Multistep Development Research Articles

Physiotherapy approach in stroke rehabilitation: Development and testing of a survey of current practice

BACKGROUND AND PURPOSE: Physiotherapy is a key discipline in stroke rehabilitation. Physiotherapists sometimes select interventions following personal preference rather than a scientific rational. Data on physiotherapy approaches used in stroke rehabilitation may help policy makers and educators to plan education strategies and implement efficient clinical practices, thus improving rehabilitation effectiveness. We aimed to develop and test a questionnaire designed to survey physiotherapy interventions utilized in stroke rehabilitation. METHODS: We used a multistep questionnaire development method (literature review and synthesis; questionnaire drafting; expert validation; cognitive interviewing). Afterwards the survey proceeded to reliability testing; the outcomes of interest were completion time, estimated comprehensiveness of the lists of interventions, and intraclass correlation coefficient (ICC). RESULTS AND DISCUSSION: Retrieved survey tools, their items, and a taxonomy were useful for the questionnaire development. We interviewed four experts; changes were made to the survey following their suggestions. Thirteen physiotherapists participated in cognitive interviewing and further changes were made. Thirty-five raters participated in the test-retest study. Most participants considered the list of physiotherapy interventions and assistive device exhaustive. Median compilation time and time interval between the two compilations were 7 minutes and 21 days. The observed ICC was 0.844 (95% confidence interval, 0.829/0.857). Our method provided a valid and reliable questionnaire, however further methodological considerations of sampling methods and contact delivery modes are needed. CONCLUSIONS: If adequately implemented, the questionnaire can provide information about interventions utilized in stroke rehabilitation practice by physiotherapists. Data eventually acquired could be useful for planning educational strategies and implementing effective clinical practices.

Health-related quality of life in parents and partners of people with type 1 diabetes: Development and validation of type 1 diabetes and life (T1DAL) measures.

Despite the significant impact of type 1 diabetes (T1D) on family, few instruments are available to assess health-related quality of life (HRQOL) among family members of people with T1D. This study aimed to develop and evaluate the psychometric properties of new measures of diabetes-specific HRQOL for parents and partners of people with T1D. We report on the multistep development and validation process for the self-report Type 1 Diabetes and Life (T1DAL) measures, with versions for parents of youth age <8, 8-11, 12-17, and 18-25 years, and for partners of people age ≥18 years with T1D. First, we conducted qualitative interviews (total parents/partners n = 38) to develop draft measures and piloted them (total n = 20). Next, we tested the measures' psychometric properties. Participants (total across versions n = 813) at six T1D Exchange Clinic Network sites completed the appropriate T1DAL measure and validated measures of related constructs. We then reduced each T1DAL measure to 20-30 items in length based on psychometric data and participant feedback. Eleven participants reviewed the final measures via cognitive debriefing. The T1DAL measures for parents and partners demonstrated good internal consistency (α = .80-.88) and test-retest reliability (r = .73-.86). Correlations with measures of general quality of life, generic and diabetes-specific HRQOL, and diabetes burden demonstrated construct validity. Factor analyses identified 3-4 subscales/measure. Participants reported being satisfied with the shortened measures, which took 5-10 minutes to complete. The new T1DAL measures for parents and partners of people with T1D are reliable, valid, and ready for use in research and clinical settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effect of Inductively Coupled Electromagnetic Field on Bottom Oxide Etch in a High Aspect Ratio Trench

CMOS optical sensors devices are becoming increasingly important and popular for many different applications. Some of these devices are fabricated starting from SOI (Silicon On Insulator) wafers and using semiconductor manufacturing techniques. A common feature of the CMOS sensors is the isolating trench that protects the device from electrical noise. We report on the multistep etch process development to fabricate trenches deeper than usual, in order to isolate the sensor also from stray light interference. We focus the attention on unexpected features that originated during the Buried Oxide (BOX) etch.

In Silico Logical Modelling to Uncover Cooperative Interactions in Cancer.

The multistep development of cancer involves the cooperation between multiple molecular lesions, as well as complex interactions between cancer cells and the surrounding tumour microenvironment. The search for these synergistic interactions using experimental models made tremendous contributions to our understanding of oncogenesis. Yet, these approaches remain labour-intensive and challenging. To tackle such a hurdle, an integrative, multidisciplinary effort is required. In this article, we highlight the use of logical computational models, combined with experimental validations, as an effective approach to identify cooperative mechanisms and therapeutic strategies in the context of cancer biology. In silico models overcome limitations of reductionist approaches by capturing tumour complexity and by generating powerful testable hypotheses. We review representative examples of logical models reported in the literature and their validation. We then provide further analyses of our logical model of Epithelium to Mesenchymal Transition (EMT), searching for additional cooperative interactions involving inputs from the tumour microenvironment and gain of function mutations in NOTCH.

