Additional Items Research Articles

Validity and reliability of a physical literacy knowledge, attitudes, self-efficacy and behaviors questionnaire for early childhood educators (PLKASB-ECE): An exploratory factor analysis.

Nurturing physical literacy in young children offers a unique opportunity to address global physical inactivity trend. Early childhood education and care (ECEC) environments, with their extensive reach into this age group, and early childhood educators, through their daily interactions with children, are strategically positioned to influence children's physical literacy development. However, enhancing educators' ability to foster physical literacy requires valid and reliable assessment tools to measure holistic physical literacy constructs (i.e., cognitive, affective, behavioral) to assess the impact of physical literacy educational interventions. The purpose of this study was to develop a holistic digital tool to measure physical literacy knowledge, attitudes, self-efficacy, and behaviors of early childhood educators (PLKASB-ECE) for both their professional teaching context as well as the educator's own personal physical literacy behaviours. This study was conducted in two phases. Phase 1 involved item generation and content validation. Phase 2 employed a cross-sectional validation study design to assess the psychometric properties of the PLKASB-ECE tool. Based on a literature review an initial 19-item instrument was developed that subsequently underwent three rounds of expert content validation. Six additional items were added, resulting in a final 25-item self-report measure with a readability score equivalent to an 8th grade reading level (Flesch-Kincaid Grade Level: 8.7). This included 1 global rating item, 2 qualitative response items, 7 knowledge items, and 15 items addressing physical literacy attitudes, self-efficacy and behaviors using a 7-point Likert response scale. The PLKASB-ECE tool was administered to 470 educators in Alberta, Canada between 2019 to 2022. The 15 items were subjected to exploratory factor analysis and resulted in a five-factor scale with one item not loading. The five-factor scale held with the final 14 items with loadings ranging from 0.481 to 0.886, Cronbach's alpha ranging from 0.70 to 0.82, with ordinal omega ranging from 0.72 to 0.82. Usability, as assessed by completion time, was 8.15 minutes. These findings demonstrate good indices of reliability and validity for the PLKASB-ECE tool. This tool will be valuable as a research outcome measure for assessing educational interventions aimed at enhancing educators' understanding, confidence, and strategies for fostering holistic concepts of physical literacy in young children within ECECs.

Measuring navigational health literacy – an extension of the HLS19-NAV scale

Abstract Background European healthcare systems are characterized by a high complexity and intransparency. Finding one’s way through the multitude of services requires navigational health literacy (NAV-HL). NAV-HL is defined as the ability to maneuver the healthcare system and deal with information necessary to do so at the system, organizational, and interactive levels. Using a newly developed scale, the European health literacy population survey 2019-2021 (HLS19) measured NAV-HL across multiple countries. To better capture the complexity of the construct and enhance scale validity, the aim was to improve it by generating additional items on the interactive level. Methods An international panel of health literacy experts from ten countries generated additional items that specifically covered tasks related to interactions with healthcare professionals. These skills are important for ensuring continuity of healthcare and navigating the healthcare system. The items were generated in an iterative process, translated, and tested in cognitive interviews. Results Four items were generated according to the four cognitive domains of the underlying conceptual model. These items concern the proficiency to: a) obtain information from health-care professionals about further healthcare services, b) understand this information and c) assess it in relation to one’s own preferences, and d) use it to make decisions about further healthcare. Using cognitive interviews, the four new items have been found to be meaningful and comprehensible. Only minor adjustments were made. Conclusions The HLS19-NAV scale has already been successfully applied and validated in eight countries of the HLS19. The new items capturing the interactive level enhance the validity of the existing HLS19-NAV scale. The psychometric properties of the new (sub)scale will be explored.

Effect of a colorectal bundle in an entire health care region in Switzerland: Results from a prospective cohort study (EvaCol study).

