Assessment Tool Research Articles

A Narrative Review Comparing Nutritional Screening Tools in Outpatient Management of Cancer Patients.

Malnutrition during cancer has a negative impact on prognosis and quality of life. Therefore, it is important to identify those patients at higher nutritional risk to prevent its development. There are nutritional screening tools, such as MUST and NRS-2002, that focus on the patient on admission to hospital. However, most patients will develop malnutrition in the outpatient or ambulatory setting. This study aims to determine which nutritional screening tool is most effective in assessing nutritional risk in the outpatient oncology patient, highlighting the parameters analysed by these tools. Seventeen articles were reviewed, with the most important variables being tumour location, tumour stage, age, and gender, as well as recent weight loss, dietary intake, and digestive disorders. The Nutriscore, NRS-2002, and MUST tools are considered suitable, but the choice varies depending on these parameters. MNA is suitable for elderly patients, while SNAQ was not considered reliable in this population. In conclusion, MUST, NRS-2002, and Nutriscore are suitable tools, but their choice depends on specific characteristics. There is currently no universal tool for nutritional risk assessment in outpatients.

Interconnect Stress Testing as a Tool for Assessment of Reliability of Modern PCBs

The of miniaturization can be seen in electronics for some time already. The pinout of active components grows enabling them to have additional functions. The trend in usage of System in a Package (SiP) solutions is also evident thus routing of the active and passive elements became also challenging. To overcome this challenge boards with High Density Interconnection (HDI) where not only through hole, but also different kinds of microvias e.g. blind, buried, stacked, staggered via are used. The standard procedure to test reliability of boards and assemblies is very resource-hungry especially in time and money, as the tests have to be carried out in climatic chambers which lasts for weeks, followed by additional destructive testing like cross-sections. On the other hand IST (Interconnect Stress Testing) is a quick test, that enables to have assessment of the used technology especially the quality of the through holes of all types. Although the coupons are destroyed during the test, it is not necessary to test the manufactured circuits. This saves both materials and time. The technology optimizations and the key findings will be presented within the paper.

Psychosocial factors associated with lower extremity re-injury risk in soccer players: Contribution of self- confidence, functional attention, and re-injury anxiety.

Despite the availability of specialized assessment tools, psychological readiness is usually not considered when deciding to return to sport (RTS) after sport injury. Re-injury anxiety, self-confidence, and functional attention may be associated with sport re-injury, making it important to evaluate these factors before RTS. This study aimed to predict lower extremity re-injury in soccer players using self- confidence, functional attention, and re-injury anxiety as predictive variables. Prospective cohort study. Laboratory. Sixty-two male soccer players, who were older than 18 years of age, suffered from lower extremity injuries, had completed the rehabilitation program, and were ready to RTS. Prior to returning to the sport, participants completed a pre-season questionnaire on their previous injuries, self-confidence, re-injury anxiety, and level of functional attention. The primary outcome measured was the risk of re-injury during the upcoming competitive season, and logistic regression was utilized to calculate odds ratios (OR) with 95% confidence intervals to determine the association between each risk factor and re- injury. Overall re-injury rate was 5.56 injuries per 1000 hours of play. Self-confidence scores ≤ 47 increased the risk of re-injury by 2.26 times (relative risk, 2.26; 95% CI, 1.31-3.91; OR, 5.00; 95% CI, 1.56-16.04) and each unit increase in self-confidence score reduced the risk of re-injury by 10% (OR:0.90; CI: 0.82-0.99, p=0.03). Regarding re-injury anxiety, a score >22 was associated with 2.43 times the risk of re-injury (relative risk, 2.43; 95% CI, 1.44-4.13; OR, 6.46; 95% CI, 1.93-21.69) and each unit increase in re-injury anxiety score increased the risk of injury by 45% (OR:1.45; CI: 1.13-0.87, p=0.004). Increased re-injury anxiety and decreased self-confidence are associated with higher odds of lower extremity re-injury in male soccer players. To reduce the risk of re-injury, athletic trainers and sport psychologists should take these psychological factors into account when evaluating the psychological readiness of soccer players with a history of lower extremity injury to RTS.

