Individual Component Scores Research Articles

707 EXAMINING THE UTILITY OF THE R.E.N.A.L. NEPHROMETRY SCORING SYSTEM AS A PREDICTOR OF THE EFFICACY OF NEPHRON-SPARING SURGERY IN THE SOLITARY KIDNEY

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging II1 Apr 2012707 EXAMINING THE UTILITY OF THE R.E.N.A.L. NEPHROMETRY SCORING SYSTEM AS A PREDICTOR OF THE EFFICACY OF NEPHRON-SPARING SURGERY IN THE SOLITARY KIDNEY David Buethe, Sammy Moussly, Hui-Yi Lin, Xiuhua Zhao, Philippe Spiess, and Wade Sexton David BuetheDavid Buethe Tampa, FL More articles by this author , Sammy MousslySammy Moussly Tampa, FL More articles by this author , Hui-Yi LinHui-Yi Lin Tampa, FL More articles by this author , Xiuhua ZhaoXiuhua Zhao Tampa, FL More articles by this author , Philippe SpiessPhilippe Spiess Tampa, FL More articles by this author , and Wade SextonWade Sexton Tampa, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.791AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recently, the R.E.N.A.L. nephrometry scoring system was introduced to objectively describe renal masses with respect to size, the degree to which they are exo/endophytic, the nearness to the collecting system, whether they are anterior or posterior and the location relative to polar lines. It is our aim to evaluate the R.E.N.A.L. nephrometry scoring system's ability to predict functional renal loss attributed to nephron−sparing surgery (NSS). METHODS We evaluated 42 patients presenting with either an anatomic (32) or functionally solitary (10) kidney undergoing partial nephrectomy (PN). Each renal unit was assigned a R.E.N.A.L. nephrometry score utilizing pre-operative cross−sectional imaging. The CKD−EPI equation was applied to serum creatinine levels to generate corresponding estimated glomerular filtration rates (eGFR). The difference between the eGFR at baseline and at post−operative time points served as a measurement of renal function loss attributed to PN. RESULTS Forty−two patients underwent PN with mean pre− operative eGFR of 61.5 mL/min/1.73m2. The median total nephrometry score was 8, ranging from 4−10. Twenty−eight (66.7%) of the renal lesions were ¡Ü 4 cm, 13 (31%) were between 4 and 7 cm, and 1 (2.4%) was >7 cm in diameter. The majority (54.8%) of the patients had tumors with more than 50% of tumor burden lying outside the expected renal border whereas 3 patients (7.1%) had tumors considered to be completely endophytic. Twenty−seven (64.3%) were within 4 mm of the collecting system. Tumor locations defined as: completely polar, interpolar, and completely central were assigned to 11, 15, and 16 lesions respectively. By post−operative month 6, the overall average eGFR of 53.9 mL/min/1.73m2 (a 12.3% reduction) was significantly less (p = 0.0293) than the pre−operative value. However, we were unable to correlate a change in eGFR with the pre-operatively assigned individual component scores nor the total R.E.N.A.L. score. CONCLUSIONS Neither the individual components of the R.E.N.A.L. nephrometry scoring system nor the total nephrometry score correlated with realized functional loss as assessed by percent change in eGFR in patients with a solitary kidney undergoing NSS. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e290 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Buethe Tampa, FL More articles by this author Sammy Moussly Tampa, FL More articles by this author Hui-Yi Lin Tampa, FL More articles by this author Xiuhua Zhao Tampa, FL More articles by this author Philippe Spiess Tampa, FL More articles by this author Wade Sexton Tampa, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Lower Body Functioning Prevalence and Correlates in Older American Indians in a Southeastern Tribe: The Native Elder Care Study

