Majority Of Scores Research Articles

The Fibrodysplasia Ossificans Progressiva Physical Function Questionnaire (FOP-PFQ): A patient-reported, disease-specific measure.

To assess the reliability and validity of age-specific versions of the Fibrodysplasia Ossificans Progressiva Physical Function Questionnaire (FOP-PFQ), developed to measure the impact of FOP on physical function and activities of daily living. FOP-PFQ development included a literature review, two iterative phases of qualitative work involving individuals with FOP, and clinical expert review. The analysis used pooled FOP-PFQ data from an FOP natural history study (NCT02322255), a patient registry (NCT02745158), and phase II trials (NCT02190747; NCT02279095; NCT02979769). Item-level and factor analysis informed item retention and determined factor structure. Reliability was evaluated using Cronbach's alpha and intraclass correlation coefficients. Convergent validity was assessed by comparing scores with age, the Cumulative Analogue Joint Involvement Scale (CAJIS), the Patient-Reported Outcomes Measurement Information System Global Health Scale (PROMIS), and heterotopic ossification (HO) volume. Known-groups validity assessment used age, CAJIS, and HO volume. Factor analysis confirmed a two-factor solution: Mobility and Upper Extremity. Results reflected high internal consistency and were supportive of test-retest reliability; correlation coefficients >0.90 demonstrated FOP-PFQ scores were stable over a one- to three-week period. The majority of scores were moderately (r=0.30-0.50) to highly (r≥0.50) correlated with CAJIS and HO volume, supporting convergent validity. With the exception of some age-based and functional groups, FOP-PFQ scores were significantly worse in groups with more severe disease, demonstrating known-groups validity. The FOP-PFQ was demonstrated to be a reliable, valid measure that may be responsive to change in individuals with FOP, although some results were inconclusive for pediatric versions.

Abstract TMP22: Exploring The Impact Of Material Deprivation, Clinical, And Radiological Features On Neurological Outcomes Of Neonatal Stroke

Introduction: Neonatal arterial ischemic stroke (AIS) is an important cause of neurologic disability in children. No research to date has examined the influence of determinants of health on outcomes in a neonatal AIS population. This study examined whether neighbourhood-level material deprivation was associated with long-term neurological outcomes in neonatal AIS patients, after accounting for the influence of clinical and radiological factors. Methods: Patients with neonatal AIS between 2004 and 2019 at a comprehensive stroke centre were included. The Ontario Marginalization Index (ON-Marg) was used to assess neighbourhood-level material deprivation. Participant postal codes were linked to census data and ON-Marg scores were reported. Neurological outcomes were assessed using the Pediatric Stroke Outcome Measure Severity Classification Scale (PSOM-SCS) at latest follow up (median = 49 months, range = 12 to 187 months). A poor outcome was defined as any neurologic deficit (i.e., mild, moderate, or severe). Univariable and multivariable logistic regression models were developed. Results: Amongst 154 participants, the majority of scores (66.23%) were within the normal range. Remaining participants demonstrated neurological deficits, including 25.97% mild and 7.79% moderate-to-severe. Predictors of poor outcome in the multivariable model included hemiparesis at stroke presentation (OR = 12.81, p < 0.05) and basal ganglia involvement (OR = 3.68, p < 0.05). Neighbourhood-level material deprivation was not significantly associated with poor outcome. Conclusions: Hemiparesis and basal ganglia involvement are important in determining long-term outcomes. Although material deprivation was not associated with poor outcomes in our study, it may be associated with neurological outcomes at later ages. Further research is needed to understand the role of socioeconomic factors in a neonatal stroke population, including the measurement of individual-level indicators and outcomes at later ages post-stroke. While outcomes after neonatal stroke are generally favourable, identifying predictors of poor outcomes may assist clinicians in developing a more precise risk evaluation regarding recovery after stroke.

