Core Measurements Research Articles

Construct validity of PROMIS pain interference, fatigue, and physical function as patient-reported outcomes in adults with idiopathic inflammatory myopathies: An international study from the OMERACT myositis working group

BackgroundValidated patient-reported outcome measures to assess disease impact in patients with adult idiopathic inflammatory myopathies (IIMs) are needed. The objective of this study was to assess the construct validity of PROMIS Pain Interference, Fatigue, and Physical Function measures in comparison with core disease activity measures. MethodsAdults with IIM, excluding inclusion body myositis, from OMERACT Myositis Working Group (MWG) clinic sites completed PROMIS Short Form v1.0—Pain Interference 6a, PROMIS Short Form v1.0—Fatigue 7a, and PROMIS Short Form v2.0—Physical Function 8b measures. Core disease activity measures including patient and physician global disease activity assessments, manual muscle testing, serum creatine kinase activity, and Health Assessment Questionnaire Disability Index (HAQ-DI) were simultaneously assessed. To evaluate construct validity, a priori hypotheses for the expected correlations between PROMIS measures, age, and core disease measures were determined by >70 % agreement among MWG members and were compared against observed Pearson's correlations. Internal consistency of items and floor or ceiling effects for the PROMIS measures were also assessed. Subgroup analysis according to IIM subtype (dermatomyositis vs. non-dermatomyositis IIM) was performed. Results135 adults with IIM from 5 countries across North America, Europe, Asia, and Australia were included. For construct validity, a priori hypotheses were confirmed for 5 of 6 (83 %) PROMIS Pain Interference, 4 of 5 (80 %) PROMIS Fatigue, and 3 of 4 (75 %) PROMIS Physical Function correlations. Internal consistency was high for each PROMIS measure (Cronbach's alpha >0.9). Ceiling effects were observed only for PROMIS Pain Interference, with low/no pain in 29 % of patients. Subgroup analysis between dermatomyositis (n = 65) and non-dermatomyositis (n = 70) subtypes demonstrated similar correlations between PROMIS measures and disease activity measures. ConclusionsPROMIS Short Form v1.0—Pain Interference 6a, PROMIS Short Form v1.0—Fatigue 7a, and PROMIS Short Form v2.0—Physical Function 8b measures demonstrate strong construct validity when compared to core disease activity measures in IIM, with consistent results across IIM subtypes. These findings support the use of these selected PROMIS measures to assess core domains of interest for measuring life impact in IIMs.

MRI and Clinical Variables for Prediction of Outcomes After Pediatric Severe Traumatic Brain Injury

Traumatic brain injury (TBI) is a leading cause of death and disability in children, and predicting functional outcome after TBI is challenging. Magnetic resonance imaging (MRI) is frequently conducted after severe TBI; however, the predictive value of MRI remains uncertain. To identify early MRI measures that predict long-term outcome after severe TBI in children and to assess the added predictive value of MRI measures over well-validated clinical predictors. This preplanned prognostic study used data from the Approaches and Decisions in Acute Pediatric TBI (ADAPT) prospective observational comparative effectiveness study. The ADAPT study enrolled 1000 consecutive children (aged <18 years) with severe TBI between February 1, 2014, and September 30, 2017. Participants had a Glasgow Coma Scale (GCS) score of 8 or less and received intracranial pressure monitoring. Magnetic resonance imaging scans performed as part of standard clinical care within 30 days of injury were collected at 24 participating sites in the US, UK, and Australia. Summary imaging measures were correlated with the Glasgow Outcome Scale-Extended for Pediatrics (GOSE-Peds), and the predictive value of MRI measures was compared with the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) core clinical predictors. Data collection, image analysis, and data analyses were completed in July 2023. Pediatric severe TBI with an MRI scan performed as part of clinical care. All measures were selected a priori. Magnetic resonance imaging measures included contusion, ischemia, diffuse axonal injury, intracerebral hemorrhage, and brainstem injury. Clinical predictors included the IMPACT core measures (GCS motor score and pupil reactivity). All models adjusted for age and sex. Outcome measures included the GOSE-Peds score obtained at 3, 6, and 12 months after injury. This study included 233 children with severe TBI who were enrolled at participating sites and had an MRI scan and preselected clinical predictors available. Their median age was 6.9 (IQR, 3.0-13.3) years, and more than half of participants (134 [57.5%]) were male. In a multivariable model including MRI measures and IMPACT core clinical variables, contusion volume (odds ratio [OR], 1.13; 95% CI, 1.02-1.26), brain ischemia (OR, 2.11; 95% CI, 1.58-2.81), brainstem lesions (OR, 5.40; 95% CI, 1.90-15.35), and pupil reactivity were each independently associated with GOSE-Peds score. Adding MRI measures to the IMPACT clinical predictors significantly improved model fit and discrimination between favorable and unfavorable outcomes compared with IMPACT predictors alone (area under the receiver operating characteristic curve, 0.77; 95% CI, 0.72-0.85 vs 0.67; 95% CI, 0.61-0.76 for GOSE-Peds score >3 at 6 months after injury). In this prognostic study of children with severe TBI, the addition of MRI measures significantly improved outcome prediction over well-established and validated clinical predictors. Magnetic resonance imaging should be considered in children with severe TBI to inform prognosis and may also promote stratification of patients in future clinical trials.

