Redundant Items Research Articles

Pre- and post-intervention factor structure of functional independence measure (Fim®) in patients with spinal cord injury

The usefulness of Functional Independence Measure (FIM ® ) scores was questioned by several previous research due to its multidimensional factor structure. The FIM ® has been widely used amongst people with spinal cord injury (SCI). Previous evidence on FIM ® validity amongst people with SCI is scarce. A few studies have reported that FIM ® has substantial ceiling effect in a cognitive area, a possible item redundancy in a motor area, and poor psychometrics assessed by the Rasch analysis. Based on the Rasch analysis, the FIM ® motor score was not recommended for use, at least as a raw sum of items’ scores. The cognitive scale was found to work well except for considerable ceiling effect. The aim was to evaluate the factor structure of FIM ® scale amongst people with SCI. The 155 people with SCI participated in multidisciplinary inpatient rehabilitation. FIM ® was assessed at the beginning and at the end of intervention. Retrospective register-based study. Cronbach's alpha and exploratory factor analysis. The internal consistency demonstrated a high Cronbach's alpha of 0.95 to 0.96. For both pre- and post-intervention assessments, the exploratory factor analysis resulted in 3-factor structures. Except for two items (‘walking or using a wheelchair’ and ‘expression’), the structures of the identified three factors remained the same at the beginning and at the end of rehabilitation. The loadings of all the items were sufficient exceeding 0.3. Both pre- and post-intervention chi-square tests showed significant P -values < 0.0001. Within the sample of people with SCI, FIM ® failed to demonstrate unidimensionality. Instead, it showed a 3-factor structure that was unstable depending on the timing of measurement. Using a total or subscale FIM ® scores seem to be unjustified in the studied population.

Reliability and Validity of Scores from the Foot and Ankle Ability Measure

Category: Ankle Introduction/Purpose: A commonly used measure of ankle function is the Foot and Ankle Ability Measure (FAAM). To support interpretation of the FAAM, evidence of reliability and validity must be established. Some studies have assessed FAAM scores; however, these studies had small sample sizes, sample characteristics that may limit generalizability, and did not report reliability estimates. These studies were also unable to account for person ability and item difficulty, a unique feature Rasch modeling offers, which is key when attempting to generalize to other populations. The purpose of this study was to determine whether there is evidence of reliability and validity for the FAAM ADL and Sport scales, utilizing the Rasch model, in patients who have undergone surgical intervention for the treatment of an ankle injury. Methods: Evidence of reliability and validity were determined utilizing the Rasch measurement model, a special case of item response theory, which has been used to develop new patient reported outcome measures and improve existing measures. This is a widely used technique that may be used as an alternative to classical test theory due to advantages including generalizability across samples, accounting for response options not equally spaced in terms of ability, and identifying poorly functioning items. The scale of interest is measured in terms of item difficulty and generates estimates of locations of individual items (item difficulty) and ability level along a common interval-level scale (log-odds). To identify misfit items, outfit mean-square (MNSQ) and infit MNSQ statistics were assessed. Infit and outfit MNSQ range from 0 to positive infinity (ideal value of 1.0 means observed variance = expected variance; acceptable value range 0.5 -1.7). Person reliability was also reported (analogous to Cronbach’s a). Results: There were 456 patients included in the study(192 females, 264 males)(average age=47.6 years(18-79). Rasch analysis showed good evidence of reliability for FAAM ADL and FAAM Sport scores (Figure 1). Person reliability was 0.87 for FAAM ADL and 0.89 for FAAM Sport. Outfit MNSQ values for FAAM ADL items 11 (Coming Up On Toes) and 10 (Squatting) were high (2.17, 1.96). Item 19 “Light/Moderate Work” was low(0.48), indicating item redundancy. For FAAM Sport, all outfit values (range 0.67 -1.64) were within the acceptable range. For internal scale validity, infit MNSQ values for FAAM ADL items 11 and 10 were high(2.30, 2.05). All other infit values (range 0.61 -1.48) were within the acceptable range. For FAAM Sport, all infit values (range 0.74 -1.65) were within the acceptable range. Conclusion: This study provides good evidence of reliability for FAAM ADL and Sport scores in a wide range of patients who underwent ankle surgery, which may demonstrate wide clinical applicability. Both scales demonstrated good internal scale validity; however, 3 FAAM ADL items may indicate the need for further scale development for use in a diverse ankle population.