Application of failure mode and effects analysis to validate a novel hybrid Linac QC program that integrates automated and conventional QC testing

A hybrid quality control (QC) program was developed that integrates automated and conventional Linac QC, realizing the benefits of both automated and conventional QC, increasing efficiency and maintaining independent measurement methods. Failure mode and effects analysis (FMEA) was then applied in order to validate the program prior to clinical implementation. The hybrid QC program consists of automated QC with machine performance check and DailyQA3 array on the TrueBeam Linac, and Delta4 volumetric modulated arc therapy (VMAT) standard plan measurements, alongside conventional monthly QC at a reduced frequency. The FMEA followed the method outlined in TG-100. Process maps were created for each treatment type at our center: VMAT, stereotactic body radiotherapy (SBRT), conformal, and palliative. Possible failure modes were established by evaluating each stage in the process map. The FMEA followed semiquantitative methods, using data from our QC records from eight Linacs over 3 years for the occurrence estimates, and simulation of failure modes in the treatment planning system, with scoring surveys for severity and detectability. The risk priority number (RPN) was calculated from the product of the occurrence, severity, and detectability scores and then normalized to the maximum and ranked to determine the most critical failure modes. The highest normalized RPN values (100, 90) were found to be for MLC position dynamic for both VMAT and SBRT treatments. The next highest score was 35 for beam position for SBRT, and the majority of scores were less than 20. Overall, these RPN scores for the hybrid Linac QC program indicated that it would be acceptable, but the high RPN score associated with the dynamic MLC failure mode indicates that it would be valuable to perform more rigorous testing of the MLC. The FMEA proved to be a useful tool in validating hybrid QC.

Readability, understandability and language accessibility of Swedish websites about the coronavirus disease 2019: a cross-sectional study

BackgroundThe COVID-19 pandemic has caused significant morbidity and mortality. To mitigate its spread, members in the general population were prompted to apply significant behavioral changes. This required an effective dissemination of understandable information accessible for people with a wide range of literacy backgrounds. The aim of this study was to investigate the readability, understandability and language accessibility of Swedish consumer-oriented websites containing information about COVID-19.MethodsWebsites were identified through systematic searches in Google.se (n = 76), and were collected in May 2020 when the pandemic spread started in Sweden. Readability and understandability were assessed with the Readability Index, the Ensuring Quality Information for Patients (EQIP) tool, and the Patient Education Materials Assessment Tool Understandability subscale (PEMAT-PU).ResultsThe median total sample score for Readability Index was 42.0, with the majority of scores being classified as moderate (n = 30, 39%) or difficult (n = 43, 57%). Median total sample scores were for EQIP 54.0% (IQR = 17.0, Range = 8–75) and for PEMAT-PU 60.0% (IQR = 14.75, Range = 12–87). The majority of the websites did not have any texts or links containing information in an alternative language (n = 58, 76%).ConclusionsSwedish websites contained information of difficult readability and understandability at the beginning of the coronavirus disease 2019 pandemic, with few providing information available in alternative languages. It is possible that these deficits contributed to the spread and impact of the virus. There is a need for studies investigating methods aiming to enhance the readability, understandability and language accessibility of web-based information at the beginning of an epidemic or pandemic.

NSAID-induced gastropathies associated with the treatment of SARS‑CoV-2 infection: how to improve therapy safety? Focus on esomeprazole