Enhancing Elderly Nutrition: A Qualitative Evaluation of Menus in a Social Solidarity Institution in the North of Portugal.

This work addresses the importance of food and nutrition in promoting the health of the elderly population, with a specific focus on the qualitative evaluation of menus provided by a social solidarity institution in Portugal. The aim of this study is to conduct a qualitative evaluation of menus furnished by a social solidarity institution situated in the northern region of Portugal in order to prevent and/or treat malnutrition in the elderly. The methodology involves the evaluation of four weekly menus, totaling 28 complete daily menus for the elderly, using the "Avaliação Qualitativa de Ementas Destinadas a Idosos" (AQEDI) tool. This assessment tool comprises six domains: general items, soup, protein suppliers, carbohydrate suppliers, vegetable suppliers, and dessert, each consisting of various parameters. The findings reveal that all menus were classified as "acceptable," with percentages ranging from 60.73% to 68.84%, and suggest that there exists room for improvement. This study emphasizes the necessity for coordinated efforts within the institution to enhance menu planning, taking into account both nutritional guidelines and sensory aspects of food. Effective coordination within the institution is crucial for maintaining positive aspects and rectifying inadequacies in menu planning.

Mental and Physical Symptoms and Perceived Health Risks of Pregnant and Postpartum Women following the Significant Shift in COVID-19 Management in China: A Cross-Sectional Survey

Background. There was a remarkable downgrade in China’s COVID-19 response strategies in January 2023. The COVID-19 infection rate grew rapidly in the early stages following the management policy shift. This study attempted to explore the associations between SARS-CoV-2 infection and mental or physical health status in pregnant and postpartum women and the role of perceived health risks and family members’ SARS-CoV-2 infection status on these associations by capturing the impact of policy shifts in a short period of time. Methods. This cross-sectional study with a random sample from a convenience sample of hospitals was conducted in pregnant and postpartum women in January 2023. Standardized assessment tools were employed to assess anxiety, depressive and physical symptoms, and feelings of hopelessness. Hierarchical multiple logistic regressions were conducted to examine the mechanisms of associations of interests by including a range of sociodemographic factors, self-perceived health, SARS-CoV-2 infection status, and perceived health risks as covariates. Results. Of the 1,013 pregnant and postpartum women aged 32.0 ± 0.3 years, 58.2% (n = 590) were diagnosed with COVID-19, and 49.4% (n = 500) had family members who were infected with SARS-CoV-2. Nearly 98% of the included participants took measures to prevent SARS-CoV-2 infection. A COVID-19 diagnosis was positively associated with feelings of hopelessness (OR = 1.68, 95% CI: 1.20–2.35), probable anxiety (OR = 6.42, 95% CI: 2.18–24.61), possible depression (OR = 2.56, 95% CI: 1.07–6.70), and physical symptoms (OR = 6.28, 95% CI: 1.63–42.03) after adjusting for sociodemographic and health characteristics, while the associations presented no statistical significance when family members’ SARS-CoV-2 infection status and perceived health risks were introduced into the models. Conclusions. Our results suggested that pregnant and postpartum women may experience physical and mental health challenges when they or their family members contracted COVID-19 in the context of a considerable shift in COVID-19 management. Early detection of poor health status and its risk factors for vulnerable groups during shifts in health policy and administrative practice is very necessary, and health services, including easy access to psychosocial support and obstetric counselling, should be prioritized.

Factor model for ordinal categorical data with latent factors explained by auxiliary variables applied to the major depression inventory

In behavioral and social research, questionnaires are an important assessment tool, through which individuals can be categorized according to how they classify themselves in respect to a personal trait. One example is the Major Depression Inventory (MDI), which is widely used for the assessment of depression. It can also be used as a depression severity scale, with scores ranging from 0 to 50 constructed considering the same weight for each item in the MDI. However, the dependence among the items of the questionnaire suggests that a score with better properties could be obtained through factor models, which besides allowing to reduce the dimensionality of multivariate data, provides the estimation of common factors and factor loadings that often have an interesting theoretical interpretation. Additionally, auxiliary information could be available and, the effect of these variables in the latent factor could be estimated and provide interesting results. Thus, the main aim of this paper is to propose a factor model for ordered categorical data which incorporates auxiliary variables to explain the latent factors. The proposed model provides an alternative score to MDI based on the estimated latent factors that takes the uncertainty in the data and auxiliary information into account.