Asteroseismic measurement of core and envelope rotation rates for 2006 red giant branch stars

Context. Tens of thousands of red giant stars in the Kepler data exhibit solar-like oscillations. The mixed-mode characteristics of their oscillations enable us to study the internal physics from the core to the surface, such as differential rotation. However, envelope rotation rates have only been measured for about a dozen red giant branch (RGB) stars so far. This limited the theoretical interpretation of angular momentum transport in post-main sequence phases. Aims. We report the measurements of g-mode properties and differential rotation in the largest sample of Kepler RGB stars. Methods. We applied a new approach to calculate the asymptotic frequencies of mixed modes, which accounts for so-called near-degeneracy effects (NDEs) and leads to improved measurements of envelope rotation rates. By fitting these asymptotic expressions to the observations, we obtained measurements of the properties of g modes (period spacing, ΔΠ1, coupling factor, q, g-mode offset term, εg, small separation, δν01) and the internal rotation (mean core, Ωcore, and envelope, Ωenv, rotation rates). Results. Among 2495 stars with clear mixed-mode patterns, we found that 800 show doublets and 1206 show triplets, while the remaining stars do not show any rotational splittings. We measured core rotation rates for 2006 red giants, doubling the size of pre-existing catalogues. This led us to discover an over-density of stars that are narrowly distributed around a well-defined ridge in the plane, showing core rotation rate versus evolution along the RGB. These stars could experience a different angular momentum transport compared to other red giants. With this work, we also increased the sample of stars with measured envelope rotation rates by two orders of magnitude. We found a decreasing trend between envelope rotation rates and evolution, implying that the envelopes slow down with expansion, as expected. We found 243 stars whose envelope rotation rates are significantly larger than zero. For these stars, the core-to-envelope rotation ratios are around Ωcore/Ωenv ∼ 20 and show a large spread with evolution. Several stars show extremely mild differential rotations, with core-to-surface ratios between 1 and 2. These stars also have very slow core rotation rates, suggesting that they go through a peculiar rotational evolution. We also discovered more stars located below the ΔΠ1–Δν degeneracy sequence, which presents an opportunity to study the history of plausible stellar mergers.

Validity of Patient-Reported Outcome Measures in Evaluating Nerve Damage Following Chemotherapy

