High Rate Of Agreement Research Articles

Flexural Behavior of Composite GFRP Pultruded I-Section Beams under Static and Impact Loading

In this study, the effect of glass fiber reinforced polymer (GFRP) section and compressive strength of concrete in composite beams under static and low velocity impact loads was examined. Modeling was performed and the obtained results were compared with the test results and their compatibility was evaluated.‎ Experimental tests of four composite beams were carried out, where two of them are control specimen with 20 MPa compressive strength of concrete deck slab and 50 MPa for other. Bending characteristics were affected by the strength of concrete under impact loading case, as it increased maximum impact force and damping time at a ratio of 59% and reduced the damping ratio by 47% compared to the reference hybrid beam. Under static loading, there was an increase in all the parameters, including the maximum load, ductility, and stiffness. Mid-span deflection was reduced by 25% under static and impact loads. A finite element analysis was performed by using the ABAQUS software. The midspan deflection value was greater than the experimental values by 6% and 3% for impact and static loads, respectively, and all other results showed a high rate of agreement with the obtained test results. The agreement between the numerical and experimental results indicates that the developed numerical model is capable of analyzing the impact and static behavior of such hybrid GFRP-concrete system. Doi: 10.28991/cej-2020-03091608 Full Text: PDF

الأدوار المستقبلية لمعلم التربية الفنية في ضوء مهارات القرن الحادي والعشرون

يهدف البحث الحالي تحديد أدوار معلم التربية الفنية في ضوء التوجهات المعاصرة لمعلم المستقبل والتي فرضتها مهارات القرن الحادي والعشرون . وقد تمحورت مشکلة الدراسة في الإجابة على الأسئلة التالية: ما العلاقة بين مقومات معلم التربية الفنية وبين تحقيق مؤشرات مرتبطة بمهارات القرن الحادي والعشرون؟ ، ما مدى تضمين الأدوار المتعددة لمعلم التربية الفنية لمؤشرات ترتبط باداؤه کمعلم فعال ومؤشرات الاستجابة المتوقعة من الطلبة؟ وقد اتبع الباحث إجراءات المنهج الوصفي خلال تصميم نموذج يتضح خلاله تحديد العمليات والمؤشرات المتوقعة للأدوار الجديدة لمعلم المستقبل ، بالتزامن واستشراف مؤشرات الاستجابة المتوقعة من الطلبة. وقد تم تصنيف ادوار المعلم الى معايير ومؤشرات على هيئة نموذج للاستبيان على صلاحيته تم توزيعه على لجنة من الخبراء في الميدان . أظهرت نتائج البحث ارتفاع نسب الاتفاق على المعايير والمؤشرات الخاصة بمواصفات معلم التربية الفنية المستقبلي . قدم البحث عددا من التوصيات أهمها العمل على الأخذ بالمعايير المقترحة عند تطوير نظم اعتماد برامج التربية الفنية في المؤسسات الجامعية . الکلمات المفتاحية: معلم التربية الفنية ، معلم المستقبل ، مهارات القرن الحادي والعشرون. Abstract The current research aims to define the roles of the art education teacher in light of the contemporary trends of the future teacher imposed by the skills of the twenty first century. The study problem centered in answering the following questions: What is the relationship between the components of the art education teacher and the achievement of indicators related to the skills of the twenty first century? To what extent do the various roles of the art education teacher include indicators related to his performance as an effective teacher and the response indicators expected from students? The researcher followed the descriptive approach procedures during designing a model in which it is clear to define the expected processes and indicators for the new roles of the future teacher, in conjunction with exploring the expected response indicators from the students. The teacher's roles were classified into criteria and indicators in the form of a questionnaire on its validity, which was distributed to a committee of experts in the field. The results of the research showed high rates of agreement on the criteria and indicators for the specifications of the future art education teacher. The research presented a number of recommendations, the most important of which is to work on adopting the proposed standards when developing systems for accrediting art education programs in university institutions. Key words: art education teacher, future teacher, twenty-first century skills.

