Bonus Points Research Articles

Assessment of Whether the American Society of Clinical Oncology’s Value Framework and the European Society for Medical Oncology’s Magnitude of Clinical Benefit Scale Measure Absolute or Relative Clinical Survival Benefit

The American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO) have independently published value frameworks. To date, whether the clinical benefit scoring algorithms from these framework were intended to measure absolute or relative survival benefit remains unclear. To empirically examine the measurement characteristics of these frameworks by comparing their survival efficacy components (ASCO clinical benefit score [CBS] and ESMO preliminary magnitude of clinical benefit grade [PMCBG]) with established measures of absolute (median survival difference and restricted mean survival time [RMST] difference) and relative (hazard ratios [HRs]) survival benefit. The US Food and Drug Administration (FDA)'s Hematology and Oncology Approvals and Safety Notifications database was retrospectively reviewed to identify phase 3 randomized controlled trials (RCTs) cited for clinical efficacy evidence in oncology drug approvals from January 1, 2006, through December 31, 2017. Two reviewers searched the database for initial trials cited for approval. Phase 3 trials with overall survival, progression-free survival, and/or time to progression as their primary or coprimary end points were included. Notifications for noncancer indications or presenting label changes and trials that did not report HRs for the required end points and/or did not publish survival curves with number-at-risk data were excluded. Of 269 notifications initially identified, 107 met the selection criteria. Sensitivity analyses were conducted by calculating the scores using (1) the framework-defined end point, including tail-of-curve bonus points (ASCO) or long-term plateau adjustments (ESMO) (framework-defined end point plus tail-of-curve bonus), (2) overall survival data only, and (3) progression-free survival data only. For primary and sensitivity analyses, Spearman correlation coefficients were calculated to examine the relationships between (1) ASCO-CBS or ESMO-PMCBG and RMST difference, (2) ASCO-CBS or ESMO-PMCBG and median survival difference, and (3) ASCO-CBS or ESMO-PMCBG and HR. Data were analyzed from January 7 through April 30, 2018. In the primary analysis, ASCO-CBSs and ESMO-PMCBGs were calculated for the included trials using the framework-defined end point. Compared with measures of absolute survival benefit, ESMO-PMCBGs showed low to moderate correlations with RMST difference (ρ = 0.44) and moderate to high correlations with median survival difference (ρ = 0.64). ASCO-CBSs showed low to moderate correlations with both measures of absolute benefit (ρ = 0.43 for RMST difference; ρ = 0.44 for median survival). Compared with a relative measure of survival (HRs), ESMO-PMCBGs showed a low correlation (ρ = 0.47) and ASCO-CBSs showed a higher correlation (ρ = 0.76). Neither framework consistently performed as an absolute measure of survival benefit. The incorporation of a direct measure of absolute clinical benefit, such as RMST difference, into the survival efficacy components of their algorithms should be considered.

Gamification in Educational Contexts

Gamification as a tool or procedure to add entertaining and motivating elements to usually non-entertaining environments such as schools or workplaces is becoming more and more popular. E-learning platforms like Moodle provide tools and sets of functions to add elements of gamification. An important factor, especially for education, is technology: individual achievements and progress can be recorded, measured, tracked and visualized and, therefore, identified and honored through bonus points, awards or rankings. This is where gamification can add some challenge and excitement to learning.

Use of Late-Life Expectancy for Assessing the Long-Term Benefit of Immune Checkpoint Inhibitors.

To grade the long-term benefit of anticancer agents, the American Society of Clinical Oncology Value Framework (ASCO-VF) awards tail-of-the-curve bonus points by using milestone survival at twice the median control survival. Here, we propose an alternative, late-life expectancy that we defined as the area under the Kaplan-Meier curve from median control survival to the end of follow-up. We analyzed all indications of immune checkpoint inhibitors with survival data and found that 9 indications out of 13 (69.2%) qualified for ASCO-VF tail-of-the-curve bonus points either in progression-free or overall survival. Our proposed score recognized a long-term benefit not captured by the ASCO-VF, for example, for CHECKMATE-66 where twice the median overall survival was not reached. We found that nivolumab was associated with an increase of 65.3% (95% CI = 38.9 to 89.5) in overall survival late-life expectancy, which highlights its important long-term benefit. In conclusion, the ASCO-VF could be improved with the use of late-life expectancy.