Objective — Using mFSSG questionnaire, to define the presences of gastrointestinal disturbances, associated with the intake of nonsteroidal anti‑inflammatory drugs (NSAIDs) in patients with moderate course of SARS‑CoV‑2 infection and to investigate ability of esomeprazole (Ezonexa, Farmak) to preventing the development of dyspeptic and reflux symptoms in these patients.
 Materials and methods. All patients with the established diagnosis of coronaviral disease (n = 85), hospitalized for treatment in the Centre of Therapy of Clinical Emergency Hospital in Lviv, who signed the informed consent, became the participants of an open controlled trial of Ezonexa efficacy at this pathology. The medication was administered in a dose of 20 mg/day in the morning, 30 mins before meals, used to prevent NSAID‑induces gastropathies for 28 days. Simple blinded method was used to randomize patients into two groups. Subjects of the first group (n = 45) took esomeprazole, second group included controls (n = 40) without active prophylaxis of NSAID‑induces gastropathies. The mean patients’ age was 69.4 ± 2.6 years. The men age of male subjects was 66.4 ± 2.4 years, of females 72.3 ± 2.7 years. The follow up period lasted 4 weeks. All patients underwent standard examinations and survey to assess the dynamics of clinical manifestations of the disease against the background of the treatment of coronaviral infection. Besides, patients used mFSSG questionnaire to evaluate the intensity of dyspeptic and reflux symptoms. Examinations and survey were performed on the 1st, 10 — 14th and 28th days of follow up. The quality of life indices were assessed with the use of SF‑36 questionnaire in all patients at baseline and 4 weeks after the study start.
 Results. No significant difference in mFSSG scores was reveled in the patients of both groups on the 1st day in terms of clinical manifestations of dyspepsia and reflux. At the second testing on 10 — 14th days, the assessment of dyspeptic and reflux symptoms didn’t change in patients of the 1st group, whereas in 49.6 % subjects of the control group presence of the signs of NSAID‑induced gastropathy with a pronounced dyspeptic and moderate reflux syndrome was registered. At 28th day, symptoms of both dyspepsia and reflux developed in 11.3 % of patients in the first group, and 78.6 % in the second group. No differences in age and gender ratio were reveled after comparative analysis. However, comorbid pathology, for which patients constantly took low doses of acetylsalicylic acid, was an additional aggravating risk factor of the development of NSAID‑induced gastropathy. Analysis of the baseline indices of quality of life in both groups showed the significant (р < 0.05) decrease in the majority of scores, except for the scales of physical functions and pain. Positive dynamics against the background of esomeprazole treatment was defined in all indices of the quality of life, in the most extent in the scores of pain, vitality, social and role emotional functions.
 Conclusions. Esomeprazole in a dose of 20 mg demonstrated excellent protective effects in regard to the gastrointestinal mucosa in elderly patients from the high‑risk group, who are particularly sensitive to the gastroduodenal NSAID‑induced toxicity even at short therapeutic course for coronaviral infection. Ezonexa may be considered as a drug of choice to treat NSAID‑induced gastropathy; due to its prolonged and stable acid‑inhibiting ability, Ezonexa promotes prompt symptoms’ relief. Owing to the phenomenon of stereoselectivity, the drug has pharmacokinetic properties that ensure its high clinical efficacy in acid‑dependent diseases.
 Keywords: COVID‑19, acid‑dependent diseases, nonsteroidal anti‑inflammatory drugs, NSAID‑induced gas

Platelet-rich plasma therapy in dogs with bilateral hip osteoarthritis

BackgroundOsteoarthritis (OA) is the most commonly diagnosed joint disease in companion animals, and hip OA is commonly diagnosed in the canine population. The use of platelet-rich plasma has gained increasing interest for the treatment of musculoskeletal conditions in companion animals. To evaluate the effect of the intra-articular administration of platelet-rich plasma in police working dogs with bilateral hip OA compared to a control group, twenty dogs were assigned to a control group (CG, n = 10) or treatment group (PG, n = 10), using the statistical analysis software. PG received two intra-articular administrations of platelet-rich plasma, 14 days apart, while CG received an intra-articular administration of saline, in the same moments. Response to treatment was determined with the Canine Brief Pain Inventory, Liverpool Osteoarthritis in Dogs, Canine Orthopedic Index, and Hudson Visual Analogue Scale, before treatment, + 8, + 15, + 30, + 60, + 90, + 120, 150, and + 180 days after initial treatment. Kaplan-Meier estimators were conducted and compared with the log-rank test. Cox proportional hazard regression analysis was performed to determine treatment survival, p < 0.05.ResultsThe sample comprised 20 animals of both sexes (male n = 12, female n = 8), with a mean age of 8.4 ± 2.4 years and a bodyweight of 31.5 ± 5.7 kg. Joints were classified as moderate (13) and severe (7) according to the Orthopedic Foundation for Animals grading scheme. No differences were found between groups at the initial evaluation. Better results with the majority of scores were observed in the PG, in some cases lasting up to the last evaluation moment. Kaplan-Meier estimators showed that PG produced longer periods with better results in all scores compared to CG. Treatment was the covariate influencing all scores in the Cox regression analysis. OFA hip score also influenced two dimensions of the Canine Orthopedic Index.ConclusionThe intra-articular administration of platelet-rich plasma can improve pain and functional scores of police working dogs with bilateral hip OA, compared with a control group. Its effects lasted for significantly longer periods, and treatment was the main covariate affecting the improvements observed.

Intra-articular Injections With Either Triamcinolone Hexacetonide, Stanozolol, Hylan G-F 20, or a Platelet Concentrate Improve Clinical Signs in Police Working Dogs With Bilateral Hip Osteoarthritis.