Digital morphology analyzers in hematology: a French survey

questionnaire sent by e-mail in 2018 to French public and private laboratories. out of 118 responses (56 private, 62 public), 117 participants had a CellaVision® microscope, 1 had a West Medica®. Practices were sometimes different, especially in the choice of smears to be digitized or for quality controls (16.1% had internal quality controls, 48.3% external quality controls); 62.1% never used the red blood cell (RBC) characterization tool; the number of cells counted varied from 100 to 400. The study reported a high rate of agreement for these benefits: traceability (95.7%), staff training (94.1%), eye strain (91.4%), risk of error (87.2%), time saving (83.6%). Among the disadvantages, apart from the inadequate search for platelets clumps (93.2%), the agreement rates were often lower: adaptation to digital images (61.2%), difficult assessment of atypical morphologies (49.6%) or RBC morphology (49.6%). despite well-established benefits, standardization of practices and technical improvement are still needed.

Development of BDMS Utilization Review Technology (BURT): An Artificial Intelligence Tool Using Thai Natural Language Processing to Assess Appropriateness of Hospitalization

OBJECTIVES: To develop an effective artificial intelligence (AI) driven platform to optimize the process of assessing appropriateness of hospitalization. MATERIALS AND METHODS: Anonymized data of 22,020 insured-patient admissions in a BDMS network hospital were included to build a prediction model based on a comprehensive guideline for appropriate hospitalization. To develop Thai Natural Language Processing (NLP) model, 77,707 sentences from medical records were used and separated into two datasets, 80% for training and 20% for testing. A combined NLP and rule-based algorithms formed an AI engine and outputs were displayed using a web-based application. An expert panel of five Utilization Management (UM) physicians had several collaborative discussions to fine tune the NLP model, application of clinical criteria, and classification engine. Eventually, NLP model in the latest version (BURT1.1), had satisfactory features with overall higher than 99% accuracy, precision, recall, and F1.  RESULTS: Performance of BURT1.1 was assessed using 300 cases randomly selected from the main dataset, against other methods, including concurrent review by UM nurses at the participating hospital, and UM nurses at Bangkok Hospital Headquarters (BHQ). Agreement upon UM Physician Panel consensus was set as one of the performance indicators, and BURT1.1 showed a favorable outcome with the highest rate of agreement (86%) among all the methods. The precision rate was 99% as compared to insurance claim approval status. Additionally, dramatic time savings were achieved with 0.59 second of processing time as compared to 10-15 minutes per case by conventional manual review. CONCLUSION: BURT1.1 should be effectively implemented as an automatic daily tool to screen inappropriate hospitalization. It can immediately identify patients at high risk of inappropriate hospitalization that require further assessment by UM nurse, thus providing feedback to attending physicians on the completeness and quality of documentation, with parallel notification to UM physicians. Ultimately, BURT1.1 can contribute to increase UM efficiency, speeding up the claim process, reducing health care costs due to unnecessary hospitalization, and reduction of claim denials.

Italian young doctors’ knowledge, attitudes and practices on antibiotic use and resistance: A national cross-sectional survey

ObjectivesAntimicrobial resistance (AMR) is one of the major health issues worldwide. Clinicians should play a central role to fight AMR, and medical training is a pivotal issue to combat it; therefore, assessing levels of knowledge, attitudes and practices among young doctors is essential for future antimicrobial stewardship (AMS) programmes. MethodsA nationwide, cross-sectional, multicentre survey was conducted in Italy. A descriptive analysis of knowledge and attitudes was performed, along with a univariate and multivariate analysis of their determinants. ResultsOverall, 1179 young doctors accessed the survey and 1055 (89.5%) completed all sections. Regarding the knowledge section of the questionnaire, almost all participants declared to know the different species of bacteria proposed, however the percentage of participants who correctly responded to clinical quizzes was 23% for the question on vancomycin-resistant enterococci (VRE), 42% on carbapenem-resistant Enterobacteriaceae (CRE), 32% on extended-spectrum β-lactamase-producing enterobacteria (ESBL) and 27% on methicillin-resistantStaphylococcus aureus (MRSA). Similarly, 81% of participants disagreed in stating that AMR was adequately addressed during their medical training and 71% disagreed that they received the right example from their tutors. Finally, a high rate of agreement with the proposed actions to combat AMR was documented; in particular, the percentage agreement was 76% for respondents who agreed to be part of an active surveillance system or AMS programme. ConclusionsTackling AMR should be a priority for politicians and for all health workers. Inclusion of competencies in antibiotic use in all specialty curricula is urgently needed.