Immune Landscape of Thyroid Cancers: New Insights.

Immune system plays a key role in cancer prevention as well as in its initiation and progression. During multistep development of tumors, cells must acquire the capability to evade immune destruction. Both in vitro and in vivo studies showed that thyroid tumor cells can avoid immune response by promoting an immunosuppressive microenvironment. The recruitment of immunosuppressive cells such as TAMs (tumor-associated macrophages), TAMCs (tumor-associated mast cells), MDSC (myeloid-derived suppressor cells), TANs (tumor-associated neutrophils) and Tregs (regulatory T cells) and/or the expression of negative immune checkpoints, like PD-L1 (programmed death-ligand 1), CTLA-4 (cytotoxic T-lymphocyte associated protein 4), and/or immunosuppressive enzymes, as IDO1 (indoleamine 2,3-dioxygenase 1), are just some of the mechanisms that thyroid cancer cells exploit to escape immune destruction. Some authors systematically characterized immune cell populations and soluble mediators (chemokines, cytokines, and angiogenic factors) that constitute thyroid cancer microenvironment. Their purpose was to verify immune system involvement in cancer growth and progression, highlighting the differences in immune infiltrate among tumor histotypes. More recently, some authors have provided a more comprehensive view of the relationships between tumor and immune system involved in thyroid carcinogenesis. The Cancer Genome Atlas (TCGA) delivered a large amount of data that allowed to combine information on the inflammatory microenvironment with gene expression data, genetic and clinical-pathological characteristics, and differentiation degree of papillary thyroid carcinoma (PTC). Moreover, using a new sensitive and highly multiplex analysis, the NanoString Technology, it was possible to divide thyroid tumors in two main clusters based on expression of immune-related genes. Starting from these results, the authors performed an immune phenotype analysis that allowed to classify thyroid cancers in hot, cold, or intermediate depending on immune infiltration patterns of the tumor microenvironment. The aim of this review is to provide a comprehensive and updated view of the knowledge on immune landscape of thyroid tumors. Understanding interactions between tumor and microenvironment is crucial to effectively direct immunotherapeutic approaches in the treatment of thyroid cancer, particularly for those not responsive to conventional therapies.

The Urokinase Receptor: A Multifunctional Receptor in Cancer Cell Biology. Therapeutic Implications.

Proteolysis is a key event in several biological processes; proteolysis must be tightly controlled because its improper activation leads to dramatic consequences. Deregulation of proteolytic activity characterizes many pathological conditions, including cancer. The plasminogen activation (PA) system plays a key role in cancer; it includes the serine-protease urokinase-type plasminogen activator (uPA). uPA binds to a specific cellular receptor (uPAR), which concentrates proteolytic activity at the cell surface, thus supporting cell migration. However, a large body of evidence clearly showed uPAR involvement in the biology of cancer cell independently of the proteolytic activity of its ligand. In this review we will first describe this multifunctional molecule and then we will discuss how uPAR can sustain most of cancer hallmarks, which represent the biological capabilities acquired during the multistep cancer development. Finally, we will illustrate the main data available in the literature on uPAR as a cancer biomarker and a molecular target in anti-cancer therapy.

Determining the psychometric properties of a novel questionnaire to measure \u201cpreparedness for the future\u201d (Prep FQ)