Establishment and educational measurement of department examination system of clinical practice internship

Objective To set up a standardized examination system for clinical internship at the de-partment level, and to evaluate the system using educational measurement method. Methods All the 327 clinical five-year and eight-year intern trainees who took clinical internship in the spinal orthopedics de-partment of a teaching hospital from July 1, 2014 to June 30, 2016 were selected as the research subjects. All the subjects took the standardized examination, educational and measurement methods such as general descriptive analysis, project relevance analysis and grader consistency analysis were executed to assess the content validity of the system, the relevance of the project and the consistency of the scorers. Statistical calculation was executed by SPSS 23.0 software. Results The average score of all 312 trainees included was controlled at (80.07±4.67), the lowest score was 70.01, and the highest score was 90.01, which reflected that the overall difficulty was moderate, the difference was reasonable and the scores were evenly distributed. To the theory, skills, medical records, teachers' score and the reward plus, normalized regression coefficients were 0.479, 0.473, 0.118, 0.135 and 0.364 respectively, which were in good agreement with the scores of each item in the total score. To the theory, skills and teacher evaluation, the analysis of variance of the total score showed that the P values were both ≥0.05 with no significant difference between the groups, so the consistency of the scorers were satisfactory. The P values of variance analysis of the two items of the medical record and bonus points were 0.000 and 0.002 respectively, with significant differences among the groups, the scorers were less consistent. Conclusion The standardized examination system can meet the requirements of comprehensive, full-scale, quantitative and stable feedback teaching effect. The system of internship practice examination must be able to withstand continuous implementation and repeated correction over many years, so as to ensure the teaching quality. Key words: Clinical internship; Department examination; Education measurement

PCN26 - ASSESSING THE POTENTIAL VALUE OF AN INNOVATIVE ONCOLOGY THERAPY FROM THE HEALTH TECHNOLOGY ASSESSMENT (HTA) PERSPECTIVE: MARRYING CLINICAL VALUE FRAMEWORKS WITH ECONOMIC ASSESSMENT METHODOLOGY

This study assessed the clinical benefit of oncology regimens for an ultra-rare tumor using concepts from European Society of Medical Oncology (ESMO) and American Society of Clinical Oncology (ASCO) frameworks. It also enhanced clinical assessment of these frameworks by accounting for potential long-term benefits of a novel treatment. An enhanced value framework (EVF) was developed by combining ESMO and ASCO frameworks with well-validated approaches for projecting long-term survival. Published single-arm data for chemotherapies and patient-level data from recently approved immuno-oncology (IO) agent for treating aggressive ultra-rare tumor in metastatic setting was used. Under the ESMO Magnitude of Clinical Benefit Scale (MCBS), form 2a was selected due to lack of sufficient follow-up data on potential curative benefits in terms of overall survival (OS) at the time of approval. Along with OS benefit (1 to 4, indicating increasing OS benefit), MCBS also valued improvements in toxicity and/or quality of life (QoL) (1 for significant improvement in either). The ASCO value framework calculated incremental net health benefit (NHB) by combining scores attributable to clinical benefit, toxicity, and bonus benefits. The projected mean OS over life-time for IO was 42.5 months in the base case compared with 4.2 months for chemotherapies, driven mostly by improvements in progression-free survival (35.0 vs 2.5 months). Under ESMO MCBS version 1.1, IO scored 3 points higher than chemotherapies for efficacy (4 over 1) as well as 1 for improvement in both toxicity and QoL. Under the ASCO framework, the NHB of IO vs chemotherapies ranged from 212-218, with 193 attributable to clinical benefit, 0-5 to toxicity, and 20 bonus points. From HTA perspective, the IO agent for ultra-rare tumor in this case study was determined to provide considerable clinical benefit, irrespective of value framework used to assess benefits associated with the product.