Objectives: To compare the effect of intra-articular treatment with triamcinolone hexacetonide (TH), stanozolol, hyaluronan, and a platelet concentrate in police working dogs with bilateral hip osteoarthritis (OA).Study Design: Prospective, longitudinal, double-blinded, negative controlled study.Sample Population: Fifty police working dogs with naturally occurring hip OA.Methods: Animals were randomly assigned to a control group (CG, n = 10), TH group (THG, n = 10), platelet concentrate group (PCG, n = 10), stanozolol group (SG, n = 10), and Hylan G-F 20 group (HG). On days 0 (T0), 8, 15, 30, 90, and 180 days post-treatment, weight-bearing distribution was evaluated. In those days, and on days 60, 120, and 150, four clinical metrology instruments were completed. Kaplan–Meier estimators were conducted and compared with the log-rank test. Cox proportional hazard regression analysis was performed to determine treatment survival. Significance was set at p < 0.05.Results: Patients had a mean age of 6.5 ± 2.4 years and body weight of 26.7 ± 5.2 kg. At T0, hips were classified as mild (n = 35), moderate (n = 10), and severe (n = 5), according to the Orthopedic Foundation for Animals grading scheme. No differences were found between groups at that moment considering age, body weight, OFA hip score, and all assessments performed. All treatments improved clinical signs in various OA dimensions in some groups, with a broad effect interval. PCG showed a lower range of variation while maintaining a positive result for more extended periods (p < 0.01 for symmetry index and 0.01 < p < 0.04 in the majority of scores). Breed, age, sex, and OFA grade did not significantly influence response to treatment.Conclusions and Clinical Relevance: This is the first prospective, negative controlled, double-blinded study to compare the effect of a single administration of these IA treatments in dogs with hip OA. HG and PCG recorded more significant improvements throughout the 180-day follow-up. In particular, PCG also registered a lower variation in results, seemingly the best therapeutic option. Nevertheless, improvements were still observed in THG and SG, and these treatment options can be considered, mainly when the first two treatments are not available.

DESENVOLVIMENTO E VALIDAÇÃO DO INVENTÁRIO DE CARACTERIZAÇÃO DE AMBIENTES PARA A EDUCAÇÃO INICIAL

In this study, the psychometric properties of the Environment Characterization Inventory for Early Education (INCA-EI), and the effect of socioeconomic context and type of institution on the quality of environments were evaluated. 142 early education classrooms were evaluated. The analysis of Unidimensionality for the Structure Dimension and the CFA for the Process Dimension showed a good fit of the items to the Structure sub-dimensions (p&gt;.05; CFI ≥.90; RMSEA&lt;.08), validating the organization of three correlated factors in the Process sub-dimensions (χ²=323.82; RMSEA=.06; CFI=.96; TLI=.96). The instrument presents good values of internal consistency (α =.88; ω =.93), and moderate to considerable agreements in the majority of scores in the inter-rater reliability analysis (ICC=.80). Differences are presented between the quality of the environment of schools and kindergartens and Institutions of different socioeconomic contexts. The results show that INCA-EI is a valid and reliable instrument for the evaluation of environments in early education, which can be used for research purposes and monitoring of public policies.

EVALUATION OF TUTOR PERFORMANCE IN PROBLEM BASED LEARNING: RATING THE SKILL ON STUDENTS PERSPECTIVE

Background: The Problem based learning (PBL) was developed at McMaster University School of Medicine in Canada in the 1960s. It has become today’s most accepted method of teaching and learning activities in the field of medicine. A skilled and well-trained tutor plays major role in PBL. Present study is aimed to evaluate tutor performance on student’s perspective based on questionnaire. Methods: This questionnaire-based study was conducted with MBBS I (n=100) and II (n=100) year students of Nobel Medical College and Teaching Hospital. Tutors performance evaluation form was prepared provided with nine question items and the responses were limited to likert scale (1=strongly disagree, 2=disagree, 3=uncertain, 4=agree and 5=strongly agree). Students were in­structed to give their opinion and total percentage score along with mean score of every question items were obtained. Then, mean score of each questions were compared between both MBBS batches. Results: Performance of tutors in problem-based learning sessions were analyzed which were ob­tained as Likert scale score; the percentage score 4 (agree, MBBS I= 52.11 %, MBBS II=53.55 %) followed by 5 (strongly agree, MBBS I=20.77 %, MBBS II= 32.22 %). Mean score obtained for each question items were compared between MBBS I and II year which significantly vary though the majority of scores were 4 (agree) and 5(strongly agree). Conclusions: Satisfactory tutor performance was procured on evaluating the tutor for their skill in PBL as facilitator based on student’s opinion.

