma (UM will develop metastatic disease, usually involving the liver. The outcome of metastatic UM (mUM is generally poor and no standard therapy has been established. Additionally, clinicians lack a validated prognostic tool to evaluate these patients. The aim of this work was to develop a reliable prognostic nomogram for clinicians.Two cohorts of mUM patients, from Veneto Oncology Institute (IOV (N=152 and Mayo Clinic (MC (N=102, were analyzed to develop and externally validate, a prognostic nomogram.The median survival of mUM was 17.2 months in the IOV cohort and 19.7 in the MC cohort. Percentage of liver involvement (HR 1.6, elevated levels of serum LDH (HR 1.6, and a WHO performance status=1 (HR 1.5 or 2-3 (HR 4.6 were associated with worse prognosis. Longer disease-free interval from diagnosis of UM to that of mUM conferred a survival advantage (HR 0.9. The nomogram had a concordance probability of 0.75 (SE .006 in the development dataset (IOV, and 0.80 (SE .009 in the external validation (MC. Nomogram predictions were well calibrated.The nomogram, which includes percentage of liver involvement, LDH levels, WHO performance status and disease free-interval accurately predicts the prognosis of mUM and could be useful for decision-making and risk stratification for clinical trials.

  20. When all children comprehend: increasing the external validity of narrative comprehension development research

    Science.gov (United States)

    Burris, Silas E.; Brown, Danielle D.

    2014-01-01

    Narratives, also called stories, can be found in conversations, children's play interactions, reading material, and television programs. From infancy to adulthood, narrative comprehension processes interpret events and inform our understanding of physical and social environments. These processes have been extensively studied to ascertain the multifaceted nature of narrative comprehension. From this research we know that three overlapping processes (i.e., knowledge integration, goal structure understanding, and causal inference generation) proposed by the constructionist paradigm are necessary for narrative comprehension, narrative comprehension has a predictive relationship with children's later reading performance, and comprehension processes are generalizable to other contexts. Much of the previous research has emphasized internal and predictive validity; thus, limiting the generalizability of previous findings. We are concerned these limitations may be excluding underrepresented populations from benefits and implications identified by early comprehension processes research. This review identifies gaps in extant literature regarding external validity and argues for increased emphasis on externally valid research. We highlight limited research on narrative comprehension processes in children from low-income and minority populations, and argue for changes in comprehension assessments. Specifically, we argue both on- and off-line assessments should be used across various narrative types (e.g., picture books, televised narratives) with traditionally underserved and underrepresented populations. We propose increasing the generalizability of narrative comprehension processes research can inform persistent reading achievement gaps, and have practical implications for how children learn from narratives. PMID:24659973

  1. When All Children Comprehend: Increasing the External Validity of Narrative Comprehension Development Research

    Directory of Open Access Journals (Sweden)

    Silas E. Burris

    2014-03-01

    Full Text Available Narratives, also called stories, can be found in conversations, children’s play interactions, reading material, and television programs. From infancy to adulthood, narrative comprehension processes interpret events and inform our understanding of physical and social environments. These processes have been extensively studied to ascertain the multifaceted nature of narrative comprehension. From this research we know that three overlapping processes (i.e., knowledge integration, goal structure understanding, and causal inference generation proposed by the constructionist paradigm are necessary for narrative comprehension, narrative comprehension has a predictive relationship with children’s later reading performance, and comprehension processes are generalizable to other contexts. Much of the previous research has emphasized internal and predictive validity; thus, limiting the generalizability of previous findings. We are concerned these limitations may be excluding underrepresented populations from benefits and implications identified by early comprehension processes research. This review identifies gaps in extant literature regarding external validity and argues for increased emphasis on externally valid research. We highlight limited research on narrative comprehension processes in children from low-income and minority populations, and argue for changes in comprehension assessments. Specifically, we argue both on- and off-line assessments should be used across various narrative types (e.g., picture books, televised narratives with traditionally underserved and underrepresented populations. We propose increasing the generalizability narrative comprehension processes research can inform persistent reading achievement gaps, and have practical implications for how children learn from narratives.

  2. Extending Validity Evidence for Multidimensional Measures of Coaching Competency

    Science.gov (United States)

    Myers, Nicholas D.; Wolfe, Edward W.; Maier, Kimberly S.; Feltz, Deborah L.; Reckase, Mark D.

    2006-01-01

    This study extended validity evidence for multidimensional measures of coaching competency derived from the Coaching Competency Scale (CCS; Myers, Feltz, Maier, Wolfe, & Reckase, 2006) by examining use of the original rating scale structure and testing how measures related to satisfaction with the head coach within teams and between teams.…

  3. Literature evidence in open targets - a target validation platform.

    Science.gov (United States)

    Kafkas, Şenay; Dunham, Ian; McEntyre, Johanna

    2017-06-06

    We present the Europe PMC literature component of Open Targets - a target validation platform that integrates various evidence to aid drug target identification and validation. The component identifies target-disease associations in documents and ranks the documents based on their confidence from the Europe PMC literature database, by using rules utilising expert-provided heuristic information. The confidence score of a given document represents how valuable the document is in the scope of target validation for a given target-disease association by taking into account the credibility of the association based on the properties of the text. The component serves the platform regularly with the up-to-date data since December, 2015. Currently, there are a total number of 1168365 distinct target-disease associations text mined from >26 million PubMed abstracts and >1.2 million Open Access full text articles. Our comparative analyses on the current available evidence data in the platform revealed that 850179 of these associations are exclusively identified by literature mining. This component helps the platform's users by providing the most relevant literature hits for a given target and disease. The text mining evidence along with the other types of evidence can be explored visually through https://www.targetvalidation.org and all the evidence data is available for download in json format from https://www.targetvalidation.org/downloads/data .

  4. Poor quality of external validity reporting limits generalizability of overweight and/or obesity lifestyle prevention interventions in young adults: a systematic review.

    Science.gov (United States)

    Partridge, S R; Juan, S J-H; McGeechan, K; Bauman, A; Allman-Farinelli, M

    2015-01-01

    Young adulthood is a high-risk life stage for weight gain. Evidence is needed to translate behavioural approaches into community practice to prevent weight gain in young adults. This systematic review assessed the effectiveness and reporting of external validity components in prevention interventions. The search was limited to randomized controlled trial (RCT) lifestyle interventions for the prevention of weight gain in young adults (18-35 years). Mean body weight and/or body mass index (BMI) change were the primary outcomes. External validity, quality assessment and risk of bias tools were applied to all studies. Twenty-one RCTs were identified through 14 major electronic databases. Over half of the studies were effective in the short term for significantly reducing body weight and/or BMI; however, few showed long-term maintenance. All studies lacked full reporting on external validity components. Description of the intervention components and participant attrition rates were reported by most studies. However, few studies reported the representativeness of participants, effectiveness of recruitment methods, process evaluation detail or costs. It is unclear from the information reported how to implement the interventions into community practice. Integrated reporting of intervention effectiveness and enhanced reporting of external validity components are needed for the translation and potential upscale of prevention strategies. © 2014 World Obesity.

  5. External gear pumps operating with non-Newtonian fluids: Modelling and experimental validation

    Science.gov (United States)

    Rituraj, Fnu; Vacca, Andrea

    2018-06-01

    External Gear Pumps are used in various industries to pump non-Newtonian viscoelastic fluids like plastics, paints, inks, etc. For both design and analysis purposes, it is often a matter of interest to understand the features of the displacing action realized by meshing of the gears and the description of the behavior of the leakages for this kind of pumps. However, very limited work can be found in literature about methodologies suitable to model such phenomena. This article describes the technique of modelling external gear pumps that operate with non-Newtonian fluids. In particular, it explains how the displacing action of the unit can be modelled using a lumped parameter approach which involves dividing fluid domain into several control volumes and internal flow connections. This work is built upon the HYGESim simulation tool, conceived by the authors' research team in the last decade, which is for the first time extended for the simulation of non-Newtonian fluids. The article also describes several comparisons between simulation results and experimental data obtained from numerous experiments performed for validation of the presented methodology. Finally, operation of external gear pump with fluids having different viscosity characteristics is discussed.

  6. Derivation and External Validation of Prediction Models for Advanced Chronic Kidney Disease Following Acute Kidney Injury.

    Science.gov (United States)

    James, Matthew T; Pannu, Neesh; Hemmelgarn, Brenda R; Austin, Peter C; Tan, Zhi; McArthur, Eric; Manns, Braden J; Tonelli, Marcello; Wald, Ron; Quinn, Robert R; Ravani, Pietro; Garg, Amit X

    2017-11-14

    Some patients will develop chronic kidney disease after a hospitalization with acute kidney injury; however, no risk-prediction tools have been developed to identify high-risk patients requiring follow-up. To derive and validate predictive models for progression of acute kidney injury to advanced chronic kidney disease. Data from 2 population-based cohorts of patients with a prehospitalization estimated glomerular filtration rate (eGFR) of more than 45 mL/min/1.73 m2 and who had survived hospitalization with acute kidney injury (defined by a serum creatinine increase during hospitalization > 0.3 mg/dL or > 50% of their prehospitalization baseline), were used to derive and validate multivariable prediction models. The risk models were derived from 9973 patients hospitalized in Alberta, Canada (April 2004-March 2014, with follow-up to March 2015). The risk models were externally validated with data from a cohort of 2761 patients hospitalized in Ontario, Canada (June 2004-March 2012, with follow-up to March 2013). Demographic, laboratory, and comorbidity variables measured prior to discharge. Advanced chronic kidney disease was defined by a sustained reduction in eGFR less than 30 mL/min/1.73 m2 for at least 3 months during the year after discharge. All participants were followed up for up to 1 year. The participants (mean [SD] age, 66 [15] years in the derivation and internal validation cohorts and 69 [11] years in the external validation cohort; 40%-43% women per cohort) had a mean (SD) baseline serum creatinine level of 1.0 (0.2) mg/dL and more than 20% had stage 2 or 3 acute kidney injury. Advanced chronic kidney disease developed in 408 (2.7%) of 9973 patients in the derivation cohort and 62 (2.2%) of 2761 patients in the external validation cohort. In the derivation cohort, 6 variables were independently associated with the outcome: older age, female sex, higher baseline serum creatinine value, albuminuria, greater severity of acute kidney injury, and higher

  7. The use of Geographic Information System (GIS) and non-GIS methods to assess the external validity of samples postcollection.

    Science.gov (United States)

    Richardson, Esther; Good, Margaret; McGrath, Guy; More, Simon J

    2009-09-01

    External validity is fundamental to veterinary diagnostic investigation, reflecting the accuracy with which sample results can be extrapolated to a broader population of interest. Probability sampling methods are routinely used during the collection of samples from populations, specifically to maximize external validity. Nonprobability sampling (e.g., of blood samples collected as part of routine surveillance programs or laboratory submissions) may provide useful data for further posthoc epidemiological analysis, adding value to the collection and submission of samples. As the sample has already been submitted, the analyst or investigator does not have any control over the sampling methodology, and hence external validity as routine probability sampling methods may not have been employed. The current study describes several Geographic Information System (GIS) and non-GIS methods, applied posthoc, to assess the external validity of samples collected using both probability and nonprobability sampling methods. These methods could equally be employed for inspecting other datasets. Mapping was conducted using ArcView 9.1. Based on this posthoc assessment, results from the random field sample could provide an externally valid, albeit relatively imprecise, estimate of national disease prevalence, of disease prevalence in 3 of the 4 provinces (all but Ulster, in the north and northwest, where sample size was small), and in beef and dairy herds. This study provides practical methods for examining the external validity of samples postcollection.

  8. Agglomeration externalities, market structure and employment growth in high-tech industries: Revisiting the evidence

    Directory of Open Access Journals (Sweden)

    Cieślik Andrzej

    2015-09-01

    Full Text Available In this paper we revisit the existing empirical evidence on the effects of various agglomeration externalities and the market structure on employment growth in the high-tech industries of the European Economic Area (EEA. Our study is based on the dynamic panel dataset of two-digit NACE rev 1.1. industries in 285 regions of the European Economic Area for the period 1995-2007. We find that employment growth is negatively related to competition, while localization and urbanization externalities do not seem to affect growth.

  9. 20 CFR 404.727 - Evidence of a deemed valid marriage.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Evidence of a deemed valid marriage. 404.727... DISABILITY INSURANCE (1950- ) Evidence Evidence of Age, Marriage, and Death § 404.727 Evidence of a deemed valid marriage. (a) General. A deemed valid marriage is a ceremonial marriage we consider valid even...

  10. Development and External Validation of a Prognostic Nomogram for Metastatic Uveal Melanoma

    Science.gov (United States)

    Valpione, Sara; Moser, Justin C.; Parrozzani, Raffaele; Bazzi, Marco; Mansfield, Aaron S.; Mocellin, Simone; Pigozzo, Jacopo; Midena, Edoardo; Markovic, Svetomir N.; Aliberti, Camillo; Campana, Luca G.; Chiarion-Sileni, Vanna

    2015-01-01

    Background Approximately 50% of patients with uveal melanoma (UM) will develop metastatic disease, usually involving the liver. The outcome of metastatic UM (mUM) is generally poor and no standard therapy has been established. Additionally, clinicians lack a validated prognostic tool to evaluate these patients. The aim of this work was to develop a reliable prognostic nomogram for clinicians. Patients and Methods Two cohorts of mUM patients, from Veneto Oncology Institute (IOV) (N=152) and Mayo Clinic (MC) (N=102), were analyzed to develop and externally validate, a prognostic nomogram. Results The median survival of mUM was 17.2 months in the IOV cohort and 19.7 in the MC cohort. Percentage of liver involvement (HR 1.6), elevated levels of serum LDH (HR 1.6), and a WHO performance status=1 (HR 1.5) or 2–3 (HR 4.6) were associated with worse prognosis. Longer disease-free interval from diagnosis of UM to that of mUM conferred a survival advantage (HR 0.9). The nomogram had a concordance probability of 0.75 (SE .006) in the development dataset (IOV), and 0.80 (SE .009) in the external validation (MC). Nomogram predictions were well calibrated. Conclusions The nomogram, which includes percentage of liver involvement, LDH levels, WHO performance status and disease free-interval accurately predicts the prognosis of mUM and could be useful for decision-making and risk stratification for clinical trials. PMID:25780931

  11. Evidence for external forcing of the Atlantic Multidecadal Oscillation since termination of the Little Ice Age.

    Science.gov (United States)

    Knudsen, Mads Faurschou; Jacobsen, Bo Holm; Seidenkrantz, Marit-Solveig; Olsen, Jesper

    2014-02-25

    The Atlantic Multidecadal Oscillation (AMO) represents a significant driver of Northern Hemisphere climate, but the forcing mechanisms pacing the AMO remain poorly understood. Here we use the available proxy records to investigate the influence of solar and volcanic forcing on the AMO over the last ~450 years. The evidence suggests that external forcing played a dominant role in pacing the AMO after termination of the Little Ice Age (LIA; ca. 1400-1800), with an instantaneous impact on mid-latitude sea-surface temperatures that spread across the North Atlantic over the ensuing ~5 years. In contrast, the role of external forcing was more ambiguous during the LIA. Our study further suggests that the Atlantic Meridional Overturning Circulation is important for linking external forcing with North Atlantic sea-surface temperatures, a conjecture that reconciles two opposing theories concerning the origin of the AMO.

  12. Evidence of Validity of the Job Crafting Behaviors Scale

    Directory of Open Access Journals (Sweden)

    Renata Silva de Carvalho Chinelato

    2015-12-01

    Full Text Available AbstractJob crafting behavior refers to the changes made by workers in their job context for adjusting their activities to their preferences. We sought to adapt and collect validity evidences of the Job Crafting Behaviors Scale for the Brazilian context, in a sample of 491 workers, with a mean age of 26.7 years. Factor analysis revealed that the final instrument consisted of three dimensions (increasing structural job resources, increasing social job resources, increasing challenging job demands, which showed good internal consistency indexes. These dimensions showed low or moderate correlations with work engagement, positive psychological capital, positive job affect, and in-role performance. The scale showed evidence of validity, the use of which is recommended for future research on the changes that people make in their jobs.

  13. Development and Validation of a Mobile Device-based External Ventricular Drain Simulator.

    Science.gov (United States)

    Morone, Peter J; Bekelis, Kimon; Root, Brandon K; Singer, Robert J

    2017-10-01

    Multiple external ventricular drain (EVD) simulators have been created, yet their cost, bulky size, and nonreusable components limit their accessibility to residency programs. To create and validate an animated EVD simulator that is accessible on a mobile device. We developed a mobile-based EVD simulator that is compatible with iOS (Apple Inc., Cupertino, California) and Android-based devices (Google, Mountain View, California) and can be downloaded from the Apple App and Google Play Store. Our simulator consists of a learn mode, which teaches users the procedure, and a test mode, which assesses users' procedural knowledge. Twenty-eight participants, who were divided into expert and novice categories, completed the simulator in test mode and answered a postmodule survey. This was graded using a 5-point Likert scale, with 5 representing the highest score. Using the survey results, we assessed the module's face and content validity, whereas construct validity was evaluated by comparing the expert and novice test scores. Participants rated individual survey questions pertaining to face and content validity a median score of 4 out of 5. When comparing test scores, generated by the participants completing the test mode, the experts scored higher than the novices (mean, 71.5; 95% confidence interval, 69.2 to 73.8 vs mean, 48; 95% confidence interval, 44.2 to 51.6; P mobile-based EVD simulator that is inexpensive, reusable, and accessible. Our results demonstrate that this simulator is face, content, and construct valid. Copyright © 2017 by the Congress of Neurological Surgeons

  14. Prognosis in moderate and severe traumatic brain injury: External validation of the IMPACT models and the role of extracranial injuries

    NARCIS (Netherlands)

    Lingsma, Hester; Andriessen, Teuntje M. J. C.; Haitsema, Iain; Horn, Janneke; van der Naalt, Joukje; Franschman, Gaby; Maas, Andrew I. R.; Vos, Pieter E.; Steyerberg, Ewout W.

    2013-01-01

    BACKGROUND: Several prognostic models to predict outcome in traumatic brain injury (TBI) have been developed, but few are externally validated. We aimed to validate the International Mission on Prognosis and Analysis of Clinical Trials in TBI (IMPACT) prognostic models in a recent unselected patient

  15. The relationship between external and internal validity of randomized controlled trials: A sample of hypertension trials from China

    Directory of Open Access Journals (Sweden)

    Xin Zhang

    2015-10-01

    Conclusion: Several components relate to the external validity of RCTs do associate with the internal validity, that do not stand in an easy relationship to each other. Regarding the poor reporting, other possible links between two variables need to trace in the future methodological researches.

  16. External validation of the ability of the DRAGON score to predict outcome after thrombolysis treatment.

    Science.gov (United States)

    Ovesen, C; Christensen, A; Nielsen, J K; Christensen, H

    2013-11-01

    Easy-to-perform and valid assessment scales for the effect of thrombolysis are essential in hyperacute stroke settings. Because of this we performed an external validation of the DRAGON scale proposed by Strbian et al. in a Danish cohort. All patients treated with intravenous recombinant plasminogen activator between 2009 and 2011 were included. Upon admission all patients underwent physical and neurological examination using the National Institutes of Health Stroke Scale along with non-contrast CT scans and CT angiography. Patients were followed up through the Outpatient Clinic and their modified Rankin Scale (mRS) was assessed after 3 months. Three hundred and three patients were included in the analysis. The DRAGON scale proved to have a good discriminative ability for predicting highly unfavourable outcome (mRS 5-6) (area under the curve-receiver operating characteristic [AUC-ROC]: 0.89; 95% confidence interval [CI] 0.81-0.96; pDRAGON scale provided good discriminative capability (AUC-ROC: 0.89; 95% CI 0.78-1.0; p=0.003) for highly unfavourable outcome. We confirmed the validity of the DRAGON scale in predicting outcome after thrombolysis treatment. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Cointegration Analysis of the Economic Growth, Military Expenditure, and External Debt: Evidence from Pakistan

    Directory of Open Access Journals (Sweden)

    Khalid Zaman

    2012-06-01

    Full Text Available This paper attempts to examine the relationship between real military spending (RME, level of economic activity (RGNP, and real external debt (RED by using a Johansen multivariate cointegration framework. The analysis is carried out using time series data over 1980-2008 The study investigates the long-run effects and short-run dynamics of the effect of rise in RGNP and RME on RED Pakistan. The quantitative evidence shows that external debt is more elastic with respect to military expenditure in the long run, whereas, there has been insignificant effect in the short-run. In the long-run, 1.00% increase in military expenditure leads to an increase in external debt by almost 3.96%. On the other hand, 1.00% increases in economic growth decreases external debt by 2.13%. In the short run, 1.00% increase in economic growth reduces external debt by 2.90%. The results presented in this study reinforce the importance to government, academic, and policy makers.

  18. Little Evidence That Time in Child Care Causes Externalizing Problems During Early Childhood in Norway

    Science.gov (United States)

    Zachrisson, Henrik Daae; Dearing, Eric; Lekhal, Ratib; Toppelberg, Claudio O.

    2012-01-01

    Associations between maternal reports of hours in child care and children’s externalizing problems at 18 and 36 months of age were examined in a population-based Norwegian sample (n = 75,271). Within a sociopolitical context of homogenously high-quality child care, there was little evidence that high quantity of care causes externalizing problems. Using conventional approaches to handling selection bias and listwise deletion for substantial attrition in this sample, more hours in care predicted higher problem levels, yet with small effect sizes. The finding, however, was not robust to using multiple imputation for missing values. Moreover, when sibling and individual fixed-effects models for handling selection bias were used, no relation between hours and problems was evident. PMID:23311645

  19. Preparing Dental Students and Residents to Overcome Internal and External Barriers to Evidence-Based Practice.

    Science.gov (United States)

    Coleman, Brandon G; Johnson, Thomas M; Erley, Kenneth J; Topolski, Richard; Rethman, Michael; Lancaster, Douglas D

    2016-10-01

    In recent years, evidence-based dentistry has become the ideal for research, academia, and clinical practice. However, barriers to implementation are many, including the complexity of interpreting conflicting evidence as well as difficulties in accessing it. Furthermore, many proponents of evidence-based care seem to assume that good evidence consistently exists and that clinicians can and will objectively evaluate data so as to apply the best evidence to individual patients' needs. The authors argue that these shortcomings may mislead many clinicians and that students should be adequately prepared to cope with some of the more complex issues surrounding evidence-based practice. Cognitive biases and heuristics shape every aspect of our lives, including our professional behavior. This article reviews literature from medicine, psychology, and behavioral economics to explore the barriers to implementing evidence-based dentistry. Internal factors include biases that affect clinical decision making: hindsight bias, optimism bias, survivor bias, and blind-spot bias. External factors include publication bias, corporate bias, and lack of transparency that may skew the available evidence in the peer-reviewed literature. Raising awareness of how these biases exert subtle influence on decision making and patient care can lead to a more nuanced discussion of addressing and overcoming barriers to evidence-based practice.

  20. Derivation and external validation of a case mix model for the standardized reporting of 30-day stroke mortality rates.

    Science.gov (United States)

    Bray, Benjamin D; Campbell, James; Cloud, Geoffrey C; Hoffman, Alex; James, Martin; Tyrrell, Pippa J; Wolfe, Charles D A; Rudd, Anthony G

    2014-11-01

    Case mix adjustment is required to allow valid comparison of outcomes across care providers. However, there is a lack of externally validated models suitable for use in unselected stroke admissions. We therefore aimed to develop and externally validate prediction models to enable comparison of 30-day post-stroke mortality outcomes using routine clinical data. Models were derived (n=9000 patients) and internally validated (n=18 169 patients) using data from the Sentinel Stroke National Audit Program, the national register of acute stroke in England and Wales. External validation (n=1470 patients) was performed in the South London Stroke Register, a population-based longitudinal study. Models were fitted using general estimating equations. Discrimination and calibration were assessed using receiver operating characteristic curve analysis and correlation plots. Two final models were derived. Model A included age (<60, 60-69, 70-79, 80-89, and ≥90 years), National Institutes of Health Stroke Severity Score (NIHSS) on admission, presence of atrial fibrillation on admission, and stroke type (ischemic versus primary intracerebral hemorrhage). Model B was similar but included only the consciousness component of the NIHSS in place of the full NIHSS. Both models showed excellent discrimination and calibration in internal and external validation. The c-statistics in external validation were 0.87 (95% confidence interval, 0.84-0.89) and 0.86 (95% confidence interval, 0.83-0.89) for models A and B, respectively. We have derived and externally validated 2 models to predict mortality in unselected patients with acute stroke using commonly collected clinical variables. In settings where the ability to record the full NIHSS on admission is limited, the level of consciousness component of the NIHSS provides a good approximation of the full NIHSS for mortality prediction. © 2014 American Heart Association, Inc.

  1. External validation of a decision tree early warning score using only laboratory data

    DEFF Research Database (Denmark)

    Holm Atkins, Tara E; Öhman, Malin C; Brabrand, Mikkel

    2018-01-01

    INTRODUCTION: Early warning scores (EWS) have been developed to identify the degree of illness severity among acutely ill patients. One system, The Laboratory Decision Tree Early Warning Score (LDT-EWS) is wholly laboratory data based. Laboratory data was used in the development of a rare...... computerized method, developing a decision tree analysis. This article externally validates LDT-EWS, which is obligatory for an EWS before clinical use. METHOD: We conducted a retrospective review of prospectively collected data based on a time limited sample of all patients admitted through the medical......) and calibration (precision) as Hosmer-Lemeshow Goodness of fit test. RESULTS: A total of 5858 patients were admitted and 4902 included (83.7%). In-hospital mortality in our final dataset (n=4902) was 3.5%. Discriminatory power (95% CI), identifying in-hospital death was 0.809 (0.777-0.842). Calibration was good...

  2. External validation of the Society of Thoracic Surgeons General Thoracic Surgery Database.

    Science.gov (United States)

    Magee, Mitchell J; Wright, Cameron D; McDonald, Donna; Fernandez, Felix G; Kozower, Benjamin D

    2013-11-01

    The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) reports outstanding results for lung and esophageal cancer resection. However, a major weakness of the GTSD has been the lack of validation of this voluntary registry. The purpose of this study was to perform an external, independent audit to assess the accuracy of the data collection process and the quality of the database. An independent firm was contracted to audit 5% of sites randomly selected from the GTDB in 2011. Audits were performed remotely to maximize the number of audits performed and reduce cost. Auditors compared lobectomy cases submitted to the GTSD with the hospital operative logs to evaluate completeness of the data. In addition, 20 lobectomy records from each site were audited in detail. Agreement rates were calculated for 32 individual data elements, 7 data categories pertaining to patient status or care delivery, and an overall agreement rate for each site. Six process variables were also evaluated to assess best practice for data collection and submission. Ten sites were audited from the 222 participants. Comparison of the 559 submitted lobectomy cases with operative logs from each site identified 28 omissions, a 94.6% agreement rate (discrepancies/site range, 2 to 27). Importantly, cases not submitted had no mortality or major morbidity, indicating a lack of purposeful omission. The aggregate agreement rates for all categories were greater than 90%. The overall data accuracy was 94.9%. External audits of the GTSD validate the accuracy and completeness of the data. Careful examination of unreported cases demonstrated no purposeful omission or gaming. Although these preliminary results are quite good, it is imperative that the audit process is refined and continues to expand along with the GTSD to insure reliability of the database. The audit results are currently being incorporated into educational and quality improvement processes to add further value. Copyright

  3. External validation of the MRI-DRAGON score: early prediction of stroke outcome after intravenous thrombolysis.

    Science.gov (United States)

    Turc, Guillaume; Aguettaz, Pierre; Ponchelle-Dequatre, Nelly; Hénon, Hilde; Naggara, Olivier; Leclerc, Xavier; Cordonnier, Charlotte; Leys, Didier; Mas, Jean-Louis; Oppenheim, Catherine

    2014-01-01

    The aim of our study was to validate in an independent cohort the MRI-DRAGON score, an adaptation of the (CT-) DRAGON score to predict 3-month outcome in acute ischemic stroke patients undergoing MRI before intravenous thrombolysis (IV-tPA). We reviewed consecutive (2009-2013) anterior circulation stroke patients treated within 4.5 hours by IV-tPA in the Lille stroke unit (France), where MRI is the first-line pretherapeutic work-up. We assessed the discrimination and calibration of the MRI-DRAGON score to predict poor 3-month outcome, defined as modified Rankin Score >2, using c-statistic and the Hosmer-Lemeshow test, respectively. We included 230 patients (mean ±SD age 70.4±16.0 years, median [IQR] baseline NIHSS 8 [5]-[14]; poor outcome in 78(34%) patients). The c-statistic was 0.81 (95%CI 0.75-0.87), and the Hosmer-Lemeshow test was not significant (p = 0.54). The MRI-DRAGON score showed good prognostic performance in the external validation cohort. It could therefore be used to inform the patient's relatives about long-term prognosis and help to identify poor responders to IV-tPA alone, who may be candidates for additional therapeutic strategies, if they are otherwise eligible for such procedures based on the institutional criteria.

  4. External validation of the MRI-DRAGON score: early prediction of stroke outcome after intravenous thrombolysis.

    Directory of Open Access Journals (Sweden)

    Guillaume Turc

    Full Text Available The aim of our study was to validate in an independent cohort the MRI-DRAGON score, an adaptation of the (CT- DRAGON score to predict 3-month outcome in acute ischemic stroke patients undergoing MRI before intravenous thrombolysis (IV-tPA.We reviewed consecutive (2009-2013 anterior circulation stroke patients treated within 4.5 hours by IV-tPA in the Lille stroke unit (France, where MRI is the first-line pretherapeutic work-up. We assessed the discrimination and calibration of the MRI-DRAGON score to predict poor 3-month outcome, defined as modified Rankin Score >2, using c-statistic and the Hosmer-Lemeshow test, respectively.We included 230 patients (mean ±SD age 70.4±16.0 years, median [IQR] baseline NIHSS 8 [5]-[14]; poor outcome in 78(34% patients. The c-statistic was 0.81 (95%CI 0.75-0.87, and the Hosmer-Lemeshow test was not significant (p = 0.54.The MRI-DRAGON score showed good prognostic performance in the external validation cohort. It could therefore be used to inform the patient's relatives about long-term prognosis and help to identify poor responders to IV-tPA alone, who may be candidates for additional therapeutic strategies, if they are otherwise eligible for such procedures based on the institutional criteria.

  5. Evidence Based Validation of Indian Traditional Medicine – Way Forward

    Directory of Open Access Journals (Sweden)

    Pulok K Mukherjee

    2016-01-01

    Full Text Available Evidence based validation of the ethno-pharmacological claims on traditional medicine (TM is the need of the day for its globalization and reinforcement. Combining the unique features of identifying biomarkers that are highly conserved across species, this can offer an innovative approach to biomarker-driven drug discovery and development. TMs are an integral component of alternative health care systems. India has a rich wealth of TMs and the potential to accept the challenge to meet the global demand for them. Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH medicine are the major healthcare systems in Indian Traditional Medicine. The plant species mentioned in the ancient texts of these systems may be explored with the modern scientific approaches for better leads in the healthcare. TM is the best sources of chemical diversity for finding new drugs and leads. Authentication and scientific validation of medicinal plant is a fundamental requirement of industry and other organizations dealing with herbal drugs. Quality control (QC of botanicals, validated processes of manufacturing, customer awareness and post marketing surveillance are the key points, which could ensure the quality, safety and efficacy of TM. For globalization of TM, there is a need for harmonization with respect to its chemical and metabolite profiling, standardization, QC, scientific validation, documentation and regulatory aspects of TM. Therefore, the utmost attention is necessary for the promotion and development of TM through global collaboration and co-ordination by national and international programme.

  6. Firms' contribution to the internal and external employability of older employees: evidence from Germany.

    Science.gov (United States)

    Tisch, Anita

    2015-03-01

    In the examination of older employees' employability, one can distinguish between internal and external employability. Internal employability can be measured by individual employment stability, and external employability occurs when employees replace one employment relationship with another. Most studies focus on the personal skills and characteristics that are necessary to maintain employability. However, external factors also contribute to individual employability. Therefore, this study examines which organisational attributes of firms contribute to older employees' employability in Germany. Taking firm and individual characteristics into account, the results of discrete-time survival models show that in specific organisational structures, older employees have higher internal employability. Accordingly, older employees are more likely to maintain employment in the service sector and in recruiting organisations facing (skilled) labour shortages. However, the results also indicate that financially investing organisations facilitate early labour market exits. With regard to older employees' external employability, the results show only little evidence indicating an association between organisational attributes of firms and the likelihood of job change.

  7. 20 CFR 404.725 - Evidence of a valid ceremonial marriage.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Evidence of a valid ceremonial marriage. 404... DISABILITY INSURANCE (1950- ) Evidence Evidence of Age, Marriage, and Death § 404.725 Evidence of a valid ceremonial marriage. (a) General. A valid ceremonial marriage is one that follows procedures set by law in...

  8. The relationship between external and internal validity of randomized controlled trials: A sample of hypertension trials from China.

    Science.gov (United States)

    Zhang, Xin; Wu, Yuxia; Ren, Pengwei; Liu, Xueting; Kang, Deying

    2015-10-30

    To explore the relationship between the external validity and the internal validity of hypertension RCTs conducted in China. Comprehensive literature searches were performed in Medline, Embase, Cochrane Central Register of Controlled Trials (CCTR), CBMdisc (Chinese biomedical literature database), CNKI (China National Knowledge Infrastructure/China Academic Journals Full-text Database) and VIP (Chinese scientific journals database) as well as advanced search strategies were used to locate hypertension RCTs. The risk of bias in RCTs was assessed by a modified scale, Jadad scale respectively, and then studies with 3 or more grading scores were included for the purpose of evaluating of external validity. A data extract form including 4 domains and 25 items was used to explore relationship of the external validity and the internal validity. Statistic analyses were performed by using SPSS software, version 21.0 (SPSS, Chicago, IL). 226 hypertension RCTs were included for final analysis. RCTs conducted in university affiliated hospitals (P internal validity. Multi-center studies (median = 4.0, IQR = 2.0) were scored higher internal validity score than single-center studies (median = 3.0, IQR = 1.0) (P internal validity (P = 0.004). Multivariate regression indicated sample size, industry-funding, quality of life (QOL) taken as measure and the university affiliated hospital as trial setting had statistical significance (P external validity of RCTs do associate with the internal validity, that do not stand in an easy relationship to each other. Regarding the poor reporting, other possible links between two variables need to trace in the future methodological researches.

  9. Serum Gamma-Glutamyl-Transferase Independently Predicts Outcome After Transarterial Chemoembolization of Hepatocellular Carcinoma: External Validation

    Energy Technology Data Exchange (ETDEWEB)

    Guiu, Boris, E-mail: boris.guiu@chu-dijon.fr; Deschamps, Frederic [Institut Gustave Roussy, Department of Interventional Radiology (France); Boulin, Mathieu [University Hospital, INSERM U866 (France); Boige, Valerie; Malka, David; Ducreux, Michel [Institut Gustave Roussy, Department of Digestive Oncology (France); Hillon, Patrick [University Hospital, INSERM U866 (France); Baere, Thierry de [Institut Gustave Roussy, Department of Interventional Radiology (France)

    2012-10-15

    Purpose: An Asian study showed that gamma glutamyl transpeptidase (GGT) can predict survival after transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). This study was designed to validate in a European population this biomarker as an independent predictor of outcome after TACE of HCC and to determine a threshold value for clinical use. Methods: In 88 consecutive patients treated by TACE for HCC, the optimal threshold for GGT serum level was determined by a ROC analysis. Endpoints were time-to-treatment failure (TTTF) and overall survival (OS). All multivariate models were internally validated using bootstrapping (90 replications). Results: Median follow-up lasted 373 days, and median overall survival was 748 days. The optimal threshold for GGT was 165 U/L (sensitivity: 89.3%; specificity: 56.7%; area under the ROC curve: 0.7515). Median TTTF was shorter when GGT was {>=}165 U/L (281 days vs. 850 days; P < 0.001). GGT {>=}165 U/L (hazard ratio (HR) = 2.06; P = 0.02), WHO PS of 2 (HR = 5.4; P = 0.002), and tumor size (HR = 1.12; P = 0.014) were independently associated with shorter TTTF. Median OS was shorter when GGT was {>=}165 U/L (508 days vs. not reached; P < 0.001). GGT {>=} 165 U/L (HR = 3.05; P = 0.029), WHO PS of 2 (HR = 12.95; P < 0.001), alfa-fetoprotein (HR = 2.9; P = 0.01), and tumor size (HR = 1.096; P = 0.013) were independently associated with shorter OS. The results were confirmed by bootstrapping. Conclusions: Our results provide in a European population the external validation of GGT as an independent predictor of outcome after TACE of HCC. A serum level of GGT {>=} 165 U/L is independently associated with both shorter TTTF and OS.

  10. Serum Gamma-Glutamyl-Transferase Independently Predicts Outcome After Transarterial Chemoembolization of Hepatocellular Carcinoma: External Validation

    International Nuclear Information System (INIS)

    Guiu, Boris; Deschamps, Frédéric; Boulin, Mathieu; Boige, Valérie; Malka, David; Ducreux, Michel; Hillon, Patrick; Baère, Thierry de

    2012-01-01

    Purpose: An Asian study showed that gamma glutamyl transpeptidase (GGT) can predict survival after transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). This study was designed to validate in a European population this biomarker as an independent predictor of outcome after TACE of HCC and to determine a threshold value for clinical use. Methods: In 88 consecutive patients treated by TACE for HCC, the optimal threshold for GGT serum level was determined by a ROC analysis. Endpoints were time-to-treatment failure (TTTF) and overall survival (OS). All multivariate models were internally validated using bootstrapping (90 replications). Results: Median follow-up lasted 373 days, and median overall survival was 748 days. The optimal threshold for GGT was 165 U/L (sensitivity: 89.3%; specificity: 56.7%; area under the ROC curve: 0.7515). Median TTTF was shorter when GGT was ≥165 U/L (281 days vs. 850 days; P < 0.001). GGT ≥165 U/L (hazard ratio (HR) = 2.06; P = 0.02), WHO PS of 2 (HR = 5.4; P = 0.002), and tumor size (HR = 1.12; P = 0.014) were independently associated with shorter TTTF. Median OS was shorter when GGT was ≥165 U/L (508 days vs. not reached; P < 0.001). GGT ≥ 165 U/L (HR = 3.05; P = 0.029), WHO PS of 2 (HR = 12.95; P < 0.001), alfa-fetoprotein (HR = 2.9; P = 0.01), and tumor size (HR = 1.096; P = 0.013) were independently associated with shorter OS. The results were confirmed by bootstrapping. Conclusions: Our results provide in a European population the external validation of GGT as an independent predictor of outcome after TACE of HCC. A serum level of GGT ≥ 165 U/L is independently associated with both shorter TTTF and OS.

  11. Prevalence of diabetes treatment effect modifiers: the external validity of trials to older adults.

    Science.gov (United States)

    Weiss, Carlos O; Boyd, Cynthia M; Wolff, Jennifer L; Leff, Bruce

    2012-08-01

    Potential treatment effect modifiers (TEMs) are specific diseases or conditions with a well-described mechanism for treatment effect modification. The prevalence of TEMs in older adults with type 2 diabetes mellitus (DM) is unknown. Objectives were to 1) determine the prevalence of pre-specified potential TEMs; 2) demonstrate the potential impact of TEMs in the older adult population using a simulated trial; 3) identify TEM combinations associated with number of hospitalizations to test construct validity. Data are from the nationally-representative United States National Health and Examination Survey, 1999-2004: 8646 Civilian, non-institutionalized adults aged 45-64 or 65+ years, including 1443 with DM. TEMs were anemia, congestive heart failure, liver inflammation, polypharmacy, renal insufficiency, cognitive impairment, dizziness, frequent mental distress, mobility difficulty, and visual impairment. A trial was simulated to examine prevalence of potential TEM impact. The cross-sectional association between TEM patterns and number of hospitalizations was estimated to assess construct validity. The prevalence of TEMs was substantial such that 19.0% (95% CI 14.8-23.2) of middle-aged adults and 38.0% (95% CI 33.4-42.5) of older adults had any two. A simulated trial with modest levels of interaction suggested the prevalence of TEMs could nullify treatment benefit in 3.9-27.2% of older adults with DM. Compared to having DM alone, hospitalization rate was increased by several combinations of TEMs with substantial prevalence. We provide national benchmarks that can be used to evaluate TEM prevalence reported by clinical trials of DM, and correspondingly their external validity to older adults.

  12. Predicting the success of IVF: external validation of the van Loendersloot's model.

    Science.gov (United States)

    Sarais, Veronica; Reschini, Marco; Busnelli, Andrea; Biancardi, Rossella; Paffoni, Alessio; Somigliana, Edgardo

    2016-06-01

    Is the predictive model for IVF success proposed by van Loendersloot et al. valid in a different geographical and cultural context? The model discriminates well but was less accurate than in the original context where it was developed. Several independent groups have developed models that combine different variables with the aim of estimating the chance of pregnancy with IVF but only four of them have been externally validated. One of these four, the van Loendersloot's model, deserves particular attention and further investigation for at least three reasons; (i) the reported area under the receiver operating characteristics curve (c-statistics) in the temporal validation setting was the highest reported to date (0.68), (ii) the perspective of the model is clinically wise since it includes variables obtained from previous failed cycles, if any, so it can be applied to any women entering an IVF cycle, (iii) the model lacks external validation in a geographically different center. Retrospective cohort study of women undergoing oocyte retrieval for IVF between January 2013 and December 2013 at the infertility unit of the Fondazione Ca' Granda, Ospedale Maggiore Policlinico of Milan, Italy. Only the first oocyte retrieval cycle performed during the study period was included in the study. Women with previous IVF cycles were excluded if the last one before the study cycle was in another center. The main outcome was the cumulative live birth rate per oocytes retrieval. Seven hundred seventy-two women were selected. Variables included in the van Loendersloot's model and the relative weights (beta) were used. The variable resulting from this combination (Y) was transformed into a probability. The discriminatory capacity was assessed using the c-statistics. Calibration was made using a logistic regression that included Y as the unique variable and live birth as the outcome. Data are presented using both the original and the calibrated models. Performance was evaluated

  13. Development and validation of the ExPRESS instrument for primary health care providers' evaluation of external supervision.

    Science.gov (United States)

    Schriver, Michael; Cubaka, Vincent Kalumire; Vedsted, Peter; Besigye, Innocent; Kallestrup, Per

    2018-01-01

    External supervision of primary health care facilities to monitor and improve services is common in low-income countries. Currently there are no tools to measure the quality of support in external supervision in these countries. To develop a provider-reported instrument to assess the support delivered through external supervision in Rwanda and other countries. "External supervision: Provider Evaluation of Supervisor Support" (ExPRESS) was developed in 18 steps, primarily in Rwanda. Content validity was optimised using systematic search for related instruments, interviews, translations, and relevance assessments by international supervision experts as well as local experts in Nigeria, Kenya, Uganda and Rwanda. Construct validity and reliability were examined in two separate field tests, the first using exploratory factor analysis and a test-retest design, the second for confirmatory factor analysis. We included 16 items in section A ('The most recent experience with an external supervisor'), and 13 items in section B ('The overall experience with external supervisors'). Item-content validity index was acceptable. In field test I, test-retest had acceptable kappa values and exploratory factor analysis suggested relevant factors in sections A and B used for model hypotheses. In field test II, models were tested by confirmatory factor analysis fitting a 4-factor model for section A, and a 3-factor model for section B. ExPRESS is a promising tool for evaluation of the quality of support of primary health care providers in external supervision of primary health care facilities in resource-constrained settings. ExPRESS may be used as specific feedback to external supervisors to help identify and address gaps in the supervision they provide. Further studies should determine optimal interpretation of scores and the number of respondents needed per supervisor to obtain precise results, as well as test the functionality of section B.

  14. Can Findings from Randomized Controlled Trials of Social Skills Training in Autism Spectrum Disorder Be Generalized? The Neglected Dimension of External Validity

    Science.gov (United States)

    Jonsson, Ulf; Olsson, Nora Choque; Bölte, Sven

    2016-01-01

    Systematic reviews have traditionally focused on internal validity, while external validity often has been overlooked. In this study, we systematically reviewed determinants of external validity in the accumulated randomized controlled trials of social skills group interventions for children and adolescents with autism spectrum disorder. We…

  15. Clinical endpoint adjudication in a contemporary all-comers coronary stent investigation: methodology and external validation.

    Science.gov (United States)

    Vranckx, Pascal; McFadden, Eugene; Cutlip, Donald E; Mehran, Roxana; Swart, Michael; Kint, P P; Zijlstra, Felix; Silber, Sigmund; Windecker, Stephan; Serruys, Patrick W C J

    2013-01-01

    Globalisation in coronary stent research calls for harmonization of clinical endpoint definitions and event adjudication. Little has been published about the various processes used for event adjudication or their impact on outcome reporting. We performed a validation of the clinical event committee (CEC) adjudication process on 100 suspected events in the RESOLUTE All-comers trial (Resolute-AC). Two experienced Clinical Research Organisations (CRO) that had already extensive internal validation processes in place, participated in the study. After initial adjudication by the primary-CEC, events were cross-adjudicated by an external-CEC using the same definitions. Major discrepancies affecting the primary end point of target-lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction (TV-MI), or clinically-indicated target-lesion revascularization (CI-TLR), were analysed by an independent oversight committee who provided recommendations for harmonization. Discordant adjudications were reconsidered by the primary CEC. Subsequently, the RAC database was interrogated for cases that based on these recommendations merited re-adjudication and these cases were also re-adjudicated by the primary CEC. Final discrepancies in adjudication of individual components of TLF occurred in 7 out of 100 events in 5 patients. Discrepancies for the (hierarchical) primary endpoint occurred in 5 events (2 cardiac deaths and 3 TV-MI). After application of harmonization recommendations to the overall RAC population (n=2292), the primary CEC adjudicated 3 additional clinical-TLRs and considered 1 TV-MI as no event. A harmonization process provided a high level of concordance for event adjudication and improved accuracy for final event reporting. These findings suggest it is feasible to pool clinical event outcome data across clinical trials even when different CECs are responsible for event adjudication. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Multicentre external validation of the BIMC model for solid solitary pulmonary nodule malignancy prediction

    Energy Technology Data Exchange (ETDEWEB)

    Soardi, Gian Alberto; Perandini, Simone; Motton, Massimiliano; Montemezzi, Stefania [AOUI Verona, UOC Radiologia, Ospedale Maggiore di Borgo Trento, Verona (Italy); Larici, Anna Rita; Del Ciello, Annemilia [Universita Cattolica del Sacro Cuore, Dipartimento di Scienze Radiologiche, Roma (Italy); Rizzardi, Giovanna [UO Chirurgia Toracica, Ospedale Humanitas Gavazzeni, Bergamo (Italy); Solazzo, Antonio [UO Radiologia, Ospedale Humanitas Gavazzeni, Bergamo (Italy); Mancino, Laura [UO Pneumologia, Ospedale dell' Angelo di Mestre, Mestre (Italy); Bernhart, Marco [UO Radiologia, Ospedale dell' Angelo di Mestre, Mestre (Italy)

    2017-05-15

    To provide multicentre external validation of the Bayesian Inference Malignancy Calculator (BIMC) model by assessing diagnostic accuracy in a cohort of solitary pulmonary nodules (SPNs) collected in a clinic-based setting. To assess model impact on SPN decision analysis and to compare findings with those obtained via the Mayo Clinic model. Clinical and imaging data were retrospectively collected from 200 patients from three centres. Accuracy was assessed by means of receiver-operating characteristic (ROC) areas under the curve (AUCs). Decision analysis was performed by adopting both the American College of Chest Physicians (ACCP) and the British Thoracic Society (BTS) risk thresholds. ROC analysis showed an AUC of 0.880 (95 % CI, 0.832-0.928) for the BIMC model and of 0.604 (95 % CI, 0.524-0.683) for the Mayo Clinic model. Difference was 0.276 (95 % CI, 0.190-0.363, P < 0.0001). Decision analysis showed a slightly reduced number of false-negative and false-positive results when using ACCP risk thresholds. The BIMC model proved to be an accurate tool when characterising SPNs. In a clinical setting it can distinguish malignancies from benign nodules with minimal errors by adopting current ACCP or BTS risk thresholds and guiding lesion-tailored diagnostic and interventional procedures during the work-up. (orig.)

  17. An External Independent Validation of APACHE IV in a Malaysian Intensive Care Unit.

    Science.gov (United States)

    Wong, Rowena S Y; Ismail, Noor Azina; Tan, Cheng Cheng

    2015-04-01

    Intensive care unit (ICU) prognostic models are predominantly used in more developed nations such as the United States, Europe and Australia. These are not that popular in Southeast Asian countries due to costs and technology considerations. The purpose of this study is to evaluate the suitability of the acute physiology and chronic health evaluation (APACHE) IV model in a single centre Malaysian ICU. A prospective study was conducted at the single centre ICU in Hospital Sultanah Aminah (HSA) Malaysia. External validation of APACHE IV involved a cohort of 916 patients who were admitted in 2009. Model performance was assessed through its calibration and discrimination abilities. A first-level customisation using logistic regression approach was also applied to improve model calibration. APACHE IV exhibited good discrimination, with an area under receiver operating characteristic (ROC) curve of 0.78. However, the model's overall fit was observed to be poor, as indicated by the Hosmer-Lemeshow goodness-of-fit test (Ĉ = 113, P discrimination was not affected. APACHE IV is not suitable for application in HSA ICU, without further customisation. The model's lack of fit in the Malaysian study is attributed to differences in the baseline characteristics between HSA ICU and APACHE IV datasets. Other possible factors could be due to differences in clinical practice, quality and services of health care systems between Malaysia and the United States.

  18. External validity of sentiment mining reports: Can current methods identify demographic biases, event biases, and manipulation of reviews?

    NARCIS (Netherlands)

    Wijnhoven, Alphonsus B.J.M.; Bloemen, Oscar

    2014-01-01

    Many publications in sentiment mining provide new techniques for improved accuracy in extracting features and corresponding sentiments in texts. For the external validity of these sentiment reports, i.e., the applicability of the results to target audiences, it is important to well analyze data of

  19. A Psychometric Validation of the Internal and External Motivation to Respond without Prejudice toward People with Disabilities Scale

    Science.gov (United States)

    Pruett, Steven R.; Deiches, Jon; Pfaller, Joseph; Moser, Erin; Chan, Fong

    2014-01-01

    Objective: To determine the factorial validity of the Internal and External Motivation to Respond without Prejudice toward People with Disabilities Scale (D-IMS/EMS). Design: A quantitative descriptive design using factor analysis. Participants: 233 rehabilitation counseling and rehabilitation services students. Results: Both exploratory and…

  20. Process evaluation to explore internal and external validity of the "Act in Case of Depression" care program in nursing homes.

    Science.gov (United States)

    Leontjevas, Ruslan; Gerritsen, Debby L; Koopmans, Raymond T C M; Smalbrugge, Martin; Vernooij-Dassen, Myrra J F J

    2012-06-01

    A multidisciplinary, evidence-based care program to improve the management of depression in nursing home residents was implemented and tested using a stepped-wedge design in 23 nursing homes (NHs): "Act in case of Depression" (AiD). Before effect analyses, to evaluate AiD process data on sampling quality (recruitment and randomization, reach) and intervention quality (relevance and feasibility, extent to which AiD was performed), which can be used for understanding internal and external validity. In this article, a model is presented that divides process evaluation data into first- and second-order process data. Qualitative and quantitative data based on personal files of residents, interviews of nursing home professionals, and a research database were analyzed according to the following process evaluation components: sampling quality and intervention quality. Nursing home. The pattern of residents' informed consent rates differed for dementia special care units and somatic units during the study. The nursing home staff was satisfied with the AiD program and reported that the program was feasible and relevant. With the exception of the first screening step (nursing staff members using a short observer-based depression scale), AiD components were not performed fully by NH staff as prescribed in the AiD protocol. Although NH staff found the program relevant and feasible and was satisfied with the program content, individual AiD components may have different feasibility. The results on sampling quality implied that statistical analyses of AiD effectiveness should account for the type of unit, whereas the findings on intervention quality implied that, next to the type of unit, analyses should account for the extent to which individual AiD program components were performed. In general, our first-order process data evaluation confirmed internal and external validity of the AiD trial, and this evaluation enabled further statistical fine tuning. The importance of

  1. External validation of a normal tissue complication probability model for radiation-induced hypothyroidism in an independent cohort

    DEFF Research Database (Denmark)

    Rønjom, Marianne F; Brink, Carsten; Bentzen, Søren M

    2015-01-01

    blood tests in the validation cohort relative to the original cohort. However, Pearson's correlation coefficients between model and clinical outcome were high: r = 0.97 estimated by the original model versus the original cohort, and r = 0.97 estimated by the original model versus the new cohort....... CONCLUSION: Dmean and Vthyroid were significant predictors of RIHT in both cohorts. The original NTCP model demonstrated external validity owing to high Pearson's correlation coefficients between estimated and observed incidence rates of RIHT in the original as well as in the validation cohort. This model...

  2. External validation of scoring systems in risk stratification of upper gastrointestinal bleeding.

    Science.gov (United States)

    Anchu, Anna Cherian; Mohsina, Subair; Sureshkumar, Sathasivam; Mahalakshmy, T; Kate, Vikram

    2017-03-01

    The aim of this study was to externally validate the four commonly used scoring systems in the risk stratification of patients with upper gastrointestinal bleed (UGIB). Patients of UGIB who underwent endoscopy within 24 h of presentation were stratified prospectively using the pre-endoscopy Rockall score (PRS) >0, complete Rockall score (CRS) >2, Glasgow Blatchford bleeding scores (GBS) >3, and modified GBS (m-GBS) >3 scores. Patients were followed up to 30 days. Prognostic accuracy of the scores was done by comparing areas under curve (AUC) in terms of overall risk stratification, re-bleeding, mortality, need for intervention, and length of hospitalization. One hundred and seventy-five patients were studied. All four scores performed better in the overall risk stratification on AUC [PRS = 0.566 (CI: 0.481-0.651; p-0.043)/CRS = 0.712 (CI: 0.634-0.790); p0.001); m-GBS = 0.802 (CI: 0.734-0.871; pbleed [AUC-0.679 (CI: 0.579-0.780; p = 0.003)]. All the scoring systems except PRS were found to be significantly better in detecting 30-day mortality with a high AUC (CRS = 0.798; p-0.042)/GBS = 0.833; p-0.023); m-GBS = 0.816; p-0.031). All four scores demonstrated significant accuracy in the risk stratification of non-variceal patients; however, only GBS and m-GBS were significant in variceal etiology. Higher cutoff scores achieved better sensitivity/specificity [RS > 0 (50/60.8), CRS > 1 (87.5/50.6), GBS > 7 (88.5/63.3), m-GBS > 7(82.3/72.6)] in the risk stratification. GBS and m-GBS appear to be more valid in risk stratification of UGIB patients in this region. Higher cutoff values achieved better predictive accuracy.

  3. Characteristics of a multisensor system for non invasive glucose monitoring with external validation and prospective evaluation.

    Science.gov (United States)

    Caduff, Andreas; Mueller, Martin; Megej, Alexander; Dewarrat, Francois; Suri, Roland E; Klisic, Jelena; Donath, Marc; Zakharov, Pavel; Schaub, Dominik; Stahel, Werner A; Talary, Mark S

    2011-05-15

    The Multisensor Glucose Monitoring System (MGMS) features non invasive sensors for dielectric characterisation of the skin and underlying tissue in a wide frequency range (1 kHz-100 MHz, 1 and 2 GHz) as well as optical characterisation. In this paper we describe the results of using an MGMS in a miniaturised housing with fully integrated sensors and battery. Six patients with Type I Diabetes Mellitus (age 44±16 y; BMI 24.1±1.3 kg/m(2), duration of diabetes 27±12 y; HbA1c 7.3±1.0%) wore a single Multisensor at the upper arm position and performed a total of 45 in-clinic study days with 7 study days per patient on average (min. 5 and max. 10). Glucose changes were induced either orally or by i.v. glucose administration and the blood glucose was measured routinely. Several prospective data evaluation routines were applied to evaluate the data. The results are shown using one of the restrictive data evaluation routines, where measurements from the first 22 study days were used to train a linear regression model. The global model was then prospectively applied to the data of the remaining 23 study days to allow for an external validation of glucose prediction. The model application yielded a Mean Absolute Relative Difference of 40.8%, a Mean Absolute Difference of 51.9 mg dL(-1), and a correlation of 0.84 on average per study day. The Clarke error grid analyses showed 89.0% in A+B, 4.5% in C, 4.6% in D and 1.9% in the E region. Prospective application of a global, purely statistical model, demonstrates that glucose variations can be tracked non invasively by the MGMS in most cases under these conditions. Copyright © 2011 Elsevier B.V. All rights reserved.

  4. European Randomized Study of Screening for Prostate Cancer Risk Calculator: External Validation, Variability, and Clinical Significance.

    Science.gov (United States)

    Gómez-Gómez, Enrique; Carrasco-Valiente, Julia; Blanca-Pedregosa, Ana; Barco-Sánchez, Beatriz; Fernandez-Rueda, Jose Luis; Molina-Abril, Helena; Valero-Rosa, Jose; Font-Ugalde, Pilar; Requena-Tapia, Maria José

    2017-04-01

    To externally validate the European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculator (RC) and to evaluate its variability between 2 consecutive prostate-specific antigen (PSA) values. We prospectively catalogued 1021 consecutive patients before prostate biopsy for suspicion of prostate cancer (PCa). The risk of PCa and significant PCa (Gleason score ≥7) from 749 patients was calculated according to ERSPC-RC (digital rectal examination-based version 3 of 4) for 2 consecutive PSA tests per patient. The calculators' predictions were analyzed using calibration plots and the area under the receiver operating characteristic curve (area under the curve). Cohen kappa coefficient was used to compare the ability and variability. Of 749 patients, PCa was detected in 251 (33.5%) and significant PCa was detected in 133 (17.8%). Calibration plots showed an acceptable parallelism and similar discrimination ability for both PSA levels with an area under the curve of 0.69 for PCa and 0.74 for significant PCa. The ERSPC showed 226 (30.2%) unnecessary biopsies with the loss of 10 significant PCa. The variability of the RC was 16% for PCa and 20% for significant PCa, and a higher variability was associated with a reduced risk of significant PCa. We can conclude that the performance of the ERSPC-RC in the present cohort shows a high similitude between the 2 PSA levels; however, the RC variability value is associated with a decreased risk of significant PCa. The use of the ERSPC in our cohort detects a high number of unnecessary biopsies. Thus, the incorporation of ERSPC-RC could help the clinical decision to carry out a prostate biopsy. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. External validity of randomized controlled trials of glycaemic control and vascular disease: how representative are participants?

    Science.gov (United States)

    Saunders, C; Byrne, C D; Guthrie, B; Lindsay, R S; McKnight, J A; Philip, S; Sattar, N; Walker, J J; Wild, S H

    2013-03-01

    To describe the proportion of people with Type 2 diabetes living in Scotland who meet eligibility criteria for inclusion in several large randomized controlled trials of glycaemic control to inform physicians and guideline developers about the generalizibility of trial results. A literature review was performed to identify large trials assessing the impact of glycaemic control on risk of macrovascular disease. Inclusion and exclusion criteria from each trial were applied to data on the population of people with a diagnosis of Type 2 diabetes living in Scotland in 2008 (n = 180,590) in a population-based cross-sectional study and the number and proportion of people eligible for each trial was determined. Seven trials were identified. The proportion of people with Type 2 diabetes who met the eligibility criteria for the trials ranged from 3.5 to 50.7%. Trial participants were younger at age of diagnosis of diabetes and at time of trial recruitment than in the Scottish study population. The application of upper age criteria excluded the largest proportion of patients, with up to 39% of people with Type 2 diabetes ineligible for a trial with the most stringent criteria based on age alone. We found that many of the large trials of glycaemic control among people with Type 2 diabetes have limited external validity when applied to a population-based cohort of people with Type 2 diabetes. In particular, the age distribution of trial participants often does not reflect that of people with Type 2 diabetes in a contemporary British population. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

  6. External validity of randomized controlled trials in older adults, a systematic review.

    Directory of Open Access Journals (Sweden)

    Floor J van Deudekom

    Full Text Available To critically assess the external validity of randomized controlled trials (RCTs it is important to know what older adults have been enrolled in the trials. The aim of this systematic review is to study what proportion of trials specifically designed for older patients report on somatic status, physical and mental functioning, social environment and frailty in the patient characteristics.PubMed was searched for articles published in 2012 and only RCTs were included. Articles were further excluded if not conducted with humans or only secondary analyses were reported. A random sample of 10% was drawn. The current review analyzed this random sample and further selected trials when the reported mean age was ≥ 60 years. We extracted geriatric assessments from the population descriptives or the in- and exclusion criteria.In total 1396 trials were analyzed and 300 trials included. The median of the reported mean age was 66 (IQR 63-70 and the median percentage of men in the trials was 60 (IQR 45-72. In 34% of the RCTs specifically designed for older patients somatic status, physical and mental functioning, social environment or frailty were reported in the population descriptives or the in- and exclusion criteria. Physical and mental functioning was reported most frequently (22% and 14%. When selecting RCTs on a mean age of 70 or 80 years the report of geriatric assessments in the patient characteristics was 46% and 85% respectively but represent only 5% and 1% of the trials.Somatic status, physical and mental functioning, social environment and frailty are underreported even in RCTs specifically designed for older patients published in 2012. Therefore, it is unclear for clinicians to which older patients the results can be applied. We recommend systematic to transparently report these relevant characteristics of older participants included in RCTs.

  7. External validation of prognostic models to predict risk of gestational diabetes mellitus in one Dutch cohort: prospective multicentre cohort study.

    NARCIS (Netherlands)

    Lamain-de Ruiter, M.; Kwee, A.; Naaktgeboren, C.A.; Groot, I. de; Evers, I.M.; Groenendaal, F.; Hering, Y.R.; Huisjes, A.J.M.; Kirpestein, C.; Monincx, W.M.; Siljee, J.E.; Zelfde, A. van't; Oirschot, C.M. van; Vankan-Buitelaar, S.A.; Vonk, M.A.A.W.; Wiegers, T.A.; Zwart, J.J.; Franx, A.; Moons, K.G.M.; Koster, M.P.H.

    2016-01-01

    Objective: To perform an external validation and direct comparison of published prognostic models for early prediction of the risk of gestational diabetes mellitus, including predictors applicable in the first trimester of pregnancy. Design: External validation of all published prognostic models in

  8. Assessing the external validity of model-based estimates of the incidence of heart attack in England: a modelling study

    Directory of Open Access Journals (Sweden)

    Peter Scarborough

    2016-11-01

    Full Text Available Abstract Background The DisMod II model is designed to estimate epidemiological parameters on diseases where measured data are incomplete and has been used to provide estimates of disease incidence for the Global Burden of Disease study. We assessed the external validity of the DisMod II model by comparing modelled estimates of the incidence of first acute myocardial infarction (AMI in England in 2010 with estimates derived from a linked dataset of hospital records and death certificates. Methods Inputs for DisMod II were prevalence rates of ever having had an AMI taken from a population health survey, total mortality rates and AMI mortality rates taken from death certificates. By definition, remission rates were zero. We estimated first AMI incidence in an external dataset from England in 2010 using a linked dataset including all hospital admissions and death certificates since 1998. 95 % confidence intervals were derived around estimates from the external dataset and DisMod II estimates based on sampling variance and reported uncertainty in prevalence estimates respectively. Results Estimates of the incidence rate for the whole population were higher in the DisMod II results than the external dataset (+54 % for men and +26 % for women. Age-specific results showed that the DisMod II results over-estimated incidence for all but the oldest age groups. Confidence intervals for the DisMod II and external dataset estimates did not overlap for most age groups. Conclusion By comparison with AMI incidence rates in England, DisMod II did not achieve external validity for age-specific incidence rates, but did provide global estimates of incidence that are of similar magnitude to measured estimates. The model should be used with caution when estimating age-specific incidence rates.

  9. Multiple Score Comparison: a network meta-analysis approach to comparison and external validation of prognostic scores

    Directory of Open Access Journals (Sweden)

    Sarah R. Haile

    2017-12-01

    Full Text Available Abstract Background Prediction models and prognostic scores have been increasingly popular in both clinical practice and clinical research settings, for example to aid in risk-based decision making or control for confounding. In many medical fields, a large number of prognostic scores are available, but practitioners may find it difficult to choose between them due to lack of external validation as well as lack of comparisons between them. Methods Borrowing methodology from network meta-analysis, we describe an approach to Multiple Score Comparison meta-analysis (MSC which permits concurrent external validation and comparisons of prognostic scores using individual patient data (IPD arising from a large-scale international collaboration. We describe the challenges in adapting network meta-analysis to the MSC setting, for instance the need to explicitly include correlations between the scores on a cohort level, and how to deal with many multi-score studies. We propose first using IPD to make cohort-level aggregate discrimination or calibration scores, comparing all to a common comparator. Then, standard network meta-analysis techniques can be applied, taking care to consider correlation structures in cohorts with multiple scores. Transitivity, consistency and heterogeneity are also examined. Results We provide a clinical application, comparing prognostic scores for 3-year mortality in patients with chronic obstructive pulmonary disease using data from a large-scale collaborative initiative. We focus on the discriminative properties of the prognostic scores. Our results show clear differences in performance, with ADO and eBODE showing higher discrimination with respect to mortality than other considered scores. The assumptions of transitivity and local and global consistency were not violated. Heterogeneity was small. Conclusions We applied a network meta-analytic methodology to externally validate and concurrently compare the prognostic properties

  10. External Validation Study of First Trimester Obstetric Prediction Models (Expect Study I): Research Protocol and Population Characteristics.

