Rating Categories Research Articles

Investigating the validity of rating scales using many-faceted rasch model

The characteristics of a test instrument, particularly the frame of a scoring system, would be a strong candidate to increase or decrease rater reliability due to individual raters’ different perceptions on each rating scale. This indicates that scoring reliability may be affected by two parts, both the rater and the scoring system. The purpose of this study is to quantitatively investigate the optimized scoring system in order to acquire the validity of a rating scale by reducing systematic errors from the test instrument. The validation process of an analytical rating scale was conducted and the utility of the newly proposed rating scales were evaluated using the Many-Faceted Rasch Measurement (MFRM). The rating data were derived from multiple ratings of ninety essays. Four scoring models were proposed and evaluated. The results showed that the rating scale seemed to show some problems at the initial analysis. As a remedy to consider this matter, the number of the rating categories was reduced and re-evaluated in terms of reliability. It was found that a scoring system would function more reliably and consistently when evaluating rater reliability. The findings are discussed in reference to their implications for the development of statistically solid rating scales. The validation process of the rating scale is essential in order to identify the source of errors, for instance, whether it comes from the test instrument or randomness in rater performance.

Factors affecting audiological performance and speech intelligibility in prelingually deaf children after cochlear implantation: a study

<p class="abstract"><strong>Background:</strong> The primary aim is to understand the factors affecting the audiological, speech and language outcome in prelingually deaf children, with bilateral severe to profound sensorineural hearing loss, who have undergone cochlear implantation.</p><p class="abstract"><strong>Methods:</strong> 40 prelingually deaf children, with bilateral severe to profound sensorineural hearing loss, who have undergone cochlear implantation were enrolled. Auditory performance and speech intelligibility was gauged by revised categories of auditory performance (CAP) score and speech intelligibility rating (SIR) respectively, preoperatively and at 3 months, 6 months and 1 year post cochlear implantation. These values were analysed using statistical package for social sciences with respect to duration of auditory deprivation, duration of use of hearing aid prior to cochlear implantation, duration of auditory verbal therapy prior to cochlear implantation and age of child at cochlear implantation. </p><p class="abstract"><strong>Results:</strong> There is a negative relation between CAP and duration of auditory deprivation at 6 months and 1 year post cochlear implantation. Also, negative relation is seen between CAP and age of child at cochlear implantation at 6 months and 1 year post cochlear implantation. There is a negative relation between SIR and duration of auditory deprivation at 6 months and 1 year post cochlear implantation. Also, negative relation is seen between SIR score and age of child at cochlear implantation at 3 months, 6 months and 1 year post cochlear implantation.</p><p class="abstract"><strong>Conclusions:</strong> Lesser the auditory deprivation and younger the child at cochlear implantation, better is the audiological performance and speech intelligibility post cochlear implantation.</p><p> </p>

Temporal variation of renal function in people with type 2 diabetes mellitus: A retrospective UK clinical practice research datalink cohort study.

AimTo characterize the longitudinal variability of estimated glomerular filtration rate (eGFR) in people with type 2 diabetes mellitus (T2DM), including variation between categories and individuals.MethodsPeople with T2DM and sufficient recorded serum creatinine measurements were identified from the Clinical Practice Research Datalink (T2DM diagnosis from 1 January 2009 to 1 January 2011 with 5 years follow‐up); eGFR was calculated using the CKD‐EPI equation.ResultsIn total, 7766 individuals were included; 32.8%, 50.2%, 12.4%, 4.0% and 0.6% were in glomerular filtration rate (GFR) categories G1, G2, G3a, G3b and G4, respectively. Overall, eGFR decreased by 0.44 mL/min/1.73 m2 per year; eGFR increased by 0.80 mL/min/1.73 m2 between index and year 1, then decreased by 0.75 mL/min/1.73 m2 annually up to year 5. Category G1 showed a steady decline in eGFR over time; G2, G3a and G3b showed an increase between index and year 1, followed by a decline. Category G4 showed a mean eGFR increase of 1.85 mL/min/1.73 m2 annually. People in categories G3‐G4 moved across a greater number of GFR categories than those in G1 and G2. Individual patients' eGFR showed a wide range of values (change from baseline at year 5 varied from −80 to +59 mL/min/1.73 m2).ConclusionOverall, eGFR declined over time, although there was considerable variation between GFR categories and individuals. This highlights the difficulty in prescribing many glucose‐lowering therapies, which require dose adjustment for renal function. The study also emphasizes the importance of regular monitoring of renal impairment in people with T2DM.