Chemotherapy-induced peripheral neuropathy (CIPN) is a substantial adverse effect of anticancer treatments. As such, the assessment of CIPN remains critically important in both research and clinic settings. To compare the validity of various patient-reported outcome measures (PROMs) with neurophysiological and sensory functional measures as the optimal method of CIPN assessment. This cohort study evaluated participants treated with neurotoxic chemotherapy across 2 cohorts using a dual-study design. Participants commencing treatment were assessed prospectively at beginning of neurotoxic treatment, midtreatment, and at the end of treatment. Participants who completed treatment up to 5 years prior were assessed cross-sectionally and completed a single assessment time point. Participants were recruited from oncology centers in Australia from August 2015 to November 2022. Data analysis occurred from February to November 2023. Neurotoxic cancer treatment including taxanes, platinums, vinca-alkaloids, proteasome inhibitors, and thalidomide. CIPN was assessed via PROMs (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC-CIPN20], Functional Assessment of Cancer Therapy/Gynecological Cancer Group Neurotoxicity Questionnaire (FACT/GOG-Ntx), and the patient-reported outcomes version of the Common Terminology Criteria for Adverse Events [PRO-CTCAE]), neurological and neurophysiological assessment (Total Neuropathy Score and sural and tibial compound nerve amplitudes), and sensory measures (Grating orientation, Von Frey monofilament, and 2-point discrimination tasks). Core measurement properties of CIPN outcome measures were evaluated. Convergent and known-groups validity was assessed cross-sectionally following treatment completion, and responsiveness was evaluated prospectively during treatment. Neurological, neurophysiological, and sensory outcome measure scores were compared between those who reported high and low levels of CIPN symptoms using linear regressions. A total of 1033 participants (median [IQR] age, 61 [50-59] years; 676 female [65.4%]) were recruited to this study, incorporating 1623 assessments. PROMs demonstrated best ability to accurately assess CIPN (convergent validity), especially the PRO-CTCAE composite score (r = 0.85; P < .001) and EORTC-CIPN20 (r = 0.79; P < .001). PROMS also demonstrated the best ability to discriminate between CIPN severity (known-groups validity) and to detect changes at onset of CIPN development (responsiveness), especially for EORTC-CIPN20 (d = 0.67; 95% CI, 0.52-0.83), FACT/GOG-Ntx (d = 0.65; 95% CI, 0.49-0.81) and the PRO-CTCAE (d = 0.83; 95% CI, 0.64-1.02). Other measures did not achieve threshold for convergent validity (α < 0.7). Neurophysiological and sensory measures did not demonstrate acceptable responsiveness. In regression models, neurological, neurophysiological, and sensory outcome measures were significantly impaired in participants who reported high levels of CIPN symptoms compared with those who reported low levels of CIPN symptoms. In this cohort study of 1033 cancer patients, PROMs were the only measures to satisfy all 3 core measurement property criteria (convergent validity, known-groups validity, and responsiveness). These findings suggest that adoption of PROMs in clinical practice can equip clinicians with valuable information in assessing CIPN morbidity.

Monetary policy and heterogeneous price effects in the United Kingdom

AbstractThis paper examines the heterogeneous effects of monetary policy on consumer prices in the United Kingdom. We estimate a proxy Structural Vector Autoregressive (SVAR) model, using extended high‐frequency monetary surprises from Cesa‐Bianchi et al. (European Economic Review, 123, 2020, 103375) to instrument shifts in UK monetary policy. We then analyze the impulse responses for various components of the UK Consumer Price Index. Our findings reveal that while monetary policy tightening leads to a persistent decline in aggregate consumer prices, the impact on disaggregated components is highly heterogeneous. Notably, we observe that energy price changes offset movements in food, beverage, and tobacco prices, resulting in identical responses of core and headline consumer CPIH inflation measures. The contrasting effects across different CPI components highlight the importance of examining disaggregated data when assessing the transmission of monetary policy to consumer prices.

Level of thermal maturity estimation in unconventional reservoirs using interval inversion and simulating annealing method

AbstractThis study presents a novel geophysical approach for estimating the level of thermal maturity (LOM) in unconventional hydrocarbon reservoirs using well log data. LOM is a crucial parameter for assessing the hydrocarbon generation potential of source rocks, but it traditionally relies on laboratory measurements of core samples, which can be time-consuming and costly. The proposed method combines two techniques: interval inversion for estimating total organic carbon (TOC) content from well logs and simulated annealing (SA) optimization for deriving LOM from the estimated TOC. The interval inversion method enables accurate TOC estimation by jointly interpreting multiple well logs over depth intervals, overcoming limitations of conventional point-by-point inversion. Using the estimated TOC, the SA algorithm optimizes an energy function related to Passey's empirical TOC-LOM relationship, iteratively finding the optimal LOM value that best fits the well log data. This approach provides a continuous in situ LOM profile along the borehole without requiring core measurements. The effectiveness of the method is demonstrated through case studies on datasets from the North Sea (Norway), the Pannonian Basin (Hungary), and the Kingak Formation (Alaska). The LOM estimates show good agreement with reported maturity levels and allow reliable reservoir characterization. Statistical analysis confirms the robustness and accuracy of the results. By reducing dependence on core data, this integrated inversion-optimization workflow streamlines the reservoir prospecting phase, enhancing operational efficiency. The method holds promising applications across diverse geological settings for cost-effective evaluation of unconventional hydrocarbon plays.