BackgroundPeople are living longer than ever before. However, with living longer comes increased problems that negatively impact on quality of life and the quality of death. Tools are needed to help individuals assess whether they are practicing the best attitudes and behaviors that are associated with a future long life, high quality of life, high quality of death and a satisfying post-death legacy. The purpose of paper is to describe the process we used to develop a novel questionnaire (“Preparedness for the Future Questionnaire™ or Prep FQ”) and to define its psychometric properties.MethodsUsing a multi-step development procedure, items were generated, for the new questionnaire after which the psychometric properties were tested with a heterogeneous sample of 502 Canadians. Using an online polling panel, respondents were asked to complete demographic questions as well as the Prep-FQ, Global Rating of Life Satisfaction, the Keyes Psychological Well-Being scale and the Short-Form 12.ResultsThe final version of the questionnaire contains 34 items in 8 distinct domains (“Medico-legal”, “Social”, “Psychological Well-being”, “Planning”, “Enrichment”, “Positive Health Behaviors”, “Negative Health Behaviors”, and “Late-life Planning”). We observed minimum missing data and good usage of all response options. The average overall Prep FQ score is 51.2 (SD = 13.3). The Cronbach alphas assessing internal reliability for the Prep FQ domains ranged from 0.33 to 0.88. The intra-class correlation coefficient (ICC) used to assess the test–retest reliability had an overall score of 0.87. For the purposes of establishing construct validity, all the pre-specified relationships between Prep FQ and the other questionnaires were met.ConclusionAnalyses of this novel measure offered support for its face validity, construct validity, test–retest reliability, and internal consistency. With the development of this useful and valid scale, future research can utilize this measure to engage people in the process of comprehensively assessing and improving their state of preparedness for the future, tracking their progress along the way. Ultimately, this program of research aims to improve the quality and quantity of peoples live by helping them ‘think ahead’ and ‘plan ahead’ on the aspects of their daily life that matter to their future.

A Competence Model to Assess and Develop Designing Competence Assessment Tool

Studies showed that competency-based assessment improvement had generated a much greater impact on students’ achievements on standardized tests than other forms of educational activities. However, studies also indicated a number of challenges for teachers when designing competence assessment tools (CAT), especially in building assessment tasks that replicate real-life practice. There have been many different models for teachers’ assessment competencies, but the competency of designing competence assessment tools (CDCAT) was not paid much attention. In hope to develop a competency model that would serve as a supporting role in developing the CDCAT for pre-service teachers and teachers, this study used a multi-step development process to construct a teachable model that reflectived the complexity of designing assessment tools. The model consisted of 12 behavioural indicators spreading across four dimensions informed by the existing literature and empirical findings in particular contexts. To guarantee the content value of the proposed model, the research twice used the expert method by two panels. The reliability of the model was tested by analyzing the data collected from the survey with students. Interesting findings were met, and the outlined CDCAT model assisted pre-service teachers in solving issues related to their assessment competence. The model was intended for educational researchers, educators, teachers, and policy makers to support teachers’ assessment competence concerning the current accountability model across educational systems. Specific implications for developing pre-service teachers' CDCAT were discussed, followed by suggestions for future studies.

Development of avisual tool to assess six dimensions of health and its validation in patients with endocrine disorders.

BackgroundPsychosocial factors significantly influence patient care in many fields of medicine, among these in the field of endocrinology. Easily applicable validated assessment tools for such psychosocial factors are lacking. Visual instruments may facilitate doctor-patient communication. This study describes the development and validation of a multidimensional visual tool for the self-assessment of health.MethodsAn expert panel performed the multistep development of the psychosomatic assessment health disc (PAHD). Assessment of face validity was performed by means of a focus group of medical doctors (n = 6) and patient interviews (n = 24). For determining test-retest reliability, internal consistency and construct validity, patients of an endocrine outpatient clinic in Graz, Austria, completed the PAHD and the following questionnaires: short-form 36 health survey, work ability index, Pittsburgh sleep quality index and the social life scales of the life satisfaction questionnaire.ResultsA numeric six-item analogue scale was developed in the form of a disc. It addresses the following aspects of health: physical well-being, social life, sexuality, mental well-being, sleep, working ability/performance. For the validation process, 177 patients (57.1% females) participated in the study. Correlation coefficients of the six items with other questionnaires ranged between r = 0.51 (social life) and r = 0.72 (sleep). Test-retest reliability was assessed among 98 patients and was ≥ 0.74 for all 6 items, while Cronbach’s alpha was 0.78.ConclusionThe psychometric properties of the PAHD support its use in clinical encounters with patients suffering from endocrine disorders. Further validation studies may be required to extend its application to other fields of medicine.Supplementary InformationThe online version of this article (10.1007/s00508-021-01809-y) contains supplementary material, which is available to authorized users.