The objective of this study was to use performance-based measurements to identify, in a population of community-dwelling American Indians aged 55 and older, the prevalence and correlates of lower body functioning. Data were collected as part of a cross-sectional study of disability from members of a tribe in the southeast. Lower body functioning was measured using the Short Physical Performance Battery (SPPB), where higher scores reflect better functioning. Independent variables included age, sex, marital status, educational attainment, current cigarette smoking, physical activity, body mass index (BMI), hearing loss, vision loss, bone or joint trauma, chronic pain syndrome, osteoporosis, medical comorbidity, and depressive symptomatology. The total composite SPPB score (8.8 ± 3.4) declined significantly with increasing age and was negatively associated with unmarried status, physical inactivity, vision loss, bone or joint trauma, and medical comorbidity after adjustment for all other factors in the model. Likewise, all individual SPPB component scores declined significantly with increasing age and were negatively associated with physical inactivity and comorbidity. The balance test score was significantly and negatively associated with unmarried status and vision loss; gait speed was negatively related to unmarried status; and chair stand test score was negatively related to BMI, vision loss, bone or joint trauma, and chronic pain syndrome. In the clinical setting, the SPPB can be an important screening tool for adverse health-related events. Further studies are needed to investigate the determinants and sequelae of physical dysfunction in this population.

Association Between Students’ Dental Admission Test Scores and Performance on Comprehensive Clinical Exams

This study examined the association between Dental Admission Test (DAT) scores and the comprehensive exams conducted at Harvard School of Dental Medicine. The authors hypothesized that students who scored high on the DAT would also perform well on the comprehensive examinations. Sixty-six students from the graduating classes of 2005 and 2006 were included. The outcome variable of interest was the final composite grade obtained by the students in the three comprehensive examinations. The main independent variable of interest was the individual component scores on the DAT. Multivariable logistic regression analysis using the maximum likelihood methods was used to examine the association between comprehensive exam grades and DAT scores. Effects of age, gender, and race/ethnicity were adjusted in the regression models. On the first comprehensive examination, seventeen students obtained an Honors grade, while thirteen did so on the second comprehensive examination and fifteen on the third comprehensive examination. None of the DAT component scores were significantly associated with Honors grades on the first comprehensive examination. On the second comprehensive examination, quantitative reasoning scores (OR=2.48, 95 percent CI=1.09-5.68, p=0.03) and total science scores (OR=14.17, 95 percent CI=1.89-106.80, p=0.01) were significantly associated with Honors grades. Reading comprehension score was associated with increased odds of obtaining Honors grade on the third comprehensive examination (OR=1.81, 95 percent CI=1.13-2.92, p=0.01). Students who scored well on the quantitative reasoning, total science, and reading comprehension sections of the DAT had higher odds of receiving an Honors grade on the second and third comprehensive examinations. These factors may be associated with the problem-solving/critical thinking components in the school's PBL curriculum.

Itch Severity and Quality of Life in Patients with Pruritus: Preliminary Validity of a Danish Adaptation of the Itch Severity Scale

The aim of this study was to examine the validity of a Danish adaptation of the Itch Severity Scale (ISS) by exploring the associations between pruritus severity, psychological symptoms, and quality of life in a consecutively recruited sample of 20 patients with atopic dermatitis, 20 with psoriasis, 20 with urticaria, 12 with genital pruritus, 11 with nephrogenic pruritus, and 20 controls with vascular malformations. Convergent and discriminative validity was explored by analysing the associations of the ISS total score and the individual ISS component scores with age, sex, diagnosis, disease severity, sleep quality, depressive symptoms, anxiety, non-specific somatic symptoms, and pruritus-related quality of life impairment. Patients with urticaria reported significantly (p < 0.05) greater pruritus severity scores than the remaining patient groups, and pruritus severity was significantly associated with impaired sleep quality, more depressive symptoms, higher levels of anxiety, more non-specific somatic symptoms, and impaired quality of life. The results also confirmed the multidimensional nature of pruritus, with the affective dimension of pruritus being a better predictor of depressive symptoms, anxiety, and quality of life impairment than the sensory dimension. Finally, our results confirmed previous findings that the associations between pruritus severity and depressive symptoms and somatic symptoms were partly mediated by the effect of pruritus on sleep quality.