Digital Measures Development: Lessons Learned from an Expert Workshop Addressing Cross-Therapeutic Area Measures of Sleep

Introduction: The Digital Measures Development: Core Measures of Sleep project, led by the Digital Medicine Society (DiMe), emphasizes the importance of sleep as a cornerstone of health and the need for standardized measurements of sleep and its disturbances outside the laboratory. This initiative recognizes the complex relationship between sleep and overall health, addressing it as both a symptom of underlying conditions and a consequence of therapeutic interventions. It aims to fill a crucial gap in healthcare by promoting the development of accessible, nonintrusive, and cost-effective digital tools for sleep assessment, focusing on factors important to patients, caregivers, and clinicians. Methods: A central feature of this project was an expert workshop conducted on April 19th, 2023. The workshop convened stakeholders from diverse backgrounds, including regulatory, payer, industry, academic, and patient groups, to deliberate on the project’s direction. This gathering focused on discussing the challenges and necessities of measuring sleep across various therapeutic areas, aiming to identify broad areas for initial focus while considering the feasibility of generalizing these measures where applicable. The methodological emphasis was on leveraging expert consensus to guide the project’s approach to digital sleep measurement. Results: The workshop resulted in the identification of seven key themes that will direct the DiMe Core Digital Measures of Sleep project and the broader field of sleep research moving forward. These themes underscore the project’s innovative approach to sleep health, highlighting the complexity of omni-therapeutic sleep measurement and identifying potential areas for targeted research and development. The discussions and outcomes of the workshop serve as a roadmap for enhancing digital sleep measurement tools, ensuring they are relevant, accurate, and capable of addressing the nuanced needs of diverse patient populations. Conclusion: The Digital Medicine Society’s Core Measures of Sleep project represents a pivotal effort to advance sleep health through digital innovation. By focusing on the development of standardized, patient-centric, and clinically relevant digital sleep assessment tools, the project addresses a significant need in healthcare. The expert workshop’s outcomes underscore the importance of collaborative, multi-stakeholder engagement in identifying and overcoming the challenges of sleep measurement. This initiative sets a new precedent for the integration of digital tools into sleep health research and practice, promising to improve outcomes for patients worldwide by enhancing our understanding and measurement of sleep.

ALMA-IMF

Context. The star formation process leads to an increased chemical complexity in the interstellar medium. Sites associated with high-mass star and cluster formation exhibit a so-called hot core phase, characterized by high temperatures and column densities of complex organic molecules. Aims. We aim to systematically search for and identify a sample of hot cores toward the 15 Galactic protoclusters of the ALMA-IMF Large Program and investigate their statistical properties. Methods. We built a comprehensive census of hot core candidates toward the ALMA-IMF protoclusters based on the detection of two CH3OCHO emission lines at 216.1 GHz. We used the source extraction algorithm GExt2D to identify peaks of methyl formate (CH3OCHO) emission, a complex species commonly observed toward sites of star formation. We performed a cross-matching with the catalog of thermal dust continuum sources from the ALMA-IMF 1.3 mm continuum data to infer their physical properties. Results. We built a catalog of 76 hot core candidates with masses ranging from ~0.2 M⊙ to ~80 M⊙, of which 56 are new detections. A large majority of these objects, identified from methyl formate emission, are compact and rather circular, with deconvolved full width at half maximum (FWHM) sizes of ~2300 au on average. The central sources of two target fields show more extended, but still rather circular, methyl formate emission with deconvolved FWHM sizes of ~6700 au and 13 400 au. About 30% of our sample of methyl formate sources have core masses above 8 M⊙ and range in size from ~1000 au to 13 400 au, which is in line with measurements of archetypical hot cores. The origin of the CH3OCHO emission toward the lower-mass cores may be explained as a mixture of contributions from shocks or may correspond to objects in a more evolved state (i.e., beyond the hot core stage). We find that the fraction of hot core candidates increases with the core mass, suggesting that the brightest dust cores are all in the hot core phase. Conclusions. Our results suggest that most of these compact methyl formate sources are readily explained by simple symmetric models, while collective effects from radiative heating and shocks from compact protoclusters are needed to explain the observed extended CH3OCHO emission. The large fraction of hot core candidates toward the most massive cores suggests that they rapidly enter the hot core phase and that feedback effects from the forming protostar(s) impact their environment on short timescales.

Value-Based Healthcare: A Primer for the Dermatologist.