    Science.gov (United States)

    Meertens, Linda Jacqueline Elisabeth; Scheepers, Hubertina Cj; De Vries, Raymond G; Dirksen, Carmen D; Korstjens, Irene; Mulder, Antonius Lm; Nieuwenhuijze, Marianne J; Nijhuis, Jan G; Spaanderman, Marc Ea; Smits, Luc Jm

    2017-10-26

    A number of first-trimester prediction models addressing important obstetric outcomes have been published. However, most models have not been externally validated. External validation is essential before implementing a prediction model in clinical practice. The objective of this paper is to describe the design of a study to externally validate existing first trimester obstetric prediction models, based upon maternal characteristics and standard measurements (eg, blood pressure), for the risk of pre-eclampsia (PE), gestational diabetes mellitus (GDM), spontaneous preterm birth (PTB), small-for-gestational-age (SGA) infants, and large-for-gestational-age (LGA) infants among Dutch pregnant women (Expect Study I). The results of a pilot study on the feasibility and acceptability of the recruitment process and the comprehensibility of the Pregnancy Questionnaire 1 are also reported. A multicenter prospective cohort study was performed in The Netherlands between July 1, 2013 and December 31, 2015. First trimester obstetric prediction models were systematically selected from the literature. Predictor variables were measured by the Web-based Pregnancy Questionnaire 1 and pregnancy outcomes were established using the Postpartum Questionnaire 1 and medical records. Information about maternal health-related quality of life, costs, and satisfaction with Dutch obstetric care was collected from a subsample of women. A pilot study was carried out before the official start of inclusion. External validity of the models will be evaluated by assessing discrimination and calibration. Based on the pilot study, minor improvements were made to the recruitment process and online Pregnancy Questionnaire 1. The validation cohort consists of 2614 women. Data analysis of the external validation study is in progress. This study will offer insight into the generalizability of existing, non-invasive first trimester prediction models for various obstetric outcomes in a Dutch obstetric population

  11. Development and external validation of a risk-prediction model to predict 5-year overall survival in advanced larynx cancer.

    Science.gov (United States)

    Petersen, Japke F; Stuiver, Martijn M; Timmermans, Adriana J; Chen, Amy; Zhang, Hongzhen; O'Neill, James P; Deady, Sandra; Vander Poorten, Vincent; Meulemans, Jeroen; Wennerberg, Johan; Skroder, Carl; Day, Andrew T; Koch, Wayne; van den Brekel, Michiel W M

    2018-05-01

    TNM-classification inadequately estimates patient-specific overall survival (OS). We aimed to improve this by developing a risk-prediction model for patients with advanced larynx cancer. Cohort study. We developed a risk prediction model to estimate the 5-year OS rate based on a cohort of 3,442 patients with T3T4N0N+M0 larynx cancer. The model was internally validated using bootstrapping samples and externally validated on patient data from five external centers (n = 770). The main outcome was performance of the model as tested by discrimination, calibration, and the ability to distinguish risk groups based on tertiles from the derivation dataset. The model performance was compared to a model based on T and N classification only. We included age, gender, T and N classification, and subsite as prognostic variables in the standard model. After external validation, the standard model had a significantly better fit than a model based on T and N classification alone (C statistic, 0.59 vs. 0.55, P statistic to 0.68. A risk prediction model for patients with advanced larynx cancer, consisting of readily available clinical variables, gives more accurate estimations of the estimated 5-year survival rate when compared to a model based on T and N classification alone. 2c. Laryngoscope, 128:1140-1145, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  12. External Finance and the Foreign Direct Investment Decision: Evidence from Privately-Owned-Enterprises in China

    OpenAIRE

    Duanmu, J-L

    2015-01-01

    Access to external finance is found to be a statistically significant factor explaining the probability of privately owned enterprises (POEs) in China undertaking foreign direct investment (FDI). The significance of external finance is magnified in industries featuring a heavy dependence on external finance, high technology, low tangibility, and high inventory. The external finance and FDI linkage is weaker for POEs with group affiliation, but stronger for those with generous employment welfa...

  13. Predicting the 6-month risk of severe hypoglycemia among adults with diabetes: Development and external validation of a prediction model.

    Science.gov (United States)

    Schroeder, Emily B; Xu, Stan; Goodrich, Glenn K; Nichols, Gregory A; O'Connor, Patrick J; Steiner, John F

    2017-07-01

    To develop and externally validate a prediction model for the 6-month risk of a severe hypoglycemic event among individuals with pharmacologically treated diabetes. The development cohort consisted of 31,674 Kaiser Permanente Colorado members with pharmacologically treated diabetes (2007-2015). The validation cohorts consisted of 38,764 Kaiser Permanente Northwest members and 12,035 HealthPartners members. Variables were chosen that would be available in electronic health records. We developed 16-variable and 6-variable models, using a Cox counting model process that allows for the inclusion of multiple 6-month observation periods per person. Across the three cohorts, there were 850,992 6-month observation periods, and 10,448 periods with at least one severe hypoglycemic event. The six-variable model contained age, diabetes type, HgbA1c, eGFR, history of a hypoglycemic event in the prior year, and insulin use. Both prediction models performed well, with good calibration and c-statistics of 0.84 and 0.81 for the 16-variable and 6-variable models, respectively. In the external validation cohorts, the c-statistics were 0.80-0.84. We developed and validated two prediction models for predicting the 6-month risk of hypoglycemia. The 16-variable model had slightly better performance than the 6-variable model, but in some practice settings, use of the simpler model may be preferred. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Validation Evidence of the Motivation for Teaching Scale in Secondary Education.

    Science.gov (United States)

    Abós, Ángel; Sevil, Javier; Martín-Albo, José; Aibar, Alberto; García-González, Luis

    2018-04-10

    Grounded in self-determination theory, the aim of this study was to develop a scale with adequate psychometric properties to assess motivation for teaching and to explain some outcomes of secondary education teachers at work. The sample comprised 584 secondary education teachers. Analyses supported the five-factor model (intrinsic motivation, identified regulation, introjected regulation, external regulation and amotivation) and indicated the presence of a continuum of self-determination. Evidence of reliability was provided by Cronbach's alpha, composite reliability and average variance extracted. Multigroup confirmatory factor analyses supported the partial invariance (configural and metric) of the scale in different sub-samples, in terms of gender and type of school. Concurrent validity was analyzed by a structural equation modeling that explained 71% of the work dedication variance and 69% of the boredom at work variance. Work dedication was positively predicted by intrinsic motivation (ß = .56, p amotivation (ß = -.49, p amotivation (ß = .68, p < .001). The Motivation for Teaching Scale in Secondary Education (Spanish acronym EME-ES, Escala de Motivación por la Enseñanza en Educación Secundaria) is discussed as a valid and reliable instrument. This is the first specific scale in the work context of secondary teachers that has integrated the five-factor structure together with their dedication and boredom at work.

  15. Evidence-Based School Behavior Assessment of Externalizing Behavior in Young Children.

    Science.gov (United States)

    Bagner, Daniel M; Boggs, Stephen R; Eyberg, Sheila M

    2010-02-01

    This study examined the psychometric properties of the Revised Edition of the School Observation Coding System (REDSOCS). Participants were 68 children ages 3 to 6 who completed parent-child interaction therapy for Oppositional Defiant Disorder as part of a larger efficacy trial. Interobserver reliability on REDSOCS categories was moderate to high, with percent agreement ranging from 47% to 90% (M = 67%) and Cohen's kappa coefficients ranging from .69 to .95 (M = .82). Convergent validity of the REDSOCS categories was supported by significant correlations with the Intensity Scale of the Sutter-Eyberg Student Behavior Inventory-Revised and related subscales of the Conners' Teacher Rating Scale-Revised: Long Version (CTRS-R: L). Divergent validity was indicated by nonsignificant correlations between REDSOCS categories and scales on the CTRS-R: L expected not to relate to disruptive classroom behavior. Treatment sensitivity was demonstrated for two of the three primary REDSOCS categories by significant pre to posttreatment changes. This study provides psychometric support for the designation of REDSOCS as an evidence-based assessment procedure for young children.

  16. Clinical prediction models for bronchopulmonary dysplasia: a systematic review and external validation study

    NARCIS (Netherlands)

    Onland, Wes; Debray, Thomas P.; Laughon, Matthew M.; Miedema, Martijn; Cools, Filip; Askie, Lisa M.; Asselin, Jeanette M.; Calvert, Sandra A.; Courtney, Sherry E.; Dani, Carlo; Durand, David J.; Marlow, Neil; Peacock, Janet L.; Pillow, J. Jane; Soll, Roger F.; Thome, Ulrich H.; Truffert, Patrick; Schreiber, Michael D.; van Reempts, Patrick; Vendettuoli, Valentina; Vento, Giovanni; van Kaam, Anton H.; Moons, Karel G.; Offringa, Martin

    2013-01-01

    Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Very different models using clinical parameters at an early postnatal age to predict BPD have been developed with little extensive quantitative validation. The objective of this study is to review and validate clinical

  17. Internal and External Validation of a multivariable Model to Define Hospital-Acquired Pneumonia After Esophagectomy

    NARCIS (Netherlands)

    Weijs, Teus J; Seesing, Maarten F J; van Rossum, Peter S N; Koëter, Marijn; van der Sluis, Pieter C; Luyer, Misha D P; Ruurda, Jelle P; Nieuwenhuijzen, Grard A P; van Hillegersberg, Richard

    BACKGROUND: Pneumonia is an important complication following esophagectomy; however, a wide range of pneumonia incidence is reported. The lack of one generally accepted definition prevents valid inter-study comparisons. We aimed to simplify and validate an existing scoring model to define pneumonia

  18. Eating Disorder Diagnostic Scale: Additional Evidence of Reliability and Validity

    Science.gov (United States)

    Stice, Eric; Fisher, Melissa; Martinez, Erin

    2004-01-01

    The authors conducted 4 studies investigating the reliability and validity of the Eating Disorder Diagnostic Scale (HDDS; E. Stice, C. F. Telch, & S. L. Rizvi, 2000), a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa, and binge eating disorder. Study 1 found that the HDDS showed criterion validity with interview-based…

  19. External validation of approaches to prediction of falls during hospital rehabilitation stays and development of a new simpler tool

    Directory of Open Access Journals (Sweden)

    Angela Vratsistas-Curto

    2017-12-01

    Full Text Available Objectives: To test the external validity of 4 approaches to fall prediction in a rehabilitation setting (Predict_FIRST, Ontario Modified STRATIFY (OMS, physiotherapists’ judgement of fall risk (PT_Risk, and falls in the past year (Past_Falls, and to develop and test the validity of a simpler tool for fall prediction in rehabilitation (Predict_CM2. Participants: A total of 300 consecutively-admitted rehabilitation inpatients. Methods: Prospective inception cohort study. Falls during the rehabilitation stay were monitored. Potential predictors were extracted from medical records. Results: Forty-one patients (14% fell during their rehabilitation stay. The external validity, area under the receiver operating characteristic curve (AUC, for predicting future fallers was: 0.71 (95% confidence interval (95% CI: 0.61–0.81 for OMS (Total_Score; 0.66 (95% CI: 0.57–0.74 for Predict_FIRST; 0.65 (95% CI 0.57–0.73 for PT_Risk; and 0.52 for Past_Falls (95% CI: 0.46–0.60. A simple 3-item tool (Predict_CM2 was developed from the most predictive individual items (impaired mobility/transfer ability, impaired cognition, and male sex. The accuracy of Predict_CM2 was 0.73 (95% CI: 0.66–0.81, comparable to OMS (Total_Score (p = 0.52, significantly better than Predict_FIRST (p = 0.04, and Past_Falls (p < 0.001, and approaching significantly better than PT_Risk (p = 0.09. Conclusion: Predict_CM2 is a simpler screening tool with similar accuracy for predicting fallers in rehabilitation to OMS (Total_Score and better accuracy than Predict_FIRST or Past_Falls. External validation of Predict_CM2 is required.

  20. External validation of prognostic models to predict risk of gestational diabetes mellitus in one Dutch cohort: prospective multicentre cohort study.

    Science.gov (United States)

    Lamain-de Ruiter, Marije; Kwee, Anneke; Naaktgeboren, Christiana A; de Groot, Inge; Evers, Inge M; Groenendaal, Floris; Hering, Yolanda R; Huisjes, Anjoke J M; Kirpestein, Cornel; Monincx, Wilma M; Siljee, Jacqueline E; Van 't Zelfde, Annewil; van Oirschot, Charlotte M; Vankan-Buitelaar, Simone A; Vonk, Mariska A A W; Wiegers, Therese A; Zwart, Joost J; Franx, Arie; Moons, Karel G M; Koster, Maria P H

    2016-08-30

     To perform an external validation and direct comparison of published prognostic models for early prediction of the risk of gestational diabetes mellitus, including predictors applicable in the first trimester of pregnancy.  External validation of all published prognostic models in large scale, prospective, multicentre cohort study.  31 independent midwifery practices and six hospitals in the Netherlands.  Women recruited in their first trimester (diabetes mellitus of any type were excluded.  Discrimination of the prognostic models was assessed by the C statistic, and calibration assessed by calibration plots.  3723 women were included for analysis, of whom 181 (4.9%) developed gestational diabetes mellitus in pregnancy. 12 prognostic models for the disorder could be validated in the cohort. C statistics ranged from 0.67 to 0.78. Calibration plots showed that eight of the 12 models were well calibrated. The four models with the highest C statistics included almost all of the following predictors: maternal age, maternal body mass index, history of gestational diabetes mellitus, ethnicity, and family history of diabetes. Prognostic models had a similar performance in a subgroup of nulliparous women only. Decision curve analysis showed that the use of these four models always had a positive net benefit.  In this external validation study, most of the published prognostic models for gestational diabetes mellitus show acceptable discrimination and calibration. The four models with the highest discriminative abilities in this study cohort, which also perform well in a subgroup of nulliparous women, are easy models to apply in clinical practice and therefore deserve further evaluation regarding their clinical impact. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. SU-C-BRF-05: Design and Geometric Validation of An Externally and Internally Deformable, Programmable Lung Motion Phantom

    International Nuclear Information System (INIS)

    Cheung, Y; Sawant, A

    2014-01-01

    Purpose: Most clinically-deployed strategies for respiratory motion management in lung radiotherapy (e.g., gating, tracking) use external markers that serve as surrogates for tumor motion. However, typical lung phantoms used to validate these strategies are rigid-exterior+rigid-interior or rigid-exterior+deformable-interior. Neither class adequately represents the human anatomy, which is deformable internally as well as externally. We describe the construction and experimental validation of a more realistic, externally- and internally-deformable, programmable lung phantom. Methods: The outer shell of a commercially-available lung phantom (RS- 1500, RSD Inc.) was used. The shell consists of a chest cavity with a flexible anterior surface, and embedded vertebrae, rib-cage and sternum. A 3-axis platform was programmed with sinusoidal and six patient-recorded lung tumor trajectories. The platform was used to drive a rigid foam ‘diaphragm’ that compressed/decompressed the phantom interior. Experimental characterization comprised of mapping the superior-inferior (SI) and anterior-posterior (AP) trajectories of external and internal radioopaque markers with kV x-ray fluoroscopy and correlating these with optical surface monitoring using the in-room VisionRT system. Results: The phantom correctly reproduced the programmed motion as well as realistic effects such as hysteresis. The reproducibility of marker trajectories over multiple runs for sinusoidal as well as patient traces, as characterized by fluoroscopy, was within 0.4 mm RMS error for internal as well as external markers. The motion trajectories of internal and external markers as measured by fluoroscopy were found to be highly correlated (R=0.97). Furthermore, motion trajectories of arbitrary points on the deforming phantom surface, as recorded by the VisionRT system also showed a high correlation with respect to the fluoroscopically-measured trajectories of internal markers (R=0.92). Conclusion: We have

  2. Does External Knowledge Sourcing Enhance Market Performance? Evidence from the Korean Manufacturing Industry.

    Science.gov (United States)

    Lee, Kibaek; Yoo, Jaeheung; Choi, Munkee; Zo, Hangjung; Ciganek, Andrew P

    2016-01-01

    Firms continuously search for external knowledge that can contribute to product innovation, which may ultimately increase market performance. The relationship between external knowledge sourcing and market performance is not well-documented. The extant literature primarily examines the causal relationship between external knowledge sources and product innovation performance or to identify factors which moderates the relationship between external knowledge sourcing and product innovation. Non-technological innovations, such as organization and marketing innovations, intervene in the process of external knowledge sourcing to product innovation to market performance but has not been extensively examined. This study addresses two research questions: does external knowledge sourcing lead to market performance and how does external knowledge sourcing interact with a firm's different innovation activities to enhance market performance. This study proposes a comprehensive model to capture the causal mechanism from external knowledge sourcing to market performance. The research model was tested using survey data from manufacturing firms in South Korea and the results demonstrate a strong statistical relationship in the path of external knowledge sourcing (EKS) to product innovation performance (PIP) to market performance (MP). Organizational innovation is an antecedent to EKS while marketing innovation is a consequence of EKS, which significantly influences PIP and MP. The results imply that any potential EKS effort should also consider organizational innovations which may ultimately enhance market performance. Theoretical and practical implications are discussed as well as concluding remarks.

  3. Does External Funding Help Adaptation? Evidence from Community-Based Water Management in the Colombian Andes

    Science.gov (United States)

    Murtinho, Felipe; Eakin, Hallie; López-Carr, David; Hayes, Tanya M.

    2013-11-01

    Despite debate regarding whether, and in what form, communities need external support for adaptation to environmental change, few studies have examined how external funding impacts adaptation decisions in rural resource-dependent communities. In this article, we use quantitative and qualitative methods to assess how different funding sources influence the initiative to adapt to water scarcity in the Colombian Andes. We compare efforts to adapt to water scarcity in 111 rural Andean communities with varied dependence on external funding for water management activities. Findings suggest that despite efforts to use their own internal resources, communities often need external support to finance adaptation strategies. However, not all external financial support positively impacts a community’s abilities to adapt. Results show the importance of community-driven requests for external support. In cases where external support was unsolicited, the results show a decline, or “crowding-out,” in community efforts to adapt. In contrast, in cases where communities initiated the request for external support to fund their own projects, findings show that external intervention is more likely to enhance or “crowds-in” community-driven adaptation.

  4. Does External Knowledge Sourcing Enhance Market Performance? Evidence from the Korean Manufacturing Industry

    Science.gov (United States)

    Lee, Kibaek; Yoo, Jaeheung; Choi, Munkee; Zo, Hangjung; Ciganek, Andrew P.

    2016-01-01

    Firms continuously search for external knowledge that can contribute to product innovation, which may ultimately increase market performance. The relationship between external knowledge sourcing and market performance is not well-documented. The extant literature primarily examines the causal relationship between external knowledge sources and product innovation performance or to identify factors which moderates the relationship between external knowledge sourcing and product innovation. Non-technological innovations, such as organization and marketing innovations, intervene in the process of external knowledge sourcing to product innovation to market performance but has not been extensively examined. This study addresses two research questions: does external knowledge sourcing lead to market performance and how does external knowledge sourcing interact with a firm’s different innovation activities to enhance market performance. This study proposes a comprehensive model to capture the causal mechanism from external knowledge sourcing to market performance. The research model was tested using survey data from manufacturing firms in South Korea and the results demonstrate a strong statistical relationship in the path of external knowledge sourcing (EKS) to product innovation performance (PIP) to market performance (MP). Organizational innovation is an antecedent to EKS while marketing innovation is a consequence of EKS, which significantly influences PIP and MP. The results imply that any potential EKS effort should also consider organizational innovations which may ultimately enhance market performance. Theoretical and practical implications are discussed as well as concluding remarks. PMID:28006022

  5. External validation of models predicting the individual risk of metachronous peritoneal carcinomatosis from colon and rectal cancer.

    Science.gov (United States)

    Segelman, J; Akre, O; Gustafsson, U O; Bottai, M; Martling, A

    2016-04-01

    To externally validate previously published predictive models of the risk of developing metachronous peritoneal carcinomatosis (PC) after resection of nonmetastatic colon or rectal cancer and to update the predictive model for colon cancer by adding new prognostic predictors. Data from all patients with Stage I-III colorectal cancer identified from a population-based database in Stockholm between 2008 and 2010 were used. We assessed the concordance between the predicted and observed probabilities of PC and utilized proportional-hazard regression to update the predictive model for colon cancer. When applied to the new validation dataset (n = 2011), the colon and rectal cancer risk-score models predicted metachronous PC with a concordance index of 79% and 67%, respectively. After adding the subclasses of pT3 and pT4 stage and mucinous tumour to the colon cancer model, the concordance index increased to 82%. In validation of external and recent cohorts, the predictive accuracy was strong in colon cancer and moderate in rectal cancer patients. The model can be used to identify high-risk patients for planned second-look laparoscopy/laparotomy for possible subsequent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  6. External validation of blood eosinophils, FE(NO) and serum periostin as surrogates for sputum eosinophils in asthma.

    Science.gov (United States)

    Wagener, A H; de Nijs, S B; Lutter, R; Sousa, A R; Weersink, E J M; Bel, E H; Sterk, P J

    2015-02-01

    Monitoring sputum eosinophils in asthma predicts exacerbations and improves management of asthma. Thus far, blood eosinophils and FE(NO) show contradictory results in predicting eosinophilic airway inflammation. More recently, serum periostin was proposed as a novel biomarker for eosinophilic inflammation. Quantifying the mutual relationships of blood eosinophils, FE(NO), and serum periostin with sputum eosinophils by external validation in two independent cohorts across various severities of asthma. The first cohort consisted of 110 patients with mild to moderate asthma (external validation cohort). The replication cohort consisted of 37 patients with moderate to severe asthma. Both cohorts were evaluated cross-sectionally. Sputum was induced for the assessment of eosinophils. In parallel, blood eosinophil counts, serum periostin concentrations and FENO were assessed. The diagnostic accuracy of these markers to identify eosinophilic asthma (sputum eosinophils ≥3%) was calculated using receiver operating characteristics area under the curve (ROC AUC). In the external validation cohort, ROC AUC for blood eosinophils was 89% (peosinophilic from non-eosinophilic airway inflammation (ROC AUC=55%, p=0.44). When combining these three variables, no improvement was seen. The diagnostic value of blood eosinophils was confirmed in the replication cohort (ROC AUC 85%, peosinophils had the highest accuracy in the identification of sputum eosinophilia in asthma. The use of blood eosinophils can facilitate individualised treatment and management of asthma. NTR1846 and NTR2364. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  7. Sample size calculation to externally validate scoring systems based on logistic regression models.

    Directory of Open Access Journals (Sweden)

    Antonio Palazón-Bru

    Full Text Available A sample size containing at least 100 events and 100 non-events has been suggested to validate a predictive model, regardless of the model being validated and that certain factors can influence calibration of the predictive model (discrimination, parameterization and incidence. Scoring systems based on binary logistic regression models are a specific type of predictive model.The aim of this study was to develop an algorithm to determine the sample size for validating a scoring system based on a binary logistic regression model and to apply it to a case study.The algorithm was based on bootstrap samples in which the area under the ROC curve, the observed event probabilities through smooth curves, and a measure to determine the lack of calibration (estimated calibration index were calculated. To illustrate its use for interested researchers, the algorithm was applied to a scoring system, based on a binary logistic regression model, to determine mortality in intensive care units.In the case study provided, the algorithm obtained a sample size with 69 events, which is lower than the value suggested in the literature.An algorithm is provided for finding the appropriate sample size to validate scoring systems based on binary logistic regression models. This could be applied to determine the sample size in other similar cases.

  8. External validity of the Indonesian Wechsler Adult Intelligence Scale - Fourth edition (WAIS-IV-ID)

    NARCIS (Netherlands)

    Suwartono, C.; Hidajat, L.L.; Halim, M.S.; Hendriks, M.P.H.; Kessels, R.P.C.

    2016-01-01

    The Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV-ID) has been adapted and proved to be valid for its internal structure for Indonesian population. The same structure found as in the American WAIS-IV (WAIS-IV-US; Suwartono, Hendriks, Hidajat, Halim, & Kessels, 2015). Despite its strong

  9. The Subaxial Cervical Spine Injury Classification System: an external agreement validation study

    NARCIS (Netherlands)

    Middendorp, J.J. van; Audige, L.; Bartels, R.H.M.A.; Bolger, C.; Deverall, H.; Dhoke, P.; Diekerhof, C.H.; Govaert, G.A.; Guimera, V.; Koller, H.; Morris, S.A.; Setiobudi, T.; Hosman, A.J.F.

    2013-01-01

    BACKGROUND CONTEXT: In 2007, the Subaxial Cervical Spine Injury Classification (SLIC) system was introduced demonstrating moderate reliability in an internal validation study. PURPOSE: To assess the agreement on the SLIC system using clinical data from a spinal trauma population and whether the SLIC

  10. The Subaxial Cervical Spine Injury Classification System : an external agreement validation study

    NARCIS (Netherlands)

    van Middendorp, Joost J.; Audige, Laurent; Bartels, Ronald H.; Bolger, Ciaran; Deverall, Hamish; Dhoke, Priyesh; Diekerhof, Carel H.; Govaert, Geertje A. M.; Guimera, Vicente; Koller, Heiko; Morris, Stephen A. C.; Setiobudi, Tony; Hosman, Allard J. F.

    BACKGROUND CONTEXT: In 2007, the Subaxial Cervical Spine Injury Classification (SLIC) system was introduced demonstrating moderate reliability in an internal validation study. PURPOSE: To assess the agreement on the SLIC system using clinical data from a spinal trauma population and whether the SLIC

  11. Validity evidence and reliability of a simulated patient feedback instrument.

    Science.gov (United States)

    Schlegel, Claudia; Woermann, Ulrich; Rethans, Jan-Joost; van der Vleuten, Cees

    2012-01-27

    In the training of healthcare professionals, one of the advantages of communication training with simulated patients (SPs) is the SP's ability to provide direct feedback to students after a simulated clinical encounter. The quality of SP feedback must be monitored, especially because it is well known that feedback can have a profound effect on student performance. Due to the current lack of valid and reliable instruments to assess the quality of SP feedback, our study examined the validity and reliability of one potential instrument, the 'modified Quality of Simulated Patient Feedback Form' (mQSF). Content validity of the mQSF was assessed by inviting experts in the area of simulated clinical encounters to rate the importance of the mQSF items. Moreover, generalizability theory was used to examine the reliability of the mQSF. Our data came from videotapes of clinical encounters between six simulated patients and six students and the ensuing feedback from the SPs to the students. Ten faculty members judged the SP feedback according to the items on the mQSF. Three weeks later, this procedure was repeated with the same faculty members and recordings. All but two items of the mQSF received importance ratings of > 2.5 on a four-point rating scale. A generalizability coefficient of 0.77 was established with two judges observing one encounter. The findings for content validity and reliability with two judges suggest that the mQSF is a valid and reliable instrument to assess the quality of feedback provided by simulated patients.

  12. Efficacy and External Validity of Electronic and Mobile Phone-Based Interventions Promoting Vegetable Intake in Young Adults: Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Nour, Monica; Chen, Juliana; Allman-Farinelli, Margaret

    2016-04-08

    Young adults (18-35 years) remain among the lowest vegetable consumers in many western countries. The digital era offers opportunities to engage this age group in interventions in new and appealing ways. This systematic review evaluated the efficacy and external validity of electronic (eHealth) and mobile phone (mHealth) -based interventions that promote vegetable intake in young adults. We searched several electronic databases for studies published between 1990 and 2015, and 2 independent authors reviewed the quality and risk of bias of the eligible papers and extracted data for analyses. The primary outcome of interest was the change in vegetable intake postintervention. Where possible, we calculated effect sizes (Cohen d and 95% CIs) for comparison. A random effects model was applied to the data for meta-analysis. Reach and representativeness of participants, intervention implementation, and program maintenance were assessed to establish external validity. Published validation studies were consulted to determine the validity of tools used to measure intake. We applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to evaluate the overall quality of the body of evidence. Of the 14 studies that met the selection criteria, we included 12 in the meta-analysis. In the meta-analysis, 7 studies found positive effects postintervention for fruit and vegetable intake, Cohen d 0.14-0.56 (pooled effect size 0.22, 95% CI 0.11-0.33, I(2)=68.5%, P=.002), and 4 recorded positive effects on vegetable intake alone, Cohen d 0.11-0.40 (pooled effect size 0.15, 95% CI 0.04-0.28, I(2)=31.4%, P=.2). These findings should be interpreted with caution due to variability in intervention design and outcome measures. With the majority of outcomes documented as a change in combined fruit and vegetable intake, it was difficult to determine intervention effects on vegetable consumption specifically. Measurement of intake was most commonly by self

  13. Parametric oesophageal multiple swallow scintigraphy for validation of dysphageal symptoms during external beam irradiation of mediastinal tumours

    Energy Technology Data Exchange (ETDEWEB)

    Brandt-Mainz, K.; Eising, E.G.; Bockisch, A. [Essen Univ. (Gesamthochschule) (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Mallek, D. von; Poettgen, C.; Stuschke, M.; Sack, H. [Klinik und Poliklinik fuer Strahlentherapie, Universitaetsklinikum Essen (Germany)

    2001-03-01

    The aim of the study was to evaluate dysphageal symptoms and to measure the effect of local analgesic treatment using parametric oesophageal multiple swallow scintigraphy (PES) during external beam irradiation of the mediastinal region. Fifteen patients (most with lung cancer) with dysphagia grade II underwent PES during external beam radiotherapy of the mediastinum before and after application of local analgesics. Dynamic parametric condensed images were recorded. The intensity of clinical symptoms was correlated with the emptying rate at 10 s (ER-10 s) and the mean transit time (MTT). Visual analysis of the images was performed and the results were correlated with the fields of irradiation portals. Of the 15 patients, 12 showed a correlation between irradiation portals and the region of oesophageal motility disorder. Concordant results of clinical symptoms and PES data were found. In nine patients with a decrease in dysphagia following local analgesia, an increase in mean ER-10 s and a decrease in MTT were observed. In three patients with deterioration in clinical symptoms after analgesic treatment, a similar decrease in mean ER-10 s was found, though MTT remained constant. In three patients with normal values, motility disorders were detected in the dynamic study. In conclusion, PES was found to be a sensitive tool for the validation of dysphageal symptoms in patients during external beam irradiation of mediastinal tumours and for the evaluation and quantification of the efficacy of local analgesic treatment. Additional visual analysis of the dynamic study is helpful in diagnosing minimal disorders. (orig.)

  14. Parametric oesophageal multiple swallow scintigraphy for validation of dysphageal symptoms during external beam irradiation of mediastinal tumours

    International Nuclear Information System (INIS)

    Brandt-Mainz, K.; Eising, E.G.; Bockisch, A.

    2001-01-01

    The aim of the study was to evaluate dysphageal symptoms and to measure the effect of local analgesic treatment using parametric oesophageal multiple swallow scintigraphy (PES) during external beam irradiation of the mediastinal region. Fifteen patients (most with lung cancer) with dysphagia grade II underwent PES during external beam radiotherapy of the mediastinum before and after application of local analgesics. Dynamic parametric condensed images were recorded. The intensity of clinical symptoms was correlated with the emptying rate at 10 s (ER-10 s) and the mean transit time (MTT). Visual analysis of the images was performed and the results were correlated with the fields of irradiation portals. Of the 15 patients, 12 showed a correlation between irradiation portals and the region of oesophageal motility disorder. Concordant results of clinical symptoms and PES data were found. In nine patients with a decrease in dysphagia following local analgesia, an increase in mean ER-10 s and a decrease in MTT were observed. In three patients with deterioration in clinical symptoms after analgesic treatment, a similar decrease in mean ER-10 s was found, though MTT remained constant. In three patients with normal values, motility disorders were detected in the dynamic study. In conclusion, PES was found to be a sensitive tool for the validation of dysphageal symptoms in patients during external beam irradiation of mediastinal tumours and for the evaluation and quantification of the efficacy of local analgesic treatment. Additional visual analysis of the dynamic study is helpful in diagnosing minimal disorders. (orig.)

  15. Deficit and External Debt Effects on Money and Inflation in Brazil and Mexico: Some Evidence

    OpenAIRE

    Bharat R. Koluri; Demetrios S. Giannaros

    1987-01-01

    The purpose of this study is to examine the monetarist propositions regarding the effects of budget deficits, external debt, and money growth on inflation in the cases of Brazil and Mexico. To this end, a money growth equation and a price equation have been specified and estimated for empirical analysis. In general, it is concluded that the government budget deficit is not a determinant of money supply growth or of inflation. External debt is found to be a significant factor of money growth. ...

  16. State Gun Policy and Cross-State Externalities: Evidence from Crime Gun Tracing

    OpenAIRE

    Brian Knight

    2013-01-01

    This paper provides a theoretical and empirical analysis of cross-state externalities associated with gun regulations in the context of the gun trafficking market. Using gun tracing data, which identify the source state for crime guns recovered in destination states, we find that firearms in this market tend to flow from states with weak gun laws to states with strict gun laws, satisfying a necessary condition for the existence of cross-state externalities in the theoretical model. We also fi...

  17. The Analysis of the Impact of Depreciation on External Debt in Long Run: Evidence From Croatia

    Directory of Open Access Journals (Sweden)

    Irena Palić

    2018-03-01

    Full Text Available The impact of exchange rate changes in small open economies has been a widely researched topic for decades. According to economic theory and relevant research, depreciation can have a positive impact on the economy through an increase in exports, and a negative effect through decrease in an individual consumption. The aim of this artcle is to assess the impact of exchange rate depreciation on external debt in Croatia in the long-run. The long-run impact of depreciation on external debt in Croatia is assessed using Johansen cointegration approach. The results point to the existence of one cointegration relation. The long-run impact of exchange rate depreciation on external debt in Croatia is statistically significant and positive, what is in line with previous research and economic theory. The conducted analysis outlines the possible negative impact of depreciation on Croatian economy through the increase of external indebtedness, what could consequently decrease the wealth of all sectors indebted in foreign currency. Since Croatia is a highly euroised small open economy with high external indebtedness in foreign currency, this research provides captivating results for monetary and fiscal policy-making in Croatia. Therefore, as a result of the conducted empirical analysis, the exchange rate depreciation in Croatia is not recommended as the instrument of increasing export competitiveness due to current high external indebtedness in foreign currency.

  18. External validation of the use of vignettes in cross-country health studies

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Kristensen, Nicolai; Pozzoli, Dario

    2010-01-01

    Cross-country comparisons of subjective assessments are rendered difficult if not impossible because of sub-population specific response style. To correct for this, the use of vignettes has become increasingly popular, notably within cross-country health studies. However, the validity of vignette...... and vignettes. Our results indicate that the assumption of RC is not innocuous and that our extended model relaxing this assumption improves the fit and significantly changes the cross-country rankings of health vis-a-vis the standard Chopit model.......Cross-country comparisons of subjective assessments are rendered difficult if not impossible because of sub-population specific response style. To correct for this, the use of vignettes has become increasingly popular, notably within cross-country health studies. However, the validity of vignettes...

  19. External Validation of the Use of Vignettes in Cross-Country Health Studies

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Kristensen, Nicolai; Pozzoli, Dario

    Cross-country comparisons of subjective assessments are rendered difficult if not impossible because of sub-population specific response style. To correct for this, the use of vignettes has become increasingly popular, notably within cross-country health studies. However, the validity of vignette...... and vignettes. Our results indicate that the assumption of RC is not innocuous and that our extended model relaxing this assumption improves the fit and significantly changes the cross-country rankings of health vis-à-vis the standard Chopit model.......Cross-country comparisons of subjective assessments are rendered difficult if not impossible because of sub-population specific response style. To correct for this, the use of vignettes has become increasingly popular, notably within cross-country health studies. However, the validity of vignettes...

  20. External validation of the use of vignettes in cross-country health studies

    DEFF Research Database (Denmark)

    Gupta, Nabanita Datta; Kristensen, Nicolai; Pozzoli, Dario

    Cross-country comparisons of subjective assessments are rendered difficult if not impossible because of sub-population specific response style. To correct for this, the use of vignettes has become increasingly popular, notably within cross-country health studies. However, the validity of vignette...... and vignettes. Our results indicate that the assumption of RC is not innocous and that our extended model relaxing this assumption improves the fit and significantly changes the cross-country rankings of health vis-\\'{a}-vis the standard Chopit model.......Cross-country comparisons of subjective assessments are rendered difficult if not impossible because of sub-population specific response style. To correct for this, the use of vignettes has become increasingly popular, notably within cross-country health studies. However, the validity of vignettes...

  1. Further Validation of the IDAS: Evidence of Convergent, Discriminant, Criterion, and Incremental Validity

    Science.gov (United States)

    Watson, David; O'Hara, Michael W.; Chmielewski, Michael; McDade-Montez, Elizabeth A.; Koffel, Erin; Naragon, Kristin; Stuart, Scott

    2008-01-01

    The authors explicated the validity of the Inventory of Depression and Anxiety Symptoms (IDAS; D. Watson et al., 2007) in 2 samples (306 college students and 605 psychiatric patients). The IDAS scales showed strong convergent validity in relation to parallel interview-based scores on the Clinician Rating version of the IDAS; the mean convergent…

  2. Further validation of the Satisfaction with Life Scale: evidence for the cross-method convergence of well-being measures.

    Science.gov (United States)

    Pavot, W; Diener, E; Colvin, C R; Sandvik, E

    1991-08-01

    The structure of subjective well-being has been conceptualized as consisting of two major components: the emotional or affective component and the judgmental or cognitive component (Diener, 1984; Veenhoven, 1984). The judgmental component has also been conceptualized as life satisfaction (Andrews & Withey, 1976). Although the affective component of subjective well-being has received considerable attention from researchers, the judgmental component has been relatively neglected. The Satisfaction With Life Scale (SWLS; Diener, Emmons, Larsen, & Griffin, 1985) was developed as a measure of the judgmental component of subjective well-being (SWB). Two studied designed to validate further the SWLS are reported. Peer reports, a memory measure, and clinical ratings are used as external criteria for validation. Evidence for the reliability and predictive validity of the SWLS is presented, and its performance is compared to other related scales. The SWLS is shown to be a valid and reliable measure of life satisfaction, suited for use with a wide range of age groups and applications, which makes possible the savings of interview time and resources compared to many measures of life satisfaction. In addition, the high convergence of self- and peer-reported measures of subjective well-being and life satisfaction provide strong evidence that subjective well-being is a relatively global and stable phenomenon, not simply a momentary judgment based on fleeting influences.

  3. Validity evidence as a key marker of quality of technical skill assessment in OTL-HNS.

    Science.gov (United States)

    Labbé, Mathilde; Young, Meredith; Nguyen, Lily H P

    2018-01-13

    Quality monitoring of assessment practices should be a priority in all residency programs. Validity evidence is one of the main hallmarks of assessment quality and should be collected to support the interpretation and use of assessment data. Our objective was to identify, synthesize, and present the validity evidence reported supporting different technical skill assessment tools in otolaryngology-head and neck surgery (OTL-HNS). We performed a secondary analysis of data generated through a systematic review of all published tools for assessing technical skills in OTL-HNS (n = 16). For each tool, we coded validity evidence according to the five types of evidence described by the American Educational Research Association's interpretation of Messick's validity framework. Descriptive statistical analyses were conducted. All 16 tools included in our analysis were supported by internal structure and relationship to variables validity evidence. Eleven articles presented evidence supporting content. Response process was discussed only in one article, and no study reported on evidence exploring consequences. We present the validity evidence reported for 16 rater-based tools that could be used for work-based assessment of OTL-HNS residents in the operating room. The articles included in our review were consistently deficient in evidence for response process and consequences. Rater-based assessment tools that support high-stakes decisions that impact the learner and programs should include several sources of validity evidence. Thus, use of any assessment should be done with careful consideration of the context-specific validity evidence supporting score interpretation, and we encourage deliberate continual assessment quality-monitoring. NA. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

  4. The predictive and external validity of the STarT Back Tool in Danish primary care.

    Science.gov (United States)

    Morsø, Lars; Kent, Peter; Albert, Hanne B; Hill, Jonathan C; Kongsted, Alice; Manniche, Claus

    2013-08-01

    The STarT Back Tool (SBT) was recently translated into Danish and its concurrent validity described. This study tested the predictive validity of the Danish SBT. Danish primary care patients (n = 344) were compared to a UK cohort. SBT subgroup validity for predicting high activity limitation at 3 months' follow-up was assessed using descriptive proportions, relative risks, AUC and odds ratios. The SBT had a statistically similar predictive ability in Danish primary care as in UK primary care. Unadjusted relative risks for poor clinical outcome on activity limitation in the Danish cohort were 2.4 (1.7-3.4) for the medium-risk subgroup and 2.8 (1.8-3.8) for the high-risk subgroup versus 3.1 (2.5-3.9) and 4.5 (3.6-5.6) for the UK cohort. Adjusting for confounders appeared to explain the lower predictive ability of the Danish high-risk group. The Danish SBT distinguished between low- and medium-risk subgroups with a similar predictive ability of the UK SBT. That distinction is useful information for informing patients about their expected prognosis and may help guiding clinicians' choice of treatment. However, cross-cultural differences in the SBT psychosocial subscale may reduce the predictive ability of the high-risk subgroup in Danish primary care.

  5. An Econometric Validation of Malthusian Theory: Evidence in Nigeria

    Directory of Open Access Journals (Sweden)

    Musa Abdullahi Sakanko

    2018-01-01

    Full Text Available Rising population is an asset, provided, the skills of the workforce are used to the maximum extent. If not appropriately channelized, it can be a liability for a nation. A skilled and hardworking population can emerge as a foundation for a country’s development. This study examines the validity of Malthusian Theory in Nigeria using time series data from 1960 to 2016, employs the ARDL bound test techniques. The result shows that in the long-run, population growth and food production move proportionately, while population growth poses a depleting effect on food production in the short-run, thus validating the incidence of Malthusian impact in Nigerian economy in the short-run. The researcher recommended the government should strategize plans, which will further intensify family planning and birth control measure, compulsory western education and revitalization of the agricultural sector.DOI: 10.150408/sjie.v7i1.6461

  6. 20 CFR 219.31 - Evidence of a valid ceremonial marriage.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Evidence of a valid ceremonial marriage. 219... marriage. (a) Preferred evidence. Preferred evidence of a ceremonial marriage is— (1) A copy of the public record of the marriage, certified by the custodian of the record or by a Board employee; (2) A copy of a...

  7. An inquiry on dimensions of external technology search and their influence on technological innovations: evidence from Chinese firms

    DEFF Research Database (Denmark)

    Li-Ying, Jason; Wang, Yuandi; Salomo, Søren

    2014-01-01

    A central part of technological innovation for industrial firms involves search for new external knowledge. A well‐established stream of literature on firms' external knowledge search has demonstrated that firms investing in broader search may have a great ability to innovate. In this paper, we...... explore the influences of technology search on firms' technological innovation performance along three distinctive dimensions: technical, geographic, and temporal dimensions, using a unique panel data set containing information on Chinese firms that were active in technology in‐licensing and patenting...... during the period 2000–2009. Our findings reveal that Chinese firms' technological innovation performances are related to external technology search in quite different ways from the ones suggested in the extant literature using evidence from developed countries. We find that Chinese firms searching...

  8. What should we mean by empirical validation in hypnotherapy: evidence-based practice in clinical hypnosis.

    Science.gov (United States)

    Alladin, Assen; Sabatini, Linda; Amundson, Jon K

    2007-04-01

    This paper briefly surveys the trend of and controversy surrounding empirical validation in psychotherapy. Empirical validation of hypnotherapy has paralleled the practice of validation in psychotherapy and the professionalization of clinical psychology, in general. This evolution in determining what counts as evidence for bona fide clinical practice has gone from theory-driven clinical approaches in the 1960s and 1970s through critical attempts at categorization of empirically supported therapies in the 1990s on to the concept of evidence-based practice in 2006. Implications of this progression in professional psychology are discussed in the light of hypnosis's current quest for validation and empirical accreditation.

  9. Development, external validation and clinical usefulness of a practical prediction model for radiation-induced dysphagia in lung cancer patients

    International Nuclear Information System (INIS)

    Dehing-Oberije, Cary; De Ruysscher, Dirk; Petit, Steven; Van Meerbeeck, Jan; Vandecasteele, Katrien; De Neve, Wilfried; Dingemans, Anne Marie C.; El Naqa, Issam; Deasy, Joseph; Bradley, Jeff; Huang, Ellen; Lambin, Philippe

    2010-01-01

    Introduction: Acute dysphagia is a distressing dose-limiting toxicity occurring frequently during concurrent chemo-radiation or high-dose radiotherapy for lung cancer. It can lead to treatment interruptions and thus jeopardize survival. Although a number of predictive factors have been identified, it is still not clear how these could offer assistance for treatment decision making in daily clinical practice. Therefore, we have developed and validated a nomogram to predict this side-effect. In addition, clinical usefulness was assessed by comparing model predictions to physicians' predictions. Materials and methods: Clinical data from 469 inoperable lung cancer patients, treated with curative intent, were collected prospectively. A prediction model for acute radiation-induced dysphagia was developed. Model performance was evaluated by the c-statistic and assessed using bootstrapping as well as two external datasets. In addition, a prospective study was conducted comparing model to physicians' predictions in 138 patients. Results: The final multivariate model consisted of age, gender, WHO performance status, mean esophageal dose (MED), maximum esophageal dose (MAXED) and overall treatment time (OTT). The c-statistic, assessed by bootstrapping, was 0.77. External validation yielded an AUC of 0.94 on the Ghent data and 0.77 on the Washington University St. Louis data for dysphagia ≥ grade 3. Comparing model predictions to the physicians' predictions resulted in an AUC of 0.75 versus 0.53, respectively. Conclusions: The proposed model performed well was successfully validated and demonstrated the ability to predict acute severe dysphagia remarkably better than the physicians. Therefore, this model could be used in clinical practice to identify patients at high or low risk.

  10. Social Networks and Externalities from Gift Exchange: Evidence from A Field Experiment.

    Science.gov (United States)

    Currie, Janet; Lin, Wanchuan; Meng, Juanjuan

    2013-11-01

    This paper asks whether gift exchange generates externalities for people outside of the bilateral relationship between the gift giver and recipient, and whether the nature of this relationship is affected by social networks. We examine this question in the context of a field experiment in urban Chinese hospital outpatient clinics. We first show that when patients give a small gift, doctors reciprocate with better service and a fewer unnecessary prescriptions of antibiotics. We then show that gift giving creates externalities for third parties. If two patients, A and B are perceived as unrelated, B receives worse care when A gives a gift. However, if A identifies B as a friend, then both A and B benefit from A's gift giving. Hence, we show that gift giving can create positive or negative externalities, depending on the giver's social distance to the third party.

  11. Social Networks and Externalities from Gift Exchange: Evidence from A Field Experiment☆

    Science.gov (United States)

    Currie, Janet; Lin, Wanchuan; Meng, Juanjuan

    2016-01-01

    This paper asks whether gift exchange generates externalities for people outside of the bilateral relationship between the gift giver and recipient, and whether the nature of this relationship is affected by social networks. We examine this question in the context of a field experiment in urban Chinese hospital outpatient clinics. We first show that when patients give a small gift, doctors reciprocate with better service and a fewer unnecessary prescriptions of antibiotics. We then show that gift giving creates externalities for third parties. If two patients, A and B are perceived as unrelated, B receives worse care when A gives a gift. However, if A identifies B as a friend, then both A and B benefit from A’s gift giving. Hence, we show that gift giving can create positive or negative externalities, depending on the giver’s social distance to the third party. PMID:26949272

  12. Opportunistic screening for osteoporosis on routine computed tomography? An external validation study

    Energy Technology Data Exchange (ETDEWEB)

    Buckens, Constantinus F. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Universitair Medisch Centrum Utrecht, Department of Radiology, Utrecht (Netherlands); Dijkhuis, Gawein; Jong, Pim A. de [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Keizer, Bart de [University Medical Center Utrecht, Department of Nuclear Medicine, Utrecht (Netherlands); Verhaar, Harald J. [University Medical Center Utrecht, Department of Geriatric Medicine, Utrecht (Netherlands)

    2015-07-15

    Opportunistic screening for osteoporosis using computed tomography (CT) examinations that happen to visualise the spine can be used to identify patients with osteoporosis. We sought to verify the diagnostic performance of vertebral Hounsfield unit (HU) measurements on routine CT examinations for diagnosing osteoporosis in a separate, external population. Consecutive patients who underwent a CT examination of the chest or abdomen and had also received a dual-energy X-ray absorptiometry (DXA) test were retrospectively included. CTs were evaluated for vertebral fractures and vertebral attenuation (density) values were measured. Diagnostic performance measures and the area under the receiver operator characteristics curve (AUC) for diagnosing osteoporosis were calculated. Three hundred and two patients with a mean age of 57.9 years were included, of which 82 (27 %) had osteoporosis according to DXA and 65 (22 %) had vertebral fractures. The diagnostic performance for vertebral HU measurements was modest, with a maximal AUC of 0.74 (0.68 - 0.80). At that optimal threshold the sensitivity was 62 % (51 - 72 %) and the specificity was 79 % (74 - 84 %). We confirmed that simple trabecular vertebral density measurements on routine CT contain diagnostic information related to bone mineral density as measured by DXA, albeit with substantially lower diagnostic accuracy than previously reported. (orig.)

  13. Opportunistic screening for osteoporosis on routine computed tomography? An external validation study

    International Nuclear Information System (INIS)

    Buckens, Constantinus F.; Dijkhuis, Gawein; Jong, Pim A. de; Keizer, Bart de; Verhaar, Harald J.

    2015-01-01

    Opportunistic screening for osteoporosis using computed tomography (CT) examinations that happen to visualise the spine can be used to identify patients with osteoporosis. We sought to verify the diagnostic performance of vertebral Hounsfield unit (HU) measurements on routine CT examinations for diagnosing osteoporosis in a separate, external population. Consecutive patients who underwent a CT examination of the chest or abdomen and had also received a dual-energy X-ray absorptiometry (DXA) test were retrospectively included. CTs were evaluated for vertebral fractures and vertebral attenuation (density) values were measured. Diagnostic performance measures and the area under the receiver operator characteristics curve (AUC) for diagnosing osteoporosis were calculated. Three hundred and two patients with a mean age of 57.9 years were included, of which 82 (27 %) had osteoporosis according to DXA and 65 (22 %) had vertebral fractures. The diagnostic performance for vertebral HU measurements was modest, with a maximal AUC of 0.74 (0.68 - 0.80). At that optimal threshold the sensitivity was 62 % (51 - 72 %) and the specificity was 79 % (74 - 84 %). We confirmed that simple trabecular vertebral density measurements on routine CT contain diagnostic information related to bone mineral density as measured by DXA, albeit with substantially lower diagnostic accuracy than previously reported. (orig.)

  14. Validating evidence based decision making in health care

    DEFF Research Database (Denmark)

    Nüssler, Emil Karl; Eskildsen, Jacob Kjær; Håkonsson, Dorthe Døjbak

    Surgeons who perform prolapse surgeries face the dilemma of choosing to use mesh, with its assumed benefits, and the risks associated with mesh. In this paper, we examine whether decisions to use mesh is evidence based. Based on data of 30,398 patients from the Swedish National Quality Register o...... are highly influenced by the geographical placement of surgeons. Therfore, decisions to use mesh are boundedly rationality, rather than rational.......Surgeons who perform prolapse surgeries face the dilemma of choosing to use mesh, with its assumed benefits, and the risks associated with mesh. In this paper, we examine whether decisions to use mesh is evidence based. Based on data of 30,398 patients from the Swedish National Quality Register...... of Gynecological Surgery we examine factors related to decisions to use mesh. Our results indicate that decisions to use mesh are not evidence based, and cannot be explained neither by FDA safety communications, nor by medical conditions usually assumed to predict its usage. Instead, decisions to use mesh...

  15. Does external technology acquisition determine export performance? Evidence from Chinese manufacturing firms

    DEFF Research Database (Denmark)

    Wang, Yuandi; Cao, Wei; Zhou, Zhao

    2013-01-01

    understanding of the determinants of export performance by examining the impact of the inter-organizational dimension of innovation strategy to export performance, which has been ignored in the prevailing “strategy tripod” perspective of exporting research. This study is based on a sample of 141 Chinese...... indigenous manufacturing firms that engaged in inward technology licensing between 2000 and 2003. The empirical results indicate that external technology acquisitions positively influence Chinese firms’ export performance. Moreover the exporting performance of using external technology varies depending...

  16. External validation of a measurement tool to assess systematic reviews (AMSTAR.

    Directory of Open Access Journals (Sweden)

    Beverley J Shea

    Full Text Available BACKGROUND: Thousands of systematic reviews have been conducted in all areas of health care. However, the methodological quality of these reviews is variable and should routinely be appraised. AMSTAR is a measurement tool to assess systematic reviews. METHODOLOGY: AMSTAR was used to appraise 42 reviews focusing on therapies to treat gastro-esophageal reflux disease, peptic ulcer disease, and other acid-related diseases. Two assessors applied the AMSTAR to each review. Two other assessors, plus a clinician and/or methodologist applied a global assessment to each review independently. CONCLUSIONS: The sample of 42 reviews covered a wide range of methodological quality. The overall scores on AMSTAR ranged from 0 to 10 (out of a maximum of 11 with a mean of 4.6 (95% CI: 3.7 to 5.6 and median 4.0 (range 2.0 to 6.0. The inter-observer agreement of the individual items ranged from moderate to almost perfect agreement. Nine items scored a kappa of >0.75 (95% CI: 0.55 to 0.96. The reliability of the total AMSTAR score was excellent: kappa 0.84 (95% CI: 0.67 to 1.00 and Pearson's R 0.96 (95% CI: 0.92 to 0.98. The overall scores for the global assessment ranged from 2 to 7 (out of a maximum score of 7 with a mean of 4.43 (95% CI: 3.6 to 5.3 and median 4.0 (range 2.25 to 5.75. The agreement was lower with a kappa of 0.63 (95% CI: 0.40 to 0.88. Construct validity was shown by AMSTAR convergence with the results of the global assessment: Pearson's R 0.72 (95% CI: 0.53 to 0.84. For the AMSTAR total score, the limits of agreement were -0.19+/-1.38. This translates to a minimum detectable difference between reviews of 0.64 'AMSTAR points'. Further validation of AMSTAR is needed to assess its validity, reliability and perceived utility by appraisers and end users of reviews across a broader range of systematic reviews.

  17. Predicting AKI in emergency admissions: an external validation study of the acute kidney injury prediction score (APS).

    Science.gov (United States)

    Hodgson, L E; Dimitrov, B D; Roderick, P J; Venn, R; Forni, L G

    2017-03-08

    Hospital-acquired acute kidney injury (HA-AKI) is associated with a high risk of mortality. Prediction models or rules may identify those most at risk of HA-AKI. This study externally validated one of the few clinical prediction rules (CPRs) derived in a general medicine cohort using clinical information and data from an acute hospitals electronic system on admission: the acute kidney injury prediction score (APS). External validation in a single UK non-specialist acute hospital (2013-2015, 12 554 episodes); four cohorts: adult medical and general surgical populations, with and without a known preadmission baseline serum creatinine (SCr). Performance assessed by discrimination using area under the receiver operating characteristic curves (AUCROC) and calibration. HA-AKI incidence within 7 days (kidney disease: improving global outcomes (KDIGO) change in SCr) was 8.1% (n=409) of medical patients with known baseline SCr, 6.6% (n=141) in those without a baseline, 4.9% (n=204) in surgical patients with baseline and 4% (n=49) in those without. Across the four cohorts AUCROC were: medical with known baseline 0.65 (95% CIs 0.62 to 0.67) and no baseline 0.71 (0.67 to 0.75), surgical with baseline 0.66 (0.62 to 0.70) and no baseline 0.68 (0.58 to 0.75). For calibration, in medicine and surgical cohorts with baseline SCr, Hosmer-Lemeshow p values were non-significant, suggesting acceptable calibration. In the medical cohort, at a cut-off of five points on the APS to predict HA-AKI, positive predictive value was 16% (13-18%) and negative predictive value 94% (93-94%). Of medical patients with HA-AKI, those with an APS ≥5 had a significantly increased risk of death (28% vs 18%, OR 1.8 (95% CI 1.1 to 2.9), p=0.015). On external validation the APS on admission shows moderate discrimination and acceptable calibration to predict HA-AKI and may be useful as a severity marker when HA-AKI occurs. Harnessing linked data from primary care may be one way to achieve more accurate

  18. The development and validation of dried blood spots for external quality assurance of syphilis serology

    Directory of Open Access Journals (Sweden)

    Smit Pieter W

    2013-02-01

    Full Text Available Abstract Background Syphilis causes up to 1,500,000 congenital syphilis cases annually. These could be prevented if all pregnant women were screened, and those with syphilis treated with a single dose of penicillin before 28 weeks gestation. In recent years, rapid point-of-care tests have allowed greater access to syphilis screening, especially in rural or remote areas, but the lack of quality assurance of rapid testing has been a concern. We determined the feasibility of using dried blood spots (DBS as specimens for quality assurance of syphilis serological assays. Methods We developed DBS extraction protocols for use with Treponema pallidum particle agglutination assay (TPPA, Treponema pallidum haemagglutination assay (TPHA and an enzyme immunoassay (EIA and compared the results with those using matching plasma samples from the same patient. Results Since DBS samples showed poor performance with TPHA and EIA (TPHA sensitivity was 50.5% (95% confidence interval: 39.9–61.2% and EIA specificity was 50.4% (95% CI: 43.7–57.1%, only the DBS TPPA was used in the final evaluation. DBS TPPA showed an sensitivity of 95.5% (95% CI: 91.3–98.0% and a specificity of 99.0% (95% CI: 98.1–99.5% compared to TPPA using plasma samples as a reference. Conclusion DBS samples can be recommended for use with TPPA, and may be of value for external quality assurance of point-of-care syphilis testing.

  19. Aggressive Behavior between Siblings and the Development of Externalizing Problems: Evidence from a Genetically Sensitive Study

    Science.gov (United States)

    Natsuaki, Misaki N.; Ge, Xiaojia; Reiss, David; Neiderhiser, Jenae M.

    2009-01-01

    This study investigated the prospective links between sibling aggression and the development of externalizing problems using a multilevel modeling approach with a genetically sensitive design. The sample consisted of 780 adolescents (390 sibling pairs) who participated in 2 waves of the Nonshared Environment in Adolescent Development project.…

  20. Evidence for a Multi-Dimensional Latent Structural Model of Externalizing Disorders

    Science.gov (United States)

    Witkiewitz, Katie; King, Kevin; McMahon, Robert J.; Wu, Johnny; Luk, Jeremy; Bierman, Karen L.; Coie, John D.; Dodge, Kenneth A.; Greenberg, Mark T.; Lochman, John E.; Pinderhughes, Ellen E.

    2013-01-01

    Strong associations between conduct disorder (CD), antisocial personality disorder (ASPD) and substance use disorders (SUD) seem to reflect a general vulnerability to externalizing behaviors. Recent studies have characterized this vulnerability on a continuous scale, rather than as distinct categories, suggesting that the revision of the…

  1. The relation between external governance environment and over-investment: Evidence from industry regulation

    Directory of Open Access Journals (Sweden)

    Kejing Chen

    2014-11-01

    Full Text Available Based on the Law and Finance theory, and the regulatory capture theory, external governance environment and industrial regulations can exert a certain influence on corporate over-investment. On the basis of qualitative analysis of the relationship between external governance environment and corporate over-investment under different industrial regulation conditions, this paper, using data of non-financial companies listed in Shanghai and Shenzhen Stock Exchanges in the period 2001-2010, describes the regional distribution characteristics of over-investment of Chinese listed companies, and establishes an OLS regression model of the relationship between external governance environment and over-investment. The study respectively groups data from regulated and non-regulated industries as a sample and empirically tests the OLS regression model. Results show that: from the perspective of economic geography, there exists a local spatial cluster phenomenon in the distribution of over-investment of listed companies in regulated industries, while non-regulated industries conform to no regularity. In regulated industries, external governance environment factors (level of government intervention, rule of law and financial development may exert a significant negative influence on the degree of over-investment of listed companies, but on non-regulated industries, their effect is reversed. Also, government intervention, legal enforcement and financial development are positively correlated to over-investment. Further research indicates that, compared with government intervention and financial development, legal enforcement influences over-investment the most.

  2. External causes of euro zone inflation differentials : A re-examniation of the evidence

    NARCIS (Netherlands)

    Arnold, I.J.M.; Verhoef, B.

    2004-01-01

    This article focuses on external causes of Euro Zone inflation differential. Persistent inflation differences may influence inflationary expectations and can amplify regional business cycles. With a uniform nominal interest rate, the domestic real interest rates will be lower in high inflation

  3. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria.

    Science.gov (United States)

    Parvizi, Javad; Tan, Timothy L; Goswami, Karan; Higuera, Carlos; Della Valle, Craig; Chen, Antonia F; Shohat, Noam

    2018-05-01

    The introduction of the Musculoskeletal Infection Society (MSIS) criteria for periprosthetic joint infection (PJI) in 2011 resulted in improvements in diagnostic confidence and research collaboration. The emergence of new diagnostic tests and the lessons we have learned from the past 7 years using the MSIS definition, prompted us to develop an evidence-based and validated updated version of the criteria. This multi-institutional study of patients undergoing revision total joint arthroplasty was conducted at 3 academic centers. For the development of the new diagnostic criteria, PJI and aseptic patient cohorts were stringently defined: PJI cases were defined using only major criteria from the MSIS definition (n = 684) and aseptic cases underwent one-stage revision for a noninfective indication and did not fail within 2 years (n = 820). Serum C-reactive protein (CRP), D-dimer, erythrocyte sedimentation rate were investigated, as well as synovial white blood cell count, polymorphonuclear percentage, leukocyte esterase, alpha-defensin, and synovial CRP. Intraoperative findings included frozen section, presence of purulence, and isolation of a pathogen by culture. A stepwise approach using random forest analysis and multivariate regression was used to generate relative weights for each diagnostic marker. Preoperative and intraoperative definitions were created based on beta coefficients. The new definition was then validated on an external cohort of 222 patients with PJI who subsequently failed with reinfection and 200 aseptic patients. The performance of the new criteria was compared to the established MSIS and the prior International Consensus Meeting definitions. Two positive cultures or the presence of a sinus tract were considered as major criteria and diagnostic of PJI. The calculated weights of an elevated serum CRP (>1 mg/dL), D-dimer (>860 ng/mL), and erythrocyte sedimentation rate (>30 mm/h) were 2, 2, and 1 points, respectively. Furthermore, elevated

  4. External validation of the clinical dehydration scale for children with acute gastroenteritis.

    Science.gov (United States)

    Bailey, Benoit; Gravel, Jocelyn; Goldman, Ran D; Friedman, Jeremy N; Parkin, Patricia C

    2010-06-01

    The objective was to validate the clinical dehydration scale (CDS) for children with gastroenteritis in a different pediatric emergency department (ED) from where it was initially derived and validated. A prospective cohort study was performed in a tertiary care pediatric ED over a 1-year period. A sample of triage nurses were trained in applying the CDS. The CDS consists of four clinical characteristics (general appearance, eyes, mucous membranes, and tears), each of which are scored 0, 1, or 2 for a total score of 0 to 8, with 0 representing no dehydration; 1 to 4, some dehydration; and 5 to 8, moderate/severe dehydration. Children 1 month to 5 years of age with vomiting and/or diarrhea who had the CDS documented at triage and a final diagnosis of gastroenteritis, gastritis, or enteritis were enrolled. Exclusion criteria included a chronic disease, treatment with intravenous (IV) rehydration within the previous 24 hours, visit to the ED for the same illness in the 7 days prior to arrival, and diarrhea of more than 10 days' duration. The primary outcome was the length of stay (LOS) in the ED from the time of seeing a physician to discharge, analyzed with a Kruskal-Wallis test. From April 2008 to March 2009, 150 patients with a mean (+/-SD) age of 22 (+/-14) months (range = 4 months to 4 years) were enrolled. Fifty-six patients had no dehydration, 74 had some dehydration, and 20 had moderate/severe dehydration. The median LOS in the ED after being seen by a physician was significantly longer as children appeared more dehydrated according to the CDS: 54 minutes (interquartile range [IQR] = 26-175 minutes), 128 minutes (IQR = 25-334 minutes), and 425 minutes (IQR = 218-673 minutes) for the no, some, and moderate/severe dehydration groups, respectively (p children with gastroenteritis in a different pediatric center than the original one where it was developed. It is a good predictor of LOS in the ED after being seen by a physician. (c) 2010 by the Society for

  5. External Validation and Optimization of International Consensus Clinical Target Volumes for Adjuvant Radiation Therapy in Bladder Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Reddy, Abhinav V. [Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, Illinois (United States); Christodouleas, John P. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Wu, Tianming [Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, Illinois (United States); Smith, Norman D.; Steinberg, Gary D. [Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois (United States); Liauw, Stanley L., E-mail: sliauw@radonc.uchicago.edu [Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, Illinois (United States)

    2017-03-15

    Purpose: International consensus (IC) clinical target volumes (CTVs) have been proposed to standardize radiation field design in the treatment of patients at high risk of locoregional failure (LRF) after radical cystectomy. The purpose of this study was to externally validate the IC CTVs in a cohort of postsurgical patients followed up for LRF and identify revisions that might improve the IC CTVs' performance. Methods and Materials: Among 334 patients with pT3 to pT4 bladder cancer treated with radical cystectomy, LRF developed in 58 (17%), of whom 52 had computed tomography scans available for review. Images with LRF were exported into a treatment planning system, and IC CTVs were contoured and evaluated for adequacy of coverage of each LRF with respect to both the patient and each of 6 pelvic subsites: common iliac (CI) region, obturator region (OR), external and internal iliac region, presacral region, cystectomy bed, or other pelvic site. Revisions to the IC contours were proposed based on the findings. Results: Of the 52 patients with documented LRF, 13 (25%) had LRFs that were outside of the IC CTV involving 17 pelvic subsites: 5 near the CI CTV, 5 near the OR CTV, 1 near the external and internal iliac region, and 6 near the cystectomy bed. The 5 CI failures were located superior to the CTV, and the 5 OR failures were located medial to the CTV. Increasing the superior boundary of the CI to a vessel-based definition of the aortic bifurcation, as well as increasing the medial extension of the OR by an additional 9 mm, decreased the number of patients with LRF outside of the IC CTV to 7 (13%). Conclusions: Modified IC CTVs inclusive of a slight adjustment superiorly for the CI region and medially for the OR may reduce the risk of pelvic failure in patients treated with adjuvant radiation therapy.