Development of a Multinational Clinical Practice Guideline: A Practical Structured Procedure

Introduction: The development of a clinical guideline is a challenging process. National and international organizations have established a variety of approaches, grading systems, evaluation scales, and voting modes; however, a practical description which illustrates all steps from starting the initiative to publication and dissemination of the guideline is usually not provided. We describe a structured guideline procedure that can be adjusted to the requirements of other multinational guidelines. Methods: A group of European specialist gastroenterological societies and national societies initiated a guideline for the use of breath tests in gastroenterology. A balance between scientific evidence and clinical experience was achieved by involving European specialist societies and physicians from 18 European countries. For persons contributing to the guideline process, different levels of involvement were defined. The tasks were assigned to different groups of persons, which formed scientific institutions. Results: We describe organizational structures and institutions, the stepwise approach, and illustrate the multistep guideline development procedure in a flowchart diagram that shows workflow and assigned responsibilities and provides details for the execution of each step, including timelines. The process is split into 4 phases: foundation, preparation, voting, and publication. Discussion: This structured procedure of a gastroenterological clinical practice guideline can serve as a blueprint for future multinational guideline initiatives and may aid future attempts to standardize and harmonize guideline development processes in gastroenterology and in other medical fields. Although the described procedure is for a diagnostic guideline, it may also be appropriate for therapeutic guidelines by adjusting the acceptance criteria for recommendations.

Development and validation of the pick-up service quality scale of the buy-online-pick-up-in-store service

Buy-Online-Pick-up-in-Store (BOPS) service is a popular omnichannel retail initiative, intended to enhance the convenience of online customers. Focusing on the pick-up (PU) stage of BOPS service, we develop a comprehensive scale (BOPS-PU-QUAL) for its quality perceived by customers. A multi-step scale development procedure involving one qualitative and two quantitative studies resulted in a scale consisting of 16 items under four dimensions. Service effectiveness is found to be the strongest influencer on quality perceptions of BOPS-PU, followed by problem-handling, ease of access, and item-quality. A structural equation analysis reveals that BOPS-PU-QUAL perceptions positively affect customers’ behavioral intentions towards the brand’s BOPS service, with the relationship fully mediated by satisfaction with BOPS. This study contributes to omnichannel service quality research by identifying the critical quality dimensions of BOPS pick-up service that reflect the uniqueness of BOPS customers. These findings help practitioners realize the importance of managing BOPS-PU service quality and provide practical guidance.

Roles of long non-coding RNAs in the hallmarks of glioma.

Glioma is one of the most common types of tumor of the central nervous system. Due to the aggressiveness and invasiveness of high-level gliomas, the survival time of patients with these tumors is short, at ~15 months, even after combined treatment with surgery, radiotherapy and/or chemotherapy. Recently, a number of studies have demonstrated that long non-coding RNA (lncRNAs) serve crucial roles in the multistep development of human gliomas. Gliomas acquire numerous biological abilities during multistep development that collectively constitute the hallmarks of glioma. Thus, in this review, the roles of lncRNAs associated with glioma hallmarks and the current and future prospects for their development are summarized.

The role of pathologists in recognition of morphologic and biologic features of genetically mutated breast cancer.

The recent introduction of genomic medicine and emphasis on optimizing breast cancer risk reduction mortalities has provided opportunities for pathologists to partner with clinicians in advancing the diagnosis and management of breast cancer patients. The discovery of breast cancer genes BRCA1, BRCA2, and other breast cancer genes is considered a major breakthrough in the understanding of hereditary breast cancer. These discoveries have contributed to investigate the nature of tumorigenesis and the genetic and molecular pathology in multistep tumor development, as well as their relationship to endocrine and environmental factors. The recognition of unique morphologic and biological features associated with genetically mutated breast cancer by pathologists may have an impact on appropriate follow-up management of breast cancer patients.

Single-cell transcriptomic analysis in a mouse model deciphers cell transition states in the multistep development of esophageal cancer

Esophageal squamous cell carcinoma (ESCC) is prevalent in some geographical regions of the world. ESCC development presents a multistep pathogenic process from inflammation to invasive cancer; however, what is critical in these processes and how they evolve is largely unknown, obstructing early diagnosis and effective treatment. Here, we create a mouse model mimicking human ESCC development and construct a single-cell ESCC developmental atlas. We identify a set of key transitional signatures associated with oncogenic evolution of epithelial cells and depict the landmark dynamic tumorigenic trajectories. An early downregulation of CD8+ response against the initial tissue damage accompanied by the transition of immune response from type 1 to type 3 results in accumulation and activation of macrophages and neutrophils, which may create a chronic inflammatory environment that promotes carcinogen-transformed epithelial cell survival and proliferation. These findings shed light on how ESCC is initiated and developed.