Utility of the R.E.N.A.L. Nephrometry Scoring System in Objectifying Treatment Decision-making of the Enhancing Renal Mass

To evaluate the treatment patterns of solid renal masses according to the quantifiable anatomic features using nephrometry. The treatment of localized renal cell carcinoma remains overly subjective. The R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior/posterior, location relative to polar lines) nephrometry score quantifies the salient characteristics of renal mass anatomy in an objective and reproducible manner. Nephrometry scores were available in 615 patients in our prospective kidney tumor database (2000-2010). The nephrometry score sum and its individual component scores were analyzed to determine their relationship to treatment approach. The median age, age-adjusted Charlson co-morbidity index, and estimated glomerular filtration rate was 60 years (range 25-89), 2 (range 0-10), and 80.5 mL/min (range 5.1-120.0), respectively. Increasing tumor complexity, as measured by a greater overall nephrometry score was associated with both radical nephrectomy and open partial nephrectomy (P < .0001). Compared with patients who underwent partial nephrectomy, the patients treated with radical nephrectomy had a significantly greater size (R), central proximity (N), and location (L) component scores (P < .001). Furthermore, tumors treated with radical nephrectomy were more often hilar (P < .001). Similarly, compared with minimally invasive partial nephrectomy (laparoscopic or robotic), open partial nephrectomy was associated with an increasing individual component score for size, endophytic, and central proximity to the collecting system (P < .001) and nonpolar location (P = .016). The R.E.N.A.L nephrometry score standardizes the reporting of solid renal masses and appears to effectively stratify by treatment type. Although only 1 part of the treatment decision-making process, nephrometry aids in objectifying previously subjective measures.

Detection of morphometric differentiation between isolated up- and downstream populations of Siah Mahi (Capoeta capoeta gracilis) (Pisces: Cyprinidae) in the Tajan River (Iran)

It has been postulated that the building of the Shahid-Rajaei dam on the Tajan River around 1995 has lead to the morphological divergence of Siah Mahi Capotes capoeta gracilis (Pisces) of up- and downstream populations due to the isolation. A 13-landmark morphometric truss network system was used to investigate the hypothesis. Univariate analysis of variance showed significant differences between the means of the two groups for 45 standardized morphometric measurements out of 78 characters studied. In linear discriminant function analysis (DFA), the overall assignment of individuals into their original groups was 87.6%. The proportion of individuals correctly classified into their original groups was 90.3% for upstream and 83.7% for downstream population. The principal component analysis (PCA) scatter plot of individual component scores between PC1 and PC2 showed 121 fish specimens grouped into two areas but with a relativity high degree of overlap between two populations. Clustering analysis based on Euclidean square distances among groups of centroids using an UPGMA resulted into two main clusters indicating two populations of C. c. gracilis. The present study indicated the presence of two morphologically different populations of C. c. gracilis in the Tajan River across the Shahid-Rajaei dam, probably due to their limited downstream dispersal and the elimination of upstream migration altogether, due the construction of the dam.

Anxiety and Depression Profile of 188 Consecutive New Patients Presenting to a Neuro-Emotional Technique Practitioner

The objective of this study was to describe the profile of a cohort of patients who presented to a Neuro-Emotional Technique (NET) clinic. This study investigated the change in the Distress and Risk Assessment Method (DRAM) outcome measure score after a 3-month course of NET was administered to participants. This was an uncontrolled cohort study in private practice. One hundred and eighty-eight (188) consecutive new patients presented to a NET clinic. The intervention was a 3-month course of NET, which incorporates elements of muscle testing, general semantics, Traditional Chinese Medicine, acupuncture, and chiropractic principles to manage patients' conditions. Scoring on the DRAM questionnaire was the outcome measure. Of the participants, 55.9% had musculoskeletal complaints, 34.6% had nonmusculoskeletal complaints, and 9.6% reported no presenting complaint. Strongly significant differences in the mean DRAM scores and the mean individual component scores were found between pre- and post-treatment. There was strong evidence to suggest that the Modified Somatic Perceptions Questionnaire and the Modified Zung Depression Index scores were correlated (p < 0.001), and that the allocation of subjects in any pretest category to categories on the basis of post-test scores changed from category to category. NET is different from traditionally described chiropractic practice, and appears, based on this one clinic, to have far more nonmusculoskeletal presentations. This profile, if consistent with other practices, has strong implications for scope of practice for this form of chiropractic practitioners. Many participant presentations were "at risk" of, or were clinically depressed, according to the DRAM. The DRAM status of the patient cohort significantly and clinically improved with the NET treatment. As this study was nonrandomized and uncontrolled, the results should be viewed with caution. We recommend that larger-scale randomized controlled trials be commenced to investigate the preliminary findings of this report.