Building interactive computer play games with youth with cerebral palsy: Improving practice efficacy through biofeedback and user-centered design

Interactive computer play (ICP), or serious games, can provide motivational and flexible rehabilitation environments. This is useful for the 1 in 400 children born with Cerebral Palsy (CP) each year, whose daily activities are impacted by impaired motor control. Improvement through traditional rehabilitation is often hindered by low adherence and limited repetitions. This study aims to build an ICP game which offers a motivational and effective environment to supplement reaching and grasping rehabilitation in youth with CP. Through a user-centered design process, we first met with five youth with CP and four occupational therapists to establish reach and grasp movement priorities. Then, seven youth, age 16–23 years with hemiplegic CP, participated in 1–3 game design sessions. During each design session, participants extended and relaxed their hand to control an ICP game using a forearm muscle activity sensor (Myo Armband). Participants played games with different types of feedback and control mechanisms (detailed in Fig. 1 ). Game versions were iterated between design sessions. The top priority identified by youth and therapists was increasing amplitude and endurance of wrist extension while fingers open. Thus, this action was used as the primary game control. At each design session, participants played an average of 15 levels, each lasting 129 ± 56 seconds and requiring 43 ± 19 wrist extension repetitions. In total, during a typical session, participants practiced 645 ± 285 repetitions through the ICP game. User input showed participants were most responsive when feedback directly followed wrist extension (e.g. increased power bar or bonus points). The user-centered design process engages participants to build practice tools that they find motivating. The ICP game can offer youth with CP the high quantity of repetitions required to improve reach and grasp activities. Next, the game will be used in a home-based pilot study to demonstrate its efficacy for improving reach and grasp activities.

Student Perceptions of a Revise and Resubmit Policy for Writing Assignments

Effective writing is a soft skill that is highly in demand in today’s workforce. This qualitative study examines student perceptions of a revise and resubmit policy aimed at increasing student engagement with an instructor’s writing feedback and ultimately improving students’ writing skills. Students across three business communication courses were offered bonus points if they made revisions and documented those revisions. The findings suggest that students were willing to complete a revision even if given only a small grade incentive. While some expressed negativity toward the extensive feedback, others viewed the revision option as a rare but valuable opportunity.

Writing Prompts Help Improve Expression of Conceptual Understanding in Chemistry.

To improve the writing performance of secondary school students in chemistry assessments, a set of activities was developed. First, through document analysis of written tests, five categories of frequent mistakes in answers were identified: poor punctuation (capital letters, periods), missing key answer components (omitting concepts necessary to answer the question), incomplete reasoning (logical steps are missing), unclear use of antecedents (meanings of pronouns such as “it” are difficult to discern), and poor connectives (words like “because” are lacking or used incorrectly). After this, five strategies were formulated: focus on punctuation, repeat key question components, show complete reasoning, minimize use of references, and check use of connectives. Second, a two-part intervention study was conducted. In Part A, a written prompt (arrow symbol with the word “LANGUAGE”) placed in front of context-based questions was implemented to find out if that could help students avoid making any of those mistakes. Following promising effects on the performance of 99 students, the intervention was extended with a Part B to find out if, in addition to the prompt, bonus points (for each prompt question one bonus point was awarded if the answer was formulated correctly in terms of language use) and language support (prompt card listing the five strategies, and supportive assignments) could be of extra help to students. The findings suggest that the writing performance of students can be improved by increasing students’ awareness through a simple written prompt, providing language support, and awarding bonus points for properly formulated answers to chemistry test questions.

Redistribution Without Distortion: Evidence from an Affirmative Action Programme at a Large Brazilian University

In this paper, we examine an innovative affirmative action policy designed to increase the representation of underprivileged students at UNICAMP, a large and highly ranked Brazilian university. The university awarded bonus points to targeted applicants (i.e., public high school applicants) on their admission exam, as opposed to imposing a typical quota system. Using a rich set of administrative data from UNICAMP, we assess the effect of this policy on the composition of admitted students, and investigate for possible behavioral responses at the extensive (participation) and intensive (preparation effort) margins. We find that the admission probability of public high school applicants, the targeted applicants, significantly increased following the adoption of the affirmative action program. The policy was also associated with sizable redistribution in the composition of admitted students, with a shift towards students from families with lower socio-economic status. Surprisingly, we find little evidence of behavioral reactions to the affirmative action policy, in terms of test performance or application decision.