Nutrition students and mathematics: Competent but not confident

Aim: To assess skills, competence and disposition of nutrition students towards mathematics. Methods: A cross-sectional study was conducted at Curtin University, Perth, Western Australia, to assess the numeracy of undergraduate nutrition students enrolled in a level 2 biochemistry unit ( n = 40). Primary outcome measures were evaluations of competence when answering discipline-specific questions and students’ confidence and perceived ease and disposition towards mathematics. Results: The majority of students were competent (mean diagnostic test score = 72%), with only four students scoring below the competence midpoint. However, many students reported low confidence and a high perception of difficulty, indicated by the majority of scores above the line of equality in self-confidence and ease of questions. Furthermore, 30% of students identified as having anxiety related to mathematical understanding and mathematical knowledge below the midpoint. Conclusions: Results showed a significant proportion of students were not confident with mathematics, despite being competent. Anxiety concerning knowledge and understanding was present in 30% of students. These findings are important for tailoring a numeracy support framework that specifically addresses confidence and disposition towards mathematics to ensure that students can succeed in the mathematical challenges inherent to their course and future nutrition career.

Identifying Behavioral Phenotypes of Loneliness and Social Isolation with Passive Sensing: Statistical Analysis, Data Mining and Machine Learning of Smartphone and Fitbit Data

BackgroundFeelings of loneliness are associated with poor physical and mental health. Detection of loneliness through passive sensing on personal devices can lead to the development of interventions aimed at decreasing rates of loneliness.ObjectiveThe aim of this study was to explore the potential of using passive sensing to infer levels of loneliness and to identify the corresponding behavioral patterns.MethodsData were collected from smartphones and Fitbits (Flex 2) of 160 college students over a semester. The participants completed the University of California, Los Angeles (UCLA) loneliness questionnaire at the beginning and end of the semester. For a classification purpose, the scores were categorized into high (questionnaire score>40) and low (≤40) levels of loneliness. Daily features were extracted from both devices to capture activity and mobility, communication and phone usage, and sleep behaviors. The features were then averaged to generate semester-level features. We used 3 analytic methods: (1) statistical analysis to provide an overview of loneliness in college students, (2) data mining using the Apriori algorithm to extract behavior patterns associated with loneliness, and (3) machine learning classification to infer the level of loneliness and the change in levels of loneliness using an ensemble of gradient boosting and logistic regression algorithms with feature selection in a leave-one-student-out cross-validation manner.ResultsThe average loneliness score from the presurveys and postsurveys was above 43 (presurvey SD 9.4 and postsurvey SD 10.4), and the majority of participants fell into the high loneliness category (scores above 40) with 63.8% (102/160) in the presurvey and 58.8% (94/160) in the postsurvey. Scores greater than 1 standard deviation above the mean were observed in 12.5% (20/160) of the participants in both pre- and postsurvey scores. The majority of scores, however, fell between 1 standard deviation below and above the mean (pre=66.9% [107/160] and post=73.1% [117/160]).Our machine learning pipeline achieved an accuracy of 80.2% in detecting the binary level of loneliness and an 88.4% accuracy in detecting change in the loneliness level. The mining of associations between classifier-selected behavioral features and loneliness indicated that compared with students with low loneliness, students with high levels of loneliness were spending less time outside of campus during evening hours on weekends and spending less time in places for social events in the evening on weekdays (support=17% and confidence=92%). The analysis also indicated that more activity and less sedentary behavior, especially in the evening, was associated with a decrease in levels of loneliness from the beginning of the semester to the end of it (support=31% and confidence=92%).ConclusionsPassive sensing has the potential for detecting loneliness in college students and identifying the associated behavioral patterns. These findings highlight intervention opportunities through mobile technology to reduce the impact of loneliness on individuals’ health and well-being.