RNA in situ hybridization for human papillomavirus testing in oropharyngeal squamous cell carcinoma on a routine clinical diagnostic platform.

The current diagnostic standard for detection of high-risk human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma is via a two-stage algorithm, namely p16 immunohistochemistry followed by HPV DNA in situ hybridization in p16 positive cases. This study evaluated the feasibility of automated RNA in situ hybridization on a clinical platform as a single-step alternative to the two-stage algorithm within a routine diagnostic histopathology setting. Thirty-eight cases positive for both p16 and DNA in situ hybridization, 42 p16 negative cases and 20 cases positive for p16 but negative for DNA in situ hybridization were randomly selected. High-risk HPV RNA in situ hybridization was undertaken on all cases on an automated clinical platform. Manufacturer-recommended and on-slide additional p16/HPV positive and negative controls were used. Test quality assurance and diagnostic RNA in situ hybridization were independently assessed by two observers. A consensus diagnosis was reached in the presence of a third observer on discordant cases. All RNA in situ hybridization results were then correlated against p16 and DNA ISH status. Inter-slide RNA in situ hybridization staining variation was observed in control sections. RNA in situ hybridization demonstrated a high inter-observer agreement rate (κ=.897, P<.001). Following consensus review, there was full concordance between RNA in situ hybridization and the current standard. Human papillomavirus testing by standalone automated RNA in situ hybridization on a clinical diagnostic platform currently available in routine diagnostic histopathology laboratories is a feasible alternative to the two-step algorithm of p16 and DNA in situ hybridization. Control tissue staining procedures need to be adapted to achieve the most accurate results.

Barriers and Facilitators for Referrals of Primary Care Patients to Blended Internet-Based Psychotherapy for Depression: Mixed Methods Study of General Practitioners' Views.

BackgroundMajor depressive disorder (MDD) is highly prevalent and often managed by general practitioners (GPs). GPs mostly prescribe medication and show low referral rates to psychotherapy. Many patients remain untreated. Blended psychotherapy (bPT) combines internet-based interventions with face-to-face psychotherapy and could increase treatment access and availability. Effectively implementing bPT in routine care requires an understanding of professional users’ perspectives and behavior.ObjectiveThis study aims to identify barriers and facilitators perceived by GPs in referring patients to bPT. Explanations for variations in referral rates were examined.MethodsSemistructured interviews were conducted with 12 of 110 GPs participating in a German randomized controlled trial (RCT) to investigate barriers to and facilitators for referrals to bPT for MDD (10 web-based modules, app-based assessments, and 6 face-to-face sessions). The interview guide was based on the theoretical domains framework. The interviews were audio recorded and transcribed verbatim, and the qualitative content was analyzed by 2 independent coders (intercoder agreement, k=0.71). A follow-up survey with 12 interviewed GPs enabled the validation of emergent themes. The differences in the barriers and facilitators identified between groups with different characteristics (eg, GPs with high or low referral rates) were described. Correlations between referrals and characteristics, self-rated competences, and experiences managing depression of the RCT-GPs (n=76) were conducted.ResultsGPs referred few patients to bPT, although varied in their referral rates, and interviewees referred more than twice as many patients as RCT-GPs (interview-GPs: mean 6.34, SD 9.42; RCT-GPs: mean 2.65, SD 3.92). A negative correlation was found between GPs’ referrals and their self-rated pharmacotherapeutic competence, r(73)=−0.31, P<.001. The qualitative findings revealed a total of 19 barriers (B) and 29 facilitators (F), at the levels of GP (B=4 and F=11), patient (B=11 and F=9), GP practice (B=1 and F=3), and sociopolitical circumstances (B=3 and F=6). Key barriers stated by all interviewed GPs included “little knowledge about internet-based interventions” and “patients’ lack of familiarity with technology/internet/media” (number of statements, each k=22). Key facilitators were “perceived patient suitability, e.g. well-educated, young” (k=22) and “no conflict with GP’s role” (k=16). The follow-up survey showed a very high agreement rate of at least 75% for 71% (34/48) of the identified themes. Descriptive findings indicated differences between GPs with low and high referral rates in terms of which and how many barriers (low: mean 9.75, SD 1.83; high: mean 10.50, SD 2.38) and facilitators (low: mean 18.25, SD 4.13; high: mean 21.00; SD 3.92) they mentioned.ConclusionsThis study provides insights into factors influencing GPs’ referrals to bPT as gatekeepers to depression care. Barriers and facilitators should be considered when designing implementation strategies to enhance referral rates. The findings should be interpreted with care because of the small and self-selected sample and low response rates.