Comparison of quality of life in advanced laryngeal cancer patients after concurrent chemoradiotherapy vs total laryngectomy

To compare quality of life (QOL) of patients with advanced laryngeal cancers treated by total laryngectomy with those who received concurrent chemoradiotherapy. This is a cross-sectional study of the patients treated in our institution who have completed one year of follow-up and were disease-free at the time of evaluation. Forty patients treated for advanced cancer of the larynx (stage III/IV), either by concurrent chemoradiation (11) or total laryngectomy and postoperative radiation (29), have been included in this study. The Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) version 4 questionnaire was used. Total scores for overall QOL are equal in both treatment groups (P = 0.69). Scores for individual components are similar in both treatment groups. However, dryness of mouth is significantly worse in the chemoradiotherapy group (P = 0.01) and ability to communicate with others is poorer in the laryngectomy group (P = 0.03). Long-term overall QOL remains similar in all the patients treated for advanced carcinoma of the larynx irrespective of treatment modality.

Evaluation of the Healthy Eating Index-2005

Background The Healthy Eating Index (HEI), a measure of diet quality as specified by federal dietary guidance, was revised to conform to the Dietary Guidelines for Americans 2005. The HEI has several components, the scores of which are totaled. Objective The validity and reliability of the HEI-2005 were evaluated. Design Validity was assessed by answering four questions: Does the HEI-2005 1) give maximum scores to menus developed by experts; 2) distinguish between groups with known differences in diet quality—smokers and nonsmokers; 3) measure diet quality independently of energy intake, a proxy for diet quantity; and 4) have more than one underlying dimension? The relevant type of reliability, internal consistency, was also assessed. Subjects Twenty-four−hour recalls from 8,650 participants, aged 2 years and older, in the National Health and Nutrition Examination Survey, 2001-2002 were analyzed to answer questions 2 to 4. Results were weighted to consider sample design and nonresponse. Statistical analyses T tests determined differences in scores between smokers and nonsmokers. Pearson correlation coefficients determined the relationship between energy intake and scores. Principal components analysis determined the number of factors that comprise the HEI-2005. Cronbach's coefficient α tested internal consistency. Results HEI-2005 scores are at or very near the maximum levels for all sets of exemplary menus with one exception; the Harvard menus scored low on the milk component because these menus intentionally include only small amounts of milk products. Nine of 12 component scores were lower for smokers than nonsmokers. The correlations of component scores were virtually independent of energy intake (< ∣.22∣). Multiple factors underlie the HEI-2005. Coefficient α was .43. The α value for all tests was .01. Conclusions The HEI-2005 is a valid measure of diet quality. Potential uses include population monitoring, evaluation of interventions, and research. The individual component scores provide essential information in addition to that provided by the total score.

The Relationship between Posttreatment Smile Esthetics and the ABO Objective Grading System

To evaluate the correlations between the components of the Objective Grading System developed by the American Board of Orthodontics (ABO) and smile esthetics. The clinical photographs of 48 orthodontically treated patients were rated by a panel of 25 experienced orthodontists (15 men and 10 women) and 20 parents of orthodontic patients (eight men and 12 women). One of the investigators, a director of the ABO, scored the posttreatment dental casts and panoramic radiographs of all patients according to the guidelines of the Objective Grading System. The relationship between the occlusal outcome and perceived smile attractiveness of the subjects were evaluated by a Pearson product-moment correlation. Logistic regression was used to determine whether the individual component or total combined scores of the ABO Grading System could predict whether a smile would be considered "attractive" or "unattractive" by the panel of raters. Extremely weak relationships were found among all factors of the ABO Objective Grading System and perceived smile attractiveness (r values ranging from -0.11 to 0.14; P > .05). As derived from logistic regression equations, neither total scores nor individual components of the ABO Grading system could predict attractive or unattractive smiles. This study suggests that additional criteria might be incorporated into the assessment of overall orthodontic treatment outcomes, including variables evaluating the smile.