Impact of haemoglobin A1c trajectories on chronic kidney disease progression in type 2 diabetes.

To characterize haemoglobin A1c (HbA1c) trajectories and examine their associations with chronic kidney disease (CKD) progression. This was a prospective cohort study on 770 patients with type 2 diabetes mellitus (T2DM) attending a diabetes centre in 2002-2017. Group-based trajectory modelling was used to identify HbA1c trajectories. Cox proportional hazards models were used to examine association between the trajectories and CKD progression which was defined as deterioration across the Kidney Disease: Improving Global Outcomes estimated glomerular filtration rate categories with ≥25% drop from baseline. We identified four HbA1c trajectories: 'near-optimal stable' (49.1%), 'moderate stable' (37.9%), 'moderate-increasing' (6.0%) and 'high-decreasing' (7.0%). Over a median follow-up period of 4.6 years (interquartile range 2.5-5.6), CKD progression occurred in 35.6% of patients. The risk of CKD progression was significantly higher in the moderate-increasing with adjusted hazard ratios (HR) 2.23 (95% confidence interval (CI) 1.09-4.57). After additional adjustment for mean HbA1c, the association between the moderate-increasing subgroup and CKD progression remained significant at HR 3.07 (95% CI 1.08-8.77). Moderate-increasing HbA1c trajectory is associated with renal disease progression in patients with T2DM, independent of mean HbA1c. The deleterious effects of deteriorating HbA1c trajectory highlight the importance of achieving sustained good glycaemic control in diabetes management.

What does (and does not) affect crime in India?

PurposeThis paper uses data from 2010 to 2016 across 32 states and union territories to investigate the determinants of crime in India. Results indicate the significance of macroeconomic, demographic, socioeconomic and deterrence factors in accounting for various categories of crime.Design/methodology/approachDue to the evidence of heteroskedasticity and cross-sectional dependence, linear regression with panel-corrected standard errors is implemented.FindingsIt has been found that among the macroeconomic factors, only GSDP per capita was found relevant in explaining total crime rates. However, the unemployment rate and price level are crucial in explaining some categories of crime. The demographic factor, that is, population density, socioeconomic factors, that is, income inequality, poverty rate, literacy rate exhibit important and significant relationship with crime rates in India. Further, out of the four deterrence factors, charge-sheeting rate, conviction rate, pendency in police cases are important in explaining various categories of crime rates in India.Originality/valueWhile implications of some socioeconomic variables are consistent with those found in previous studies, literacy rates and deterrence variables were found to have a positive association with crime. In particular, in a developing country such as India, white-collar crimes tend to increase as literacy rates increase. This calls for implementing policies that lead to greater employment opportunities for the educated masses. This paper also sheds light on the relationship between deterrence factors and crime rates in India. Deficiencies in the legal and judicial system have been detrimental to the nation's ability to curb crime rates.