Development and validation of a conceptually novel performance-based balance scale in community-living older adults

Balance testing is critical for identifying fall risk and initiating preventive strategies. However, current balance tests used with community-living older adults (CLOAs) are limited. Our purposes were to develop and validate a conceptually novel performance-based test to quantify balance ability in CLOAs that minimizes ceiling effects, decreases test time and demonstrates test-retest reliability, internal consistency, and convergent validity. Phase 1: we developed a 26-item, dichotomously-scored preliminary Performance-based Balance Scale (PBS) by (1) using an expert panel to build the scale by adapting test items from existing balance measures and organizing them by difficulty into 5 postural stability domains, (2) pilot testing, and (3) post-test revising. Phase 2: we tested the preliminary PBS (N = 35; 60–91 y). Using Rasch dichotomous analysis, we created a non-fixed-item format and identified 2 items to serve as starting points for testing based on performance ability; thereby, eliminating the need to administer all items. Phase 3: we re-tested 32 of the same participants 4–8 weeks later using the non-fixed-item PBS. We confirmed the non-fixed format with Spearman's rho and a paired t -test between scores for all 26 items and scores for non-fixed-item PBS. Using Rasch analysis, we eliminated redundant items. Phase 4: we determined test-retest reliability, internal consistency, and convergent validity. Correlation between the 26-item and non-fixed-item scores was r = 0.94 and no difference was found between the 2 scores, t (31) = −0.32 (95% CI: −0.70–0.51), P = 0.75. After revising the preliminary PBS, 20 items were retained. This PBS showed excellent test-retest reliability with ICC (2,1) = 0.97, high internal consistency with Cronbach's α = 0.94, and good convergent validity ( chenhan204@yahoo.com = 0.71) with the Short Physical Performance Battery. The PBS is a valid, 5-domain clinical balance test for CLOAs. The non-fixed test format reduces test time.

Establishing the HLS-Q12 short version of the European Health Literacy Survey Questionnaire: latent trait analyses applying Rasch modelling and confirmatory factor analysis

BackgroundThe European Health Literacy Survey Questionnaire (HLS-EU-Q47) is widely used in assessing health literacy (HL). There has been some controversy whether the comprehensive HLS-EU-Q47 data, reflecting a conceptual model of four cognitive domains across three health domains (i.e. 12 subscales), fit unidimensional Rasch models. Still, the HLS-EU-Q47 raw score is commonly interpreted as a sufficient statistic. Combining Rasch modelling and confirmatory factor analysis, we reduced the 47 item scale to a parsimonious 12 item scale that meets the assumptions and requirements of objective measurement while offering a clinically feasible HL screening tool. This paper aims at (1) evaluating the psychometric properties of the HLS-EU-Q47 and associated short versions in a large Norwegian sample, and (2) establishing a short version (HLS-Q12) with sufficient psychometric properties.MethodsUsing computer-assisted telephone interviews during November 2014, data were collected from 900 randomly sampled individuals aged 16 and over. The data were analysed using the partial credit parameterization of the unidimensional polytomous Rasch model (PRM) and the ‘between-item’ multidimensional PRM, and by using one-factorial and multi-factorial confirmatory factor analysis (CFA) with categorical variables.ResultsUsing likelihood-ratio tests to compare data-model fit for nested models, we found that the observed HLS-EU-Q47 data were more likely under a 12-dimensional Rasch model than under a three- or a one-dimensional Rasch model. Several of the 12 theoretically defined subscales suffered from low reliability owing to few items. Excluding poorly discriminating items, items displaying differential item functioning and redundant items violating the assumption of local independency, a parsimonious 12-item HLS-Q12 scale is suggested. The HLS-Q12 displayed acceptable fit to the unidimensional Rasch model and achieved acceptable goodness-of-fit indexes using CFA.ConclusionsUnlike the HLS-EU-Q47 data, the parsimonious 12-item version (HLS-Q12) meets the assumptions and the requirements of objective measurement while offering clinically feasible screening without applying advanced psychometric methods on site. To avoid invalid measures of HL using the HLS-EU-Q47, we suggest using the HLS-Q12. Valid measures are particularly important in studies aiming to explain the variance in the latent trait HL, and explore the relation between HL and health outcomes with the purpose of informing policy makers.