Development and validation of a brain fog scale for coeliac disease.

Brain fog is a subjective cognitive impairment commonly reported in coeliac disease. A standardised tool to define and assess it is an important unmet need. To develop a patient-informed tool to assess brain fog in coeliac disease to support clinical care, research and drug development. A pilot online study defined patient descriptors of brain fog. A second study evaluated the factor structure and performance of the scale across two-time points ('Now' and in the 'Past week'). One month later, participants were invited to repeat the study with two online cognitive processing tests, the Stroop task and the trail making test. Among adults with treated coeliac disease, 37 (91.9% F) participated in the pilot study and 510 (88.8% F) in the second study of whom 99 repeated the study 1 month later with 51 completing cognitive testing. The most common brain fog descriptors were 'difficulty focusing', 'difficulty thinking' and 'difficulty finding the right words and communicating'. The 12-item scale reflects 'cognitive impairment' and 'somatic and affective experience' and demonstrates strong psychometric properties. It tracked with patients report of brain fog being present or absent across two-time points. It did not significantly correlate with the cognitive tests. The brain fog assessment and severity scale is the first patient-informed clinical outcomes assessment tool measuring brain fog in coeliac disease. It is brief and validated for two time-based formats. Further research coupling it with biomarker discovery is needed to confirm its validity as a predictor of cognitive performance.

A publicly available deep learning model and dataset for segmentation of breast, fibroglandular tissue, and vessels in breast MRI

Breast density, or the amount of fibroglandular tissue (FGT) relative to the overall breast volume, increases the risk of developing breast cancer. Although previous studies have utilized deep learning to assess breast density, the limited public availability of data and quantitative tools hinders the development of better assessment tools. Our objective was to (1) create and share a large dataset of pixel-wise annotations according to well-defined criteria, and (2) develop, evaluate, and share an automated segmentation method for breast, FGT, and blood vessels using convolutional neural networks. We used the Duke Breast Cancer MRI dataset to randomly select 100 MRI studies and manually annotated the breast, FGT, and blood vessels for each study. Model performance was evaluated using the Dice similarity coefficient (DSC). The model achieved DSC values of 0.92 for breast, 0.86 for FGT, and 0.65 for blood vessels on the test set. The correlation between our model’s predicted breast density and the manually generated masks was 0.95. The correlation between the predicted breast density and qualitative radiologist assessment was 0.75. Our automated models can accurately segment breast, FGT, and blood vessels using pre-contrast breast MRI data. The data and the models were made publicly available.

Clinician Educator Milestones: Assessing and Improving Educators' Skills.

The importance of the clinician educator (CE) role in delivery of competency-based medical education is well recognized. There is, however, no formal mechanism to identify when faculty have the knowledge, skills, and attitudes to be successful CEs. In 2020, the Accreditation Council for Graduate Medical Education, Accreditation Council for Continuing Medical Education, Association of American Medical Colleges, and American Association of Colleges of Osteopathic Medicine convened a workgroup of 18 individuals representing multiple medical specialties and diverse institutions in the United States, including nonphysician educators, a medical student, and a resident, to develop a set of competencies, subcompetencies, and milestones for CEs.A 5-step process was used to create the Clinician Educator Milestones (CEMs). In step 1, the workgroup developed an initial CEM draft. Through brainstorming, 141 potential education-related CE tasks were identified. Descriptive statements for each competency and developmental trajectories for each subcompetency were developed and confirmed by consensus. The workgroup then created a supplemental guide, assessment tools, and additional resources. In step 2, a diverse group of CEs were surveyed in 2021 and provided feedback on the CEMs. In step 3, this feedback was used by the workgroup to refine the CEMs. In step 4, the second draft of the CEMs was submitted for public comment, and the CEMs were finalized. In step 5, final CEMs were released for public use in 2022.The CEMs consist of 1 foundational domain that focuses on commitment to lifelong learning, 4 additional domains of competence for CEs in the learning environment, and 20 subcompetencies. These milestones have many potential uses for CEs, including self-assessment, constructing learning and improvement plans, and designing systematic faculty development efforts. The CEMs will continue to evolve as they are applied in practice and as the role of CEs continues to grow and develop.