Green building standards: Opportunities for Nigeria

A large continuing body of works has highlighted the pivotal role of Green Building Assessment Tools (GBAT) in achieving sustainable development. As such, different countries have developed different contextual building assessment tools such as – but not limited to – the Leadership in Energy and Environmental Design (LEED), Building Research Establishment Environmental Assessment Method (BREAM), and the Deutsche Gesellschaft für Nachhaltiges Bauen (DGNB) to ensure sustainable development on the different countries. However, in spite of the robustness of awareness in the role of GBATs, Nigeria remains a country without a significant building assessment tool. In spite of its exponentially growing population and the imperative need to house this population, the Nigeria construction section remains without any viable tool to ensure sustainable development. As such, this present study is driven on the implicit assumption that the assessment criteria of LEED holds potential to guide the improvement of the Nigeria National Building Code. Thus, this paper aims to adopt LEED as a contextual reference to assess the advantages and disadvantages of the Nation Building Code in the context of sustainable development compliance. To achieve this aim, the following rating categories were considered; material/waste control; water efficiency; indoor environmental quality; energy efficiency; sustainable site; innovation in design. Methodologically, the collection of data and interpretation are based on a qualitative research approach. Methods used include critical reviews and content analysis among others. To this end, this paper suggests a framework which demonstrates how the suggested criteria can be synthesized into the National building code to improve its sustainability criteria for ensuring the construction sector is in line with the global ethos of sustainable development.

Categories of Auditory Performance and Speech Intelligibility Ratings in Prelingually Deaf Children With Bilateral Implantation.

Purpose The aim of the current study was to review all pediatric cases with congenital deafness who underwent bilateral implantation in our center. Specifically, auditory performance and speech intelligibility ratings were compared across children based on their mode of bilateral stimulation (simultaneous or sequential implantation). Method A retrospective chart review design was used in this study. A total of 46 congenitally deaf children were included. Children ranged in age between 2 and 8 years, with a mean of 3 years 7 months. Participants were divided into 2 groups: those who received their bilateral implant simultaneously and those who received them sequentially. Categories of Auditory Performance (CAP; Archbold, Lutman, & Marshall, 1995 ) scores and Speech Intelligibility Rating (SIR; M. C. Allen, Nikolopoulos, & O'Donoghue, 1998 ) scores were used to measure their performance. Results Children scored an average of 4.1 (±1.6) on the CAP Scale and 1.6 (±1) on the SIR Scale. Results showed that children who received their implants simultaneously scored relatively higher on the CAP Scale than those with sequential implants. However, there were no differences between the 2 groups in SIR scores. These 2 outcome measures were not correlated with age at implantation. Conclusion The current study demonstrated that simultaneous implantation could potentially improve audiologic outcome.

Abstract P160: Racial Differences in the Association of NTproBNP With Risk of Incident Heart Failure in REGARDS Participants

Background: Black individuals have lower N-terminal-pro-B-type natriuretic peptide (NTproBNP) levels than whites. Higher NTproBNP levels are associated with increased risk of incident heart failure (HF). Although, the ability of NTproBNP for risk stratification is variable in the setting of obesity and kidney disease. We studied the 1) association of NTproBNP with incident HF stratified by race and 2) tested the predictive ability across body mass index (BMI) and estimated glomerular filtration rate (eGFR) categories. Methods: Using a case-cohort design, NTproBNP levels were measured from the Reasons for Geographic And Racial Differences in Stroke study for 855 participants who subsequently developed incident HF and 3,680 randomly selected participants. Multivariable Cox proportional hazard modeling including all the factors which can affect NTproBNP levels was used to assess 1) the association of NTproBNP with incident HF; 2) interaction by race, and 3) predictive ability of NTproBNP based on percentage contribution in global Wald Chi-square score across BMI and eGFR categories. Results: The mean age of the random sub-cohort was 66.6 (12.1) years, 1,847 (50.2%) were females and 1,775 (48.2%) were blacks. The magnitude and strength of the relationship of NTproBNP with incident HF differed by race (p=0.01 for interaction). A doubling in NTproBNP levels was associated with greater risk of incident HF among whites [(hazard ratio (HR): 1.82; 95% CI: 1.62-2.04] compared with blacks (HR: 1.54; 95% CI: 1.35-1.75). NTproBNP remained a strong predictor (25%-50% Wald score) of incident HF across all BMI and eGFR categories in whites. However, among blacks with obesity (BMI ≥ 30 kg/m 2 ) and eGFR ≤60 mL/min/1.73 m 2 , NTproBNP was a weak predictor of incident HF (<7% Wald score) ( Figure ). Conclusions: Higher NTproBNP was more strongly associated with incident HF among whites compared with blacks. The predictive ability of NTproBNP levels with incident HF was preserved with obesity and impaired renal function among whites, but not in blacks.