A Need for Contouring Education in Latin America: Evaluating an E-contouring Experience with Novel Reporting of DICE Metrics

As the technology for radiation oncology advances, therapy is able to be delivered in a more conformal fashion with a goal of both greater targeting of the tumor as well as avoidance of healthy structures. However, greater conformality requires the ability to correctly identify and contour both tumor volumes and organs at risk. One method of delivering content, particularly for practitioners abroad, is through e-contouring sessions. E-contouring allows for interactive didactic sessions allowing participants to see contouring of structures in real time. This represents the first international education intervention in Latin America utilizing e-contouring reporting DICE coefficients. An e-contouring workshop was undertaken in Lima, Peru at the 2018 eCancer conference. Registered students had access to an online platform beginning two weeks before the workshop along with case vignettes. Seven cases were presented with indications for radiation: locally advanced lung, lung SBRT, post-operative cervix, anaplastic astrocytoma, hippocampal sparing whole-brain, and two cases of linear accelerator based stereotactic radiosurgery for brain metastases. Each case listed various structures to contour for designated slices. Concordance of student responses with educator contours was measured using DICE coefficients. Post-educational intervention, students were given two weeks to redo homework assignments with intent to compare DICE coefficients with paired t-test. Fifty-five people registered for the contouring workshop and 13 (24%) completed homework pre-workshop. For the four non-palliative cases, the total mean DICE coefficient was 0.58. Average DICE scores pre-workshop for the entire case, which included organs at risk, and tumor volumes, are shown in the table. Of the 13 students who completed homework pre-workshop, only one student attempted the post-intervention homework with no significant change in DICE score. We present the first e-contouring experience with DICE coefficients in Latin America. Approximately a quarter of the registered students completed homework. The remaining pre-intervention scores serve as a diagnostic and highlight the importance of a need for contouring education with a majority of scores below 0.70. Unfortunately, participation in pre-assessment homework was low and post-assessment homework was minimal which does not allow for meaningful assessment of retained knowledge. Future e-contouring courses in Latin America would benefit by completing post-assessments at the time of workshop.Abstract TU_3_2919; Table 1CaseDICE scoreLocally Advanced Lung Cancer0.52GTVp0.85GTVn0.48SBRT Lung0.63ITV0.49Post-op Cervix0.52CTV0.45Anaplastic Astrocytoma0.66CTV0.74 Open table in a new tab

Factors Associated with Heart Failure Self-Care in a Low Socioeconomic Status, Urban Patient Population

Introduction Patients with low socioeconomic status (SES) have worse heart failure (HF) outcomes than patients with high SES, including higher readmissions. Interventions to improve outcomes in low SES patient populations have not been successful however the reasons remain unclear. Objective To describe the social factors impacting psychological stress and self-care in a low SES patient population with HF and multiple readmissions. Methods In this mixed methods study, 35 subjects with low SES participated in semi-structured interviews about personal and community factors impacting their stress and self-care. Subjects were interviewed during an inpatient readmission for acute decompensated heart failure from two urban hospitals in Chicago. Subjects completed standardized instruments measuring psychological stress (PSS-10), and self-care (SCHFI). Subjects were categorized into high stress (PSS-10 >20) and moderate/low stress (PSS-10 Results Ninety one percent of subjects were African American and 91% were from neighborhoods with high rates of poverty and violence according to US Census data. Subjects experienced a range of admissions (2–12) within the previous 180 days of the current HF admission. Across all three SCHFI sub-scales, the majority of scores were 20 (PSS-10 (14.9 [8.2]). The overarching qualitative theme was that social factors and psychological stress influence self-care. Subjects described the following events as stressful and impacting their self-care: financial difficulties, concern for children/grandchildren's safety, personal health, past impactful deaths, and a recent stressful event. Among subjects whose PSS-10 scores were Conclusion Social factors and psychological stress has impacted the ability of this low SES patient population to perform adequate HF self-care. Research to develop and test sensitive interventions that address social determinants influencing self-care are needed since low SES patient populations continue to experience poorer outcomes.

Responsiveness to Change of Functional Limitation Reporting: Cross-sectional Study Using the Intermountain ROMS Scale in Outpatient Rehabilitation.