Development and validation of the Kernis-Goldman authenticity inventory-short form (KGAI-SF)

Psychological authenticity has long been of interest to social thinkers, and empirical research on this topic has steadily increased since the 1970s. The present work contributes to this body of knowledge by describing the development of a short form for the Kernis-Goldman Authenticity Inventory (KGAI), a widely used self-report instrument. Thirteen of the 45 items from the original KGAI were removed on the basis of semantic ambiguity or redundancy, and the remaining 32-items were subjected to cross-validated ordinal confirmatory factor analysis (N = 1252) in an effort to identify psychometrically redundant or unreliable items. The resulting 20-item short-form (KGAI-SF) exhibited good reliability across the ranges of the four underlying dimensions of authenticity (awareness, unbiased processing, behavior, relational orientation), as well as good discriminant and convergent validity.

The effects of safety knowledge and psychological factors on self-reported risky driving behaviors including group violations for e-bike riders in China

ObjectivesIt is unknown that how safety knowledge and psychological factors affect e-bike rider safety. Also, group violation behaviors, which are commonly observed in the field, have been rarely examined for e-bike riders in China. In this paper, the effects of safety knowledge and psychological factors on self-reported risky driving behaviors including group violations were examined. MethodsA questionnaire was developed to acquire information of e-bike riders in Guilin, Guangxi Province. Explanatory factor analysis was used to examine the reliability of the questionnaire and exclude redundant measurement items. Then, a Structure Equation Model was developed to examine the relationships among safety knowledge, safety attitude, risk perception and risky driving behaviors. After that, multiple regression models were fitted to examine the effect of safety knowledge on each type of risky driving behavior, as well as factors associated with group violations. At last, ANOVA tests were conducted to identify significant differences among e-bike rider groups in safety knowledge, safety attitude, and risk perception. ResultsSafety knowledge was found significantly associated with risky driving behaviors for e-bike riders in China, including aggressive driving, erroneous driving, and group violations. E-bike riders severely lack safety knowledge, especially that of traffic rules, including unmarried riders, under-educated riders, riders without driver’s license, younger riders, and riders with little riding experience. Group violations were largely found among e-bike riders, and to be associated with safety knowledge of traffic rules, risk-taking attitude, and riding experience of e-bike riders. ConclusionsThe findings could add some new safety implication and be beneficial for developing safety policies and interventions for e-bikes.

A Chinese version of the Language Screening Test (CLAST) for early-stage stroke patients.

There is a severe lack of aphasia screening tools for bedside use in Chinese. A number of aphasia assessment tools have recently been developed abroad, but some of these scales were not suitable for patients with acute stroke. The Language Screening Test (which includes two parallel versions [a/b]) in French has been proven to be an effective and time-saving aphasia screening scale for early-stage stroke patients. Therefore, we worked out a Chinese version of the LAST taking into consideration Chinese language and culture. Two preliminary parallel versions (a/b) were tested on 154 patients with stroke at acute phase and 107 patients with stroke at non-acute phase, with the Western Aphasia Battery serving as a gold standard. The equivalence between the two parallel versions and the reliability/validity of each version were assessed. The median time to complete one preliminary Chinese version (each had some item redundancy) was 98 seconds. Two final parallel versions were established after adjustment/elimination of the redundant items and were found to be equivalent (intra-class correlation coefficient: 0.991). Internal consistency is(Cronbach α for each version [a/b] was 0.956 and 0.965, respectively) good. Internal validity was fine: (a) no floor or ceiling effect/item redundancy; (b) construct validity revealed a 1-dimension structure, just like the French version. The higher educated subjects scored higher than their lower educated counterparts (p<0.01). The external validity: at the optimum cut-off point where the score of version a/b <14 in higher educated group(<13 in lower): the specificity of each version was 0.878/0.902(1/1 in lower) and sensitivity was 0.972/0.944(0.944/0.944 in lower). Inter-rater equivalence (intra-class correlation coefficient) was 1. The Chinese version of the Language Screening Test was proved to be an efficient and time-saving bedside aphasia screening tool for stroke patients at acute phase and can be used by an average medical physician.