Standardisation has the potential to serve as a measure to mitigate complication rates. The objective was to assess the impact of standardisation by implementing a colorectal bundle (CB), which comprises nine elements, on the complication rates in left-sided colorectal resections. This prospective, multicentre, observational, cohort trial was conducted in Switzerland at nine participating hospitals. During the control period, each patient was treated in accordance with the local standard protocol at their respective hospital. In the CB period, all patients were treated in accordance with the CB. The primary endpoint was the Comprehensive Complication Index (CCI) at 30 days. A total of 1141 patients were included (723 in the No CB group and 418 in the CB group). Median age was 66 years and 50.6% were female. Median CCI before and after CB implementation was 0.0 (Interquartile Range [IQR]: 0.0-20.9). A hurdle model approach was used for the analysis. The CB was not associated with the presence or severity of complications. Older age (Odds Ratio [OR] 1.02, 95% Confidence Intervall [CI]: 1.00-1.03), surgery for malignancy (OR 1.34, 95% CI: 1.01-1.92), emergency surgery (OR 2.19, 95% CI: 1.31-3.41), elevated nutritional risk score (OR 1.13, 95% CI: 1.01-1.24) and Body-Mass Index (OR 1.04, 95% CI: 1.00-1.06) were associated with higher odds of postoperative complications. In a supplementary per-protocol analysis, for each additional item of the CB fulfilled, the odds of anastomotic leakage (AL) were 24% lower (OR 0.76, 95% CI: 0.64-0.93). Dedicated teams can establish high quality colorectal services in a network of hospitals with a joint standard. The study can serve as a model for other healthcare settings to conduct and implement quality improvement programs. The consistent implementation of the CB items can reduce the occurrence of AL.

Quality of life in disease-free survived patients with early-stage extranodal nasal-type NK/T-cell lymphoma after definitive intensity-modulated radiotherapy: a cross-sectional study of 310 cases

PurposeRadiotherapy is a critical treatment for early-stage extranodal nasal-type NK/T-cell lymphoma (ENKTL) and has yielded favorable survival outcomes. However, their postradiotherapy quality of life (QOL) has not been investigated. Here, we conducted a cross-sectional study to assess the QOL of ENKTL patients with disease-free survival after definitive radiotherapy and to identify factors associated with QOL and treatment optimization.MethodsThis cross-sectional study included 310 patients with stage I–II ENKTL of the upper aerodigestive tract (UADT) who had received simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) with a consistent design and achieved disease-free survival. The median postradiotherapy time was 47.2 months (range, 3.1–115.7). The EORTC QLQ-H&N35 questionnaire was used to assess symptom-related QOL, and nine additional items were added to incorporate nasal, optical, and aural-related symptoms. The scores indicate the severity of the symptoms.ResultsThe most common postradiotherapy symptoms among patients with ENKTL were nose problems (49.7%), dry mouth (44.8%), tooth problems (41.3%), sensory problems (32.6%), and less sexuality (25.8%). Tooth problems had the highest average score of 18.6, which is still acceptable. The severity of these symptoms decreased over time and reached a plateau in the second year after radiotherapy. Multivariable regression analysis showed that whole-neck irradiation was an independent predictive factor for xerostomia (P = 0.013, OR = 1.114), while age > 60 years was a predictive factor for lower sexuality (P < 0.001, OR = 1.32).ConclusionThe QOL of patients with early-stage ENKTL after radiotherapy was favorable, and most symptoms improved over time. Radiotherapy was correlated with specific symptoms, which may suggest a direction for further improvement in SIB-IMRT.

8404 Use of the Acromegaly Symptom Diary (ASD) in a Phase 3, Placebo-Controlled Study of Once-Daily, Oral Paltusotine in Patients With Acromegaly Switched From Injected Octreotide or Lanreotide