Change in Knowledge of Midwives and Obstetricians Following Obstetric Emergency Training: A Randomized Controlled Trial of Local Hospital, Simulation Centre and Teamwork Training

Surveys in the United Kingdom have repeatedly discovered substandard care in significant proportions of maternal, fetal, and neonatal deaths. In the United Kingdom, training in obstetrical emergencies is carried out both nationally and locally in maternity units. This prospective, randomized controlled trial evaluated training in 6 hospitals in the United Kingdom. The 140 participants included 22 junior and 23 senior doctors as well as 47 junior and 48 senior midwives. They were randomized to one of 4 obstetrical emergency training interventions: a 1-day course at a local hospital, a 1-day course at a simulation center, a 2-day course with teamwork training at a local hospital, and a 2-day course with teamwork training at a simulation center. A 183-question multiple choice questionnaire (MCQ) was completed up to 3 weeks before the training intervention and again 3 weeks after the intervention. All but 7 of the 140 participants completed training and the posttraining assessment. Knowledge of obstetrical emergency management increased following training. The increase in the mean MCQ score was significant at the P < 0.001 level. All but 10 of 133 participants who completed both assessments had increased MCQ scores. Neither the location of training nor the inclusion of teamwork training significantly influenced posttraining scores. Changes in MCQ scores after training correlated negatively with pretraining scores. There were, however, no significant differences between staff groups in their relative responses to the 4 training interventions. With one exception—management of breech presentation—scores for individual components of the MCQ improved significantly. This is the first study demonstrating objective improvement in what doctors and midwives know following training in obstetrical emergency management. It remains to be determined whether this translates into lower maternal and neonatal morbidity and mortality rates. The investigators believe that all relevant staff should take part in this type of training on an annual basis.

Assessing Diet Quality in a Population of Low-Income Pregnant Women: A Comparison Between Native Americans and Whites

To assess diet quality of pregnant women in the WIC program in North Dakota and to compare Native Americans with whites, we used a DQI-P (diet quality index for pregnancy) among low-income pregnant women enrolled in WIC, a special supplemental program for women, infants, and children. Dietary information was collected for all participants using the Harvard Service Food Frequency Questionnaire (HSFFQ). DQI-P scores were based on 10 components previously used in other diet quality indices: percent recommended intake of grains, vegetables, fruits, folate, calcium, and iron; total fat, saturated fat, and cholesterol; and dietary diversity. Each component contributed 10 points to the total possible DQI-P score of 100. The mean DQI-P score was 53.9. Native Americans (51.8) had significantly lower DQI-P scores (51.8 vs. 54.2; p<0.0001); significantly higher scores for iron and folate; and significantly lower scores for cholesterol, total fat intake, and saturated fat components than did whites. As DQI-P scores increased, diet improved and scores for individual components increased. While there were significant differences between the diet quality of Native American and white pregnant women, the differences were minimal. The DQI-P scores for all women in this population indicate that their diets are not meeting dietary recommendations. Interventions should focus on decreasing fat intake and increasing iron and folate intake to meet national dietary recommendations. More emphasis should be placed on eating whole fruit and vegetables.

The Relationship between Self-Rated Health Status and the Overall Quality of Dietary Intake of US Adolescents

The objective of this study was to compare the quality of overall dietary intake of US adolescents by self-rated health status. Using 2 nonconsecutive days of dietary recall data and responses to a single question describing self-rated health status from the Continuing Survey of Food Intakes by Individuals 1994-1996, linear regression analysis was used to detect differences in Healthy Eating Index (HEI) scores by self-rated health status for 1,504 adolescents, ages 11 to 18 years. After adjusting for factors related to both overall dietary quality and self-rated health status, overall HEI scores did not differ by self-reported health status. However, two individual HEI component scores were found to be significantly related to adolescent self-rated health status: the vegetables score ( P=0.01) was higher among those with positive self-rated health status, and the total fat score ( P=0.01) was higher among those with negative self-rated health status. Self-perception of health status is not related to the overall quality of the adolescent diet; therefore, food and nutrition professionals should focus on understanding motivators other than health status when exploring adolescent dietary behaviors.