Value-based healthcare (VBHC) is an increasingly employed strategy to transform healthcare organizations into economically sustainable systems that deliver high-value care. In dermatology, the need for VBHC is evident as chronic skin diseases require long-term, often expensive treatments. This narrative review aims to introduce dermatologists to the principles and implementation of VBHC. VBHC emphasizes maximizing outcomes that are directly relevant to patients. Key components of VBHC include a systematic assessment of standardized patient-relevant outcomes by using core outcome sets and measurement of healthcare cost for the individual patient. Systematic reporting and comparing of risk-adjusted outcomes across the full cycle of care for a specific condition provide benchmarked feedback and actionable insights to promote high-value care and reduce low-value care. VBHC aims to organize care around the patient in condition-specific and team-based integrated practice units with multidisciplinary collaboration, utilize information technology platforms to enable digital data monitoring, reduce cost, and eventually reform payment systems to support bundled payments for the overall care cycle. VBHC implementation in practice necessitates the establishment of a systematic framework for outcome-based quality improvement, the incorporation of value and outcomes in shared decision-making practices, and the cultivation of a value-centric culture among healthcare professionals through continuous training. Dermatologists can benefit from implementing VBHC principles in their practice. An essential step toward value-driven dermatological care is to start measuring outcomes relevant for patients for each patient, which is lacking partly due to the absence of core outcome sets developed for clinical practice. By reducing low-value care and emphasizing optimal patient-centered outcomes, VBHC has the potential to improve the quality of care and ensure cost containment. Efforts are needed to enhance the development and uptake of VBHC in dermatological clinical practice to realize these benefits.

Evaluation scale and definitions of core and core stability in sports: A systematic review

BACKGROUND: Core stability has been reported to be important for improving performance in athletes. However, the variety of measures used to assess core stability has made it difficult to compare results across studies. In addition, there is a lack of consensus on precise definitions of core and core stability, which is a barrier to research in this field. OBJECTIVE: The overall purpose of this review was to summarize the definitions of core and core stability and measurements of core stability used in previous studies on athletes. METHODS: We searched four electronic databases (PubMed/Medline, SPORTDiscus, Web of Science and Science Direct) from their inception to October 2023. Studies evaluating core stability in athletes across all sports were included. We excluded case studies and case series, opinion pieces, letters to editors and studies not written in the English language. Two researchers independently assessed articles for inclusion and exclusion criteria and methodological quality. RESULTS: One hundred thirty-four studies were included, of which two were of high quality. The definitions of core and core stability varied widely, and ‘core’ was not defined in 108 studies and ‘core stability’ was not defined in 105 studies. The most used test protocol was the McGill test, which was used in 19 studies. CONCLUSIONS: There are multiple tests to measure core stability, and there is some confusion as to whether the measurement results represent core strength or core endurance. Future research papers should clarify the definitions of core and core stability, and consider core strength and core endurance separately.

Developing the Open Psychedelic Evaluation Nexus consensus measures for assessment of supervised psilocybin services: An e-Delphi study.

Voter initiatives in Oregon and Colorado authorize legal frameworks for supervised psilocybin services, but no measures monitor safety or outcomes. To develop core measures of best practices. A three-phase e-Delphi process recruited 36 experts with 5 or more years' experience facilitating psilocybin experiences in various contexts (e.g., ceremonial settings, indigenous practices, clinical trials), or other pertinent psilocybin expertise. Phase I, an on-line survey with qualitative, open-ended text responses, generated potential measures to assess processes, outcomes, and structure reflecting high quality psilocybin services. In Phase II, experts used seven-point Likert scales to rate the importance and feasibility of the Phase I measures. Measures were priority ranked. Qualitative interviews and analysis in Phase III refined top-rated measures. Experts (n = 36; 53% female; 71% white; 56% heterosexual) reported currently providing psilocybin services (64%) for a mean of 15.2 [SD 13.1] years, experience with indigenous psychedelic practices (67%), and/or conducting clinical trials (36%). Thematic analysis of Phase I responses yielded 55 candidate process measures (e.g., preparatory hours with client, total dose of psilocybin administered, documentation of touch/sexual boundaries), outcome measures (e.g., adverse events, well-being, anxiety/depression symptoms), and structure measures (e.g., facilitator training in trauma informed care, referral capacity for medical/psychiatric issues). In Phase II and III, experts prioritized a core set of 11 process, 11 outcome, and 17 structure measures that balanced importance and feasibility. Service providers and policy makers should consider standardizing core measures developed in this study to monitor the safety, quality, and outcomes of community-based psilocybin services.