Abstract Disclosure: M.R. Gadelha: Consulting Fee; Self; Crinetics, Ipsen, Novo Nordisk, and Recordati. Research Investigator; Self; Crinetics and Recordati. Speaker; Self; Ipsen, Novo Nordisk, and Recordati. A. Casagrande: Employee; Self; Crinetics Pharmaceuticals. Stock Owner; Self; Crinetics Pharmaceuticals. C.J. Strasburger: Consulting Fee; Self; Amolyt Pharma, Consilient Health, Novo Nordisk, Recordati, and Sandoz-Hexal. Research Investigator; Self; Crinetics. M. Bidlingmaier: Consulting Fee; Self; Crinetics, Ionis, Novo Nordisk, Pfizer, Roche, and Sandoz. Research Investigator; Self; Amolyt, Camurus, Chiasma, Crinetics, IDS, Ionis, Lumos, and OPKO. Speaker; Self; Euroimmun, Novo Nordisk, and Pfizer. P.J. Snyder: Research Investigator; Self; Crinetics. M.A. Guitelman: Consulting Fee; Self; Recordati, Sanofi Aventis, and Varifarma. Research Investigator; Self; Crinetics. Speaker; Self; Recordati, Sanofi Aventis, and Varifarma. C.L. Boguszewski: Consulting Fee; Self; Ipsen, Novo Nordisk, and Recordati. Research Investigator; Self; Crinetics. Speaker; Self; Ipsen, Novo Nordisk, and Recordati. M. Buchfelder: Research Investigator; Self; Crinetics. I. Shimon: Consulting Fee; Self; Medison and Pfizer. Research Investigator; Self; Crinetics and Debiopharm. Speaker; Self; Medison and Pfizer. G. Raverot: Consulting Fee; Self; Amolyt, Crinetics, Ipsen, Novo Nordisk, Pfizer, and Recordati. Research Investigator; Self; Crinetics. Speaker; Self; Ipsen, Pfizer, and Recordati. M. Toth: Consulting Fee; Self; Ipsen, Lilly, Novartis, and Recordati. Research Investigator; Self; Crinetics. Speaker; Self; Ipsen, Lilly, Novartis, and Recordati. E. Mezosi: Research Investigator; Self; Crinetics. M. Doknic: Advisory Board Member; Self; Pfizer in CEE. Research Investigator; Self; Crinetics. X. Fan: Employee; Self; Crinetics Pharmaceuticals. Stock Owner; Self; Crinetics Pharmaceuticals. D. Clemmons: Consulting Fee; Self; Crinetics. M. Keeley: Employee; Self; Crinetics Pharmaceuticals. Stock Owner; Self; Crinetics Pharmaceuticals. P.J. Trainer: Employee; Self; Crinetics Pharmaceuticals. Stock Owner; Self; Crinetics Pharmaceuticals. R. Struthers: Employee; Self; Crinetics Pharmaceuticals. Stock Owner; Self; Crinetics Pharmaceuticals. A. Krasner: Employee; Self; Crinetics Pharmaceuticals. Stock Owner; Self; Crinetics Pharmaceuticals. B.M. Biller: Consulting Fee; Self; Amryt, Camurus, Crinetics, and Recordati. Research Investigator; Self; Crinetics and Ionis. Paltusotine is a once-daily, selective, non-peptide, SST2 receptor agonist in development as an oral treatment for patients with acromegaly or carcinoid syndrome. The Acromegaly Symptom Diary (ASD) is a novel patient-reported outcome tool developed in accordance with US FDA guidance to assess disease-related symptom burden. The ASD consists of 7 core items (headache, joint pain, sweating, fatigue, leg weakness, swelling, numbness/tingling, score range: 0-70; higher scores indicate greater symptom burden) plus 2 additional items (sleep difficulty, memory difficulty) and is completed daily. We previously reported the topline results of PATHFNDR-1 (NCT04837040), a phase 3 trial evaluating the efficacy and safety of paltusotine in adults with acromegaly who were previously controlled (IGF-I ≤1.0 ×ULN) on stable (≥12 weeks) injected octreotide or lanreotide. Patients were randomly allocated to once-daily paltusotine 40 mg or placebo for 36 weeks, with uptitration to 60 mg/day permitted through week 24. IGF-I and GH levels (IDS-iSYS) and pituitary tumor volume (MRI) were measured centrally. Fifty-eight patients (paltusotine, n=30; placebo, n=28) were enrolled: mean (±SD) age 54.9±13.7 years; 55.2% female; prior treatment octreotide LAR (n=34) or lanreotide depot (n=24). The primary endpoint (proportion of patients maintaining IGF-I ≤1.0 ×ULN [mean of weeks 34 and 36]) was met by significantly more patients on paltusotine (83.3%) versus placebo (3.6%; odds ratio: 126.53; 95% CI: 13.73, &amp;gt;999.99; P&amp;lt;0.0001). All secondary endpoints were met: mean (±SE) change in IGF-I of 0.04±0.09 ×ULN versus 0.83±0.1 ×ULN (P&amp;lt;0.0001); and GH maintained at &amp;lt;1.0 ng/mL in 87.0% versus 27.8% of patients (odds ratio: 16.61; 95% CI: 2.86, 181.36; P&amp;lt;0.001). The most common adverse events (AEs) were typical of the somatostatin receptor ligand (SRL) class or acromegaly symptoms. There were no severe or serious AEs in the paltusotine group. One patient in the placebo group discontinued study participation (patient decision). There were no clinically significant changes in pituitary tumor volume. The mean completion rate of the daily ASD questionnaire was 79.1%. At the end of randomized treatment, the ASD total score was significantly increased from baseline (indicating worsening) in the placebo group compared with the paltusotine group, meeting the secondary endpoint (-0.6±1.5 versus 4.6±1.6; P=0.02). For individual ASD symptoms, mean scores were consistently indicative of improvement with paltusotine compared to placebo; the between-group difference was statistically significant for joint pain (P&amp;lt;0.05), numbness/tingling (P&amp;lt;0.01), and the “most bothersome” symptom (P&amp;lt;0.05). In conclusion, once-daily oral paltusotine maintained symptom control in concert with biochemical values in well-controlled patients switched from injected SRLs and was well tolerated. Support: Crinetics Pharmaceuticals Presentation: 6/3/2024

Verification of five-factor models and reference scores for personality dysfunction and trait domains of the Personality Assessment Questionnaire for ICD-11 (PAQ-11), revised version.