Living with Dysphagia: A Survey Exploring the Experiences of Adults Living with Neuromuscular Disease and their Caregivers in the United Kingdom.

Dysphagia is common in adults living with neuromuscular disease (NMD). Increased life expectancy, secondary to improvements in standards of care, requires the recognition and treatment of dysphagia with an increased priority. Evidence to support the establishment of healthcare pathways is, however, lacking. The experiences of people living with NMD (pplwNMD) and their caregivers are valuable to guide targeted, value-based healthcare. To generate preliminary considerations for neuromuscular dysphagia care and future research in the United Kingdom, based on the experiences of those living with, or caring for, people with NMD. Two surveys (one for adults living with NMD and dysphagia, and a second for caregivers) were co-designed with an advisory group of people living with NMD. Surveys were electronically distributed to adults living with NMD and their caregivers between 18th May and 26th July 2020. Distribution was through UK disease registries, charity websites, newsletters, and social media. Adults living with NMD receive little information or education that they are likely to develop swallowing difficulties. Most respondents report wanting this information prior to developing these difficulties. Difficulties with swallowing food and medication are common in this group, and instrumental assessment is considered a helpful assessment tool. Both adults living with NMD and caregivers want earlier access to neuromuscular swallowing specialists and training in how best to manage their difficulties. Improvement is needed in the dysphagia healthcare pathway for adults living with NMD to help mitigate any profound physical and psychological consequences that may be caused by dysphagia. Education about swallowing difficulties and early referral to a neuromuscular swallowing specialist are important to pplwNMD and their caregivers. Further research is required to better understand the experiences of pplwNMD and their caregivers to inform the development of dysphagia healthcare pathways.

CARL Library Impact Framework

In December 2021, the Canadian Association of Research Libraries (CARL) released the CARL Library Impact Framework (CLIF). While library impact has been a topic of discussion for many years, CLIF offers a new contribution to the dialogue on the demonstration of impact of research libraries. The concept of impact pathways was borrowed from the Federation for the Humanities and Social Sciences report entitled Approaches to Assessing Impacts in the Humanities and Social Sciences. To realize the impact pathways concept, CLIF has adapted a logic model framework. This approach provides users of CLIF with a way to represent a more complete arc of influence of research libraries systematically and visually. By design, CLIF encourages the use of assessment techniques and tools beyond the quantitative data collection and descriptive statistics often used by research libraries. This paper provides an overview of CLIF, its genesis, intent, structure, and possibilities for its application in research libraries.

Aggressive Behaviour Based on the Types of Agni Bala Among Young Adults

Agni is one of the main concepts that are dealt in Ayurveda. Agni is responsible for the digestion and metabolism of the ingested food. The types of Agni included are Visama agni, Tikshna agni, Manda agni and Sama agni. Aggression is often a harmful social interaction with the intention of inflicting damage or harm to others or on self. The independent variable and dependent variable is Agni bala and aggressive behaviour respectively. This study is attempted to study the difference on aggressive behaviour based on the Agni type among young adults. The hypothesis proposed was a null hypothesis which implied that there is no significance of Agni bala on aggressive behaviour among young adults. Data was collected using Agni bala assessment tool and Buss-Perry aggressive questionnaire. It is a quantitative study which has employed comparative research design. Comparative research design is used since there is a comparison among the Agni bala types (Visama agni, Tikshna agni, Manda agni and Sama agni). Random sampling was done and the total sample size is 180 young adults between the age group 18-30 years. ANOVA was the statistical test used for the study. The ANOVA test showed that there is no difference on the aggressive behaviour based on the Agni type since the significance level is 0.007. The results were calculated using Statistical Package for Social Sciences (SPSS). The hypothesis was accepted which indicate that the there is no significant difference on aggressive behaviour based on the type of Agni bala among young adults. The study concluded that there is no difference on aggressive behaviour based on the type of Agni bala among young adults.

Understanding Antenatal Care Service Quality for Malaria in Pregnancy through Supportive Supervision Data in Tanzania.