  6. Development and external multicenter validation of Chinese Prostate Cancer Consortium prostate cancer risk calculator for initial prostate biopsy.

    Science.gov (United States)

    Chen, Rui; Xie, Liping; Xue, Wei; Ye, Zhangqun; Ma, Lulin; Gao, Xu; Ren, Shancheng; Wang, Fubo; Zhao, Lin; Xu, Chuanliang; Sun, Yinghao

    2016-09-01

    Substantial differences exist in the relationship of prostate cancer (PCa) detection rate and prostate-specific antigen (PSA) level between Western and Asian populations. Classic Western risk calculators, European Randomized Study for Screening of Prostate Cancer Risk Calculator, and Prostate Cancer Prevention Trial Risk Calculator, were shown to be not applicable in Asian populations. We aimed to develop and validate a risk calculator for predicting the probability of PCa and high-grade PCa (defined as Gleason Score sum 7 or higher) at initial prostate biopsy in Chinese men. Urology outpatients who underwent initial prostate biopsy according to the inclusion criteria were included. The multivariate logistic regression-based Chinese Prostate Cancer Consortium Risk Calculator (CPCC-RC) was constructed with cases from 2 hospitals in Shanghai. Discriminative ability, calibration and decision curve analysis were externally validated in 3 CPCC member hospitals. Of the 1,835 patients involved, PCa was identified in 338/924 (36.6%) and 294/911 (32.3%) men in the development and validation cohort, respectively. Multivariate logistic regression analyses showed that 5 predictors (age, logPSA, logPV, free PSA ratio, and digital rectal examination) were associated with PCa (Model 1) or high-grade PCa (Model 2), respectively. The area under the curve of Model 1 and Model 2 was 0.801 (95% CI: 0.771-0.831) and 0.826 (95% CI: 0.796-0.857), respectively. Both models illustrated good calibration and substantial improvement in decision curve analyses than any single predictors at all threshold probabilities. Higher predicting accuracy, better calibration, and greater clinical benefit were achieved by CPCC-RC, compared with European Randomized Study for Screening of Prostate Cancer Risk Calculator and Prostate Cancer Prevention Trial Risk Calculator in predicting PCa. CPCC-RC performed well in discrimination and calibration and decision curve analysis in external validation compared

  7. External validation of the Cardiff model of information sharing to reduce community violence: natural experiment.

    Science.gov (United States)

    Boyle, Adrian A; Snelling, Katrina; White, Laura; Ariel, Barak; Ashelford, Lawrence

    2013-12-01

    Community violence is a substantial problem for the NHS. Information sharing of emergency department data with community safety partnerships (CSP) has been associated with substantial reductions in assault attendances in emergency departments supported by academic institutions. We sought to validate these findings in a setting not supported by a public health or academic structure. We instituted anonymous data sharing with the police to reduce community violence, and increased involvement with the local CSP. We measured the effectiveness of this approach with routinely collected data at the emergency department and the police. We used police data from 2009, and emergency department data from 2000. Initially, the number of assault patients requiring emergency department treatment rose after we initiated data sharing. After improving the data flows, the number of assault patients fell back to the predata-sharing level. There was no change in the number of hospital admissions during the study period. There were decreases in the numbers of violent crimes against the person, with and without injury, recorded by the police. We have successfully implemented data sharing in our institution without the support of an academic institution. This has been associated with reductions in violent crime, but it is not clear whether this association is causal.

  8. External validation of structure-biodegradation relationship (SBR) models for predicting the biodegradability of xenobiotics.

    Science.gov (United States)

    Devillers, J; Pandard, P; Richard, B

    2013-01-01

    Biodegradation is an important mechanism for eliminating xenobiotics by biotransforming them into simple organic and inorganic products. Faced with the ever growing number of chemicals available on the market, structure-biodegradation relationship (SBR) and quantitative structure-biodegradation relationship (QSBR) models are increasingly used as surrogates of the biodegradation tests. Such models have great potential for a quick and cheap estimation of the biodegradation potential of chemicals. The Estimation Programs Interface (EPI) Suite™ includes different models for predicting the potential aerobic biodegradability of organic substances. They are based on different endpoints, methodologies and/or statistical approaches. Among them, Biowin 5 and 6 appeared the most robust, being derived from the largest biodegradation database with results obtained only from the Ministry of International Trade and Industry (MITI) test. The aim of this study was to assess the predictive performances of these two models from a set of 356 chemicals extracted from notification dossiers including compatible biodegradation data. Another set of molecules with no more than four carbon atoms and substituted by various heteroatoms and/or functional groups was also embodied in the validation exercise. Comparisons were made with the predictions obtained with START (Structural Alerts for Reactivity in Toxtree). Biowin 5 and Biowin 6 gave satisfactorily prediction results except for the prediction of readily degradable chemicals. A consensus model built with Biowin 1 allowed the diminution of this tendency.

  9. Validation of Likelihood Ratio Methods Used for Forensic Evidence Evaluation: Application in Forensic Fingerprints

    NARCIS (Netherlands)

    Haraksim, Rudolf

    2014-01-01

    In this chapter the Likelihood Ratio (LR) inference model will be introduced, the theoretical aspects of probabilities will be discussed and the validation framework for LR methods used for forensic evidence evaluation will be presented. Prior to introducing the validation framework, following

  10. Evaluating Existing and New Validity Evidence for the Academic Motivation Scale

    Science.gov (United States)

    Fairchild, Amanda J.; Horst, S. Jeanne; Finney, Sara J.; Barron, Kenneth E.

    2005-01-01

    The current study evaluates existing and new validity evidence for the Academic Motivation Scale (AMS; Vallerand et al., 1992). We first provide a narrative review synthesizing past research, and then conduct a validity investigation of the scores from the measure. Data analysis using a sample of 1406 American college students provided construct…

  11. Importance of Statistical Evidence in Estimating Valid DEA Scores.

    Science.gov (United States)

    Barnum, Darold T; Johnson, Matthew; Gleason, John M

    2016-03-01

    Data Envelopment Analysis (DEA) allows healthcare scholars to measure productivity in a holistic manner. It combines a production unit's multiple outputs and multiple inputs into a single measure of its overall performance relative to other units in the sample being analyzed. It accomplishes this task by aggregating a unit's weighted outputs and dividing the output sum by the unit's aggregated weighted inputs, choosing output and input weights that maximize its output/input ratio when the same weights are applied to other units in the sample. Conventional DEA assumes that inputs and outputs are used in different proportions by the units in the sample. So, for the sample as a whole, inputs have been substituted for each other and outputs have been transformed into each other. Variables are assigned different weights based on their marginal rates of substitution and marginal rates of transformation. If in truth inputs have not been substituted nor outputs transformed, then there will be no marginal rates and therefore no valid basis for differential weights. This paper explains how to statistically test for the presence of substitutions among inputs and transformations among outputs. Then, it applies these tests to the input and output data from three healthcare DEA articles, in order to identify the effects on DEA scores when input substitutions and output transformations are absent in the sample data. It finds that DEA scores are badly biased when substitution and transformation are absent and conventional DEA models are used.

  12. Modification and validation of an analytical source model for external beam radiotherapy Monte Carlo dose calculations

    Energy Technology Data Exchange (ETDEWEB)

    Davidson, Scott E., E-mail: sedavids@utmb.edu [Radiation Oncology, The University of Texas Medical Branch, Galveston, Texas 77555 (United States); Cui, Jing [Radiation Oncology, University of Southern California, Los Angeles, California 90033 (United States); Kry, Stephen; Ibbott, Geoffrey S.; Followill, David S. [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 (United States); Deasy, Joseph O. [Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York 10065 (United States); Vicic, Milos [Department of Applied Physics, University of Belgrade, Belgrade 11000 (Serbia); White, R. Allen [Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030 (United States)

    2016-08-15

    Purpose: A dose calculation tool, which combines the accuracy of the dose planning method (DPM) Monte Carlo code and the versatility of a practical analytical multisource model, which was previously reported has been improved and validated for the Varian 6 and 10 MV linear accelerators (linacs). The calculation tool can be used to calculate doses in advanced clinical application studies. One shortcoming of current clinical trials that report dose from patient plans is the lack of a standardized dose calculation methodology. Because commercial treatment planning systems (TPSs) have their own dose calculation algorithms and the clinical trial participant who uses these systems is responsible for commissioning the beam model, variation exists in the reported calculated dose distributions. Today’s modern linac is manufactured to tight specifications so that variability within a linac model is quite low. The expectation is that a single dose calculation tool for a specific linac model can be used to accurately recalculate dose from patient plans that have been submitted to the clinical trial community from any institution. The calculation tool would provide for a more meaningful outcome analysis. Methods: The analytical source model was described by a primary point source, a secondary extra-focal source, and a contaminant electron source. Off-axis energy softening and fluence effects were also included. The additions of hyperbolic functions have been incorporated into the model to correct for the changes in output and in electron contamination with field size. A multileaf collimator (MLC) model is included to facilitate phantom and patient dose calculations. An offset to the MLC leaf positions was used to correct for the rudimentary assumed primary point source. Results: Dose calculations of the depth dose and profiles for field sizes 4 × 4 to 40 × 40 cm agree with measurement within 2% of the maximum dose or 2 mm distance to agreement (DTA) for 95% of the data

  13. Foreign direct investment, institutional development, and environmental externalities: evidence from China.

    Science.gov (United States)

    Wang, Danny T; Chen, Wendy Y

    2014-03-15

    The question of how foreign direct investment (FDI) affects a host country's natural environment has generated much debate but little consensus. Building on an institution-based theory, this article examines how the institutional development of a host setting affects the degree of FDI-related environmental externalities in China (specifically, industrial sulfur dioxide emissions). With a panel data set of 287 Chinese cities, over the period 2002-2009, this study reveals that FDI in general induces negative environmental externalities. Investments from OECD countries increase sulfur dioxide emissions, whereas FDI from Hong Kong, Macau, and Taiwan shows no significant effect. Institutional development reduces the impacts of FDI across the board. By focusing on the moderating role of institutions, this study sheds new light on the long-debated relationships among FDI, institutions, and the environments of the host countries. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Antisocial peer affiliation and externalizing disorders: Evidence for Gene × Environment × Development interaction.

    Science.gov (United States)

    Samek, Diana R; Hicks, Brian M; Keyes, Margaret A; Iacono, William G; McGue, Matt

    2017-02-01

    Gene × Environment interaction contributes to externalizing disorders in childhood and adolescence, but little is known about whether such effects are long lasting or present in adulthood. We examined gene-environment interplay in the concurrent and prospective associations between antisocial peer affiliation and externalizing disorders (antisocial behavior and substance use disorders) at ages 17, 20, 24, and 29. The sample included 1,382 same-sex twin pairs participating in the Minnesota Twin Family Study. We detected a Gene × Environment interaction at age 17, such that additive genetic influences on antisocial behavior and substance use disorders were greater in the context of greater antisocial peer affiliation. This Gene × Environment interaction was not present for antisocial behavior symptoms after age 17, but it was for substance use disorder symptoms through age 29 (though effect sizes were largest at age 17). The results suggest adolescence is a critical period for the development of externalizing disorders wherein exposure to greater environmental adversity is associated with a greater expression of genetic risk. This form of Gene × Environment interaction may persist through young adulthood for substance use disorders, but it appears to be limited to adolescence for antisocial behavior.

  15. [Accidents and violence in childhood: survey evidence of emergency care for external causes--Brazil, 2009].

    Science.gov (United States)

    Malta, Deborah Carvalho; Mascarenhas, Márcio Dênis Medeiros; Bernal, Regina Tomie Ivata; Viegas, Anna Paula Bise; de Sá, Naiza Nayla Bandeira; da Silva Junior, Jarbas Barbosa

    2012-09-01

    Understanding the characteristics and magnitude of accidents and violence due to external causes in children from 0 to 9 years of age is becoming ever more important in Public Health. The scope of this paper was to analyze emergency care for accidents due to external causes in children. The Sentinel Urgency and Emergency Services of the Violence and Accident Vigilance System (VIVA Survey), performed in 74 urgency services in the Federal District and 23 State capitals in 2009 was used. Data of 7,123 children were analyzed: 6,897 (96.7%) victims of accidents and 226 (3.3%) of violence. In comparison with victims of violence, the visits for accidents were more frequent among white children from 2 to 5 years old occurring in the home (p accidents, falls and burns predominated in the 0 to 1group, while traffic accidents were most frequent in the 6 to 9-year-old age group (p < 0.001). With respect to violence, the visits for neglect and physical assault predominated, respectively, in extreme age groups, with someone in the family being the perpetrator (p < 0.001). Information on the occurrence of external causes in children may support health promotion policies, besides guiding health professionals, teachers and families in the prevention of such causes.

  16. Antisocial Peer Affiliation and Externalizing Disorders: Evidence for Gene × Environment × Development Interaction

    Science.gov (United States)

    Samek, Diana R.; Hicks, Brian M.; Keyes, Margaret A.; Iacono, William G.; McGue, Matt

    2016-01-01

    Gene × environment interaction contributes to externalizing disorders in adolescence, but little is known about whether such effects are long-lasting or present in adulthood. We examined gene-environment interplay in the concurrent and prospective associations between antisocial peer affiliation and externalizing disorders (antisocial behavior and substance use disorders) at ages 17, 20, 24, and 29. The sample included 1,382 same-sex twin pairs participating in the Minnesota Twin Family Study. We detected a gene × environment interaction at age 17, such that additive genetic influences on antisocial behavior and substance use disorders were greater in the context of greater antisocial peer affiliation. This gene × environment interaction was not present for antisocial behavior symptoms after age 17, but was for substance use disorder symptoms through age 29 (though effect sizes were largest at age 17). Results suggest adolescence is a critical period for the development of externalizing disorders wherein exposure to greater environmental adversity is associated with a greater expression of genetic risk. This form of gene × environment interaction may persist through young adulthood for substance use disorders, but is limited to adolescence for antisocial behavior. PMID:27580681

  17. easyCBM® Reading Criterion Related Validity Evidence: Grades K-1. Technical Report #1309

    Science.gov (United States)

    Lai, Cheng-Fei; Alonzo, Julie; Tindal, Gerald

    2013-01-01

    In this technical report, we present the results of a study to gather criterion-related evidence for Grade K-1 easyCBM® reading measures. We used correlations to examine the relation between the easyCBM® measures and other published measures with known reliability and validity evidence, including the Dynamic Indicators of Basic Early Literacy…

  18. easyCBM® Reading Criterion Related Validity Evidence: Grades 2-5. Technical Report #1310

    Science.gov (United States)

    Lai, Cheng-Fei; Alonzo, Julie; Tindal, Gerald

    2013-01-01

    In this technical report, we present the results of a study to gather criterion-related evidence for Grade 2-5 easyCBM® reading measures. We used correlations to examine the relation between the easyCBM® measures and other published measures with known reliability and validity evidence, including the Gates-MacGinitie Reading Tests and the Dynamic…

  19. External validation of the endometriosis fertility index (EFI) staging system for predicting non-ART pregnancy after endometriosis surgery.

    Science.gov (United States)

    Tomassetti, C; Geysenbergh, B; Meuleman, C; Timmerman, D; Fieuws, S; D'Hooghe, T

    2013-05-01

    Can the ability of the endometriosis fertility index (EFI) to predict non-assisted reproductive technology (ART) pregnancy after endometriosis surgery be confirmed by an external validation study? The significant relationship between the EFI score and the time to non-ART pregnancy observed in our study represents an external validation of this scoring system. The EFI was previously developed and tested prospectively in a single center, but up to now no external validation has been published. Our data provide validation of the EFI in an external fertility unit on a robust scientific basis, to identify couples with a good prognosis for spontaneous conception who can therefore defer ART treatment, regardless of their revised American Fertility Society (rAFS) endometriosis staging. Retrospective cohort study where the EFI was calculated based on history and detailed surgical findings, and related to pregnancy outcome in 233 women attempting non-ART conception immediately after surgery; all data used for EFI calculation and analysis of reproductive outcome had been collected prospectively as part of another study. The EFI score was calculated (score 0-10) for 233 women with all rAFS endometriosis stages (minimal-mild, n = 75; moderate-severe, n = 158) after endometriosis surgery (1 September 2006-30 September 2010) in a university hospital-based reproductive medicine unit with combined expertise in reproductive surgery and medically assisted reproduction. All participants attempted non-ART conception immediately after surgery by natural intercourse, ovulation induction with timed intercourse or intrauterine insemination (with or without ovulation induction or controlled ovarian stimulation). All analyses were performed for three different definitions of pregnancy [overall (any HCG >25 IU/l), clinical and ongoing >20 weeks]. Six groups were distinguished (EFI scores 1-3, 4, 5, 6, 7+8, 9+10), and Kaplan-Meier (K-M) estimates for cumulative pregnancy rate were calculated

  20. External validation and calibration of IVFpredict: a national prospective cohort study of 130,960 in vitro fertilisation cycles.

    Directory of Open Access Journals (Sweden)

    Andrew D A C Smith

    Full Text Available Accurately predicting the probability of a live birth after in vitro fertilisation (IVF is important for patients, healthcare providers and policy makers. Two prediction models (Templeton and IVFpredict have been previously developed from UK data and are widely used internationally. The more recent of these, IVFpredict, was shown to have greater predictive power in the development dataset. The aim of this study was external validation of the two models and comparison of their predictive ability.130,960 IVF cycles undertaken in the UK in 2008-2010 were used to validate and compare the Templeton and IVFpredict models. Discriminatory power was calculated using the area under the receiver-operator curve and calibration assessed using a calibration plot and Hosmer-Lemeshow statistic. The scaled modified Brier score, with measures of reliability and resolution, were calculated to assess overall accuracy. Both models were compared after updating for current live birth rates to ensure that the average observed and predicted live birth rates were equal. The discriminative power of both methods was comparable: the area under the receiver-operator curve was 0.628 (95% confidence interval (CI: 0.625-0.631 for IVFpredict and 0.616 (95% CI: 0.613-0.620 for the Templeton model. IVFpredict had markedly better calibration and higher diagnostic accuracy, with calibration plot intercept of 0.040 (95% CI: 0.017-0.063 and slope of 0.932 (95% CI: 0.839-1.025 compared with 0.080 (95% CI: 0.044-0.117 and 1.419 (95% CI: 1.149-1.690 for the Templeton model. Both models underestimated the live birth rate, but this was particularly marked in the Templeton model. Updating the models to reflect improvements in live birth rates since the models were developed enhanced their performance, but IVFpredict remained superior.External validation in a large population cohort confirms IVFpredict has superior discrimination and calibration for informing patients, clinicians and

  1. Physical activity promotion in Latin American populations: a systematic review on issues of internal and external validity.

    Science.gov (United States)

    Galaviz, Karla I; Harden, Samantha M; Smith, Erin; Blackman, Kacie Ca; Berrey, Leanna M; Mama, Scherezade K; Almeida, Fabio A; Lee, Rebecca E; Estabrooks, Paul A

    2014-06-17

    The purpose of this review was to determine the degree to which physical activity interventions for Latin American populations reported on internal and external validity factors using the RE-AIM framework (reach & representativeness, effectiveness, adoption, implementation, maintenance). We systematically identified English (PubMed; EbscoHost) and Spanish (SCIELO; Biblioteca Virtual en Salud) language studies published between 2001 and 2012 that tested physical activity, exercise, or fitness promotion interventions in Latin American populations. Cross-sectional/descriptive studies, conducted in Brazil or Spain, published in Portuguese, not including a physical activity/fitness/exercise outcome, and with one time point assessment were excluded. We reviewed 192 abstracts and identified 46 studies that met the eligibility criteria (34 in English, 12 in Spanish). A validated 21-item RE-AIM abstraction tool was used to determine the quality of reporting across studies (0-7 = low, 8-14 = moderate, and 15-21 = high). The number of indicators reported ranged from 3-14 (mean = 8.1 ± 2.6), with the majority of studies falling in the moderate quality reporting category. English and Spanish language articles did not differ on the number of indicators reported (8.1 vs. 8.3, respectively). However, Spanish articles reported more across reach indicators (62% vs. 43% of indicators), while English articles reported more across effectiveness indicators (69% vs 62%). Across RE-AIM dimensions, indicators for reach (48%), efficacy/effectiveness (67%), and implementation (41%) were reported more often than indicators of adoption (25%) and maintenance (10%). Few studies reported on the representativeness of participants, staff that delivered interventions, or the settings where interventions were adopted. Only 13% of the studies reported on quality of life and/or potential negative outcomes, 20% reported on intervention fidelity, and 11% on cost of implementation

  2. External validation of the Intensive Care National Audit & Research Centre (ICNARC) risk prediction model in critical care units in Scotland.

    Science.gov (United States)

    Harrison, David A; Lone, Nazir I; Haddow, Catriona; MacGillivray, Moranne; Khan, Angela; Cook, Brian; Rowan, Kathryn M

    2014-01-01

    Risk prediction models are used in critical care for risk stratification, summarising and communicating risk, supporting clinical decision-making and benchmarking performance. However, they require validation before they can be used with confidence, ideally using independently collected data from a different source to that used to develop the model. The aim of this study was to validate the Intensive Care National Audit & Research Centre (ICNARC) model using independently collected data from critical care units in Scotland. Data were extracted from the Scottish Intensive Care Society Audit Group (SICSAG) database for the years 2007 to 2009. Recoding and mapping of variables was performed, as required, to apply the ICNARC model (2009 recalibration) to the SICSAG data using standard computer algorithms. The performance of the ICNARC model was assessed for discrimination, calibration and overall fit and compared with that of the Acute Physiology And Chronic Health Evaluation (APACHE) II model. There were 29,626 admissions to 24 adult, general critical care units in Scotland between 1 January 2007 and 31 December 2009. After exclusions, 23,269 admissions were included in the analysis. The ICNARC model outperformed APACHE II on measures of discrimination (c index 0.848 versus 0.806), calibration (Hosmer-Lemeshow chi-squared statistic 18.8 versus 214) and overall fit (Brier's score 0.140 versus 0.157; Shapiro's R 0.652 versus 0.621). Model performance was consistent across the three years studied. The ICNARC model performed well when validated in an external population to that in which it was developed, using independently collected data.

  3. Update of the German Diabetes Risk Score and external validation in the German MONICA/KORA study.

    Science.gov (United States)

    Mühlenbruch, Kristin; Ludwig, Tonia; Jeppesen, Charlotte; Joost, Hans-Georg; Rathmann, Wolfgang; Meisinger, Christine; Peters, Annette; Boeing, Heiner; Thorand, Barbara; Schulze, Matthias B

    2014-06-01

    Several published diabetes prediction models include information about family history of diabetes. The aim of this study was to extend the previously developed German Diabetes Risk Score (GDRS) with family history of diabetes and to validate the updated GDRS in the Multinational MONItoring of trends and determinants in CArdiovascular Diseases (MONICA)/German Cooperative Health Research in the Region of Augsburg (KORA) study. We used data from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study for extending the GDRS, including 21,846 participants. Within 5 years of follow-up 492 participants developed diabetes. The definition of family history included information about the father, the mother and/or sibling/s. Model extension was evaluated by discrimination and reclassification. We updated the calculation of the score and absolute risks. External validation was performed in the MONICA/KORA study comprising 11,940 participants with 315 incident cases after 5 years of follow-up. The basic ROC-AUC of 0.856 (95%-CI: 0.842-0.870) was improved by 0.007 (0.003-0.011) when parent and sibling history was included in the GDRS. The net reclassification improvement was 0.110 (0.072-0.149), respectively. For the updated score we demonstrated good calibration across all tenths of risk. In MONICA/KORA, the ROC-AUC was 0.837 (0.819-0.855); regarding calibration we saw slight overestimation of absolute risks. Inclusion of the number of diabetes-affected parents and sibling history improved the prediction of type 2 diabetes. Therefore, we updated the GDRS algorithm accordingly. Validation in another German cohort study showed good discrimination and acceptable calibration for the vast majority of individuals. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. A guideline for the validation of likelihood ratio methods used for forensic evidence evaluation.

    Science.gov (United States)

    Meuwly, Didier; Ramos, Daniel; Haraksim, Rudolf

    2017-07-01

    This Guideline proposes a protocol for the validation of forensic evaluation methods at the source level, using the Likelihood Ratio framework as defined within the Bayes' inference model. In the context of the inference of identity of source, the Likelihood Ratio is used to evaluate the strength of the evidence for a trace specimen, e.g. a fingermark, and a reference specimen, e.g. a fingerprint, to originate from common or different sources. Some theoretical aspects of probabilities necessary for this Guideline were discussed prior to its elaboration, which started after a workshop of forensic researchers and practitioners involved in this topic. In the workshop, the following questions were addressed: "which aspects of a forensic evaluation scenario need to be validated?", "what is the role of the LR as part of a decision process?" and "how to deal with uncertainty in the LR calculation?". The questions: "what to validate?" focuses on the validation methods and criteria and "how to validate?" deals with the implementation of the validation protocol. Answers to these questions were deemed necessary with several objectives. First, concepts typical for validation standards [1], such as performance characteristics, performance metrics and validation criteria, will be adapted or applied by analogy to the LR framework. Second, a validation strategy will be defined. Third, validation methods will be described. Finally, a validation protocol and an example of validation report will be proposed, which can be applied to the forensic fields developing and validating LR methods for the evaluation of the strength of evidence at source level under the following propositions. Copyright © 2016. Published by Elsevier B.V.

  5. Understanding the dynamics of correct and error responses in free recall: evidence from externalized free recall.

    Science.gov (United States)

    Unsworth, Nash; Brewer, Gene A; Spillers, Gregory J

    2010-06-01

    The dynamics of correct and error responses in a variant of delayed free recall were examined in the present study. In the externalized free recall paradigm, participants were presented with lists of words and were instructed to subsequently recall not only the words that they could remember from the most recently presented list, but also any other words that came to mind during the recall period. Externalized free recall is useful for elucidating both sampling and postretrieval editing processes, thereby yielding more accurate estimates of the total number of error responses, which are typically sampled and subsequently edited during free recall. The results indicated that the participants generally sampled correct items early in the recall period and then transitioned to sampling more erroneous responses. Furthermore, the participants generally terminated their search after sampling too many errors. An examination of editing processes suggested that the participants were quite good at identifying errors, but this varied systematically on the basis of a number of factors. The results from the present study are framed in terms of generate-edit models of free recall.

  6. When Assessment Data Are Words: Validity Evidence for Qualitative Educational Assessments.

    Science.gov (United States)

    Cook, David A; Kuper, Ayelet; Hatala, Rose; Ginsburg, Shiphra

    2016-10-01

    Quantitative scores fail to capture all important features of learner performance. This awareness has led to increased use of qualitative data when assessing health professionals. Yet the use of qualitative assessments is hampered by incomplete understanding of their role in forming judgments, and lack of consensus in how to appraise the rigor of judgments therein derived. The authors articulate the role of qualitative assessment as part of a comprehensive program of assessment, and translate the concept of validity to apply to judgments arising from qualitative assessments. They first identify standards for rigor in qualitative research, and then use two contemporary assessment validity frameworks to reorganize these standards for application to qualitative assessment.Standards for rigor in qualitative research include responsiveness, reflexivity, purposive sampling, thick description, triangulation, transparency, and transferability. These standards can be reframed using Messick's five sources of validity evidence (content, response process, internal structure, relationships with other variables, and consequences) and Kane's four inferences in validation (scoring, generalization, extrapolation, and implications). Evidence can be collected and evaluated for each evidence source or inference. The authors illustrate this approach using published research on learning portfolios.The authors advocate a "methods-neutral" approach to assessment, in which a clearly stated purpose determines the nature of and approach to data collection and analysis. Increased use of qualitative assessments will necessitate more rigorous judgments of the defensibility (validity) of inferences and decisions. Evidence should be strategically sought to inform a coherent validity argument.

  7. Predictors of outcome after elective endovascular abdominal aortic aneurysm repair and external validation of a risk prediction model.

    Science.gov (United States)

    Wisniowski, Brendan; Barnes, Mary; Jenkins, Jason; Boyne, Nicholas; Kruger, Allan; Walker, Philip J

    2011-09-01

    Endovascular abdominal aortic aneurysm (AAA) repair (EVAR) has been associated with lower operative mortality and morbidity than open surgery but comparable long-term mortality and higher delayed complication and reintervention rates. Attention has therefore been directed to identifying preoperative and operative variables that influence outcomes after EVAR. Risk-prediction models, such as the EVAR Risk Assessment (ERA) model, have also been developed to help surgeons plan EVAR procedures. The aims of this study were (1) to describe outcomes of elective EVAR at the Royal Brisbane and Women's Hospital (RBWH), (2) to identify preoperative and operative variables predictive of outcomes after EVAR, and (3) to externally validate the ERA model. All elective EVAR procedures at the RBWH before July 1, 2009, were reviewed. Descriptive analyses were performed to determine the outcomes. Univariate and multivariate analyses were performed to identify preoperative and operative variables predictive of outcomes after EVAR. Binomial logistic regression analyses were used to externally validate the ERA model. Before July 1, 2009, 197 patients (172 men), who were a mean age of 72.8 years, underwent elective EVAR at the RBWH. Operative mortality was 1.0%. Survival was 81.1% at 3 years and 63.2% at 5 years. Multivariate analysis showed predictors of survival were age (P = .0126), American Society of Anesthesiologists (ASA) score (P = .0180), and chronic obstructive pulmonary disease (P = .0348) at 3 years and age (P = .0103), ASA score (P = .0006), renal failure (P = .0048), and serum creatinine (P = .0022) at 5 years. Aortic branch vessel score was predictive of initial (30-day) type II endoleak (P = .0015). AAA tortuosity was predictive of midterm type I endoleak (P = .0251). Female sex was associated with lower rates of initial clinical success (P = .0406). The ERA model fitted RBWH data well for early death (C statistic = .906), 3-year survival (C statistic = .735), 5-year

  8. Modeling and simulation of maintenance treatment in first-line non-small cell lung cancer with external validation

    International Nuclear Information System (INIS)

    Han, Kelong; Claret, Laurent; Sandler, Alan; Das, Asha; Jin, Jin; Bruno, Rene

    2016-01-01

    Maintenance treatment (MTx) in responders following first-line treatment has been investigated and practiced for many cancers. Modeling and simulation may support interpretation of interim data and development decisions. We aimed to develop a modeling framework to simulate overall survival (OS) for MTx in NSCLC using tumor growth inhibition (TGI) data. TGI metrics were estimated using longitudinal tumor size data from two Phase III first-line NSCLC studies evaluating bevacizumab and erlotinib as MTx in 1632 patients. Baseline prognostic factors and TGI metric estimates were assessed in multivariate parametric models to predict OS. The OS model was externally validated by simulating a third independent NSCLC study (n = 253) based on interim TGI data (up to progression-free survival database lock). The third study evaluated pemetrexed + bevacizumab vs. bevacizumab alone as MTx. Time-to-tumor-growth (TTG) was the best TGI metric to predict OS. TTG, baseline tumor size, ECOG score, Asian ethnicity, age, and gender were significant covariates in the final OS model. The OS model was qualified by simulating OS distributions and hazard ratios (HR) in the two studies used for model-building. Simulations of the third independent study based on interim TGI data showed that pemetrexed + bevacizumab MTx was unlikely to significantly prolong OS vs. bevacizumab alone given the current sample size (predicted HR: 0.81; 95 % prediction interval: 0.59–1.09). Predicted median OS was 17.3 months and 14.7 months in both arms, respectively. These simulations are consistent with the results of the final OS analysis published 2 years later (observed HR: 0.87; 95 % confidence interval: 0.63–1.21). Final observed median OS was 17.1 months and 13.2 months in both arms, respectively, consistent with our predictions. A robust TGI-OS model was developed for MTx in NSCLC. TTG captures treatment effect. The model successfully predicted the OS outcomes of an independent study based on interim

  9. Modeling and simulation of maintenance treatment in first-line non-small cell lung cancer with external validation.

    Science.gov (United States)

    Han, Kelong; Claret, Laurent; Sandler, Alan; Das, Asha; Jin, Jin; Bruno, Rene

    2016-07-13

    Maintenance treatment (MTx) in responders following first-line treatment has been investigated and practiced for many cancers. Modeling and simulation may support interpretation of interim data and development decisions. We aimed to develop a modeling framework to simulate overall survival (OS) for MTx in NSCLC using tumor growth inhibition (TGI) data. TGI metrics were estimated using longitudinal tumor size data from two Phase III first-line NSCLC studies evaluating bevacizumab and erlotinib as MTx in 1632 patients. Baseline prognostic factors and TGI metric estimates were assessed in multivariate parametric models to predict OS. The OS model was externally validated by simulating a third independent NSCLC study (n = 253) based on interim TGI data (up to progression-free survival database lock). The third study evaluated pemetrexed + bevacizumab vs. bevacizumab alone as MTx. Time-to-tumor-growth (TTG) was the best TGI metric to predict OS. TTG, baseline tumor size, ECOG score, Asian ethnicity, age, and gender were significant covariates in the final OS model. The OS model was qualified by simulating OS distributions and hazard ratios (HR) in the two studies used for model-building. Simulations of the third independent study based on interim TGI data showed that pemetrexed + bevacizumab MTx was unlikely to significantly prolong OS vs. bevacizumab alone given the current sample size (predicted HR: 0.81; 95 % prediction interval: 0.59-1.09). Predicted median OS was 17.3 months and 14.7 months in both arms, respectively. These simulations are consistent with the results of the final OS analysis published 2 years later (observed HR: 0.87; 95 % confidence interval: 0.63-1.21). Final observed median OS was 17.1 months and 13.2 months in both arms, respectively, consistent with our predictions. A robust TGI-OS model was developed for MTx in NSCLC. TTG captures treatment effect. The model successfully predicted the OS outcomes of an independent study

  10. External Validity of Randomized Controlled Trials on Alzheimer’s Disease: The Biases of Frailty and Biological Aging

    Directory of Open Access Journals (Sweden)

    Marco Canevelli

    2017-11-01

    Full Text Available To date, the external validity of randomized controlled trials (RCTs on Alzheimer’s disease (AD has been assessed only considering monodimensional variables. Nevertheless, looking at isolated and single characteristics cannot guarantee a sufficient level of appreciation of the AD patients’ complexity. The only way to understand whether the two worlds (i.e., research and clinics deal with the same type of patients is to adopt multidimensional approaches more holistically reflecting the biological age of the individual. In the present study, we compared measures of frailty/biological aging [assessed by a Frailty Index (FI] of a sample of patients with AD resulted eligible and subsequently included in phase III RCTs compared to patients referring to the same clinical service, but not considered for inclusion. The “RCT sample” and the “real world sample” were found to be statistically similar for all the considered sociodemographic and clinical variables. Nevertheless, the “real world sample” was found to be significantly frailer compared to the “RCT sample,” as indicated by higher FI scores [0.28 (SD 0.1 vs. 0.17 (SD 0.1; p < 0.001, respectively]. Moreover, when assessing the relationship between FI and age, we found that the correlation was almost null in the “RCT sample” (Spearman’s r = 0.01; p = 0.98, while it was statistically significant in the “real world sample” (r = 0.49; p = 0.02. The application of too rigid designs may result in the poor representativeness of RCT samples. It may even imply the study of a condition biologically different from that observed in the “real world.” The adoption of multidimensional measures capable to capture the individual’s biological age may facilitate evaluating the external validity of clinical studies, implicitly improving the interpretation of the results and their translation in the clinical arena.

  11. Divestments in Banking. Preliminary Evidence on the Role of External Factors

    Directory of Open Access Journals (Sweden)

    Krzysztof Jackowicz

    2011-06-01

    Full Text Available Divestment constitutes an important method of corporate restructuring. Despite this fact, the banking literature on divestment is very limited. In this text, we try to remediate partially to the shortcomings of the existing literature by examining empirically the role of external factors. Using a large sample of 313 transactions, we have established that parent companies originate from countries with relatively high accumulated wealth, slow GDP growth, stable macroeconomic situation and dominant bank intermediation in financial system. The acquirers in turn come from poorer countries with faster economic growth and relatively more market-oriented financial systems. Those results broadly conform with the predictions of three hypotheses formulated in the text, namely the weak performance hypothesis, the corporate governance hypothesis and the rebalancing hypothesis.

  12. Functional Role of Internal and External Visual Imagery: Preliminary Evidences from Pilates

    Directory of Open Access Journals (Sweden)

    Simone Montuori

    2018-01-01

    Full Text Available The present study investigates whether a functional difference between the visualization of a sequence of movements in the perspective of the first- (internal VMI-I or third- (external VMI-E person exists, which might be relevant to promote learning. By using a mental chronometry experimental paradigm, we have compared the time or execution, imagination in the VMI-I perspective, and imagination in the VMI-E perspective of two kinds of Pilates exercises. The analysis was carried out in individuals with different levels of competence (expert, novice, and no-practice individuals. Our results showed that in the Expert group, in the VMI-I perspective, the imagination time was similar to the execution time, while in the VMI-E perspective, the imagination time was significantly lower than the execution time. An opposite pattern was found in the Novice group, in which the time of imagination was similar to that of execution only in the VMI-E perspective, while in the VMI-I perspective, the time of imagination was significantly lower than the time of execution. In the control group, the times of both modalities of imagination were significantly lower than the execution time for each exercise. The present data suggest that, while the VMI-I serves to train an already internalised gesture, the VMI-E perspective could be useful to learn, and then improve, the recently acquired sequence of movements. Moreover, visual imagery is not useful for individuals that lack a specific motor experience. The present data offer new insights in the application of mental training techniques, especially in field of sports. However, further investigations are needed to better understand the functional role of internal and external visual imagery.

  13. Functional Role of Internal and External Visual Imagery: Preliminary Evidences from Pilates

    Science.gov (United States)

    Montuori, Simone; Sorrentino, Pierpaolo; Belloni, Lidia; Sorrentino, Giuseppe

    2018-01-01

    The present study investigates whether a functional difference between the visualization of a sequence of movements in the perspective of the first- (internal VMI-I) or third- (external VMI-E) person exists, which might be relevant to promote learning. By using a mental chronometry experimental paradigm, we have compared the time or execution, imagination in the VMI-I perspective, and imagination in the VMI-E perspective of two kinds of Pilates exercises. The analysis was carried out in individuals with different levels of competence (expert, novice, and no-practice individuals). Our results showed that in the Expert group, in the VMI-I perspective, the imagination time was similar to the execution time, while in the VMI-E perspective, the imagination time was significantly lower than the execution time. An opposite pattern was found in the Novice group, in which the time of imagination was similar to that of execution only in the VMI-E perspective, while in the VMI-I perspective, the time of imagination was significantly lower than the time of execution. In the control group, the times of both modalities of imagination were significantly lower than the execution time for each exercise. The present data suggest that, while the VMI-I serves to train an already internalised gesture, the VMI-E perspective could be useful to learn, and then improve, the recently acquired sequence of movements. Moreover, visual imagery is not useful for individuals that lack a specific motor experience. The present data offer new insights in the application of mental training techniques, especially in field of sports. However, further investigations are needed to better understand the functional role of internal and external visual imagery. PMID:29849565

  14. External factors affecting decision-making and use of evidence in an Australian public health policy environment.

    Science.gov (United States)

    Zardo, Pauline; Collie, Alex; Livingstone, Charles

    2014-05-01

    This study examined external factors affecting policy and program decision-making in a specific public health policy context: injury prevention and rehabilitation compensation in the Australian state of Victoria. The aim was twofold: identify external factors that affect policy and program decision-making in this specific context; use this evidence to inform targeting of interventions aimed at increasing research use in this context. Qualitative interviews were undertaken from June 2011 to January 2012 with 33 employees from two state government agencies. Key factors identified were stakeholder feedback and action, government and ministerial input, legal feedback and action, injured persons and the media. The identified external factors were able to significantly influence policy and program decision-making processes: acting as both barriers and facilitators, depending on the particular issue at hand. The factors with the most influence were the Minister and government, lawyers, and agency stakeholders, particularly health providers, trade unions and employer groups. This research revealed that interventions aimed at increasing use of research in this context must target and harness the influence of these groups. This research provides critical insights for researchers seeking to design interventions to increase use of research in policy environments and influence decision-making in Victorian injury prevention and rehabilitation compensation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Predicting Overall Survival After Stereotactic Ablative Radiation Therapy in Early-Stage Lung Cancer: Development and External Validation of the Amsterdam Prognostic Model

    Energy Technology Data Exchange (ETDEWEB)

    Louie, Alexander V., E-mail: Dr.alexlouie@gmail.com [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Department of Radiation Oncology, London Regional Cancer Program, University of Western Ontario, London, Ontario (Canada); Department of Epidemiology, Harvard School of Public Health, Harvard University, Boston, Massachusetts (United States); Haasbeek, Cornelis J.A. [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Mokhles, Sahar [Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam (Netherlands); Rodrigues, George B. [Department of Radiation Oncology, London Regional Cancer Program, University of Western Ontario, London, Ontario (Canada); Stephans, Kevin L. [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Lagerwaard, Frank J. [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Palma, David A. [Department of Radiation Oncology, London Regional Cancer Program, University of Western Ontario, London, Ontario (Canada); Videtic, Gregory M.M. [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Warner, Andrew [Department of Radiation Oncology, London Regional Cancer Program, University of Western Ontario, London, Ontario (Canada); Takkenberg, Johanna J.M. [Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam (Netherlands); Reddy, Chandana A. [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Maat, Alex P.W.M. [Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam (Netherlands); Woody, Neil M. [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Slotman, Ben J.; Senan, Suresh [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands)

    2015-09-01

    Purpose: A prognostic model for 5-year overall survival (OS), consisting of recursive partitioning analysis (RPA) and a nomogram, was developed for patients with early-stage non-small cell lung cancer (ES-NSCLC) treated with stereotactic ablative radiation therapy (SABR). Methods and Materials: A primary dataset of 703 ES-NSCLC SABR patients was randomly divided into a training (67%) and an internal validation (33%) dataset. In the former group, 21 unique parameters consisting of patient, treatment, and tumor factors were entered into an RPA model to predict OS. Univariate and multivariate models were constructed for RPA-selected factors to evaluate their relationship with OS. A nomogram for OS was constructed based on factors significant in multivariate modeling and validated with calibration plots. Both the RPA and the nomogram were externally validated in independent surgical (n=193) and SABR (n=543) datasets. Results: RPA identified 2 distinct risk classes based on tumor diameter, age, World Health Organization performance status (PS) and Charlson comorbidity index. This RPA had moderate discrimination in SABR datasets (c-index range: 0.52-0.60) but was of limited value in the surgical validation cohort. The nomogram predicting OS included smoking history in addition to RPA-identified factors. In contrast to RPA, validation of the nomogram performed well in internal validation (r{sup 2}=0.97) and external SABR (r{sup 2}=0.79) and surgical cohorts (r{sup 2}=0.91). Conclusions: The Amsterdam prognostic model is the first externally validated prognostication tool for OS in ES-NSCLC treated with SABR available to individualize patient decision making. The nomogram retained strong performance across surgical and SABR external validation datasets. RPA performance was poor in surgical patients, suggesting that 2 different distinct patient populations are being treated with these 2 effective modalities.

  16. Implementation lessons: the importance of assessing organizational "fit" and external factors when implementing evidence-based teen pregnancy prevention programs.

    Science.gov (United States)

    Demby, Hilary; Gregory, Alethia; Broussard, Marsha; Dickherber, Jennifer; Atkins, Shantice; Jenner, Lynne W

    2014-03-01

    In recent years, the demand for evidence-based teen pregnancy prevention programs has increased, but practitioners often struggle to replicate and implement them as designed in real-world community settings. The purpose of this article is to describe the barriers and facilitators encountered during pilot year attempts to implement an evidence-based teen pregnancy prevention program within three types of organizations: (1) small community-based organizations; (2) a school-based organization; and (3) a large decentralized city-sponsored summer youth program. We frame our discussion of these experiences within the context of a systemic, multilevel framework for implementation consisting of (1) core implementation components; (2) organizational components; and (3) external factors. This article explores the organizational and external implementation factors we experienced during the implementation process, describes our lessons learned throughout this process, and offers strategies for other practitioners to proactively address these factors from the start of program planning. These findings may provide useful insight for other organizations looking to implement multi-session, group-level interventions with fidelity. Copyright © 2014 Society for Adolescent Health and Medicine. All rights reserved.

  17. Evaluating the predictive accuracy and the clinical benefit of a nomogram aimed to predict survival in node-positive prostate cancer patients: External validation on a multi-institutional database.

    Science.gov (United States)

    Bianchi, Lorenzo; Schiavina, Riccardo; Borghesi, Marco; Bianchi, Federico Mineo; Briganti, Alberto; Carini, Marco; Terrone, Carlo; Mottrie, Alex; Gacci, Mauro; Gontero, Paolo; Imbimbo, Ciro; Marchioro, Giansilvio; Milanese, Giulio; Mirone, Vincenzo; Montorsi, Francesco; Morgia, Giuseppe; Novara, Giacomo; Porreca, Angelo; Volpe, Alessandro; Brunocilla, Eugenio

    2018-04-06

    To assess the predictive accuracy and the clinical value of a recent nomogram predicting cancer-specific mortality-free survival after surgery in pN1 prostate cancer patients through an external validation. We evaluated 518 prostate cancer patients treated with radical prostatectomy and pelvic lymph node dissection with evidence of nodal metastases at final pathology, at 10 tertiary centers. External validation was carried out using regression coefficients of the previously published nomogram. The performance characteristics of the model were assessed by quantifying predictive accuracy, according to the area under the curve in the receiver operating characteristic curve and model calibration. Furthermore, we systematically analyzed the specificity, sensitivity, positive predictive value and negative predictive value for each nomogram-derived probability cut-off. Finally, we implemented decision curve analysis, in order to quantify the nomogram's clinical value in routine practice. External validation showed inferior predictive accuracy as referred to in the internal validation (65.8% vs 83.3%, respectively). The discrimination (area under the curve) of the multivariable model was 66.7% (95% CI 60.1-73.0%) by testing with receiver operating characteristic curve analysis. The calibration plot showed an overestimation throughout the range of predicted cancer-specific mortality-free survival rates probabilities. However, in decision curve analysis, the nomogram's use showed a net benefit when compared with the scenarios of treating all patients or none. In an external setting, the nomogram showed inferior predictive accuracy and suboptimal calibration characteristics as compared to that reported in the original population. However, decision curve analysis showed a clinical net benefit, suggesting a clinical implication to correctly manage pN1 prostate cancer patients after surgery. © 2018 The Japanese Urological Association.

  18. Validity evidence for the measurement of the strength of motivation for medical school.

    Science.gov (United States)

    Kusurkar, Rashmi; Croiset, Gerda; Kruitwagen, Cas; ten Cate, Olle

    2011-05-01

    The Strength of Motivation for Medical School (SMMS) questionnaire is designed to determine the strength of motivation of students particularly for medical study. This research was performed to establish the validity evidence for measuring strength of motivation for medical school. Internal structure and relations to other variables were used as the sources of validity evidence. The SMMS questionnaire was filled out by 1,494 medical students in different years of medical curriculum. The validity evidence for the internal structure was analyzed by principal components analysis with promax rotation. Validity evidence for relations to other variables was tested by comparing the SMMS scores with scores on the Academic Motivation Scale (AMS) and the exhaustion scale of Maslach Burnout Inventory-Student Survey (MBI-SS) for measuring study stress. Evidence for internal consistency was determined through the Cronbach's alpha for reliability. The analysis showed that the SMMS had a 3-factor structure. The validity in relations to other variables was established as both, the subscales and full scale scores significantly correlated positively with the intrinsic motivation scores and with the more autonomous forms of extrinsic motivation, the correlation decreasing and finally becoming negative towards the extrinsic motivation end of the spectrum. They also had significant negative correlations with amotivation scale of the AMS and exhaustion scale of MBI-SS. The Cronbach's alpha for reliability of the three subscales and full SMMS scores was 0.70, 0.67, 0.55 and 0.79. The strength of motivation for medical school has a three factor structure and acceptable validity evidence was found in our study.

  19. Protection of Mobile Agents Execution Using a Modified Self-Validating Branch-Based Software Watermarking with External Sentinel

    Science.gov (United States)

    Tomàs-Buliart, Joan; Fernández, Marcel; Soriano, Miguel

    Critical infrastructures are usually controlled by software entities. To monitor the well-function of these entities, a solution based in the use of mobile agents is proposed. Some proposals to detect modifications of mobile agents, as digital signature of code, exist but they are oriented to protect software against modification or to verify that an agent have been executed correctly. The aim of our proposal is to guarantee that the software is being executed correctly by a non trusted host. The way proposed to achieve this objective is by the improvement of the Self-Validating Branch-Based Software Watermarking by Myles et al.. The proposed modification is the incorporation of an external element called sentinel which controls branch targets. This technique applied in mobile agents can guarantee the correct operation of an agent or, at least, can detect suspicious behaviours of a malicious host during the execution of the agent instead of detecting when the execution of the agent have finished.

  20. External Validation of Risk Prediction Scores for Invasive Candidiasis in a Medical/Surgical Intensive Care Unit: An Observational Study

    Science.gov (United States)

    Ahmed, Armin; Baronia, Arvind Kumar; Azim, Afzal; Marak, Rungmei S. K.; Yadav, Reema; Sharma, Preeti; Gurjar, Mohan; Poddar, Banani; Singh, Ratender Kumar

    2017-01-01

    Background: The aim of this study was to conduct external validation of risk prediction scores for invasive candidiasis. Methods: We conducted a prospective observational study in a 12-bedded adult medical/surgical Intensive Care Unit (ICU) to evaluate Candida score >3, colonization index (CI) >0.5, corrected CI >0.4 (CCI), and Ostrosky's clinical prediction rule (CPR). Patients' characteristics and risk factors for invasive candidiasis were noted. Patients were divided into two groups; invasive candidiasis and no-invasive candidiasis. Results: Of 198 patients, 17 developed invasive candidiasis. Discriminatory power (area under receiver operator curve [AUROC]) for Candida score, CI, CCI, and CPR were 0.66, 0.67, 0.63, and 0.62, respectively. A large number of patients in the no-invasive candidiasis group (114 out of 181) were exposed to antifungal agents during their stay in ICU. Subgroup analysis was carried out after excluding such patients from no-invasive candidiasis group. AUROC of Candida score, CI, CCI, and CPR were 0.7, 0.7, 0.65, and 0.72, respectively, and positive predictive values (PPVs) were in the range of 25%–47%, along with negative predictive values (NPVs) in the range of 84%–96% in the subgroup analysis. Conclusion: Currently available risk prediction scores have good NPV but poor PPV. They are useful for selecting patients who are not likely to benefit from antifungal therapy. PMID:28904481

  1. External Validation of the ISAN, A2DS2, and AIS-APS Scores for Predicting Stroke-Associated Pneumonia.

    Science.gov (United States)

    Zapata-Arriaza, Elena; Moniche, Francisco; Blanca, Pardo-Galiana; Bustamante, Alejandro; Escudero-Martínez, Irene; Uclés, Oscar; Ollero-Ortiz, Ángela; Sánchez-García, Jose Antonio; Gamero, Miguel Ángel; Quesada, Ángeles; Vidal De Francisco, Diana; Romera, Mercedes; De la Cruz, Carlos; Sanz, Gema; Montaner, Joan

    2018-03-01

    The Prestroke Independence, Sex, Age, National Institutes of Health Stroke Scale (ISAN), Age, Atrial Fibrillation, Dysphagia, male sex, and National Institutes of Health Stroke Scale (A2DS2), and acute ischemic stroke-associated pneumonia score (AIS-APS) scores were created to predict stroke-associated pneumonia (SAP), one of the most important medical stroke complications. External validation of all such scores in an acute stroke population was the aim of our study. Patients with ischemic or hemorrhagic stroke were prospectively enrolled in the multicenter Stroke-Induced Pneumonia in Andalucía project between October 2014 and May 2016. Receiver operating characteristic curves and linear regression analyses were used to determine discrimination ability of the scores. The Hosmer-Lemeshow goodness-of-fit test and the plot of observed versus predicted SAP risk were used to assess model calibration. Among 201 included patients, SAP rate was 15.5% (31). Higher ISAN, A2DS2, and AIS-APS scores were related to SAP (all P manage SAP. The AIS-APS score would be recommendable for the development of future clinical trials. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  2. Analysis of risk factors for schizophrenia with two different case definitions: a nationwide register-based external validation study.

    Science.gov (United States)

    Sørensen, Holger J; Larsen, Janne T; Mors, Ole; Nordentoft, Merete; Mortensen, Preben B; Petersen, Liselotte

    2015-03-01

    Different case definitions of schizophrenia have been used in register based research. However, no previous study has externally validated two different case definitions of schizophrenia against a wide range of risk factors for schizophrenia. We investigated hazard ratios (HRs) for a wide range of risk factors for ICD-10 DCR schizophrenia using a nationwide Danish sample of 2,772,144 residents born in 1955-1997. We compared one contact only (OCO) (the case definition of schizophrenia used in Danish register based studies) with two or more contacts (TMC) (a case definition of at least 2 inpatient contacts with schizophrenia). During the follow-up, the OCO definition included 15,074 and the TMC 7562 cases; i.e. half as many. The TMC case definition appeared to select for a worse illness course. A wide range of risk factors were uniformly associated with both case definitions and only slightly higher risk estimates were found for the TMC definition. Choosing at least 2 inpatient contacts with schizophrenia (TMC) instead of the currently used case definition would result in almost similar risk estimates for many well-established risk factors. However, this would also introduce selection and include considerably fewer cases and reduce power of e.g. genetic studies based on register-diagnosed cases only. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Validation of an amino-acid-based radionuclide therapy plus external beam radiotherapy in heterotopic glioblastoma models

    Energy Technology Data Exchange (ETDEWEB)

    Israel, Ina [Department of Nuclear Medicine, University of Wuerzburg, D-97080 Wuerzburg (Germany); Blass, Georg [Department of Radiotherapy and Radiooncology, Saarland University Medical Center, Homburg (Germany); Reiners, Christoph [Department of Nuclear Medicine, University of Wuerzburg, D-97080 Wuerzburg (Germany); Samnick, Samuel, E-mail: samnick_s@klinik.uni-wuerzburg.d [Department of Nuclear Medicine, University of Wuerzburg, D-97080 Wuerzburg (Germany)

    2011-05-15

    Background and purpose: Malignant gliomas represent a major therapeutic challenge because no efficient treatment is currently available. p-[{sup 131}I]iodo-L-phenylalanine ([{sup 131}I]IPA) is a glioma avid radiopharmaceutical that demonstrated antiproliferative and tumoricidal effects in gliomas. The present study validated the therapeutic efficiency of [{sup 131}I]IPA combined with external beam radiotherapy in experimental gliomas. Materials and methods: Glioma cells derived from the primary human A1207, T5135, Tx3868 and M059K glioblastoma cell lines or rat F98 glioma cell line were treated with various doses of [{sup 131}I]IPA, external photon irradiation (RT) or combined [{sup 131}I]IPA/RT treatment. Responsiveness of glioma cells to the different therapy modalities was investigated at 24, 48 and 72 h after treatments by trypan blue, WST-1 assay, propidium iodide and bisbenzimide staining as well as by clonogenic assay. In addition, the therapy-induced DNA damage and repair were evaluated using phosphorylated histone H2AX ({gamma}-H2AX). In vivo, the effectiveness of the combination treatment was validated in human Tx3868 and A1207 glioblastoma xenografts in CD1 nu/nu mice and RNU rats. Results: In vitro, the combination treatment resulted in a greater than additive increase in cytotoxic effect in glioma cell lines. Cell survival rate following a treatment with 1.0 {mu}Ci (37 kBq) of [{sup 131}I]IPA amounted to 70%{+-}15% and 60%{+-}10% after 48 and 72 h, respectively, and decreased under 20% after additional RT with 5 Gy. At higher RT doses, cell survival rate decreased below 5%. As a measure of DNA double-strand break, nuclear {gamma}-H2AX foci were determined as a function of time. Within 24 h, the number of {gamma}-H2AX foci per cell was significantly greater after combined modality compared with the individual treatments. In vivo, when combined with RT, the radionuclide therapy with [{sup 131}I]IPA resulted in an extended tumor growth delay, a reduction

  4. Hypopituitarism after external irradiation. Evidence for both hypothalamic and pituitary origin

    International Nuclear Information System (INIS)

    Samaan, N.A.; Bakdash, M.M.; Caderao, J.B.; Cangir, A.; Jesse, R.H. Jr.; Ballantyne, A.J.

    1975-01-01

    Endocrine complications after radiotherapy for tumors of the head and neck are thought to be relatively rare. The availability of synthetic hypothalamic hormones for clinical investigations and the radioimmunoassay of hormones have enabled us to study function of the hypothalamic pituitary axis in 15 patients who had radiotherapy for nasopharyngeal cancer. Fourteen had evidence of endocrine deficiency. Twelve patients had evidence of hypothalamic dysfunction, 7 developed primary pituitary hormone deficiencies, and 3 developed primary hypothyroidism. These results indicate that (1) secondary hypopituitarism due to a hypothalamic lesion after radiotherapy for nasopharyngeal cancer may be more common than suspected in the past; (2) primary hypopituitarism after irradiation of extracranial tumors can occur; and (3) primary hypothyroidism may result from irradiation of regional neck nodes

  5. Reliability and validity evidence of the Assessment of Language Use in Social Contexts for Adults (ALUSCA).

    Science.gov (United States)

    Valente, Ana Rita S; Hall, Andreia; Alvelos, Helena; Leahy, Margaret; Jesus, Luis M T

    2018-04-12

    The appropriate use of language in context depends on the speaker's pragmatic language competencies. A coding system was used to develop a specific and adult-focused self-administered questionnaire to adults who stutter and adults who do not stutter, The Assessment of Language Use in Social Contexts for Adults, with three categories: precursors, basic exchanges, and extended literal/non-literal discourse. This paper presents the content validity, item analysis, reliability coefficients and evidences of construct validity of the instrument. Content validity analysis was based on a two-stage process: first, 11 pragmatic questionnaires were assessed to identify items that probe each pragmatic competency and to create the first version of the instrument; second, items were assessed qualitatively by an expert panel composed by adults who stutter and controls, and quantitatively and qualitatively by an expert panel composed by clinicians. A pilot study was conducted with five adults who stutter and five controls to analyse items and calculate reliability. Construct validity evidences were obtained using the hypothesized relationships method and factor analysis with 28 adults who stutter and 28 controls. Concerning content validity, the questionnaires assessed up to 13 pragmatic competencies. Qualitative and quantitative analysis revealed ambiguities in items construction. Disagreement between experts was solved through item modification. The pilot study showed that the instrument presented internal consistency and temporal stability. Significant differences between adults who stutter and controls and different response profiles revealed the instrument's underlying construct. The instrument is reliable and presented evidences of construct validity.

  6. Internal and External Dynamics in Language: Evidence from Verb Regularity in a Historical Corpus of English

    Science.gov (United States)

    Cuskley, Christine F.; Pugliese, Martina; Castellano, Claudio; Colaiori, Francesca; Loreto, Vittorio; Tria, Francesca

    2014-01-01

    Human languages are rule governed, but almost invariably these rules have exceptions in the form of irregularities. Since rules in language are efficient and productive, the persistence of irregularity is an anomaly. How does irregularity linger in the face of internal (endogenous) and external (exogenous) pressures to conform to a rule? Here we address this problem by taking a detailed look at simple past tense verbs in the Corpus of Historical American English. The data show that the language is open, with many new verbs entering. At the same time, existing verbs might tend to regularize or irregularize as a consequence of internal dynamics, but overall, the amount of irregularity sustained by the language stays roughly constant over time. Despite continuous vocabulary growth, and presumably, an attendant increase in expressive power, there is no corresponding growth in irregularity. We analyze the set of irregulars, showing they may adhere to a set of minority rules, allowing for increased stability of irregularity over time. These findings contribute to the debate on how language systems become rule governed, and how and why they sustain exceptions to rules, providing insight into the interplay between the emergence and maintenance of rules and exceptions in language. PMID:25084006

  7. Predicting new service adoption with conjoint analysis : External validity of BDM-based incentive-aligned and dual-response choice designs

    NARCIS (Netherlands)

    Wlömert, Nils; Eggers, Felix

    2016-01-01

    In this paper, we compare the standard, single-response choice-based con- joint (CBC) approach with three extended CBC procedures in terms of their external predictive validity and their ability to realistically capture consumers’ willingness to pay: (1) an incentive-aligned CBC mechanism (IA-CBC),

  8. Predictive Accuracy of the PanCan Lung Cancer Risk Prediction Model -External Validation based on CT from the Danish Lung Cancer Screening Trial

    NARCIS (Netherlands)

    Wille, M.M.W.; Riel, S.J. van; Saghir, Z.; Dirksen, A.; Pedersen, J.H.; Jacobs, C.; Thomsen, L.H.u.; Scholten, E.T.; Skovgaard, L.T.; Ginneken, B. van

    2015-01-01

    Lung cancer risk models should be externally validated to test generalizability and clinical usefulness. The Danish Lung Cancer Screening Trial (DLCST) is a population-based prospective cohort study, used to assess the discriminative performances of the PanCan models.From the DLCST database, 1,152

  9. External validation of two prediction models identifying employees at risk of high sickness absence : cohort study with 1-year follow-up

    NARCIS (Netherlands)

    Roelen, Corne A. M.; Bultmann, Ute; van Rhenen, Willem; van der Klink, Jac J. L.; Twisk, Jos W. R.; Heymans, Martijn W.

    2013-01-01

    Background: Two models including age, self-rated health (SRH) and prior sickness absence (SA) were found to predict high SA in health care workers. The present study externally validated these prediction models in a population of office workers and investigated the effect of adding gender as a

  10. A method for the statistical interpretation of friction ridge skin impression evidence: Method development and validation.

    Science.gov (United States)

    Swofford, H J; Koertner, A J; Zemp, F; Ausdemore, M; Liu, A; Salyards, M J

    2018-04-03

    The forensic fingerprint community has faced increasing amounts of criticism by scientific and legal commentators, challenging the validity and reliability of fingerprint evidence due to the lack of an empirically demonstrable basis to evaluate and report the strength of the evidence in a given case. This paper presents a method, developed as a stand-alone software application, FRStat, which provides a statistical assessment of the strength of fingerprint evidence. The performance was evaluated using a variety of mated and non-mated datasets. The results show strong performance characteristics, often with values supporting specificity rates greater than 99%. This method provides fingerprint experts the capability to demonstrate the validity and reliability of fingerprint evidence in a given case and report the findings in a more transparent and standardized fashion with clearly defined criteria for conclusions and known error rate information thereby responding to concerns raised by the scientific and legal communities. Published by Elsevier B.V.

  11. External Costs of Risky Health Behaviors Associated with Leading Actual Causes of Death in the U.S.: A Review of the Evidence and Implications for Future Research

    Directory of Open Access Journals (Sweden)

    Armineh Zohrabian

    2010-06-01

    Full Text Available This paper reviews the evidence on external costs of risky behaviors in the U.S. and provides a framework for estimating them. External costs arise when a person does not bear all the costs of his or her behavior. They provide one of the strongest rationales for government interventions. Although the earlier estimates of external costs no longer have policy relevance, they demonstrated that the existence of external costs was an empirical question. We recommend that the estimates of external costs be updated as insurance structures, environments, and knowledge about these behaviors change. The general aspects of external costs may apply to countries other than the U.S. after taking into account differences in institutional, policy and epidemiological characteristics.

  12. An Australian Version of the Neighborhood Environment Walkability Scale: Validity Evidence

    Science.gov (United States)

    Cerin, Ester; Leslie, Eva; Owen, Neville; Bauman, Adrian

    2008-01-01

    This study examined validity evidence for the Australian version of the Neighborhood Environment Walkability Scale (NEWS-AU). A stratified two-stage cluster sampling design was used to recruit 2,650 adults from Adelaide (Australia). The sample was drawn from residential addresses within eight high-walkable and eight low-walkable suburbs matched…

  13. Validity-Supporting Evidence of the Self-Efficacy for Teaching Mathematics Instrument

    Science.gov (United States)

    McGee, Jennifer R.; Wang, Chuang

    2014-01-01

    The purpose of this study is to provide evidence of reliability and validity of the Self-Efficacy for Teaching Mathematics Instrument (SETMI). Self-efficacy, as defined by Bandura, was the theoretical framework for the development of the instrument. The complex belief systems of mathematics teachers, as touted by Ernest provided insights into the…

  14. Logic Brightens My Day: Evidence for Implicit Sensitivity to Logical Validity

    Science.gov (United States)

    Trippas, Dries; Handley, Simon J.; Verde, Michael F.; Morsanyi, Kinga

    2016-01-01

    A key assumption of dual process theory is that reasoning is an explicit, effortful, deliberative process. The present study offers evidence for an implicit, possibly intuitive component of reasoning. Participants were shown sentences embedded in logically valid or invalid arguments. Participants were not asked to reason but instead rated the…

  15. A Brazilian Portuguese Survey of School Climate: Evidence of Validity and Reliability

    Science.gov (United States)

    Bear, George G.; Holst, Bruna; Lisboa, Carolina; Chen, Dandan; Yang, Chunyan; Chen, Fang Fang

    2016-01-01

    This study presents evidence of the validity and reliability of scores for the newly developed Brazilian Portuguese version of the Delaware School Climate Survey-Student (Brazilian DSCS-S). The sample consisted of 378 students, grades 5 through 9, attending four private and three public schools in southern Brazil. Confirmatory factor analyses…

  16. Validity Evidence for the Measurement of the Strength of Motivation for Medical School

    Science.gov (United States)

    Kusurkar, Rashmi; Croiset, Gerda; Kruitwagen, Cas; ten Cate, Olle

    2011-01-01

    The Strength of Motivation for Medical School (SMMS) questionnaire is designed to determine the strength of motivation of students particularly for medical study. This research was performed to establish the validity evidence for measuring strength of motivation for medical school. Internal structure and relations to other variables were used as…

  17. Measuring Students' Motivation: Validity Evidence for the MUSIC Model of Academic Motivation Inventory

    Science.gov (United States)

    Jones, Brett D.; Skaggs, Gary

    2016-01-01

    This study provides validity evidence for the MUSIC Model of Academic Motivation Inventory (MUSIC Inventory; Jones, 2012), which measures college students' beliefs related to the five components of the MUSIC Model of Motivation (MUSIC model; Jones, 2009). The MUSIC model is a conceptual framework for five categories of teaching strategies (i.e.,…

  18. Is the readmission rate a valid quality indicator? A review of the evidence

    NARCIS (Netherlands)

    Fischer, Claudia; Lingsma, Hester F.; Marang-van de Mheen, Perla J.; Kringos, Dionne S.; Klazinga, Niek S.; Steyerberg, Ewout W.