Impact of skilled nursing facility quality on postoperative outcomes after pancreatic surgery

Data on skilled nursing facility utilization among patients undergoing pancreatic surgery remain scarce. We sought to define the incidence of utilization of skilled nursing facilities and determine the impact of skilled nursing facility quality markers on postoperative outcomes among patients who underwent pancreatic surgery. Medicare Standard Analytic Files were used to identify patients who underwent pancreatic resection during 2013-2015. Nursing Home Compare datasets were used to examine the influence of skilled nursing facility quality as estimated by quality markers (Medicare star ratings) on postoperative outcomes. Among 13,018 patients who underwent pancreatectomy, 2,247 (17.3%) were discharged to a skilled nursing facility. Compared with patients discharged home, patients discharged to a skilled nursing facility were older (median age: 72 [interquartile range 68-76] vs 76 [interquartile range 71-80]), more likely female (44.4% vs 56.8%), and had greater Charlson comorbidity index scores (median score: 3 [interquartile range 2-8] vs 4 [interquartile range 2-8]) (all P < .001). Most patients were discharged to an above-average skilled nursing facility (N = 1,463, 65.1%), and a lesser subset was discharged to a skilled nursing facility with a below-average (N = 490, 21.8%) or average (N = 294, 13.1%) star rating. The 30-day hospital readmission was greatest among patients discharged to a below-average skilled nursing facility (below average N = 217, 44.3%; average N = 110, 37.4%; above average N = 517, 35.3%; P = .002). On multivariate analysis, patients discharged to below-average skilled nursing facilities remained 64% more likely to be readmitted within 30 days (OR 1.64, 1.29-2.02, P < .001). In contrast, 30-day mortality was comparable across the skilled nursing facility star rating categories (P = .08). Roughly 1 in 6 patients undergoing pancreatic surgery were discharged to a skilled nursing facility. Patients discharged to a below-average skilled nursing facility were more likely to be readmitted compared with patients discharged to an above-average skilled nursing facility.

Severe Chronic Kidney Disease Is Associated with a Lower Efficiency of Bariatric Surgery.

Obesity is a risk factor for chronic kidney disease (CKD) and a relative contraindication for renal transplantation. Bariatric surgery (BS) is an option to address this issue but we hypothesize that severe CKD is associated with a loss of efficacy of BS which could justify recommending it at an earlier stage of the CKD. A retrospective study (n = 101 patients) to test primarily for differences in weight loss at 6 and 12months according to estimated glomerular filtration rate categories (eGFR< 30 including patients on dialysis, 30-60, 60-90, and ≥ 90ml/min/1.73m2) was performed with multivariate analysis adjusted for sex, age, BMI, surgical procedure, and diabetes. We used a second method to confirm our hypothesis comparing weight loss in patients with stage 4-5 CKD (eGFR < 30ml/min/1.73m2, n = 17), and matched controls with eGFR ≥ 90ml/min/1.73m2. In the first comparison, the multivariate analysis showed a significant positive association between eGFR and weight loss. However, after exclusion of the subgroup of patients with eGFR < 30ml/min/1.73m2, the difference between groups was no more significant. In addition, percent total weight loss (%TWL) was significantly lower in patients with severe CKD compared to controls: - 15% vs - 23% at 6months (p < 0.01); - 17% vs - 27% at 12months (p < 0.01). The percent excess weight loss at 1year reached 47% in patients with stage 4-5 CKD and 68% in controls subjects (p < 0.01). Surgery was a success at 12months (weight loss > 50% of excess weight) in 38% of advanced CKD and 88% of controls (p < 0.01). The efficacy of BS was reduced in patients with advanced CKD. These results support early BS in patients with early-to-moderate CKD.