Malaria in pregnancy (MiP) is associated with maternal anemia, spontaneous abortion, and infant and maternal death. In Tanzania, MiP service data are collected through routine Malaria Services and Data Quality Improvement (MSDQI) supportive supervision rounds at antenatal care (ANC) facilities. Using structured assessment tools, the U.S. President's Malaria Initiative Impact Malaria Project reviewed two annual rounds of MSDQI data (492 facilities in 2021 and 522 facilities in 2022), including ANC records and client satisfaction interviews. We assessed coverage of key MiP care components, used logistic regression to analyze uptake of the recommended three or more doses of intermittent preventive treatment in pregnancy (IPTp3+), and assessed client satisfaction. Coverage of most MiP care components exceeded 80%; however, only 38% of women received all components. Odds of receiving IPTp3+ were much lower among late ANC initiators than among those who initiated ANC during their first trimester (odds ratio [OR], 0.46; 95% CI, 0.38-0.57). Uptake of IPTp3+ increased almost exponentially by number of ANC visits. Women with seven visits were 30 times more likely than those with three visits to receive IPTp3+ (OR, 30.71; 95% CI, 11.33-83.22). Just 54% of clients had anemia screening and only 46% received IPTp3+. Client satisfaction with services and provider communication was high (98% and 97%, respectively); only 8% of client visits exceeded 3 hours. Increased ANC visits could boost IPTp3+ coverage. Routine MSDQI supportive supervision data are useful to assess quality of care, identify service delivery gaps, and guide policies to improve quality of MiP services.

Unveiling quality, clinical, and financial Impacts of Pulmonary Tuberculosis Clinical Pathway Implementation in Magelang Public Hospital, Indonesia

Tuberculosis (TB) is a popular endemic disease in Indonesia with increased risk outcomes. The clinical pathway (CP) is crucial to enhancing healthcare services and resource efficiency despite discrepancies in service variability reduction, clinical outcomes improvement, and cost saving. Therefore, this study aimed to assess pulmonary TB CP and evaluate its impacts on clinical and financial results, as well as barriers to implementation at Tidar Hospital in Magelang, Indonesia. A sequential explanatory mixed-method design was used from July 2022 to January 2023. The study began with a retrospective analysis of medical records of TB patients (total sampling, n=92). In-depth interviews (IDIs) were conducted with healthcare workers including the quality and medical committee, case manager, CP team, inpatient and non-inpatient nursing sub-coordinators, and pulmonary specialists. In addition, eight multidiscipline healthcare professionals attended the focus group discussions (FGDs). The audio recordings were transcripted verbatim and subjected to thematic analysis. The results showed that the quality and content of CP based on TB evaluation using the Integrated Clinical Pathway Assessment Tool (ICPAT) was 62.6%. Four themes were obtained: 1) CP implementation techniques, 2) supportive factors in the success of CP, 3) organization support in CP implementation, and 4) TB patient outcomes. Furthermore, procedure compliance after CP implementation was 33%. There were no significant differences in the length of stay (p=0.77), diagnosis investigation and therapy appropriateness (100%), mortality (4 vs 3 patients; p=0.589), and cost efficiency with an average cost of care (Rp 6.994.508,- vs Rp 5.521.091,-; p=0.083) before and after CP implementation. Readmission rates were low before and after deployment (1 vs. 2 patients). This study found no significant clinical or financial benefits in TB CP implementation. These results imply the need for hospital leadership and a multidisciplinary team to overcome CP implementation hurdles.

PROTOCOL: Effectiveness of public-private partnerships on educational access and quality of primary and secondary schooling in low- and middle-income countries: A systematic review.

This protocol serves as a guiding source for a Campbell registered systematic review aiming to assess the effectiveness of Public-Private Partnerships (PPPs) in education in Low- and Middle-Income Countries (LMICs). The primary question for this review is: What is known about the impact of PPPs on improving access (i.e., enrolment, attendance, drop-out, and completion) and quality (i.e., students' learning outcomes and teachers' teaching practices) of primary and secondary schooling in LMICs? Using a predefined search query, we will retrieve studies from various databases including Scopus, Campbell Library, EBSCO Education Research Complete, NBER, Dissertation and Theses Global (ProQuest), along with other sources of grey literature. Covidence will be used for screening and extraction. A bias assessment tool will be used for the included studies. A standardised mean difference (SMD) effect size of Hedges' g will be calculated for the outcome variables using RevMan. This review will provide updated evidence about the impact of PPP in school education across LMICs, which will be instrumental for policy and practice level decisions for education improvement.