A brief self-reported measure of the Personality Assessment Questionnaire for the 11th edition of the World Health Organization's International Classification of Disease (ICD-11) (PAQ-11) was developed to evaluate ICD-11 personality traits. The aim of this study was to investigate the validity of the revised PAQ-11 version (PAQ-11R) with an additional item in the Dissociality domain and thresholds for the severity of personality dysfunction and domains. Study 1 examined the construct validity of the PAQ-11R in 192 university students in Korea. Study 2 estimated tentative reference scores of personality dysfunction and domains of the PAQ-11R in 91 patients in Korea. In study 1, the PAQ-11R had a five-factor structure and the revised Dissociality scale had better convergent and discriminant validities than the previous version. In study 2, the receiver operating characteristic (ROC) curve of the PAQ-11R identified a threshold score of 35. Reference scores for domains were estimated as 15 for Negative Affectivity, 10 for Detachment, 8 for Anankastia, and 5 each for Disinhibition and Dissociality. These scores contribute to severity of personality disturbance but remain qualifiers only; they are not diagnostic. The results suggest that the PAQ-11R is useful as a quick assessment tool for identifying the domains of personality dysfunction in clinical practice in harmony with the ICD-11 guidelines.

Utility of a Questionnaire Short Form for Adolescents with Listening Difficulties in Japan.

A short and easy questionnaire is needed to identify symptoms of listening difficulties (LiD) at an early stage. This study aimed to evaluate the utility of such a questionnaire for adolescents with and without LiD. We included adolescents with and without LiD and adults without LiD in this study. We utilized a questionnaire designed for individuals with LiD, which combined the Speech, Spatial, and Quality of Hearing scales (SSQ)-12 and four additional psychological items. From this, we selected three items that exhibited the largest differences between adolescents with and without LiD. We subsequently examined the relationship between the total scores of all items and the three selected items to develop the short questionnaire. The responses of adolescents to the questionnaire were consistent with those of adults. The total scores from the three selected items exhibited a strong correlation with the overall questionnaire score for adolescents both with and without LiD, indicating their potential for identifying LiD symptoms. The wide implementation of the short questionnaire developed in this study could lead to the early detection of potential LiD symptoms and timely intervention.

De-mixing variational mode decomposition and its application on operational modal analysis in the presence of closely spaced modes

Variational mode decomposition (VMD), and its derivative methods have been demonstrated to be promising signal decomposition tools and widely utilized in modal analysis. However, they inevitably suffer from mode mixing sometimes, greatly impairing the quality of decomposition. This paper proposes a pair of novel VMD-based methods for univariate signal and multivariate signal respectively, referred to as de-mixing VMD (D-VMD) and de-mixing multivariate VMD (D-MVMD), which can greatly alleviate mode mixing in decomposition. The ensemble correlation coefficient is defined to evaluate the correlatedness between one mode and others and then involved in the variational formulation as an additional Lagrangian multiplier item to enhance the constraint in terms of mode mixing. Additionally, a new scheme is proposed to robustly identify modal parameters from the decomposed modal responses. Numerical simulations and a pedestrian bridge were investigated to validate the effectiveness of the proposed methods in identifying closely spaced modes.

Most Common Symptomatic Adverse Reactions of Cancer Treatments From US Drug Labels (2015-2021) to Inform Selection of Patient-Reported Outcomes

ObjectivesIncorporating patient-reported outcomes (PROs) to assess symptomatic adverse events (AEs) in cancer clinical trials (CTs) is important to characterize treatment tolerability. Cancer therapies approved over the past decade have expanded the types of expected toxicities. To inform future symptomatic AE PRO item selection, we identified the most common symptomatic adverse reactions from recently approved products. MethodsWe reviewed approvals from 2015 to 2021 for lung, breast, and hematologic cancer indications. Using United States Prescribing Information safety data, we recorded symptomatic adverse reactions reported in ≥20% of patients in the experimental arm of CTs supporting approvals. We calculated the proportion of arms reporting each symptomatic adverse reaction. ResultsIn total, 130 experimental arms were included (lung = 30, breast = 10, hematologic = 90). For all cancer types, fatigue and diarrhea were reported in >50% of the arms. Nausea was reported in ≥50% of the arms for all except lung. Vomiting, decreased appetite, and alopecia, were reported in ≥50% of breast cancer arms. Rash, musculoskeletal pain, and cough were reported in >50% of leukemia/lymphoma arms. Cough was common (50%) in multiple myeloma arms. ConclusionsHeterogeneity in symptomatic adverse reactions across CTs supports the use of item libraries when building a PRO strategy to assess tolerability. Fatigue, diarrhea, and nausea were the most frequent symptomatic adverse reactions reported in contemporary cancer CTs and could provide a starting point when selecting PRO symptomatic AE items. Additional symptomatic AE PRO items should be selected based on the mechanism of action, early clinical data, published literature, and patient and clinician input.