A modified Sydney system for the diagnosis of chronic gastritis in dogs

BackgroundThe Sydney system for assessing inflammatory lesions in the gastric mucosa is based on endoscopic and histological examinations. This study aimed to apply the Sydney system to diagnose gastritis in dogs. The study also compared the results of endoscopic and histological examinations conducted on gastric mucosal biopsy specimens. A total of 56 dogs with chronic vomiting were analyzed in the study. The physical appearance of the gastric mucosa was assessed through endoscopic examination, while the severity of the gastric inflammation, inflammation activity, glandular atrophy, and intestinal metaplasia were assessed by histopathological examination.ResultsThe endoscopic examination confirmed the presence of inflammatory lesions affecting the gastric corpus and pylorus in all the dogs, although the severity of these lesions differed between the individuals. Reflux gastritis was the most commonly observed gastric inflammation. In the histopathological examination of the gastric mucosal samples, inflammatory lesions were found in the gastric corpus of 53 dogs, while 55 dogs had lesions in the pylorus. This corresponds to a 96.4% agreement between the methods.ConclusionsThe Sydney system is a useful tool for macroscopic and microscopic assessment of changes in the gastric mucosa as it enables the determination of inflammation type and severity, which helps the canine gastroenterologists to reliably compare the results of the tests performed in different facilities. Besides, the use of the Sydney system in diagnosing lesions facilitates the selection and effective monitoring of treatment. However, despite a high rate of agreement between the results of endoscopic and histopathological examinations, it is recommended to use both these methods for the assessment of the gastric mucosa in dogs.

Eating disorder diagnostics in the digital era: validation of the Norwegian version of the Eating Disorder Assessment for DSM-5 (EDA-5)

ObjectiveThe Eating Disorder Assessment for DSM-5 (EDA-5) is an electronic, semi-structured interview developed to assess feeding and eating disorders following DSM-5 criteria. The original English version has strong psychometric properties, and previous research has shown high rates of agreement between diagnoses generated by the Eating Disorder Examination (EDE) interview and the EDA-5. The current study aimed to validate the Norwegian version of the EDA-5, and is the first international validation of this diagnostic tool.MethodA total of 91 (87 females and 4 males) adult in- and out-patients were recruited from two of the largest eating disorder clinics in Norway. Diagnoses assigned using the EDA-5 were compared to diagnoses from the EDE interview (v. 17.0D).ResultsResults showed that diagnoses assigned using EDE and EDA-5 were identical for 75 (82.4%) of the 91 cases. Among individual diagnostic categories, kappas ranged from moderate (.49) to perfect (1.00) agreement. The majority of discrepant cases occurred between full- and sub-threshold AN and BN. The EDA-5 was significantly quicker to administer compared to the EDE (22 vs. 54 min).ConclusionsThe Norwegian EDA-5 can quickly and efficiently generate DSM-5 diagnoses without compromising diagnostic accuracy. It is a promising alternative to existing diagnostic tools, and may help streamline the identification of feeding and eating disorders in clinical settings and in research.