The Centers for Medicare and Medicaid Services (CMS) require physical therapists document patients' functional limitations. The process is not standardized. A systematic approach to determine a patient's functional limitations and responsiveness to change is needed. The purpose of this study is to compare patient-reported outcomes (PROs) responsiveness to change using 7-level severity/complexity modifier scale proposed by Medicare to a derived scale implemented by Intermountain Healthcare's Rehabilitation Outcomes Management System (ROMS). This was a retrospective, observational cohort design. 165,183 PROs prior to July 1, 2013, were compared to 46,334 records from July 1, 2013, to December 31, 2015. Histograms and ribbon plots illustrate distribution and change of patients' scores. ROMS raw score ranges were calculated and compared to CMS' severity/complexity levels based on score percentage. Distribution of the population was compared based on the 2 methods. Sensitivity and specificity were compared for responsiveness to change based on minimal clinically important difference (MCID). Histograms demonstrated few patient scores placed in CMS scale levels at the extremes, whereas the majority of scores placed in 2 middle levels (CJ, CK). ROMS distributed scores more evenly across levels. Ribbon plots illustrated advantage of ROMS' using narrower score ranges. Greater chance for patients to change levels was observed with ROMS when an MCID was achieved. ROMS narrower scale levels resulted in greater sensitivity and good specificity. Geographic representation for the United States was limited. Without patients' global rating of change, a reference standard to gauge validation of improvement could not be provided. ROMS provides a standard approach to identify accurately functional limitation modifier levels and to detect improvement more accurately than a straight across transposition using the CMS scale.

PD-L1 immunohistochemistry in clinical diagnostics: Inter-pathologist variability is as high as assay variability.

e20637 Background: Several checkpoint inhibitors targeting the PD1 axis are now approved for the treatment of non-small cell lung cancer (NSCLC). The best predictor for therapy response is PD-L1 expression on tumor cells assessed by immunohistochemistry (IHC). However, the PD-L1 assays have been developed independently for each available drugs. In this study, we evaluated the different assays to determine the comparability between the assays and the concordance between pathologists under conditions reflecting the clinical situation. Methods: We tested four IHC assays (28-8, 22C3, SP263 and SP142) and one in-house protocol (28-8 on the Ventana system) on a tissue microarray (TMA) including 55 resected tissue specimens of NSCLC patients. The TMAs were independently annotated by seven pathologists with regard to the percentage of tumor cell membrane staining using a six-grade scale ( &lt; 1%; 1-≤5%; 5%-≤10%; 10-≤25%; 25-≤50%; ≥50%). Results: The staining scores were comparable for the three assays with clones 28-8, 22C3 and SP263 as well as the in-house 28-8 protocol (κ-value: 0.75-0.91). The use of the SP142 clone resulted in a lower percentage of positive tumor cells and positive cases (κ: 0.44-0.63). When a reference score was defined based on the majority of scores, the proportion of positive cases (≥1%) were 38% for 28-8, 29% for 22C3, 42% for SP263, 37% for 28-8 in-house and 16% for SP142%. With ≥1% cut-off 3-8 of the 55 cases (5-15%) were differently classified as positive or negative when comparing any two assays excluding SP142. Analysing the scoring of the seven pathologists a clear inter-rater variability (κ: 0.71-0.96) was observed independent from the assay. With a ≥1% cut-off, 20% of cases were annotated differently by at least one pathologist. Conclusions: The concordance between the three antibody clones 28-8, 22C3 and SP263 was acceptable and was in the similar range as inter-rater variability of different pathologists. The results suggest that assessment of tumor cell staining for Nivolumab, Pembrolizumab and Durvalumab might be performed with only one of these assays. The assessment of the pathologist presents an intrinsic source of error that should be considered especially at low PD-L1 scores.

The Effects of Repeated Readings on the Reading Performances of Hispanic English Language Learners with Specific Learning Disabilities

AbstractA multiple probe across participants design was used to explore the effects of repeated readings on the reading fluency, errors, and comprehension of 4, third-to-fifth grade English language learners (ELLs) with specific learning disabilities (SLD). Also, generalization measures to untaught passages and maintenance data were collected. In baseline, participants read a passage aloud once, while during repeated readings, they read a passage 3 times. In the repeated readings condition, participants read more words correctly per minute, made fewer reading errors, and answered more literal comprehension questions correctly. The gains observed generalized to untaught passages. A majority of scores on maintenance probes at 2, 4, and 6 weeks maintained near or above the levels scored for each dependent variable during the last intervention session.