    2014-01-01

    Hospital readmission rates are increasingly used for both quality improvement and cost control. However, the validity of readmission rates as a measure of quality of hospital care is not evident. We aimed to give an overview of the different methodological aspects in the definition and measurement

  19. Validity Evidence for the Neuro-Endoscopic Ventriculostomy Assessment Tool (NEVAT)

    NARCIS (Netherlands)

    Breimer, Gerben E.; Haji, Faizal A.; Cinalli, Giuseppe; Hoving, Eelco W.; Drake, James M.

    BACKGROUND: Growing demand for transparent and standardized methods for evaluating surgical competence prompted the construction of the Neuro-Endoscopic Ventriculostomy Assessment Tool (NEVAT). OBJECTIVE: To provide validity evidence of the NEVAT by reporting on the tool's internal structure and its

  20. A Motor Speech Assessment for Children with Severe Speech Disorders: Reliability and Validity Evidence

    Science.gov (United States)

    Strand, Edythe A.; McCauley, Rebecca J.; Weigand, Stephen D.; Stoeckel, Ruth E.; Baas, Becky S.

    2013-01-01

    Purpose: In this article, the authors report reliability and validity evidence for the Dynamic Evaluation of Motor Speech Skill (DEMSS), a new test that uses dynamic assessment to aid in the differential diagnosis of childhood apraxia of speech (CAS). Method: Participants were 81 children between 36 and 79 months of age who were referred to the…

  1. Validity of 'post-traumatic stress disorder with secondary psychotic features': a review of the evidence

    NARCIS (Netherlands)

    Braakman, M. H.; Kortmann, F. A. M.; van den Brink, W.

    2009-01-01

    OBJECTIVE: To review the evidence from empirical studies regarding the validity of 'post-traumatic stress disorder with secondary psychotic features' (PTSD-SP) as a separate diagnostic entity. METHOD: The authors performed a review tracing publications between 1980 and January 2008. RESULTS:

  2. Validity evidence of the Social and Emotional Nationwide Assessment (SENNA 1.0 Inventory

    Directory of Open Access Journals (Sweden)

    Gina Pancorbo

    Full Text Available Abstract: Given the necessity of adequate instruments to measure socio-emotional skills, this study aimed to obtain validity evidence of the Social and Emotional Nationwide Assessment inventory (SENNA 1.0. The instrument was administered to a sample of 634 students (59% females with a mean age of 16.3 years (SD = 1.21, from eight secondary schools of the Federal District ] of Brazil. Exploratory factor analysis indicated a six factor structure that explained 42.7% of the common variance, while confirmatory factor analysis and exploratory structural equational modeling analysis showed a moderate fit to the data. Reliability coefficients of the factor scores varied between .66 and .89. The coefficients of the convergent validity with the Reduced Scale of the Big Five Personality Factors (ER5FP had a mean value of .59. In conclusion, the results indicate satisfactory evidence for the score validity of the SENNA 1.0 inventory.

  3. External validation and comparison of two variants of the Elixhauser comorbidity measures for all-cause mortality.

    Directory of Open Access Journals (Sweden)

    Yannick Fortin

    Full Text Available Assessing prevalent comorbidities is a common approach in health research for identifying clinical differences between individuals. The objective of this study was to validate and compare the predictive performance of two variants of the Elixhauser comorbidity measures (ECM for inhospital mortality at index and at 1-year in the Cerner Health Facts® (HF U.S.We estimated the prevalence of select comorbidities for individuals 18 to 89 years of age who received care at Cerner contributing health facilities between 2002 and 2011 using the AHRQ (version 3.7 and the Quan Enhanced ICD-9-CM ECMs. External validation of the ECMs was assessed with measures of discrimination [c-statistics], calibration [Hosmer-Lemeshow goodness-of-fit test, Brier Score, calibration curves], added predictive ability [Net Reclassification Improvement], and overall model performance [R2]. Of 3,273,298 patients with a mean age of 43.9 years and a female composition of 53.8%, 1.0% died during their index encounter and 1.5% were deceased at 1-year. Calibration measures were equivalent between the two ECMs. Calibration performance was acceptable when predicting inhospital mortality at index, although recalibration is recommended for predicting inhospital mortality at 1 year. Discrimination was marginally better with the Quan ECM compared the AHRQ ECM when predicting inhospital mortality at index (cQuan = 0.887, 95% CI: 0.885-0.889 vs. cAHRQ = 0.880, 95% CI: 0.878-0.882; p < .0001 and at 1-year (cQuan = 0.884, 95% CI: 0.883-0.886 vs. cAHRQ = 0.880, 95% CI: 0.878-0.881, p < .0001. Both the Quan and the AHRQ ECMs demonstrated excellent discrimination for inhospital mortality of all-causes in Cerner Health Facts®, a HIPAA compliant observational research and privacy-protected data warehouse. While differences in discrimination performance between the ECMs were statistically significant, they are not likely clinically meaningful.

  4. External validation of the ITA.LI.CA prognostic system for patients with hepatocellular carcinoma: A multicenter cohort study.

    Science.gov (United States)

    Borzio, Mauro; Dionigi, Elena; Rossini, Angelo; Marignani, Massimo; Sacco, Rodolfo; De Sio, Ilario; Bertolini, Emanuela; Francica, Giampiero; Giacomin, Anna; Parisi, Giancarlo; Vicari, Susanna; Toldi, Anna; Salmi, Andrea; Boccia, Sergio; Mitra, Mario; Fornari, Fabio

    2017-11-22

    Several staging systems for hepatocellular carcinoma (HCC) have been developed. The Barcelona Clinic Liver Cancer staging system is considered the best in predicting survival, although limitations have emerged. Recently, the Italian Liver Cancer (ITA.LI.CA) prognostic system, integrating ITA.LI.CA tumor staging (stages 0, A, B1-3, C) with the Child-Turcotte-Pugh score, Eastern Cooperative Oncology Group performance status, and alpha-fetoprotein with a strong ability to predict survival, was proposed. The aim of our study was to provide an external validation of the ITA.LI.CA system in an independent real-life occidental cohort of HCCs. From September 2008 to April 2016, 1,508 patients with cirrhosis and incident HCC were consecutively enrolled in 27 Italian institutions. Clinical, tumor, and treatment-related variables were collected, and patients were stratified according to scores of the Barcelona Clinic Liver Cancer system, ITA.LI.CA prognostic system, Hong Kong Liver Cancer system, Cancer of the Liver Italian Program, Japanese Integrated System, and model to estimate survival in ambulatory patients with hepatocellular carcinoma. Harrell's C-index, Akaike information criterion, and likelihood-ratio test were used to compare the predictive ability of the different systems. A subgroup analysis for treatment category (curative versus palliative) was performed. Median follow-up was 44 months (interquartile range, 23-63 months), and median overall survival was 34 months (interquartile range, 13-82 months). Median age was 71 years, and patients were mainly male individuals and hepatitis C virus carriers. According to ITA.LI.CA tumor staging, 246 patients were in stage 0, 472 were in stage A, 657 were in stages B1/3, and 133 were in stage C. The ITA.LI.CA prognostic system showed the best discriminatory ability (C-index = 0.77) and monotonicity of gradients compared to other systems, and its superiority was also confirmed after stratification for treatment strategy

  5. External Validation of Contact Surface Area as a Predictor of Postoperative Renal Function in Patients Undergoing Partial Nephrectomy.

    Science.gov (United States)

    Haifler, Miki; Ristau, Benjamin T; Higgins, Andrew M; Smaldone, Marc C; Kutikov, Alexander; Zisman, Amnon; Uzzo, Robert G

    2017-09-20

    We sought to externally validate a mathematical formula for tumor contact surface area as a predictor of postoperative renal function in patients undergoing partial nephrectomy for renal cell carcinoma. We queried a prospectively maintained kidney cancer database for patients who underwent partial nephrectomy between 2014 and 2016. Contact surface area was calculated using data obtained from preoperative cross-sectional imaging. The correlation between contact surface area and perioperative variables was examined. The correlation between postoperative renal functional outcomes, contact surface area and the R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines and tumor touches main renal artery or vein) nephrometry score was also assessed. A total of 257 patients who underwent partial nephrectomy had sufficient data to enter the study. Median contact surface area was 14.5 cm 2 (IQR 6.2-36) and the median nephrometry score was 9 (IQR 7-10). Spearman correlation analysis showed that contact surface area correlated with estimated blood loss (r s = 0.42, p contact surface area and nephrometry score were independent predictors of the absolute change in the estimated glomerular filtration rate (each p contact surface area was a better predictor of a greater than 20% postoperative decline in the estimated glomerular filtration rate compared with the nephrometry score (AUC 0.94 vs 0.80). Contact surface area correlated with the change in postoperative renal function after partial nephrectomy. It can be used in conjunction with the nephrometry score to counsel patients about the risk of renal functional decline after partial nephrectomy. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  6. Effort-Based Decision-Making Paradigms for Clinical Trials in Schizophrenia: Part 2—External Validity and Correlates.

    Science.gov (United States)

    Horan, William P; Reddy, L Felice; Barch, Deanna M; Buchanan, Robert W; Dunayevich, Eduardo; Gold, James M; Marder, Steven R; Wynn, Jonathan K; Young, Jared W; Green, Michael F

    2015-09-01

    Effort-based decision making has strong conceptual links to the motivational disturbances that define a key subdomain of negative symptoms. However, the extent to which effort-based decision-making performance relates to negative symptoms, and other clinical and functionally important variables has yet to be systematically investigated. In 94 clinically stable outpatients with schizophrenia, we examined the external validity of 5 effort-based paradigms, including the Effort Expenditure for Rewards, Balloon Effort, Grip Strength Effort, Deck Choice Effort, and Perceptual Effort tasks. These tasks covered 3 types of effort: physical, cognitive, and perceptual. Correlations between effort related performance and 6 classes of variables were examined, including: (1) negative symptoms, (2) clinically rated motivation and community role functioning, (3) self-reported motivational traits, (4) neurocognition, (5) other psychiatric symptoms and clinical/demographic characteristics, and (6) subjective valuation of monetary rewards. Effort paradigms showed small to medium relationships to clinical ratings of negative symptoms, motivation, and functioning, with the pattern more consistent for some measures than others. They also showed small to medium relations with neurocognitive functioning, but were generally unrelated to other psychiatric symptoms, self-reported traits, antipsychotic medications, side effects, and subjective valuation of money. There were relatively strong interrelationships among the effort measures. In conjunction with findings from a companion psychometric article, all the paradigms warrant further consideration and development, and 2 show the strongest potential for clinical trial use at this juncture. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  7. Teamwork assessment in internal medicine: a systematic review of validity evidence and outcomes.

    Science.gov (United States)

    Havyer, Rachel D A; Wingo, Majken T; Comfere, Nneka I; Nelson, Darlene R; Halvorsen, Andrew J; McDonald, Furman S; Reed, Darcy A

    2014-06-01

    Valid teamwork assessment is imperative to determine physician competency and optimize patient outcomes. We systematically reviewed published instruments assessing teamwork in undergraduate, graduate, and continuing medical education in general internal medicine and all medical subspecialties. We searched MEDLINE, MEDLINE In-process, CINAHL and PsycINFO from January 1979 through October 2012, references of included articles, and abstracts from four professional meetings. Two content experts were queried for additional studies. Included studies described quantitative tools measuring teamwork among medical students, residents, fellows, and practicing physicians on single or multi-professional (interprofessional) teams. Instrument validity and study quality were extracted using established frameworks with existing validity evidence. Two authors independently abstracted 30 % of articles and agreement was calculated. Of 12,922 citations, 178 articles describing 73 unique teamwork assessment tools met inclusion criteria. Interrater agreement was intraclass correlation coefficient 0.73 (95 % CI 0.63-0.81). Studies involved practicing physicians (142, 80 %), residents/fellows (70, 39 %), and medical students (11, 6 %). The majority (152, 85 %) assessed interprofessional teams. Studies were conducted in inpatient (77, 43 %), outpatient (42, 24 %), simulation (37, 21 %), and classroom (13, 7 %) settings. Validity evidence for the 73 tools included content (54, 74 %), internal structure (51, 70 %), relationships to other variables (25, 34 %), and response process (12, 16 %). Attitudes and opinions were the most frequently assessed outcomes. Relationships between teamwork scores and patient outcomes were directly examined for 13 (18 %) of tools. Scores from the Safety Attitudes Questionnaire and Team Climate Inventory have substantial validity evidence and have been associated with improved patient outcomes. Review is limited to quantitative assessments of teamwork in internal

  8. The behavioral regulation in sport questionnaire (BRSQ): instrument development and initial validity evidence.

    Science.gov (United States)

    Lonsdale, Chris; Hodge, Ken; Rose, Elaine A

    2008-06-01

    The purpose of the four studies described in this article was to develop and test a new measure of competitive sport participants' intrinsic motivation, extrinsic motivation, and amotivation (self-determination theory; Deci & Ryan, 1985). The items for the new measure, named the Behavioral Regulation in Sport Questionnaire (BRSQ), were constructed using interviews, expert review, and pilot testing. Analyses supported the internal consistency, test-retest reliability, and factorial validity of the BRSQ scores. Nomological validity evidence was also supportive, as BRSQ subscale scores were correlated in the expected pattern with scores derived from measures of motivational consequences. When directly compared with scores derived from the Sport Motivation Scale (SMS; Pelletier, Fortier, Vallerand, Tuson, & Blais, 1995) and a revised version of that questionnaire (SMS-6; Mallett, Kawabata, Newcombe, Otero-Forero, & Jackson, 2007), BRSQ scores demonstrated equal or superior reliability and factorial validity as well as better nomological validity.

  9. External Validation and Evaluation of Reliability and Validity of the Modified Seoul National University Renal Stone Complexity Scoring System to Predict Stone-Free Status After Retrograde Intrarenal Surgery.

    Science.gov (United States)

    Park, Juhyun; Kang, Minyong; Jeong, Chang Wook; Oh, Sohee; Lee, Jeong Woo; Lee, Seung Bae; Son, Hwancheol; Jeong, Hyeon; Cho, Sung Yong

    2015-08-01

    The modified Seoul National University Renal Stone Complexity scoring system (S-ReSC-R) for retrograde intrarenal surgery (RIRS) was developed as a tool to predict stone-free rate (SFR) after RIRS. We externally validated the S-ReSC-R. We retrospectively reviewed 159 patients who underwent RIRS. The S-ReSC-R was assigned from 1 to 12 according to the location and number of sites involved. The stone-free status was defined as no evidence of a stone or with clinically insignificant residual fragment stones less than 2 mm. Interobserver and test-retest reliabilities were evaluated. Statistical performance of the prediction model was assessed by its predictive accuracy, predictive probability, and clinical usefulness. Overall SFR was 73.0%. The SFRs were 86.7%, 70.2%, and 48.6% in low-score (1-2), intermediate-score (3-4), and high-score (5-12) groups, respectively (pR revealed an area under the curve (AUC) of 0.731 (95% CI 0.650-0.813). The AUC of the three-titered S-ReSC-R was 0.701 (95% CI 0.609-0.794). The calibration plot showed that the predicted probability of SFR had a concordance comparable to that of observed frequency. The Hosmer-Lemeshow goodness of fit test revealed a p-value of 0.01 for the S-ReSC-R and 0.90 for the three-titered S-ReSC-R. Interobserver and test-retest reliabilities revealed an almost perfect level of agreement. The present study proved the predictive value of S-ReSC-R to predict SFR following RIRS in an independent cohort. Interobserver and test-retest reliabilities confirmed that S-ReSC-R was reliable and valid.

  10. External validation of a publicly available computer assisted diagnostic tool for mammographic mass lesions with two high prevalence research datasets.

    Science.gov (United States)

    Benndorf, Matthias; Burnside, Elizabeth S; Herda, Christoph; Langer, Mathias; Kotter, Elmar

    2015-08-01

    Lesions detected at mammography are described with a highly standardized terminology: the breast imaging-reporting and data system (BI-RADS) lexicon. Up to now, no validated semantic computer assisted classification algorithm exists to interactively link combinations of morphological descriptors from the lexicon to a probabilistic risk estimate of malignancy. The authors therefore aim at the external validation of the mammographic mass diagnosis (MMassDx) algorithm. A classification algorithm like MMassDx must perform well in a variety of clinical circumstances and in datasets that were not used to generate the algorithm in order to ultimately become accepted in clinical routine. The MMassDx algorithm uses a naïve Bayes network and calculates post-test probabilities of malignancy based on two distinct sets of variables, (a) BI-RADS descriptors and age ("descriptor model") and (b) BI-RADS descriptors, age, and BI-RADS assessment categories ("inclusive model"). The authors evaluate both the MMassDx (descriptor) and MMassDx (inclusive) models using two large publicly available datasets of mammographic mass lesions: the digital database for screening mammography (DDSM) dataset, which contains two subsets from the same examinations-a medio-lateral oblique (MLO) view and cranio-caudal (CC) view dataset-and the mammographic mass (MM) dataset. The DDSM contains 1220 mass lesions and the MM dataset contains 961 mass lesions. The authors evaluate discriminative performance using area under the receiver-operating-characteristic curve (AUC) and compare this to the BI-RADS assessment categories alone (i.e., the clinical performance) using the DeLong method. The authors also evaluate whether assigned probabilistic risk estimates reflect the lesions' true risk of malignancy using calibration curves. The authors demonstrate that the MMassDx algorithms show good discriminatory performance. AUC for the MMassDx (descriptor) model in the DDSM data is 0.876/0.895 (MLO/CC view) and AUC

  11. Collecting Validity Evidence for Simulation-Based Assessment of Point-of-Care Ultrasound Skills

    DEFF Research Database (Denmark)

    Jensen, Jesper Kørup; Dyre, Liv; Jørgensen, Mattis Enggaard

    2017-01-01

    OBJECTIVES: The aim of this study was to examine the validity of a simulator test designed to evaluate focused assessment with sonography for trauma (FAST) skills. METHODS: Participants included a group of ultrasound novices (n = 25) and ultrasound experts (n = 10). All participants had their FAST...... skills assessed using a virtual reality ultrasound simulator. Procedural performance on the 4 FAST windows was assessed by automated simulator metrics, which received a passing or failing score. The validity evidence for these simulator metrics was examined by a stepwise approach according...

  12. External validation of the DRAGON score in an elderly Spanish population: prediction of stroke prognosis after IV thrombolysis.

    Science.gov (United States)

    Giralt-Steinhauer, Eva; Rodríguez-Campello, Ana; Cuadrado-Godia, Elisa; Ois, Ángel; Jiménez-Conde, Jordi; Soriano-Tárraga, Carolina; Roquer, Jaume

    2013-01-01

    Intravenous (i.v.) thrombolysis within 4.5 h of symptom onset has proven efficacy in acute ischemic stroke treatment, although half of all outcomes are unfavorable. The recently published DRAGON score aims to predict the 3-month outcome in stroke patients who have received i.v. alteplase. The purpose of this study was an external validation of the results of the DRAGON score in a Spanish cohort. Patients with acute stroke treated with alteplase were prospectively registered in our BasicMar database. We collected demographic characteristics, vascular risk factors, the time from stroke onset to treatment, baseline serum glucose levels and stroke severity for this population. We then reviewed hyperdense cerebral artery signs and signs of early infarct on the admission CT scan. We calculated the DRAGON score and used the developers' 3-month prognosis categories: good [modified Rankin Scale score (mRS) 0-2], poor (mRS 3-6) and miserable (mRS 5-6) outcome. Discrimination was tested using the area under the receiver operator curve (AUC-ROC). Calibration was assessed by the Hosmer-Lemeshow test. Our final cohort of 297 patients was older (median age 74 years, IQR 65-80) and had more risk factors and severe strokes [median National Institutes of Health Stroke Scale (NIHSS) points 13, IQR 7-19] than the original study population. Poor prognosis was observed in 143 (48.1%) patients. Higher DRAGON scores were associated with a higher risk of poor prognosis. None of our treated stroke patients with a DRAGON score ≥8 at admission experienced a favorable outcome after 3 months. All DRAGON variables were significantly associated with a worse outcome in the multivariate analysis except for onset-to-treatment time (p = 0.334). Discrimination to predict poor prognosis was very good (AUC-ROC 0.84) and the score had good Hosmer-Lemeshow calibration (p = 0.84). The DRAGON score is easy to perform and offers a rapid, reliable prediction of poor prognosis in acute-stroke patients

  13. External validation of the A2SD2 and ISAN scales for predicting infectious respiratory complications of ischaemic stroke.

    Science.gov (United States)

    Ramírez-Moreno, J M; Martínez-Acevedo, M; Cordova, R; Roa, A M; Constantino, A B; Ceberino, D; Muñoz, P

    2016-10-21

    Pneumonia as a complication of stroke is associated with poor outcomes. The A2DS2 and ISAN scales were developed by German and English researchers, respectively, to predict in-hospital stroke-associated pneumonia. We conducted an external validation study of these scales in a series of consecutive patients admitted to our hospital due to ischaemic stroke. These predictive models were applied to a sample of 340 consecutive patients admitted to hospital in 2015 due to stroke. Discrimination was assessed by calculating the area under the ROC curve for diagnostic efficacy. Calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test and graphing the corresponding curve. Logistic regression analysis was performed to determine the independent predictors of respiratory infection secondary to stroke. We included 285 patients, of whom 45 (15.8%) had respiratory infection after stroke according to the study criteria. Mean age was 71.01±12.62 years; men accounted for 177 of the patients (62.1%). Seventy-two patients (25.3%) had signs or symptoms of dysphagia, 42 (14.7%) had atrial fibrillation, and 14 (4.9%) were functionally dependent before stroke; the median NIHSS score was 4 points. Mean scores on A2DS2 and ISAN were 3.25±2.54 and 6.49±3.64, respectively. Our analysis showed that higher A2DS2 scores were associated with an increased risk of infection (OR=1.576; 95% CI: 1.363-1.821); the same was true for ISAN scores (OR=1.350; 95% CI: 1.214-1.501). High scores on A2DS2 and ISAN were found to be a strong predictor of respiratory infection associated with acute stroke in a cohort of consecutive patients with stroke. These easy-to-use scales are promising tools for predicting this complication in routine clinical practice. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Multisite external validation of a risk prediction model for the diagnosis of blood stream infections in febrile pediatric oncology patients without severe neutropenia.

    Science.gov (United States)

    Esbenshade, Adam J; Zhao, Zhiguo; Aftandilian, Catherine; Saab, Raya; Wattier, Rachel L; Beauchemin, Melissa; Miller, Tamara P; Wilkes, Jennifer J; Kelly, Michael J; Fernbach, Alison; Jeng, Michael; Schwartz, Cindy L; Dvorak, Christopher C; Shyr, Yu; Moons, Karl G M; Sulis, Maria-Luisa; Friedman, Debra L

    2017-10-01

    Pediatric oncology patients are at an increased risk of invasive bacterial infection due to immunosuppression. The risk of such infection in the absence of severe neutropenia (absolute neutrophil count ≥ 500/μL) is not well established and a validated prediction model for blood stream infection (BSI) risk offers clinical usefulness. A 6-site retrospective external validation was conducted using a previously published risk prediction model for BSI in febrile pediatric oncology patients without severe neutropenia: the Esbenshade/Vanderbilt (EsVan) model. A reduced model (EsVan2) excluding 2 less clinically reliable variables also was created using the initial EsVan model derivative cohort, and was validated using all 5 external validation cohorts. One data set was used only in sensitivity analyses due to missing some variables. From the 5 primary data sets, there were a total of 1197 febrile episodes and 76 episodes of bacteremia. The overall C statistic for predicting bacteremia was 0.695, with a calibration slope of 0.50 for the original model and a calibration slope of 1.0 when recalibration was applied to the model. The model performed better in predicting high-risk bacteremia (gram-negative or Staphylococcus aureus infection) versus BSI alone, with a C statistic of 0.801 and a calibration slope of 0.65. The EsVan2 model outperformed the EsVan model across data sets with a C statistic of 0.733 for predicting BSI and a C statistic of 0.841 for high-risk BSI. The results of this external validation demonstrated that the EsVan and EsVan2 models are able to predict BSI across multiple performance sites and, once validated and implemented prospectively, could assist in decision making in clinical practice. Cancer 2017;123:3781-3790. © 2017 American Cancer Society. © 2017 American Cancer Society.

  15. Real external predictivity of QSAR models: how to evaluate it? Comparison of different validation criteria and proposal of using the concordance correlation coefficient.

    Science.gov (United States)

    Chirico, Nicola; Gramatica, Paola

    2011-09-26

    The main utility of QSAR models is their ability to predict activities/properties for new chemicals, and this external prediction ability is evaluated by means of various validation criteria. As a measure for such evaluation the OECD guidelines have proposed the predictive squared correlation coefficient Q(2)(F1) (Shi et al.). However, other validation criteria have been proposed by other authors: the Golbraikh-Tropsha method, r(2)(m) (Roy), Q(2)(F2) (Schüürmann et al.), Q(2)(F3) (Consonni et al.). In QSAR studies these measures are usually in accordance, though this is not always the case, thus doubts can arise when contradictory results are obtained. It is likely that none of the aforementioned criteria is the best in every situation, so a comparative study using simulated data sets is proposed here, using threshold values suggested by the proponents or those widely used in QSAR modeling. In addition, a different and simple external validation measure, the concordance correlation coefficient (CCC), is proposed and compared with other criteria. Huge data sets were used to study the general behavior of validation measures, and the concordance correlation coefficient was shown to be the most restrictive. On using simulated data sets of a more realistic size, it was found that CCC was broadly in agreement, about 96% of the time, with other validation measures in accepting models as predictive, and in almost all the examples it was the most precautionary. The proposed concordance correlation coefficient also works well on real data sets, where it seems to be more stable, and helps in making decisions when the validation measures are in conflict. Since it is conceptually simple, and given its stability and restrictiveness, we propose the concordance correlation coefficient as a complementary, or alternative, more prudent measure of a QSAR model to be externally predictive.

  16. Development and external validation of a clinical prognostic score for death in visceral leishmaniasis patients in a high HIV co-infection burden area in Ethiopia.

    Directory of Open Access Journals (Sweden)

    Charles Abongomera

    Full Text Available In Ethiopia, case fatality rates among subgroups of visceral leishmaniasis (VL patients are high. A clinical prognostic score for death in VL patients could contribute to optimal management and reduction of these case fatality rates. We aimed to identify predictors of death from VL, and to develop and externally validate a clinical prognostic score for death in VL patients, in a high HIV co-infection burden area in Ethiopia.We conducted a retrospective cohort study in north west Ethiopia. Predictors with an adjusted likelihood ratio ≥1.5 or ≤0.67 were retained to calculate the predictor score. The derivation cohort consisted of 1686 VL patients treated at an upgraded health center and the external validation cohort consisted of 404 VL patients treated in hospital. There were 99 deaths in the derivation cohort and 53 deaths in the external validation cohort. The predictors of death were: age >40 years (score +1; HIV seropositive (score +1; HIV seronegative (score -1; hemoglobin ≤6.5 g/dl (score +1; bleeding (score +1; jaundice (score +1; edema (score +1; ascites (score +2 and tuberculosis (score +1. The total predictor score per patient ranged from -1 to +5. A score of -1, indicated a low risk of death (1.0%, a score of 0 an intermediate risk of death (3.8% and a score of +1 to +5, a high risk of death (10.4-85.7%. The area under the receiver operating characteristic curve was 0.83 (95% confidence interval: 0.79-0.87 in derivation, and 0.78 (95% confidence interval: 0.72-0.83 in external validation.The overall performance of the score was good. The score can enable the early detection of VL cases at high risk of death, which can inform operational, clinical management guidelines, and VL program management. Implementation of focused strategies could contribute to optimal management and reduction of the case fatality rates.

  17. External validation and clinical utility of a prediction model for 6-month mortality in patients undergoing hemodialysis for end-stage kidney disease.

    Science.gov (United States)

    Forzley, Brian; Er, Lee; Chiu, Helen Hl; Djurdjev, Ognjenka; Martinusen, Dan; Carson, Rachel C; Hargrove, Gaylene; Levin, Adeera; Karim, Mohamud

    2018-02-01

    End-stage kidney disease is associated with poor prognosis. Health care professionals must be prepared to address end-of-life issues and identify those at high risk for dying. A 6-month mortality prediction model for patients on dialysis derived in the United States is used but has not been externally validated. We aimed to assess the external validity and clinical utility in an independent cohort in Canada. We examined the performance of the published 6-month mortality prediction model, using discrimination, calibration, and decision curve analyses. Data were derived from a cohort of 374 prevalent dialysis patients in two regions of British Columbia, Canada, which included serum albumin, age, peripheral vascular disease, dementia, and answers to the "the surprise question" ("Would I be surprised if this patient died within the next year?"). The observed mortality in the validation cohort was 11.5% at 6 months. The prediction model had reasonable discrimination (c-stat = 0.70) but poor calibration (calibration-in-the-large = -0.53 (95% confidence interval: -0.88, -0.18); calibration slope = 0.57 (95% confidence interval: 0.31, 0.83)) in our data. Decision curve analysis showed the model only has added value in guiding clinical decision in a small range of threshold probabilities: 8%-20%. Despite reasonable discrimination, the prediction model has poor calibration in this external study cohort; thus, it may have limited clinical utility in settings outside of where it was derived. Decision curve analysis clarifies limitations in clinical utility not apparent by receiver operating characteristic curve analysis. This study highlights the importance of external validation of prediction models prior to routine use in clinical practice.

  18. Validity Evidence for the Reduced Version of the Young Parenting Inventory (YPI

    Directory of Open Access Journals (Sweden)

    Felipe Valentini

    2013-09-01

    Full Text Available To gain more insight in family processes, psychometrically tests are required. The present study aimed to adapt a reduced version of the Young Parenting Inventory (YPI to the Portuguese language and to obtain evidence of its validity. The instrument was administered to a sample of 920 persons (59% female with an average age of 21.3 years. Exploratory factor analysis indicated the existence of five factors explaining approximately 45% of the variance. Confirmatory factor analysis showed fit indices above.80. In comparison with other models, the five factor model showed a better fit to the data. Between the YPI and Familiograma (another test of family processes moderate correlations were observed. The results of this study suggest satisfactory evidence of the validity for the YPI in Brazil.

  19. Evidences of validity and reliability of the Luria-Nebraska Test for Children

    Directory of Open Access Journals (Sweden)

    Ricardo Franco de Lima

    2016-01-01

    Full Text Available Abstract This paper aimed to verify evidences of validity and reliability of Luria-Nebraska Test for Children (TLN-C, in Portuguese. Three hundred eighty-seven students aged 6–13 years old, with learning difficulties, comprised the study. They were assessed with the Wechsler Intelligence Scale for Children (WISC-III and TLN-C; and effect of age differences, as well as accuracy rating by internal consistency were investigated. Age effects were found for all subtests and in the general score, except for receptive speech subtest, even when total IQ effect was controlled. Reliability analysis had satisfactory results (0.79. The TLN-C showed evidences of validity and reliability. Receptive speech subtest requires revision.

  20. Cheating Admission Self Report Scale: Evidence of Factorial Validity and Precision

    Directory of Open Access Journals (Sweden)

    Valdiney Veloso Gouveia

    2018-01-01

    Full Text Available This study aimed to adapt the Cheating Admission Self Report Scale (CASRSto the Brazilian context and collect evi-dence on factorial validity and internal consistency. 441 students participated (M=16 years, 54.6% females, randomly divided in two groups. All responded to CASRS and to demographic questions. The analysis of the main components demonstrated a bifactor structure, whose factors presented Cronbach’s alphas (α greater than .80 (G1. This structure was corroborated by means of confirmatory factor analysis (for example, CFI=.87 and RMSEA=.08. The scale was shown to be psychometrically adequate and there was evidence of factorial validity and internal consistency; the scale can be used to measure plagiarism in the academic context.

  1. Recent evidence of the validity of the export-led growth hypothesis for Thailand

    OpenAIRE

    Komain Jiranyakul

    2010-01-01

    Numerous empirical studies have devoted to analyze the role of exports in the growth process. This paper examines the relationship between real exports and real GDP in Thailand using quarterly data from 1993 to 2008. The results from the bounds testing for cointegration in a multivariate framework show that there is evidence of the validity of the export-led growth hypothesis, even though some previous studies that used Thailand data reject it. There exists the long-run causation running from...

  2. Criminal profiling as expert witness evidence: The implications of the profiler validity research.

    Science.gov (United States)

    Kocsis, Richard N; Palermo, George B

    The use and development of the investigative tool colloquially known as criminal profiling has steadily increased over the past five decades throughout the world. Coupled with this growth has been a diversification in the suggested range of applications for this technique. Possibly the most notable of these has been the attempted transition of the technique from a tool intended to assist police investigations into a form of expert witness evidence admissible in legal proceedings. Whilst case law in various jurisdictions has considered with mutual disinclination the evidentiary admissibility of criminal profiling, a disjunction has evolved between these judicial examinations and the scientifically vetted research testing the accuracy (i.e., validity) of the technique. This article offers an analysis of the research directly testing the validity of the criminal profiling technique and the extant legal principles considering its evidentiary admissibility. This analysis reveals that research findings concerning the validity of criminal profiling are surprisingly compatible with the extant legal principles. The overall conclusion is that a discrete form of crime behavioural analysis is supported by the profiler validity research and could be regarded as potentially admissible expert witness evidence. Finally, a number of theoretical connections are also identified concerning the skills and qualifications of individuals who may feasibly provide such expert testimony. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Validity evidence of non-technical skills assessment instruments in simulated anaesthesia crisis management.

    Science.gov (United States)

    Jirativanont, T; Raksamani, K; Aroonpruksakul, N; Apidechakul, P; Suraseranivongse, S

    2017-07-01

    We sought to evaluate the validity of two non-technical skills evaluation instruments, the Anaesthetists' Non-Technical Skills (ANTS) behavioural marker system and the Ottawa Global Rating Scale (GRS), to apply them to anaesthesia training. The content validity, response process, internal structure, relations with other variables and consequences were described for validity evidence. Simulated crisis management sessions were initiated during which two trained raters evaluated the performance of postgraduate first-, second- and third-year (PGY-1, PGY-2 and PGY-3) anaesthesia residents. The study included 70 participants, composed of 24 PGY-1, 24 PGY-2 and 22 PGY-3 residents. Both instruments differentiated the non-technical skills of PGY-1 from PGY-3 residents ( P skills were 0.86, 0.83, 0.84, 0.87, 0.80 and 0.86, respectively. The Cronbach's alpha for internal consistency of the ANTS instrument was 0.93, and was 0.96 for the Ottawa GRS. There was a high correlation between the ANTS and Ottawa GRS. The raters reported the ease of use of the Ottawa GRS compared to the ANTS. We found sufficient evidence of validity in the ANTS instrument and the Ottawa GRS for the evaluation of non-technical skills in a simulated anaesthesia setting, but the Ottawa GRS was more practical and had higher reliability.

  4. Validity Evidence for the Neuro-Endoscopic Ventriculostomy Assessment Tool (NEVAT).

    Science.gov (United States)

    Breimer, Gerben E; Haji, Faizal A; Cinalli, Giuseppe; Hoving, Eelco W; Drake, James M

    2017-02-01

    Growing demand for transparent and standardized methods for evaluating surgical competence prompted the construction of the Neuro-Endoscopic Ventriculostomy Assessment Tool (NEVAT). To provide validity evidence of the NEVAT by reporting on the tool's internal structure and its relationship with surgical expertise during simulation-based training. The NEVAT was used to assess performance of trainees and faculty at an international neuroendoscopy workshop. All participants performed an endoscopic third ventriculostomy (ETV) on a synthetic simulator. Participants were simultaneously scored by 2 raters using the NEVAT procedural checklist and global rating scale (GRS). Evidence of internal structure was collected by calculating interrater reliability and internal consistency of raters' scores. Evidence of relationships with other variables was collected by comparing the ETV performance of experts, experienced trainees, and novices using Jonckheere's test (evidence of construct validity). Thirteen experts, 11 experienced trainees, and 10 novices participated. The interrater reliability by the intraclass correlation coefficient for the checklist and GRS was 0.82 and 0.94, respectively. Internal consistency (Cronbach's α) for the checklist and the GRS was 0.74 and 0.97, respectively. Median scores with interquartile range on the checklist and GRS for novices, experienced trainees, and experts were 0.69 (0.58-0.86), 0.85 (0.63-0.89), and 0.85 (0.81-0.91) and 3.1 (2.5-3.8), 3.7 (2.2-4.3) and 4.6 (4.4-4.9), respectively. Jonckheere's test showed that the median checklist and GRS score increased with performer expertise ( P = .04 and .002, respectively). This study provides validity evidence for the NEVAT to support its use as a standardized method of evaluating neuroendoscopic competence during simulation-based training. Copyright © 2016 by the Congress of Neurological Surgeons

  5. Validation of the prognostic gene portfolio, ClinicoMolecular Triad Classification, using an independent prospective breast cancer cohort and external patient populations.

    Science.gov (United States)

    Wang, Dong-Yu; Done, Susan J; Mc Cready, David R; Leong, Wey L

    2014-07-04

    Using genome-wide expression profiles of a prospective training cohort of breast cancer patients, ClinicoMolecular Triad Classification (CMTC) was recently developed to classify breast cancers into three clinically relevant groups to aid treatment decisions. CMTC was found to be both prognostic and predictive in a large external breast cancer cohort in that study. This study serves to validate the reproducibility of CMTC and its prognostic value using independent patient cohorts. An independent internal cohort (n = 284) and a new external cohort (n = 2,181) were used to validate the association of CMTC between clinicopathological factors, 12 known gene signatures, two molecular subtype classifiers, and 19 oncogenic signalling pathway activities, and to reproduce the abilities of CMTC to predict clinical outcomes of breast cancer. In addition, we also updated the outcome data of the original training cohort (n = 147). The original training cohort reached a statistically significant difference (p value of the triad classification was reproduced in the second independent internal cohort and the new external validation cohort. CMTC achieved even higher prognostic significance when all available patients were analyzed (n = 4,851). Oncogenic pathways Myc, E2F1, Ras and β-catenin were again implicated in the high-risk groups. Both prospective internal cohorts and the independent external cohorts reproduced the triad classification of CMTC and its prognostic significance. CMTC is an independent prognostic predictor, and it outperformed 12 other known prognostic gene signatures, molecular subtype classifications, and all other standard prognostic clinicopathological factors. Our results support further development of CMTC portfolio into a guide for personalized breast cancer treatments.

  6. Trainees' Perceptions of Feedback: Validity Evidence for Two FEEDME (Feedback in Medical Education) Instruments.

    Science.gov (United States)

    Bing-You, Robert; Ramesh, Saradha; Hayes, Victoria; Varaklis, Kalli; Ward, Denham; Blanco, Maria

    2018-01-01

    Construct: Medical educators consider feedback a core component of the educational process. Effective feedback allows learners to acquire new skills, knowledge, and attitudes. Learners' perceptions of feedback are an important aspect to assess with valid methods in order to improve the feedback skills of educators and the feedback culture. Although guidelines for delivering effective feedback have existed for several decades, medical students and residents often indicate that they receive little feedback. A recent scoping review on feedback in medical education did not reveal any validity evidence on instruments to assess learner's perceptions of feedback. The purpose of our study was to gather validity evidence on two novel FEEDME (Feedback in Medical Education) instruments to assess medical students' and residents' perceptions of the feedback that they receive. After the authors developed an initial instrument with 54 items, cognitive interviews with medical students and residents suggested that 2 separate instruments were needed, one focused on the feedback culture (FEEDME-Culture) and the other on the provider of feedback (FEEDME-Provider). A Delphi study with 17 medical education experts and faculty members assessed content validity. The response process was explored involving 31 medical students and residents at 2 academic institutions. Exploratory factor analysis and reliability analyses were performed on completed instruments. Two Delphi consultation rounds refined the wording of items and eliminated several items. Learners found both instruments easy and quick to answer; it took them less than 5 minutes to complete. Learners preferred an electronic format of the instruments over paper. Factor analysis revealed a two- and three-factor solution for the FEEDME-Culture and FEEDME-Provider instruments, respectively. Cronbach's alpha was greater than 0.80 for all factors. Items on both instruments were moderately to highly correlated (range, r = .3-.7). Our

  7. Validity Evidence for a Serious Game to Assess Performance on Critical Pediatric Emergency Medicine Scenarios.

    Science.gov (United States)

    Gerard, James M; Scalzo, Anthony J; Borgman, Matthew A; Watson, Christopher M; Byrnes, Chelsie E; Chang, Todd P; Auerbach, Marc; Kessler, David O; Feldman, Brian L; Payne, Brian S; Nibras, Sohail; Chokshi, Riti K; Lopreiato, Joseph O

    2018-01-26

    We developed a first-person serious game, PediatricSim, to teach and assess performances on seven critical pediatric scenarios (anaphylaxis, bronchiolitis, diabetic ketoacidosis, respiratory failure, seizure, septic shock, and supraventricular tachycardia). In the game, players are placed in the role of a code leader and direct patient management by selecting from various assessment and treatment options. The objective of this study was to obtain supportive validity evidence for the PediatricSim game scores. Game content was developed by 11 subject matter experts and followed the American Heart Association's 2011 Pediatric Advanced Life Support Provider Manual and other authoritative references. Sixty subjects with three different levels of experience were enrolled to play the game. Before game play, subjects completed a 40-item written pretest of knowledge. Game scores were compared between subject groups using scoring rubrics developed for the scenarios. Validity evidence was established and interpreted according to Messick's framework. Content validity was supported by a game development process that involved expert experience, focused literature review, and pilot testing. Subjects rated the game favorably for engagement, realism, and educational value. Interrater agreement on game scoring was excellent (intraclass correlation coefficient = 0.91, 95% confidence interval = 0.89-0.9). Game scores were higher for attendings followed by residents then medical students (Pc game and written test scores (r = 0.84, P game scores to assess knowledge of pediatric emergency medicine resuscitation.

  8. Validity evidence for the Fundamentals of Laparoscopic Surgery (FLS) program as an assessment tool: a systematic review.

    Science.gov (United States)

    Zendejas, Benjamin; Ruparel, Raaj K; Cook, David A

    2016-02-01

    The Fundamentals of Laparoscopic Surgery (FLS) program uses five simulation stations (peg transfer, precision cutting, loop ligation, and suturing with extracorporeal and intracorporeal knot tying) to teach and assess laparoscopic surgery skills. We sought to summarize evidence regarding the validity of scores from the FLS assessment. We systematically searched for studies evaluating the FLS as an assessment tool (last search update February 26, 2013). We classified validity evidence using the currently standard validity framework (content, response process, internal structure, relations with other variables, and consequences). From a pool of 11,628 studies, we identified 23 studies reporting validity evidence for FLS scores. Studies involved residents (n = 19), practicing physicians (n = 17), and medical students (n = 8), in specialties of general (n = 17), gynecologic (n = 4), urologic (n = 1), and veterinary (n = 1) surgery. Evidence was most common in the form of relations with other variables (n = 22, most often expert-novice differences). Only three studies reported internal structure evidence (inter-rater or inter-station reliability), two studies reported content evidence (i.e., derivation of assessment elements), and three studies reported consequences evidence (definition of pass/fail thresholds). Evidence nearly always supported the validity of FLS total scores. However, the loop ligation task lacks discriminatory ability. Validity evidence confirms expected relations with other variables and acceptable inter-rater reliability, but other validity evidence is sparse. Given the high-stakes use of this assessment (required for board eligibility), we suggest that more validity evidence is required, especially to support its content (selection of tasks and scoring rubric) and the consequences (favorable and unfavorable impact) of assessment.

  9. Validation of the prognostic gene portfolio, ClinicoMolecular Triad Classification, using an independent prospective breast cancer cohort and external patient populations

    Science.gov (United States)

    2014-01-01

    Introduction Using genome-wide expression profiles of a prospective training cohort of breast cancer patients, ClinicoMolecular Triad Classification (CMTC) was recently developed to classify breast cancers into three clinically relevant groups to aid treatment decisions. CMTC was found to be both prognostic and predictive in a large external breast cancer cohort in that study. This study serves to validate the reproducibility of CMTC and its prognostic value using independent patient cohorts. Methods An independent internal cohort (n = 284) and a new external cohort (n = 2,181) were used to validate the association of CMTC between clinicopathological factors, 12 known gene signatures, two molecular subtype classifiers, and 19 oncogenic signalling pathway activities, and to reproduce the abilities of CMTC to predict clinical outcomes of breast cancer. In addition, we also updated the outcome data of the original training cohort (n = 147). Results The original training cohort reached a statistically significant difference (p risk groups. Conclusions Both prospective internal cohorts and the independent external cohorts reproduced the triad classification of CMTC and its prognostic significance. CMTC is an independent prognostic predictor, and it outperformed 12 other known prognostic gene signatures, molecular subtype classifications, and all other standard prognostic clinicopathological factors. Our results support further development of CMTC portfolio into a guide for personalized breast cancer treatments. PMID:24996446

  10. The validation of forensic DNA extraction systems to utilize soil contaminated biological evidence.

    Science.gov (United States)

    Kasu, Mohaimin; Shires, Karen

    2015-07-01

    The production of full DNA profiles from biological evidence found in soil has a high failure rate due largely to the inhibitory substance humic acid (HA). Abundant in various natural soils, HA co-extracts with DNA during extraction and inhibits DNA profiling by binding to the molecular components of the genotyping assay. To successfully utilize traces of soil contaminated evidence, such as that found at many murder and rape crime scenes in South Africa, a reliable HA removal extraction system would often be selected based on previous validation studies. However, for many standard forensic DNA extraction systems, peer-reviewed publications detailing the efficacy on soil evidence is either lacking or is incomplete. Consequently, these sample types are often not collected or fail to yield suitable DNA material due to the use of unsuitable methodology. The aim of this study was to validate the common forensic DNA collection and extraction systems used in South Africa, namely DNA IQ, FTA elute and Nucleosave for processing blood and saliva contaminated with HA. A forensic appropriate volume of biological evidence was spiked with HA (0, 0.5, 1.5 and 2.5 mg/ml) and processed through each extraction protocol for the evaluation of HA removal using QPCR and STR-genotyping. The DNA IQ magnetic bead system effectively removed HA from highly contaminated blood and saliva, and generated consistently acceptable STR profiles from both artificially spiked samples and crude soil samples. This system is highly recommended for use on soil-contaminated evidence over the cellulose card-based systems currently being preferentially used for DNA sample collection. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Model validation and the role of the proposed Rock Characterisation Facility at Sellafield. Proof of evidence

    International Nuclear Information System (INIS)

    Wallace, H.

    1996-01-01

    Proof of Evidence is given by an expert witness on behalf of Greenpeace Ltd as part of their submission to a Planning Inquiry in 1995 hearing the application of UK Nirex Ltd for permission to construct an underground Rock Characterisation Facility (RCF) at a site near Sellafield. The RCF is part of an investigation by Nirex into a suitable site for the disposal of radioactive waste. An examination of the groundwater flow models used by Nirex and the procedure for their validation have led to the following conclusions: no evidence has been presented by Nirex to show that the construction of the RCF will improve the confidence they claim to have in the site; the prospects are slim for validating the models of present groundwater flow so that they satisfy the criteria to meet the risk target; it is extremely unlikely that results from the RCF will increase confidence in a safety assessment of this site; all the evidence available to date suggests that the risk assessment is not, and will not become, robust to variations in flux through the repository. (1 figure; 8 references). (UK)

  12. Hardiness scales in Iranian managers: evidence of incremental validity in relationships with the five factor model and with organizational and psychological adjustment.

    Science.gov (United States)

    Ghorbani, Nima; Watson, P J

    2005-06-01

    This study examined the incremental validity of Hardiness scales in a sample of Iranian managers. Along with measures of the Five Factor Model and of Organizational and Psychological Adjustment, Hardiness scales were administered to 159 male managers (M age = 39.9, SD = 7.5) who had worked in their organizations for 7.9 yr. (SD=5.4). Hardiness predicted greater Job Satisfaction, higher Organization-based Self-esteem, and perceptions of the work environment as being less stressful and constraining. Hardiness also correlated positively with Assertiveness, Emotional Stability, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness and negatively with Depression, Anxiety, Perceived Stress, Chance External Control, and a Powerful Others External Control. Evidence of incremental validity was obtained when the Hardiness scales supplemented the Five Factor Model in predicting organizational and psychological adjustment. These data documented the incremental validity of the Hardiness scales in a non-Western sample and thus confirmed once again that Hardiness has a relevance that extends beyond the culture in which it was developed.

  13. Development and validation of a computational model to study the effect of foot constraint on ankle injury due to external rotation.

    Science.gov (United States)

    Wei, Feng; Hunley, Stanley C; Powell, John W; Haut, Roger C

    2011-02-01

    Recent studies, using two different manners of foot constraint, potted and taped, document altered failure characteristics in the human cadaver ankle under controlled external rotation of the foot. The posterior talofibular ligament (PTaFL) was commonly injured when the foot was constrained in potting material, while the frequency of deltoid ligament injury was higher for the taped foot. In this study an existing multibody computational modeling approach was validated to include the influence of foot constraint, determine the kinematics of the joint under external foot rotation, and consequently obtain strains in various ligaments. It was hypothesized that the location of ankle injury due to excessive levels of external foot rotation is a function of foot constraint. The results from this model simulation supported this hypothesis and helped to explain the mechanisms of injury in the cadaver experiments. An excessive external foot rotation might generate a PTaFL injury for a rigid foot constraint, and an anterior deltoid ligament injury for a pliant foot constraint. The computational models may be further developed and modified to simulate the human response for different shoe designs, as well as on various athletic shoe-surface interfaces, so as to provide a computational basis for optimizing athletic performance with minimal injury risk.

  14. Evidence of Reliability and Validity for a Children’s Auditory Continuous Performance Test

    Directory of Open Access Journals (Sweden)

    Michael J. Lasee

    2013-11-01

    Full Text Available Continuous Performance Tests (CPTs are commonly utilized clinical measures of attention and response inhibition. While there have been many studies of CPTs that utilize a visual format, there is considerably less research employing auditory CPTs. The current study provides initial reliability and validity evidence for the Auditory Vigilance Screening Measure (AVSM, a newly developed CPT. Participants included 105 five- to nine-year-old children selected from two rural Midwestern school districts. Reliability data for the AVSM was collected through retesting of 42 participants. Validity was evaluated through correlation of AVSM scales with subscales from the ADHD Rating Scale–IV. Test–retest reliability coefficients ranged from .62 to .74 for AVSM subscales. A significant (r = .31 correlation was obtained between the AVSM Impulsivity Scale and teacher ratings of inattention. Limitations and implications for future study are discussed.

  15. Accumulation of Content Validation Evidence for the Critical Thinking Self-Assessment Scale.

    Science.gov (United States)

    Nair, Girija Gopinathan; Hellsten, Laurie-Ann M; Stamler, Lynnette Leeseberg

    2017-04-01

    Critical thinking skills (CTS) are essential for nurses; assessing students' acquisition of these skills is a mandate of nursing curricula. This study aimed to develop a self-assessment instrument of critical thinking skills (Critical Thinking Self-Assessment Scale [CTSAS]) for students' self-monitoring. An initial pool of 196 items across 6 core cognitive skills and 16 subskills were generated using the American Philosophical Association definition of CTS. Experts' content review of the items and their ratings provided evidence of content relevance using the item-level content validity index (I-CVI) and Aiken's content validity coefficient (VIk). 115 items were retained (range of I-CVI values = .70 to .94 and range of VIk values = .69-.95; significant at pself-assessment purposes.

  16. Does Gender Moderate the Relations Between Externalizing Behavior and Key Emergent Literacy Abilities? Evidence From a Longitudinal Study.

    Science.gov (United States)

    Allan, Nicholas P; Joye, Shauna W; Lonigan, Christopher J

    2017-05-01

    There is a significant negative relation between externalizing behavior and emergent literacy skills among preschool children. The purpose of this study was to examine the impact of gender on the predictive relation of externalizing behavior and emergent literacy in a group of 178 preschool children (mean age = 48.50 months, SD = 3.66; 48% boys). Externalizing behaviors predicted emergent literacy over time. Distinct patterns of predictive associations dependent on gender were found. Girls with higher levels of externalizing behaviors experienced less change in their vocabulary skills compared with the vocabulary change shown by girls with lower levels of these problem behaviors. The results suggest that early identification programs that include externalizing behavior problems and their relation with emergent literacy development should account for potential gender differences. A theoretical framework in which girls with behavior problems receive less opportunity for vocabulary acquisition is presented.

  17. A computable phenotype for asthma case identification in adult and pediatric patients: External validation in the Chicago Area Patient-Outcomes Research Network (CAPriCORN).

    Science.gov (United States)

    Afshar, Majid; Press, Valerie G; Robison, Rachel G; Kho, Abel N; Bandi, Sindhura; Biswas, Ashvini; Avila, Pedro C; Kumar, Harsha Vardhan Madan; Yu, Byung; Naureckas, Edward T; Nyenhuis, Sharmilee M; Codispoti, Christopher D

    2017-10-13

    Comprehensive, rapid, and accurate identification of patients with asthma for clinical care and engagement in research efforts is needed. The original development and validation of a computable phenotype for asthma case identification occurred at a single institution in Chicago and demonstrated excellent test characteristics. However, its application in a diverse payer mix, across different health systems and multiple electronic health record vendors, and in both children and adults was not examined. The objective of this study is to externally validate the computable phenotype across diverse Chicago institutions to accurately identify pediatric and adult patients with asthma. A cohort of 900 asthma and control patients was identified from the electronic health record between January 1, 2012 and November 30, 2014. Two physicians at each site independently reviewed the patient chart to annotate cases. The inter-observer reliability between the physician reviewers had a κ-coefficient of 0.95 (95% CI 0.93-0.97). The accuracy, sensitivity, specificity, negative predictive value, and positive predictive value of the computable phenotype were all above 94% in the full cohort. The excellent positive and negative predictive values in this multi-center external validation study establish a useful tool to identify asthma cases in in the electronic health record for research and care. This computable phenotype could be used in large-scale comparative-effectiveness trials.

  18. External Validity of a Risk Stratification Score Predicting Early Distant Brain Failure and Salvage Whole Brain Radiation Therapy After Stereotactic Radiosurgery for Brain Metastases.

    Science.gov (United States)

    Press, Robert H; Boselli, Danielle M; Symanowski, James T; Lankford, Scott P; McCammon, Robert J; Moeller, Benjamin J; Heinzerling, John H; Fasola, Carolina E; Burri, Stuart H; Patel, Kirtesh R; Asher, Anthony L; Sumrall, Ashley L; Curran, Walter J; Shu, Hui-Kuo G; Crocker, Ian R; Prabhu, Roshan S

    2017-07-01

    A scoring system using pretreatment factors was recently published for predicting the risk of early (≤6 months) distant brain failure (DBF) and salvage whole brain radiation therapy (WBRT) after stereotactic radiosurgery (SRS) alone. Four risk factors were identified: (1) lack of prior WBRT; (2) melanoma or breast histologic features; (3) multiple brain metastases; and (4) total volume of brain metastases external patient population. We reviewed the records of 247 patients with 388 brain metastases treated with SRS between 2010 at 2013 at Levine Cancer Institute. The Press (Emory) risk score was calculated and applied to the validation cohort population, and subsequent risk groups were analyzed using cumulative incidence. The low-risk (LR) group had a significantly lower risk of early DBF than did the high-risk (HR) group (22.6% vs 44%, P=.004), but there was no difference between the HR and intermediate-risk (IR) groups (41.2% vs 44%, P=.79). Total lesion volume externally valid, but the model was able to stratify between 2 levels (LR and not-LR [combined IR and HR]) for early (≤6 months) DBF. These results reinforce the importance of validating predictive models in independent cohorts. Further refinement of this scoring system with molecular information and in additional contemporary patient populations is warranted. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. External validation of a PCA-3-based nomogram for predicting prostate cancer and high-grade cancer on initial prostate biopsy.

    Science.gov (United States)

    Greene, Daniel J; Elshafei, Ahmed; Nyame, Yaw A; Kara, Onder; Malkoc, Ercan; Gao, Tianming; Jones, J Stephen

    2016-08-01

    The aim of this study was to externally validate a previously developed PCA3-based nomogram for the prediction of prostate cancer (PCa) and high-grade (intermediate and/or high-grade) prostate cancer (HGPCa) at the time of initial prostate biopsy. A retrospective review was performed on a cohort of 336 men from a large urban academic medical center. All men had serum PSA PCa, PSA at diagnosis, PCA3, total prostate volume (TPV), and abnormal finding on digital rectal exam (DRE). These variables were used to test the accuracy (concordance index) and calibration of a previously published PCA3 nomogram. Biopsy confirms PCa and HGPCa in 51.0% and 30.4% of validation patients, respectively. This differed from the original cohort in that it had significantly more PCa and HGPCA (51% vs. 44%, P = 0.019; and 30.4% vs. 19.1%, P PCa detection the concordance index was 75% and 77% for overall PCa and HGPCa, respectively. Calibration for overall PCa was good. This represents the first external validation of a PCA3-based prostate cancer predictive nomogram in a North American population. Prostate 76:1019-1023, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  20. New Evidence of Construct Validity Problems for Pettigrew and Meertens' (1995) Blatant and Subtle Prejudice Scale.

    Science.gov (United States)

    Arancibia-Martini, Héctor; Ruiz, Miguel Á; Blanco, Amalio; Cárdenas, Manuel

    2016-04-01

    Given the current debate over the distinction between subtle and blatant prejudice, this study provides new evidence regarding problems with the construct validity of the Pettigrew and Meertens' Blatant and Subtle Prejudice Scale. To assess these issues, an existing data sample of 896 Chilean participants collected in 2010 was reanalyzed. The main analysis method used was a confirmatory factor analysis. The model that best represented the original theory (a model of two correlated second-order factors) had an improper solution due to the unidentified model. The scale has substantial psychometric problems, and it was not possible to distinguish between subtle and blatant prejudice. © The Author(s) 2016.

  1. Structure-independent cross-validation between residual dipolar couplings originating from internal and external orienting media

    International Nuclear Information System (INIS)

    Barbieri, Renato; Bertini, Ivano; Lee, Yong-Min; Luchinat, Claudio; Velders, Aldrik H.

    2002-01-01

    Lanthanide-substituted calcium binding proteins are known to partially orient in high magnetic fields. Orientation provides residual dipolar couplings (rdc's). Two of these systems, Tm 3+ - and Dy 3+ -substituted calbindin D 9k , dissolved in an external orienting medium (nonionic liquid crystalline phase) provide rdc values which are the sum of those induced by the lanthanides and by the liquid crystalline phase on the native calcium binding protein. This structure-independent check shows the innocence of the orienting medium with respect to the structure of the protein in solution. Furthermore, the simultaneous use of lanthanide substitution and external orienting media provides a further effective tool to control and tune the orientation tensor

  2. External validation of a clinical prediction rule to predict full recovery and ongoing moderate/severe disability following acute whiplash injury.

    Science.gov (United States)

    Ritchie, Carrie; Hendrikz, Joan; Jull, Gwendolen; Elliott, James; Sterling, Michele

    2015-04-01

    Retrospective secondary analysis of data. To investigate the external validity of the whiplash clinical prediction rule (CPR). We recently derived a whiplash CPR to consolidate previously established prognostic factors for poor recovery from a whiplash injury and predicted 2 recovery pathways. Prognostic factors for full recovery were being less than 35 years of age and having an initial Neck Disability Index (NDI) score of 32% or less. Prognostic factors for ongoing moderate/severe pain and disability were being 35 years of age or older, having an initial NDI score of 40% or more, and the presence of hyperarousal symptoms. Validation is required to confirm the reproducibility and accuracy of this CPR. Clinician feedback on the usefulness of the CPR is also important to gauge acceptability. A secondary analysis of data from 101 individuals with acute whiplash-associated disorder who had previously participated in either a randomized controlled clinical trial or prospective cohort study was performed using accuracy statistics. Full recovery was defined as NDI score at 6 months of 10% or less, and ongoing moderate/severe pain and disability were defined as an NDI score at 6 months of 30% or greater. In addition, a small sample of physical therapists completed an anonymous survey on the clinical acceptability and usability of the tool. Results The positive predictive value of ongoing moderate/severe pain and disability was 90.9% in the validation cohort, and the positive predictive value of full recovery was 80.0%. Surveyed physical therapists reported that the whiplash CPR was simple, understandable, would be easy to use, and was an acceptable prognostic tool. External validation of the whiplash CPR confirmed the reproducibility and accuracy of this dual-pathway tool for individuals with acute whiplash-associated disorder. Further research is needed to assess prospective validation, the impact of inclusion on practice, and to examine the efficacy of linking treatment

  3. Reliability and Validity Evidence of Multiple Balance Assessments in Athletes With a Concussion

    Science.gov (United States)

    Murray, Nicholas; Salvatore, Anthony; Powell, Douglas; Reed-Jones, Rebecca

    2014-01-01

    Context: An estimated 300 000 sport-related concussion injuries occur in the United States annually. Approximately 30% of individuals with concussions experience balance disturbances. Common methods of balance assessment include the Clinical Test of Sensory Organization and Balance (CTSIB), the Sensory Organization Test (SOT), the Balance Error Scoring System (BESS), and the Romberg test; however, the National Collegiate Athletic Association recommended the Wii Fit as an alternative measure of balance in athletes with a concussion. A central concern regarding the implementation of the Wii Fit is whether it is reliable and valid for measuring balance disturbance in athletes with concussion. Objective: To examine the reliability and validity evidence for the CTSIB, SOT, BESS, Romberg test, and Wii Fit for detecting balance disturbance in athletes with a concussion. Data Sources: Literature considered for review included publications with reliability and validity data for the assessments of balance (CTSIB, SOT, BESS, Romberg test, and Wii Fit) from PubMed, PsycINFO, and CINAHL. Data Extraction: We identified 63 relevant articles for consideration in the review. Of the 63 articles, 28 were considered appropriate for inclusion and 35 were excluded. Data Synthesis: No current reliability or validity information supports the use of the CTSIB, SOT, Romberg test, or Wii Fit for balance assessment in athletes with a concussion. The BESS demonstrated moderate to high reliability (interclass correlation coefficient = 0.87) and low to moderate validity (sensitivity = 34%, specificity = 87%). However, the Romberg test and Wii Fit have been shown to be reliable tools in the assessment of balance in Parkinson patients. Conclusions: The BESS can evaluate balance problems after a concussion. However, it lacks the ability to detect balance problems after the third day of recovery. Further investigation is needed to establish the use of the CTSIB, SOT, Romberg test, and Wii Fit for

  4. Reliability and validity evidence of multiple balance assessments in athletes with a concussion.

    Science.gov (United States)

    Murray, Nicholas; Salvatore, Anthony; Powell, Douglas; Reed-Jones, Rebecca

    2014-01-01

    An estimated 300 000 sport-related concussion injuries occur in the United States annually. Approximately 30% of individuals with concussions experience balance disturbances. Common methods of balance assessment include the Clinical Test of Sensory Organization and Balance (CTSIB), the Sensory Organization Test (SOT), the Balance Error Scoring System (BESS), and the Romberg test; however, the National Collegiate Athletic Association recommended the Wii Fit as an alternative measure of balance in athletes with a concussion. A central concern regarding the implementation of the Wii Fit is whether it is reliable and valid for measuring balance disturbance in athletes with concussion. To examine the reliability and validity evidence for the CTSIB, SOT, BESS, Romberg test, and Wii Fit for detecting balance disturbance in athletes with a concussion. Literature considered for review included publications with reliability and validity data for the assessments of balance (CTSIB, SOT, BESS, Romberg test, and Wii Fit) from PubMed, PsycINFO, and CINAHL. We identified 63 relevant articles for consideration in the review. Of the 63 articles, 28 were considered appropriate for inclusion and 35 were excluded. No current reliability or validity information supports the use of the CTSIB, SOT, Romberg test, or Wii Fit for balance assessment in athletes with a concussion. The BESS demonstrated moderate to high reliability (interclass correlation coefficient = 0.87) and low to moderate validity (sensitivity = 34%, specificity = 87%). However, the Romberg test and Wii Fit have been shown to be reliable tools in the assessment of balance in Parkinson patients. The BESS can evaluate balance problems after a concussion. However, it lacks the ability to detect balance problems after the third day of recovery. Further investigation is needed to establish the use of the CTSIB, SOT, Romberg test, and Wii Fit for assessing balance in athletes with concussions.

  5. External validation of a biomarker and clinical prediction model for hospital mortality in acute respiratory distress syndrome.