Estimating High School GPA Weighting Parameters With a Graded Response Model

AbstractThe high school grade point average (GPA) is often adjusted to account for nominal indicators of course rigor, such as “honors” or “advanced placement.” Adjusted GPAs—also known as weighted GPAs—are frequently used for computing students’ rank in class and in the college admission process. Despite the high stakes attached to GPA, weighting policies vary considerably across states and high schools. Previous methods of estimating weighting parameters have used regression models with college course performance as the dependent variable. We discuss and demonstrate the suitability of the graded response model for estimating GPA weighting parameters and evaluating traditional weighting schemes. In our sample, which was limited to self‐reported performance in high school mathematics courses, we found that commonly used policies award more than twice the bonus points necessary to create parity for standard and advanced courses.

Back-Testing Methods Used to Estimate Future Spot Exchange Rates Utilizing Bloomberg Data

Since students ask for real life examples and employers look for better excel skills, I added an empirical project to International Finance class. Using Bloomberg data students, in teams of four, calculate annual and average annual currency appreciations, as well as, various parity conditions between dollar and major foreign currency. In the last phase of the project students back-test methods for predicting future spot exchange rates. As an incentive to experiment with different lengths of the estimation period, the team with the smallest standard deviation between estimated and actual exchange rates earn bonus points.

Smartphone app uses loyalty point incentives and push notifications to encourage influenza vaccine uptake

PurposeCarrot Rewards is a free, incentive-based, smartphone health app available in participating provinces in Canada. One feature of Carrot was designed to incentivize influenza vaccine education messages and encourage vaccine uptake for users in the province of British Columbia. This study aimed to evaluate the uptake of the Carrot Flu Campaign educational quiz and to determine if mobile “push” notifications, plus loyalty point incentives, resulted in users visiting a sponsored pharmacy to discuss and receive the influenza vaccine. MethodsThe Carrot Flu Campaign delivered an in-app quiz, educating users on the importance of the influenza vaccine. Push notifications were then sent to users when they came within 200 m of a sponsored pharmacy. Those who visited the pharmacy collected bonus points and completed a follow up quiz tracking influenza vaccine behaviour. A sub-sample of users completed the Flu Campaign between their baseline and follow up Health Risk Assessment (HRA), a survey which asked about influenza vaccine uptake behaviour. Descriptive statistics were summarized. ResultsA total of 38.1% (30,538/80,228) registered Carrot users completed the Flu Campaign quiz. Of those in participating cities (n = 21,469), 41% clicked on the map to show the nearest sponsored pharmacy and 78% enabled their smartphone’s “locations” feature, allowing them to receive the push notifications. A small number of users spoke to a pharmacist (n = 96) and less than half reported receiving the influenza vaccine (38/96; 39.6%). From the HRA sub-sample (n = 3693), approximately 5% more users reported receiving the influenza vaccine during the 2017 influenza season compared to the previous year. ConclusionsCarrot Rewards used a novel delivery method to educate the general population and showed geolocation could be used to facilitate influenza vaccine uptake. Future iterations could tailor content to target those most at risk and should consider more robust evaluation methods to determine the app’s effectiveness.