Usefulness of Tumor Tissue Biopsy for Predicting the Biological Behavior of Hepatocellular Carcinoma.

Assessment of the biological behavior of tumors is important for choosing an appropriate cancer therapy. In hepatocellular carcinoma (HCC), the biological behaviour can be assessed by tumor morphology and molecular biology. This study investigated the usefulness of tumor tissue biopsy for predicting the biological behavior of HCC. We studied 43 patients who underwent hepatectomy and preoperative liver tumor biopsy for HCC. We performed clinicopathological and immunohistochemical (IHC) analyses. The expression of the following molecules was examined: regulator of G-protein signaling 5 (RGS5), glypican-3 (GPC3), keratin 19 (K19), epithelial cell adhesion molecule (EpCAM), protein induced by vitamin K absence or antagonist-II (PIVKA-II), β-Catenin, and p53. There was an overall 83.7% agreement regarding tumor differentiation between the preoperative biopsy specimens and the resected specimens. The accuracy of IHC analysis was more than 70% for all molecules between the preoperative biopsy specimens and the resected specimens. The RGS5-positive biopsy cases had higher serum α-fetoprotein levels (p=0.04), a higher rate of moderately or poorly differentiated tumors (p=0.02) and portal vein invasion (p=0.0003) than the RGS5-negative biopsy cases. The GPC3-positive biopsy cases were younger (p=0.04), had higher serum PIVKA-II levels (p=0.01), and a higher rate of portal vein invasion (p=0.03) than the GPC3-negative biopsy cases. The PIVKA-II-positive biopsy cases had significantly higher serum PIVKA-II levels than the PIVKA-II-negative biopsy cases (p=0.02). The other molecular markers showed no significantly different clinical findings between the positive and negative cases. In HCC, there was a high agreement rate of both the histopathological and IHC findings between preoperative biopsy specimens and resected specimens. In the biopsy specimens of HCC, RGS5 and GPC3 expression were useful molecular makers for predicting portal vein invasion. Liver tumor biopsy is useful for predicting the biological behavior of HCC through histopathological and immunohistochemical findings.

Food defense: Perceptions and attitudes of Brazilian dairy companies

This study aimed to evaluate the perception of Brazilian dairy processors (n = 31) concerning food defense. The results showed that respondents consider the implementation of control procedures related to facilities, products, materials, and individuals as important measures in food defense. The higher agreement rates (strongly agreed + slightly agreed) of the companies in relation to the perception of food defense were 84% for external security, followed by personnel security (82%), generalities (81%), and internal security (74%). Thus, protecting facilities and controlling the traffic flow were considered to be the most important actions under the participants' perspectives. Employee satisfaction and identification of end products and raw materials are also considered relevant in the food defense program. Although food defense is not a formal requirement in Brazilian law, the results show that there is adequate awareness of this topic by the Brazilian dairy companies.

The validity and reliability analysis of the Turkish version of the 8-item passion scale

AimThe aim of this study is to conduct the validity and reliability analysis of the Turkish version of the 8-item Passion Scale. Materials and methodThe methodologically designed study was conducted with 155 university students. “Descriptive Characteristics Form”, “Passion Scale”, and “Grit-S Scale” were used to collect data. Language and content validity, construct validity and reliability value determination tests were conducted respectively. ResultsThe content validity analysis revealed high agreement rate among expert opinions regarding scale items (CVI = 0.93). Exploratory factor analysis found that the scale has a single-factor construct explaining 51.9% of the total variance. The results of the confirmatory factor analysis indicated that the model is around the borders of admissible fit index and factor loads varied between 0.51 and 0.83. The Cronbach Alpha Coefficient for the reliability of the scale was calculated as 0.864. ConclusionThe results of the study showed that the Turkish version of the Passion Scale is valid and reliable, thus, can be used to evaluate overall success grit in an objective manner.