    Science.gov (United States)

    Zhao, Zhiguo; Wickersham, Nancy; Kangelaris, Kirsten N; May, Addison K; Bernard, Gordon R; Matthay, Michael A; Calfee, Carolyn S; Koyama, Tatsuki; Ware, Lorraine B

    2017-08-01

    Mortality prediction in ARDS is important for prognostication and risk stratification. However, no prediction models have been independently validated. A combination of two biomarkers with age and APACHE III was superior in predicting mortality in the NHLBI ARDSNet ALVEOLI trial. We validated this prediction tool in two clinical trials and an observational cohort. The validation cohorts included 849 patients from the NHLBI ARDSNet Fluid and Catheter Treatment Trial (FACTT), 144 patients from a clinical trial of sivelestat for ARDS (STRIVE), and 545 ARDS patients from the VALID observational cohort study. To evaluate the performance of the prediction model, the area under the receiver operating characteristic curve (AUC), model discrimination, and calibration were assessed, and recalibration methods were applied. The biomarker/clinical prediction model performed well in all cohorts. Performance was better in the clinical trials with an AUC of 0.74 (95% CI 0.70-0.79) in FACTT, compared to 0.72 (95% CI 0.67-0.77) in VALID, a more heterogeneous observational cohort. The AUC was 0.73 (95% CI 0.70-0.76) when FACTT and VALID were combined. We validated a mortality prediction model for ARDS that includes age, APACHE III, surfactant protein D, and interleukin-8 in a variety of clinical settings. Although the model performance as measured by AUC was lower than in the original model derivation cohort, the biomarker/clinical model still performed well and may be useful for risk assessment for clinical trial enrollment, an issue of increasing importance as ARDS mortality declines, and better methods are needed for selection of the most severely ill patients for inclusion.

  6. Applying hospital evidence to paramedicine: issues of indirectness, validity and knowledge translation.

    Science.gov (United States)

    Bigham, Blair; Welsford, Michelle

    2015-05-01

    The practice of emergency medicine (EM) has been intertwined with emergency medical services (EMS) for more than 40 years. In this commentary, we explore the practice of translating hospital based evidence into the prehospital setting. We will challenge both EMS and EM dogma-bringing hospital care to patients in the field is not always better. In providing examples of therapies championed in hospitals that have failed to translate into the field, we will discuss the unique prehospital environment, and why evidence from the hospital setting cannot necessarily be translated to the prehospital field. Paramedicine is maturing so that the capability now exists to conduct practice-specific research that can inform best practices. Before translation from the hospital environment is implemented, evidence must be evaluated by people with expertise in three domains: critical appraisal, EM, and EMS. Scientific evidence should be assessed for: quality and bias; directness, generalizability, and validity to the EMS population; effect size and anticipated benefit from prehospital application; feasibility (including economic evaluation, human resource availability in the mobile environment); and patient and provider safety.

  7. Project on Elite Athlete Commitment (PEAK): III. An examination of the external validity across gender, and the expansion and clarification of the Sport Commitment Model.

    Science.gov (United States)

    Scanlan, Tara K; Russell, David G; Magyar, T Michelle; Scanlan, Larry A

    2009-12-01

    The Sport Commitment Model was further tested using the Scanlan Collaborative Interview Method to examine its generalizability to New Zealand's elite female amateur netball team, the Silver Ferns. Results supported or clarified Sport Commitment Model predictions, revealed avenues for model expansion, and elucidated the functions of perceived competence and enjoyment in the commitment process. A comparison and contrast of the in-depth interview data from the Silver Ferns with previous interview data from a comparable elite team of amateur male athletes allowed assessment of model external validity, tested the generalizability of the underlying mechanisms, and separated gender differences from discrepancies that simply reflected team or idiosyncratic differences.

  8. Validation of the Portuguese version of the Evidence-Based Practice Questionnaire

    Directory of Open Access Journals (Sweden)

    Rui Pedro Gomes Pereira

    2015-04-01

    Full Text Available OBJECTIVES: to describe the process of translation and linguistic and cultural validation of the Evidence Based Practice Questionnaire for the Portuguese context: Questionário de Eficácia Clínica e Prática Baseada em Evidências (QECPBE. METHOD: a methodological and cross-sectional study was developed. The translation and back translation was performed according to traditional standards. Principal Components Analysis with orthogonal rotation according to the Varimax method was used to verify the QECPBE's psychometric characteristics, followed by confirmatory factor analysis. Internal consistency was determined by Cronbach's alpha. Data were collected between December 2013 and February 2014. RESULTS: 358 nurses delivering care in a hospital facility in North of Portugal participated in the study. QECPBE contains 20 items and three subscales: Practice (α=0.74; Attitudes (α=0.75; Knowledge/Skills and Competencies (α=0.95, presenting an overall internal consistency of α=0.74. The tested model explained 55.86% of the variance and presented good fit: χ2(167=520.009; p = 0.0001; χ2df=3.114; CFI=0.908; GFI=0.865; PCFI=0.798; PGFI=0.678; RMSEA=0.077 (CI90%=0.07-0.08. CONCLUSION: confirmatory factor analysis revealed the questionnaire is valid and appropriate to be used in the studied context.

  9. Performance of a cognitive load inventory during simulated handoffs: Evidence for validity.

    Science.gov (United States)

    Young, John Q; Boscardin, Christy K; van Dijk, Savannah M; Abdullah, Ruqayyah; Irby, David M; Sewell, Justin L; Ten Cate, Olle; O'Sullivan, Patricia S

    2016-01-01

    Advancing patient safety during handoffs remains a public health priority. The application of cognitive load theory offers promise, but is currently limited by the inability to measure cognitive load types. To develop and collect validity evidence for a revised self-report inventory that measures cognitive load types during a handoff. Based on prior published work, input from experts in cognitive load theory and handoffs, and a think-aloud exercise with residents, a revised Cognitive Load Inventory for Handoffs was developed. The Cognitive Load Inventory for Handoffs has items for intrinsic, extraneous, and germane load. Students who were second- and sixth-year students recruited from a Dutch medical school participated in four simulated handoffs (two simple and two complex cases). At the end of each handoff, study participants completed the Cognitive Load Inventory for Handoffs, Paas' Cognitive Load Scale, and one global rating item for intrinsic load, extraneous load, and germane load, respectively. Factor and correlational analyses were performed to collect evidence for validity. Confirmatory factor analysis yielded a single factor that combined intrinsic and germane loads. The extraneous load items performed poorly and were removed from the model. The score from the combined intrinsic and germane load items associated, as predicted by cognitive load theory, with a commonly used measure of overall cognitive load (Pearson's r = 0.83, p load during handoffs may be measured via a self-report measure. Additional work is required to develop an adequate measure of extraneous load.

  10. Validity of Quinpirole Sensitization Rat Model of OCD: Linking Evidence from Animal and Clinical Studies.

    Science.gov (United States)

    Stuchlik, Ales; Radostová, Dominika; Hatalova, Hana; Vales, Karel; Nekovarova, Tereza; Koprivova, Jana; Svoboda, Jan; Horacek, Jiri

    2016-01-01

    Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder with 1-3% prevalence. OCD is characterized by recurrent thoughts (obsessions) and repetitive behaviors (compulsions). The pathophysiology of OCD remains unclear, stressing the importance of pre-clinical studies. The aim of this article is to critically review a proposed animal model of OCD that is characterized by the induction of compulsive checking and behavioral sensitization to the D2/D3 dopamine agonist quinpirole. Changes in this model have been reported at the level of brain structures, neurotransmitter systems and other neurophysiological aspects. In this review, we consider these alterations in relation to the clinical manifestations in OCD, with the aim to discuss and evaluate axes of validity of this model. Our analysis shows that some axes of validity of quinpirole sensitization model (QSM) are strongly supported by clinical findings, such as behavioral phenomenology or roles of brain structures. Evidence on predictive validity is contradictory and ambiguous. It is concluded that this model is useful in the context of searching for the underlying pathophysiological basis of the disorder because of the relatively strong biological similarities with OCD.

  11. Evidence for validity within workplace assessment: the Longitudinal Evaluation of Performance (LEP).

    Science.gov (United States)

    Prescott-Clements, Linda; van der Vleuten, Cees P M; Schuwirth, Lambert W T; Hurst, Yvonne; Rennie, James S

    2008-05-01

    The drive towards valid and reliable assessment methods for health professions' training is becoming increasingly focused towards authentic models of workplace performance assessment. This study investigates the validity of such a method, longitudinal evaluation of performance (LEP), which has been implemented in the assessment of postgraduate dental trainees in Scotland. Although it is similar in format to the mini-CEX (mini clinical evaluation exercise) and other tools that use global ratings for assessing performance in the workplace, a number of differences exist in the way in which the LEP has been implemented. These include the use of a reference point for evaluators' judgement that represents the standard expected upon completion of the training, flexibility, a greater range of cases assessed and the use of frequency scores within feedback to identify trainees' progress over time. A range of qualitative and quantitative data were collected and analysed from 2 consecutive cohorts of trainees in Scotland (2002-03 and 2003-04). There is rich evidence supporting the validity, educational impact and feasibility of the LEP. In particular, a great deal of support was given by trainers for the use of a fixed reference point for judgements, despite initial concerns that this might be demotivating to trainees. Trainers were highly positive about this approach and considered it useful in identifying trainees' progress and helping to drive learning. The LEP has been successful in combining a strong formative approach to continuous assessment with the collection of evidence on performance within the workplace that (alongside other tools within an assessment system) can contribute towards a summative decision regarding competence.

  12. Screening tool for oropharyngeal dysphagia in stroke - Part I: evidence of validity based on the content and response processes.

    Science.gov (United States)

    Almeida, Tatiana Magalhães de; Cola, Paula Cristina; Pernambuco, Leandro de Araújo; Magalhães, Hipólito Virgílio; Magnoni, Carlos Daniel; Silva, Roberta Gonçalves da

    2017-08-17

    The aim of the present study was to identify the evidence of validity based on the content and response process of the Rastreamento de Disfagia Orofaríngea no Acidente Vascular Encefálico (RADAVE; "Screening Tool for Oropharyngeal Dysphagia in Stroke"). The criteria used to elaborate the questions were based on a literature review. A group of judges consisting of 19 different health professionals evaluated the relevance and representativeness of the questions, and the results were analyzed using the Content Validity Index. In order to evidence validity based on the response processes, 23 health professionals administered the screening tool and analyzed the questions using a structured scale and cognitive interview. The RADAVE structured to be applied in two stages. The first version consisted of 18 questions in stage I and 11 questions in stage II. Eight questions in stage I and four in stage II did not reach the minimum Content Validity Index, requiring reformulation by the authors. The cognitive interview demonstrated some misconceptions. New adjustments were made and the final version was produced with 12 questions in stage I and six questions in stage II. It was possible to develop a screening tool for dysphagia in stroke with adequate evidence of validity based on content and response processes. Both validity evidences obtained so far allowed to adjust the screening tool in relation to its construct. The next studies will analyze the other evidences of validity and the measures of accuracy.

  13. External validation of the Blunt Abdominal Trauma in Children (BATiC) score : Ruling out significant abdominal injury in children

    NARCIS (Netherlands)

    de Jong, Willem-Jan J.; Stoepker, Leon; Nellensteijn, David R.; Groen, Henk; El Moumni, Mostafa; Hulscher, Jan B.

    BACKGROUND: The aim of this study was to validate the use of the Blunt Abdominal Trauma in Children (BATiC) score. The BATiC score uses only readily available laboratory parameters, ultrasound results, and results from physical examination and does therefore not carry any risk of additional

  14. External Validation and Update of a Prediction Rule for the Duration of Sickness Absence Due to Common Mental Disorders

    NARCIS (Netherlands)

    Norder, Giny; Roelen, Corne A. M.; van der Klink, Jac J. L.; Bultmann, Ute; Sluiter, J. K.; Nieuwenhuijsen, K.

    Purpose The objective of the present study was to validate an existing prediction rule (including age, education, depressive/anxiety symptoms, and recovery expectations) for predictions of the duration of sickness absence due to common mental disorders (CMDs) and investigate the added value of

  15. Prognosis of patients with nonspecific neck pain: development and external validation of a prediction rule for persistence of complaints

    NARCIS (Netherlands)

    Schellingerhout, J.M.; Heijmans, M.W.; Verhagen, A.P.; Lewis, M.; de Vet, H.C.W.; Koes, B.W.

    2010-01-01

    Study Design.: Reanalysis of data from 3 randomized controlled trials. Objective.: Development and validation of a prediction rule that estimates the probability of complaints persisting for at least 6 months in patients presenting with nonspecific neck pain in primary care. Sumary of Background

  16. STRUCTURE AND VALIDATION OF A CONTEXTUAL QUALITY OF LIFE SCALE FOR PEOPLE WITH INTELLECTUAL DISABILITIES IN SOCIAL SERVICES: AN ORGANIZATION-ORIENTED MEASURE FROM AN EXTERNAL PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Carolina Moliner

    2013-09-01

    Full Text Available The aim of this study is to develop and validate a scale on the Quality of Life (QoL of people with intellectual disabilities as assessed by family members (external perspective. The instrument measures improvement in QoL due to actions by organizations delivering services to individuals with intellectual disabilities (organization-oriented measure. In order to design the items for the scale, focus groups were set up with professionals dedicated to attending to individuals with intellectual disabilities. An initial scale of 20 items was constructed by consensus. A total of 1195 family members answered the questionnaire. In order to assess the structure of the scale, EFA recommended deleting 3 overlapping items. The final scale consisted of 17 items (α=95 and was composed of four main dimensions: self-determination (SD, social inclusion (SI, rights (RI and overall improvement (OI, which explained 74.83% of the variance. Finally, the consistency and validity were assessed. Convergent validity and discriminant validity were satisfactory. Moreover, CFA confirmed the structure of the scale. Main conclusions, limitations and practical implications are discussed.

  17. External Validation of a Case-Mix Adjustment Model for the Standardized Reporting of 30-Day Stroke Mortality Rates in China.

    Science.gov (United States)

    Yu, Ping; Pan, Yuesong; Wang, Yongjun; Wang, Xianwei; Liu, Liping; Ji, Ruijun; Meng, Xia; Jing, Jing; Tong, Xu; Guo, Li; Wang, Yilong

    2016-01-01

    A case-mix adjustment model has been developed and externally validated, demonstrating promise. However, the model has not been thoroughly tested among populations in China. In our study, we evaluated the performance of the model in Chinese patients with acute stroke. The case-mix adjustment model A includes items on age, presence of atrial fibrillation on admission, National Institutes of Health Stroke Severity Scale (NIHSS) score on admission, and stroke type. Model B is similar to Model A but includes only the consciousness component of the NIHSS score. Both model A and B were evaluated to predict 30-day mortality rates in 13,948 patients with acute stroke from the China National Stroke Registry. The discrimination of the models was quantified by c-statistic. Calibration was assessed using Pearson's correlation coefficient. The c-statistic of model A in our external validation cohort was 0.80 (95% confidence interval, 0.79-0.82), and the c-statistic of model B was 0.82 (95% confidence interval, 0.81-0.84). Excellent calibration was reported in the two models with Pearson's correlation coefficient (0.892 for model A, pcase-mix adjustment model could be used to effectively predict 30-day mortality rates in Chinese patients with acute stroke.

  18. External Validation of a Case-Mix Adjustment Model for the Standardized Reporting of 30-Day Stroke Mortality Rates in China.

    Directory of Open Access Journals (Sweden)

    Ping Yu

    Full Text Available A case-mix adjustment model has been developed and externally validated, demonstrating promise. However, the model has not been thoroughly tested among populations in China. In our study, we evaluated the performance of the model in Chinese patients with acute stroke.The case-mix adjustment model A includes items on age, presence of atrial fibrillation on admission, National Institutes of Health Stroke Severity Scale (NIHSS score on admission, and stroke type. Model B is similar to Model A but includes only the consciousness component of the NIHSS score. Both model A and B were evaluated to predict 30-day mortality rates in 13,948 patients with acute stroke from the China National Stroke Registry. The discrimination of the models was quantified by c-statistic. Calibration was assessed using Pearson's correlation coefficient.The c-statistic of model A in our external validation cohort was 0.80 (95% confidence interval, 0.79-0.82, and the c-statistic of model B was 0.82 (95% confidence interval, 0.81-0.84. Excellent calibration was reported in the two models with Pearson's correlation coefficient (0.892 for model A, p<0.001; 0.927 for model B, p = 0.008.The case-mix adjustment model could be used to effectively predict 30-day mortality rates in Chinese patients with acute stroke.

  19. Moderators and Mediators in Social Work Research: Toward a More Ecologically Valid Evidence Base for Practice

    Science.gov (United States)

    Magill, Molly

    2012-01-01

    Summary Evidence-based practice involves the consistent and critical consumption of the social work research literature. As methodologies advance, primers to guide such efforts are often needed. In the present work, common statistical methods for testing moderation and mediation are identified, summarized, and corresponding examples, drawn from the substance abuse, domestic violence, and mental health literature, are provided. Findings While methodologically complex, analyses of these third variable effects can provide an optimal fit for the complexity involved in the provision of evidence-based social work services. While a moderator may identify the trait or state requirement for a causal relationship to occur, a mediator is concerned with the transmission of that relationship. In social work practice, these are questions of “under what conditions and for whom?” and of the “how?” of behavior change. Implications Implications include a need for greater attention to these methods among practitioners and evaluation researchers. With knowledge gained through the present review, social workers can benefit from a more ecologically valid evidence base for practice. PMID:22833701

  20. A general psychopathology factor (P factor) in children: Structural model analysis and external validation through familial risk and child global executive function.

    Science.gov (United States)

    Martel, Michelle M; Pan, Pedro M; Hoffmann, Maurício S; Gadelha, Ary; do Rosário, Maria C; Mari, Jair J; Manfro, Gisele G; Miguel, Eurípedes C; Paus, Tomás; Bressan, Rodrigo A; Rohde, Luis A; Salum, Giovanni A

    2017-01-01

    High rates of comorbidities and poor validity of disorder diagnostic criteria for mental disorders hamper advances in mental health research. Recent work has suggested the utility of continuous cross-cutting dimensions, including general psychopathology and specific factors of externalizing and internalizing (e.g., distress and fear) syndromes. The current study evaluated the reliability of competing structural models of psychopathology and examined external validity of the best fitting model on the basis of family risk and child global executive function (EF). A community sample of 8,012 families from Brazil with children ages 6-12 years completed structured interviews about the child and parental psychiatric syndromes, and a subsample of 2,395 children completed tasks assessing EF (i.e., working memory, inhibitory control, and time processing). Confirmatory factor analyses tested a series of structural models of psychopathology in both parents and children. The model with a general psychopathology factor ("P factor") with 3 specific factors (fear, distress, and externalizing) exhibited the best fit. The general P factor accounted for most of the variance in all models, with little residual variance explained by each of the 3 specific factors. In addition, associations between child and parental factors were mainly significant for the P factors and nonsignificant for the specific factors from the respective models. Likewise, the child P factor-but not the specific factors-was significantly associated with global child EF. Overall, our results provide support for a latent overarching P factor characterizing child psychopathology, supported by familial associations and child EF. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  1. External validation of three dimensional conformal radiotherapy based NTCP models for patient-rated xerostomia and sticky saliva among patients treated with intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Beetz, Ivo; Schilstra, Cornelis; Luijk, Peter van; Christianen, Miranda E.M.C.; Doornaert, Patricia; Bijl, Henk P.; Chouvalova, Olga; Heuvel, Edwin R. van den; Steenbakkers, Roel J.H.M.; Langendijk, Johannes A.

    2012-01-01

    Purpose: The purpose of this study was to investigate the ability of predictive models for patient-rated xerostomia (XER 6M ) and sticky saliva (STIC 6M ) at 6 months after completion of primary (chemo)radiation developed in head and neck cancer patients treated with 3D-conformal radiotherapy (3D-CRT) to predict outcome in patients treated with intensity modulated radiotherapy (IMRT). Methods and materials: Recently, we published the results of a prospective study on predictive models for patient-rated xerostomia and sticky saliva in head and neck cancer patients treated with 3D-CRT (3D-CRT based NTCP models). The 3D-CRT based model for XER 6M consisted of three factors, including the mean parotid dose, age, and baseline xerostomia (none versus a bit). The 3D-CRT based model for STIC 6M consisted of the mean submandibular dose, age, the mean sublingual dose, and baseline sticky saliva (none versus a bit). In the current study, a population consisting of 162 patients treated with IMRT was used to test the external validity of these 3D-CRT based models. External validity was described by the explained variation (R 2 Nagelkerke) and the Brier score. The discriminative abilities of the models were calculated using the area under the receiver operating curve (AUC) and calibration (i.e. the agreement between predicted and observed outcome) was assessed with the Hosmer–Lemeshow “goodness-of-fit” test. Results: Overall model performance of the 3D-CRT based predictive models for XER 6M and STIC 6M was significantly worse in terms of the Brier score and R 2 Nagelkerke among patients treated with IMRT. Moreover the AUC for both 3D-CRT based models in the IMRT treated patients were markedly lower. The Hosmer–Lemeshow test showed a significant disagreement for both models between predicted risk and observed outcome. Conclusion: 3D-CRT based models for patient-rated xerostomia and sticky saliva among head and neck cancer patients treated with primary radiotherapy or

  2. Is there any evidence for the validity of diagnostic criteria used for accommodative and nonstrabismic binocular dysfunctions?

    Directory of Open Access Journals (Sweden)

    Pilar Cacho-Martínez

    2014-01-01

    Conclusions: Scientific literature reveals differences between authors according to diagnostic criteria for accommodative and nonstrabismic binocular dysfunctions. Diagnostic accuracy studies show that there is only certain evidence for accommodative conditions. For binocular anomalies there is only evidence about a validated questionnaire for convergence insufficiency with no data of diagnostic accuracy.

  3. Process Evaluation to Explore Internal and External Validity of the "Act in Case of Depression" Care Program in Nursing Homes

    NARCIS (Netherlands)

    Leontjevas, R.; Gerritsen, D.L.; Koopmans, R.T.C.M.; Smalbrugge, M.; Vernooij-Dassen, M.F.J.

    2012-01-01

    Background: A multidisciplinary, evidence-based care program to improve the management of depression in nursing home residents was implemented and tested using a stepped-wedge design in 23 nursing homes (NHs): " Act in case of Depression" (AiD). Objective: Before effect analyses, to evaluate AiD

  4. Process evaluation to explore internal and external validity of the "Act in Case of Depression" care program in nursing homes.

    NARCIS (Netherlands)

    Leontjevas, R.; Gerritsen, D.L.; Koopmans, R.T.C.M.; Smalbrugge, M.; Vernooij-Dassen, M.J.F.J.

    2012-01-01

    BACKGROUND: A multidisciplinary, evidence-based care program to improve the management of depression in nursing home residents was implemented and tested using a stepped-wedge design in 23 nursing homes (NHs): "Act in case of Depression" (AiD). OBJECTIVE: Before effect analyses, to evaluate AiD

  5. Evidence of validity for the Japanese version of the foot and ankle ability measure.

    Science.gov (United States)

    Uematsu, Daisuke; Suzuki, Hidetomo; Sasaki, Shogo; Nagano, Yasuharu; Shinozuka, Nobuyuki; Sunagawa, Norihiko; Fukubayashi, Toru

    2015-01-01

    The Foot and Ankle Ability Measure (FAAM) is a valid, reliable, and self-reported outcome instrument for the foot and ankle region. To provide evidence for translation, cross-cultural adaptation, validity, and reliability of the Japanese version of the FAAM (FAAM-J). Cross-sectional study. Collegiate athletic training/sports medicine clinical setting. Eighty-three collegiate athletes. All participants completed the Activities of Daily Living and Sports subscales of the FAAM-J and the Physical Functioning and Mental Health subscales of the Japanese version of the Short Form-36v2 (SF-36). Also, 19 participants (23%) whose conditions were expected to be stable completed another FAAM-J 2 to 6 days later for test-retest reliability. We analyzed the scores of those subscales for convergent and divergent validity, internal consistency, and test-retest reliability. The Activities of Daily Living and Sports subscales of the FAAM-J had correlation coefficients of 0.86 and 0.75, respectively, with the Physical Functioning section of the SF-36 for convergent validity. For divergent validity, the correlation coefficients with Mental Health of the SF-36 were 0.29 and 0.27 for each subscale, respectively. Cronbach α for internal consistency was 0.99 for the Activities of Daily Living and 0.98 for the Sports subscale. A 95% confidence interval with a single measure was ±8.1 and ±14.0 points for each subscale. The test-retest reliability measures revealed intraclass correlation coefficient values of 0.87 for the Activities of Daily Living and 0.91 for the Sports subscales with minimal detectable changes of ±6.8 and ±13.7 for the respective subscales. The FAAM was successfully translated for a Japanese version, and the FAAM-J was adapted cross-culturally. Thus, the FAAM-J can be used as a self-reported outcome measure for Japanese-speaking individuals; however, the scores must be interpreted with caution, especially when applied to different populations and other types of

  6. Development and External Validation of Prognostic Model for 2-Year Survival of Non-Small-Cell Lung Cancer Patients Treated With Chemoradiotherapy

    International Nuclear Information System (INIS)

    Dehing-Oberije, Cary; Yu Shipeng; De Ruysscher, Dirk; Meersschout, Sabine; Van Beek, Karen; Lievens, Yolande; Van Meerbeeck, Jan; De Neve, Wilfried; Rao, Bharat Ph.D.; Weide, Hiska van der; Lambin, Philippe

    2009-01-01

    Purpose: Radiotherapy, combined with chemotherapy, is the treatment of choice for a large group of non-small-cell lung cancer (NSCLC) patients. Recent developments in the treatment of these patients have led to improved survival. However, the clinical TNM stage is highly inaccurate for the prediction of survival, and alternatives are lacking. The objective of this study was to develop and validate a prediction model for survival of NSCLC patients, treated with chemoradiotherapy. Patients and Methods: The clinical data from 377 consecutive inoperable NSCLC patients, Stage I-IIIB, treated radically with chemoradiotherapy were collected. A prognostic model for 2-year survival was developed, using 2-norm support vector machines. The performance of the model was expressed as the area under the curve of the receiver operating characteristic and assessed using leave-one-out cross-validation, as well as two external data sets. Results: The final multivariate model consisted of gender, World Health Organization performance status, forced expiratory volume in 1 s, number of positive lymph node stations, and gross tumor volume. The area under the curve, assessed by leave-one-out cross-validation, was 0.74, and application of the model to the external data sets yielded an area under the curve of 0.75 and 0.76. A high- and low-risk group could be clearly identified using a risk score based on the model. Conclusion: The multivariate model performed very well and was able to accurately predict the 2-year survival of NSCLC patients treated with chemoradiotherapy. The model could support clinicians in the treatment decision-making process.

  7. The gender identity/gender dysphoria questionnaire for adolescents and adults: further validity evidence.

    Science.gov (United States)

    Singh, Devita; Deogracias, Joseph J; Johnson, Laurel L; Bradley, Susan J; Kibblewhite, Sarah J; Owen-Anderson, Allison; Peterson-Badali, Michele; Meyer-Bahlburg, Heino F L; Zucker, Kenneth J

    2010-01-01

    This study aimed to provide further validity evidence for the dimensional measurement of gender identity and gender dysphoria in both adolescents and adults. Adolescents and adults with gender identity disorder (GID) were compared to clinical control (CC) adolescents and adults on the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA), a 27-item scale originally developed by Deogracias et al. (2007). In Study 1, adolescents with GID (n = 44) were compared to CC adolescents (n = 98); and in Study 2, adults with GID (n = 41) were compared to CC adults (n = 94). In both studies, clients with GID self-reported significantly more gender dysphoria than did the CCs, with excellent sensitivity and specificity rates. In both studies, degree of self-reported gender dysphoria was significantly correlated with recall of cross-gender behavior in childhood-a test of convergent validity. The research and clinical utility of the GIDYQ-AA is discussed, including directions for further research in distinct clinical populations.

  8. The Spanish-Version of the Subjective Vitality Scale: Psychometric Properties and Evidence of Validity.

    Science.gov (United States)

    Castillo, Isabel; Tomás, Inés; Balaguer, Isabel

    2017-06-05

    The Subjective Vitality Scale (SVS) assess the subjective experience of being full of energy and alive, a clinically relevant outcome measure of positive psychological well-being. The purpose of this paper was to translate the 7-item SVS into Spanish and examine its psychometric properties. In Study 1 (n = 790 adolescents) and Study 2 (n = 130 athletes) reliability and exploratory factor analysis (EFA) were carried out. In Study 1 and Study 3 (n = 197 dancers) evidence of validity of inferences based on SVS scores estimating relationships with other variables (life satisfaction, global self-esteem and emotional and physical exhaustion) was obtained. In Study 2 invariance across time was tested. Finally in Study 3, the factorial structure was cross-validated using confirmatory factor analysis (CFA). Results of EFA showed a one-factor solution. CFA also supported a unidimensional factor structure for the Spanish 6-item SVS (RMSEA = .050 (90% CI = .00, .080); NNFI = .993; CFI = .996). Reliability analysis indicated a strong internal consistency in all study samples (α ranged from .82 to .89). Further, results from multi-sample analysis supported the replicability of SVS factor structure across time. Finally, the SVS scores showed the expected correlations patterns (all them significant, p < .01) with the measured outcomes. In conclusion, the Spanish version of the SVS demonstrated adequate psychometric properties, indicating that the scale can be confidently used to measure the experience of possessing energy and aliveness; furthermore, differences across time can be meaningfully carried out.

  9. External validation of leukocytosis and neutrophilia as a prognostic marker in anal carcinoma treated with definitive chemoradiation.

    Science.gov (United States)

    Schernberg, Antoine; Huguet, Florence; Moureau-Zabotto, Laurence; Chargari, Cyrus; Rivin Del Campo, Eleonor; Schlienger, Michel; Escande, Alexandre; Touboul, Emmanuel; Deutsch, Eric

    2017-07-01

    To validate the prognostic value of leukocyte disorders in anal squamous cell carcinoma (SCC) patients receiving definitive concurrent chemoradiation. Bi-institutional clinical records from consecutive patients treated between 2001 and 2015 with definitive chemoradiation for anal SCC were retrospectively reviewed. Prognostic value of pretreatment leukocyte disorders was examined, with focus on patterns of relapse and survival. Leukocytosis and neutrophilia were defined as leukocyte or neutrophil count exceeding 10G/L and 7G/L, respectively. We identified 133 patients, treated in two institutions. Eight% and 7% displayed baseline leukocytosis and neutrophilia, respectively. Estimated 3-year overall survival (OS) and progression-free survival (PFS) were 88% and 77%, respectively. In univariate analysis, both leukocytosis and neutrophilia were associated with worse OS, PFS (p<0.01), locoregional control (LRC) and Distant Metastasis Control (DMC) (p<0.05), also after stratification by each institution. In multivariate analysis, leukocytosis and neutrophilia remained as independent risk factors associated with poorer OS, PFS, LRC and DMC (p<0.05). This study validates leukocytosis and neutrophilia as independent prognostic factors in anal SCC patients treated with definitive chemoradiation. Although prospective confirmation is warranted, it is suggested that the leukocyte and neutrophil count parameters are clinically relevant biomarkers to be considered for further clinical investigations. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. External validation of the DHAKA score and comparison with the current IMCI algorithm for the assessment of dehydration in children with diarrhoea: a prospective cohort study.

    Science.gov (United States)

    Levine, Adam C; Glavis-Bloom, Justin; Modi, Payal; Nasrin, Sabiha; Atika, Bita; Rege, Soham; Robertson, Sarah; Schmid, Christopher H; Alam, Nur H

    2016-10-01

    Dehydration due to diarrhoea is a leading cause of child death worldwide, yet no clinical tools for assessing dehydration have been validated in resource-limited settings. The Dehydration: Assessing Kids Accurately (DHAKA) score was derived for assessing dehydration in children with diarrhoea in a low-income country setting. In this study, we aimed to externally validate the DHAKA score in a new population of children and compare its accuracy and reliability to the current Integrated Management of Childhood Illness (IMCI) algorithm. DHAKA was a prospective cohort study done in children younger than 60 months presenting to the International Centre for Diarrhoeal Disease Research, Bangladesh, with acute diarrhoea (defined by WHO as three or more loose stools per day for less than 14 days). Local nurses assessed children and classified their dehydration status using both the DHAKA score and the IMCI algorithm. Serial weights were obtained and dehydration status was established by percentage weight change with rehydration. We did regression analyses to validate the DHAKA score and compared the accuracy and reliability of the DHAKA score and IMCI algorithm with receiver operator characteristic (ROC) curves and the weighted κ statistic. This study was registered with ClinicalTrials.gov, number NCT02007733. Between March 22, 2015, and May 15, 2015, 496 patients were included in our primary analyses. On the basis of our criterion standard, 242 (49%) of 496 children had no dehydration, 184 (37%) of 496 had some dehydration, and 70 (14%) of 496 had severe dehydration. In multivariable regression analyses, each 1-point increase in the DHAKA score predicted an increase of 0·6% in the percentage dehydration of the child and increased the odds of both some and severe dehydration by a factor of 1·4. Both the accuracy and reliability of the DHAKA score were significantly greater than those of the IMCI algorithm. The DHAKA score is the first clinical tool for assessing

  11. Micro-evidence on the determinants of innovation in the Netherlands : The relative importance of absorptive capacity and agglomeration externalities

    NARCIS (Netherlands)

    Smit, Martijn J.|info:eu-repo/dai/nl/298800276; Abreu, Maria A.; de Groot, Henri L. F.

    Although the benefits of clustering for innovation have received much attention in the theoretical as well as empirical literature, analyses at the regional level often disregard the characteristics of local firms. We tackle both at the same time: agglomeration externalities (Marshall, Porter,

  12. Development of Decision Support Formulas for the Prediction of Bladder Outlet Obstruction and Prostatic Surgery in Patients With Lower Urinary Tract Symptom/Benign Prostatic Hyperplasia: Part II, External Validation and Usability Testing of a Smartphone App

    Directory of Open Access Journals (Sweden)

    Min Soo Choo

    2017-04-01

    Full Text Available Purpose We aimed to externally validate the prediction model we developed for having bladder outlet obstruction (BOO and requiring prostatic surgery using 2 independent data sets from tertiary referral centers, and also aimed to validate a mobile app for using this model through usability testing. Methods Formulas and nomograms predicting whether a subject has BOO and needs prostatic surgery were validated with an external validation cohort from Seoul National University Bundang Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center between January 2004 and April 2015. A smartphone-based app was developed, and 8 young urologists were enrolled for usability testing to identify any human factor issues of the app. Results A total of 642 patients were included in the external validation cohort. No significant differences were found in the baseline characteristics of major parameters between the original (n=1,179 and the external validation cohort, except for the maximal flow rate. Predictions of requiring prostatic surgery in the validation cohort showed a sensitivity of 80.6%, a specificity of 73.2%, a positive predictive value of 49.7%, and a negative predictive value of 92.0%, and area under receiver operating curve of 0.84. The calibration plot indicated that the predictions have good correspondence. The decision curve showed also a high net benefit. Similar evaluation results using the external validation cohort were seen in the predictions of having BOO. Overall results of the usability test demonstrated that the app was user-friendly with no major human factor issues. Conclusions External validation of these newly developed a prediction model demonstrated a moderate level of discrimination, adequate calibration, and high net benefit gains for predicting both having BOO and requiring prostatic surgery. Also a smartphone app implementing the prediction model was user-friendly with no major human factor issue.

  13. Dengue score as a diagnostic predictor for pleural effusion and/or ascites: external validation and clinical application.

    Science.gov (United States)

    Suwarto, Suhendro; Hidayat, Mohammad Jauharsyah; Widjaya, Bing

    2018-02-23

    The Dengue Score is a model for predicting pleural effusion and/or ascites and uses the hematocrit (Hct), albumin concentration, platelet count and aspartate aminotransferase (AST) ratio as independent variables. As this metric has not been validated, we conducted a study to validate the Dengue Score and assess its clinical application. A retrospective study was performed at a private hospital in Jakarta, Indonesia. Patients with dengue infection hospitalized from January 2011 through March 2016 were included. The Dengue Score was calculated using four parameters: Hct increase≥15.1%, serum albumin≤3.49 mg/dL, platelet count≤49,500/μL and AST ratio ≥ 2.51. Each parameter was scored as 1 if present and 0 if absent. To validate the Dengue Score, goodness-of-fit was used to assess calibration, and the area under the receiver operating characteristic curve (AROC) was used to assess discrimination. Associations between clinical parameters and Dengue Score groups were determined by bivariate analysis. A total of 207 patients were included in this study. The calibration of the Dengue Score was acceptable (Hosmer-Lemeshow test, p = 0.11), and the score's discriminative ability was good (AROC = 0.88 (95% CI: 0.83-0.92)). At a cutoff of ≥2, the Dengue Score had a positive predictive value (PPV) of 79.03% and a negative predictive value (NPV) of 90.36% for the diagnostic prediction of pleural effusion and/or ascites. Compared with the Dengue Score ≤ 1 group, the Dengue Score = 2 group was significantly associated with hemoconcentration> 20% (p = 0.029), severe thrombocytopenia (p = 0.029), and increased length of hospital stay (p = 0.003). Compared with the Dengue Score = 2 group, the Dengue Score ≥ 3 group was significantly associated with hemoconcentration> 20% (p = 0.001), severe thrombocytopenia (p = 0.024), severe dengue (p = 0.039), and increased length of hospital stay (p = 0.011). The Dengue Score performed well and can

  14. Direct Observation of Clinical Skills Feedback Scale: Development and Validity Evidence.

    Science.gov (United States)

    Halman, Samantha; Dudek, Nancy; Wood, Timothy; Pugh, Debra; Touchie, Claire; McAleer, Sean; Humphrey-Murto, Susan

    2016-01-01

    Construct: This article describes the development and validity evidence behind a new rating scale to assess feedback quality in the clinical workplace. Competency-based medical education has mandated a shift to learner-centeredness, authentic observation, and frequent formative assessments with a focus on the delivery of effective feedback. Because feedback has been shown to be of variable quality and effectiveness, an assessment of feedback quality in the workplace is important to ensure we are providing trainees with optimal learning opportunities. The purposes of this project were to develop a rating scale for the quality of verbal feedback in the workplace (the Direct Observation of Clinical Skills Feedback Scale [DOCS-FBS]) and to gather validity evidence for its use. Two panels of experts (local and national) took part in a nominal group technique to identify features of high-quality feedback. Through multiple iterations and review, 9 features were developed into the DOCS-FBS. Four rater types (residents n = 21, medical students n = 8, faculty n = 12, and educators n = 12) used the DOCS-FBS to rate videotaped feedback encounters of variable quality. The psychometric properties of the scale were determined using a generalizability analysis. Participants also completed a survey to gather data on a 5-point Likert scale to inform the ease of use, clarity, knowledge acquisition, and acceptability of the scale. Mean video ratings ranged from 1.38 to 2.96 out of 3 and followed the intended pattern suggesting that the tool allowed raters to distinguish between examples of higher and lower quality feedback. There were no significant differences between rater type (range = 2.36-2.49), suggesting that all groups of raters used the tool in the same way. The generalizability coefficients for the scale ranged from 0.97 to 0.99. Item-total correlations were all above 0.80, suggesting some redundancy in items. Participants found the scale easy to use (M = 4.31/5) and clear

  15. Constructing a Validity Argument for the Objective Structured Assessment of Technical Skills (OSATS): A Systematic Review of Validity Evidence

    Science.gov (United States)

    Hatala, Rose; Cook, David A.; Brydges, Ryan; Hawkins, Richard

    2015-01-01

    In order to construct and evaluate the validity argument for the Objective Structured Assessment of Technical Skills (OSATS), based on Kane's framework, we conducted a systematic review. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, Scopus, and selected reference lists through February 2013. Working in duplicate, we selected…

  16. Predictive Accuracy of the PanCan Lung Cancer Risk Prediction Model -External Validation based on CT from the Danish Lung Cancer Screening Trial

    DEFF Research Database (Denmark)

    Winkler Wille, Mathilde M.; van Riel, Sarah J.; Saghir, Zaigham

    2015-01-01

    Objectives: Lung cancer risk models should be externally validated to test generalizability and clinical usefulness. The Danish Lung Cancer Screening Trial (DLCST) is a population-based prospective cohort study, used to assess the discriminative performances of the PanCan models. Methods: From...... the DLCST database, 1,152 nodules from 718 participants were included. Parsimonious and full PanCan risk prediction models were applied to DLCST data, and also coefficients of the model were recalculated using DLCST data. Receiver operating characteristics (ROC) curves and area under the curve (AUC) were...... used to evaluate risk discrimination. Results: AUCs of 0.826–0.870 were found for DLCST data based on PanCan risk prediction models. In the DLCST, age and family history were significant predictors (p = 0.001 and p = 0.013). Female sex was not confirmed to be associated with higher risk of lung cancer...

  17. Bureaucratic structure, geographical location and the autonomy of administrative systems. Evidence from the European External Action Service

    OpenAIRE

    Henökl, Thomas; Trondal, Jarle

    2013-01-01

    Presentation on department page: http://www.uia.no/no/portaler/om_universitetet/oekonomi_og_samfunnsvitenskap/statsvitenskap_og_ledelsesfag/ forskning_isl/isl_working_papers_series Formulating and implementing public policy in Europe has historically been a prerogative of national administrations. This paper explores how these prerogatives may have become challenged with the ‘autonomization’ of the European Union’s (EU’s) foreign affairs administration (The European External Action Service...

  18. Model-based clinical dose optimization for phenobarbital in neonates: An illustration of the importance of data sharing and external validation.

    Science.gov (United States)

    Völler, Swantje; Flint, Robert B; Stolk, Leo M; Degraeuwe, Pieter L J; Simons, Sinno H P; Pokorna, Paula; Burger, David M; de Groot, Ronald; Tibboel, Dick; Knibbe, Catherijne A J

    2017-11-15

    Particularly in the pediatric clinical pharmacology field, data-sharing offers the possibility of making the most of all available data. In this study, we utilize previously collected therapeutic drug monitoring (TDM) data of term and preterm newborns to develop a population pharmacokinetic model for phenobarbital. We externally validate the model using prospective phenobarbital data from an ongoing pharmacokinetic study in preterm neonates. TDM data from 53 neonates (gestational age (GA): 37 (24-42) weeks, bodyweight: 2.7 (0.45-4.5) kg; postnatal age (PNA): 4.5 (0-22) days) contained information on dosage histories, concentration and covariate data (including birth weight, actual weight, post-natal age (PNA), postmenstrual age, GA, sex, liver and kidney function, APGAR-score). Model development was carried out using NONMEM ® 7.3. After assessment of model fit, the model was validated using data of 17 neonates included in the DINO (Drug dosage Improvement in NeOnates)-study. Modelling of 229 plasma concentrations, ranging from 3.2 to 75.2mg/L, resulted in a one compartment model for phenobarbital. Clearance (CL) and volume (V d ) for a child with a birthweight of 2.6kg at PNA day 4.5 was 0.0091L/h (9%) and 2.38L (5%), respectively. Birthweight and PNA were the best predictors for CL maturation, increasing CL by 36.7% per kg birthweight and 5.3% per postnatal day of living, respectively. The best predictor for the increase in V d was actual bodyweight (0.31L/kg). External validation showed that the model can adequately predict the pharmacokinetics in a prospective study. Data-sharing can help to successfully develop and validate population pharmacokinetic models in neonates. From the results it seems that both PNA and bodyweight are required to guide dosing of phenobarbital in term and preterm neonates. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  19. External Validation of a Decision Tool To Guide Post-Operative Management of Patients with Secondary Peritonitis.

    Science.gov (United States)

    Atema, Jasper J; Ram, Kim; Schultz, Marcus J; Boermeester, Marja A

    Timely identification of patients in need of an intervention for abdominal sepsis after initial surgical management of secondary peritonitis is vital but complex. The aim of this study was to validate a decision tool for this purpose and to evaluate its potential to guide post-operative management. A prospective cohort study was conducted on consecutive adult patients undergoing surgery for secondary peritonitis in a single hospital. Assessments using the decision tool, based on one intra-operative and five post-operative variables, were performed on the second and third post-operative days and when the patients' clinical status deteriorated. Scores were compared with the clinical reference standard of persistent sepsis based on the clinical course or findings at imaging or surgery. Additionally, the potential of the decision tool to guide management in terms of diagnostic imaging in three previously defined score categories (low, intermediate, and high) was evaluated. A total of 161 assessments were performed in 69 patients. The majority of cases of secondary peritonitis (68%) were caused by perforation of the gastrointestinal tract. Post-operative persistent sepsis occurred in 28 patients. The discriminative capacity of the decision tool score was fair (area under the curve of the receiver operating characteristic = 0.79). The incidence rate differed significantly between the three score categories (p peritonitis, the decision tool score predicts with fair accuracy whether persistent sepsis is present.

  20. External Knowledge Sourcing and Green Innovation Growth with Environmental and Energy Regulations: Evidence from Manufacturing in China

    Directory of Open Access Journals (Sweden)

    Jian Hou

    2017-02-01

    Full Text Available This paper adopts the slacks-based measure-directional distance function (SBM-DDF, 2009 method for deriving the “Green Innovation Growth” rates of 28 manufacturing industries in China. The results indicate that the overall level of green innovation growth in China’s manufacturing is relatively low, with a declining trend. The tradeoffs among energy, environment and economy are rather sharp, and the “Porter Effect (1995” (environmental regulation will promote green technology innovation is not currently realized quickly in manufacturing. These evaluations imply an unsustainable development model in China, with significant differences among industries. By using a dynamic panel threshold model and employing an industry-level panel dataset for 2008–2014, we show that external knowledge sourcing has a significant negative impact on green innovation growth but with different constraints on R&D levels among industries. With the strengthening of R&D levels, gradually surpassing “critical mass”, the negative role of external knowledge sourcing in driving this mechanism becomes smaller and smaller; it has a non-linear relationship with the “threshold effect”. Consequently, we provide insights into the relationship among energy consumption, environmental pollution and technology innovation, and show how the heterogeneity of the R&D threshold affects differences in external knowledge sourcing and green innovation growth. These insights lead to a better understanding of the driving force, realizing path and policy design for green innovation growth.

  1. Multicenter external validation of two malignancy risk prediction models in patients undergoing 18F-FDG-PET for solitary pulmonary nodule evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Perandini, Simone; Soardi, G.A.; Signorini, M.; Motton, M.; Montemezzi, S. [Azienda Ospedaliera Universitaria Integrata di Verona, UOC Radiologia, Ospedale Maggiore di Borgo Trento, Verona (Italy); Larici, A.R.; Del Ciello, A. [Universita Cattolica del Sacro Cuore, Dipartimento di Scienze Radiologiche, Roma (Italy); Rizzardi, G. [Ospedale Humanitas Gavazzeni, UO Chirurgia Toracica, Bergamo (Italy); Solazzo, A. [Ospedale Humanitas Gavazzeni, UO Radiologia, Bergamo (Italy); Mancino, L.; Zeraj, F. [Ospedale dell' Angelo di Mestre, UO Pneumologia, Venezia (Italy); Bernhart, M. [Ospedale dell' Angelo di Mestre, UO Radiologia, Venezia (Italy)

    2017-05-15

    To achieve multicentre external validation of the Herder and Bayesian Inference Malignancy Calculator (BIMC) models. Two hundred and fifty-nine solitary pulmonary nodules (SPNs) collected from four major hospitals which underwent 18-FDG-PET characterization were included in this multicentre retrospective study. The Herder model was tested on all available lesions (group A). A subgroup of 180 SPNs (group B) was used to provide unbiased comparison between the Herder and BIMC models. Receiver operating characteristic (ROC) area under the curve (AUC) analysis was performed to assess diagnostic accuracy. Decision analysis was performed by adopting the risk threshold stated in British Thoracic Society (BTS) guidelines. Unbiased comparison performed In Group B showed a ROC AUC for the Herder model of 0.807 (95 % CI 0.742-0.862) and for the BIMC model of 0.822 (95 % CI 0.758-0.875). Both the Herder and the BIMC models were proven to accurately predict the risk of malignancy when tested on a large multicentre external case series. The BIMC model seems advantageous on the basis of a more favourable decision analysis. (orig.)

  2. Multicenter external validation of two malignancy risk prediction models in patients undergoing 18F-FDG-PET for solitary pulmonary nodule evaluation

    International Nuclear Information System (INIS)

    Perandini, Simone; Soardi, G.A.; Signorini, M.; Motton, M.; Montemezzi, S.; Larici, A.R.; Del Ciello, A.; Rizzardi, G.; Solazzo, A.; Mancino, L.; Zeraj, F.; Bernhart, M.

    2017-01-01

    To achieve multicentre external validation of the Herder and Bayesian Inference Malignancy Calculator (BIMC) models. Two hundred and fifty-nine solitary pulmonary nodules (SPNs) collected from four major hospitals which underwent 18-FDG-PET characterization were included in this multicentre retrospective study. The Herder model was tested on all available lesions (group A). A subgroup of 180 SPNs (group B) was used to provide unbiased comparison between the Herder and BIMC models. Receiver operating characteristic (ROC) area under the curve (AUC) analysis was performed to assess diagnostic accuracy. Decision analysis was performed by adopting the risk threshold stated in British Thoracic Society (BTS) guidelines. Unbiased comparison performed In Group B showed a ROC AUC for the Herder model of 0.807 (95 % CI 0.742-0.862) and for the BIMC model of 0.822 (95 % CI 0.758-0.875). Both the Herder and the BIMC models were proven to accurately predict the risk of malignancy when tested on a large multicentre external case series. The BIMC model seems advantageous on the basis of a more favourable decision analysis. (orig.)

  3. External validation and newly development of a nomogram to predict overall survival of abiraterone-treated, castration-resistant patients with metastatic prostate cancer

    Directory of Open Access Journals (Sweden)

    Yun-Jie Yang

    2018-01-01

    Full Text Available Abiraterone acetate is approved for the treatment of castration-resistant prostate cancer (CRPC; however, its effects vary. An accurate prediction model to identify patient groups that will benefit from abiraterone treatment is therefore urgently required. The Chi model exhibits a good profile for risk classification, although its utility for the chemotherapy-naive group is unclear. This study aimed to externally validate the Chi model and develop a new nomogram to predict overall survival (OS. We retrospectively analyzed a cohort of 110 patients. Patients were distributed among good-, intermediate-, and poor-risk groups, according to the Chi model. The good-, intermediate-, and poor-risk groups had a sample size of 59 (53.6%, 34 (30.9%, and 17 (15.5% in our dataset, and a median OS of 48.4, 29.1, and 10.5 months, respectively. The C-index of external validation of Chi model was 0.726. Univariate and multivariate analyses identified low hemoglobin concentrations (<110 g l−1, liver metastasis, and a short time interval from androgen deprivation therapy to abiraterone initiation (<36 months as predictors of OS. Accordingly, a new nomogram was developed with a C-index equal to 0.757 (95% CI, 0.678–0.836. In conclusion, the Chi model predicted the prognosis of abiraterone-treated, chemotherapy-naive patients with mCRPC, and we developed a new nomogram to predict the overall survival of this group of patients with less parameters.

  4. The Impact of Recipient Site External Expansion in Fat Grafting Surgical Outcomes

    Directory of Open Access Journals (Sweden)

    Carlo M. Oranges, MD

    2018-02-01

    Conclusions:. External expansion and fat grafting is a promising technique for breast reconstruction and augmentation. However, due to the overall low level of evidence of the available studies, further research is needed to validate the procedure.

  5. Is the Readmission Rate a Valid Quality Indicator? A Review of the Evidence

    Science.gov (United States)

    Fischer, Claudia; Lingsma, Hester F.; Marang-van de Mheen, Perla J.; Kringos, Dionne S.; Klazinga, Niek S.; Steyerberg, Ewout W.

    2014-01-01

    Introduction Hospital readmission rates are increasingly used for both quality improvement and cost control. However, the validity of readmission rates as a measure of quality of hospital care is not evident. We aimed to give an overview of the different methodological aspects in the definition and measurement of readmission rates that need to be considered when interpreting readmission rates as a reflection of quality of care. Methods We conducted a systematic literature review, using the bibliographic databases Embase, Medline OvidSP, Web-of-Science, Cochrane central and PubMed for the period of January 2001 to May 2013. Results The search resulted in 102 included papers. We found that definition of the context in which readmissions are used as a quality indicator is crucial. This context includes the patient group and the specific aspects of care of which the quality is aimed to be assessed. Methodological flaws like unreliable data and insufficient case-mix correction may confound the comparison of readmission rates between hospitals. Another problem occurs when the basic distinction between planned and unplanned readmissions cannot be made. Finally, the multi-faceted nature of quality of care and the correlation between readmissions and other outcomes limit the indicator's validity. Conclusions Although readmission rates are a promising quality indicator, several methodological concerns identified in this study need to be addressed, especially when the indicator is intended for accountability or pay for performance. We recommend investing resources in accurate data registration, improved indicator description, and bundling outcome measures to provide a more complete picture of hospital care. PMID:25379675

  6. Is the readmission rate a valid quality indicator? A review of the evidence.

    Directory of Open Access Journals (Sweden)

    Claudia Fischer

    Full Text Available Hospital readmission rates are increasingly used for both quality improvement and cost control. However, the validity of readmission rates as a measure of quality of hospital care is not evident. We aimed to give an overview of the different methodological aspects in the definition and measurement of readmission rates that need to be considered when interpreting readmission rates as a reflection of quality of care.We conducted a systematic literature review, using the bibliographic databases Embase, Medline OvidSP, Web-of-Science, Cochrane central and PubMed for the period of January 2001 to May 2013.The search resulted in 102 included papers. We found that definition of the context in which readmissions are used as a quality indicator is crucial. This context includes the patient group and the specific aspects of care of which the quality is aimed to be assessed. Methodological flaws like unreliable data and insufficient case-mix correction may confound the comparison of readmission rates between hospitals. Another problem occurs when the basic distinction between planned and unplanned readmissions cannot be made. Finally, the multi-faceted nature of quality of care and the correlation between readmissions and other outcomes limit the indicator's validity.Although readmission rates are a promising quality indicator, several methodological concerns identified in this study need to be addressed, especially when the indicator is intended for accountability or pay for performance. We recommend investing resources in accurate data registration, improved indicator description, and bundling outcome measures to provide a more complete picture of hospital care.

  7. In-vivo dosimetry in external radiotherapy with amorphous silicon Portal Imaging Devices: from method to clinical validation

    International Nuclear Information System (INIS)

    Boissard, Philippe

    2012-01-01

    In vivo dose verification is used to prevent major deviations between the prescribed dose and the dose really delivered to the patient. This quality control was, nationally and internationally, widely recommended by scientific organizations. In France, its implementation and its use are now regulated. To do this, small detectors are fixed on the patient skin at the beginning of the treatment. However, the treatment delay is increased and not all treatment techniques could be assessed, such as IMRT plans (Intensity Modulated Radiation Therapy). In this context, Transit dosimetry performed with Electronic Portal Imaging Devices (EPIDs) appears as an interesting alternative for in vivo dose verification. During the treatment session, a transit dose is measured with the EPID, in two dimensions, and the dose in the patient is estimated from back projection of the portal dose. This work presents a quick and simple alternative method for verification of dose delivered to the patient using photon beams. Verifications in cases of complexes patient shapes and Intensity Modulated Radiation Therapy (IMRT) have been improved by using a Clarkson-Cunningham's integration method. 46 phantom test cases were designed to assess the accuracy of the method for 4, 6, 10 and 20 MV photon beams. For some points of interest the dose reconstructed by the method is compared to the dose measured with an ionization chamber. An additional in vivo uncertainty due to day to day deviations is defined and investigated. In the same time, a clinical study was driven during three years. In vivo dosimetry was performed for 494 patients treated for various tumors sites. Most of the patients were treated for a prostate cancer using IMRT. The in vivo dose is here compared to the dose calculated by the Treatment Planning System, TPS. The results of these two ways of validations are within the accepted tolerance of classical in vivo dosimetry. From the phantom study, we have estimated that the standard

  8. Validation and evaluation of measuring methods for the 3D documentation of external injuries in the field of forensic medicine.

    Science.gov (United States)

    Buck, Ursula; Buße, Kirsten; Campana, Lorenzo; Schyma, Christian

    2018-03-01

    Three-dimensional (3D) measurement techniques are gaining importance in many areas. The latest developments brought more cost-effective, user-friendly, and faster technologies onto the market. Which 3D techniques are suitable in the field of forensic medicine and what are their advantages and disadvantages? This wide-ranging study evaluated and validated various 3D measurement techniques for the forensic requirements. High-tech methods as well as low-budget systems have been tested and compared in terms of accuracy, ease of use, expenditure of time, mobility, cost, necessary knowhow, and their limitations. Within this study, various commercial measuring systems of the different techniques were tested. Based on the first results, one measuring system was selected for each technique, which appeared to be the most suitable for the forensic application or is already established in forensic medicine. A body of a deceased, a face and an injury of a living person, and a shoe sole were recorded by 11 people with different professions and previous knowledge using the selected systems. The results were assessed and the personal experiences were evaluated using a questionnaire. In addition, precision investigations were carried out using test objects. The study shows that the hand-held scanner and photogrammetry are very suitable for the 3D documentation of forensic medical findings. Their moderate acquisition costs and easy operation could lead to more frequent application in forensic medicine in the future. For special applications, the stripe-light scanner still has its justification due to its high precision, the flexible application area, and the high reliability. The results show that, thanks to the technological advances, the 3D measurement technology will have more and more impact on the routine of the forensic medical examination.

  9. Regional Externalities

    NARCIS (Netherlands)

    Heijman, W.J.M.

    2007-01-01

    The book offers practical and theoretical insights in regional externalities. Regional externalities are a specific subset of externalities that can be defined as externalities where space plays a dominant role. This class of externalities can be divided into three categories: (1) externalities

  10. Evidence-based cross validation for acoustic power transmission for a novel treatment system.

    Science.gov (United States)

    Mihcin, Senay; Strehlow, Jan; Demedts, Daniel; Schwenke, Michael; Levy, Yoav; Melzer, Andreas

    2017-06-01

    The novel Trans-Fusimo Treatment System (TTS) is designed to control Magnetic Resonance guided Focused Ultrasound (MRgFUS) therapy to ablate liver tumours under respiratory motion. It is crucial to deliver the acoustic power within tolerance limits for effective liver tumour treatment via MRgFUS. Before application in a clinical setting, evidence of reproducibility and reliability is a must for safe practice. The TTS software delivers the acoustic power via ExAblate-2100 Conformal Bone System (CBS) transducer. A built-in quality assurance application was developed to measure the force values, using a novel protocol to measure the efficiency for the electrical power values of 100 and 150W for 6s of sonication. This procedure was repeated 30 times by two independent users against the clinically approved ExAblate-2100 CBS for cross-validation. Both systems proved to deliver the power within the accepted efficiency levels (70-90%). Two sample t-tests were used to assess the differences in force values between the ExAblate-2100 CBS and the TTS (p > 0.05). Bland-Altman plots were used to demonstrate the limits of agreement between the two systems falling within the 10% limits of agreement. Two sample t-tests indicated that TTS does not have user dependency (p > 0.05). The TTS software proved to deliver the acoustic power without exceeding the safety levels. Results provide evidence as a part of ISO13485 regulations for CE marking purposes. The developed methodology could be utilised as a part of quality assurance system in clinical settings; when the TTS is used in clinical practice.

  11. External Validation of Health Economic Decision Models for Chronic Obstructive Pulmonary Disease (COPD): Report of the Third COPD Modeling Meeting.

    Science.gov (United States)

    Hoogendoorn, Martine; Feenstra, Talitha L; Asukai, Yumi; Briggs, Andrew H; Hansen, Ryan N; Leidl, Reiner; Risebrough, Nancy; Samyshkin, Yevgeniy; Wacker, Margarethe; Rutten-van Mölken, Maureen P M H

    2017-03-01

    To validate outcomes of presently available chronic obstructive pulmonary disease (COPD) cost-effectiveness models against results of two large COPD trials-the 3-year TOwards a Revolution in COPD Health (TORCH) trial and the 4-year Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT) trial. Participating COPD modeling groups simulated the outcomes for the placebo-treated groups of the TORCH and UPLIFT trials using baseline characteristics of the trial populations as input. Groups then simulated treatment effectiveness by using relative reductions in annual decline in lung function and exacerbation frequency observed in the most intensively treated group compared with placebo as input for the models. Main outcomes were (change in) total/severe exacerbations and mortality. Furthermore, the absolute differences in total exacerbations and quality-adjusted life-years (QALYs) were used to approximate the cost per exacerbation avoided and the cost per QALY gained. Of the six participating models, three models reported higher total exacerbation rates than observed in the TORCH trial (1.13/patient-year) (models: 1.22-1.48). Four models reported higher rates than observed in the UPLIFT trial (0.85/patient-year) (models: 1.13-1.52). Two models reported higher mortality rates than in the TORCH trial (15.2%) (models: 20.0% and 30.6%) and the UPLIFT trial (16.3%) (models: 24.8% and 36.0%), whereas one model reported lower rates (9.8% and 12.1%, respectively). Simulation of treatment effectiveness showed that the absolute reduction in total exacerbations, the gain in QALYs, and the cost-effectiveness ratios did not differ from the trials, except for one model. Although most of the participating COPD cost-effectiveness models reported higher total exacerbation rates than observed in the trials, estimates of the absolute treatment effect and cost-effectiveness ratios do not seem different from the trials in most models. Copyright © 2017 International

  12. Predictive accuracy of the PanCan lung cancer risk prediction model - external validation based on CT from the Danish Lung Cancer Screening Trial

    International Nuclear Information System (INIS)

    Winkler Wille, Mathilde M.; Dirksen, Asger; Riel, Sarah J. van; Jacobs, Colin; Scholten, Ernst T.; Ginneken, Bram van; Saghir, Zaigham; Pedersen, Jesper Holst; Hohwue Thomsen, Laura; Skovgaard, Lene T.

    2015-01-01

    Lung cancer risk models should be externally validated to test generalizability and clinical usefulness. The Danish Lung Cancer Screening Trial (DLCST) is a population-based prospective cohort study, used to assess the discriminative performances of the PanCan models. From the DLCST database, 1,152 nodules from 718 participants were included. Parsimonious and full PanCan risk prediction models were applied to DLCST data, and also coefficients of the model were recalculated using DLCST data. Receiver operating characteristics (ROC) curves and area under the curve (AUC) were used to evaluate risk discrimination. AUCs of 0.826-0.870 were found for DLCST data based on PanCan risk prediction models. In the DLCST, age and family history were significant predictors (p = 0.001 and p = 0.013). Female sex was not confirmed to be associated with higher risk of lung cancer; in fact opposing effects of sex were observed in the two cohorts. Thus, female sex appeared to lower the risk (p = 0.047 and p = 0.040) in the DLCST. High risk discrimination was validated in the DLCST cohort, mainly determined by nodule size. Age and family history of lung cancer were significant predictors and could be included in the parsimonious model. Sex appears to be a less useful predictor. (orig.)

  13. Development and external validation of nomograms to predict the risk of skeletal metastasis at the time of diagnosis and skeletal metastasis-free survival in nasopharyngeal carcinoma.

    Science.gov (United States)

    Yang, Lin; Xia, Liangping; Wang, Yan; He, Shasha; Chen, Haiyang; Liang, Shaobo; Peng, Peijian; Hong, Shaodong; Chen, Yong

    2017-09-06

    The skeletal system is the most common site of distant metastasis in nasopharyngeal carcinoma (NPC); various prognostic factors have been reported for skeletal metastasis, though most studies have focused on a single factor. We aimed to establish nomograms to effectively predict skeletal metastasis at initial diagnosis (SMAD) and skeletal metastasis-free survival (SMFS) in NPC. A total of 2685 patients with NPC who received bone scintigraphy (BS) and/or 18F-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and 2496 patients without skeletal metastasis were retrospectively assessed to develop individual nomograms for SMAD and SMFS. The models were validated externally using separate cohorts of 1329 and 1231 patients treated at two other institutions. Five independent prognostic factors were included in each nomogram. The SMAD nomogram had a significantly higher c-index than the TNM staging system (training cohort, P = 0.005; validation cohort, P system (P skeletal metastasis, which may improve counseling and facilitate individualized management of patients with NPC.

  14. Predictive accuracy of the PanCan lung cancer risk prediction model - external validation based on CT from the Danish Lung Cancer Screening Trial

    Energy Technology Data Exchange (ETDEWEB)

    Winkler Wille, Mathilde M.; Dirksen, Asger [Gentofte Hospital, Department of Respiratory Medicine, Hellerup (Denmark); Riel, Sarah J. van; Jacobs, Colin; Scholten, Ernst T.; Ginneken, Bram van [Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen (Netherlands); Saghir, Zaigham [Herlev Hospital, Department of Respiratory Medicine, Herlev (Denmark); Pedersen, Jesper Holst [Copenhagen University Hospital, Department of Thoracic Surgery, Rigshospitalet, Koebenhavn Oe (Denmark); Hohwue Thomsen, Laura [Hvidovre Hospital, Department of Respiratory Medicine, Hvidovre (Denmark); Skovgaard, Lene T. [University of Copenhagen, Department of Biostatistics, Koebenhavn Oe (Denmark)

    2015-10-15

    Lung cancer risk models should be externally validated to test generalizability and clinical usefulness. The Danish Lung Cancer Screening Trial (DLCST) is a population-based prospective cohort study, used to assess the discriminative performances of the PanCan models. From the DLCST database, 1,152 nodules from 718 participants were included. Parsimonious and full PanCan risk prediction models were applied to DLCST data, and also coefficients of the model were recalculated using DLCST data. Receiver operating characteristics (ROC) curves and area under the curve (AUC) were used to evaluate risk discrimination. AUCs of 0.826-0.870 were found for DLCST data based on PanCan risk prediction models. In the DLCST, age and family history were significant predictors (p = 0.001 and p = 0.013). Female sex was not confirmed to be associated with higher risk of lung cancer; in fact opposing effects of sex were observed in the two cohorts. Thus, female sex appeared to lower the risk (p = 0.047 and p = 0.040) in the DLCST. High risk discrimination was validated in the DLCST cohort, mainly determined by nodule size. Age and family history of lung cancer were significant predictors and could be included in the parsimonious model. Sex appears to be a less useful predictor. (orig.)

  15. Assessment of generalizability, applicability and predictability (GAP) for evaluating external validity in studies of universal family-based prevention of alcohol misuse in young people: systematic methodological review of randomized controlled trials.