Impact of a Comprehensive Financial Navigation Intervention to Reduce Cancer-Related Financial Toxicity.

Although the need to reduce the impact of financial toxicity among patients with cancer is widely acknowledged, few interventions have been developed to address this issue. We tested a novel, multiphase, patient-centered financial navigation (FN) intervention at a large academic medical center. We developed a financial toxicity screening tool consisting of the Comprehensive Score for Financial Toxicity (COST) measure plus several additional items based on patient feedback. After systematizing the screening process, 50 patients from the North Carolina Basnight Cancer Hospital were enrolled in the FN intervention following a positive screen for financial distress (COST score <23). The FN intervention involved one-on-one consultations with a trained financial navigator and included an initial comprehensive intake appointment to determine patient eligibility for financial assistance and follow-up appointments to discuss paperwork and application(s) status. We assessed preliminary intervention effectiveness (preintervention and postintervention COST scores) and implementation (ie, fidelity, uptake, acceptability). All 50 patients assessed for study eligibility screened positive for financial distress. A total of 46 patients completed both the preintervention and postintervention COST instrument and other measures. Postintervention mean COST scores improved from 6.4 at baseline to 13.3 post-FN (P<.0001), indicating a significant decrease in perceived financial toxicity. Fidelity to the intervention was high and 96% of participants received financial assistance. A patient-centered FN intervention fully integrated into an existing care coordination model can help to decrease the burden of cancer-related financial toxicity among patients with cancer experiencing financial distress. Further studies are needed to test FN interventions in various oncology settings and among targeted populations.

Agrotourism in Kazakhstan as a factor of economic empowerment of rural population

Nowadays agrotourism is one of the most important tools for improving the image of the village and its attractiveness for economically active population, an effective mechanism for spreading entrepreneurship in rural areas and increasing economic opportunities for rural residents by diversifying the activities of peasant (farmer) farms. Purpose - the concept of "agrotourism", factors constraining the development of the industry are considered, new approaches to expanding the range of tourism services in rural areas of Kazakhstan on the basis of the model "One Village - One Product" (OVOP) are studied. Methods - empirical for the purpose of data selection, observation and research of specific phenomena, establishing links between them; statistical, economic analysis, logical - to identify general trends or effects, use of international experience and generalization of results. Results - the authors note that rural tourism in the country is fragmented, there is no concept and system principles in the tourism sector, which are the key barriers to the development of tourism agribusiness in the country. Popularization of the OVOP movement in the regions of the Republic of Kazakhstan will contribute to the creation of new jobs, the growth of rural people's welfare. It is shown that the agritourism sector is one of the rapidly developing directions in modern tourism. In Kazakhstan there are potential reserves of its wide distribution, which allow to diversify the tourist product and create an additional item of income to the budget of the republic. Conclusions - agrarian tourism is an important segment of modernization of agrarian sector economy, promising innovative rural entrepreneurship. The development of tourism infrastructure in rural areas contributes to the diversification of rural economy, increasing employment and income of rural population, increasing the number of small business enterprises, the volume of production of environmentally friendly products of private subsidiary plots and farms, reducing the outflow of rural population to the cities. Agritourism industry has a large reserve of natural and human resources. However, the authors state that farmers need information and consulting support of tourist firms.

Development and preliminary validation of a modified Food Craving Inventory for Pregnancy (FCI-P) in U.S. military active-duty Service women