Development and Validation of a Short Version of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale.

Background:The Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale was developed to measure an athlete’s psychological readiness to return to sport after anterior cruciate ligament (ACL) injury and reconstruction surgery. The scale is being used with increasing frequency in both research and clinical settings.Purpose:To generate and validate a short version of the ACL-RSI scale.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:The ACL-RSI scale was administered to 535 patients who had undergone ACL reconstruction surgery. Reliability (Cronbach alpha) was determined and factor analysis of the full scale was undertaken along with a process of item selection and elimination. A second group of 250 patients participated in a predictive validation analysis. This group completed the ACL-RSI scale at 6 months and reported return-to-sport outcomes 12 months following ACL reconstruction surgery. The predictive validity of both scales (full and short versions) was assessed by use of receiver operating characteristic (ROC) curve statistics.Results:The scale was found to have high internal consistency (Cronbach alpha, 0.96), which suggested that item redundancy was present. After an item selection process, the scale was reduced to a 6-item format. Cronbach alpha for the short version was 0.92, and factor analysis confirmed the presence of 1 factor accounting for 71% of the total variance. Scores for the short version were significantly different between patients who had and those who had not returned to sport. Six-month ACL-RSI scores for both the full and short versions had fair to good predictive ability for 12-month return-to-sport outcomes (full version: area under ROC curve, 0.77 [95% CI, 0.7-0.8]; short version: area under ROC curve, 0.75 [95% CI, 0.7-0.8]).Conclusion:A 6-item short version of the ACL-RSI scale was developed from a large cohort of patients undergoing ACL reconstruction. The short version appears to be as robust as the full version for discriminating between and predicting return-to-sport outcomes. The short version of the ACL-RSI may be of use in busy clinical settings to help identify athletes who may find return to sport challenging.

Does the patient activation measure provide a meaningful measure of OA self-management?

Does the patient activation measure provide a meaningful measure of OA self-management?

MP13-05 URINARY STONES AND INTERVENTION QUALITY OF LIFE (USIQOL) – DEVELOPMENT AND VALIDATION OF A COMPREHENSIVE PATIENT REPORTED OUTCOME MEASURE