Consistency of new drug pricing in Korea: Bridging variations among personnel in price negotiations

ObjectivesThis study aims to explore the performance of price negotiations, over a period of 10 years, and identify individual variations in pricing that directly affect the consistency of pricing decisions. MethodsExisting literature and relative regulations were reviewed, and data provided by the National Health Insurance Service (NHIS) was analysed to evaluate the performance of price negotiations. To examine individual variations in pricing, hypothetical scenarios of four types of drugs were developed. These were subsequently given to the reviewers who have been actually conducting price negotiations at the NHIS. ResultsOver the last decade, negotiations succeeded at a rate of 85.5 %, with a higher agreement rate in the more recent years. The reduction rate, via price negotiations, from the price approved for reimbursement by the Health Insurance Review and Assessment Service (HIRA), was 12.2 %. The survey results confirmed a significant individual variation in pricing. Especially, in the case of Drug N1, the higher-grade personnel and non-pharmacists tended to give higher prices with a significant difference. ConclusionsThe individual variations that would greatly affect the financial results were confirmed when making decisions on price of new drugs.For the consistency of drug pricing, some measures to minimise the variation of reviewers’ judgement are needed.

Construction and Validation of a Video Coding Tool for an Intervention to Improve Parental Feeding

Abstract Objectives Home-based interventions have used video-recorded meals to assess feeding practices, yet no studies have used videos to directly provide feedback on the practices observed. This study describes the development and initial validation of a video coding tool to assess feeding practices observed in video-recorded family meals in order to provide feedback to caregivers. Methods The tool with operational definitions was developed based on the previous literature and other tools that capture caregiver feeding practices. To assess face validity, a sample of child feeding experts (n = 6) reviewed the tool and completed an 8-item online survey. Usability and content were assessed on a scale of 0–100, with 100 representing high usability and importance, respectively. The tool was modified based on expert feedback and used by trained research assistants to code 10 video-recorded family meals. Inter-rater reliability (IRR) was calculated and 3 videos were then randomly selected and coded by each research assistant at two different time points to assess test re-test reliability. Results Expert ratings of tool usability (81.83 ± 11.67) and content (87.67 ± 13.98) included feedback regarding the need to expand the operational definitions to better code practices, in particular with regards to pressure and encouragement. They also suggested merging practices, such as nutrition education and reasoning, which may be difficult to discern in an observational setting. Average IRR was 86.4% with pressure (75.1%) and encouragement (66.9%) having the lowest rates of agreement between coders. Limited choices (100%) and restriction (95.9%) had the highest rates of agreement. For test re-test reliability, the average agreement between the two timepoints was 80.0%. Conclusions Following the feedback from experts, the face validity of the developed tool improved, and the inter-rater reliability and test re-test reliability of the tool was acceptable. Future studies should focus on the expansion of operational definitions and training efforts to further improve inter-rater and test re-test reliabilities. Funding Sources This work was supported by the National Institutes on Health National Heart, Lung and Blood Institute [Tovar/R34HL 140,229].