Sense of Coherence (SOC) Among Psychotherapists in Austria, Differentiated According to Number of Individually Completed Training Therapy Sessions

The sense of coherence (according Aaron Antonovsky, 1923—1994, when a persons sense that his/her own life and the world are sufficiently comprehensible, manageable, and meaningful) of Austrian psychotherapists was assessed and compared with a standard sample, as well as with the sense of coherence (SOC) of members of other professions. In addition, the question as to whether psychotherapists who had completed more extensive individual training therapy/self-awareness sessions had a higher SOC than do those with fewer, was addressed. Forty psychotherapists who worked in private practices and various psychosocial health care institutions in Styria, Austria took part in the study. The investigation was conducted in the form of a questionnaire assessment. The evaluation showed that the overall SOC value of the professional group in question was significantly higher than that of the standard sample (162.3 vs. 145.7), as well as other samples (physicians: SOC = 153.8; teachers: SOC = 156.1; physiotherapists SOC = 158.1). Concerning whether psychotherapists who had completed more individual training therapy/self-awareness sessions had higher SOC values than did those with fewer, we found no difference in regard to the overall SOC score or SOC scores for individual components. The SOC of psychotherapists did not seem to depend on the number of additional training therapy/self-awareness sessions.

The 57th Annual Meeting of the American Academy of Neurology, Miami, Florida, April 9-16, 2005

The 57th Annual Meeting of the American Academy of Neurology, Miami, Florida, April 9-16, 2005

Prevalence and Burden of Fecal Incontinence: A Population-Based Study in Women

The epidemiology of fecal incontinence (FI) is incompletely understood. We report the prevalence, clinical spectrum, health care-seeking behavior, and quality of life (QOL) in community women with FI. A questionnaire was mailed to an age-stratified random sample of 5300 Olmsted County, Minnesota, women identified by the Rochester Epidemiology Project. Symptom severity was assessed by a validated scale, and impact on QOL was evaluated for subjects who had any FI during the past year. The prevalence of FI was calculated with direct age adjustment to the 2000 US white female population. Altogether, 2800 of 5300 women (53%) responded to the survey. The overall age-adjusted prevalence of FI in the past year was 12.1 per 100 (95% confidence interval, 11.0-13.1). The prevalence increased with age from 7 (third decade) to 22 (sixth decade) per 100 and was steady thereafter. Symptoms were mild (45%), moderate (50%), or severe (5%), and symptom severity was related to the impact of FI on QOL and physician-consulting behavior. Moderate to severe impact on >/=1 domain of QOL was reported by 6% with mild, 35% with moderate, and 82% with severe symptoms, whereas 5% with mild, 10% with moderate, and 48% with severe FI had consulted a physician for FI in the past year. More than 1 of 10 adult women in the population have FI; almost 1 of 15 have moderate to severe FI. FI significantly impacts QOL and prompts health care utilization predominantly in women with moderate to severe symptoms.

Personality traits in captive lion-tailed macaques (Macaca silenus)

Personality influences an individual's perception of a situation and orchestrates behavioral responses. It is an important factor in elucidating variation in behavior both within and between species. The major focus of this research was to test a method that differs from those used in most previous personality studies, while investigating the personality traits of 52 captive lion-tailed macaques from four zoos. In this study, data from behavioral observations, a P-type principal components analysis (PCA), and bootstrapped confidence intervals as criteria for judging the significance of factor loadings were used rather than subjective ratings, R-type factor analyses, and arbitrary rules of thumb to determine significance. We investigated the relationships among individual component scores and sex, hormonal status, and dominance rank (controlling for age and social group) using a multiple regression analysis with bootstrapped confidence intervals. Three personality dimensions emerged from this analysis: Component 1 contained Extraversion-like behaviors related to sociability and affiliativeness. The higher mean Component score for females suggests that they are more "extraverted" than males. Only agonistic behaviors were significantly related to component 2. High-ranking individuals exhibited higher mean Component 2 scores than mid- or low-ranked individuals. Bold and cautious behaviors both loaded positively on Component 3, suggesting a dimension related to curiosity. The mean Component 3 score for females was higher than the mean score for males. The method used in this study should facilitate intraspecific and general interspecific comparisons. Developing a standardized trait term list that is applicable to many species, and collecting trait term data in the same manner and concurrent with behavioral observations (and physiologic measures when feasible) could prove useful in primate research and should be explored.