Rating Migration and Bond Valuation: Towards Ahistorical Rating Migration Matrices and Default Probability Term Structures

The study examines rating migration, and default probability term structures obtained from rating migration matrices. It expands on the use of rating migration matrices with reduced form bond valuation models, by formally delineating the probability of default according to the likely rating paths of a bond, as implied by the rating migration matrix. Further, two alternatives are also considered. First, the cost of default is stipulated as the recovery of par according to the exit rating upon default. Also, in addition to stating the value of a bond in terms of expected cash flows, when considering the probability of default, the value of a bond is alternatively stated as the present value of all likely rating paths of the bond, discounted against the market risk-bearing bond forward rates of the different rating categories. The impact of term structure volatility and rating migration uncertainty on bond valuation is also considered.It is shown that the relationship between rating migration and default probability is complex, and the default probabilities of different rating categories are time-dependent and not isolated from each other. Also, rating migration resembles a delayed default process that influences default probabilities of subsequent intervals. The implications of a rating migration matrix may perhaps only be fully understood through simulation. This form one of the first points by which to evaluate rating migration matrices. The results of the valuation model show that historical rating migration matrices may not be optimal for pricing bonds ahistorically. A principal premise of the study is the dichotomy between historical values and ahistorical estimates, particularly with regards to rating migration. It is argued that historical estimates face two key shortcomings: they must be able to accurately forecast future rating migration and rating category intensities as a result, and they must specify a method to include rating migration uncertainty. An optimization model is delineated to extract ahistorical rating migration matrices from market prices. This too has implications that should be considered. In light of the above, reduced form models may have an advantage over structural models, in their ability to portray a far more sophisticated default process.

Rating Migration and Bond Valuation: Towards Ahistorical Rating Migration Matrices and Default Probability Term Structures

The study examines rating migration, and default probability term structures obtained from rating migration matrices. It expands on the use of rating migration matrices with reduced form bond valuation models, by formally delineating the probability of default according to the likely rating paths of a bond, as implied by the rating migration matrix. Further, two alternatives are also considered. First, the cost of default is stipulated as the recovery of par according to the exit rating upon default. Also, in addition to stating the value of a bond in terms of expected cash flows, when considering the probability of default, the value of a bond is alternatively stated as the present value of all likely rating paths of the bond, discounted against the market risk-bearing bond forward rates of the different rating categories. The impact of term structure volatility and rating migration uncertainty on bond valuation is also considered.It is shown that the relationship between rating migration and default probability is complex, and the default probabilities of different rating categories are time-dependent and not isolated from each other. Also, rating migration resembles a delayed default process that influences default probabilities of subsequent intervals. The implications of a rating migration matrix may perhaps only be fully understood through simulation. This form one of the first points by which to evaluate rating migration matrices. The results of the valuation model show that historical rating migration matrices may not be optimal for pricing bonds ahistorically. A principal premise of the study is the dichotomy between historical values and ahistorical estimates, particularly with regards to rating migration. It is argued that historical estimates face two key shortcomings: they must be able to accurately forecast future rating migration and rating category intensities as a result, and they must specify a method to include rating migration uncertainty. An optimization model is delineated to extract ahistorical rating migration matrices from market prices. This too has implications that should be considered. In light of the above, reduced form models may have an advantage over structural models, in their ability to portray a far more sophisticated default process.

Homoplasy-Based Partitioning Outperforms Alternatives in Bayesian Analysis of Discrete Morphological Data.