Team Collaboration in Learning Anatomy with Ultrasound in a Clinical Presentation‐Driven Curriculum

INTRODUCTIONAt California University of Science and Medicine, School of Medicine, we have developed a clinical presentation‐driven curriculum. During the pre‐clerkship courses students will spend most of their time in activities related to self‐directed learning, most of these activities will occur in a team based environment that is a modified version of the traditional TBL approach. To follow along the same educational lines, the laboratory sessions were designed to utilize a self‐directed learning approach but in a team based environment.MethodsUltrasound laboratory sessions have been developed to support the learning of anatomy by interpretation of normal images. The topics are integrated with the weekly theme related to the clinical skills, clinical presentation, and clinical case sessions. During week 4 of the course entitled “The Structural Integrity of the Human Body” i.e., musculoskeletal and integumentary systems, the clinical presentation is joint pain and the clinical skills are related to the evaluation of joints. The anatomy lab session is ‘ultrasonography of joints'.ResultsThe session learning outcomes (SLOs) of the two‐hour lab session are: 1) Describe the normal ultrasonographic anatomy of shoulder, elbow, wrist, hip, knee and ankle joints, in oblique and axial planes. 2) Identify and describe the ultrasonographic appearance of excessive fluid in the hip/knee/ankle joints. To achieve these outcomes, the lab activities were divided in three sessions: 1) Information and independent self‐directed learning: the students will review the information through self‐study from the resources provided as PowerPoints, lecture recordings, text book reference pages. 2) Identification of structures and confirmation by instructors: students will receive study guided questions about the imaging anatomy of joints mainly based on simple principles of: a) How to identify the structure? b) What is the relation of structure and its normal function? c) What will happen if it is dysfunctional? Students will work in groups and each group will have ultrasound equipment to identify the joints. 3) Interactivity and integration followed by presentation and discussion: the focus of this session is on problem solving exercises, critical‐thinking and presentation of exercises by the teams. The problems will focus on joints and related anatomical appearances on ultrasound. This will be followed by a discussion about team thinking and interpretation of concepts. The instructor will select the presenter from a team at random. The questions will be written in a way that there will be many discussions stimulating concepts focused on the topic of the lab. During the discussion they will be encouraged to justify their answer and extra bonus points will be given to show the abnormality in the joints on images. Evaluation forms will be used to get feedback and suggestions to improve.ConclusionIndependent self‐directed learning with interactivity and integration in a collaborative team based environment makes anatomy learning clinically applicable and fun.Support or Funding Informationself fundedThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Incentivizing with Bonus in a College Statistics Course

Many studies have argued the negative effects of external rewards on internal motivation while others assert that external motivation does not necessarily undermine intrinsic motivation. At a private university, students were given the option to earn bonus points for achieving mastery in the online homework systems associated with Statistics and Pre-Calculus courses. The results showed a significant difference in online homework grades and final exam scores, dependent upon when the incentive was given. The findings of this research suggest that college students thrive when incentivized. When compared to the students who were not incentivized, the incentivized group had a statistically significantly higher mean for both online homework scores and final exam scores. Many of the incentivized students chose to take the opportunity to earn the bonus points to increase the final semester grade, which apparently also helped to increase the content knowledge necessary for the final exam.

Association of Immunotherapy With Durable Survival as Defined by Value Frameworks for Cancer Care

Modern immuno-oncology agents have generated great excitement because of their potential to provide durable survival for some patients. However, there is concern regarding the cost of cancer care, and multiple frameworks have been developed to assess value. The American Society of Clinical Oncology (ASCO) framework awards bonus points if substantial durable survival is demonstrated. To assess whether modern immuno-oncology agents reach defined efficacy thresholds in value frameworks. In this analysis, all US Food and Drug Administration (FDA) approvals for immuno-oncology agents between March 2011 and August 2017 were reviewed. Data required for the ASCO framework were collected, specifically improvement in proportion of patients alive with the test regimen and survival rate with standard treatment. Awarding of bonus points for durable survival based on the ASCO criteria. Twenty-three metastatic indications for 6 immuno-oncology agents (ipilimumab, pembrolizumab, nivolumab, atezolizumab, avelumab, and durvalumab) were approved by the FDA from March 2011 to August 2017. Ten (43%) of the approvals were based on survival end points, while 13 (57%) were based on response rates. Only 3 drug indications fulfilled the threshold defined for the survival rate of patients receiving standard care (minimum 20%). Nine indications achieved the required level of improvement in proportion to patients alive in the test regimen compared with the standard (above 50%). There was overlap between these 2 criteria for 3 drug indications, allowing them to gain the durable survival bonus points awarded by the ASCO framework. Durable survival and response rates of modern immuno-oncology agents are rarely recognized as significant by current oncology value frameworks. This may be due to insufficient demonstration of efficacy of such agents or inappropriately calibrated value frameworks.