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I1 Apr 2018MP13-05 URINARY STONES AND INTERVENTION QUALITY OF LIFE (USIQOL) – DEVELOPMENT AND VALIDATION OF A COMPREHENSIVE PATIENT REPORTED OUTCOME MEASURE Hrishikesh Joshi, Aditya Raja, Haitham Abdelmoteleb, David Bratt, Shekhar Biyani, and Fiona Wood Hrishikesh JoshiHrishikesh Joshi More articles by this author , Aditya RajaAditya Raja More articles by this author , Haitham AbdelmotelebHaitham Abdelmoteleb More articles by this author , David BrattDavid Bratt More articles by this author , Shekhar BiyaniShekhar Biyani More articles by this author , and Fiona WoodFiona Wood More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.477AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urolithiasis has a range of symptoms and involves many treatment options which can have significant impact on patients' health-related quality of life (HRQoL). There is a need for patient reported outcome measure (PROM) to evaluate this impact. We developed Urinary stones and Intervention quality of Life (USIQoL), a new multidimensional PROM that would form a valid outcome measure. METHODS Adult patients with urinary (renal and ureteral) stones covering all index stone categories were asked to participate in different phases (over 350 patients). Phase 1 included literature review and qualitative research involving semistructured patient and focus group interviews with thematic analysis. This formed the foundation for the initial long draft of the USIQoL. Phase 2 included cognitive debriefing, pilot testing alongside review of the measure by a panel of international urologists. Phase 3 involved RASCH (internal construct) analysis (partial credit model) and validity and reliability (external construct) assessments by administering the new measure to the patients, before and after medical and surgical treatments, with metabolic abnormalities disease as well as no active treatments. Patients also completed existing tools (SF12, EuroQoL, HADS, USSQ) to evaluate concurrent validity to develop the final draft of the measure. RESULTS Mean patient age was 51 years (range 18-92) with male patient predominance (65%). Phase 1 studies (qualitative research) involved 80 patients and 30 family members. The results identified significant negative QoL impact affecting pain, physical and psycho-social domains along with concerns, specific to stones and treatments, such as employment, travel and need of support. The thematic analyses formed the basis for the initial 60 item multidimensional long draft of the USIQoL. Phase 2 showed that the tool had ace content validity with all stakeholders confirming adequacy of the instrument. In phase 3 the RASCH polytomous analysis identified redundant items and helped develop final 20 item version with good item, personal fit and satisfactory separation index. The measure covers all relevant domains of health (pain, physical and psychosocial) along with stone and intervention specific factors. The validation studies showed questionnaire to be internally consistent (cronebach’s alpha>0.7) and reliable (Pearson coefficient>0.8) with satisfactory sensitivity to change (p<0.01). CONCLUSIONS Urinary calculi and their treatment have variable, but significant impact on HRQoL that would influence treatment decisions. The new USIQoL is a comprehensive valid PROM that has been developed using rigorous standards in meaurement studies. It is expected to serve as a standard PROM to evaluate impact of stone disease and treatments. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e173 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Hrishikesh Joshi More articles by this author Aditya Raja More articles by this author Haitham Abdelmoteleb More articles by this author David Bratt More articles by this author Shekhar Biyani More articles by this author Fiona Wood More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Neuropsychiatric Fluctuations Scale for Parkinson's Disease: A Pilot Study.

Non-motor fluctuations represent a main source of disability in Parkinson's disease (PD). Among them, neuropsychiatric fluctuations are the most frequent and are often under-recognized by patients and physicians, partly because specific tools for assessment of neuropsychiatric fluctuations are lacking. To develop a scale for detecting and evaluating the presence and the severity of neuropsychological symptoms during the ON and OFF phases of non-motor fluctuations. Neuropsychiatric symptoms reported by PD patients in the OFF- and the ON-medication conditions were collected using different neuropsychiatric scales (BDI-II, BAI, Young, VAS, etc.). Subsequently, tree phases of a pilot study was performed for cognitive pretesting, identification of ambiguous or redundant items (item reduction), and to obtain preliminary data of acceptability of the new scale. In all the three phases, the scale was applied in both the OFF and ON condition during a levodopa challenge. Twenty items were selected for the final version of the neuropsychiatric fluctuation scale (NFS): ten items measured the ON neuropsychological symptoms and ten items the OFF neuropsychological manifestations. Each item rated from 0-3, providing respective subscores from 0 to 30. Once validated, our NFS can be used to identify and quantify neuropsychiatric fluctuations during motor fluctuations. The main novelty is that it could be used in acute settings. As such, the NFS can assess the neuropsychiatric state of the patient at the time of examination. The next step will be to validate the NFS to be used in current practice.

Privacy preserving proof of ownership for data in cloud storage systems

Storing data in cloud has become a necessity as users are accumulating abundant data every day and they are running out of physical storage devices. But majority of the data in the cloud storage is redundant. Data deduplication using convergent key encryption has been the mechanism popularly used to eliminate redundant data items in the cloud storage. Convergent key encryption suffers from various drawbacks. For instance, if data items are deduplicated based on convergent key, any unauthorized user can compromise the cloud storage by simply having a guessed hash of the file. So, ensuring the ownership of the data items is essential to protect the data items. As cukoo filter offers the minimum false positive rate, with minimal space overhead our mechanism has provided the proof of ownership.

Patient Perception and Satisfaction Questionnaire for Microtia Reconstruction: A New Clinical Tool to Improve Patient Outcome.