Bibliometrics and systematic reviews: A comparison between the Proknow-C and the Methodi Ordinatio

Abstract This research aims to analyze and compare the selection of relevant papers by two bibliometric methods, namely, the Knowledge Development Process-Constructivist (Proknow-C) and the Methodi Ordinatio, which were also discussed in terms of common steps, limitations and underlying assumptions. Particularly, the topic of knowledge management in small and medium-sized enterprises was chosen in order to illustrate the application of these two methods that support systematic reviews. Besides descriptive indexes such as citations and journal impact, co-citation analysis was employed to examine selected papers. The results showed that both methods possess a high agreement rate in terms of selecting recent articles, but a low agreement rate regarding relevant/seminal articles, besides revealing a strong bias of the Methodi Ordinatio towards recent articles when the alpha constant is 10. Particularly, recent papers (up to two years of publication) represent about 80 % of top-50 InOrdinatio ranked articles. The co-citation analysis of the 46 selected articles (29 recent; 17 relevant) corroborated the methods capacity to select relevant articles. Finally, further bibliometric reviews in other topics may benefit from the common steps, limitations and underlying assumptions discussed in this research for selecting and analyzing relevant papers.

Contrast-Sparing Imaging Utilizing Spectral Detector CT for Transcatheter Aortic Valve Replacement Procedure Planning

ABSTRACT Background : Cardiac CTA is an indispensable imaging tool for TAVR procedure planning. Post-processing of the dual-energy CT utilizing dual-source and kV-switching approach enables an increase in the density of iodine and allows the reduction of iodine dose. We hypothesized that the use of a dual-layer Spectral Detector CT (SDCT) can enhance the signal of intravascular iodine contrast material, reduce iodine contrast material volume, and facilitate pre-TAVR planning. Methods : We tested this in a preclinical porcine animal model, with results suggesting that spectral imaging may be superior to conventional imaging even at 21-35% of the full contrast medium dose with regard to reader confidence, higher SNR and CNR at the level of the aortic annulus and root. We subsequently followed this up by a prospective human validation study of 24 patients undergoing TAVR. Results : We demonstrate that SNR and CNR with SDCT were significantly higher (highest in lower energy virtual mono-energetic images (VMI) (monoE 40 keV) compared to conventional images, with the spectral images preferred for procedure planning by an experienced TAVR operator and imaging specialist. This was associated with a reduction in inter-observer variability in TAVR sizing measurements in low dose contrast studies (33% of the full contrast dose) resulting in a higher rate of agreement on the choice of valve prosthesis size. Conclusion : Low contrast dose spectral images achieved similar SNR and CNR compared to full contrast dose conventional images. Taken together, our results suggest that the use of SDCT imaging may facilitate the routine use of low contrast dose as part of pre-TAVR imaging.

A Novel Interprofessional Palliative Care and Geriatrics Curriculum for Nephrology Teams.

The population of older adults with chronic kidney disease (CKD) is increasing and nephrologists need education on the principles of geriatrics and palliative care to effectively care for this population. Our objective was to develop and deliver a curriculum to interprofessional clinicians caring for older adults with CKD. The aim of this curriculum would be to improve knowledge of the principles of geriatrics and palliative care. We have previously developed a curriculum on geriatrics and palliative care targeted toward primary care teams. In this project, we used an interdisciplinary steering committee to modify the curriculum for nephrology teams. This curriculum was delivered in a live grand rounds setting and was recorded and made available via online platform for virtual learning. The 6-session curriculum was delivered to 611 live and online learners between January 2018 and April 2019, with more than half of the participants (n = 317) completing more than 1 session. Participants came from a variety of disciplines including medicine, nursing, pharmacy, and social work. Participants had a high rate of agreement with the statement that the curriculum met learning objectives, with live participants having stronger agreement. Participants reported that the activity would change their practice behavior by calling palliative care earlier, as well as improving their communication skills. Interprofessional collaboration can result in improved learning around the management of patients with CKD or end-stage kidney disease.

Luminal A versus luminal B breast cancer: MammaTyper mRNA versus immunohistochemical subtyping with an emphasis on standardised Ki67 labelling-based or mitotic activity index-based proliferation assessment.