The role of early cerebral edema and hematoma assessment in aneurysmal subarachnoid hemorrhage (a-SAH) in predicting structural brain abnormalities in cognitive impairments-- case controlled study.

Early assessment and management of cerebral edema and hematoma following aneurysmal subarachnoid hemorrhage (a-SAH) can significantly impact clinical cognitive outcomes. However, current clinical practices lack predictive models to identify early structural brain abnormalities affecting cognition. To address this gap, we propose the development of a predictive model termed the a-SAH Early Brain Edema/Hematoma Compression Neural (Structural Brain) Networks Score System (SEBE-HCNNSS). In this study, 202 consecutive patients with spontaneous a-SAH underwent initial computed tomography (CT) or magnetic resonance imaging (MRI) scans within 24 hours of ictus with follow-up 2 months after discharge. Using logistic regression analysis (univariate and multivariate), we evaluated the association of clinically relevant factors and various traditional scale ratings with cognitive impairment (CI). Risk factors with the highest area under the curve (AUC) values were included in the multivariate analysis and least absolute shrinkage and selection operator (LASSO) analysis or Cox regression analysis. A total of 177 patients were enrolled in the study, and 43 patients were classified with a high SEBE-HCNNSS grade (3 to 5). After a mean follow-up of 2 months, 121 individuals (68.36%) with a-SAH and 3 control subjects developed incident CI. The CT inter-observer reliability of the SEBE-HCNNSS scale was high, with a Kappa value of 1. Furthermore, ROC analysis identified the SEBE-HCNNSS scale (OR 3.322, 95% CI 2.312-7.237, P=0.00025) as an independent predictor of edema, CI, and unfavorable prognosis. These results were also replicated in a validation cohort. Overall, the SEBE-HCNNSS scale represents a simple assessment tool with promising predictive value for CI and clinical outcomes post-a-SAH. Our findings indicate its practical utility as a prognostic instrument for risk evaluation after a-SAH, potentially facilitating early intervention and treatment.

Prevalence of Dysphagia and Risk of Malnutrition in Elderly Living in Nursing Homes.

Swallowing difficulties commonly co-occur with malnutrition in the elderly. However, there is no consensus on which assessment tools to use, and thus reported prevalence varies. The aim of this study was to survey the prevalence of dysphagia and risk of malnutrition in elderly people in nursing homes, evaluate the possible associations between swallowing function and malnutrition and survey whether there were associations between self-perceived function and the results of a screening of dysphagia. A total of 35 residents (aged 67-100years old) without serious cognitive impairment in the general wards of two nursing homes in Gothenburg were investigated. Swallowing ability was assessed with the Gugging Swallowing Screen (GUSS) test, self-rated swallowing ability with the 4QT and the Swedish Eating Assessment Tool-10 (S-EAT-10) and risk of malnutrition with the Minimal Eating Observation and Nutrition Form-Version 2 (MEONF-II). Eleven participants (31.4%) exhibited dysphagia according to the GUSS and 10 participants (29.4%) showed moderate or high risk of malnutrition. In total 16 (46%) participants reported abnormal swallowing on 4QT and 14 (40%) participants reported abnormal swallowing on S-EAT-10. However, less than half of these had dysphagia according to the GUSS. No association was found between swallowing ability measured by the GUSS and risk of malnutrition, although a tendency towards a weak association was noted, or self-rated swallowing ability measured by the 4QT and S-EAT-10. The study found that approximately one-third of the tested participants presented with signs of dysphagia as measured with the screening instrument GUSS, even though only a few were known to have any difficulties prior to testing. This highlights that dysphagia is probably more prevalent than patients themselves and caregivers are aware of, thus, screening is of importance, to enable safer nutritional intake.

An effort to improve the collection of patient-generated data: readability and understandability of patient-reported outcomes measures in a survivorship cohort.