Multidimensional green brand equity: A cross-cultural scale development and validation study

A plethora of studies indicate that brand equity is an intangible asset that played a vital role in increasing overall performance and customer preferences. The next logical questions would be the following: “How can a firm offer eco-friendly brands?” and “How can one measure green brand equity?” The purpose of this research is to propose an original, unique, and validated scale to measure multidimensional green brand equity for both products and services in a cross-cultural context. This study used a multistep scale development research design, and collected data from 980 consumers of telecommunication and home appliances industries in Pakistan and Italy. The six-dimensional green brand equity scale consists of social influence, sustainability, perceived quality, brand awareness, brand association, and brand leadership. As the green brand equity scale was invariant across Pakistan and Italy, researchers can test this scale both conceptually in the research and theoretically in the corporate environment.

HDAC9 deficiency promotes tumor progression by decreasing the CD8+ dendritic cell infiltration of the tumor microenvironment

BackgroundThe tumor microenvironment (TME) contains a variety of immune cells, which play critical roles during the multistep development of tumors. Histone deacetylase 9 (HDAC9) has been reported to have either...

Effect of Inductively Coupled Electro-Magnetic Field on Bottom Oxide Etch in a High Aspect Ratio Trench

CMOS optical sensors devices are becoming increasingly important and popular for many different applications. Some of these devices are fabricated starting from SOI (Silicon On Insulator) wafers and using semiconductor manufacturing techniques. A common feature of the CMOS sensors is the isolating trench that protects the device from electrical noise. We report on the multistep etch process development to fabricate trenches deeper than usual, in order to isolate the sensor also from stray light interference. We focus the attention on unexpected features that originated during the Buried Oxide (BOX) etch.

Shallow metabolic depression and human spaceflight: a feasible first step.

Synthetic torpor is an induced state of deep metabolic depression (MD) in an organism that does not naturally employ regulated and reversible MD. If applied to spaceflight crewmembers, this metabolic state may theoretically mitigate numerous biological and logistical challenges of human spaceflight. These benefits have been the focus of numerous recent articles where, invariably, they are discussed in the context of hypothetical deep MD states in which the metabolism of crewmembers is profoundly depressed relative to basal rates. However, inducing these deep MD states in humans, particularly humans aboard spacecraft, is currently impossible. Here, we discuss shallow MD as a feasible first step toward synthetic torpor during spaceflight and summarize perspectives following a recent NASA-hosted workshop. We discuss methods to safely induce shallow MD (e.g., sleep and slow wave enhancement via acoustic and photoperiod stimulation; moderate sedation via dexmedetomidine), which we define as an ~20% depression of metabolic rate relative to basal levels. We also discuss different modes of shallow MD application (e.g., habitual versus targeted, whereby shallow MD is induced routinely throughout a mission or only under certain circumstances, respectively) and different spaceflight scenarios that would benefit from its use. Finally, we propose a multistep development plan toward the application of synthetic torpor to human spaceflight, highlighting shallow MD's role. As space agencies develop missions to send humans further into space than ever before, shallow MD has the potential to confer health benefits for crewmembers, reduce demands on spacecraft capacities, and serve as a testbed for deeper MD technologies.

Understanding the importance that consumers attach to social media sharing (ISMS): Scale development and validation

In response to the increasing ubiquity of social media platforms, improved consumer choice, and technological progress, the importance of consumer-generated content (CGC) continues to grow for organizations marketing their destinations, products, and services to tourists. Yet, despite the importance tourists place on CGC and information shared via social media, there remains a lack of academic focus in this area. To address this gap, we use a rigorous multi-step scale development procedure to create a scale centered on understanding the importance consumers attach to social media sharing (ISMS) from a tourists' perspective. Studies conducted across different contexts (Turkey and Scotland), comprising 1183 participants, were used to validate the newly developed ISMS scale. The scale indicates internal consistency and reliability, alongside construct and predictive validity. Directions for future research and the practical implications of the newly developed ISMS scale are discussed by way of conclusion.

Advances in the diagnostic pathological features of precancerous lesions of hepatocellular carcinoma

The occurrence of hepatocellular carcinoma (HCC) is a multistep development process through precancerous lesions. A precancerous lesion of HCC is classified into hepatocyte dysplasia at the cytological level and dysplastic nodules at the histological level, and the corresponding lesion subtypes have different risks of canceration. Pathology is the "gold standard" for the diagnosis of early stage HCC and its precancerous lesions. However, it also faces many difficulties and challenges, such as the accumulation of experience in the pathological diagnosis, the understanding and grasp of key points of histopathological diagnosis and differential diagnosis, the combination application of immune and molecular diagnostic markers, and many others. This article briefly discusses the key points of pathological features and differential diagnosis of precancerous lesions of HCC.