Patients' satisfaction is an increasingly important indicator for successful ear reconstruction surgeries. However, there is no scientifically sound patient-based outcome instrument in this field. This study aims at developing a patient-reported outcome measure for microtia reconstruction for investigating patients' satisfaction and perception of reconstructed ear and clinical researches. The development of questionnaire included 3 stages. Traditional psychometric tests were used for analysis. At first stage, a preliminary version of the questionnaire was developed using qualitative methods, including interviews with 10 patients. At second stage, the questionnaire was field tested by survey of 76 patients. Redundant items were deleted; acceptability, reliability, and responsiveness were examined. At third stage, survey was conducted to another 94 patients with the shortened questionnaire to further evaluate the acceptability, reliability, and validity. A questionnaire of 12 items for microtia reconstruction was developed. Results demonstrated the instrument satisfied the current criteria. The acceptability (missing data <1%, largest endorsement frequencies <60%), reliability (Cronbach alphas >0.80, item-total correlations >0.7, interitem correlation <0.8), validity (scale intercorrelations r = 0.59, low correlations with age and sex) of the questionnaire. The questionnaire is an acceptable, reliable, and validated outcome measure for evaluation of ear reconstruction esthetic outcomes in microtia patients. It could be used for further comparison studies and effectiveness studies.

Factor structure and convergent validity of the Derriford Appearance Scale-24 using standard scoring versus treating ‘not applicable’ responses as missing data: a Scleroderma Patient-centered Intervention Network (SPIN) cohort study

ObjectiveValid measures of appearance concern are needed in systemic sclerosis (SSc), a rare, disfiguring autoimmune disease. The Derriford Appearance Scale-24 (DAS-24) assesses appearance-related distress related to visible differences. There is...

Fatigue in chronically critically ill patients following intensive care - reliability and validity of the multidimensional fatigue inventory (MFI-20)

BackgroundFatigue often occurs as long-term complication in chronically critically ill (CCI) patients after prolonged intensive care treatment. The Multidimensional Fatigue Inventory (MFI-20) has been established as valid instrument to measure fatigue in a wide range of medical illnesses. Regarding the measurement of fatigue in CCI patients, the psychometric properties of the MFI-20 have not been investigated so far. Thus, the present study examines reliability and validity of the MFI-20 in CCI patients.MethodsA convenience sample of n = 195 patients with Critical Illness Polyneuropathy (CIP) or Myopathy (CIM) were recruited via personal contact within four weeks (t1) following the transfer from acute care ICU to post-acute ICU at a large rehabilitation hospital. N = 113 (median age 61.1 yrs., 72.6% men) patients were again contacted via telephone three (t2) and six (t3) months following the transfer to post-acute ICU. The MFI-20, the Euro-Quality of Life (EQ-5D-3 L) and the Structured Clinical Interview for the Diagnostic and Statistical Manual of mental disorders DSM-IV (SCID-I) were applied within this prospective cohort study.ResultsThe internal consistency Cronbach’s α was adequate for the MFI-total and all but the subscale Reduced Motivation (RM) (range: .50–.91). Item-to-total correlations (range: .22–.80) indicated item redundancy for the subscale RM. Confirmatory Factor analyses (CFAs) revealed poor model fit for the original 5-factor model of the MFI-20 (t2/t3, Confirmatory Fit Index, CFI = .783/ .834; Tucker-Lewis Index, TLI = .751/ .809; Root Mean Square Error of Approximation, RMSEA = .112/ .103). Among the alternative models (1-, 2-, 3-factor models), the data best fit to a 3-factor solution summarizing the highly correlated factors General −/ Physical Fatigue/ Reduced Activity (GF/ PF/ RA) (t2/ t3, CFI = .878/ .896, TLI = .846/ .869, RMSEA = .089/ .085, 90% Confidence Interval .073–.104/ .066–.104). The MFI-total score significantly correlated with the health-related quality of life (range: −.65-(−).66) and the diagnosis of major depression (range: .27–.37).ConclusionsIn the present sample of CCI patients, a reliable and valid factor structure of the MFI-20 could not be ascertained. Especially the subscale RM should be revised. Since the factors GF, PF and RA cannot be separated from each other and the unclear factorial structure in the present sample of CCI patients, the MFI-20 is not recommended for use in this context.Trial registrationGerman Clinical Trials Registration DRKS00003386. Registered 13 December 2011, retrospectively registered.