Bayesian analysis of morphological data is becoming increasingly popular mainly (but not only) because it allows for time-calibrated phylogenetic inference using relaxed morphological clocks and tip dating whenever fossils are available. As with molecular data, recent studies have shown that modeling among-character rate variation (ACRV) in morphological matrices greatly improves phylogenetic inference. In a likelihood framework this may be accomplished, for instance, by employing a hidden Markov model to assign characters to rate categories drawn from a (discretized) $\Gamma$ distribution and/or by partitioning data sets according to rate heterogeneity and estimating per-partition branch lengths, conditioned on a single topology. While the first approach is available in many phylogenetic analysis software, there is still no clear consensus on how to partition data, except perhaps in the simplest cases (e.g., "by codon" partitioning of coding sequences). Additionally, there is a trade-off between improvement in likelihood scores and the number of free parameters in the analysis, which rises quickly with the number of partitions. This trade-off may be dealt with by employing statistics that penalize overfitting of complex models, such as Akaike or Bayesian information criteria, or the more recently introduced stepping-stone method for marginal likelihood approximation. We applied the latter to three distinct matrices of discrete morphological data and demonstrated that sorting characters by homoplasy scores (obtained from implied weighting parsimony analysis) outperformed other partitioning strategies (anatomically-based and PartitionFinder2). The method was in fact so efficient in segregating characters by rates of evolution that no within-partition ACRV modeling was necessary, while among-partition rate variation was adequately accommodated by rate multipliers. We conclude that partitioning by homoplasy is a powerful and easy-to-implement strategy to address ACRV in complex data sets. We provide some guidelines focusing on morphological matrices, although this approach may be also applicable to molecular data sets.

Evaluating Teacher Effectiveness Using Classroom Observations: A Rasch Analysis of the Rater Effects of Principals

ABSTRACTIn most U.S. schools, teachers are evaluated using observation of teaching practice (OTP). This study investigates rater effects on OTP ratings among 421 principals in an authentic teacher evaluation system. Many-facet Rasch analysis (MFR) using a block of shared ratings revealed that principals generally (a) differentiated between more and less effective teachers, (b) rated their teachers with leniency (i.e., overused higher rating categories), and (c) differentiated between teaching practices (e.g., Cognitive Engagement vs. Classroom Management) with minimal halo effect. Individual principals varied significantly in degree of leniency, and approximately 12% of principals exhibited severe rater bias. Implications for use of OTP ratings for evaluating teachers’ effectiveness are discussed. Strengths and limitations of MFR to analyze rater effects in OTP are also discussed.

Equity Valuation Based on a Random Process Modelling of Earnings and Equity Growth

The study reviews equity valuation, and proposes an alternative equity valuation model based on a random process modelling of earnings and equity growth. A Markov process is used to model earnings, standardized as earnings to book value, and book value based on rating category. This assumes a distinct relationship between rating category, and standardized earnings as well as book value: that both standardized earnings as well as book value are comparable per rating category, but distinct across rating categories. It is also assumed that a company inherits the earnings and book value distribution of its current rating. To test the premises of the equity valuation model, the study examines the standardized earnings and book value distributions of rating categories. The research population comprised all publicly-traded, rated equity of the JSE and NYSE stock markets. Sample data was limited to all equity of the major rating categories (AAA, AA, A, BBB, BB, B) for the 8 year window period 2009 to 2017. It is shown that earnings to book value are comparable per rating category, and distinct across rating categories. Analysis of book value growth revealed unexpected and surprising results, with no truly consistent pattern across rating categories, but rather individual relationships per rating category. The results raise questions regarding rating accuracy and rating theory. The implications of the results for equity valuation are discussed.

Visceral leishmaniasis and its relationship with climate and environmental factors in the State of Tocantins, Brazil, from 2007 to 2014

Visceral leishmaniasis (VL) may be influenced by climate and environmental factors. Tocantins is the state with the highest incidence in Brazil, contributing to the increase in the number of cases in the North macro-region. This study seeks to identify the correlation between VL incidence rates and climate and environmental factors in the municipalities of the State of Tocantins between 2007 and 2014. Correlations between crude VL incidence rates and the variables elevation, precipitation, Enhanced Vegetation Index (EVI) and temperature were tested using the Global and Local Moran Indexes, while also identifying clusters of VL incidence. We tested a variance analysis for linear trend between variable means in each rate category. Results show an increase in incidence rates with an increase in values of annual precipitation, humidity, EVI and nighttime temperature; and an inverse relationship with elevation and daytime temperature. The clusters we identified show that climate and environmental variables are related to VL incidence. Other studies are needed that adjust for individual-related factors in order to gauge how much the environment, or human influence over it, impact the disease.