    Science.gov (United States)

    Fernandez-Hermida, Jose Ramon; Calafat, Amador; Becoña, Elisardo; Tsertsvadze, Alexander; Foxcroft, David R

    2012-09-01

    To assess external validity characteristics of studies from two Cochrane Systematic Reviews of the effectiveness of universal family-based prevention of alcohol misuse in young people. Two reviewers used an a priori developed external validity rating form and independently assessed three external validity dimensions of generalizability, applicability and predictability (GAP) in randomized controlled trials. The majority (69%) of the included 29 studies were rated 'unclear' on the reporting of sufficient information for judging generalizability from sample to study population. Ten studies (35%) were rated 'unclear' on the reporting of sufficient information for judging applicability to other populations and settings. No study provided an assessment of the validity of the trial end-point measures for subsequent mortality, morbidity, quality of life or other economic or social outcomes. Similarly, no study reported on the validity of surrogate measures using established criteria for assessing surrogate end-points. Studies evaluating the benefits of family-based prevention of alcohol misuse in young people are generally inadequate at reporting information relevant to generalizability of the findings or implications for health or social outcomes. Researchers, study authors, peer reviewers, journal editors and scientific societies should take steps to improve the reporting of information relevant to external validity in prevention trials. © 2012 The Authors. Addiction © 2012 Society for the Study of Addiction.

  16. Factor analysis methods and validity evidence: A systematic review of instrument development across the continuum of medical education

    Science.gov (United States)

    Wetzel, Angela Payne

    Previous systematic reviews indicate a lack of reporting of reliability and validity evidence in subsets of the medical education literature. Psychology and general education reviews of factor analysis also indicate gaps between current and best practices; yet, a comprehensive review of exploratory factor analysis in instrument development across the continuum of medical education had not been previously identified. Therefore, the purpose for this study was critical review of instrument development articles employing exploratory factor or principal component analysis published in medical education (2006--2010) to describe and assess the reporting of methods and validity evidence based on the Standards for Educational and Psychological Testing and factor analysis best practices. Data extraction of 64 articles measuring a variety of constructs that have been published throughout the peer-reviewed medical education literature indicate significant errors in the translation of exploratory factor analysis best practices to current practice. Further, techniques for establishing validity evidence tend to derive from a limited scope of methods including reliability statistics to support internal structure and support for test content. Instruments reviewed for this study lacked supporting evidence based on relationships with other variables and response process, and evidence based on consequences of testing was not evident. Findings suggest a need for further professional development within the medical education researcher community related to (1) appropriate factor analysis methodology and reporting and (2) the importance of pursuing multiple sources of reliability and validity evidence to construct a well-supported argument for the inferences made from the instrument. Medical education researchers and educators should be cautious in adopting instruments from the literature and carefully review available evidence. Finally, editors and reviewers are encouraged to recognize

  17. Task Irrelevant External Cues Can Influence Language Selection in Voluntary Object Naming: Evidence from Hindi-English Bilinguals.

    Directory of Open Access Journals (Sweden)

    Divya Bhatia

    Full Text Available We examined if external cues such as other agents' actions can influence the choice of language during voluntary and cued object naming in bilinguals in three experiments. Hindi-English bilinguals first saw a cartoon waving at a color patch. They were then asked to either name a picture in the language of their choice (voluntary block or to name in the instructed language (cued block. The colors waved at by the cartoon were also the colors used as language cues (Hindi or English. We compared the influence of the cartoon's choice of color on naming when speakers had to indicate their choice explicitly before naming (Experiment 1 as opposed to when they named directly on seeing the pictures (Experiment 2 and 3. Results showed that participants chose the language indicated by the cartoon greater number of times (Experiment 1 and 3. Speakers also switched significantly to the language primed by the cartoon greater number of times (Experiment 1 and 2. These results suggest that choices leading to voluntary action, as in the case of object naming can be influenced significantly by external non-linguistic cues. Importantly, these symbolic influences can work even when other agents are merely indicating their choices and are not interlocutors in bilingual communication.

  18. Leaflet manual of external beam radiation therapy for hepatocellular carcinoma: a review of the indications, evidences, and clinical trials

    Directory of Open Access Journals (Sweden)

    Rim CH

    2018-05-01

    Full Text Available Chai Hong Rim, Won Sup Yoon Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, Republic of Korea Abstract: The use of external beam radiation therapy (EBRT in the treatment of hepatocellular carcinoma (HCC, which was rarely performed due to liver toxicity with a previous technique, has increased. Palliation of portal vein thrombosis, supplementation for insufficient transarterial chemoembolization, and provision of new curative opportunities using stereotactic body radiotherapy are the potential indications for use of EBRT. The mechanism of EBRT treatment, with its radiobiological and physical perspectives, differs from those of conventional medical treatment or surgery. Therefore, understanding the effects of EBRT may be unfamiliar to physicians other than radiation oncologists, especially in the field of HCC, where EBRT has recently begun to be applied. The first objective of this review was to concisely explain the indications for use of EBRT for HCC for all physicians treating HCC. Therefore, this review focuses on the therapeutic outcomes rather than the detailed biological and physical background. We also reviewed recent clinical trials that may extend the indications for use of EBRT. Finally, we reviewed the current clinical practice guidelines for the treatment of HCC and discuss the current recommendations and future perspectives. Keywords: hepatocellular carcinoma, liver neoplasm, external beam radiotherapy, stereotactic body radiotherapy, clinical trials, sorafenib, guidelines

  19. External Validation of Fatty Liver Index for Identifying Ultrasonographic Fatty Liver in a Large-Scale Cross-Sectional Study in Taiwan

    Science.gov (United States)

    Fang, Kuan-Chieh; Wang, Yuan-Chen; Huo, Teh-Ia; Huang, Yi-Hsiang; Yang, Hwai-I; Su, Chien-Wei; Lin, Han-Chieh; Lee, Fa-Yauh; Wu, Jaw-Ching; Lee, Shou-Dong

    2015-01-01

    Background and Aims The fatty liver index (FLI) is an algorithm involving the waist circumference, body mass index, and serum levels of triglyceride and gamma-glutamyl transferase to identify fatty liver. Although some studies have attempted to validate the FLI, few studies have been conducted for external validation among Asians. We attempted to validate FLI to predict ultrasonographic fatty liver in Taiwanese subjects. Methods We enrolled consecutive subjects who received health check-up services at the Taipei Veterans General Hospital from 2002 to 2009. Ultrasonography was applied to diagnose fatty liver. The ability of the FLI to detect ultrasonographic fatty liver was assessed by analyzing the area under the receiver operating characteristic (AUROC) curve. Results Among the 29,797 subjects enrolled in this study, fatty liver was diagnosed in 44.5% of the population. Subjects with ultrasonographic fatty liver had a significantly higher FLI than those without fatty liver by multivariate analysis (odds ratio 1.045; 95% confidence interval, CI 1.044–1.047, pfatty liver (AUROC: 0.827, 95% confidence interval, 0.822–0.831). An FLI fatty liver. Moreover, an FLI ≥ 35 (positive likelihood ratio (LR+) 3.12) for males and ≥ 20 (LR+ 4.43) for females rule in ultrasonographic fatty liver. Conclusions FLI could accurately identify ultrasonographic fatty liver in a large-scale population in Taiwan but with lower cut-off value than the Western population. Meanwhile the cut-off value was lower in females than in males. PMID:25781622

  20. External validation of fatty liver index for identifying ultrasonographic fatty liver in a large-scale cross-sectional study in Taiwan.

    Directory of Open Access Journals (Sweden)

    Bi-Ling Yang

    Full Text Available The fatty liver index (FLI is an algorithm involving the waist circumference, body mass index, and serum levels of triglyceride and gamma-glutamyl transferase to identify fatty liver. Although some studies have attempted to validate the FLI, few studies have been conducted for external validation among Asians. We attempted to validate FLI to predict ultrasonographic fatty liver in Taiwanese subjects.We enrolled consecutive subjects who received health check-up services at the Taipei Veterans General Hospital from 2002 to 2009. Ultrasonography was applied to diagnose fatty liver. The ability of the FLI to detect ultrasonographic fatty liver was assessed by analyzing the area under the receiver operating characteristic (AUROC curve.Among the 29,797 subjects enrolled in this study, fatty liver was diagnosed in 44.5% of the population. Subjects with ultrasonographic fatty liver had a significantly higher FLI than those without fatty liver by multivariate analysis (odds ratio 1.045; 95% confidence interval, CI 1.044-1.047, p< 0.001. Moreover, FLI had the best discriminative ability to identify patients with ultrasonographic fatty liver (AUROC: 0.827, 95% confidence interval, 0.822-0.831. An FLI < 25 (negative likelihood ratio (LR- 0.32 for males and <10 (LR- 0.26 for females rule out ultrasonographic fatty liver. Moreover, an FLI ≥ 35 (positive likelihood ratio (LR+ 3.12 for males and ≥ 20 (LR+ 4.43 for females rule in ultrasonographic fatty liver.FLI could accurately identify ultrasonographic fatty liver in a large-scale population in Taiwan but with lower cut-off value than the Western population. Meanwhile the cut-off value was lower in females than in males.

  1. Mapping the EORTC QLQ-C30 onto the EQ-5D-3L: assessing the external validity of existing mapping algorithms.

    Science.gov (United States)

    Doble, Brett; Lorgelly, Paula

    2016-04-01

    To determine the external validity of existing mapping algorithms for predicting EQ-5D-3L utility values from EORTC QLQ-C30 responses and to establish their generalizability in different types of cancer. A main analysis (pooled) sample of 3560 observations (1727 patients) and two disease severity patient samples (496 and 93 patients) with repeated observations over time from Cancer 2015 were used to validate the existing algorithms. Errors were calculated between observed and predicted EQ-5D-3L utility values using a single pooled sample and ten pooled tumour type-specific samples. Predictive accuracy was assessed using mean absolute error (MAE) and standardized root-mean-squared error (RMSE). The association between observed and predicted EQ-5D utility values and other covariates across the distribution was tested using quantile regression. Quality-adjusted life years (QALYs) were calculated using observed and predicted values to test responsiveness. Ten 'preferred' mapping algorithms were identified. Two algorithms estimated via response mapping and ordinary least-squares regression using dummy variables performed well on number of validation criteria, including accurate prediction of the best and worst QLQ-C30 health states, predicted values within the EQ-5D tariff range, relatively small MAEs and RMSEs, and minimal differences between estimated QALYs. Comparison of predictive accuracy across ten tumour type-specific samples highlighted that algorithms are relatively insensitive to grouping by tumour type and affected more by differences in disease severity. Two of the 'preferred' mapping algorithms suggest more accurate predictions, but limitations exist. We recommend extensive scenario analyses if mapped utilities are used in cost-utility analyses.

  2. Development and External Validation of the Korean Prostate Cancer Risk Calculator for High-Grade Prostate Cancer: Comparison with Two Western Risk Calculators in an Asian Cohort.

    Science.gov (United States)

    Park, Jae Young; Yoon, Sungroh; Park, Man Sik; Choi, Hoon; Bae, Jae Hyun; Moon, Du Geon; Hong, Sung Kyu; Lee, Sang Eun; Park, Chanwang; Byun, Seok-Soo

    2017-01-01

    We developed the Korean Prostate Cancer Risk Calculator for High-Grade Prostate Cancer (KPCRC-HG) that predicts the probability of prostate cancer (PC) of Gleason score 7 or higher at the initial prostate biopsy in a Korean cohort (http://acl.snu.ac.kr/PCRC/RISC/). In addition, KPCRC-HG was validated and compared with internet-based Western risk calculators in a validation cohort. Using a logistic regression model, KPCRC-HG was developed based on the data from 602 previously unscreened Korean men who underwent initial prostate biopsies. Using 2,313 cases in a validation cohort, KPCRC-HG was compared with the European Randomized Study of Screening for PC Risk Calculator for high-grade cancer (ERSPCRC-HG) and the Prostate Cancer Prevention Trial Risk Calculator 2.0 for high-grade cancer (PCPTRC-HG). The predictive accuracy was assessed using the area under the receiver operating characteristic curve (AUC) and calibration plots. PC was detected in 172 (28.6%) men, 120 (19.9%) of whom had PC of Gleason score 7 or higher. Independent predictors included prostate-specific antigen levels, digital rectal examination findings, transrectal ultrasound findings, and prostate volume. The AUC of the KPCRC-HG (0.84) was higher than that of the PCPTRC-HG (0.79, pexternal validation. Calibration plots also revealed better performance of KPCRC-HG and ERSPCRC-HG than that of PCPTRC-HG on external validation. At a cut-off of 5% for KPCRC-HG, 253 of the 2,313 men (11%) would not have been biopsied, and 14 of the 614 PC cases with Gleason score 7 or higher (2%) would not have been diagnosed. KPCRC-HG is the first web-based high-grade prostate cancer prediction model in Korea. It had higher predictive accuracy than PCPTRC-HG in a Korean population and showed similar performance with ERSPCRC-HG in a Korean population. This prediction model could help avoid unnecessary biopsy and reduce overdiagnosis and overtreatment in clinical settings.

  3. Assessing mental health clinicians' intentions to adopt evidence-based treatments: reliability and validity testing of the evidence-based treatment intentions scale.

    Science.gov (United States)

    Williams, Nathaniel J

    2016-05-05

    Intentions play a central role in numerous empirically supported theories of behavior and behavior change and have been identified as a potentially important antecedent to successful evidence-based treatment (EBT) implementation. Despite this, few measures of mental health clinicians' EBT intentions exist and available measures have not been subject to thorough psychometric evaluation or testing. This paper evaluates the psychometric properties of the evidence-based treatment intentions (EBTI) scale, a new measure of mental health clinicians' intentions to adopt EBTs. The study evaluates the reliability and validity of inferences made with the EBTI using multi-method, multi-informant criterion variables collected over 12 months from a sample of 197 mental health clinicians delivering services in 13 mental health agencies. Structural, predictive, and discriminant validity evidence is assessed. Findings support the EBTI's factor structure (χ (2) = 3.96, df = 5, p = .556) and internal consistency reliability (α = .80). Predictive validity evidence was provided by robust and significant associations between EBTI scores and clinicians' observer-reported attendance at a voluntary EBT workshop at a 1-month follow-up (OR = 1.92, p adoption at a 12-month follow-up (R (2) = .17, p adopt EBTs. Discussion focuses on research and practice applications.

  4. Charge trapping and de-trapping in isolated CdSe/ZnS nanocrystals under an external electric field: indirect evidence for a permanent dipole moment.

    Science.gov (United States)

    Zang, Huidong; Cristea, Mihail; Shen, Xuan; Liu, Mingzhao; Camino, Fernando; Cotlet, Mircea

    2015-09-28

    Single nanoparticle studies of charge trapping and de-trapping in core/shell CdSe/ZnS nanocrystals incorporated into an insulating matrix and subjected to an external electric field demonstrate the ability to reversibly modulate the exciton dynamics and photoluminescence blinking while providing indirect evidence for the existence of a permanent ground state dipole moment in such nanocrystals. A model assuming the presence of energetically deep charge traps physically aligned along the direction of the permanent dipole is proposed in order to explain the dynamics of nanocrystal blinking in the presence of a permanent dipole moment.

  5. A Practical Measure of Student Motivation: Establishing Validity Evidence for the Expectancy-Value-Cost Scale in Middle School

    Science.gov (United States)

    Kosovich, Jeff J.; Hulleman, Chris S.; Barron, Kenneth E.; Getty, Steve

    2015-01-01

    We present validity evidence for the Expectancy-Value-Cost (EVC) Scale of student motivation. Using a brief, 10-item scale, we measured middle school students' expectancy, value, and cost for their math and science classes in the Fall and Winter of the same academic year. Confirmatory factor analyses supported the three-factor structure of the EVC…

  6. Development of an evidence-based approach to external quality assurance for breast cancer hormone receptor immunohistochemistry: comparison of reference values.

    Science.gov (United States)

    Makretsov, Nikita; Gilks, C Blake; Alaghehbandan, Reza; Garratt, John; Quenneville, Louise; Mercer, Joel; Palavdzic, Dragana; Torlakovic, Emina E

    2011-07-01

    External quality assurance and proficiency testing programs for breast cancer predictive biomarkers are based largely on traditional ad hoc design; at present there is no universal consensus on definition of a standard reference value for samples used in external quality assurance programs. To explore reference values for estrogen receptor and progesterone receptor immunohistochemistry in order to develop an evidence-based analytic platform for external quality assurance. There were 31 participating laboratories, 4 of which were previously designated as "expert" laboratories. Each participant tested a tissue microarray slide with 44 breast carcinomas for estrogen receptor and progesterone receptor and submitted it to the Canadian Immunohistochemistry Quality Control Program for analysis. Nuclear staining in 1% or more of the tumor cells was a positive score. Five methods for determining reference values were compared. All reference values showed 100% agreement for estrogen receptor and progesterone receptor scores, when indeterminate results were excluded. Individual laboratory performance (agreement rates, test sensitivity, test specificity, positive predictive value, negative predictive value, and κ value) was very similar for all reference values. Identification of suboptimal performance by all methods was identical for 30 of 31 laboratories. Estrogen receptor assessment of 1 laboratory was discordant: agreement was less than 90% for 3 of 5 reference values and greater than 90% with the use of 2 other reference values. Various reference values provide equivalent laboratory rating. In addition to descriptive feedback, our approach allows calculation of technical test sensitivity and specificity, positive and negative predictive values, agreement rates, and κ values to guide corrective actions.

  7. Validating the cross-cultural factor structure and invariance property of the Insomnia Severity Index: evidence based on ordinal EFA and CFA.

    Science.gov (United States)

    Chen, Po-Yi; Yang, Chien-Ming; Morin, Charles M

    2015-05-01

    The purpose of this study is to examine the factor structure of the Insomnia Severity Index (ISI) across samples recruited from different countries. We tried to identify the most appropriate factor model for the ISI and further examined the measurement invariance property of the ISI across samples from different countries. Our analyses included one data set collected from a Taiwanese sample and two data sets obtained from samples in Hong Kong and Canada. The data set collected in Taiwan was analyzed with ordinal exploratory factor analysis (EFA) to obtain the appropriate factor model for the ISI. After that, we conducted a series of confirmatory factor analyses (CFAs), which is a special case of the structural equation model (SEM) that concerns the parameters in the measurement model, to the statistics collected in Canada and Hong Kong. The purposes of these CFA were to cross-validate the result obtained from EFA and further examine the cross-cultural measurement invariance of the ISI. The three-factor model outperforms other models in terms of global fit indices in Taiwan's population. Its external validity is also supported by confirmatory factor analyses. Furthermore, the measurement invariance analyses show that the strong invariance property between the samples from different cultures holds, providing evidence that the ISI results obtained in different cultures are comparable. The factorial validity of the ISI is stable in different populations. More importantly, its invariance property across cultures suggests that the ISI is a valid measure of the insomnia severity construct across countries. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. Efficacy and External Validity of Electronic and Mobile Phone-Based Interventions Promoting Vegetable Intake in Young Adults: A Systematic Review Protocol.

    Science.gov (United States)

    Nour, Monica Marina; Chen, Juliana; Allman-Farinelli, Margaret

    2015-07-28

    Despite social marketing campaigns and behavior change interventions, young adults remain among the lowest consumers of vegetables. The digital era offers potential new avenues for both social marketing and individually tailored programs, through texting, web, and mobile applications. The effectiveness and generalizability of such programs have not been well documented. The aim of this systematic review is to evaluate the efficacy and external validity of social marketing, electronic, and mobile phone-based (mHealth) interventions aimed at increasing vegetable intake in young adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol will be used to conduct this systematic review. The search strategy will be executed across eleven electronic databases using combinations of the following search terms: "online intervention", "computer-assisted therapy", "internet", "website", "cell phones", "cyber", "telemedicine", "email", "social marketing", "social media", "mass media", "young adult", and "fruit and vegetables". The reference lists of included studies will also be searched for additional citations. Titles and abstracts will be screened against inclusion criteria and full texts of potentially eligible papers will be assessed by two independent reviewers. Data from eligible papers will be extracted. Quality and risk of bias will be assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies and The Cochrane Collaboration Risk of Bias assessment tool respectively. The external validity of the studies will be determined based on components such as reach, adoption, and representativeness of participants; intervention implementation and adaption; and program maintenance and institutionalization. Results will be reported quantitatively and qualitatively. Our research is in progress. A draft of the systematic review is currently being produced for publication by the end of 2015

  9. Performance improvements from imagery:evidence that internal visual imagery is superior to external visual imagery for slalom performance

    Directory of Open Access Journals (Sweden)

    Nichola eCallow

    2013-10-01

    Full Text Available We report three experiments investigating the hypothesis that use of internal visual imagery (IVI would be superior to external visual imagery (EVI for the performance of different slalom-based motor tasks. In Experiment 1, three groups of participants (IVI, EVI, and a control group performed a driving-simulation slalom task. The IVI group achieved significantly quicker lap times than EVI and the control group. In Experiment 2, participants performed a downhill running slalom task under both IVI and EVI conditions. Performance was again quickest in the IVI compared to EVI condition, with no differences in accuracy. Experiment 3 used the same group design as Experiment 1, but with participants performing a downhill ski-slalom task. Results revealed the IVI group to be significantly more accurate than the control group, with no significant differences in time taken to complete the task. These results support the beneficial effects of IVI for slalom-based tasks, and significantly advances our knowledge related to the differential effects of visual imagery perspectives on motor performance.

  10. Leaflet manual of external beam radiation therapy for hepatocellular carcinoma: a review of the indications, evidences, and clinical trials.

    Science.gov (United States)

    Rim, Chai Hong; Yoon, Won Sup

    2018-01-01

    The use of external beam radiation therapy (EBRT) in the treatment of hepatocellular carcinoma (HCC), which was rarely performed due to liver toxicity with a previous technique, has increased. Palliation of portal vein thrombosis, supplementation for insufficient transarterial chemoembolization, and provision of new curative opportunities using stereotactic body radiotherapy are the potential indications for use of EBRT. The mechanism of EBRT treatment, with its radiobiological and physical perspectives, differs from those of conventional medical treatment or surgery. Therefore, understanding the effects of EBRT may be unfamiliar to physicians other than radiation oncologists, especially in the field of HCC, where EBRT has recently begun to be applied. The first objective of this review was to concisely explain the indications for use of EBRT for HCC for all physicians treating HCC. Therefore, this review focuses on the therapeutic outcomes rather than the detailed biological and physical background. We also reviewed recent clinical trials that may extend the indications for use of EBRT. Finally, we reviewed the current clinical practice guidelines for the treatment of HCC and discuss the current recommendations and future perspectives.

  11. External Validation of the Prestroke Independence, Sex, Age, National Institutes of Health Stroke Scale Score for Predicting Pneumonia After Stroke Using Data From the China National Stroke Registry.

    Science.gov (United States)

    Zhang, Runhua; Ji, Ruijun; Pan, Yuesong; Jiang, Yong; Liu, Gaifen; Wang, Yilong; Wang, Yongjun

    2017-05-01

    Pneumonia is an important risk factor for mortality and morbidity after stroke. The Prestroke Independence, Sex, Age, National Institutes of Health Stroke Scale (ISAN) score was shown to be a useful tool for predicting stroke-associated pneumonia based on UK multicenter cohort study. We aimed to externally validate the score using data from the China National Stroke Registry (CNSR). Eligible patients with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) in the CNSR from 2007 to 2008 were included. The area under the receiver operating characteristic (AUC) curve was used to evaluate discrimination. The Hosmer-Lemeshow goodness of fit test and Pearson correlation coefficient were performed to assess calibration of the model. A total of 19,333 patients (AIS = 14400; ICH = 4933) were included and the overall pneumonia rate was 12.7%. The AUC was .76 (95% confidence interval [CI]: .75-.78) for the subgroup of AIS and .70 (95% CI: .68-.72) for the subgroup of ICH. The Hosmer-Lemeshow test showed the ISAN score with the good calibration for AIS and ICH (P = .177 and .405, respectively). The plot of observed versus predicted pneumonia rates suggested higher correlation for patients with AIS than with ICH (Pearson correlation coefficient = .99 and .83, respectively). The ISAN score was a useful tool for predicting in-hospital pneumonia after acute stroke, especially for patients with AIS. Further validations need to be done in different populations. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Stræde, Mia; Brabrand, Mikkel

    2014-01-01

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

  13. Validity of CBCL-derived PTSD and dissociation scales: further evidence in a sample of neglected children and adolescents.

    Science.gov (United States)

    Milot, Tristan; Plamondon, André; Ethier, Louise S; Lemelin, Jean-Pascal; St-Laurent, Diane; Rousseau, Michel

    2013-05-01

    There is growing evidence that child neglect is an important risk factor for posttraumatic stress disorder (PTSD) and dissociation. Considering that the Child Behavior Checklist (CBCL) is a widely used measure, the possibility of using validated CBCL-derived trauma symptoms scales could be particularly useful to better understand how trauma symptoms develop among neglected children and adolescents. This study examined the factor structure of three CBCL-derived measures of PTSD and dissociation (namely, PTSD scale, Dissociation scale, and PTSD/Dissociation scale) in a sample of 239 neglected children and adolescents aged 6 to 18 years using the latest version of CBCL (CBCL 6-18). Evidence of convergent validity of these scales was also examined for participants aged 12 and under using two well-validated measures of PTSD and Dissociation: the Trauma Symptoms Checklist for Young Children and the Child Dissociation Checklist. Findings suggest that CBCL-derived measures of trauma symptoms, especially PTSD and Dissociations scales, may be of heuristic value in the study of trauma symptomatology in neglected samples. Factor structure and evidence of convergent validity were supported for these two scales. Results also provide further support to the well-established assumption that PTSD and dissociation are two related but different constructs.

  14. Multi-Institutional External Validation of Seminal Vesicle Invasion Nomograms: Head-to-Head Comparison of Gallina Nomogram Versus 2007 Partin Tables

    International Nuclear Information System (INIS)

    Zorn, Kevin C.; Capitanio, Umberto; Jeldres, Claudio; Arjane, Philippe; Perrotte, Paul; Shariat, Shahrokh F.; Lee, David I.; Shalhav, Arieh L.; Zagaja, Gregory P.; Shikanov, Sergey A.; Gofrit, Ofer N.; Thong, Alan E.; Albala, David M.; Sun, Leon; Karakiewicz, Pierre I.

    2009-01-01

    Purpose: The Partin tables represent one of the most widely used prostate cancer staging tools for seminal vesicle invasion (SVI) prediction. Recently, Gallina et al. reported a novel staging tool for the prediction of SVI that further incorporated the use of the percentage of positive biopsy cores. We performed an external validation of the Gallina et al. nomogram and the 2007 Partin tables in a large, multi-institutional North American cohort of men treated with robotic-assisted radical prostatectomy. Methods and Materials: Clinical and pathologic data were prospectively gathered from 2,606 patients treated with robotic-assisted radical prostatectomy at one of four North American robotic referral centers between 2002 and 2007. Discrimination was quantified with the area under the receiver operating characteristics curve. The calibration compared the predicted and observed SVI rates throughout the entire range of predictions. Results: At robotic-assisted radical prostatectomy, SVI was recorded in 4.2% of patients. The discriminant properties of the Gallina et al. nomogram resulted in 81% accuracy compared with 78% for the 2007 Partin tables. The Gallina et al. nomogram overestimated the true rate of SVI. Conversely, the Partin tables underestimated the true rate of SVI. Conclusion: The Gallina et al. nomogram offers greater accuracy (81%) than the 2007 Partin tables (78%). However, both tools are associated with calibration limitations that need to be acknowledged and considered before their implementation into clinical practice.

  15. Predicting Failure in Early Acute Prosthetic Joint Infection Treated With Debridement, Antibiotics, and Implant Retention: External Validation of the KLIC Score.

    Science.gov (United States)

    Löwik, Claudia A M; Jutte, Paul C; Tornero, Eduard; Ploegmakers, Joris J W; Knobben, Bas A S; de Vries, Astrid J; Zijlstra, Wierd P; Dijkstra, Baukje; Soriano, Alex; Wouthuyzen-Bakker, Marjan

    2018-03-27

    Debridement, antibiotics, and implant retention (DAIR) is a widely used treatment modality for early acute prosthetic joint infection (PJI). A preoperative risk score was previously designed for predicting DAIR failure, consisting of chronic renal failure (K), liver cirrhosis (L), index surgery (I), cemented prosthesis (C), and C-reactive protein >115 mg/L (KLIC). The aim of this study was to validate the KLIC score in an external cohort. We retrospectively evaluated patients with early acute PJI treated with DAIR between 2006 and 2016 in 3 Dutch hospitals. Early acute PJI was defined as infection-related death within 60 days after debridement. A total of 386 patients were included. Failure occurred in 148 patients (38.3%). Patients with KLIC scores of ≤2, 2.5-3.5, 4-5, 5.5-6.5, and ≥7 had failure rates of 27.9%, 37.1%, 49.3%, 54.5%, and 85.7%, respectively (P < .001). The receiver-operating characteristic curve showed an area under the curve of 0.64 (95% confidence interval 0.59-0.69). A KLIC score higher than 6 points showed a specificity of 97.9%. The KLIC score is a relatively good preoperative risk score for DAIR failure in patients with early acute PJI and appears to be most useful in clinical practice for patients with low or high KLIC scores. Copyright © 2018 Elsevier Inc. All rights reserved.

  16. Evidence for the Criterion Validity and Clinical Utility of the Pathological Narcissism Inventory

    Science.gov (United States)

    Thomas, Katherine M.; Wright, Aidan G. C.; Lukowitsky, Mark R.; Donnellan, M. Brent; Hopwood, Christopher J.

    2012-01-01

    In this study, the authors evaluated aspects of criterion validity and clinical utility of the grandiosity and vulnerability components of the Pathological Narcissism Inventory (PNI) using two undergraduate samples (N = 299 and 500). Criterion validity was assessed by evaluating the correlations of narcissistic grandiosity and narcissistic…

  17. The Cerebral Palsy Quality of Life for Children (CP QOL-Child): Evidence of Construct Validity

    Science.gov (United States)

    Chen, Kuan-Lin; Wang, Hui-Yi; Tseng, Mei-Hui; Shieh, Jeng-Yi; Lu, Lu; Yao, Kai-Ping Grace; Huang, Chien-Yu

    2013-01-01

    The Cerebral Palsy Quality of Life for Children (CP QOL-Child) is the first health condition-specific questionnaire designed for measuring QOL in children with cerebral palsy (CP). However, its construct validity has not yet been confirmed by confirmatory factor analysis (CFA). Hence, this study assessed the construct validity of the caregiver…

  18. Validity Evidence for the Security Scale as a Measure of Perceived Attachment Security in Adolescence

    Science.gov (United States)

    Van Ryzin, Mark J.; Leve, Leslie D.

    2012-01-01

    In this study, the validity of a self-report measure of children's perceived attachment security (the Kerns Security Scale) was tested using adolescents. With regards to predictive validity, the Security Scale was significantly associated with (1) observed mother-adolescent interactions during conflict and (2) parent- and teacher-rated social…

  19. Evidence of oceanic units in the core of the External Rif (Morocco): intramargin hiatus or South-Tethyan remnants?

    Science.gov (United States)

    Benzaggagh, Mohamed; Mokhtari, Abdelkhader; El Maz, Abdelkhader; Rossi, Philippe; Michard, André; Saddiqi, Omar; Chalouan, Ahmed; Rjimati, Ech-Cherki

    2013-04-01

    Our work is based on extensive field campaigns in the central area of the External Rif Belt and on petrological-geochemical study of the magmatic samples. The aim is to disclose the westward extension of the Mesorif suture zone evidenced in the Temsamane zone of eastern Rif (Michard et al., 2007). We first describe Jurassic-Early Cretaceous sections involving basaltic rocks, spread along the 200 km-long, arcuate Prerif-Mesorif boundary zone west of the Temsamane massif. These sections are thoroughly dated by ammonites and calpionelles from the late Oxfordian to late Berriasian (Benzaggagh, 2011). They display varied traces of submarine, basic volcanism such as volcanoclastic complexes within Upper Berriasian marls, and basalt flows, olistoliths and clasts in the upper Oxfordian-lower Berriasian clayey breccias or in the lower Tithonian brecciated calcareous beds. Volcanic activity took place at the margin of a carbonate platform during the Kimmeridgian-early Tithonian interval, then in a pelagic basin from late Tithonian onward. Petrographic and geochemical studies point to E-MORB basaltic magmas (Rossi, in Benzaggah, 2011), thus testifying for strong crustal thinning in this part of the African paleomargin. Strong support to this inference is found in the occurrence of two small tectonic units of gabbros associated with basalt flows, fault-scarp breccias and radiolarites. A preliminary study of the gabbros reveals that, in thin section, many petrographic types display ortho- to heteradcumulate texture. The typical sequence of cristallization is plag-ol-cpx-ilm and the composition ranges from troctolitic olivine gabbro [An 66-60; Fo 73-71 & 68; cpx Wo 46, En 44, Fs 10 with content in Cr2O3 up to 1%]) to ferrogabbro [(An 50-45); Fo 53; cpx Wo 44, En 40, Fs 16]). Plot of these rocks onto an AFM projection fall on the cumulative composition field along the FM joint and TR patterns display systematic Eu positive anomaly characterizing cumulative plagioclase. Some more

  20. Implementing evidence-based practices for youth in an HMO: the roles of external ratings and market share.

    Science.gov (United States)

    Hamilton, John; Daleiden, Eric; Dopson, Sue

    2011-05-01

    A qualitative study of child clinicians in a non-profit HMO examined implementation of evidence-based practices (EBPs) for anxiety and oppositional defiant disorders using interviews and focus groups with 33 clinicians (97% of participants), and ethnography of emails and meetings. Analysis showed statistical measures of access and service-key elements of rating organizations' "report cards"- were central in creating "pressure" making transition to EBPs difficult. EBPs were secondary to access and service targets. "Research" and "statistics" were perceived as unrealistic, "literature" as lacking authority. Rating organizations should include outcome and fidelity metrics to align market share pressures with children's health.

  1. SU-E-J-244: Development and Validation of a Knowledge Based Planning Model for External Beam Radiation Therapy of Locally Advanced Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Z; Kennedy, A [Sarah Cannon, Nashville, TN (United States); Larsen, E; Hayes, C; Grow, A [North Florida Cancer Center, Gainesville, FL (United States); Bahamondes, S.; Zheng, Y; Wu, X [JFK Comprehensive Cancer Institute, Lake Worth, FL (United States); Choi, M; Pai, S [Good Samaritan Hospital, Los Gatos, CA (United States); Li, J [Doctors Hospital of Augusta, Augusta, GA (United States); Cranford, K [Trident Medical Center, Charleston, SC (United States)

    2015-06-15

    Purpose: The study aims to develop and validate a knowledge based planning (KBP) model for external beam radiation therapy of locally advanced non-small cell lung cancer (LA-NSCLC). Methods: RapidPlan™ technology was used to develop a lung KBP model. Plans from 65 patients with LA-NSCLC were used to train the model. 25 patients were treated with VMAT, and the other patients were treated with IMRT. Organs-at-risk (OARs) included right lung, left lung, heart, esophagus, and spinal cord. DVH and geometric distribution DVH were extracted from the treated plans. The model was trained using principal component analysis and step-wise multiple regression. Box plot and regression plot tools were used to identify geometric outliers and dosimetry outliers and help fine-tune the model. The validation was performed by (a) comparing predicted DVH boundaries to actual DVHs of 63 patients and (b) using an independent set of treatment planning data. Results: 63 out of 65 plans were included in the final KBP model with PTV volume ranging from 102.5cc to 1450.2cc. Total treatment dose prescription varied from 50Gy to 70Gy based on institutional guidelines. One patient was excluded due to geometric outlier where 2.18cc of spinal cord was included in PTV. The other patient was excluded due to dosimetric outlier where the dose sparing to spinal cord was heavily enforced in the clinical plan. Target volume, OAR volume, OAR overlap volume percentage to target, and OAR out-of-field volume were included in the trained model. Lungs and heart had two principal component scores of GEDVH, whereas spinal cord and esophagus had three in the final model. Predicted DVH band (mean ±1 standard deviation) represented 66.2±3.6% of all DVHs. Conclusion: A KBP model was developed and validated for radiotherapy of LA-NSCLC in a commercial treatment planning system. The clinical implementation may improve the consistency of IMRT/VMAT planning.

  2. KAMUTHE video microanalysis system for use in Brazil: translation, cross-cultural adaptation and evidence of validity and reliability

    Directory of Open Access Journals (Sweden)

    Gustavo Schulz Gattino

    2016-11-01

    Full Text Available Background KAMUTHE is a video microanalysis system which observes preverbal communication within the music therapy setting. This system is indicated for children with autism spectrum disorder (ASD or multiple disabilities. The purpose of this study was to translate, adapt to Brazilian Portuguese language and analyze some psychometric properties (reliability and validity evidence of KAMUTHE administration in Brazil for individuals with ASD. Participants and procedure Translation, back translation, analysis by judges, and pilot application were performed to obtain evidence of content and face validity. The second part of this study was to administer KAMUTHE in 39 consecutive children with ASD. An individual session of improvisational music therapy was applied to assess the different behaviors included in KAMUTHE. The intra-rater reliability, concurrent validity and convergent validity were analyzed. Results Translation and cross-cultural adaptation were followed and some cultural adaptations were needed. Inter-rater reliability was very good (ICCs 0.95-0.99 for the three child’s behaviors analyzed. Criteria validity with a moderate negative association was found (r = –.38, p = .017 comparing the behavior “Gazes at therapist” and the level of ASD along with the Childhood Autism Rating Scale (CARS. Convergent validity was established between the behavior “Gazes at therapist” and the two nonlinguistic communication scales (social interaction and interests of the Children’s Communication Checklist (CCC with a moderate correlation (r = –.43, p = .005. Conclusions The administration of the KAMUTHE video microanalysis system showed positive results in children with ASD. Further studies are needed to improve the reliability and validity of the instrument in Brazil.

  3. Scale of attitudes toward alcohol - Spanish version: evidences of validity and reliability.

    Science.gov (United States)

    Ramírez, Erika Gisseth León; Vargas, Divane de

    2017-08-03

    validate the Scale of attitudes toward alcohol, alcoholism and individuals with alcohol use disorders in its Spanish version. methodological study, involving 300 Colombian nurses. Adopting the classical theory, confirmatory factor analysis was applied without prior examination, based on the strong historical evidence of the factorial structure of the original scale to determine the construct validity of this Spanish version. To assess the reliability, Cronbach's Alpha and Mc Donalid's Omega coefficients were used. the confirmatory factor analysis indicated the good fit of the scale model in a four-factor distribution, with a cut-off point at 3.2, demonstrating 66.7% of sensitivity. the Scale of attitudes toward alcohol, alcoholism and individuals with alcohol use disorders in Spanish presented robust psychometric qualities, affirming that the instrument possesses a solid factorial structure and reliability and is capable of precisely measuring the nurses' atittudes towards the phenomenon proposed. validar a Escala de atitudes frente ao álcool, ao alcoolismo e a pessoas com transtornos relacionados ao uso do álcool, versão espanhola. estudo metodológico, realizado com 303 enfermeiros colombianos. Seguindo a teoria clássica, foi aplicada a análise fatorial confirmatória sem exploração preliminar, com base na forte evidência histórica da estrutura fatorial do instrumento original para a validação de construto desta versão em espanhol. Para a avaliação da confiabilidade foram utilizados os coeficientes de Alfa de Cronbach e Ômega de Mc Donald. a análise fatorial confirmatória indicou o bom ajuste do modelo da escala na distribuição de quatro fatores, compreendendo 48 itens em sua versão espanhola. Os índices de confiabilidade foram satisfatórios, com ponto de corte observado em 3,2, demonstrando sensibilidade de 66,7%. a Escala de atitudes frente ao álcool, ao alcoolismo e a pessoas com transtornos relacionados ao uso do álcool no idioma

  4. Ethical leadership: meta-analytic evidence of criterion-related and incremental validity.

    Science.gov (United States)

    Ng, Thomas W H; Feldman, Daniel C

    2015-05-01

    This study examines the criterion-related and incremental validity of ethical leadership (EL) with meta-analytic data. Across 101 samples published over the last 15 years (N = 29,620), we observed that EL demonstrated acceptable criterion-related validity with variables that tap followers' job attitudes, job performance, and evaluations of their leaders. Further, followers' trust in the leader mediated the relationships of EL with job attitudes and performance. In terms of incremental validity, we found that EL significantly, albeit weakly in some cases, predicted task performance, citizenship behavior, and counterproductive work behavior-even after controlling for the effects of such variables as transformational leadership, use of contingent rewards, management by exception, interactional fairness, and destructive leadership. The article concludes with a discussion of ways to strengthen the incremental validity of EL. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  5. Definitions and validation criteria for biomarkers and surrogate endpoints: development and testing of a quantitative hierarchical levels of evidence schema

    DEFF Research Database (Denmark)

    Lassere, Marissa N; Johnson, Kent R; Boers, Maarten

    2007-01-01

    endpoints, and leading indicators, a quantitative surrogate validation schema was developed and subsequently evaluated at a stakeholder workshop. RESULTS: The search identified several classification schema and definitions. Components of these were incorporated into a new quantitative surrogate validation...... level of evidence schema that evaluates biomarkers along 4 domains: Target, Study Design, Statistical Strength, and Penalties. Scores derived from 3 domains the Target that the marker is being substituted for, the Design of the (best) evidence, and the Statistical strength are additive. Penalties...... of the National Institutes of Health definitions of biomarker, surrogate endpoint, and clinical endpoint was useful. CONCLUSION: Further development and application of this schema provides incentives and guidance for effective biomarker and surrogate endpoint research, and more efficient drug discovery...

  6. Reliability and Validity Evidence of Scores on the French Version of the Questionnaire about Interpersonal Difficulties for Adolescents

    Directory of Open Access Journals (Sweden)

    Beatriz Delgado

    2015-10-01

    Full Text Available This study examined the reliability and validity evidence drawn from the scores of the French version of the Questionnaire about Interpersonal Difficulties for Adolescents (QIDA in a sample of 957 adolescents (48.5% boys ranging in age from 11 to 18 years ('M' = 14.48, 'SD' = 1.85. A principal axis factoring (PAF and confirmatory factor analyses (CFA were performed to determine the fit of the factor structure of scores on the QIDA. PAF and CFA replicated the previously identified correlated five-factor structure of the QIDA: Assertiveness, Heterosexual Relationships, Public Speaking, Family Relationships, and Close Friendships. The QIDA yielded acceptable reliability scores for French adolescents. Validity evidence of QIDA was also established through correlations with scores on the School Anxiety Inventory and the Social Anxiety Scale for Adolescents. Most of the correlations were positive and exceeded the established criteria of statistical significance, but the magnitude of these varied according to the scales of the QIDA. Results supported the reliability and validity evidence drawn from the scores of the French version of the QIDA.

  7. Definitions and validation criteria for biomarkers and surrogate endpoints: development and testing of a quantitative hierarchical levels of evidence schema.

    Science.gov (United States)

    Lassere, Marissa N; Johnson, Kent R; Boers, Maarten; Tugwell, Peter; Brooks, Peter; Simon, Lee; Strand, Vibeke; Conaghan, Philip G; Ostergaard, Mikkel; Maksymowych, Walter P; Landewe, Robert; Bresnihan, Barry; Tak, Paul-Peter; Wakefield, Richard; Mease, Philip; Bingham, Clifton O; Hughes, Michael; Altman, Doug; Buyse, Marc; Galbraith, Sally; Wells, George

    2007-03-01

    There are clear advantages to using biomarkers and surrogate endpoints, but concerns about clinical and statistical validity and systematic methods to evaluate these aspects hinder their efficient application. Our objective was to review the literature on biomarkers and surrogates to develop a hierarchical schema that systematically evaluates and ranks the surrogacy status of biomarkers and surrogates; and to obtain feedback from stakeholders. After a systematic search of Medline and Embase on biomarkers, surrogate (outcomes, endpoints, markers, indicators), intermediate endpoints, and leading indicators, a quantitative surrogate validation schema was developed and subsequently evaluated at a stakeholder workshop. The search identified several classification schema and definitions. Components of these were incorporated into a new quantitative surrogate validation level of evidence schema that evaluates biomarkers along 4 domains: Target, Study Design, Statistical Strength, and Penalties. Scores derived from 3 domains the Target that the marker is being substituted for, the Design of the (best) evidence, and the Statistical strength are additive. Penalties are then applied if there is serious counterevidence. A total score (0 to 15) determines the level of evidence, with Level 1 the strongest and Level 5 the weakest. It was proposed that the term "surrogate" be restricted to markers attaining Levels 1 or 2 only. Most stakeholders agreed that this operationalization of the National Institutes of Health definitions of biomarker, surrogate endpoint, and clinical endpoint was useful. Further development and application of this schema provides incentives and guidance for effective biomarker and surrogate endpoint research, and more efficient drug discovery, development, and approval.

  8. External validation of the GrazeIn model of pasture dry matter intake and milk yield prediction for cows managed at different calving dates and stocking rates

    International Nuclear Information System (INIS)

    Roca-Fernández, A.I.; González-Rodríguez, A.

    2017-01-01

    The aim was to evaluate the prediction accuracy of pasture dry matter intake (PDMI) and milk yield (MY) predicted by the GrazeIn model using a database representing 124 PDMI measurements at paddock level and 2232 MY measurements at cow level. External validation of the model was conducted using data collected from a trial carried out with Holstein-Friesian cows (n=72) while grazed 28 paddocks and were managed in a 2×2 factorial design by considering two calving dates (CD), with different number of days in milk (DIM), early (E, 29 DIM) vs. middle (M, 167 DIM), and two stocking rates (SR), medium (M, 3.9 cows ha-1) vs. high (H, 4.8 cows ha-1), under a rotational grazing system. Cows were randomly assigned to four grazing scenarios (EM, EH, MM and MH). The mean observed PDMI of the total database was 14.2 kg DM cow-1 day-1 while GrazeIn predicted a mean PDMI for the database of 13.8 kg DM cow-1 day-1. The mean bias was −0.4 kg DM cow-1 day-1. GrazeIn predicted PDMI for the total database with a relative prediction error (RPE) of 10.0% at paddock level. The mean observed MY of the database was 23.2 kg cow-1 day-1 while GrazeIn predicted a MY for the database of 23.1 kg cow-1 day-1. The mean bias was –0.1 kg cow-1 day-1. GrazeIn predicted MY for the total database with a mean RPE of 17.3% at cow level. For the scenarios investigated, GrazeIn predicted PDMI and MY with a low level of error which made it a suitable tool for decision support systems.

  9. External validation of the PROFUND index in polypathological patients from internal medicine and acute geriatrics departments in Aragón.

    Science.gov (United States)

    Díez-Manglano, Jesús; Cabrerizo García, José Luis; García-Arilla Calvo, Ernesto; Jimeno Saínz, Araceli; Calvo Beguería, Eva; Martínez-Álvarez, Rosa M; Bejarano Tello, Esperanza; Caudevilla Martínez, Aránzazu

    2015-12-01

    The objective of the study was to validate externally and prospectively the PROFUND index to predict survival of polypathological patients after a year. An observational, prospective and multicenter study was performed. Polypathological patients admitted to an internal medicine or geriatrics department and attended by investigators consecutively between March 1 and June 30, 2011 were included. Data concerning age, gender, comorbidity, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs and number of admissions during the previous year were gathered for each patient. The PROFUND index was calculated. The follow-up lasted 1 year. A Cox proportional regression model was calculated, and was used to analyze the association of the variables to mortality and C-statistic. 465 polypathological patients, 333 from internal medicine and 132 from geriatrics, were included. One-year mortality is associated with age [hazard ratio (HR) 1.52 95 % CI 1.04-2.12; p = 0.01], presence of neoplasia [HR 2.68 95 % CI 1.71-4.18; p = 0.0001] and dependence for basic activities of daily living [HR 2.34 95 % CI 1.61-3.40; p = 0.0009]. In predicting mortality, the PROFUND index shows good discrimination in patients from internal medicine (C-statistics 0.725 95 % CI 0.670-0.781), but a poor one in those from geriatrics (0.546 95 % CI 0.448-0.644). The PROFUND index is a reliable tool for predicting mortality in internal medicine PP patients.

  10. Performance of an easy-to-use prediction model for renal patient survival: an external validation study using data from the ERA-EDTA Registry.

    Science.gov (United States)

    Hemke, Aline C; Heemskerk, Martin B A; van Diepen, Merel; Kramer, Anneke; de Meester, Johan; Heaf, James G; Abad Diez, José Maria; Torres Guinea, Marta; Finne, Patrik; Brunet, Philippe; Vikse, Bjørn E; Caskey, Fergus J; Traynor, Jamie P; Massy, Ziad A; Couchoud, Cécile; Groothoff, Jaap W; Nordio, Maurizio; Jager, Kitty J; Dekker, Friedo W; Hoitsma, Andries J

    2018-01-16

    An easy-to-use prediction model for long-term renal patient survival based on only four predictors [age, primary renal disease, sex and therapy at 90 days after the start of renal replacement therapy (RRT)] has been developed in The Netherlands. To assess the usability of this model for use in Europe, we externally validated the model in 10 European countries. Data from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry were used. Ten countries that reported individual patient data to the registry on patients starting RRT in the period 1995-2005 were included. Patients prediction model was evaluated for the 10- (primary endpoint), 5- and 3-year survival predictions by assessing the calibration and discrimination outcomes. We used a data set of 136 304 patients from 10 countries. The calibration in the large and calibration plots for 10 deciles of predicted survival probabilities showed average differences of 1.5, 3.2 and 3.4% in observed versus predicted 10-, 5- and 3-year survival, with some small variation on the country level. The concordance index, indicating the discriminatory power of the model, was 0.71 in the complete ERA-EDTA Registry cohort and varied according to country level between 0.70 and 0.75. A prediction model for long-term renal patient survival developed in a single country, based on only four easily available variables, has a comparably adequate performance in a wide range of other European countries. © The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  11. External validation of the GrazeIn model of pasture dry matter intake and milk yield prediction for cows managed at different calving dates and stocking rates

    Energy Technology Data Exchange (ETDEWEB)

    Roca-Fernández, A.I.; González-Rodríguez, A.

    2017-07-01

    The aim was to evaluate the prediction accuracy of pasture dry matter intake (PDMI) and milk yield (MY) predicted by the GrazeIn model using a database representing 124 PDMI measurements at paddock level and 2232 MY measurements at cow level. External validation of the model was conducted using data collected from a trial carried out with Holstein-Friesian cows (n=72) while grazed 28 paddocks and were managed in a 2×2 factorial design by considering two calving dates (CD), with different number of days in milk (DIM), early (E, 29 DIM) vs. middle (M, 167 DIM), and two stocking rates (SR), medium (M, 3.9 cows ha-1) vs. high (H, 4.8 cows ha-1), under a rotational grazing system. Cows were randomly assigned to four grazing scenarios (EM, EH, MM and MH). The mean observed PDMI of the total database was 14.2 kg DM cow-1 day-1 while GrazeIn predicted a mean PDMI for the database of 13.8 kg DM cow-1 day-1. The mean bias was −0.4 kg DM cow-1 day-1. GrazeIn predicted PDMI for the total database with a relative prediction error (RPE) of 10.0% at paddock level. The mean observed MY of the database was 23.2 kg cow-1 day-1 while GrazeIn predicted a MY for the database of 23.1 kg cow-1 day-1. The mean bias was –0.1 kg cow-1 day-1. GrazeIn predicted MY for the total database with a mean RPE of 17.3% at cow level. For the scenarios investigated, GrazeIn predicted PDMI and MY with a low level of error which made it a suitable tool for decision support systems.

  12. Validation of an instrument to assess evidence-based practice knowledge, attitudes, access, and confidence in the dental environment.

    Science.gov (United States)

    Hendricson, William D; Rugh, John D; Hatch, John P; Stark, Debra L; Deahl, Thomas; Wallmann, Elizabeth R

    2011-02-01

    This article reports the validation of an assessment instrument designed to measure the outcomes of training in evidence-based practice (EBP) in the context of dentistry. Four EBP dimensions are measured by this instrument: 1) understanding of EBP concepts, 2) attitudes about EBP, 3) evidence-accessing methods, and 4) confidence in critical appraisal. The instrument-the Knowledge, Attitudes, Access, and Confidence Evaluation (KACE)-has four scales, with a total of thirty-five items: EBP knowledge (ten items), EBP attitudes (ten), accessing evidence (nine), and confidence (six). Four elements of validity were assessed: consistency of items within the KACE scales (extent to which items within a scale measure the same dimension), discrimination (capacity to detect differences between individuals with different training or experience), responsiveness (capacity to detect the effects of education on trainees), and test-retest reliability. Internal consistency of scales was assessed by analyzing responses of second-year dental students, dental residents, and dental faculty members using Cronbach coefficient alpha, a statistical measure of reliability. Discriminative validity was assessed by comparing KACE scores for the three groups. Responsiveness was assessed by comparing pre- and post-training responses for dental students and residents. To measure test-retest reliability, the full KACE was completed twice by a class of freshman dental students seventeen days apart, and the knowledge scale was completed twice by sixteen faculty members fourteen days apart. Item-to-scale consistency ranged from 0.21 to 0.78 for knowledge, 0.57 to 0.83 for attitude, 0.70 to 0.84 for accessing evidence, and 0.87 to 0.94 for confidence. For discrimination, ANOVA and post hoc testing by the Tukey-Kramer method revealed significant score differences among students, residents, and faculty members consistent with education and experience levels. For responsiveness to training, dental students

  13. Implementing assessments of robot-assisted technical skill in urological education: a systematic review and synthesis of the validity evidence.

    Science.gov (United States)

    Goldenberg, Mitchell G; Lee, Jason Y; Kwong, Jethro C C; Grantcharov, Teodor P; Costello, Anthony

    2018-03-31

    To systematically review and synthesise the validity evidence supporting intraoperative and simulation-based assessments of technical skill in urological robot-assisted surgery (RAS), and make evidence-based recommendations for the implementation of these assessments in urological training. A literature search of the Medline, PsycINFO and Embase databases was performed. Articles using technical skill and simulation-based assessments in RAS were abstracted. Only studies involving urology trainees or faculty were included in the final analysis. Multiple tools for the assessment of technical robotic skill have been published, with mixed sources of validity evidence to support their use. These evaluations have been used in both the ex vivo and in vivo settings. Performance evaluations range from global rating scales to psychometrics, and assessments are carried out through automation, expert analysts, and crowdsourcing. There have been rapid expansions in approaches to RAS technical skills assessment, both in simulated and clinical settings. Alternative approaches to assessment in RAS, such as crowdsourcing and psychometrics, remain under investigation. Evidence to support the use of these metrics in high-stakes decisions is likely insufficient at present. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

  14. Reliability and preliminary evidence of validity of a Farsi version of the depression anxiety stress scales.

    Science.gov (United States)

    Bayani, Ali Asghar

    2010-08-01

    The internal consistency, test-retest reliability, and construct validity of the Farsi version of the Depression Anxiety Stress Scales were examined, with a sample of 306 undergraduate students (123 men, 183 women) ranging from 18 to 51 years of age (M age = 25.4, SD = 6.1). Participants completed the Satisfaction with Life Scale, Rosenberg Self-esteem Scale, and the Depression Anxiety Stress Scales. The findings confirmed the preliminary reliabilities and preliminary construct validity of the Farsi translation of the Depression Anxiety Stress Scales.

  15. The Psychopathy Q-Sort. Construct Validity Evidence in a Nonclinical Sample

    Science.gov (United States)

    Fowler, Katherine A.; Lilienfeld, Scott O.

    2007-01-01

    Scant research has examined the validity of instruments that permit observer ratings of psychopathy. Using a nonclinical (undergraduate) sample, the authors examined the associations between both self- and observer ratings on a psychopathy prototype (Psychopathy Q-Sort, PQS) and widely used measures of psychopathy, antisocial behavior, and…

  16. School Anxiety Inventory: Reliability and Validity Evidence in a Sample of Slovenian Adolescents

    Science.gov (United States)

    Levpušcek, Melita Puklek; Inglés, Candido J.; Marzo, Juan C.; García-Fernández, Jose M.

    2015-01-01

    The purpose of this study was to examine the reliability and validity of the School Anxiety Inventory (SAI) using a sample of 646 Slovenian adolescents (48% boys), ranging in age from 12 to 19 years. Single confirmatory factor analyses replicated the correlated four-factor structure of scores on the SAI for anxiety-provoking school situations…

  17. Validation of the Adolescent Concerns Measure (ACM): Evidence from Exploratory and Confirmatory Factor Analysis

    Science.gov (United States)

    Ang, Rebecca P.; Chong, Wan Har; Huan, Vivien S.; Yeo, Lay See

    2007-01-01

    This article reports the development and initial validation of scores obtained from the Adolescent Concerns Measure (ACM), a scale which assesses concerns of Asian adolescent students. In Study 1, findings from exploratory factor analysis using 619 adolescents suggested a 24-item scale with four correlated factors--Family Concerns (9 items), Peer…

  18. Investigating Validity Evidence of the Satisfaction with Life Scale Adapted for Children

    Science.gov (United States)

    Gadermann, Anne M.; Schonert-Reichl, Kimberly A.; Zumbo, Bruno D.

    2010-01-01

    This study introduces the Satisfaction with Life Scale adapted for Children (SWLS-C) and presents psychometric findings regarding its validation. The SWLS-C was adapted from the Satisfaction with Life Scale (SWLS; Diener et al. 1985), which is one of the most commonly used measures to assess satisfaction with life in adults. Three subject matter…

  19. A guideline for the validation of likelihood ratio methods used for forensic evidence evaluation

    NARCIS (Netherlands)

    Meuwly, Didier; Ramos, Daniel; Haraksim, Rudolf

    2017-01-01

    This Guideline proposes a protocol for the validation of forensic evaluation methods at the source level, using the Likelihood Ratio framework as defined within the Bayes’ inference model. In the context of the inference of identity of source, the Likelihood Ratio is used to evaluate the strength of

  20. Assessing Irrational Beliefs and Emotional Distress: Evidence and Implications of Limited Discriminant Validity.

    Science.gov (United States)

    Zurawski, Raymond M.; Smith, Timothy W.

    1987-01-01

    Examined the disciminant validity of measures of irrational beliefs. The Irrational Beliefs Test and the Rational Behavior Inventory were highly correlated but were equally highly correlated with self-report measures of depression and anxiety. Thus, rather than assessing beliefs correlated with emotional distress, the measures may actually assess…

  1. The Social Validity of "Acceptability of Behavioral Interventions Used in Classrooms": Inferences from Longitudinal Evidence

    Science.gov (United States)

    Elliott, Stephen N.

    2017-01-01

    In this retrospective commentary on "Acceptability of Behavioral Interventions Used in Classrooms: The Influence of Amount of Teacher Time, Severity of Behavior Problem, and Type of Intervention," I first examine the concept of social validity and related measurement challenges per Wolf's concerns about consumers' subjective reactions to…

  2. Montreal Battery of Evaluation of Amusia: Validity evidence and norms for adolescents in Belo Horizonte, Minas Gerais, Brazil

    Directory of Open Access Journals (Sweden)

    Marília Nunes-Silva

    Full Text Available ABSTRACT The Montreal Battery of Evaluation of Amusia (MBEA is a battery of tests that assesses six music processing components: scale, contour, interval, rhythm, metric, and music memory. The present study sought to verify the psychometric characteristics of the MBEA in a sample of 150 adolescents aged 14-18 years in the city of Belo Horizonte, Minas Gerais, Brazil, and to develop specific norms for this population. We used statistical procedures that explored the dimensional structure of the MBEA and its items, evaluating their adequacy from empirical data, verifying their reliability, and providing evidence of validity. The results for the difficult levels for each test indicated a trend toward higher scores, corroborating previous studies. From the analysis of the criterion groups, almost all of the items were considered discriminatory. The global score of the MBEA was shown to be valid and reliable (r K-R20=0.896 for assessing the musical ability of normal teenagers. Based on the analysis of the items, we proposed a short version of the MBEA. Further studies with larger samples and amusic individuals are necessary to provide evidence of the validity of the MBEA in the Brazilian milieu. The present study brings to the Brazilian context a tool for diagnosing deficits in musical skills and will serve as a basis for comparisons with single case studies and studies of populations with specific neuropsychological syndromes.

  3. Structure validation of the Josephin domain of ataxin-3: Conclusive evidence for an open conformation

    International Nuclear Information System (INIS)

    Nicastro, Giuseppe; Habeck, Michael; Masino, Laura; Svergun, Dmitri I.; Pastore, Annalisa

    2006-01-01

    The availability of new and fast tools in structure determination has led to a more than exponential growth of the number of structures solved per year. It is therefore increasingly essential to assess the accuracy of the new structures by reliable approaches able to assist validation. Here, we discuss a specific example in which the use of different complementary techniques, which include Bayesian methods and small angle scattering, resulted essential for validating the two currently available structures of the Josephin domain of ataxin-3, a protein involved in the ubiquitin/proteasome pathway and responsible for neurodegenerative spinocerebellar ataxia of type 3. Taken together, our results demonstrate that only one of the two structures is compatible with the experimental information. Based on the high precision of our refined structure, we show that Josephin contains an open cleft which could be directly implicated in the interaction with polyubiquitin chains and other partners

  4. Validity evidence for the Security Scale as a measure of perceived attachment security in adolescence.

    Science.gov (United States)

    Van Ryzin, Mark J; Leve, Leslie D

    2012-04-01

    In this study, the validity of a self-report measure of children's perceived attachment security (the Kerns Security Scale) was tested using adolescents. With regards to predictive validity, the Security Scale was significantly associated with (1) observed mother-adolescent interactions during conflict and (2) parent- and teacher-rated social competence. With regards to convergent validity, the Security Scale was significantly associated with all subscales of the Adult Attachment Scale (i.e., Depend, Anxiety, and Close) as measured 3 years later. Further, these links were found even after controlling for mother-child relationship quality as assessed by the Inventory of Parent and Peer Attachment (IPPA), and chi-square difference tests indicated that the Security Scale was generally a stronger predictor as compared to the IPPA. These results suggest that the Security Scale can be used to assess perceived attachment security across both childhood and adolescence, and thus could contribute significantly to developmental research during this period. Copyright © 2011 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

  5. [Job stress and quality of life of primary care health-workers: evidence of validity of the PECVEC questionnaire].

    Science.gov (United States)

    Fernández-López, Juan Antonio; Fernández-Fidalgo, María; Martín-Payo, Rubén; Rödel, Andreas

    2007-08-01

    To evaluate the relationship between Health-Related Quality of Life (HRQL) and stress at work among Primary Care workers, as evidence of the construct validity of the Spanish version (PECVEC) of the profile of quality of life in the chronically ill (PLC) questionnaire. In addition, to check its other psychometric properties. Cross-sectional study. Eighteen primary care centres in Health Area IV, Asturias (Oviedo), Spain, sharing similar socio-demographic conditions. Two hundred and thirty-three primary care nurses and physicians. HRQL was evaluated by the 6 general dimensions of the Spanish version of the PLC. Stress at work was evaluated by the three scales of the Effort-Reward Imbalance (ERI) questionnaire. The construct validity of the PECVEC was assessed by testing the inverse associations of QoL dimensions and job stress ones, when the most important confuser variables were monitored. The non-response rate was low (effects and only small ceiling effects were observed. Internal consistency analysis and exploratory and confirmatory factor analysis demonstrated high reliability, factorial validity and convergent/divergent validity of the PECVEC. The PECVEC demonstrates adequate psychometric properties for evaluating HRQL in healthy subjects.

  6. Evident?

    DEFF Research Database (Denmark)

    Plant, Peter

    2012-01-01

    Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind......Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind...

  7. External validation of heart-type fatty acid binding protein, high-sensitivity cardiac troponin, and electrocardiography as rule-out for acute myocardial infarction.

    Science.gov (United States)

    Van Hise, Christopher B; Greenslade, Jaimi H; Parsonage, William; Than, Martin; Young, Joanna; Cullen, Louise

    2018-02-01

    To externally validate a clinical decision rule incorporating heart fatty acid binding protein (h-FABP), high-sensitivity troponin (hs-cTn) and electrocardiogram (ECG) for the detection of acute myocardial infarction (AMI) on presentation to the Emergency Department. We also investigated whether this clinical decision rule improved identification of AMI over algorithms incorporating hs-cTn and ECG only. This study included data from 789 patients from the Brisbane ADAPT cohort and 441 patients from the Christchurch TIMI RCT cohort. The primary outcome was index AMI. Sensitivity, specificity, positive predictive value and negative predictive value were used to assess the diagnostic accuracy of the algorithms. 1230 patients were recruited, including 112 (9.1%) with AMI. The algorithm including h-FABP and hs-cTnT had 100% sensitivity and 32.4% specificity. The algorithm utilising h-FABP and hs-cTnI had similar sensitivity (99.1%) and higher specificity (43.4%). The hs-cTnI and hs-cTnT algorithms without h-FABP both had a sensitivity of 98.2%; a result that was not significantly different from either algorithm incorporating h-FABP. Specificity was higher for the hs-cTnI algorithm (68.1%) compared to the hs-cTnT algorithm (33.0%). The specificity of the algorithm incorporating hs-cTnI alone was also significantly higher than both of the algorithms incorporating h-FABP (p<0.01). For patients presenting to the Emergency Department with chest pain, an algorithm incorporating h-FABP, hs-cTn and ECG has high accuracy and can rule out up to 40% of patients. An algorithm incorporating only hs-cTn and ECG has similar sensitivity and may rule out a higher proportion of patients. Each of the algorithms can be used to safely identify patients as low risk for AMI on presentation to the Emergency Department. Copyright © 2017 The Canadian Society of Clinical Chemists. All rights reserved.

  8. Definitions and validation criteria for biomarkers and surrogate endpoints: development and testing of a quantitative hierarchical levels of evidence schema

    DEFF Research Database (Denmark)

    Lassere, Marissa N; Johnson, Kent R; Boers, Maarten

    2007-01-01

    endpoints, and leading indicators, a quantitative surrogate validation schema was developed and subsequently evaluated at a stakeholder workshop. RESULTS: The search identified several classification schema and definitions. Components of these were incorporated into a new quantitative surrogate validation...... of the National Institutes of Health definitions of biomarker, surrogate endpoint, and clinical endpoint was useful. CONCLUSION: Further development and application of this schema provides incentives and guidance for effective biomarker and surrogate endpoint research, and more efficient drug discovery...... are then applied if there is serious counterevidence. A total score (0 to 15) determines the level of evidence, with Level 1 the strongest and Level 5 the weakest. It was proposed that the term "surrogate" be restricted to markers attaining Levels 1 or 2 only. Most stakeholders agreed that this operationalization...