In this study, we evaluated readability and understandability of nine French-languagePatient-Reported Outcome Measures (PROMs) that are currently used in a contemporary longitudinalcohort of breast cancer survivors as part of an effort to improve equity in cancer care and research. Readability of PROMs was assessed using the Flesh Reading Ease Score (FRES), the Gunning's Fog Index (FOG), and the FRY graphics. Readability was considered ideal if mean score ≤ 6th-grade level and acceptable if between 6th and 8th grade. Understandability was evaluated using the Patient Education Materials Assessment Tool and defined as ideal if PEMAT ≥ 80%. The Evaluative Linguistic Framework for Questionnaires (ELF-Q) provided additional qualitative elements to assess understandability. Plain-language best practice was met if both readability and understandability were ideal. None of the 9 PROMs evaluated had ideal readability scores and only 1 had an acceptable score. Understandability ranged from 55% to 91%, and only 3 PROMs had ideal scores. ELF-Q identified points for improvement in several understandability dimensions of the PROMs. None of the instruments met the definition of plain-language best practice. None of the studied PROMs met the standards of readability and understandability. Future development and translation of PROMs should follow comprehensive linguistic and cultural frameworks to ensure plain-language standards and enhance equitable patient-centered care and research.

Development of a vocabulary list for the Persian version of the profile of early expressive phonological skills: a pilot study

ABSTRACT This research presents a two-phase study aimed at developing and validating the Profile of Early Expressive Phonological Skills for Persian (PEEPS-P) as an assessment tool for evaluating phonological abilities in toddlers. In Phase 1, a total of 60 words were meticulously selected for inclusion in both the basic and expanded word lists, taking into account factors such as age of acquisition (AoA) and phonological complexity. The word lists included monosyllabic and multisyllabic words with diverse consonant clusters, covering various semantic categories. Moving on to Phase 2, data were collected from a sample of 81 toddlers belonging to different age groups. Three elicitation methods were employed to gather data for both the basic and expanded word lists. The study also examined the time required to complete the test and Percentage of Consonant Correct (PCC) scores. The results revealed that, as children's age increased, there was an increase in the percentage of words produced, accompanied by a decrease in the time taken to complete the test. For instance, the youngest age group (18–23 months) produced approximately 46.83% of words in the basic word list, taking an average of about 22 minutes and 3 seconds, while the oldest age group (30–35 months) produced approximately 95.5% of words in both word lists in less than 17 minutes. Ultimately, the findings suggest that the PEEPS-P has the potential to serve as a valuable tool for assessing phonological abilities in toddlers aged 18–35 months.

Don't judge a book or health app by its cover: User ratings and downloads are not linked to quality.

To analyse the relationship between health app quality with user ratings and the number of downloads of corresponding health apps. Utilising a dataset of 881 Android-based health apps, assessed via the 300-point objective Organisation for the Review of Care and Health Applications (ORCHA) assessment tool, we explored whether subjective user-level indicators of quality (user ratings and downloads) correlate with objective quality scores in the domains of user experience, data privacy and professional/clinical assurance. For this purpose, we applied spearman correlation and multiple linear regression models. For user experience, professional/clinical assurance and data privacy scores, all models had very low adjusted R squared values (< .02). Suggesting that there is no meaningful link between subjective user ratings or the number of health app downloads and objective quality measures. Spearman correlations suggested that prior downloads only had a very weak positive correlation with user experience scores (Spearman = .084, p = .012) and data privacy scores (Spearman = .088, p = .009). There was a very weak negative correlation between downloads and professional/clinical assurance score (Spearman = -.081, p = .016). Additionally, user ratings demonstrated a very weak correlation with no statistically significant correlations observed between user ratings and the scores (all p > 0.05). For ORCHA scores multiple linear regression had adjusted R-squared = -.002. This study highlights that widely available proxies which users may perceive to signify the quality of health apps, namely user ratings and downloads, are inaccurate predictors for estimating quality. This indicates the need for wider use of quality assurance methodologies which can accurately determine the quality, safety, and compliance of health apps. Findings suggest more should be done to enable users to recognise high-quality health apps, including digital health literacy training and the provision of nationally endorsed "libraries".