Eviction From Renter-occupied Households and Rates of Sexually Transmitted Infections: A County-level Ecological Analysis.

Housing instability is linked to numerous health outcomes, but the specific impact of eviction from renter-occupied households, an event that has immediate implications for residential stability for low-income individuals, on sexually transmitted infections (STI) rates has not been adequately studied. We examined county-level associations between eviction rates in 2014 and rates of chlamydia and gonorrhea in the following year using publicly available data sources (Eviction Lab National Database and AtlasPlus, respectively). Descriptive statistics compared medians and nonparametric distributions with Krusal-Wallis tests. Linear regression was used to compare tertile categories of eviction rates and STI rates while controlling for potential confounders. Median rates of chlamydia in counties with low, medium, and high rates of eviction were 229, 270, and 358 cases per 100,000 population, respectively (P < 0.001). The corresponding median rates of gonorrhea were 25, 37, and 75 cases per 100,000 population (P < 0.001). These associations remained statistically significant after controlling for all covariates in adjusted models. The beta coefficients and 95% confidence intervals (95% CI) for chlamydia and gonorrhea comparing high to low county-level eviction rates were 63.8 (95% CI, 45.1-82.5) and 20.4 (95% CI, 13.5-27.4), respectively. Similar associations were observed across levels of poverty and in both metropolitan and nonmetropolitan counties. County-level eviction rates are associated with chlamydia and gonorrhea rates in a significant and robust way independent of other known predictors of STI. These results suggest that evictions result in residential instability in a way that may increase STI risk.

Association of Bone Mineral Density With Fractures Across the Spectrum of Chronic Kidney Disease: The Regina CKD-MBD Study.

Background:Recent studies have demonstrated that measurement of areal bone mineral density by dual-energy x-ray absorptiometry (DXA) predicts fractures in patients with chronic kidney disease (CKD). However, whether fracture risk prediction through bone mineral density (BMD) is enhanced due to the assessment of biochemical markers of chronic kidney disease and mineral and bone disease (CKD-MBD) or clinical risk factors is not clear. We hypothesized that in a select cohort of patients managed in a CKD clinic, that combining T-Scores with biochemical markers would optimize fracture discrimination than using DXA alone.Objective:To examine the relationships among BMD, biochemical markers of CKD-MBD, and fracture risk across Kidney Disease Improving Global Outcomes (KDIGO) glomerular filtration rate (GFR) categories G3a to G5.Design:Retrospective study.Setting:Patients were recruited from the multidisciplinary CKD clinic, Regina General Hospital, Canada.Patients:A total of 374 patients who received a DXA scan upon initial referral to Regina Multidisciplinary CKD Program from January 31, 2001 to January 31, 2010, were included in this study. The patients were followed for a total of 5 years.Methods:We conducted a retrospective review of 374 consecutive patients who underwent DXA imaging at the point of entry into our multidisciplinary CKD program. Areal BMD, T- and Z-Scores were obtained at the lumbar spine, total hip, mean of left and right femoral neck, and the one-third radius. We collected data on demographic, cross-sectional biochemical markers of mineral metabolism and fractures (identified through self-reported questionnaires, hospital electronic medical records, and physician billing records). We were able to gather data on 8/11 variables of Fracture Risk Assessment (FRAX) tool.Results:In our cohort, 14.3% of GFR categories G3a and G3b, 15.7% of GFR category G4, and 19.7% of GFR category G5 experienced a clinical fracture during the study period. On multivariate analysis, each decline of 1.0 SD in total hip BMD T-Score was associated with a significant increase in the risk of fracture (OR = 1.46, 95% confidence interval [CI], 1.12-1.89). Adding CKD-MBD markers and clinical risk factors did not further contribute to the model. Low BMD was the only independent risk factor for fracture in patients with CKD.Limitations:Self-reporting by patients and administrative records were used to identify fractures. We did not perform spine imaging to ascertain morphometric vertebral fractures. We were unable to gather all 11 variables of FRAX score and information on ethnicity. We were unable to capture site of fracture (hips, spine, etc) from billing records. Albumin excretion rates were not collected at baseline. Treatment of the underlying bone disease with pharmacotherapeutic agents may have attenuated patients’ fracture risk and thus underestimated the association between BMD and future fracture.Conclusions:Our findings confirm that BMD predicts fracture. The addition of cross-sectional CKD-MBD parameters and clinical risk factors to BMD did not add to fracture prediction. Prospective studies should investigate the utility of longitudinal biochemical markers on improving fracture risk assessment.