  9. Reflecting on Learner Assessments and Their Validity in the Presence of Emerging Evidence from Neuroscience

    Science.gov (United States)

    Watagodakumbura, Chandana

    2015-01-01

    We can now get purposefully directed in the way we assess our learners in light of the emergence of evidence from the field of neuroscience. Why higher-order learning or abstract concepts need to be the focus in assessment is elaborated using the knowledge of semantic and episodic memories. With most of our learning identified to be implicit, why…

  10. Building Evidence of Validity: The Relation between Work Values, Interests, Personality, and Personal Values

    Science.gov (United States)

    Leuty, Melanie E.; Hansen, Jo-Ida C.

    2013-01-01

    The current study used work values components (WVC) to examine the relationship between work values, vocational interests, personality, and personal values. Most intercorrelations between work values and other constructs were in the small effect range. Overall correlations between scale scores provided evidence of convergent and discriminant…

  11. Validity and clinical utility of the DSM-5 severity specifier for bulimia nervosa: results from a multisite sample of patients who received evidence-based treatment.

    Science.gov (United States)

    Dakanalis, Antonios; Bartoli, Francesco; Caslini, Manuela; Crocamo, Cristina; Zanetti, Maria Assunta; Riva, Giuseppe; Clerici, Massimo; Carrà, Giuseppe

    2017-12-01

    A new "severity specifier" for bulimia nervosa (BN), based on the frequency of inappropriate weight compensatory behaviours (IWCBs), was added to the DSM-5 as a means of documenting heterogeneity and variability in the severity of the disorder. Yet, evidence for its validity in clinical populations, including prognostic significance for treatment outcome, is currently lacking. Existing data from 281 treatment-seeking patients with DSM-5 BN, who received the best available treatment for their disorder (manual-based cognitive behavioural therapy; CBT) in an outpatient setting, were re-analysed to examine whether these patients subgrouped based on the DSM-5 severity levels would show meaningful and consistent differences on (a) a range of clinical variables assessed at pre-treatment and (b) post-treatment abstinence from IWCBs. Results highlight that the mild, moderate, severe, and extreme severity groups were statistically distinguishable on 22 variables assessed at pre-treatment regarding eating disorder pathological features, maintenance factors of BN, associated (current) and lifetime psychopathology, social maladjustment and illness-specific functional impairment, and abstinence outcome. Mood intolerance, a maintenance factor of BN but external to eating disorder pathological features (typically addressed within CBT), emerged as the primary clinical variable distinguishing the severity groups showing a differential treatment response. Overall, the findings speak to the concurrent and predictive validity of the new DSM-5 severity criterion for BN and are important because a common benchmark informing patients, clinicians, and researchers about severity of the disorder and allowing severity fluctuation and patient's progress to be tracked does not exist so far. Implications for future research are outlined.

  12. Traits across the personality hierarchy differentially relate to positive and negative affect: Evidence for the predictive validity of empirically derived meta-traits.

    Science.gov (United States)

    Hengartner, Michael P; Graf, Markus; Schreiber, Marc

    2017-05-01

    There is increasing interest in the construct validity of higher-order domains of the Big Five personality traits. A total of 831 persons from the Swiss population completed the International Personality Item Pool and an adaptation of the Positive and Negative Affect Scales. Using Goldberg's bass-ackwards method, we found evidence for the general factor of personality (GFP) and the two meta-traits of positive emotionality (blend of low neuroticism and high extraversion) and constraint (blend of high agreeableness and conscientiousness). In association with positive affect, the explanatory power of the GFP (r = 0.43) and positive emotionality (r = 0.37) was largely superior to extraversion (r = 0.24), conscientiousness (r = 0.18), agreeableness (r = 0.09) and openness (r = 0.04), although not neuroticism (r = -0.34). In association with negative affect, neuroticism (r = 0.41), the GFP (r = -0.36) and positive emotionality (r = -0.35) were the most powerful single predictors. We conclude that the higher-order structure of personality is best explained by the meta-traits of positive emotionality and constraint, which correspond closely to the well-established superfactors of internalizing and externalizing. We further demonstrate that these have substantial criterion validity when broad positive and negative affect is the outcome of interest. These findings help to relate Big Five meta-traits to pathological personality. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  13. Modelling the pre-assessment learning effects of assessment: evidence in the validity chain.

    Science.gov (United States)

    Cilliers, Francois J; Schuwirth, Lambert W T; van der Vleuten, Cees P M

    2012-11-01

    We previously developed a model of the pre-assessment learning effects of consequential assessment and started to validate it. The model comprises assessment factors, mechanism factors and learning effects. The purpose of this study was to continue the validation process. For stringency, we focused on a subset of assessment factor-learning effect associations that featured least commonly in a baseline qualitative study. Our aims were to determine whether these uncommon associations were operational in a broader but similar population to that in which the model was initially derived. A cross-sectional survey of 361 senior medical students at one medical school was undertaken using a purpose-made questionnaire based on a grounded theory and comprising pairs of written situational tests. In each pair, the manifestation of an assessment factor was varied. The frequencies at which learning effects were selected were compared for each item pair, using an adjusted alpha to assign significance. The frequencies at which mechanism factors were selected were calculated. There were significant differences in the learning effect selected between the two scenarios of an item pair for 13 of this subset of 21 uncommon associations, even when a p-value of value. For a subset of uncommon associations in the model, the role of most assessment factor-learning effect associations and the mechanism factors involved were supported in a broader but similar population to that in which the model was derived. Although model validation is an ongoing process, these results move the model one step closer to the stage of usefully informing interventions. Results illustrate how factors not typically included in studies of the learning effects of assessment could confound the results of interventions aimed at using assessment to influence learning. © Blackwell Publishing Ltd 2012.

  14. Evidence for validity and reliability of a french version of the FAAM

    Directory of Open Access Journals (Sweden)

    Ballabeni Pierluigi

    2011-02-01

    Full Text Available Abstract Background The Foot and Ankle Ability Measure (FAAM is a self reported questionnaire for patients with foot and ankle disorders available in English, German, and Persian. This study plans to translate the FAAM from English to French (FAAM-F and assess the validity and reliability of this new version. Methods The FAAM-F Activities of Daily Living (ADL and sports subscales were completed by 105 French-speaking patients (average age 50.5 years presenting various chronic foot and ankle disorders. Convergent and divergent validity was assessed by Pearson's correlation coefficients between the FAAM-F subscales and the SF-36 scales: Physical Functioning (PF, Physical Component Summary (PCS, Mental Health (MH and Mental Component Summary (MCS. Internal consistency was calculated by Cronbach's Alpha (CA. To assess test re-test reliability, 22 patients filled out the questionnaire a second time to estimate minimal detectable changes (MDC and intraclass correlation coefficients (ICC. Results Correlations for FAAM-F ADL subscale were 0.85 with PF, 0.81 with PCS, 0.26 with MH, 0.37 with MCS. Correlations for FAAM-F Sports subscale were 0.72 with PF, 0.72 with PCS, 0.21 with MH, 0.29 with MCS. CA estimates were 0.97 for both subscales. Respectively for the ADL and Sports subscales, ICC were 0.97 and 0.94, errors for a single measure were 8 and 10 points at 95% confidence and the MDC values at 95% confidence were 7 and 18 points. Conclusion The FAAM-F is valid and reliable for the self-assessment of physical function in French-speaking patients with a wide range of chronic foot and ankle disorders.

  15. The validity of PPP: evidence from Lagrange multiplier unit root tests for ASEAN countries

    OpenAIRE

    Alper ASLAN

    2010-01-01

    The univariate and panel Lagrange Multiplier (LM) unit root tests with one and two structural breaks proposed by Lee and Strazicich (2003, 2004) which are considerably more powerful than traditional tests are employed to investigate whether the purchasing power parity (PPP) theory holds true for ASEAN countries by using both black market and official exchange rates. We find strong evidence in favour of long-run PPP for six ASEAN countries namely, Indonesia, Malaysia, Myanmar, Philippines, Sin...

  16. First evidence on the validity and reliability of the Safety Organizing Scale-Nursing Home version (SOS-NH).

    Science.gov (United States)

    Ausserhofer, Dietmar; Anderson, Ruth A; Colón-Emeric, Cathleen; Schwendimann, René

    2013-08-01

    The Safety Organizing Scale is a valid and reliable measure on safety behaviors and practices in hospitals. This study aimed to explore the psychometric properties of the Safety Organizing Scale-Nursing Home version (SOS-NH). In a cross-sectional analysis of staff survey data, we examined validity and reliability of the 9-item Safety SOS-NH using American Educational Research Association guidelines. This substudy of a larger trial used baseline survey data collected from staff members (n = 627) in a variety of work roles in 13 nursing homes (NHs) in North Carolina and Virginia. Psychometric evaluation of the SOS-NH revealed good response patterns with low average of missing values across all items (3.05%). Analyses of the SOS-NH's internal structure (eg, comparative fit indices = 0.929, standardized root mean square error of approximation = 0.045) and consistency (composite reliability = 0.94) suggested its 1-dimensionality. Significant between-facility variability, intraclass correlations, within-group agreement, and design effect confirmed appropriateness of the SOS-NH for measurement at the NH level, justifying data aggregation. The SOS-NH showed discriminate validity from one related concept: communication openness. Initial evidence regarding validity and reliability of the SOS-NH supports its utility in measuring safety behaviors and practices among a wide range of NH staff members, including those with low literacy. Further psychometric evaluation should focus on testing concurrent and criterion validity, using resident outcome measures (eg, patient fall rates). Copyright © 2013 American Medical Directors Association, Inc. All rights reserved.

  17. Zulliger e habilidade social: evidências de validade no contexto empresarial Zulliger and social skills: validity evidences in business context

    Directory of Open Access Journals (Sweden)

    Jucelaine Bier Di Domenico Grazziotin

    2012-01-01

    Full Text Available O objetivo deste estudo foi verificar evidências de validade do Zulliger no Sistema Compreensivo ZSC, focalizando a variável relacionamento, em correlação ao Inventário de Habilidades Sociais IHS. Participaram 19 sujeitos, entre 18 e 43 anos, de uma loja de supermercado. Nos indicadores, destacam-se as correlações das variáveis GHR, H, GPHR, Sum H do ZSC com os fatores GIHS, F3 e F1 do IHS, e variáveis AG, PHR, Sum T com os fatores GIHS e F5. Os resultados contribuíram para asseverar a validade do Zulliger no âmbito empresarial, e comprovaram a presença de um bom relacionamento interpessoal entre os profissionais que trabalham no atendimento ao público, confirmando as expectativas do estudo.The aim of this study was to verify the validity evidence of Zulliger Comprehensive System ZSC focusing the variable `relationship' in correlation to the Social Skills Inventory. Nineteen supermarket workers, aged between 18 and 43 years old, participated in the study. The indicators include the correlations of variables GHR, H, GPHR; Sum H of ZSC with the factors GIHS, F3 and F1 of HIS; and variables AG, PHR, Sum T with the factors GIHS and F5.The results contributed to certify the validity of Zulliger in the business field and prove the presence of good interpersonal relationships among professionals who work with the public, confirming the assumptions of the study.

  18. The thought-action fusion scale: further evidence for its reliability and validity.

    Science.gov (United States)

    Rassin, E; Merckelbach, H; Muris, P; Schmidt, H

    2001-05-01

    Thought-action fusion (TAF) refers to a set of cognitive biases that are thought to play a role in the development of obsessional phenomena. To measure these biases, R. Shafran, D. S. Thordarson, and S. Rachman (1996; Journal of Anxiety Disorders, 10, 379-391) developed the TAF-scale. They concluded that the TAF-scale possesses adequate psychometric qualities. The current study sought to further explore the reliability and validity of the TAF-scale. Results indicate that the TAF-scale has good internal consistency. TAF-scores correlated with self-reports of obsessional problems. Furthermore, mean scores in a mixed sample of anxiety disordered patients were higher than those in a normal sample. However, temporal consistency was somewhat disappointing. Also, the question remains whether TAF is specific to obsessive-compulsive disorder or taps more pervasive biases that play a role in a variety of disorders.

  19. The problem of fouling in submerged membrane bioreactors - Model validation and experimental evidence

    Science.gov (United States)

    Tsibranska, Irene; Vlaev, Serafim; Tylkowski, Bartosz

    2018-01-01

    Integrating biological treatment with membrane separation has found a broad area of applications and industrial attention. Submerged membrane bioreactors (SMBRs), based on membrane modules immersed in the bioreactor, or side stream ones connected in recycle have been employed in different biotechnological processes for separation of thermally unstable products. Fouling is one of the most important challenges in the integrated SMBRs. A number of works are devoted to fouling analysis and its treatment, especially exploring the opportunity for enhanced fouling control in SMBRs. The main goal of the review is to provide a comprehensive yet concise overview of modeling the fouling in SMBRs in view of the problematics of model validation, either by real system measurements at different scales or by analysis of the obtained theoretical results. The review is focused on the current state of research applying computational fluid dynamics (CFD) modeling techniques.

  20. Scale for Assessment of Giftedness - teacher's version: evidence of validity content

    Directory of Open Access Journals (Sweden)

    Tatiana de Cassia Nakano

    2016-07-01

    Full Text Available The assessment of high abilities is of great importance in psychology, despite scarce studies in literature. Therefore, the aim of this study was to verify, through content validity, the appropriateness of the items of the High Assessment Scale Skills - Teacher Version. The judges were six post-graduate students in the psychological assessment area who rated the 41 items of the instrument in six factors (academic intellectual ability, specific academic skills, leadership, creativity, artistic talent. The results demonstrated the suitability of the items, most of them with concordance rates above 80% (n = 29 and between 60 and 80% (n = 8. Only four items showed agreement at or below 50%, suggesting the need for reformulation. The analysis of the Kappa coefficients showed indices between 0.69 and 0.81. In general, the results indicated the suitability of the scale to the contents of the pretended model.

  1. Building the evidence on simulation validity: comparison of anesthesiologists' communication patterns in real and simulated cases.

    Science.gov (United States)

    Weller, Jennifer; Henderson, Robert; Webster, Craig S; Shulruf, Boaz; Torrie, Jane; Davies, Elaine; Henderson, Kaylene; Frampton, Chris; Merry, Alan F

    2014-01-01

    Effective teamwork is important for patient safety, and verbal communication underpins many dimensions of teamwork. The validity of the simulated environment would be supported if it elicited similar verbal communications to the real setting. The authors hypothesized that anesthesiologists would exhibit similar verbal communication patterns in routine operating room (OR) cases and routine simulated cases. The authors further hypothesized that anesthesiologists would exhibit different communication patterns in routine cases (real or simulated) and simulated cases involving a crisis. Key communications relevant to teamwork were coded from video recordings of anesthesiologists in the OR, routine simulation and crisis simulation and percentages were compared. The authors recorded comparable videos of 20 anesthesiologists in the two simulations, and 17 of these anesthesiologists in the OR, generating 400 coded events in the OR, 683 in the routine simulation, and 1,419 in the crisis simulation. The authors found no significant differences in communication patterns in the OR and the routine simulations. The authors did find significant differences in communication patterns between the crisis simulation and both the OR and the routine simulations. Participants rated team communication as realistic and considered their communications occurred with a similar frequency in the simulations as in comparable cases in the OR. The similarity of teamwork-related communications elicited from anesthesiologists in simulated cases and the real setting lends support for the ecological validity of the simulation environment and its value in teamwork training. Different communication patterns and frequencies under the challenge of a crisis support the use of simulation to assess crisis management skills.

  2. About my Child: measuring 'Complexity' in neurodisability. Evidence of reliability and validity.

    Science.gov (United States)

    Ritzema, A M; Lach, L M; Rosenbaum, P; Nicholas, D

    2016-05-01

    About my Child, 26-item version (AMC-26) was developed as a measure of child health 'complexity' and has been proposed as a tool for understanding the functional needs of children and the priorities of families. The current study investigated the reliability and validity of AMC-26 with a sample of caregivers of children with neurodevelopmental disorders (NDD; n = 258) who completed AMC-26 as part of a larger study on parenting children with NDD. A subsample of children from the larger study (n = 49) were assessed using standardized measures of cognitive and adaptive functioning. Factor analysis revealed that a four-component model explained 51.12% of the variance. Cronbach's alpha was calculated for each of the four factors and for the scale as a whole, and ranged from 0.75 to 0.85, suggesting a high level of internal consistency. Construct validity was tested through comparisons with the results of standardized measures of child functioning. Predicted relationships for factors one, two and three were statistically significant and in the expected directions. Predictions for factor four were partially supported. AMC-26 was also expected to serve as an indicator of caregiver distress. Drawing on a sample of caregivers from the larger study (n = 251) the model was found to be significant and explained 23% of the variance in caregiver depressive symptoms (R(2)  = .053, F (1, 249) = 14.06, P child function and child health complexity. Such a measure may help elucidate the relationships between child complexity and family well-being. This is an important avenue for further investigation. © 2016 John Wiley & Sons Ltd.

  3. Spatial repellents: from discovery and development to evidence-based validation

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    Achee Nicole L

    2012-05-01

    Full Text Available Abstract International public health workers are challenged by a burden of arthropod-borne disease that remains elevated despite best efforts in control programmes. With this challenge comes the opportunity to develop novel vector control paradigms to guide product development and programme implementation. The role of vector behaviour modification in disease control was first highlighted several decades ago but has received limited attention within the public health community. This paper presents current evidence highlighting the value of sub-lethal agents, specifically spatial repellents, and their use in global health, and identifies the primary challenges towards establishing a clearly defined and recommended role for spatial repellent products in disease control.

  4. The role of audience characteristics and external factors in continuing medical education and physician change: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.

    Science.gov (United States)

    Lowe, Mary Martin; Bennett, Nancy; Aparicio, Alejandro

    2009-03-01

    The Agency for Healthcare Research and Quality (AHRQ) Evidence Report identified and assessed audience characteristics (internal factors) and external factors that influence the effectiveness of continuing medical education (CME) in changing physician behavior. Thirteen studies examined a series of CME audience characteristics (internal factors), and six studies looked at external factors to reinforce the effects of CME in changing behavior. With regard to CME audience characteristics, the 13 studies examined age, gender, practice setting, years in practice, specialty, foreign vs US medical graduate, country of practice, personal motivation, nonmonetary rewards and motivations, learning satisfaction, and knowledge enhancement. With regard to the external characteristics, the six studies looked at the role of regulation, state licensing boards, professional boards, hospital credentialing, external audits, monetary and financial rewards, academic advancement, provision of tools, public demand and expectations, and CME credit. No consistent findings were identified. The AHRQ Evidence Report provides no conclusions about the ways that internal or external factors influence CME effectiveness in changing physician behavior. However, given what is known about how individuals approach learning, it is likely that internal factors play an important role in the design of effective CME. Regulatory and professional organizations are providing new structures, mandates, and recommendations for CME activities that influence the way CME providers design and present activities, supporting a role that is not yet clear for external factors. More research is needed to understand the impact of these factors in enhancing the effectiveness of CME.

  5. AIMD - a validated, simplified framework of interventions to promote and integrate evidence into health practices, systems, and policies

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    Peter Bragge

    2017-03-01

    Full Text Available Abstract Background Proliferation of terms describing the science of effectively promoting and supporting the use of research evidence in healthcare policy and practice has hampered understanding and development of the field. To address this, an international Terminology Working Group developed and published a simplified framework of interventions to promote and integrate evidence into health practices, systems, and policies. This paper presents results of validation work and a second international workgroup meeting, culminating in the updated AIMD framework [Aims, Ingredients, Mechanism, Delivery]. Methods Framework validity was evaluated against terminology schemas (n = 51; primary studies (n = 37; and reporting guidelines (n = 10. Framework components were independently categorized as fully represented, partly represented, or absent by two researchers. Opportunities to refine the framework were systematically recorded. A meeting of the expanded international Terminology Working Group updated the framework by reviewing and deliberating upon validation findings and refinement proposals. Results There was variation in representativeness of the components across the three types of literature, in particular for the component ‘causal mechanisms’. Analysis of primary studies revealed that representativeness of this concept lowered from 92 to 68% if only explicit, rather than explicit and non-explicit references to causal mechanisms were included. All components were very well represented in reporting guidelines, however the level of description of these was lower than in other types of literature. Twelve opportunities were identified to improve the framework, 9 of which were operationalized at the meeting. The updated AIMD framework comprises four components: (1 Aims: what do you want your intervention to achieve and for whom? (2 Ingredients: what comprises the intervention? (3 Mechanisms: how do you propose the intervention will

  6. Program of neuropsychological stimulation of cognition in students: Emphasis on executive functions - development and evidence of content validity

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    Caroline de Oliveira Cardoso

    Full Text Available ABSTRACT Objective: The goal of this study was to describe the construction process and content validity evidence of an early and preventive intervention program for stimulating executive functions (EF in Elementary School children within the school environment. Methods: The process has followed the recommended steps for creating neuropsychological instruments: internal phase of program organization, with literature search and analyses of available materials in the classroom; program construction; analysis by expert judges; data integration and program finalization. To determine the level of agreement among the judges, a Content Validity Index (CVI was calculated. Results: Content validity was evidenced by the agreement among the experts with regards to the program, both in general and for each activity. All steps taken were deemed necessary because they contributed to the identification of positive aspects and possible flaws in the process Conclusion: The steps also helped to adapt stimuli and improve program tasks and activities. Methodological procedures implemented in this study can be adopted by other researchers to create or adapt neuropsychological stimulation and rehabilitation programs. Furthermore, the methodological approach allows the reader to understand, in detail, the technical and scientific rigor adopted in devising this program.

  7. Oligosaccharides in infant formula: more evidence to validate the role of prebiotics.

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    Vandenplas, Yvan; Zakharova, Irina; Dmitrieva, Yulia

    2015-05-14

    The gastrointestinal (GI) microbiota differs between breast-fed and classic infant formula-fed infants. Breast milk is rich in prebiotic oligosaccharides (OS) and may also contain some probiotics, but scientific societies do not recommend the addition of prebiotic OS or probiotics to standard infant formula. Nevertheless, many infant formula companies often add one or the other or both. Different types of prebiotic OS are used in infant formula, including galacto-oligosaccharide, fructo-oligosaccharide, polydextrose and mixtures of these OS, but none adds human milk OS. There is evidence that the addition of prebiotics to infant formula brings the GI microbiota of formula-fed infants closer to that of breast-fed infants. Prebiotics change gut metabolic activity (by decreasing stool pH and increasing SCFA), have a bifidogenic effect and bring stool consistency and defecation frequency closer to those of breast-fed infants. Although there is only limited evidence that these changes in GI microbiota induce a significant clinical benefit for the immune system, interesting positive trends have been observed in some markers. Additionally, adverse effects are extremely seldom. Prebiotics are added to infant formula because breast milk contains human milk OS. Because most studies suggest a trend of beneficial effects and because these ingredients are very safe, prebiotics bring infant formula one step closer to the golden standard of breast milk.

  8. Cluster analysis of novel isometric strength measures produces a valid and evidence-based classification structure for wheelchair track racing.

    Science.gov (United States)

    Connick, Mark J; Beckman, Emma; Vanlandewijck, Yves; Malone, Laurie A; Blomqvist, Sven; Tweedy, Sean M

    2017-11-25

    The Para athletics wheelchair-racing classification system employs best practice to ensure that classes comprise athletes whose impairments cause a comparable degree of activity limitation. However, decision-making is largely subjective and scientific evidence which reduces this subjectivity is required. To evaluate whether isometric strength tests were valid for the purposes of classifying wheelchair racers and whether cluster analysis of the strength measures produced a valid classification structure. Thirty-two international level, male wheelchair racers from classes T51-54 completed six isometric strength tests evaluating elbow extensors, shoulder flexors, trunk flexors and forearm pronators and two wheelchair performance tests-Top-Speed (0-15 m) and Top-Speed (absolute). Strength tests significantly correlated with wheelchair performance were included in a cluster analysis and the validity of the resulting clusters was assessed. All six strength tests correlated with performance (r=0.54-0.88). Cluster analysis yielded four clusters with reasonable overall structure (mean silhouette coefficient=0.58) and large intercluster strength differences. Six athletes (19%) were allocated to clusters that did not align with their current class. While the mean wheelchair racing performance of the resulting clusters was unequivocally hierarchical, the mean performance of current classes was not, with no difference between current classes T53 and T54. Cluster analysis of isometric strength tests produced classes comprising athletes who experienced a similar degree of activity limitation. The strength tests reported can provide the basis for a new, more transparent, less subjective wheelchair racing classification system, pending replication of these findings in a larger, representative sample. This paper also provides guidance for development of evidence-based systems in other Para sports. © Article author(s) (or their employer(s) unless otherwise stated in the text of

  9. Is there any evidence for the validity of diagnostic criteria used for accommodative and nonstrabismic binocular dysfunctions?

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    Cacho-Martínez, Pilar; García-Muñoz, Ángel; Ruiz-Cantero, María Teresa

    2014-01-01

    To analyze the diagnostic criteria used in the scientific literature published in the past 25 years for accommodative and nonstrabismic binocular dysfunctions and to explore if the epidemiological analysis of diagnostic validity has been used to propose which clinical criteria should be used for diagnostic purposes. We carried out a systematic review of papers on accommodative and non-strabic binocular disorders published from 1986 to 2012 analysing the MEDLINE, CINAHL, PsycINFO and FRANCIS databases. We admitted original articles about diagnosis of these anomalies in any population. We identified 839 articles and 12 studies were included. The quality of included articles was assessed using the QUADAS-2 tool. The review shows a wide range of clinical signs and cut-off points between authors. Only 3 studies (regarding accommodative anomalies) assessed diagnostic accuracy of clinical signs. Their results suggest using the accommodative amplitude and monocular accommodative facility for diagnosing accommodative insufficiency and a high positive relative accommodation for accommodative excess. The remaining 9 articles did not analyze diagnostic accuracy, assessing a diagnosis with the criteria the authors considered. We also found differences between studies in the way of considering patients' symptomatology. 3 studies of 12 analyzed, performed a validation of a symptom survey used for convergence insufficiency. Scientific literature reveals differences between authors according to diagnostic criteria for accommodative and nonstrabismic binocular dysfunctions. Diagnostic accuracy studies show that there is only certain evidence for accommodative conditions. For binocular anomalies there is only evidence about a validated questionnaire for convergence insufficiency with no data of diagnostic accuracy. Copyright © 2012 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

  10. The Prospective External Validation of International Ovarian Tumor Analysis (IOTA) Simple Rules in the Hands of Level I and II Examiners.

    Science.gov (United States)

    Knafel, A; Banas, T; Nocun, A; Wiechec, M; Jach, R; Ludwin, A; Kabzinska-Turek, M; Pietrus, M; Pitynski, K

    2016-10-01

    Objective: To externally validate the International Ovarian Tumor Analysis (IOTA) Simple Rules (SR) by examiners with different levels of sonographic experience defined by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and to assess the morphological ultrasound features of the adnexal tumors classified as inconclusive based on IOTA SR. Materials and Methods: In the two-year prospective study adnexal tumors were assessed preoperatively with transvaginal ultrasound by examiners with different levels of experience (level 1- IOTA SR1, level 2-IOTA SR2). Additionally, an expert (level 3) evaluated all tumors by subjective assessment (SA). If the rules could not be applied, the tumors were considered inconclusive. The final diagnosis was based on the histopathological result of the removed mass. The diagnostic performance measures for the assessed model were sensitivity, specificity, negative (LR-) and positive(LR+) likelihood ratios, accuracy (ACC) and diagnostic odds ratio (DOR). Results: 226 women with adnexal tumors scheduled for surgery were included in the stutdy. The prevalence of malignancy was 36.3 % in the group of all studied tumors and was 52.5 % in the inconclusive group (n = 40) (p = 0.215). Fewer tumors were classified as inconclusive by level 2 examiners compared to level 1 examiners [20 (8.8 %) vs. 40 (17.7 %); p = 0.008], resulting from the discrepancy in the evaluation of acoustic shadows and the vascularization within the tumor. For level 1 examiners a diagnostic strategy using IOTA SR1 +MA (assuming malignancy when SR inconclusive) achieved a sensitivity, specificity and DOR of 96.3 %, 81.9 %, 13.624 respectively. For level 2 examiners the diagnostic strategy for IOTA SR2 +MA achieved a sensitivity, specificity and DOR of 95.1 %, 89.6 %, 137,143, respectively. Adding SA by an expert (or level 3 examiner) when IOTA SR were not applicable improved the specificity of the test and

  11. Validity evidence for the situational judgment test paradigm in emotional intelligence measurement.

    Science.gov (United States)

    Libbrecht, Nele; Lievens, Filip

    2012-01-01

    To date, various measurement approaches have been proposed to assess emotional intelligence (EI). Recently, two new EI tests have been developed based on the situational judgment test (SJT) paradigm: the Situational Test of Emotional Understanding (STEU) and the Situational Test of Emotion Management (STEM). Initial attempts have been made to examine the construct-related validity of these new tests; we extend these findings by placing the tests in a broad nomological network. To this end, 850 undergraduate students completed a personality inventory, a cognitive ability test, a self-report EI test, a performance-based EI measure, the STEU, and the STEM. The SJT-based EI tests were not strongly correlated with personality and fluid cognitive ability. Regarding their relation with existing EI measures, the tests did not capture the same construct as self-report EI measures, but corresponded rather to performance-based EI measures. Overall, these results lend support for the SJT paradigm for measuring EI as an ability.

  12. Brief Self-Efficacy Scales for use in Weight-Loss Trials: Preliminary Evidence of Validity

    Science.gov (United States)

    Wilson, Kathryn E.; Harden, Samantha M.; Almeida, Fabio A.; You, Wen; Hill, Jennie L.; Goessl, Cody; Estabrooks, Paul A.

    2015-01-01

    Self-efficacy is a commonly included cognitive variable in weight-loss trials, but there is little uniformity in its measurement. Weight-loss trials frequently focus on physical activity (PA) and eating behavior, as well as weight loss, but no survey is available that offers reliable measurement of self-efficacy as it relates to each of these targeted outcomes. The purpose of this study was to test the psychometric properties of brief, pragmatic self-efficacy scales specific to PA, healthful eating and weight-loss (4 items each). An adult sample (n=1790) from 28 worksites enrolled in a worksite weight-loss program completed the self-efficacy scale, as well as measures of PA, dietary fat intake, and weight, at baseline, 6-, and 12-months. The hypothesized factor structure was tested through confirmatory factor analysis, which supported the expected factor structure for three latent self-efficacy factors, specific to PA, healthful eating, and weight-loss. Measurement equivalence/invariance between relevant demographic groups, and over time was also supported. Parallel growth processes in self-efficacy factors and outcomes (PA, fat intake, and weight) support the predictive validity of score interpretations. Overall, this initial series of psychometric analyses supports the interpretation that scores on these scales reflect self-efficacy for PA, healthful eating, and weight-loss. The use of this instrument in large-scale weight-loss trials is encouraged. PMID:26619093

  13. Validating the psycholinguistic aspects of LITMUS-CLT: Evidence from Polish and Norwegian.

    Science.gov (United States)

    Hansen, Pernille; Simonsen, Hanne Gram; Łuniewska, Magdalena; Haman, Ewa

    2017-01-01

    The novel assessment tool Cross-Linguistic Lexical Tasks (LITMUS-CLT) aims for comparable cross-linguistic assessment of multilingual children's lexical skills by basing each language version on two language-specific variables: age of acquisition (AoA) and complexity index (CI), a novel measure related to phonology, morphology, exposure and etymology. This article investigates the validity of this methodology, asking whether the underlying properties are robust predictors of children's performance. The Polish and Norwegian CLTs were used to assess 32 bilingual Polish-Norwegian, 34 monolingual Norwegian and 36 monolingual Polish children. The effects of AoA and CI were contrasted with frequency in child directed speech (CDS) and imageability, two known predictors of lexical development. AoA was a reliable predictor of performance within all parts of CLT, in contrast to CI. Apart from AoA, only exposure and CDS frequency had a significant effect within both monolinguals and bilinguals. These results indicate that CLT assesses lexical skills in a cross-linguistically comparable manner, but suggest a revision of the CI measure.

  14. Dogs Evaluate Threatening Facial Expressions by Their Biological Validity--Evidence from Gazing Patterns.

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    Sanni Somppi

    Full Text Available Appropriate response to companions' emotional signals is important for all social creatures. The emotional expressions of humans and non-human animals have analogies in their form and function, suggesting shared evolutionary roots, but very little is known about how animals other than primates view and process facial expressions. In primates, threat-related facial expressions evoke exceptional viewing patterns compared with neutral or positive stimuli. Here, we explore if domestic dogs (Canis familiaris have such an attentional bias toward threatening social stimuli and whether observed emotional expressions affect dogs' gaze fixation distribution among the facial features (eyes, midface and mouth. We recorded the voluntary eye gaze of 31 domestic dogs during viewing of facial photographs of humans and dogs with three emotional expressions (threatening, pleasant and neutral. We found that dogs' gaze fixations spread systematically among facial features. The distribution of fixations was altered by the seen expression, but eyes were the most probable targets of the first fixations and gathered longer looking durations than mouth regardless of the viewed expression. The examination of the inner facial features as a whole revealed more pronounced scanning differences among expressions. This suggests that dogs do not base their perception of facial expressions on the viewing of single structures, but the interpretation of the composition formed by eyes, midface and mouth. Dogs evaluated social threat rapidly and this evaluation led to attentional bias, which was dependent on the depicted species: threatening conspecifics' faces evoked heightened attention but threatening human faces instead an avoidance response. We propose that threatening signals carrying differential biological validity are processed via distinctive neurocognitive pathways. Both of these mechanisms may have an adaptive significance for domestic dogs. The findings provide a novel

  15. The EADC-ADNI Harmonized Protocol for manual hippocampal segmentation on magnetic resonance: Evidence of validity

    Science.gov (United States)

    Frisoni, Giovanni B.; Jack, Clifford R.; Bocchetta, Martina; Bauer, Corinna; Frederiksen, Kristian S.; Liu, Yawu; Preboske, Gregory; Swihart, Tim; Blair, Melanie; Cavedo, Enrica; Grothe, Michel J.; Lanfredi, Mariangela; Martinez, Oliver; Nishikawa, Masami; Portegies, Marileen; Stoub, Travis; Ward, Chadwich; Apostolova, Liana G.; Ganzola, Rossana; Wolf, Dominik; Barkhof, Frederik; Bartzokis, George; DeCarli, Charles; Csernansky, John G.; deToledo-Morrell, Leyla; Geerlings, Mirjam I.; Kaye, Jeffrey; Killiany, Ronald J.; Lehéricy, Stephane; Matsuda, Hiroshi; O'Brien, John; Silbert, Lisa C.; Scheltens, Philip; Soininen, Hilkka; Teipel, Stefan; Waldemar, Gunhild; Fellgiebel, Andreas; Barnes, Josephine; Firbank, Michael; Gerritsen, Lotte; Henneman, Wouter; Malykhin, Nikolai; Pruessner, Jens C.; Wang, Lei; Watson, Craig; Wolf, Henrike; deLeon, Mony; Pantel, Johannes; Ferrari, Clarissa; Bosco, Paolo; Pasqualetti, Patrizio; Duchesne, Simon; Duvernoy, Henri; Boccardi, Marina

    2015-01-01

    Background An international Delphi panel has defined a harmonized protocol (HarP) for the manual segmentation of the hippocampus on MR. The aim of this study is to study the concurrent validity of the HarP toward local protocols, and its major sources of variance. Methods Fourteen tracers segmented 10 Alzheimer's Disease Neuroimaging Initiative (ADNI) cases scanned at 1.5 T and 3T following local protocols, qualified for segmentation based on the HarP through a standard web-platform and resegmented following the HarP. The five most accurate tracers followed the HarP to segment 15 ADNI cases acquired at three time points on both 1.5 T and 3T. Results The agreement among tracers was relatively low with the local protocols (absolute left/right ICC 0.44/0.43) and much higher with the HarP (absolute left/right ICC 0.88/0.89). On the larger set of 15 cases, the HarP agreement within (left/right ICC range: 0.94/0.95 to 0.99/0.99) and among tracers (left/right ICC range: 0.89/0.90) was very high. The volume variance due to different tracers was 0.9% of the total, comparing favorably to variance due to scanner manufacturer (1.2), atrophy rates (3.5), hemispheric asymmetry (3.7), field strength (4.4), and significantly smaller than the variance due to atrophy (33.5%, P < .001), and physiological variability (49.2%, P < .001). Conclusions The HarP has high measurement stability compared with local segmentation protocols, and good reproducibility within and among human tracers. Hippocampi segmented with the HarP can be used as a reference for the qualification of human tracers and automated segmentation algorithms. PMID:25267715

  16. Experimental Evidence for Differential Susceptibility: Dopamine D4 Receptor Polymorphism (DRD4 VNTR) Moderates Intervention Effects on Toddlers' Externalizing Behavior in a Randomized Controlled Trial

    Science.gov (United States)

    Bakermans-Kranenburg, Marian J.; Van Ijzendoorn, Marinus H.; Pijlman, Femke T. A.; Mesman, Judi; Juffer, Femmie

    2008-01-01

    In a randomized controlled trial we tested the role of genetic differences in explaining variability in intervention effects on child externalizing behavior. One hundred fifty-seven families with 1- to 3-year-old children screened for their relatively high levels of externalizing behavior participated in a study implementing Video-feedback…

  17. Bi-national cross-validation of an evidence-based conduct problem prevention model.

    Science.gov (United States)

    Porta, Carolyn M; Bloomquist, Michael L; Garcia-Huidobro, Diego; Gutiérrez, Rafael; Vega, Leticia; Balch, Rosita; Yu, Xiaohui; Cooper, Daniel K

    2018-04-01

    To (a) explore the preferences of Mexican parents and Spanish-speaking professionals working with migrant Latino families in Minnesota regarding the Mexican-adapted brief model versus the original conduct problems intervention and (b) identifying the potential challenges, and preferred solutions, to implementation of a conduct problems preventive intervention. The core practice elements of a conduct problems prevention program originating in the United States were adapted for prevention efforts in Mexico. Three focus groups were conducted in the United States, with Latino parents (n = 24; 2 focus groups) and professionals serving Latino families (n = 9; 1 focus group), to compare and discuss the Mexican-adapted model and the original conduct problems prevention program. Thematic analysis was conducted on the verbatim focus group transcripts in the original language spoken. Participants preferred the Mexican-adapted model. The following key areas were identified for cultural adaptation when delivering a conduct problems prevention program with Latino families: recruitment/enrollment strategies, program delivery format, and program content (i.e., child skills training, parent skills training, child-parent activities, and child-parent support). For both models, strengths, concerns, barriers, and strategies for overcoming concerns and barriers were identified. We summarize recommendations offered by participants to strengthen the effective implementation of a conduct problems prevention model with Latino families in the United States. This project demonstrates the strength in binational collaboration to critically examine cultural adaptations of evidence-based prevention programs that could be useful to diverse communities, families, and youth in other settings. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  18. Escala de atitudes frente ao uso de drogas: evidências de validade fatorial e preditiva Attitudes toward drugs use scale: evidences of factor and predictive validity

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    Valdiney V. Gouveia

    2007-01-01

    Full Text Available OBJETIVO: O presente estudo teve como objetivo conhecer evidências de validade fatorial e preditiva de uma medida de atitudes ante o uso de drogas em geral (EAAUD. MÉTODO: Participaram voluntariamente 276 estudantes universitários de vários cursos, provenientes de uma universidade pública (94,2% e outra particular (5,8% da cidade de João Pessoa (PB. Estes tinham idade média de 21 anos (DP = 3,40; 93,5% eram de jovens de 17 a 25 anos, a maioria solteira (91% e do sexo feminino (65,6%. Além de um conjunto de perguntas demográficas, os participantes preencheram a EAAUD. Esta compreende uma medida formada por quatro itens/adjetivos bipolares (positivo/negativo, gosto/desgosto, bom/ruim e desejável/indesejável respondidos em escala do tipo diferencial semântico, de 9 pontos, variando de - 4 a + 4. RESULTADOS: De acordo com a análise de componentes principais, um único componente emergiu, com todos os itens apresentando saturação acima de |0,40|; este teve valor próprio de 3,17, explicando 79,3% da variância total. Sua consistência interna (alfa de Cronbach foi de 0,91. Por meio de regressão logística, comprovou-se que as pontuações na EAAUD predisseram significativamente a condição de ser um usuário de drogas, B = 0,17, Wald (1 = 8,45, p = 0,004. CONCLUSÃO: Tais resultados indicam que esta medida reúne evidências de validade fatorial e preditiva, podendo ser empregada para conhecer o potencial envolvimento dos jovens com drogas. Não obstante, sugerem-se novas pesquisas com amostras maiores e mais diversificadas.OBJECTIVE: This study aimed at knowing evidences of factor and predictive validity of a measure of attitudes toward drugs use (ATDUS. METHODS: Participants were 276 volunteer undergraduate students of several courses. They were of a public (94.2% and other private (5.8% university from João Pessoa city (Paraíba, with mean age of 21 years old (SD = 3.40; 93.5% were youths, with age ranging from 17 to 25. Most of

  19. Adaptation and validation of the Evidence-Based Practice Belief and Implementation scales for French-speaking Swiss nurses and allied healthcare providers.

    Science.gov (United States)

    Verloo, Henk; Desmedt, Mario; Morin, Diane

    2017-09-01

    To evaluate two psychometric properties of the French versions of the Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales, namely their internal consistency and construct validity. The Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales developed by Melnyk et al. are recognised as valid, reliable instruments in English. However, no psychometric validation for their French versions existed. Secondary analysis of a cross sectional survey. Source data came from a cross-sectional descriptive study sample of 382 nurses and other allied healthcare providers. Cronbach's alpha was used to evaluate internal consistency, and principal axis factor analysis and varimax rotation were computed to determine construct validity. The French Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales showed excellent reliability, with Cronbach's alphas close to the scores established by Melnyk et al.'s original versions. Principal axis factor analysis showed medium-to-high factor loading scores without obtaining collinearity. Principal axis factor analysis with varimax rotation of the 16-item Evidence-Based Practice Beliefs scale resulted in a four-factor loading structure. Principal axis factor analysis with varimax rotation of the 17-item Evidence-Based Practice Implementation scale revealed a two-factor loading structure. Further research should attempt to understand why the French Evidence-Based Practice Implementation scale showed a two-factor loading structure but Melnyk et al.'s original has only one. The French versions of the Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales can both be considered valid and reliable instruments for measuring Evidence-Based Practice beliefs and implementation. The results suggest that the French Evidence-Based Practice Beliefs and Evidence-Based Practice Implementation scales are valid and reliable and can therefore be used to

  20. The predictive validity of selection for entry into postgraduate training in general practice: evidence from three longitudinal studies.

    Science.gov (United States)

    Patterson, Fiona; Lievens, Filip; Kerrin, Máire; Munro, Neil; Irish, Bill

    2013-11-01

    The selection methodology for UK general practice is designed to accommodate several thousand applicants per year and targets six core attributes identified in a multi-method job-analysis study To evaluate the predictive validity of selection methods for entry into postgraduate training, comprising a clinical problem-solving test, a situational judgement test, and a selection centre. A three-part longitudinal predictive validity study of selection into training for UK general practice. In sample 1, participants were junior doctors applying for training in general practice (n = 6824). In sample 2, participants were GP registrars 1 year into training (n = 196). In sample 3, participants were GP registrars sitting the licensing examination after 3 years, at the end of training (n = 2292). The outcome measures include: assessor ratings of performance in a selection centre comprising job simulation exercises (sample 1); supervisor ratings of trainee job performance 1 year into training (sample 2); and licensing examination results, including an applied knowledge examination and a 12-station clinical skills objective structured clinical examination (OSCE; sample 3). Performance ratings at selection predicted subsequent supervisor ratings of job performance 1 year later. Selection results also significantly predicted performance on both the clinical skills OSCE and applied knowledge examination for licensing at the end of training. In combination, these longitudinal findings provide good evidence of the predictive validity of the selection methods, and are the first reported for entry into postgraduate training. Results show that the best predictor of work performance and training outcomes is a combination of a clinical problem-solving test, a situational judgement test, and a selection centre. Implications for selection methods for all postgraduate specialties are considered.

  1. Initial construct validity evidence of a virtual human application for competency assessment in breaking bad news to a cancer patient

    Directory of Open Access Journals (Sweden)

    Guetterman TC

    2017-07-01

    Full Text Available Timothy C Guetterman,1 Frederick W Kron,1 Toby C Campbell,2 Mark W Scerbo,3 Amy B Zelenski,4 James F Cleary,5 Michael D Fetters1 1Department of Family Medicine, University of Michigan, Ann Arbor, MI, 2Department of Medicine, University of Wisconsin–Madison, Madison, WI, 3Department of Psychology, Old Dominion University, Norfolk, VA, 4Department of General Internal Medicine, University of Wisconsin–Madison, University of Wisconsin Medical Foundation, 5Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison, Clinical Science Center, Madison, WI, USA Background: Despite interest in using virtual humans (VHs for assessing health care ­communication, evidence of validity is limited. We evaluated the validity of a VH application, MPathic-VR, for assessing performance-based competence in breaking bad news (BBN to a VH patient.Methods: We used a two-group quasi-experimental design, with residents participating in a 3-hour seminar on BBN. Group A (n=15 completed the VH simulation before and after the seminar, and Group B (n=12 completed the VH simulation only after the BBN seminar to avoid the possibility that testing alone affected performance. Pre- and postseminar differences for Group A were analyzed with a paired t-test, and comparisons between Groups A and B were analyzed with an independent t-test.Results: Compared to the preseminar result, Group A’s postseminar scores improved significantly, indicating that the VH program was sensitive to differences in assessing performance-based competence in BBN. Postseminar scores of Group A and Group B were not significantly different, indicating that both groups performed similarly on the VH program.Conclusion: Improved pre–post scores demonstrate acquisition of skills in BBN to a VH patient. Pretest sensitization did not appear to influence posttest assessment. These results provide initial construct validity evidence that the VH program is effective for

  2. External validation of Vascular Study Group of New England risk predictive model of mortality after elective abdominal aorta aneurysm repair in the Vascular Quality Initiative and comparison against established models.

    Science.gov (United States)

    Eslami, Mohammad H; Rybin, Denis V; Doros, Gheorghe; Siracuse, Jeffrey J; Farber, Alik

    2018-01-01

    The purpose of this study is to externally validate a recently reported Vascular Study Group of New England (VSGNE) risk predictive model of postoperative mortality after elective abdominal aortic aneurysm (AAA) repair and to compare its predictive ability across different patients' risk categories and against the established risk predictive models using the Vascular Quality Initiative (VQI) AAA sample. The VQI AAA database (2010-2015) was queried for patients who underwent elective AAA repair. The VSGNE cases were excluded from the VQI sample. The external validation of a recently published VSGNE AAA risk predictive model, which includes only preoperative variables (age, gender, history of coronary artery disease, chronic obstructive pulmonary disease, cerebrovascular disease, creatinine levels, and aneurysm size) and planned type of repair, was performed using the VQI elective AAA repair sample. The predictive value of the model was assessed via the C-statistic. Hosmer-Lemeshow method was used to assess calibration and goodness of fit. This model was then compared with the Medicare, Vascular Governance Northwest model, and Glasgow Aneurysm Score for predicting mortality in VQI sample. The Vuong test was performed to compare the model fit between the models. Model discrimination was assessed in different risk group VQI quintiles. Data from 4431 cases from the VSGNE sample with the overall mortality rate of 1.4% was used to develop the model. The internally validated VSGNE model showed a very high discriminating ability in predicting mortality (C = 0.822) and good model fit (Hosmer-Lemeshow P = .309) among the VSGNE elective AAA repair sample. External validation on 16,989 VQI cases with an overall 0.9% mortality rate showed very robust predictive ability of mortality (C = 0.802). Vuong tests yielded a significant fit difference favoring the VSGNE over then Medicare model (C = 0.780), Vascular Governance Northwest (0.774), and Glasgow Aneurysm Score (0

  3. Memory-Focused Cognitive Therapy for Cocaine Use Disorder: Theory, Procedures and Preliminary Evidence From an External Pilot Randomised Controlled Trial

    Directory of Open Access Journals (Sweden)

    John Marsden

    2018-03-01

    of regular cocaine use, baseline outcome score, and group estimated the effectiveness of the intervention. The trial is registered with the ISCRTN (ISRCTN16462783. Findings: Between July 15, 2015, and November 27, 2016, 58 patients were assessed for eligibility and 30 participants were randomised (14 to the control group and 16 to the intervention. With outcome data collected for all participants at the endpoint, the intervention group mean CEQ-F score (14·77; SD 21·47 was lower than the control group mean (51·75; SD 22·72; ES -1·62; 95% CI -2·45 to −0·80.MFCT was associated with more cocaine abstinence in the intervention group (PDA 85·94; SD 18·96 than the control group (PDA 54·59; SD 30·29; ES 1·19; 90% CI 0·54 to 1·84. There was also greater maximum abstinence in the intervention group (LPA 15·69; SD 10·10 than the control group (6·00; SD 7·36; ES 1·06; 90% CI 0·41 to 1·70. Exploratory, confounder-adjusted regression models for this preliminary effect supported the treatment association for reduced craving experiences (CEQ-F Coef. -28·25; 95% CI -45·15 to −11·35; more abstinence (PDA Incidence Rate Ratio [IRR] 1·56; 95% CI 1·31 to 1·88; and greater maximum abstinence (LPA IRR 2·56; 95% CI 1·96 to 3·35, although relative weak unmeasured confounding could overturn these model-adjusted exposure-outcome associations.There were four serious adverse events (among three participants. None were judged related to study procedures or interventions. Interpretation: In this first external pilot randomised controlled trial of MFCT for CUD, we have shown that the intervention and control procedures and acceptable feasible and safe, and report preliminary evidence that MFCT is associated with reduced craving and increased abstinence. These findings support progression to a substantive trial. Funding Source: UK National Institute for Health Research, Biomedical Research Centre. Keywords: Cocaine, Craving, Memory, Reconsolidation, Cognitive

  4. Prognostic index for patients with parotid carcinoma - External validation using the nationwide 1985-1994 Dutch Head and Neck Oncology Cooperative Group database

    NARCIS (Netherlands)

    Vander Poorten, Vincent L. M.; Hart, Augustinus A. M.; van der Laan, Bernardus F. A. M.; Baatenburg de Jong, Robert J.; Manni, Johannes J.; Marres, Henri A. M.; Meeuwis, Cees A.; Lubsen, Herman; Terhaard, Chris H. J.; Balm, Alfonsus J. M.

    2003-01-01

    BACKGROUND. Validation of the prognostic indices for the recurrence-free interval of patients with parotid carcinoma, the development of which was described in a previous report, is needed to be confident of their generalizability and justified prospective use. METHODS. The Dutch Cooperative Group

  5. A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam Pediatric Wrist Rules

    Energy Technology Data Exchange (ETDEWEB)

    Slaar, Annelie; Maas, Mario; Rijn, Rick R. van [University of Amsterdam, Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam (Netherlands); Walenkamp, Monique M.J.; Bentohami, Abdelali; Goslings, J.C. [University of Amsterdam, Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands); Steyerberg, Ewout W. [Erasmus MC - University Medical Centre, Department of Public Health, Rotterdam (Netherlands); Jager, L.C. [University of Amsterdam, Emergency Department, Academic Medical Centre, Amsterdam (Netherlands); Sosef, Nico L. [Spaarne Hospital, Department of Surgery, Hoofddorp (Netherlands); Velde, Romuald van [Tergooi Hospitals, Department of Surgery, Hilversum (Netherlands); Ultee, Jan M. [Sint Lucas Andreas Hospital, Department of Surgery, Amsterdam (Netherlands); Schep, Niels W.L. [University of Amsterdam, Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands); Maasstadziekenhuis Rotterdam, Department of Surgery, Rotterdam (Netherlands)

    2016-01-15

    In most hospitals, children with acute wrist trauma are routinely referred for radiography. To develop and validate a clinical decision rule to decide whether radiography in children with wrist trauma is required. We prospectively developed and validated a clinical decision rule in two study populations. All children who presented in the emergency department of four hospitals with pain following wrist trauma were included and evaluated for 18 clinical variables. The outcome was a wrist fracture diagnosed by plain radiography. Included in the study were 787 children. The prediction model consisted of six variables: age, swelling of the distal radius, visible deformation, distal radius tender to palpation, anatomical snuffbox tender to palpation, and painful or abnormal supination. The model showed an area under the receiver operator characteristics curve of 0.79 (95% CI: 0.76-0.83). The sensitivity and specificity were 95.9% and 37.3%, respectively. The use of this model would have resulted in a 22% absolute reduction of radiographic examinations. In a validation study, 7/170 fractures (4.1%, 95% CI: 1.7-8.3%) would have been missed using the decision model. The decision model may be a valuable tool to decide whether radiography in children after wrist trauma is required. (orig.)

  6. A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam Pediatric Wrist Rules

    International Nuclear Information System (INIS)

    Slaar, Annelie; Maas, Mario; Rijn, Rick R. van; Walenkamp, Monique M.J.; Bentohami, Abdelali; Goslings, J.C.; Steyerberg, Ewout W.; Jager, L.C.; Sosef, Nico L.; Velde, Romuald van; Ultee, Jan M.; Schep, Niels W.L.

    2016-01-01

    In most hospitals, children with acute wrist trauma are routinely referred for radiography. To develop and validate a clinical decision rule to decide whether radiography in children with wrist trauma is required. We prospectively developed and validated a clinical decision rule in two study populations. All children who presented in the emergency department of four hospitals with pain following wrist trauma were included and evaluated for 18 clinical variables. The outcome was a wrist fracture diagnosed by plain radiography. Included in the study were 787 children. The prediction model consisted of six variables: age, swelling of the distal radius, visible deformation, distal radius tender to palpation, anatomical snuffbox tender to palpation, and painful or abnormal supination. The model showed an area under the receiver operator characteristics curve of 0.79 (95% CI: 0.76-0.83). The sensitivity and specificity were 95.9% and 37.3%, respectively. The use of this model would have resulted in a 22% absolute reduction of radiographic examinations. In a validation study, 7/170 fractures (4.1%, 95% CI: 1.7-8.3%) would have been missed using the decision model. The decision model may be a valuable tool to decide whether radiography in children after wrist trauma is required. (orig.)

  7. Analytical Validation of a Portable Mass Spectrometer Featuring Interchangeable, Ambient Ionization Sources for High Throughput Forensic Evidence Screening.

    Science.gov (United States)

    Lawton, Zachary E; Traub, Angelica; Fatigante, William L; Mancias, Jose; O'Leary, Adam E; Hall, Seth E; Wieland, Jamie R; Oberacher, Herbert; Gizzi, Michael C; Mulligan, Christopher C

    2017-06-01

    Forensic evidentiary backlogs are indicative of the growing need for cost-effective, high-throughput instrumental methods. One such emerging technology that shows high promise in meeting this demand while also allowing on-site forensic investigation is portable mass spectrometric (MS) instrumentation, particularly that which enables the coupling to ambient ionization techniques. While the benefits of rapid, on-site screening of contraband can be anticipated, the inherent legal implications of field-collected data necessitates that the analytical performance of technology employed be commensurate with accepted techniques. To this end, comprehensive analytical validation studies are required before broad incorporation by forensic practitioners can be considered, and are the focus of this work. Pertinent performance characteristics such as throughput, selectivity, accuracy/precision, method robustness, and ruggedness have been investigated. Reliability in the form of false positive/negative response rates is also assessed, examining the effect of variables such as user training and experience level. To provide flexibility toward broad chemical evidence analysis, a suite of rapidly-interchangeable ion sources has been developed and characterized through the analysis of common illicit chemicals and emerging threats like substituted phenethylamines. Graphical Abstract ᅟ.

  8. Screening the risk of bipolar spectrum disorders: Validity evidence of the Mood Disorder Questionnaire in adolescents and young adults.

    Science.gov (United States)

    Fonseca-Pedrero, Eduardo; Ortuño-Sierra, Javier; Paino, Mercedes; Muñiz, José

    2016-01-01

    The aim of this study was to gather sources of validity evidence of the Mood Disorder Questionnaire (MDQ) in young adults for its use as a screening tool for bipolar spectrum disorders. The sample was composed of 1,002 participants, 268 men (26.7%). The mean age of participants was 21.1 years (SD=3.9). The results showed that between 3 and 59% of the sample reported some hypomanic experience. Gender differences were found in the total score of the MDQ. The analysis of the internal structure by exploratory factor analysis yielded 2 factors, called Energy-Activity and Disinhibition-Attention. This dimensional structure was replicated in the exploratory structural equation modeling (ESEM), and also had factorial equivalence by gender. Participants who met the cut-off points of the MDQ reported a worse perceived mental health status and more consummatory and anticipatory pleasure, compared to the low scores group. These findings indicate that the MDQ has adequate psychometric properties in non-clinical samples, and could be useful as a screening tool in psychopathology, with the possibility of optimizing strategies for early identification and prevention in individuals at high risk for bipolar disorders. Future studies should further explore the role of subclinical bipolar phenotype and conduct longitudinal studies in samples of the general population. Copyright © 2015 SEP y SEPB. Published by Elsevier España. All rights reserved.

  9. Analytical Validation of a Portable Mass Spectrometer Featuring Interchangeable, Ambient Ionization Sources for High Throughput Forensic Evidence Screening

    Science.gov (United States)

    Lawton, Zachary E.; Traub, Angelica; Fatigante, William L.; Mancias, Jose; O'Leary, Adam E.; Hall, Seth E.; Wieland, Jamie R.; Oberacher, Herbert; Gizzi, Michael C.; Mulligan, Christopher C.

    2017-06-01

    Forensic evidentiary backlogs are indicative of the growing need for cost-effective, high-throughput instrumental methods. One such emerging technology that shows high promise in meeting this demand while also allowing on-site forensic investigation is portable mass spectrometric (MS) instrumentation, particularly that which enables the coupling to ambient ionization techniques. While the benefits of rapid, on-site screening of contraband can be anticipated, the inherent legal implications of field-collected data necessitates that the analytical performance of technology employed be commensurate with accepted techniques. To this end, comprehensive analytical validation studies are required before broad incorporation by forensic practitioners can be considered, and are the focus of this work. Pertinent performance characteristics such as throughput, selectivity, accuracy/precision, method robustness, and ruggedness have been investigated. Reliability in the form of false positive/negative response rates is also assessed, examining the effect of variables such as user training and experience level. To provide flexibility toward broad chemical evidence analysis, a suite of rapidly-interchangeable ion sources has been developed and characterized through the analysis of common illicit chemicals and emerging threats like substituted phenethylamines. [Figure not available: see fulltext.

  10. Child Effortful Control as a Mediator of Parenting Practices on Externalizing Behavior: Evidence for a Sex-Differentiated Pathway across the Transition from Preschool to School

    Science.gov (United States)

    Chang, Hyein; Olson, Sheryl L.; Sameroff, Arnold J.; Sexton, Holly R.

    2011-01-01

    An explanatory model for children's development of disruptive behavior across the transition from preschool to school was tested. It was hypothesized that child effortful control would mediate the effects of parenting on children's externalizing behavior and that child sex would moderate these relations. Participants were 241 children (123 boys)…

  11. Discrimination of Clover and Citrus Honeys from Egypt According to Floral Type Using Easily Assessable Physicochemical Parameters and Discriminant Analysis: An External Validation of the Chemometric Approach

    Directory of Open Access Journals (Sweden)

    Ioannis K. Karabagias

    2018-05-01

    Full Text Available Twenty-two honey samples, namely clover and citrus honeys, were collected from the greater Cairo area during the harvesting year 2014–2015. The main purpose of the present study was to characterize the aforementioned honey types and to investigate whether the use of easily assessable physicochemical parameters, including color attributes in combination with chemometrics, could differentiate honey floral origin. Parameters taken into account were: pH, electrical conductivity, ash, free acidity, lactonic acidity, total acidity, moisture content, total sugars (degrees Brix-°Bx, total dissolved solids and their ratio to total acidity, salinity, CIELAB color parameters, along with browning index values. Results showed that all honey samples analyzed met the European quality standards set for honey and had variations in the aforementioned physicochemical parameters depending on floral origin. Application of linear discriminant analysis showed that eight physicochemical parameters, including color, could classify Egyptian honeys according to floral origin (p < 0.05. Correct classification rate was 95.5% using the original method and 90.9% using the cross validation method. The discriminatory ability of the developed model was further validated using unknown honey samples. The overall correct classification rate was not affected. Specific physicochemical parameter analysis in combination with chemometrics has the potential to enhance the differences in floral honeys produced in a given geographical zone.

  12. Validity of Qualis database as a predictor of evidence hierarchy and risk of bias in randomized controlled trials: a case study in dentistry

    Directory of Open Access Journals (Sweden)

    Christiane Alves Ferreira

    2011-01-01

    Full Text Available OBJECTIVE: To evaluate the validity of the Qualis database in identifying the levels of scientific evidence and the quality of randomized controlled trials indexed in the Lilacs database. METHODS: We selected 40 open-access journals and performed a page-by-page hand search, to identify published articles according to the type of study during a period of six years. Classification of studies was performed by independent reviewers assessed for their reliability. Randomized controlled trials were identified for separate evaluation of risk of bias using four dimensions: generation of allocation sequence, allocation concealment, blinding, and incomplete outcome data. The Qualis classification was considered to be the outcome variable. The statistical tests used included Kappa, Spearman's correlation, Kendall-tau and ordinal regressions. RESULTS: Studies with low levels of scientific evidence received similar Qualis classifications when compared to studies with high levels of evidence. In addition, randomized controlled trials with a high risk of bias for the generation of allocation sequences and allocation concealment were more likely to be published in journals with higher Qualis levels. DISCUSSION: The hierarchy level of the scientific evidence as classified by type of research design, as well as by the validity of studies according to the bias control level, was not correlated or associated with Qualis stratification. CONCLUSION: Qualis classifications for journals are not an approximate or indirect predictor of the validity of randomized controlled trials published in these journals and are therefore not a legitimate or appropriate indicator of the validity of randomized controlled trials.

  13. Validity and reliability of isometric muscle strength measurements of hip abduction and abduction with external hip rotation in a bent-hip position using a handheld dynamometer with a belt.

    Science.gov (United States)

    Aramaki, Hidefumi; Katoh, Munenori; Hiiragi, Yukinobu; Kawasaki, Tsubasa; Kurihara, Tomohisa; Ohmi, Yorikatsu

    2016-07-01

    [Purpose] This study aimed to investigate the relatedness, reliability, and validity of isometric muscle strength measurements of hip abduction and abduction with an external hip rotation in a bent-hip position using a handheld dynamometer with a belt. [Subjects and Methods] Twenty healthy young adults, with a mean age of 21.5 ± 0.6 years were included. Isometric hip muscle strength in the subjects' right legs was measured under two posture positions using two devices: a handheld dynamometer with a belt and an isokinetic dynamometer. Reliability was evaluated using an intra-class correlation coefficient (ICC); relatedness and validity were evaluated using Pearson's product moment correlation coefficient. Differences in measurements of devices were assessed by two-way ANOVA. [Results] ICC (1, 1) was ≥0.9; significant positive correlations in measurements were found between the two devices under both conditions. No main effect was found between the measurement values. [Conclusion] Our findings revealed that there was relatedness, reliability, and validity of this method for isometric muscle strength measurements using a handheld dynamometer with a belt.

  14. External Validation of the ASTER GDEM2, GMTED2010 and CGIAR-CSI- SRTM v4.1 Free Access Digital Elevation Models (DEMs in Tunisia and Algeria

    Directory of Open Access Journals (Sweden)

    Djamel Athmania

    2014-05-01

    Full Text Available Digital Elevation Models (DEMs including Advanced Spaceborne Thermal Emission and Reflection Radiometer-Global Digital Elevation Model (ASTER GDEM, Shuttle Radar Topography Mission (SRTM, and Global Multi-resolution Terrain Elevation Data 2010 (GMTED2010 are freely available for nearly the entire earth’s surface. DEMs that are usually subject to errors need to be evaluated using reference elevation data of higher accuracy. This work was performed to assess the vertical accuracy of the ASTER GDEM version 2, (ASTER GDEM2, the Consultative Group on International Agriculture Research-Consortium for Spatial Information (CGIAR-CSI SRTM version 4.1 (SRTM v4.1 and the systematic subsample GMTED2010, at their original spatial resolution, using Global Navigation Satellite Systems (GNSS validation points. Two test sites, the Anaguid Saharan platform in southern Tunisia and the Tebessa basin in north eastern Algeria, were chosen for accuracy assessment of the above mentioned DEMs, based on geostatistical and statistical measurements. Within the geostatistical approach, empirical variograms of each DEM were compared with those of the GPS validation points. Statistical measures were computed from the elevation differences between the DEM pixel value and the corresponding GPS point. For each DEM, a Root Mean Square Error (RMSE was determined for model validation. In addition, statistical tools such as frequency histograms and Q-Q plots were used to evaluate error distributions in each DEM. The results indicate that the vertical accuracy of SRTM model is much higher than ASTER GDEM2 and GMTED2010 for both sites. In Anaguid test site, the vertical accuracy of SRTM is estimated 3.6 m (in terms of RMSE 5.3 m and 4.5 m for the ASTERGDEM2 and GMTED2010 DEMs, respectively. In Tebessa test site, the overall vertical accuracy shows a RMSE of 9.8 m, 8.3 m and 9.6 m for ASTER GDEM 2, SRTM and GMTED2010 DEM, respectively. This work is the first study to report the

  15. External Validation and Recalibration of Risk Prediction Models for Acute Traumatic Brain Injury among Critically Ill Adult Patients in the United Kingdom.