CMS Issues Final Rule for Medicare Quality Reporting in 2018

CMS Issues Final Rule for Medicare Quality Reporting in 2018

채점규칙 변경에 따른 주요 월드컵 체조대회 남자 마루운동 입상자들의 연기내용 분석

The purpose of this study was to analyze 9 gymnasts who participated in floor exercise in the FIG World Cup. The Press handstand(2s) was the most performed in element group Ⅰ. The salto forward with 1/1 turn(D value) was the most performed in element group Ⅱ. The salto backward with 5/2 turn(D value) and salto backward with 3/1 turn(D value) as a dismount were the most performed in element group Ⅲ. The 12 types of connections bonus points and 2 types of connections with 0.2 bonus points were performed by the salto backward with 5/2 turn+salto forward with 2/1 turn and salto forward with 2/1 turn+double salto forward with tucked.

Evaluation of a Behavioral Self-Care Intervention for Public Health Students

ABSTRACTBackground: Postgraduate education is recognized as a time of intense stress. Rates of anxiety and depression are elevated among graduate students, and longitudinal studies have documented increases in clinical symptoms over the course of training. Purpose: The current study was to evaluate whether an academically sponsored self-care intervention would increase engagement in health promotion activities. The primary goal was to determine whether self-care behaviors completed in the midst of a challenging academic program would prevent the worsening of student mental health. Methods: The self-care intervention included behavior change projects designed to increase health-promoting behaviors within 4 domains (nutrition, physical activity, mental health, social support). Students received incentives in the way of bonus points for maintaining health behaviors for the duration of the 12-week semester. Results: Results revealed significant increases in health-promoting behaviors. Importantly, mental health symptoms did not worsen over the course of the semester. Discussion: The study provides preliminary support for the utility of a brief self-care intervention for students in the health sciences. Translation to Health Education Practice: Future studies should examine the applicability of this intervention to students in other fields of study and through online education formats.

Incentivizing advanced mathematics study at upper secondary level: the case of bonus points in Ireland

ABSTRACTSecondary level mathematics education in Ireland has recently experienced a period of significant change with the introduction of new curricula and the addition of an incentive to study upper secondary mathematics at the most advanced level (Higher Level). This incentive, typically referred to as ‘bonus points’, appears to have aided a significant increase in the number of students studying upper secondary mathematics at Higher Level. However, thematic analysis of interviews with experienced upper secondary mathematics examiners and exploration of mathematics diagnostic test data outlined in this paper suggest that the difficulty of the Higher Level upper secondary mathematics final examination in Ireland has reduced since the introduction of the bonus points initiative. The sharp increase in students attempting this examination coupled with a policy of maintaining a consistent proportion of students achieving passing grades was identified as a key reason for this possible reduction in standards.

Preferences for work in primary care among medical students in Minas Gerais State, Brazil: evidence from a discrete choice experiment

This article presents the results of a discrete choice experiment (DCE) conducted in 2012 with 277 final-year medical students from Minas Gerais State, Brazil. The experiment tested students' preferences concerning future work as physicians in primary health care, based on hypothetical job scenarios aimed at measuring the likelihood of placement in areas with a shortage of doctors. Application of DCE involved (i) a qualitative stage to define the attributes and their respective levels to comprise the job scenarios, (ii) construction and application of the instrument, and (iii) analysis with application of multinomial logit with conditional probability to estimate the weight of attributes and to construct scenarios for choice probability. The results indicate that the job attribute that most impacted students' choice was location, followed by job conditions, pay, access to medical residency, type of employment relationship, and workload. Students from private medical schools, with higher family income, and females were generally more likely to resist job assignments in unsafe urban areas and remote areas of the countryside. The job scenarios that proved most plausible in terms of public intervention were those that combined middle-level wages, good working conditions, and 10 to 20 bonus points on medical residency exams.