Proliferation assessment by the use of Ki67 is a crucial component in intrinsic subtyping of luminal breast cancers (BCs), but suffers from variability between laboratories, observers, and methods. MammaTyper is a quantitative molecular tool that measures mRNA levels of ERBB2, ESR1, PGR and MKI67 in BC, and interprets the results according to the St Gallen 2013 consensus recommendations. We compared MammaTyper with immunohistochemistry (IHC)-based subtypes, with a focus on standardised proliferation assessment. We analysed the agreement in assigning subtypes between MammaTyper and receptor IHC in 101 unifocal luminal HER2-negative early BCs of no special type. Two Ki67 counting protocols, Ki67-Global (Ki67-G) and Ki67-HotSpot (Ki67-H), recommended by the International Ki67 in BC Working Group, and the mitotic activity index (MAI) were used for proliferation assessment. The proportions of BCs identified as luminal A and as luminal B were 55% and 45% for MammaTyper, 55% and 45% for IHC+Ki67-G, 36% and 64% for IHC+Ki67-H, and 56% and 44% for IHC+MAI. The levels of agreement between MammaTyper-based and IHC-based subtyping were 84% (κ=0.679) for IHC+Ki67-G, 72% (κ=0.462) for IHC+Ki67-H, and 89% (κ=0.779) for IHC+MAI. High rates of agreement between mRNA-based and IHC-based intrinsic subtyping of luminal HER2-negative BC can be achieved. However, the agreement between IHC-based and MammaTyper-based luminal subtypes depends on the proliferation assessment method, and was highest when the MAI was used. Further comparative clinical studies are needed to determine which method is to be preferred, including analysis of cost-effectiveness.

Effect of Daily Teacher Feedback on Subsequent Motivation and Mental Health Outcomes in Fifth Grade Students: a Person-Centered Analysis.

Prevention scientists recognize that implementing effective prevention practices and programs responsive to the needs of individuals but based solely upon the findings from variable-centered methods presents several limitations due to numerous risk factors, pathways, and unobserved influences. One such understudied influence that is masked by variable-centered methods, motivation, is a person-level characteristic that influences treatment outcomes. The purpose of this paper is to demonstrate the use of an alternative person-centered approach, group iterative multiple model estimation (GIMME), to model change over time that focuses on the interdependence of daily student motivation levels and teacher feedback and their relations to student outcomes over time. Specifically, we used GIMME to model person level responses to negative teacher feedback regarding students' next day motivational ratings using data from 58 5th grade students participating in a study of the impact of the self-monitoring and regulation training strategy (SMARTS). Results identified a set of SMARTS students whose daily readiness aligned with high rates of self and teacher agreement regarding ongoing performance ratings. However, results identified a group of students whose daily motivation and readiness for change was adversely impacted by negative teacher feedback the day before. For these students, they were more likely than their peers to experience high levels of depression and internalization scores. Motivationally oriented practice suggestions for providing feedback to students who may be sensitive to this type of feedback and research implications of these findings are discussed.

Construção e validação preliminar de instrumento para a compreensão do ensino das lutas na educação física escolar

O objetivo deste estudo foi construir e validar de forma preliminar um questionário de ensino das lutas e do jogo (QELJ), contribuindo para entender como está sendo realizado o ensino das lutas na educação física escolar. A elaboração das dimensões do instrumento baseou-se na literatura em lutas e jogo. O processo de validação de conteúdo foi realizado por cinco juízes experts na área. O V de Aiken foi usado para quantificar a concordância entre especialistas. Além disso, foi realizado a testagem do instrumento com 17 professores de educação física em dois momentos, com intervalo de 14 dias entre cada momento. O software NVivo 9.2 foi usado para análise de conteúdo nas respostas dos participantes. Os resultados mostraram altas taxas de concordância positiva entre os avaliadores, todos acima de 0,80. O estudo piloto também apresentou bons resultados de confiabilidade na análise das respostas dos participantes nos dois momentos (97% para questões fechadas, 82% para questões abertas). Conclui-se que o QELJ provou ser um instrumento válido e útil para melhorar a compreensão do ensino das lutas na educação física escolar, embora outras avaliações psicométricas do instrumento devam ser realizadas no futuro.