    Science.gov (United States)

    Harrison, David A; Griggs, Kathryn A; Prabhu, Gita; Gomes, Manuel; Lecky, Fiona E; Hutchinson, Peter J A; Menon, David K; Rowan, Kathryn M

    2015-10-01

    This study validates risk prediction models for acute traumatic brain injury (TBI) in critical care units in the United Kingdom and recalibrates the models to this population. The Risk Adjustment In Neurocritical care (RAIN) Study was a prospective, observational cohort study in 67 adult critical care units. Adult patients admitted to critical care following acute TBI with a last pre-sedation Glasgow Coma Scale score of less than 15 were recruited. The primary outcomes were mortality and unfavorable outcome (death or severe disability, assessed using the Extended Glasgow Outcome Scale) at six months following TBI. Of 3626 critical care unit admissions, 2975 were analyzed. Following imputation of missing outcomes, mortality at six months was 25.7% and unfavorable outcome 57.4%. Ten risk prediction models were validated from Hukkelhoven and colleagues, the Medical Research Council (MRC) Corticosteroid Randomisation After Significant Head Injury (CRASH) Trial Collaborators, and the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) group. The model with the best discrimination was the IMPACT "Lab" model (C index, 0.779 for mortality and 0.713 for unfavorable outcome). This model was well calibrated for mortality at six months but substantially under-predicted the risk of unfavorable outcome. Recalibration of the models resulted in small improvements in discrimination and excellent calibration for all models. The risk prediction models demonstrated sufficient statistical performance to support their use in research and audit but fell below the level required to guide individual patient decision-making. The published models for unfavorable outcome at six months had poor calibration in the UK critical care setting and the models recalibrated to this setting should be used in future research.

  16. Prediction of high-grade vesicoureteral reflux after pediatric urinary tract infection: external validation study of procalcitonin-based decision rule.

    Directory of Open Access Journals (Sweden)

    Sandrine Leroy

    Full Text Available Predicting vesico-ureteral reflux (VUR ≥3 at the time of the first urinary tract infection (UTI would make it possible to restrict cystography to high-risk children. We previously derived the following clinical decision rule for that purpose: cystography should be performed in cases with ureteral dilation and a serum procalcitonin level ≥0.17 ng/mL, or without ureteral dilatation when the serum procalcitonin level ≥0.63 ng/mL. The rule yielded a 86% sensitivity with a 46% specificity. We aimed to test its reproducibility.A secondary analysis of prospective series of children with a first UTI. The rule was applied, and predictive ability was calculated.The study included 413 patients (157 boys, VUR ≥3 in 11% from eight centers in five countries. The rule offered a 46% specificity (95% CI, 41-52, not different from the one in the derivation study. However, the sensitivity significantly decreased to 64% (95%CI, 50-76, leading to a difference of 20% (95%CI, 17-36. In all, 16 (34% patients among the 47 with VUR ≥3 were misdiagnosed by the rule. This lack of reproducibility might result primarily from a difference between derivation and validation populations regarding inflammatory parameters (CRP, PCT; the validation set samples may have been collected earlier than for the derivation one.The rule built to predict VUR ≥3 had a stable specificity (ie. 46%, but a decreased sensitivity (ie. 64% because of the time variability of PCT measurement. Some refinement may be warranted.

  17. An International External Validation Study of the 2014 European Society of Cardiology Guideline on Sudden Cardiac Death Prevention in Hypertrophic Cardiomyopathy (Evidence from HCM)

    DEFF Research Database (Denmark)

    O'Mahony, Constantinos; Jichi, Fatima; Ommen, Steve R

    2018-01-01

    Background -Identification of people with hypertrophic cardiomyopathy (HCM) who are at risk of sudden cardiac death (SCD) and require prophylactic implantable cardioverter defibrillator (ICD) is challenging. In 2014, the European Society of Cardiology (ESC) proposed a new risk stratification meth...

  18. External validation of equations to estimate resting energy expenditure in 14952 adults with overweight and obesity and 1948 adults with normal weight from Italy.

    Science.gov (United States)

    Bedogni, Giorgio; Bertoli, Simona; Leone, Alessandro; De Amicis, Ramona; Lucchetti, Elisa; Agosti, Fiorenza; Marazzi, Nicoletta; Battezzati, Alberto; Sartorio, Alessandro

    2017-11-24

    We cross-validated 28 equations to estimate resting energy expenditure (REE) in a very large sample of adults with overweight or obesity. 14952 Caucasian men and women with overweight or obesity and 1498 with normal weight were studied. REE was measured using indirect calorimetry and estimated using two meta-regression equations and 26 other equations. The correct classification fraction (CCF) was defined as the fraction of subjects whose estimated REE was within 10% of measured REE. The highest CCF was 79%, 80%, 72%, 64%, and 63% in subjects with normal weight, overweight, class 1 obesity, class 2 obesity, and class 3 obesity, respectively. The Henry weight and height and Mifflin equations performed equally well with CCFs of 77% vs. 77% for subjects with normal weight, 80% vs. 80% for those with overweight, 72% vs. 72% for those with class 1 obesity, 64% vs. 63% for those with class 2 obesity, and 61% vs. 60% for those with class 3 obesity. The Sabounchi meta-regression equations offered an improvement over the above equations only for class 3 obesity (63%). The accuracy of REE equations decreases with increasing values of body mass index. The Henry weight & height and Mifflin equations are similarly accurate and the Sabounchi equations offer an improvement only in subjects with class 3 obesity. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

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

    DEFF Research Database (Denmark)

    Stræde, Mia; Brabrand, Mikkel

    2014-01-01

    with the objective of validating the Simple Clinical Score (SCS) and the HOTEL score, two existing risk stratification systems that predict mortality for medical patients based solely on clinical information, but not only vital signs. METHODS: Pre-planned prospective observational cohort study. SETTING: Danish 460.......932 to 0.988) for 24-hours mortality and 0.826 (95% CI, 0.774-0.879) for 30-day mortality, and goodness-of-fit test, χ2 = 2.68 (10 degrees of freedom), P = 0.998 and χ2 = 4.00, P = 0.947, respectively. We included 1470 patients when calculating the HOTEL score. Discriminatory power (AUROC) was 0.931 (95......% CI, 0.901-0.962) for 24-hours mortality and goodness-of-fit test, χ2 = 5.56 (10 degrees of freedom), P = 0.234. CONCLUSION: We find that both the SCS and HOTEL scores showed an excellent to outstanding ability in identifying patients at high risk of dying with good or acceptable precision....

  20. Unavailability of thymidine kinase does not preclude the use of German comprehensive prognostic index: results of an external validation analysis in early chronic lymphocytic leukemia and comparison with MD Anderson Cancer Center model.

    Science.gov (United States)

    Molica, Stefano; Giannarelli, Diana; Mirabelli, Rosanna; Levato, Luciano; Russo, Antonio; Linardi, Maria; Gentile, Massimo; Morabito, Fortunato

    2016-01-01

    A comprehensive prognostic index that includes clinical (i.e., age, sex, ECOG performance status), serum (i.e., ß2-microglobulin, thymidine kinase [TK]), and molecular (i.e., IGVH mutational status, del 17p, del 11q) markers developed by the German CLL Study Group (GCLLSG) was externally validated in a prospective, community-based cohort consisting of 338 patients with early chronic lymphocytic leukemia (CLL) using as endpoint the time to first treatment (TTFT). Because serum TK was not available, a slightly modified version of the model based on seven instead of eight prognostic variables was used. By German index, 62.9% of patients were scored as having low-risk CLL (score 0-2), whereas 37.1% had intermediate-risk CLL (score 3-5). This stratification translated into a significant difference in the TTFT [HR = 4.21; 95% C.I. (2.71-6.53); P reliability [HR = 2.73; 95% C.I. (1.79-4.17); P German score. The c-statistic of the MDACC model was 0.65 (range, 0.53-0.78) a level below that of the German index [0.71 (range, 0.60-0.82)] and below the accepted 0.7 threshold necessary to have value at the individual patient level. Results of this external comparative validation analysis strongly support the German score as the benchmark for comparison of any novel prognostic scheme aimed at evaluating the TTFT in patients with early CLL even when a modified version which does not include TK is utilized. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. The Association Between Prenatal Stress and Externalizing Symptoms in Childhood: Evidence From the Avon Longitudinal Study of Parents and Children.

    Science.gov (United States)

    MacKinnon, Nathalie; Kingsbury, Mila; Mahedy, Liam; Evans, Jonathan; Colman, Ian

    2018-01-15

    It has been suggested that prenatal maternal stress may increase the risk of childhood externalizing disorders, yet no large cohort study has investigated this association across a large range of acute stressors. Our objective was to estimate the association between prenatal stressful events and risk of offspring conduct disorder and hyperactivity. We used data from 10,184 mother-offspring pairs from the United Kingdom-based Avon Longitudinal Study of Parents and Children. Mothers self-reported 42 prenatal stressful life events at 18 weeks' gestation. Symptoms of conduct disorder and hyperactivity in their offspring were measured at 6, 9, 11, 13, and 16 years of age using the Strengths and Difficulties Questionnaire. The primary outcome was membership in high-symptom trajectories of 1) conduct disorder and 2) hyperactivity throughout childhood, identified using latent class growth modeling. Multinomial logistic regression models estimated the association between prenatal stress and both conduct disorder and hyperactivity, after adjusting for sex, parental education, low birth weight, preterm birth, parental social class, maternal smoking and drinking, maternal mental health, offspring stressful life events, and offspring depressive and anxious symptoms. Those exposed to the highest quartile of prenatal stress were more likely to belong to the high symptom trajectory for hyperactivity (B = 0.46, p < .05) and conduct disorder (B = 0.88, p < .01), respectively. Prenatal stress further demonstrated a positive, dose-response relationship with symptoms of externalizing disorders at independent time points. The findings suggest that prenatal stressful events may be an independent risk factor for offspring externalizing symptoms, regardless of maternal mental health and offspring internalizing. Copyright © 2017 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  2. Validity of the Consensual Assessment Technique--Evidence with Three Groups of Judges and an Elementary School Student Sample

    Science.gov (United States)

    Long, Haiying

    2012-01-01

    As one of the most widely used creativity assessment tools, the Consensual Assessment Technique (CAT) has been praised as a valid tool to assess creativity. In Amabile's (1982) seminal work, the inter-rater reliability was defined as construct validity of the CAT. During the past three decades, researchers followed this definition and…

  3. Evidence for the ferromagnetic frustration in a classical spin- 1 / 2 system with multisite interaction in external magnetic field: Exact results

    Science.gov (United States)

    Jurčišinová, E.; Jurčišin, M.

    2017-11-01

    We investigate the influence of the multisite interaction among sites within elementary triangles of the kagome-like recursive lattice on the properties of the classical spin- 1 / 2 ferromagnetic Ising model in the external magnetic field. The exact solution of the model is found and it is shown that the model exhibits a nontrivial structure of the first order as well as second order phase transitions in nonzero external magnetic fields related to the multisite interaction. The equation for the exact determination of the positions of the critical points of the second order phase transitions is derived. The thermodynamic properties of the model are investigated in detail and it is shown that the competition between the ferromagnetic interaction and the multisite interaction leads to the appearance of strong ferromagnetic frustration effects represented by the formation of a nontrivial system of macroscopically degenerated plateau-like and single-point-like ground states. The residual entropies of all ground states are found and the kagome spin-ice-like highly macroscopically degenerated plateau state with nonzero magnetization is identified with the exact residual entropy per site s /kB = ln(4 / 3) / 3 ≈ 0 . 095894. The properties of the specific heat are investigated, its Schottky-type behavior near the single-point ground state values of the magnetic field is identified, the existence of large magnetocaloric effect is discussed, and the existence of the first order phase transitions without the specific heat capacity change is demonstrated.

  4. Case-finding for common mental disorders of anxiety and depression in primary care: an external validation of routinely collected data.

    Science.gov (United States)

    John, Ann; McGregor, Joanne; Fone, David; Dunstan, Frank; Cornish, Rosie; Lyons, Ronan A; Lloyd, Keith R

    2016-03-15

    The robustness of epidemiological research using routinely collected primary care electronic data to support policy and practice for common mental disorders (CMD) anxiety and depression would be greatly enhanced by appropriate validation of diagnostic codes and algorithms for data extraction. We aimed to create a robust research platform for CMD using population-based, routinely collected primary care electronic data. We developed a set of Read code lists (diagnosis, symptoms, treatments) for the identification of anxiety and depression in the General Practice Database (GPD) within the Secure Anonymised Information Linkage Databank at Swansea University, and assessed 12 algorithms for Read codes to define cases according to various criteria. Annual incidence rates were calculated per 1000 person years at risk (PYAR) to assess recording practice for these CMD between January 1(st) 2000 and December 31(st) 2009. We anonymously linked the 2799 MHI-5 Caerphilly Health and Social Needs Survey (CHSNS) respondents aged 18 to 74 years to their routinely collected GP data in SAIL. We estimated the sensitivity, specificity and positive predictive value of the various algorithms using the MHI-5 as the gold standard. The incidence of combined depression/anxiety diagnoses remained stable over the ten-year period in a population of over 500,000 but symptoms increased from 6.5 to 20.7 per 1000 PYAR. A 'historical' GP diagnosis for depression/anxiety currently treated plus a current diagnosis (treated or untreated) resulted in a specificity of 0.96, sensitivity 0.29 and PPV 0.76. Adding current symptom codes improved sensitivity (0.32) with a marginal effect on specificity (0.95) and PPV (0.74). We have developed an algorithm with a high specificity and PPV of detecting cases of anxiety and depression from routine GP data that incorporates symptom codes to reflect GP coding behaviour. We have demonstrated that using diagnosis and current treatment alone to identify cases for

  5. External validation of a multivariable claims-based rule for predicting in-hospital mortality and 30-day post-pulmonary embolism complications

    Directory of Open Access Journals (Sweden)

    Craig I. Coleman

    2016-10-01

    Full Text Available Abstract Background Low-risk pulmonary embolism (PE patients may be candidates for outpatient treatment or abbreviated hospital stay. There is a need for a claims-based prediction rule that payers/hospitals can use to risk stratify PE patients. We sought to validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT prediction rule for in-hospital and 30-day outcomes. Methods We used the Optum Research Database from 1/2008-3/2015 and included adults hospitalized for PE (415.1x in the primary position or secondary position when accompanied by a primary code for a PE complication and having continuous medical and prescription coverage for ≥6-months prior and 3-months post-inclusion or until death. In-hospital and 30-day mortality and 30-day complications (recurrent venous thromboembolism, rehospitalization or death were assessed and prognostic accuracies of IMPACT with 95 % confidence intervals (CIs were calculated. Results In total, 47,531 PE patients were included. In-hospital and 30-day mortality occurred in 7.9 and 9.4 % of patients and 20.8 % experienced any complication within 30-days. Of the 19.5 % of patients classified as low-risk by IMPACT, 2.0 % died in-hospital, resulting in a sensitivity and specificity of 95.2 % (95 % CI, 94.4–95.8 and 20.7 % (95 % CI, 20.4–21.1. Only 1 additional low-risk patient died within 30-days of admission and 12.2 % experienced a complication, translating into a sensitivity and specificity of 95.9 % (95 % CI, 95.3–96.5 and 21.1 % (95 % CI, 20.7–21.5 for mortality and 88.5 % (95 % CI, 87.9–89.2 and 21.6 % (95 % CI, 21.2–22.0 for any complication. Conclusion IMPACT had acceptable sensitivity for predicting in-hospital and 30-day mortality or complications and may be valuable for retrospective risk stratification of PE patients.

  6. External validation of a multivariable claims-based rule for predicting in-hospital mortality and 30-day post-pulmonary embolism complications.

    Science.gov (United States)

    Coleman, Craig I; Peacock, W Frank; Fermann, Gregory J; Crivera, Concetta; Weeda, Erin R; Hull, Michael; DuCharme, Mary; Becker, Laura; Schein, Jeff R

    2016-10-22

    Low-risk pulmonary embolism (PE) patients may be candidates for outpatient treatment or abbreviated hospital stay. There is a need for a claims-based prediction rule that payers/hospitals can use to risk stratify PE patients. We sought to validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) prediction rule for in-hospital and 30-day outcomes. We used the Optum Research Database from 1/2008-3/2015 and included adults hospitalized for PE (415.1x in the primary position or secondary position when accompanied by a primary code for a PE complication) and having continuous medical and prescription coverage for ≥6-months prior and 3-months post-inclusion or until death. In-hospital and 30-day mortality and 30-day complications (recurrent venous thromboembolism, rehospitalization or death) were assessed and prognostic accuracies of IMPACT with 95 % confidence intervals (CIs) were calculated. In total, 47,531 PE patients were included. In-hospital and 30-day mortality occurred in 7.9 and 9.4 % of patients and 20.8 % experienced any complication within 30-days. Of the 19.5 % of patients classified as low-risk by IMPACT, 2.0 % died in-hospital, resulting in a sensitivity and specificity of 95.2 % (95 % CI, 94.4-95.8) and 20.7 % (95 % CI, 20.4-21.1). Only 1 additional low-risk patient died within 30-days of admission and 12.2 % experienced a complication, translating into a sensitivity and specificity of 95.9 % (95 % CI, 95.3-96.5) and 21.1 % (95 % CI, 20.7-21.5) for mortality and 88.5 % (95 % CI, 87.9-89.2) and 21.6 % (95 % CI, 21.2-22.0) for any complication. IMPACT had acceptable sensitivity for predicting in-hospital and 30-day mortality or complications and may be valuable for retrospective risk stratification of PE patients.

  7. Financial decision-making abilities and financial exploitation in older African Americans: Preliminary validity evidence for the Lichtenberg Financial Decision Rating Scale (LFDRS).

    Science.gov (United States)

    Lichtenberg, Peter A; Ficker, Lisa J; Rahman-Filipiak, Annalise

    2016-01-01

    This study examines preliminary evidence for the Lichtenberg Financial Decision Rating Scale (LFDRS), a new person-centered approach to assessing capacity to make financial decisions, and its relationship to self-reported cases of financial exploitation in 69 older African Americans. More than one third of individuals reporting financial exploitation also had questionable decisional abilities. Overall, decisional ability score and current decision total were significantly associated with cognitive screening test and financial ability scores, demonstrating good criterion validity. Study findings suggest that impaired decisional abilities may render older adults more vulnerable to financial exploitation, and that the LFDRS is a valid tool.

  8. Validity Evidence and Scoring Guidelines for Standardized Patient Encounters and Patient Notes From a Multisite Study of Clinical Performance Examinations in Seven Medical Schools.

    Science.gov (United States)

    Park, Yoon Soo; Hyderi, Abbas; Heine, Nancy; May, Win; Nevins, Andrew; Lee, Ming; Bordage, Georges; Yudkowsky, Rachel

    2017-11-01

    To examine validity evidence of local graduation competency examination scores from seven medical schools using shared cases and to provide rater training protocols and guidelines for scoring patient notes (PNs). Between May and August 2016, clinical cases were developed, shared, and administered across seven medical schools (990 students participated). Raters were calibrated using training protocols, and guidelines were developed collaboratively across sites to standardize scoring. Data included scores from standardized patient encounters for history taking, physical examination, and PNs. Descriptive statistics were used to examine scores from the different assessment components. Generalizability studies (G-studies) using variance components were conducted to estimate reliability for composite scores. Validity evidence was collected for response process (rater perception), internal structure (variance components, reliability), relations to other variables (interassessment correlations), and consequences (composite score). Student performance varied by case and task. In the PNs, justification of differential diagnosis was the most discriminating task. G-studies showed that schools accounted for less than 1% of total variance; however, for the PNs, there were differences in scores for varying cases and tasks across schools, indicating a school effect. Composite score reliability was maximized when the PN was weighted between 30% and 40%. Raters preferred using case-specific scoring guidelines with clear point-scoring systems. This multisite study presents validity evidence for PN scores based on scoring rubric and case-specific scoring guidelines that offer rigor and feedback for learners. Variability in PN scores across participating sites may signal different approaches to teaching clinical reasoning among medical schools.

  9. Location-allocation model for external beam radiotherapy as an example of an evidence-based management tool implemented in healthcare sector in Poland.

    Science.gov (United States)

    Czerwiński, Adam Michał; Więckowska, Barbara

    2018-02-21

    External beam radiotherapy (EBRT) is one of three key treatment modalities of cancer patients. Its utilisation and outcomes depend on a plethora of variables, one of which is the distance a patient must travel to undergo the treatment. The relation between distance and utilisation is clearly visible in Poland. At the same time no strategic investment plan is observed. This work proposes a method of resolving these two issues. We propose a mixed-integer linear programming model that aims to optimise the distribution of linear accelerators among selected locations in such a way that a patient's journey to the nearest EBRT is as short as possible. The optimisation is done with observance of international guidelines concerning EBRT capacity. With the use of proposed theoretical framework, we develop a national, strategic plan for linear accelerator investments. According to model assumptions decentralisation of EBRT, together with new equipment purchases, is required to ensure optimal access to EBRT. The results were incorporated into Healthcare Needs Maps for Poland. The plan based on the results of this study, implemented by 2025, should deal with the most pressing concerns of Polish EBRT. Copyright © 2018 Elsevier B.V. All rights reserved.

  10. Reexamining the validity and reliability of the clinical version of the Iowa gambling task: Evidence from a normal subject group

    Directory of Open Access Journals (Sweden)

    Ching-Hung eLin

    2013-05-01

    Full Text Available Over past decade, the Iowa gambling task (IGT has been utilized to test various decision deficits induced by neurological damage or psychiatric disorders. The IGT has recently been standardized for identifying 13 different neuropsychological disorders. Neuropsychological patients choose bad decks frequently, and normal subjects prefer good EV decks. However, the IGT has several validity and reliability problems. Some research groups have pointed out that the validity of IGT is influenced by the personality and emotional state of subjects. Additionally, several other studies have proposed that the prominent deck B phenomenon (PDB phenomenon – that is, normal subjects preferring bad deck B – may be the most serious problem confronting IGT validity. Specifically, deck B offers a high frequency of gains but negative EV. In the standard IGT administration, choice behavior can be understood with reference to gain-loss frequency (GLF rather than inferred future consequences (EV, the basic assumption of IGT. Furthermore, using two different criteria (basic assumption vs. professional norm results in significantly different classification results. Therefore, we recruited 72 normal subjects to test the validity and reliability of IGT. Each subject performed three runs of the computer-based clinical IGT version. The PDB phenomenon has been observed to a significant degree in the first and second stages of the clinical IGT version. Obviously, validity, reliability and the practice effect were unstable between two given stages. The present form of the clinical IGT version has only one stage, so its use should be reconsidered for examining normal decision makers; results from patient groups must also be interpreted with great care. GLF could be the main factor to be considered in establishing the constructional validity and reliability of the clinical IGT version.

  11. The ExternE project: methodology, objectives and limitations

    International Nuclear Information System (INIS)

    Rabl, A.; Spadaro, J.V.

    2002-01-01

    This paper presents a summary of recent studies on external costs of energy systems, in particular the ExternE (External Costs of Energy) Project of the European Commission. To evaluate the impact and damage cost of a pollutant, one needs to carry out an impact pathway analysis; this involves the calculation of increased pollutant concentrations in all affected regions due to an incremental emission (e.g. μg/m 3 of particles, using models of atmospheric dispersion and chemistry), followed by the calculation of physical impacts (e.g. number of cases of asthma due to these particles, using a dose-response function). The entire so-called fuel chain (or fuel cycle) is evaluated and compared on the basis of delivered end use energy. Even though the uncertainties are large, the results provide substantial evidence that the classical air pollutants (particles, NO x and SO x ) from the combustion of fossil fuels impose a heavy toll, in addition to the cost of global warming. The external costs are especially large for coal; even for 'good current technology' they may be comparable to the price of electricity. For natural gas the external costs are about a third to a half of coal. The external costs of nuclear are small compared to the price of electricity (at most a few %), and so are the external costs of most renewable energy systems. (authors)

  12. Limitations in conduct and reporting of cochrane reviews rarely inhibit the determination of the validity of evidence for clinical decision-making.

    Science.gov (United States)

    Alper, Brian S; Fedorowicz, Zbys; van Zuuren, Esther J

    2015-08-01

    To determine how often clinical conclusions derived from Cochrane Reviews have uncertain validity due to review conduct and reporting deficiencies. We evaluated 5142 clinical conclusions in DynaMed (an evidence-based point-of-care clinical reference) based on 4743 Cochrane Reviews. Clinical conclusions with level 2 evidence due to shortcomings in the review's conduct or reporting (rather than deficiencies in the underlying evidence) were confirmed by a DynaMed editor and two Cochrane Review authors. Thirty-one Cochrane Reviews (0.65%) had confirmed deficiencies in conduct and reporting as the reason for classifying 37 assessed clinical conclusions (0.72%) as level 2 evidence. In all cases, it was not feasible for the assessors to specify a clear criticism of the studies included in the reviews. The deficiencies were specific to not accounting for dropouts (2) or inadequate assessment and reporting of allocation concealment (11), other specific trial quality criteria (14), or all trial quality criteria (4). Cochrane Reviews provide high-quality assessment and synthesis of evidence, with fewer than 1% of Cochrane Reviews having limitations which hinder the summary of best current evidence for clinical decision-making. We expect this will further decrease following recent Cochrane quality initiatives. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

  13. External hyphae of Rhizophagus irregularis DAOM 197198 are less sensitive to low pH than roots in arbuscular mycorrhizae: evidence from axenic culture system.

    Science.gov (United States)

    Wang, Ning; Feng, Zengwei; Zhou, Yang; Zhu, Honghui; Yao, Qing

    2017-10-01

    The growth of plant roots and arbuscular mycorrhizal fungi (AMF) can be inhibited by low pH; however, it is largely unknown which is more sensitive to low pH. This study aimed to compare the physiological and molecular responses of external hyphae (EH) and roots to low pH in terms of growth, development and functioning. We established AM symbiosis in a two-compartmented system (root compartment, RC; hyphal compartment, HC) using AMF and transformed hairy roots and exposed them to pH 6.5 and/or pH 4.5. The results showed that pH 4.5 significantly decreased root cell viability, while EH at pH 6.5 attenuated the effect. In either RC or HC, pH 4.5 reduced biomass, P content, colonization, ALP activity in roots, and ALP activity and polyphosphate accumulation in EH. GintPT expression in EH was inhibited by pH 4.5 in HC but not in RC. The expression of mycorrhiza-responsive LePTs was significantly reduced by the lower colonization due to decreased pH in either RC or HC, while the expression of non-mycorrhiza-responsive LePTs was not affected. Variation partitioning analysis indicated that EH was less sensitive to low pH than roots. The interactions between roots and EH under low pH stress merit further investigation. © 2017 Society for Applied Microbiology and John Wiley & Sons Ltd.

  14. REE, Sm-Nd and U-Pb zircon study of eclogites from the Alpine External Massifs (Western Alps): Evidence for crustal contamination

    International Nuclear Information System (INIS)

    Paquette, J.L.; Eidgenoessische Technische Hochschule, Zurich; Menot, R.P.; Peucat, J.J.

    1989-01-01

    A geochemical and geochronological study of the Alpine External Crystalline Massifs (AECM) of Aiguilles Rouges, Belledonne and Argentera was undertaken in order to constrain the geodynamic evolution of this segment of the Variscan foldbelt. Another aim of the study is to characterize the behaviour of isotopic markers, in particular the U-Pb zircon system, under high-grade metamorphic conditions. The whole-rock geochemistry of eclogites and amphibolites was investigated using major and trace element (including the REE) analytical techniques; isotopic studies were performed by application of the Sm-Nd whole-rock and U-Pb zircon methods. In terms of regional geological history, the early development of metamorphic and magmatic activity in the AECM is typical of the extensional tectonic regime observed throughout the Variscan foldbelt during the Cambro-Ordovician (i.e. basic magmatism dated at 475-450 Ma). The composition of the metabasic rocks is closely similar to tholeiites emplaced into thinned continental crust which are generally associated with the initial stages of oceanic rifting. The source regions for these metabasics are characterized by initial ε Nd values between +6 and +8, suggesting depleted mantle sources influenced by a weak crustal component and/or the existence of a metasomatised lithosphere. The multi-stage eclogite-facies metamorphism is dated at 425-395 Ma (i.e. Silurian). An application of the U-Pb method, associated with the artificial abrasion of zircon grains, has led to the recognition of a weak crustal contamination in the metabasic protoliths. This is implied by the Archaean and Lower Proterozoic upper intercepts on Concordia - devoid of geological significance - which reflect the presence of a pre-existing basement to the AECM. (orig./WL)

  15. Validating a Computer-Assisted Language Learning Attitude Instrument Used in Iranian EFL Context: An Evidence-Based Approach

    Science.gov (United States)

    Aryadoust, Vahid; Mehran, Parisa; Alizadeh, Mehrasa

    2016-01-01

    A few computer-assisted language learning (CALL) instruments have been developed in Iran to measure EFL (English as a foreign language) learners' attitude toward CALL. However, these instruments have no solid validity argument and accordingly would be unable to provide a reliable measurement of attitude. The present study aimed to develop a CALL…

  16. Structural Validity of the MACI Psychopathy and Narcissism Scales: Evidence of Multidimensionality and Implications for Use in Research and Screening

    Science.gov (United States)

    Penney, Stephanie R.; Moretti, Marlene M.; Da Silva, Kimberley S.

    2008-01-01

    This study investigated the psychometric properties and predictive validity of three self-report scales (the Psychopathy Content Scale, the Psychopathy-16 scale, and the Egotistic scale) derived from the Millon Adolescent Clinical Inventory (MACI) to screen for the presence of psychopathic and narcissistic personality characteristics. Exploratory…

  17. Definitions and validation criteria for biomarkers and surrogate endpoints: development and testing of a quantitative hierarchical levels of evidence schema

    NARCIS (Netherlands)

    Lassere, Marissa N.; Johnson, Kent R.; Boers, Maarten; Tugwell, Peter; Brooks, Peter; Simon, Lee; Strand, Vibeke; Conaghan, Philip G.; Ostergaard, Mikkel; Maksymowych, Walter P.; Landewe, Robert; Bresnihan, Barry; Tak, Paul-Peter; Wakefield, Richard; Mease, Philip; Bingham, Clifton O.; Hughes, Michael; Altman, Doug; Buyse, Marc; Galbraith, Sally; Wells, George

    2007-01-01

    OBJECTIVE: There are clear advantages to using biomarkers and surrogate endpoints, but concerns about clinical and statistical validity and systematic methods to evaluate these aspects hinder their efficient application. Our objective was to review the literature on biomarkers and surrogates to

  18. Evidences of Validity of the Brazilian Scale of Learner's Attitude towards Distance Education Programs

    Science.gov (United States)

    Coelho, Francisco Antonio, Jr.; Cortat, Mariane; Flores, Clarissa Leite; Santos, Flávio Augusto Mendes; Alves, Gleidilson Costa; Faiad, Cristiane; Ramos, Wilsa Maria; Rodrigues da Silva, Alan

    2018-01-01

    Online learning is one of the fastest growing trends in educational uses of technology. In this study, an instrument to measure the social attitudes of the Brazilian students based on distance education was developed and validated. The study population consisted of public administration undergraduate students that has been providing by distance…

  19. Validity of Evidence-Derived Criteria for Reactive Attachment Disorder: Indiscriminately Social/Disinhibited and Emotionally Withdrawn/Inhibited Types

    Science.gov (United States)

    Gleason, Mary Margaret; Fox, Nathan A.; Drury, Stacy; Smyke, Anna; Egger, Helen L.; Nelson, Charles A., III; Gregas, Matthew C.; Zeanah, Charles H.

    2011-01-01

    Objective: This study examined the validity of criteria for indiscriminately social/disinhibited and emotionally withdrawn/inhibited reactive attachment disorder (RAD). Method: As part of a longitudinal intervention trial of previously institutionalized children, caregiver interviews and direct observational measurements provided continuous and…

  20. Criterion Validity Evidence for the easyCBM© CCSS Math Measures: Grades 6-8. Technical Report #1402

    Science.gov (United States)

    Anderson, Daniel; Rowley, Brock; Alonzo, Julie; Tindal, Gerald

    2012-01-01

    The easyCBM© CCSS Math tests were developed to help inform teachers' instructional decisions by providing relevant information on students' mathematical skills, relative to the Common Core State Standards (CCSS). This technical report describes a study to explore the validity of the easyCBM© CCSS Math tests by evaluating the relation between…

  1. Capability beliefs regarding evidence-based practice are associated with application of EBP and research use: validation of a new measure.

    Science.gov (United States)

    Wallin, Lars; Boström, Anne-Marie; Gustavsson, J Petter

    2012-08-01

    Beliefs about capabilities, or self-efficacy, is a construct originating in social cognitive psychology. Capability beliefs have been found to be positively associated with intention and healthcare practice behaviour. A measure of an individual's beliefs about his/her capability to apply the components of evidence-based practice (EBP) has potential to be useful in implementation research. To evaluate the concurrent validity and internal structure of a new scale measuring nurses' capability beliefs regarding EBP. Data were taken from a prospective longitudinal study in Sweden (the Longitudinal Analyses of Nursing Education and Entry in Worklife [LANE]). A cohort of nursing students who graduated in the autumn of 2004 that was followed up 2 years after their graduation was used (n= 1,256). Concurrent validity was tested relating different levels of capability beliefs to extent of research use and application of EBP. An item-response approach was applied in the evaluation of internal structure of the proposed scale (six items). The psychometric analyses indicated that the six items could be summed to reflect a one-dimensional scale. Nurses with the highest level of capability beliefs reported that they used research findings in clinical practice more than twice as often as those with lower levels of capability beliefs. They also participated in the implementation of evidence seven times more often. There is a need for further studies of the construct and predictive validity of the scale. It should also be validated in other groups of health professionals. Learning including mastery experiences, role modelling, social persuasion, and manageable stress could be used in undergraduate education as well as practice development to increase beliefs about capabilities which might open the way to increased application of EBP in healthcare practice. This new measure is well grounded in social cognitive theory, functions as a one-dimensional scale and possesses promising

  2. Validity of premature ejaculation diagnostic tool and its association with International Index of Erectile Function-15 in Chinese men with evidence-based-defined premature ejaculation

    Directory of Open Access Journals (Sweden)

    Dong-Dong Tang

    2018-01-01

    Full Text Available The premature ejaculation diagnostic tool (PEDT is a brief diagnostic measure to assess premature ejaculation (PE. However, there is insufficient evidence regarding its validity in the new evidence-based-defined PE. This study was performed to evaluate the validity of PEDT and its association with IIEF-15 in different types of evidence-based-defined PE. From June 2015 to January 2016, a total of 260 men complaining of PE and defined as lifelong PE (LPE/acquired PE (APE according to the evidence-based definition from Andrology Clinic of the First Affiliated Hospital of Anhui Medical University, along with 104 male healthy controls without PE from a medical examination center, were enrolled in this study. All individuals completed questionnaires including demographics, medical and sexual history, as well as PEDT and IIEF-15. After statistical analysis, it was found that men with PE reported higher PEDT scores (14.28 ± 3.05 and lower IIEF-15 (41.26 ± 8.20 than men without PE (PEDT: 5.32 ± 3.42, IIEF-15: 52.66 ± 6.86, P < 0.001 for both. It was suggested that a score of ≥9 indicated PE in both LPE and APE by sensitivity and specificity analyses (sensitivity: 0.875, 0.913; specificity: 0.865, 0.865, respectively. In addition, IIEF-15 were higher in men with LPE (42.64 ± 8.11 than APE (39.43 ± 7.84, P < 0.001. After adjusting for age, IIEF-15 was negatively related to PEDT in men with LPE (adjust r = −0.225, P < 0.001 and APE (adjust r = −0.378, P < 0.001. In this study, we concluded that PEDT was valid in the diagnosis of evidenced-based-defined PE. Furthermore, IIEF-15 was negatively related to PEDT in men with different types of PE.

  3. How Helicobacter pylori urease may affect external pH and influence growth and motility in the mucus environment: evidence from in-vitro studies.

    Science.gov (United States)

    Sidebotham, Ramon L; Worku, Mulugeta L; Karim, Q Najma; Dhir, Nirmal K; Baron, J Hugh

    2003-04-01

    Survival of Helicobacter pylori is dependent upon urease in the cytoplasm and at the bacterial surface. We have sought to clarify how alkaline ammonium salts, released from urea by this enzyme, might alter mucus pH and so affect growth and motility of the bacterium in the gastric mucus environment. Experiments were conducted in vitro to determine how the growth and motility of H. pylori are affected by changes in external pH, and how the bacterium, by hydrolysing urea, alters the pH of the bicarbonate buffer that occurs at the gastric mucosal surface. These data were fitted into experimental models that describe how pH varies within the mucus layer in the acid-secreting stomach. H. pylori was motile between pH 5 and 8, with optimal motility at pH 5. It grew between pH 6 and 8, with optimal growth at pH 6. The bacterium had urease activity between pH 2.7 and 7.4, as evidenced by pH rises in bicarbonate-buffered solutions of urea. Changes in buffer pH were dependent upon initial pH and urea concentration, with the greatest rate of pH change occurring at pH 3. Modelling experiments utilizing these data indicated that (1) in the absence of urease, H. pylori growth and motility in the mucus layer would be restricted severely by low mucus pH in the acid-secreting stomach, and (2) urease will sometimes inhibit H. pylori growth and motility in the mucus layer by elevating the pH of the mucus environment above pH 8. Urease is essential to the growth and motility of H. pylori in the mucus layer in the acid-secreting stomach, but, paradoxically, sometimes it might suppress colonization by raising the mucus pH above 8. This latter effect may protect the bacteria from the adverse consequences of overpopulation.

  4. Validity and reliability of instruments aimed at measuring Evidence-Based Practice in Physical Therapy: a systematic review of the literature.

    Science.gov (United States)

    Fernández-Domínguez, Juan Carlos; Sesé-Abad, Albert; Morales-Asencio, Jose Miguel; Oliva-Pascual-Vaca, Angel; Salinas-Bueno, Iosune; de Pedro-Gómez, Joan Ernest

    2014-12-01

    Our goal is to compile and analyse the characteristics - especially validity and reliability - of all the existing international tools that have been used to measure evidence-based clinical practice in physiotherapy. A systematic review conducted with data from exclusively quantitative-type studies synthesized in narrative format. An in-depth search of the literature was conducted in two phases: initial, structured, electronic search of databases and also journals with summarized evidence; followed by a residual-directed search in the bibliographical references of the main articles found in the primary search procedure. The studies included were assigned to members of the research team who acted as peer reviewers. Relevant information was extracted from each of the selected articles using a template that included the general characteristics of the instrument as well as an analysis of the quality of the validation processes carried out, by following the criteria of Terwee. Twenty-four instruments were found to comply with the review screening criteria; however, in all cases, they were found to be limited as regards the 'constructs' included. Besides, they can all be seen to be lacking as regards comprehensiveness associated to the validation process of the psychometric tests used. It seems that what constitutes a rigorously developed assessment instrument for EBP in physical therapy continues to be a challenge. © 2014 John Wiley & Sons, Ltd.

  5. The Stick Design Test on the assessment of older adults with low formal education: evidences of construct, criterion-related and ecological validity.

    Science.gov (United States)

    de Paula, Jonas Jardim; Costa, Mônica Vieira; Bocardi, Matheus Bortolosso; Cortezzi, Mariana; De Moraes, Edgar Nunes; Malloy-Diniz, Leandro Fernandes

    2013-12-01

    The assessment of visuospatial abilities is usually performed by drawing tasks. In patients with very low formal education, the use of these tasks might be biased by their cultural background. The Stick Design Test was developed for the assessment of this population. We aim to expand the test psychometric properties by assessing its construct, criterion-related and ecological validity in older adults with low formal education. Healthy older adults (n = 63) and Alzheimer's disease patients (n = 92) performed the Stick Design Test, Mini-Mental State Examination, Digit Span Forward and the Clock Drawing Test. Their caregivers answered Personal Care and Instrumental Activities of Daily Living). Construct validity was assessed by factor analysis, convergent correlations (with the Clock Drawing Test), and divergent correlations (with Digit Span Forward); criterion-related validity by receiver operating characteristic curve analysis and binary logistic regression; and Ecological validity by correlations with ADL. The test factor structure was composed by one component (R 2 = 64%). Significant correlations with the Clock Drawing Test and Digit Span Forward were found, and the relationship was stronger with the first measure. The test was less associated with formal education than the Clock Drawing Test. It classified about 76% of the participants correctly and had and additive effect with the Mini-Mental State Examination (84% of correct classification). The test also correlated significantly with measures of ADL, suggesting ecological validity. The Stick Design Test shows evidence of construct, criterion-related and ecological validity. It is an interesting alternative to drawing tasks for the assessment of visuospatial abilities.

  6. Validity and power of association testing in family-based sampling designs: evidence for and against the common wisdom.

    Science.gov (United States)

    Knight, Stacey; Camp, Nicola J

    2011-04-01

    Current common wisdom posits that association analyses using family-based designs have inflated type 1 error rates (if relationships are ignored) and independent controls are more powerful than familial controls. We explore these suppositions. We show theoretically that family-based designs can have deflated type-error rates. Through simulation, we examine the validity and power of family designs for several scenarios: cases from randomly or selectively ascertained pedigrees; and familial or independent controls. Family structures considered are as follows: sibships, nuclear families, moderate-sized and extended pedigrees. Three methods were considered with the χ(2) test for trend: variance correction (VC), weighted (weights assigned to account for genetic similarity), and naïve (ignoring relatedness) as well as the Modified Quasi-likelihood Score (MQLS) test. Selectively ascertained pedigrees had similar levels of disease enrichment; random ascertainment had no such restriction. Data for 1,000 cases and 1,000 controls were created under the null and alternate models. The VC and MQLS methods were always valid. The naïve method was anti-conservative if independent controls were used and valid or conservative in designs with familial controls. The weighted association method was generally valid for independent controls, and was conservative for familial controls. With regard to power, independent controls were more powerful for small-to-moderate selectively ascertained pedigrees, but familial and independent controls were equivalent in the extended pedigrees and familial controls were consistently more powerful for all randomly ascertained pedigrees. These results suggest a more complex situation than previously assumed, which has important implications for study design and analysis. © 2011 Wiley-Liss, Inc.

  7. New Empirical Evidence on the Validity and the Reliability of the Early Life Stress Questionnaire in a Polish Sample.

    Science.gov (United States)

    Sokołowski, Andrzej; Dragan, Wojciech Ł

    2017-01-01

    Background: The Early Life Stress Questionnaire (ELSQ) is widely used to estimate the prevalence of negative events during childhood, including emotional, physical, verbal, sexual abuse, negligence, severe conflicts, separation, parental divorce, substance abuse, poverty, and so forth. Objective: This study presents the psychometric properties of the Polish adaptation of the ELSQ. It also verifies if early life stress (ELS) is a good predictor of psychopathology symptoms during adulthood. Materials and Methods: We analyzed data from two samples. Sample 1 was selected by random quota method from across the country and included 609 participants aged 18-50 years, 306 women (50.2%) and 303 men (49.8%). Sample 2 contained 503 young adults (253 women and 250 men) aged 18-25. Confirmatory and exploratory factor analyses were used to measure ELSQ internal consistency. The validity was based on the relation to psychopathological symptoms and substance misuse. Results: Results showed good internal consistency and validity. Exploratory factor analysis indicates a six-factor structure of the ELSQ. ELS was related to psychopathology in adulthood, including depressive, sociophobic, vegetative as well as pain symptoms. ELSQ score correlated also with alcohol use, but not nicotine dependence. Moreover, ELS was correlated with stress in adulthood. Conclusion: The findings indicate that the Polish version of the ELSQ is a valid and reliable instrument for assessing ELS in the Polish population and may be applied in both clinical and community samples.

  8. The Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) semistructured interview: evidence of research utility and validity.

    Science.gov (United States)

    Fortier, Catherine Brawn; Amick, Melissa M; Grande, Laura; McGlynn, Susan; Kenna, Alexandra; Morra, Lindsay; Clark, Alexandra; Milberg, William P; McGlinchey, Regina E

    2014-01-01

    Report the prevalence of lifetime and military-related traumatic brain injuries (TBIs) in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans and validate the Boston Assessment of TBI-Lifetime (BAT-L). The BAT-L is the first validated, postcombat, semistructured clinical interview to characterize head injuries and diagnose TBIs throughout the life span. Community-dwelling convenience sample of 131 OEF/OIF veterans. TBI criteria (alteration of mental status, posttraumatic amnesia, and loss of consciousness) were evaluated for all possible TBIs, including a novel evaluation of blast exposure. BAT-L, Ohio State University TBI Identification Method (OSU-TBI-ID). About 67% of veterans incurred a TBI in their lifetime. Almost 35% of veterans experienced at least 1 military-related TBI; all were mild in severity, 40% of them were due to blast, 50% were due to some other (ie, blunt) mechanism, and 10% were due to both types of injuries. Predeployment TBIs were frequent (45% of veterans). There was strong correspondence between the BAT-L and the OSU-TBI-ID (Cohen κ = 0.89; Kendall τ-b = 0.95). Interrater reliability of the BAT-L was strong (κs >0.80). The BAT-L is a valid instrument with which to assess TBI across a service member's lifetime and captures the varied and complex nature of brain injuries across OEF/OIF veterans' life span.

  9. The Educational Validity and Utility of Single-Case Design Research in Building Evidence-Based Practices in Education

    Science.gov (United States)

    Kourea, Lefki; Lo, Ya-yu

    2016-01-01

    Improving academic, behavioural, and social outcomes of students through empirical research has been a firm commitment among researchers, policy-makers, and other professionals in education across Europe and the United States (U.S.). To assist in building scientific evidences, executive bodies such as the European Commission and the Institute for…

  10. Embryonic development of Carabus insulicola (Insecta, Coleoptera, Carabidae) with special reference to external morphology and tangible evidence for the subcoxal theory.

    Science.gov (United States)

    Kobayashi, Yukimasa; Niikura, Kazuhiro; Oosawa, Yuuki; Takami, Yasuoki

    2013-12-01

    The egg morphology and successive changes in the developing embryos of the carabid ground beetle Carabus insulicola (Carabidae) are described based on light and scanning electron microscopy observations. Newly laid eggs of this species are ellipsoid and measure approximately 6.1 × 2.9 mm, before increasing to 6.6 × 3.4 mm at hatching. The egg period is about 11 days at 23°C. The egg shell is characterized by a thin fragile chorion covering a hard serosal cuticle. The embryo forms on the ventral egg surface, where it develops for the duration of the egg period. During the process of thoracic leg formation, two subcoxal rings, subcoxae-1 and 2, are clearly discernible at the basalmost region of the leg rudiments, and these subcoxae participate in the formation of the larval pleura and sterna. The result thus provides tangible evidence for the subcoxal theory, that is, that thoracic pleura and sterna are derived from subcoxal regions. Despite the complete absence of abdominal appendages in the larvae of this species, two pairs of appendage-like swellings, the medial and lateral ones, temporarily arise in the first eight abdominal segments during the middle of embryonic development. The medial swellings are assumed to be serially homologous with the coxal part of the thoracic leg, and they later flatten out and participate in the formation of the larval pleura (hypopleurites). In the light of the serially homologous relationships among gnathal appendages, thoracic legs, and abdominal appendage-like swellings, we identified the subcoxal regions in both the gnathal and abdominal segments. Although, the lateral swellings soon degenerate and disappear, it is considered that the swellings originate in the abdominal subcoxae-2 and may be homologous to the tracheal gills of larvae of Gyrinidae. Based on the embryological results, new interpretations for the constituent of gnathal appendages are proposed. Copyright © 2013 Wiley Periodicals, Inc.

  11. The Archean komatiite-hosted, PGE-bearing Ni-Cu sulfide deposit at Vaara, eastern Finland: evidence for assimilation of external sulfur and post-depositional desulfurization

    Science.gov (United States)

    Konnunaho, J. P.; Hanski, E. J.; Bekker, A.; Halkoaho, T. A. A.; Hiebert, R. S.; Wing, B. A.

    2013-12-01

    Archean komatiites host important resources of Ni, Cu, Co, and PGE, particularly in Western Australia and Canada. In Finland, several small, low-grade sulfide deposits have been found in komatiites, including the ca. 2.8 Ga Vaara deposit in the Archean Suomussalmi greenstone belt. It occurs in the central part of the serpentinized olivine cumulate zone of a komatiitic extrusive body and is composed of disseminated interstitial sulfides consisting of pyrite, pentlandite, millerite, violarite, and chalcopyrite accompanied by abundant magnetite. Although currently subeconomic, the mineralization is interesting due to the very high chalcophile element contents of the sulfide fraction (38 wt% Ni, 3.4 wt% Cu, 0.7 wt% Co, 22.4 ppm Pd, and 9.5 ppm Pt). The sulfides occur in relatively Cr-poor olivine cumulates suggesting involvement of a chromite-undersaturated magma. The parental magma was an Al-undepleted komatiite with an estimated MgO content of at least 24 wt%. In contrast to the common komatiite types in the eastern Finland greenstone belts, the Vaara rocks are moderately enriched in LREE relative to MREE, suggesting that crustal contamination played an important role in the genesis of the Vaara deposit. Multiple sulfur isotope data reveal considerable mass-independent sulfur isotope fractionation both in country rock sedimentary sulfides (Δ33S ranges from -0.50 to +2.37 ‰) and in the Vaara mineralization (Δ33S ranges from +0.53 to +0.66 ‰), which provides strong evidence for incorporation of crustal sulfur. Extensive replacement of interstitial sulfides by magnetite and the presence of millerite- and violarite-bearing, pyrrhotite-free sulfide assemblages indicate significant post-magmatic, low-temperature hydrothermal oxidation of the primary magmatic pyrrhotite-pentlandite-chalcopyrite assemblages and associated sulfur loss that led to a significant upgrading of the original metal tenors of the Vaara deposit.

  12. Structural validity and reliability of the Positive and Negative Affect Schedule (PANAS): evidence from a large Brazilian community sample.

    Science.gov (United States)

    Carvalho, Hudson W de; Andreoli, Sérgio B; Lara, Diogo R; Patrick, Christopher J; Quintana, Maria Inês; Bressan, Rodrigo A; Melo, Marcelo F de; Mari, Jair de J; Jorge, Miguel R

    2013-01-01

    Positive and negative affect are the two psychobiological-dispositional dimensions reflecting proneness to positive and negative activation that influence the extent to which individuals experience life events as joyful or as distressful. The Positive and Negative Affect Schedule (PANAS) is a structured questionnaire that provides independent indexes of positive and negative affect. This study aimed to validate a Brazilian interview-version of the PANAS by means of factor and internal consistency analysis. A representative community sample of 3,728 individuals residing in the cities of São Paulo and Rio de Janeiro, Brazil, voluntarily completed the PANAS. Exploratory structural equation model analysis was based on maximum likelihood estimation and reliability was calculated via Cronbach's alpha coefficient. Our results provide support for the hypothesis that the PANAS reliably measures two distinct dimensions of positive and negative affect. The structure and reliability of the Brazilian version of the PANAS are consistent with those of its original version. Taken together, these results attest the validity of the Brazilian adaptation of the instrument.

  13. Using G-Theory to Enhance Evidence of Reliability and Validity for Common Uses of the Paulhus Deception Scales.

    Science.gov (United States)

    Vispoel, Walter P; Morris, Carrie A; Kilinc, Murat

    2018-01-01

    We applied a new approach to Generalizability theory (G-theory) involving parallel splits and repeated measures to evaluate common uses of the Paulhus Deception Scales based on polytomous and four types of dichotomous scoring. G-theory indices of reliability and validity accounting for specific-factor, transient, and random-response measurement error supported use of polytomous over dichotomous scores as contamination checks; as control, explanatory, and outcome variables; as aspects of construct validation; and as indexes of environmental effects on socially desirable responding. Polytomous scoring also provided results for flagging faking as dependable as those when using dichotomous scoring methods. These findings argue strongly against the nearly exclusive use of dichotomous scoring for the Paulhus Deception Scales in practice and underscore the value of G-theory in demonstrating this. We provide guidelines for applying our G-theory techniques to other objectively scored clinical assessments, for using G-theory to estimate how changes to a measure might improve reliability, and for obtaining software to conduct G-theory analyses free of charge.

  14. Preliminary Validity of the Eyberg Child Behavior Inventory With Filipino Immigrant Parents.

    Science.gov (United States)

    Coffey, Dean M; Javier, Joyce R; Schrager, Sheree M

    Filipinos are an understudied minority affected by significant behavioral health disparities. We evaluate evidence for the reliability, construct validity, and convergent validity of the Eyberg Child Behavior Inventory (ECBI) in 6- to 12- year old Filipino children ( N = 23). ECBI scores demonstrated high internal consistency, supporting a single-factor model (pre-intervention α =.91; post-intervention α =.95). Results document convergent validity with the Child Behavior Checklist Externalizing scale at pretest ( r = .54, p Filipino children.

  15. The bottom-up approach to integrative validity: a new perspective for program evaluation.

    Science.gov (United States)

    Chen, Huey T

    2010-08-01

    The Campbellian validity model and the traditional top-down approach to validity have had a profound influence on research and evaluation. That model includes the concepts of internal and external validity and within that model, the preeminence of internal validity as demonstrated in the top-down approach. Evaluators and researchers have, however, increasingly recognized that in an evaluation, the over-emphasis on internal validity reduces that evaluation's usefulness and contributes to the gulf between academic and practical communities regarding interventions. This article examines the limitations of the Campbellian validity model and the top-down approach and provides a comprehensive, alternative model, known as the integrative validity model for program evaluation. The integrative validity model includes the concept of viable validity, which is predicated on a bottom-up approach to validity. This approach better reflects stakeholders' evaluation views and concerns, makes external validity workable, and becomes therefore a preferable alternative for evaluation of health promotion/social betterment programs. The integrative validity model and the bottom-up approach enable evaluators to meet scientific and practical requirements, facilitate in advancing external validity, and gain a new perspective on methods. The new perspective also furnishes a balanced view of credible evidence, and offers an alternative perspective for funding. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

  16. Sensitivity of the Halstead and Wechsler Test Batteries to brain damage: Evidence from Reitan's original validation sample.

    Science.gov (United States)

    Loring, David W; Larrabee, Glenn J

    2006-06-01

    The Halstead-Reitan Battery has been instrumental in the development of neuropsychological practice in the United States. Although Reitan administered both the Wechsler-Bellevue Intelligence Scale and Halstead's test battery when evaluating Halstead's theory of biologic intelligence, the relative sensitivity of each test battery to brain damage continues to be an area of controversy. Because Reitan did not perform direct parametric analysis to contrast group performances, we reanalyze Reitan's original validation data from both Halstead (Reitan, 1955) and Wechsler batteries (Reitan, 1959a) and calculate effect sizes and probability levels using traditional parametric approaches. Eight of the 10 tests comprising Halstead's original Impairment Index, as well as the Impairment Index itself, statistically differentiated patients with unequivocal brain damage from controls. In addition, 13 of 14 Wechsler measures including Full-Scale IQ also differed statistically between groups (Brain Damage Full-Scale IQ = 96.2; Control Group Full Scale IQ = 112.6). We suggest that differences in the statistical properties of each battery (e.g., raw scores vs. standardized scores) likely contribute to classification characteristics including test sensitivity and specificity.

  17. Clinician ratings of the Comprehensive Assessment of Psychopathic Personality (CAPP) in a representative sample of Spanish prison inmates: New validity evidence.

    Science.gov (United States)

    Flórez, Gerardo; Ferrer, Ventura; García, Luis S; Crespo, María R; Pérez, Manuel; Saíz, Pilar A; Cooke, David J

    2018-01-01

    The Comprehensive Assessment of Psychopathic Personality (CAPP) is a concept map of psychopathic personality disorder (PPD). The CAPP- Institutional Rating Scale (IRS) is a tool designed to assess CAPP symptoms in institutional settings. The CAPP contains 33 personality traits organized in six domains: attachment, behavioural, cognitive, dominance, emotional and self. Until now, much of the CAPP research has been conducted out of clinical, forensic and correctional settings using self-ratings. In the current study, the psychometric properties and construct validity of the CAPP-IRS were evaluated in a non-convenience sample of 204 Spanish convicts. Clinician ratings were employed. Participants had been imprisoned for at least 6 months at Pereiro de Aguiar Penitentiary. This group of inmates was heterogeneous with respect to type of official charges, and representative as all convicts interned for at least 6 months in this prison were screened for participation. Classical test theory indexes of reliability, correlations between CAPP items and domains and external correlations and structural analyses demonstrated that CAPP assessment is a solid and robust way of evaluating psychopathy in a correctional setting. Best fit was found for a three-factor model: attachment and emotional items associated with a callous and unemotional trait, dominance and self items associated with a pathological interpersonal style, and behavioural and residual items from other domains associated with impulsivity.

  18. Fission track dating of volcanic glass: experimental evidence for the validity of the Size-Correction Method

    International Nuclear Information System (INIS)

    Bernardes, C.; Hadler Neto, J.C.; Lattes, C.M.G.; Araya, A.M.O.; Bigazzi, G.; Cesar, M.F.

    1986-01-01

    Two techniques may be employed for correcting thermally lowered fission track ages on glass material: the so called 'size-correcting method' and 'Plateau method'. Several results from fission track dating on obsidian were analysed in order to compare the model rising size-correction method with experimental evidences. The results from this work can be summarized as follows: 1) The assumption that mean size of spontaneous and induced etched tracks are equal on samples unaffected by partial fading is supported by experimental results. If reactor effects such as an enhancing of the etching rate in the irradiated fraction due to the radiation damage and/or to the fact that induced fission releases a quantity of energy slightly greater than spontaneous one exist, their influence on size-correction method is very small. 2) The above two correction techniques produce concordant results. 3) Several samples from the same obsidian, affected by 'instantaneous' as well as 'continuous' natural fading to different degrees were analysed: the curve showing decreasing of spontaneous track mean-size vs. fraction of spontaneous tracks lost by fading is in close agreement with the correction curve constructed for the same obsidian by imparting artificial thermal treatements on induced tracks. By the above points one can conclude that the assumptions on which size-correction method is based are well supported, at least in first approximation. (Author) [pt

  19. Electronic self-monitoring of mood using IT platforms in adult patients with bipolar disorder: A systematic review of the validity and evidence.

    Science.gov (United States)

    Faurholt-Jepsen, Maria; Munkholm, Klaus; Frost, Mads; Bardram, Jakob E; Kessing, Lars Vedel

    2016-01-15

    Various paper-based mood charting instruments are used in the monitoring of symptoms in bipolar disorder. During recent years an increasing number of electronic self-monitoring tools have been developed. The objectives of this systematic review were 1) to evaluate the validity of electronic self-monitoring tools as a method of evaluating mood compared to clinical rating scales for depression and mania and 2) to investigate the effect of electronic self-monitoring tools on clinically relevant outcomes in bipolar disorder. A systematic review of the scientific literature, reported according to the Preferred Reporting items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was conducted. MEDLINE, Embase, PsycINFO and The Cochrane Library were searched and supplemented by hand search of reference lists. Databases were searched for 1) studies on electronic self-monitoring tools in patients with bipolar disorder reporting on validity of electronically self-reported mood ratings compared to clinical rating scales for depression and mania and 2) randomized controlled trials (RCT) evaluating electronic mood self-monitoring tools in patients with bipolar disorder. A total of 13 published articles were included. Seven articles were RCTs and six were longitudinal studies. Electronic self-monitoring of mood was considered valid compared to clinical rating scales for depression in six out of six studies, and in two out of seven studies compared to clinical rating scales for mania. The included RCTs primarily investigated the effect of heterogeneous electronically delivered interventions; none of the RCTs investigated the sole effect of electronic mood self-monitoring tools. Methodological issues with risk of bias at different levels limited the evidence in the majority of studies. Electronic self-monitoring of mood in depression appears to be a valid measure of mood in contrast to self-monitoring of mood in mania. There are yet few studies on the effect of electronic

  20. Elimination of trachoma as a public health problem in Ghana: Providing evidence through a pre-validation survey.

    Science.gov (United States)

    Debrah, Oscar; Mensah, Ernest O; Senyonjo, Laura; de Souza, Dziedzom K; Hervie, Tei E; Agyemang, David; Bakajika, Didier; Marfo, Benjamin; Ahorsu, Felix; Wanye, Seth; Bailey, Robin; Koroma, Joseph B; Aboe, Agatha; Biritwum, Nana-Kwadwo

    2017-12-01

    In order to achieve elimination of trachoma, a country needs to demonstrate that the elimination prevalence thresholds have been achieved and then sustained for at least a two-year period. Ghana achieved the thresholds in 2008, and since 2011 has been implementing its trachoma surveillance strategy, which includes community and school screening for signs of follicular trachoma and trichiasis, in trachoma-endemic districts. In 2015-2016, the country conducted a district level population-based survey to validate elimination of trachoma as a public health problem. As per WHO recommendations, a cross-sectional survey, employing a two-stage cluster random sampling methodology, was used across 18 previously trachoma endemic districts (evaluation units (EUs) in the Upper West and Northern Regions of Ghana. In each EU 24 villages were selected based on probability proportional to estimated size. A minimum of 40 households were targeted per village and all eligible residents were examined for clinical signs of trachoma, using the WHO simplified grading system. The number of trichiasis cases unknown to the health system was determined. Household environmental risk factors for trachoma were also assessed. Data from 45,660 individuals were examined from 11,099 households across 18 EUs, with 27,398 (60.0%) children aged 1-9 years and 16,610 (36.4%) individuals 15 years and above All EUs had shown to have maintained the WHO elimination threshold for Trachomatous inflammation-Follicular (TF) (health system in adults aged ≥15 years, ranged from 0.00% to 0.36%. In this EU, the estimated TT backlog is 417 All TT patients identified in the study, as well as through on-going surveillance efforts will require further management. A total of 75.9% (95% CI 72.1-79.3, EU range 29.1-92.6) of households defecated in the open but many households had access to an improved water source 75.9% (95%CI: 71.5-79.8, EU range 47.4-90.1%), with 45.5% (95% CI 41.5-49.7%, EU range 28.4-61.8%) making a

  1. Delirium risk stratification in consecutive unselected admissions to acute medicine: validation of a susceptibility score based on factors identified externally in pooled data for use at entry to the acute care pathway.

    Science.gov (United States)

    Pendlebury, Sarah T; Lovett, Nicola G; Smith, Sarah C; Wharton, Rose; Rothwell, Peter M

    2017-03-01

    recognition of prevalent delirium and prediction of incident delirium may be difficult at first assessment. We therefore aimed to validate a pragmatic delirium susceptibility (for any, prevalent and incident delirium) score for use in front-line clinical practice in a consecutive cohort of older acute medicine patients. consecutive patients aged ≥65 years over two 8-week periods (2010-12) were screened prospectively for delirium using the Confusion Assessment Method (CAM), and delirium was diagnosed using the DSM IV criteria. The delirium susceptibility score was the sum of weighted risk factors derived using pooled data from UK-NICE guidelines: age >80 = 2, cognitive impairment (cognitive score below cut-off/dementia) = 2, severe illness (systemic inflammatory response syndrome) = 1, infection = 1, visual impairment = 1. Score reliability was determined by the area under the receiver operating curve (AUC). among 308 consecutive patients aged ≥65 years (mean age/SD = 81/8 years, 164 (54%) female), AUC was 0.78 (95% CI 0.71-0.84) for any delirium; 0.71 (0.64-0.79), for prevalent delirium; 0.81 (0.70-0.92), for incident delirium; odds ratios (ORs) for risk score 5-7 versus delirium, 8.1 (2.2-29.7), P = 0.002 for prevalent delirium, and 25.0 (3.0-208.9) P = 0.003 for incident delirium, with corresponding relative risks of 5.4, 4.7 and 13. Higher risk scores were associated with frailty markers, increased care needs and poor outcomes. the externally derived delirium susceptibility score reliably identified prevalent and incident delirium using clinical data routinely available at initial patient assessment and might therefore aid recognition of vulnerability in acute medical admissions early in the acute care pathway. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society.

  2. Experimental evidence of the validity of Bahe–Varela theory to describe the volumetric properties of ionic liquids

    International Nuclear Information System (INIS)

    Rilo, E.; Domínguez-Pérez, M.; Varela, L.M.; Cabeza, O.

    2012-01-01

    tetrafluoroborate at T = 298 K and four with 1-ethyl-3-methyl imidazolium alkyl sulphate at (288, 298, 308 and 318) K. Also we analyze seven mixtures with ethanol of the two same IL families and for the same temperatures than the aqueous systems. From the original data, we calculated the partial molar volume of the IL for all concentrations, being its variation lower than 2% for the aqueous systems (except that with EMIM-BF 4 , where it is 5%) and lower than 4% for those with ethanol. In spite of the simplicity of the Bahe–Varela equation, with only three fitting parameters, and of the three different forms of the partial molar volume versus concentration behaviour observed, the fitting quality of the B–V equation is excellent for all analyzed systems, which tends to confirm its universal validity.

  3. Which Agglomeration Externalities Matter Most and Why?

    NARCIS (Netherlands)

    de Groot, H.L.F.; Poot, J.; Smit, M.J.

    2016-01-01

    This paper revisits the ongoing discussion on the importance of agglomeration externalities – specifically specialization, diversity and competition effects – that may contribute to innovation, productivity and urban employment growth. Previous meta-analyses suggested that the evidence on

  4. Which Agglomeration Externalities Matter Most and Why?

    NARCIS (Netherlands)

    de Groot, Henri L.F.; Poot, Jacques; Smit, Martijn J.

    2016-01-01

    This paper revisits the ongoing discussion on the importance of agglomeration externalities – specifically specialization, diversity and competition effects – that may contribute to innovation, productivity and urban employment growth. Previous meta‐analyses suggested that the evidence on

  5. Regulating multiple externalities

    DEFF Research Database (Denmark)

    Waldo, Staffan; Jensen, Frank; Nielsen, Max

    2016-01-01

    Open access is a well-known externality problem in fisheries causing excess capacity and overfishing. Due to global warming, externality problems from CO2 emissions have gained increased interest. With two externality problems, a first-best optimum can be achieved by using two regulatory instrume......Open access is a well-known externality problem in fisheries causing excess capacity and overfishing. Due to global warming, externality problems from CO2 emissions have gained increased interest. With two externality problems, a first-best optimum can be achieved by using two regulatory...