Measuring treatment burden in people with Type 2 Diabetes Mellitus (T2DM): a mixed-methods systematic review

BackgroundMeasuring treatment burden is important for the effective management of Type 2 Diabetes Mellitus (T2DM) care. The purpose of this systematic review was to identify the most robust approach for measuring treatment burden in people with T2DM based on existing evidence.MethodsArticles from seven databases were retrieved. Qualitative, quantitative, and mixed-methods studies examining treatment burden in adults with T2DM and/or reporting relevant experiences were included. A convergent segregated approach with a mixed-methods design of systematic review was employed, creating a measurement framework in a narrative review for consistent critical appraisal. The quality of included studies was assessed using the Joanna Briggs Institute tool. The measurement properties of the instruments were evaluated using the Consensus based Standards for selection of Health Measurement Instruments (COSMIN) checklist.ResultsA total of 21,584 records were screened, and 26 articles were included, comprising 11 quantitative, 11 qualitative, and 4 mixed-methods studies. A thematic analysis of qualitative data extracted from the included articles summarised a measurement framework encompassing seven core and six associated measurements. The core measurements, including financial, medication, administrative, lifestyle, healthcare, time/travel, and medical information burdens, directly reflect the constructs pertinent to the treatment burden of T2DM. In contrast, the associated measurement themes do not directly reflect the burdens or are less substantiated by current evidence. The results of the COSMIN checklist evaluation demonstrated that the Patient Experience with Treatment and Self-management (PETS), Treatment Burden Questionnaire (TBQ), and Multimorbidity Treatment Burden Questionnaire (MTBQ) have robust instrument development processes. These three instruments, with the highest total counts combining the number of themes covered and "positive" ratings in COSMIN evaluation, were in the top tertile stratification, demonstrating superior applicability for measuring T2DM treatment burden.ConclusionsThis systematic review provides evidence for the currently superior option of measuring treatment burden in people with T2DM. It also revealed that most current research was conducted in well-resourced institutions, potentially overlooking variability in under-resourced settings.

Quality of telehealth-provided cancer care in VA.

1633 Background: As the largest integrated health care system in the United States, the Veterans Health Administration (VA) has extensive experience in utilizing telehealth-(TH) to deliver care to the 10 million enrolled Veterans, including the~50,000 patients newly diagnosed with cancer annually and ~500,000 cancer survivors. The VA National TeleOncology (NTO) service was established in 2020 to provide specialized treatment regardless of geographical location. We sought to compare quality in TH-delivered care compared to traditional (TR) in-person VA care. Methods: Using the VA EHR, we identified patients who had an ICD-10 diagnostic code for an incident malignancy from Dec 2016 to March 2021 at three medical centers providing both TR and TH care. We used EHR review to classify patients as TH users, if they received TH services at least once for their cancer care, or TR care if no telehealth was used. Using both structured EHR data and manual review by two trained abstractors, we gathered demographic, clinical, and treatment characteristics to calculate 25 Quality Oncology Practice Initiative (QOPI) measures in the domains of symptoms and toxicity management (2), end of life and palliative care (10), and core measures (13). We report QOPI measures descriptively; and used chi-squared tests with alpha = 0.05 to compare TH and TR. Results: We identified 972 patients with lymphoma, prostate, lung or colorectal cancer. 427 (44%) were TH users and 545 (56%) were TR, and they were predominately white (n=819, 84.3%) men (n=930, 95.7%). TH users had better (n=13), worse (n=9), same (n=2) and unevaluable (n=1) descriptive performance on measures. For example, TH and TR were similar in administration of appropriate antiemetic therapy for high and moderate-risk antineoplastic agents (44.8% vs 42.4%). TH performed better than TR for chemotherapy summary being completed within three months of chemotherapy ending (83.4% vs 75.6%) and for emotional well-being being assessed by the second office visit (92.3% vs 89.9%). Appropriate tobacco use cessation administration within the previous year was statistically higher in TH (85.3% vs 76.2% p=0.0021). No differences were statistically significant for any other QOPI measures. Conclusions: VA is a leader in TH cancer care because of both its volume and quality. VA-provided TH cancer care quality is similar to or better than that of TR in-person care. NTO specifically, and VA teleoncology broadly, provides another option to Veterans for cancer care.

Multimodal Quality Initiatives in Sepsis Care: Assessing Impact on Core Measures and Outcomes.