Food cravings during pregnancy are highly common, yet no measure of cravings has been validated among pregnant women. The current study evaluated the psychometric properties of the Food Craving Inventory (FCI) for use during pregnancy. U.S. military active-duty Service women (N = 192; 29.5 ± 3.8 years old; 44% Army, 36% Air Force, 15% Navy, and 4% Marine Corps) were recruited from the community at 12–27 weeks' gestation. Participants completed a modified version of the FCI validated for adults with binge-eating disorder, which included 13 additional items assessing cravings for foods that women commonly report experiencing during pregnancy (e.g., pickles, sour cream, hot or spicy wings). Additional measures also assessed disinhibited eating behaviors (i.e., loss of control eating and emotional eating). A series of confirmatory factor analyses were conducted to examine model fit for a four-factor structure of: (1) the FCI validated for binge-eating disorder (excluding the pregnancy-oriented food items) and (2) the FCI modified for pregnancy (with the pregnancy-oriented food items added). The previously validated four-factor structure of the FCI for binge-eating disorder demonstrated poor model fit in the current sample of pregnant women. After examining the structure of the FCI modified for pregnancy, several items were removed due to high cross-loading across multiple subscales. The resulting 16-item, four-factor (Fats, Sweets, Carbohydrates, Spicy/Strong foods) FCI for pregnancy (FCI-P) demonstrated generally good model fit (CFI = .95, TLI = .94, SRMR = .04, RMSEA = .09) and good-to-excellent internal consistency (Cronbach's alphas: .83-.96). Convergent validity was supported by significant correlations between the FCI-P scores and the disinhibited eating behavior scores (ps < .001). Results highlight the importance of psychometrically evaluating eating-related measures for use during pregnancy to appropriately capture the potentially unique experiences of the perinatal period.

The EORTC QLQ breast modules and the FACT-B for assessing quality of life in breast cancer patients - an updated literature review.

Two commonly used quality of life questionnaires in breast cancer are EORTC QLQ-BR23, the FACT-B, and the extended FACT-B+4. More recently, the EORTC EORTC QLQ-BR42 was developed. This systematic review compares the various versions of the EORTC QLQ and FACT tools for breast cancer in terms of their content, validity, and psychometric properties. Thirty-six studies met the inclusion criteria. All questionnaires have been proven to be valid, reliable and responsive. The provisional EORTC QLQ-BR45 transitioned to the EORTC QLQ-BR42 in Phase IV of its development, which encompasses the side effects associated with the latest breast cancer treatments. Both the EORTC and FACT measures assess physical and mental dimensions of quality of life, with the EORTC measure placing relatively more emphasis on physical content and FACT placing relatively more emphasis on mental (social and emotional) content. The four additional items in the FACT-B+4 were developed to address arm lymphoedema following axillary surgery. The development and uptake of quality of life tools are essential in the evaluation of breast cancer treatments. The EORTC QLQ-BR42 and FACT-B are both valid, reliable, and responsive QoL questionnaires.

Critical Steps for Determining Capacity to Refuse Emergency Medical Services Transport: A Modified Delphi Study

ABSTRACT OBJECTIVES Emergency physicians without specialized Emergency Medical Services (EMS) training are often required to provide online medical oversight. One common ethical question faced by these physicians is the assessment for decision-making capacity in a patient who does not accept EMS transport to the hospital. We sought expert consensus for a standardized set of guiding questions and recommendations to ensure a rigorous and feasible capacity assessment. METHODS A modified Delphi method approach was used to achieve group consensus among expert individuals. Nineteen physician experts were recruited from across the country, representing populations totaling over 22 million and a variety of urban, suburban, and rural practice environments. Experts completed a Round 1 survey that included 19 questions surrounding best practices for capacity evaluation among patients refusing transport. The threshold for consensus was predefined as 80% agreement. Participants gathered virtually meeting where the results from the first round were shared with the group. Discussion generated new items and refined the language of existing items. Following the virtual meeting, a Round 2 survey was conducted, and voted on by the panel for the items that did not meet consensus in Round 1. RESULTS After the first round, 15 of 19 items reached consensus. Three of the items that met consensus were universally noted to require language modification for clarification. A large portion of the discussion involved the proper method of integrating patient concerns around ambulance transport (e.g., cost of transport, financial concerns, social barriers) into the capacity assessment and whether alternate care options should be discussed. After the second round of voting, one additional item was reversed to meet consensus, resulting in a total of 16 items. CONCLUSIONS A consensus expert panel was able to agree upon 16 standardized steps to guide best practices and assist emergency physicians in real-time evaluation of patients that refuse EMS transport.

Validation of the parents’ version of the KINDLR and Kiddy Parents questionnaire in a South African context