Analysis of the MANAGE Drain Concentration Database to Evaluate Agricultural Management Effects on Drainage Water Nutrient Concentrations

Abstract. Agricultural systems are substantial contributors of nonpoint-source nitrogen (N) and phosphorus (P) pollution, and loss of dissolved forms of these nutrients is exacerbated in subsurface-drained (tile-drained) landscapes. The majority of reviews summarizing drainage nutrient losses have focused on N and P loads, but closer inspection of drainage concentrations is necessary to more directly link cropping management factors with water quality outcomes. More than 1,500 recently compiled site-years of drainage N and P concentration in the Measured Annual loads from AGricultural Environments (MANAGE) Drain Concentration database were used to analyze the impacts of crop selelction, nutrient management, and tillage type on annual drainage nutrient concentrations. The highest annual flow-weighted mean NO3-N concentrations across the database were from corn, corn and soybean (grown within the same plot in the same year), and soybean site-years (14.0, 13.5, and 12.1 mg L-1, respectively). However, crop selection was not a significant predictor for annual average dissolved reactive phosphorus (DRP) concentrations in drainage. Nitrogen application rates below 75 kg ha-1 for corn did not significantly reduce annual NO3-N concentrations compared to rates of 75 to 149 kg ha-1 or 150 to 224 kg ha-1, although the three largest application rate categories (75 to 149 kg ha-1, 150 to 224 kg ha-1, and &amp;gt;224 kg ha-1, respectively) resulted in significantly increasing NO3-N concentrations. The stepwise regression approach was used to reduce and select predictors to model annual NO3-N and DRP concentrations. Regression analysis of NO3-N concentrations had an overall model R2 of 0.59 (n = 254) and indicated that N application rate had the greatest effect on NO3-N concentrations in corn site-years, followed by fertilizer timing and tillage type. Regression analysis of DRP concentrations had an overall R2 of 0.94, and although the model was less robust due to the small sample size (n = 47), fertilizer timing was most closely correlated with annual DRP concentrations. The MANAGE database will continue to evolve and remain a resource for new exploratory efforts to better understand and reduce nutrient losses from agricultural systems. Keywords: Concentration, Drainage, Nitrogen, Phosphorus, Water quality.

Rating migrations of US financial institutions: are different outcomes equivalent?

This study employs a competing risks approach to examine the rating migrations of US financial institutions (FIs) during the period 1984–2006. It finds that downgrades to alternative major rating categories require separate models, while upgrades can be treated as equivalent in the same analysis. Different downgrade routes exhibit different within-rating heterogeneity and time heterogeneity. The effect of rating history persists, and for downgrades to speculative ratings it becomes stronger as controls for outlooks/CreditWatch are added. The rating history, macroeconomic and political cycles jointly exhibit discrimination accuracy in predicting the outcomes of rating changes during the holdout-crisis period (2007–10). In most cases, adding the current rating, outlook or CreditWatch does not substantially improve the forecast performance of the models out-of-sample.