Providing timely and effective care for patients with sepsis is challenging due to delays in recognition and intervention. The Surviving Sepsis Campaign has developed bundles that have been shown to reduce sepsis mortality. However, hospitals have not consistently adhered to these bundles, resulting in suboptimal outcomes. To address this, a multimodal quality improvement sepsis program was implemented from 2017 to 2022 in a large urban tertiary hospital. The aim of this program was to enhance the Severe Sepsis and Septic Shock Management Bundle compliance and reduce sepsis mortality. At baseline, the Severe Sepsis and Septic Shock Management Bundle compliance rates were low, at 25%, with a sepsis observed/expected mortality ratio of 1.14. Our interventions included the formation of a multidisciplinary committee, the appointment of sepsis champions, the implementation of sepsis alerts and order sets, the formation of a Code Sepsis team, real-time audits, and peer-to-peer education. By 2022, compliance rose to 62%, and the observed/expected mortality ratio decreased to 0.73. Our approach led to improved outcomes and hospital rankings. These findings underscore the efficacy of a comprehensive sepsis care initiative, emphasizing the importance of interdisciplinary collaboration. A multimodal hospital-wide sepsis performance program is feasible and can contribute to improved outcomes. However, further research is necessary to determine the specific impact of individual strategies on sepsis outcomes.

Development of an International Standard Set of Outcomes and Measurement Methods for Routine Practice for Infants, Children, and Adolescents with Epilepsy: The International Consortium for Health Outcomes Measurement Consensus Recommendations.

At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. The International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy, and their representatives to develop minimum sets of standardized outcomes and outcome measurement methods for clinical practice. Using modified Delphi consensus methods with consecutive rounds of online voting over 12 months, a core set of outcomes and corresponding measurement tool packages to capture the outcomes were identified for infants, children, and adolescents with epilepsy. Consensus methods identified 20 core outcomes. In addition to the outcomes identified for the ICHOM Epilepsy adult standard set, behavioral, motor, and cognitive/language development outcomes were voted as essential for all infants and children with epilepsy. The proposed set of outcomes and measurement methods will facilitate the implementation of the use of patient-centered outcomes in daily practice.

Martian column CO2 and pressure measurement with spaceborne differential absorption lidar at 1.96 µm

Abstract. By utilizing progress in millijoule-level pulsed fiber lasers operating in the 1.96 µm spectral range, we introduce a concept utilizing a spaceborne differential absorption barometric lidar designed to operate within the 1.96 µm CO2 absorption band for remote sensing of Martian atmospheric properties. Our focus is on the online wavelength situated in the trough region of two absorption lines, selected due to its insensitivity to laser frequency variations, thus mitigating the necessity for stringent laser frequency stability. Our investigation revolves around a compact lidar configuration, featuring reduced telescope dimensions and lower laser pulse energies. These adjustments are geared towards minimizing costs for potential forthcoming Mars missions. The core measurement objectives encompass the determination of column CO2 absorption optical depth, columnar CO2 abundance, surface atmospheric pressure, and vertical distributions of dust and cloud layers. Through the amalgamation of surface pressure data with atmospheric temperature insights garnered from sounders and utilizing the barometric formula, the prospect of deducing atmospheric pressure profiles becomes feasible. Simulation studies validate the viability of our approach. Notably, the precision of Martian surface pressure measurements is projected to surpass 1 Pa when the aerial dust optical depth is projected to be under 0.7, a typical airborne dust scenario on Mars, considering a horizontal averaging span of 10 km.

Development of an International Standard Set of Outcomes and Measurement Methods for Routine Practice for Adults with Epilepsy: The International Consortium for Health Outcomes Measurement Consensus Recommendations.

At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. Therefore, the International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy and their representatives to develop minimum sets of standardized outcomes and outcomes measurement methods for clinical practice that support patient-clinician decision-making and quality improvement. Consensus methods identified 20 core outcomes. Measurement tools were recommended based on their evidence of strong clinical measurement properties, feasibility, and cross-cultural applicability. The essential outcomes included many non-seizure outcomes: anxiety, depression, suicidality, memory and attention, sleep quality, functional status, and the social impact of epilepsy. The proposed set will facilitate the implementation of the use of patient-centered outcomes in daily practice, ensuring holistic care. They also encourage harmonization of outcome measurement, and if widely implemented should reduce the heterogeneity of outcome measurement, accelerate comparative research, and facilitate quality improvement efforts.