Using a standardised patient assessment to measure professional attributes

Professionalism is an important topic in medical education today. While much work has focused on defining professionalism and teaching medical students the appropriate interpersonal behaviours, relatively little research has looked at meaningful ways of assessing the relevant attributes. The Educational Commission for Foreign Medical Graduates (ECFMG) clinical skills assessment (CSA) uses standardised patients (SPs) to evaluate the readiness of graduates of international medical schools to enter accredited graduate training programmes in the USA. Doctor interpersonal skills, including professional qualities such as rapport, are evaluated as part of the CSA. Attentiveness, attitude and empathy, all facets of professional behaviour, are specifically targeted as part of the assessment. To date, over 35 000 candidates have been assessed, encompassing more than 370 000 individual SP encounters. Based on a 1-year cohort of examinees, the reliability of the individual professionalism-related component scores ranged from 0.61 to 0.70. Doctors who had graduated from medical school more recently, or were younger, generally obtained higher ratings. Professional qualities were only marginally related to measures of basic science and clinical science proficiency. Female candidates were rated significantly higher than male candidates on all dimensions. While some professional behaviours are probably best measured using formats such as surveys, self-assessment and critical incident techniques, certain aspects of the domain can be reliably and validly measured in SP examinations.

Validation of the reflux finding score (RFS) for chronic laryngopharyngitis

Objectives: To externally validate the reliability of the Reflux Finding Score (RFS), a recently published laryngeal grading system, in a cohort of subjects with chronic laryngopharyngitis thought secondary to acid reflux disease. Methods: Two blinded otolaryngologists independently graded 66 videostrobe laryngeal examinations of 33 patients with chronic symptoms of laryngopharyngitis before and 2 months after treatment. The raters evaluated the examinations on 2 separate occasions at least 24 hours apart, blinded to the previous evaluation. Linear correlation was performed to assess inter- and intrarater reliability using the total reflux finding score. Results: Intrarater reliability was very good for both raters for the total reflux finding score (r = 0.87, P < 0.0001, intercept P = 0.37; and r = 0.93, P < 0.0001, intercept P = 0.51). Interrater reliability was also good between raters (r = 0.71, P < 0.0001) but raised the possibility of bias between raters (intercept = 2.4, std error = 1.4, P = 0.08). Among the individual component scores for interrater reliability, true vocal fold edema demonstrated good correlation without bias, while diffuse laryngeal edema and posterior commisure hypertrophy demonstrated good correlation with significant interrater bias. Ventricular obstruction demonstrated moderate correlation with significant bias. Thick endolaryngeal mucous demonstrated fair correlation and subglottic edema poor correlation. Granuloma showed no correlation due to low prevalence. Conclusions: The total reflux finding score demonstrates very good intrarater and good interrater correlation in this cohort of subjects with symptoms of chronic laryngopharyngitis. Individual component scores demonstrate variable correlation and significant bias between raters.

Predictors of Successful Web Sites for Law Firms

ABSTRACT This study analyzed the effects of copy elements, graphic elements, and layout elements to determine if predictors of successful web site design could be identified and measured and that information conveyed to law firms and their marketing personnel. Individual additive indices were constructed for copy, graphics, and layout. An overall evaluation of the web page, called global, was constructed from the sum of the individual component scores of informativeness, clarity, aesthetics, and navigability. In addition, since the web sites were evaluated at two points in time, another variable, called time, was included as a dummy variable. We compared those global scores to the variables and found an effect on overall evaluation from the traditional components of copy and graphics but not layout. The treatment of the graphics on the opening page does appear to make a difference. Similarly, the treatment of headlines and indicators of firm attractiveness and prestige in the copy also make a difference.