BackgroundThis study aimed to assess the usefulness of the parent version of the KINDLR and the additional items of the Kiddy Parents questionnaire in the South-African context and to validate it as an appropriate tool for measuring health-related quality of life (HRQoL).MethodThe ExAMIN Youth SA study was designed to investigate lifestyle behaviours, including psychosocial factors that may adversely impact on cardiovascular health of children. Construct validity was examined by using exploratory and confirmatory factor analysis, while internal consistency was tested by Cronbach’s alpha. The final factor structure was confirmed by model fit indices.ResultsThe study included children (n = 1088) aged between 5 and 10 years in North-West, South Africa. The reliability coefficients of the original factors could not be reproduced in this data set, with the Cronbach’s alphas ranging between 0.46 and 0.78. With exploratory factor analysis, including the additional items, our data supported a 7-factor structure with acceptable internal consistency (Cronbach’s alpha: 0.68–0.79; Omega: 0.75–0.85) and acceptable model fit indices (CFI: 0.91; TLI: 0.90; RMSEA: 0.05; SRMR: 0.07). Two factors (emotional wellbeing and everyday functioning) further split into separate factors for positive and negative experiences related to each of these dimensions.ConclusionWe confirmed a new factor structure of the parent version of the KINDLR and the additional items of the Kiddy Parents questionnaire, which can be used in the African context. Although the new factor structure has great overlap with the original structure, some items did not contribute to the factors as expected. Language and cultural differences between the original German group and the current South African study group resulted in a different factor structure.

Towards similar alignment and unique uniformity in collaborative filtering

Representation learning, with its desired properties, including Alignment and Uniformity, has recently emerged as an effective approach in collaborative filtering (CF) for recommender systems. Alignment measures the distance between positive pairs, and uniformity describes the distribution of all samples on the unit hypersphere. Despite the effectiveness of existing research, the challenges of insufficient alignment and uniformity bias persist in studies on the desired properties of recommender systems: (1) Sparse interaction information leads to an insufficient alignment representation. (2) Calculating the uniformity loss based on duplicate samples introduces bias, which affects the overall representation uniformity.Building on aforementioned challenges, we propose a Similar Alignment and Unique Uniformity model called SUAU. SUAU mitigates insufficient alignment by introducing additional item-similar item pairs for model training and employing a uniqueness strategy to prevent uniformity bias. More specifically, we propose a similar items generation method that identifies the most similar items based on the interaction behavior of the original items’ related users to form item-similar item pairs. The experimental results obtained on three highly sparse datasets demonstrate that the propose model achieves superior alignment and uniformity compared with state-of-the-art models, notably surpassing the best CF methods in terms of recommendation performance. We have open-sourced the source code on a publicly accessible website: https://github.com/ZzYUuuu/SUAU.

Registered Dietitian Nutritionists’ Attitudes Toward Interprofessional Health Care Teams: A Cross-Sectional Survey

BackgroundRegistered dietitian nutritionists (RDNs) are important members of interprofessional health care teams; yet, there is limited research of RDN perspectives of interprofessional teams. ObjectiveTo examine associations between the characteristics of RDNs and their attitudes of team-based care (TBC). DesignA cross-sectional electronic Qualtrics survey encompassing demographic questions, the Attitudes Toward Interdisciplinary Health Care Teams (ATIHCT) scale, and additional interprofessional-related items was distributed to RDNs during January 2020. Participants/settingA total of 5018 RDNs from various regions/specialties in the United States were recruited primarily via direct email from a random list of RDNs obtained through the Commission on Dietetic Registration. The final sample was N = 616; 12.3% of RDNs and 88.1% of RDNs who initiated the survey. Main outcome measuresATIHCT subscale scores, which measure attitudes regarding efficiency of TBC and service quality of TBC. Statistical analyses performedMultiple linear regression modeled area of specialty, time with RDN credential, location, sex, frequency of TBC, and how valued the RDN perceived him or herself to be as independent variables, with ATIHCT subscales as outcome variables. Data were subjected to confirmatory factor analysis to determine appropriate use of the ATIHCT scale in the sample. ResultsFoodservice (β = –1.48; P = .004) and sports nutrition RDNs (β = –2.58; P = .014) had lower scores for attitudes regarding efficiency of TBC (subscale 1) than clinical RDNs. Greater perceived value of the RDN was associated with higher scores for attitudes regarding efficiency (β = .66; P < .001). Greater perceived value of the RDN (β = .13; P = .03) was associated with higher scores for attitudes regarding service quality of TBC (subscale 2). ConclusionsSpecialty and perceived RDN value are associated with more favorable interprofessional attitudes among RDNs. To support positive attitudes regarding interprofessional collaboration, efforts should be honed to foster appreciation and clarity of the RDN’s role in TBC.