Research on magnetic field characteristics of amorphous alloy and grain‐oriented silicon steel hybrid magnetic circuit iron core

AbstractAmorphous alloy and grain‐oriented silicon steel are commonly employed as soft magnetic materials for the preparation of transformer cores, but both materials have their advantages and disadvantages. Using only silicon steel or amorphous alloy for the preparation of the core makes it difficult to achieve both high design density and low no‐load loss characteristics. In order to achieve the magnetic performance advantages of both amorphous alloy and silicon steel in transformer core development and application, the authors design and develop a kind of amorphous alloy and grain‐oriented silicon steel hybrid magnetic circuit core to explore the amorphous alloy and grain‐oriented silicon steel at different ratios under the magnetic properties of matching law. Based on the amorphous alloy and grain‐oriented silicon steel core magnetic performance comparison characteristics, the authors establish a core magnetic circuit model and design a hybrid magnetic circuit core structure with different material ratios. The hybrid magnetic circuit core model is simulated and analysed to obtain the magnetic density distribution of the hybrid magnetic circuit core. A number of hybrid magnetic circuit core experimental models are produced, and the use of a magnetic property measurement platform is made for the hybrid magnetic circuit core measurements, to reveal the magnetic performance matching law of the hybrid magnetic circuit core, providing a good solution for power distribution in the hybrid magnetic circuit.

Cancer-Specific Health Utilities: Evaluation of Core Measurement Properties of the EORTC QLU-C10D in Lung Cancer Patients-Data from Four Multicentre LUX-Lung Trials, Applying Six Country Tariffs.

Cost-utility analysis generally requires valid preference-based measures (PBMs) to assess the utility of patient health. While generic PBMs are widely used, disease-specific PBMs may capture additional aspects of health relevant for certain patient populations. This study investigates the construct and concurrent criterion validity of the cancer-specific European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Utility-Core 10 dimensions (QLU-C10D) in non-small-cell lung cancer patients. We retrospectively analysed data from four multicentre LUX-Lung trials, all of which had administered the EORTC Quality of Life Questionnaire (QLQ-C30) and the EQ-5D-3L. We applied six country-specific value sets (Australia, Canada, Italy, the Netherlands, Poland, and the United Kingdom) to both instruments. Criterion validity was assessed via correlations between the instruments' utility scores. Correlations of divergent and convergent domains and Bland-Altman plots investigated construct validity. Floor and ceiling effects were assessed. The comparison of the EORTC QLU-C10D and EQ-5D-3L produced homogenous results for five of the six country tariffs. High correlations of utilities (r > 0.7) were found for all country tariffs except for the Netherlands. Moderate to high correlations of converging domain pairs (r from 0.472 to 0.718) were found with few exceptions, such as the Social Functioning-Usual Activities domain pair (max. r = 0.376). For all but the Dutch tariff, the EORTC QLU-C10D produced consistently lower utility values compared to the EQ-5D-3L (x̄ difference from -0.082 to 0.033). Floor and ceiling effects were consistently lower for the EORTC QLU-C10D (max. 4.67% for utilities). The six country tariffs showed good psychometric properties for the EORTC QLU-C10D in lung cancer patients. Criterion and construct validity was established. The QLU-C10D showed superior measurement precision towards the upper and lower end of the scale compared to the EQ-5D-3L, which is important when cost-utility analysis seeks to measure health change across the severity spectrum.

Assessment of the Upper Cretaceous Abu Roash carbonate source rocks from the Beni Suef field, Western Desert, Egypt

Global sea-level rise during the Early Turonian-Late Cenomanian Bonarelli event resulted in oceanic anoxia and deposition of organic-rich source rocks across Northern Africa, such as the Late Cretaceous Abu Roash-F carbonates. Here, using thin sections, SEM, XRF, standard core analysis, and Rock-Eval pyrolysis data, we examine the petrographic and geochemical properties of the Abu Roash-F (AR-F) carbonate source rocks. These deep marine carbonates consist of dominantly planktonic foraminifera and calcispheres and are classified as wackestone. Extensive micritization, calcite cementation, and ferroan dolomite cement replacement (filling the bioclastic tests and chambers) are identified as the principal diagenetic factors. Core measurements indicate that these carbonates have very low porosity below 3% and horizontal permeability of 0.003 mD (3x10-18 m2), which is also supported by the observed isolated nanopores in SEM. The elemental concentration from the XRF data confirms a highly reducing depositional environment that facilitated the organic richness during the Early Turonian Oceanic Anoxia Event 2 (OAE2). The studied carbonate interval consists of Type-II kerogen in the oil window with a Tmax of about 440 °C and up to 4.2 wt.% TOC indicating ‘fair’ to ‘excellent’ organic richness and a very high probability of active oil generation and expulsion. Following the wireline logs and core data, the self-sourcing unconventional reservoir potential of the AR-F carbonates has been emphasized.