Anaemia as an independent key risk factor for major haemorrhage in patients treated with vitamin K antagonists: Results of the SCORE prospective cohort

IntroductionRisk scores for the prediction of haemorrhage are poorly predictive of major bleeding. The aim of this study was to refine the estimation of bleeding risk by identifying one or several parameters of prognostic significance among these algorithms. Materials and methodsThe SCORE study was a prospective, multicentre cohort study conducted in France in 2009–2010. Patients were eligible if they had received vitamin K antagonist (VKA) for any therapeutic indication for at least 3months. The primary outcome was the occurrence of major bleeding at 1-year follow-up. ResultsIn total, 962 patients were included in this study and evaluated at 1year. The incidence of major bleeding at 1-year follow-up (Kaplan–Meier method) was 2.9% [95% confidence interval (CI) 1.9–4.2]. The rate of major bleeding was 8.2% (95 CI 3.4–16.2) per year in patients classified as high risk by at least four scores. In a multivariate Cox analysis, of the risk factors for the different scores, only anaemia <100g/l at inclusion was strongly associated with risk of major bleeding (hazard ratio 6.1, 95% CI 2.7–13.8, P<0.0001). Through an induction tree analysis performed to identify a common parameter in the majority of scores, anaemia was found to be the main predictor of correct classification as high risk by at least four scores (55% of patients classified as high risk by at least four scores vs 3.3% in the absence of anaemia). ConclusionAnaemia with haemoglobin <100g/l is the most important predictor of high risk of bleeding in patients treated with VKA.

Impact of strabismus on the quality of life of Chinese Han teenagers.

BackgroundAlthough much research has been conducted on the impact of strabismus on the quality of life (QoL) of adults, the effect of this condition on teenagers has not been extensively studied. This study therefore aimed to assess the effect of strabismus on the vision-related QoL of Chinese teenagers.MethodsThe Chinese version of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was self-administered by 1,040 teenagers with strabismus and 1,002 individuals with normal vision. All the participants were from the Chinese Han population. The independent samples t-test was used to compare QoL between teenagers with and without strabismus.ResultsThe majority of scores on the NEI-VFQ-25 domains were significantly different between the two groups. QoL was significantly lower in individuals with strabismus compared with teenagers with normal vision on all domains, with the exception of social functioning.ConclusionStatistically significantly lower vision-related QoL scores were found in Chinese Han teenagers with strabismus compared with those without strabismus.

Psychometric Properties of Farsi Version of the Spielberger‘s State-trait Anger Expression Inventory-2 (FSTAXI-2)

The present study examines the psychometric properties of the Farsi version of Spielberger's (1988) State-Trait Anger Expression Inventory (STAXI-2) for Iranian university students. 1140 students were selected from Tehran University, and Spielberger‘s State-Trait Anger Expression Inventory-2 with one of the five instruments were completed by them. These instruments consisted of Multi-dimensional Anger Inventory (MAI; Siegel, 1986), Over-controlled Hostility Scale (O-H: Megargee, Cook, & Mendelson Bortner, 1976) Oxford Happiness Inventory (OHI; Argyle, 1998), Emotional Intelligence (FEIS- 41; Besharat, 2007) and NEO-Five Factor Inventory (NEO- PI; Mc Cera & Costa, 1999). The results showed a significant relation between STAXI-2 and its subscales, and the majority of scores on parallel instruments. Factor analysis indicated the existence of multi-factorial model that consistent with the original structure. According to the findings, STAXI-2 has a reasonable reliability, internal consistency, and construct, content, concurrent, convergent, divergent and discriminant validity. Therefore, this tool can be used in research and clinical settings.

Working with substance use: Levels and predictors of positive therapeutic attitudes across social care practitioners in England

Aims: To measure the attitudes of social care practitioners towards working with alcohol and other drug (AOD) use and to identify the factors which can be used to predict positive engagement.Methods: A cross-sectional online survey was completed by 646 front-line social care practitioners in 11 English Local Authorities. The survey included an adapted version of the Alcohol and Alcohol Problems Perceptions Questionnaire to measure overall therapeutic attitudes (OTAs). Using a principle component analysis, four attitudinal components were identified within the tool; role adequacy, role support, role legitimacy and role engagement.Findings: Analysis of 597 responses (sub-sample excluding specialists substance misuse workers) revealed an average OTA score of 4.68 (SD = 0.662; range: 1–7). The majority of scores (69%) fell in the middle range indicating that practitioners were neither positively nor negatively engaged with AOD-related work. Respondents reported more positive perceptions of role support and legitimacy (56% and 54%, respectively) than for role adequacy and role engagement (25% and 20%, respectively). A multiple regression model revealed that perceived preparedness by qualifying training, employing directorate, AOD-related practice experience and gender, were all predictors of OTAs.Conclusion: For these social care professionals, neither positive nor negative attitudes towards working with AOD dominated. However, this research identifies several factors important for converting the largely ambivalent attitudes of social care practitioners into positive engagement with AOD use.