Lessons from the implementation of Threat and Error Management: A case study of the Australian general aviation

Threat and Error Management (TEM) is one of recent safety initiatives to further improve the overall aviation safety level. In response to the recommendations of the International Civil Aviation Organisation (ICAO) for TEM to be introduced to all pilot training syllabi, the Civil Aviation Safety Authority (CASA) in Australia mandated TEM as an additional assessment item for various levels of flight tests and ground examinations in 2009. The current study adopted a two-pronged approach: A case study to highlight the importance of TEM training, followed by gaining an in-depth appreciation as to how TEM was implemented and its effects of the use of TEM training. A semi-structured interview of five highly experienced general aviation Flight Examiners (FE) was conducted, and thematic analysis was performed for the interview data from which four main themes emerged: 1) Impracticality; 2) Lack of guidance and support; 3) TEM implementation; and 4) TEM in practice. All participants shared the same view that TEM was not implemented well. It is expected that the findings from this study add to the body of knowledge to better inform and provide guidance and reference for National Aviation Authorities (NAA) to develop an implementation plan when considering the implementation of TEM training in their regulatory framework. Our study highlights a notable disconnect in CASA’s operational workforce’s grasp of TEM, impacting trust in the general aviation sector in its significance and application. It should be also noted that since our study, to address this and foster innovation in safety projects, CASA has initiated comprehensive strategies such as workforce planning and actively engaging in Technical Working Groups (TWGs) to harness community expertise for safety improvements. Nevertheless, the findings have the potential to provide information regarding pilot attitudes to future safety initiatives in other rapidly growing sectors such as Recreational Aviation (RA) and Remotely Piloted Aircraft System (RPAS).

Validation of a Primary Biliary Cholangitis-Specific Version of Chronic Liver Disease Questionnaire: CLDQ-PBC.

Primary biliary cholangitis (PBC) is a chronic liver disease, leading to cirrhosis and impairment of patient-reported outcomes. We aimed to develop a PBC-specific version of the Chronic Liver Disease Questionnaire (CLDQ) instrument to assess health-related quality of life of patients with PBC. From our Liver Database, we included patients with PBC who had CLDQ, clinicolaboratory data, and completed Short Form-36 and The Functional Assessment of Chronic Illness Therapy-Fatigue. The 29 items of CLDQ were subjected to item reduction, exploratory factor analysis, and fed into a standard instrument validation pipeline. Data were available for 108 patients with PBC: 57 ± 11 years, 7% male, 58% cirrhosis, and 24% decompensated cirrhosis (Child B and C). Of 29 CLDQ items, none met the exclusion criteria. Exploratory factor analysis (95% of variance) returned 7 factors. Based on evaluation of factor loadings and face validity, those factors yielded 7 domains (Diet, Emotion, Fatigue, Itch, Symptoms, Sleep, and Worry). Good to excellent internal consistency (Cronbach's α 0.85-0.93) was observed for 5/7 domains. For the remaining 2 domains (Diet and Itch), additional items obtained from patients, experts, and review of the literature were included. For 5 domains, known-group validity tests discriminated between patients with PBC with and without cirrhosis, advanced cirrhosis, and depression ( P < 0.05 for 3-5 domains). The CLDQ-PBC domains were correlated with relevant domains of Short Form-36, CLDQ-PBC Fatigue correlated with Fatigue Scale of Functional Assessment of Chronic Illness Therapy-Fatigue (rho = +0.85), and CLDQ-PBC Worry domain negatively correlated with alkaline phosphatase (rho = -0.38, P = 0.0082). The CLDQ-PBC has been developed based on the original CLDQ. The new instrument has evidence for internal consistency and validity and is being fully validated using an external cohort.

Validity and reliability of the Yonsei lifestyle profile-active, balance, connection, diversity.

Lifestyle, defined as a way of living resulting from an individual's deliberate choices, is a crucial factor in improving and maintaining health. Consequently, the measurement and analysis of lifestyle are of significant importance. This study aims to validate the validity and reliability of the Yonsei Lifestyle Profile-Active, Balance, Connection, Diversity (YLP-ABCD) in measuring health-related lifestyles. Data were collected from 300 participants aged 55 and older using the YLP-ABCD. To analyse the validity and reliability of the YLP-ABCD, analysed using frequency, descriptive statistics, confirmatory factor analysis, and Rasch model analysis. The results indicate that the YLP-ABCD, which consists of 35 items, demonstrates unidimensionality and local independence. The Rasch model confirmed the suitability of the 5-point Likert scale for the factors, excluding subfactors Balanced and Unbalanced. The item fit criteria (0.5 < MNSQ < 1.5) were met for all items. The distribution of the respondents' abilities suggests the need for additional items to measure their ability levels. Both the item and respondent separation indices and their reliabilities were satisfactory. This study confirmed the utility of the YLP-ABCD as a valuable tool for measuring and understanding the multifaceted diversity of lifestyles. Therefore, by utilising YLP-ABCD to quantitatively measure health lifestyles, we anticipate contributing to improvements in human health and quality of life.