The Pediatric Eating Assessment Tool: Factor Structure and Psychometric Properties.

The Pediatric Eating Assessment Tool (PediEAT) is a parent-report instrument developed to assess symptoms of feeding problems in children aged 6 months to 7 years. The purpose of this study was to identify the factor structure of the PediEAT and test its psychometric properties, including internal consistency reliability, temporal stability, and construct validity. Participants included 567 parents of children aged 6 months to 7 years. Fifty-four percent of the sample had parent report of a diagnosed feeding problem or feeding concerns. Exploratory factor-analysis techniques were used to remove redundant or non-endorsed items and identify the factor structure of the instrument. Construct validity was examined with 466 parents completing the Mealtime Behavior Questionnaire as a criterion standard. Known-groups validation was used to compare PediEAT scores between children with and without diagnosed feeding problems. Temporal stability of the PediEAT was examined with 97 parents repeating the PediEAT after 2 weeks. Principal components factor analysis with varimax rotation supported a 4-factor model accounting for 39.4% of the total variance. The 4 subscales (Physiologic Symptoms, Problematic Mealtime Behaviors, Selective/Restrictive Eating, Oral Processing) demonstrated acceptable internal consistencies (coefficient alphas: 0.92, 0.91, 0.83, 0.83; respectively). Construct validity was supported in 2 ways. The PediEAT correlated with the Mealtime Behavior Questionnaire (r = 0.77, P < 0.001) and total score and subscale scores were significantly different between children with and without diagnosed feeding problem (P < 0.001). Temporal stability was demonstrated through test-retest reliability (r = 0.95, P < 0.001). Strong psychometric properties support the use of the PediEAT in research and clinical practice.

Using Rasch Analysis to Evaluate the Reliability and Validity of the Swallowing Quality of Life Questionnaire: An Item Response Theory Approach.

The Swallowing Quality of Life questionnaire (SWAL-QOL) is widely used clinically and in research to evaluate quality of life related to swallowing difficulties. It has been described as a valid and reliable tool, but was developed and tested using classic test theory. This study describes the reliability and validity of the SWAL-QOL using item response theory (IRT; Rasch analysis). SWAL-QOL data were gathered from 507 participants at risk of oropharyngeal dysphagia (OD) across four European countries. OD was confirmed in 75.7% of participants via videofluoroscopy and/or fiberoptic endoscopic evaluation, or a clinical diagnosis based on meeting selected criteria. Patients with esophageal dysphagia were excluded. Data were analysed using Rasch analysis. Item and person reliability was good for all the items combined. However, person reliability was poor for 8 subscales and item reliability was poor for one subscale. Eight subscales exhibited poor person separation and two exhibited poor item separation. Overall item and person fit statistics were acceptable. However, at an individual item fit level results indicated unpredictable item responses for 28 items, and item redundancy for 10 items. The item-person dimensionality map confirmed these findings. Results from the overall Rasch model fit and Principal Component Analysis were suggestive of a second dimension. For all the items combined, none of the item categories were 'category', 'threshold' or 'step' disordered; however, all subscales demonstrated category disordered functioning. Findings suggest an urgent need to further investigate the underlying structure of the SWAL-QOL and its psychometric characteristics using IRT.

Measuring exclusive breastfeeding social support: Scale development and validation in Uganda.

The World Health Organization recommends exclusive breastfeeding (EBF) for 6months and continued breastfeeding for at least 2years. Social support has been widely recognized to influence breastfeeding practices. However, existing scales do not measure exclusive breastfeeding social support (EBFSS), rather they assess social support for any breastfeeding. Further, they are tailored towards high-income settings. Therefore, our objectives were to develop and validate a tool to measure EBFSS in low-income settings. To develop the scale, local and international breastfeeding experts were consulted on modifications to the Hughes' Breastfeeding Social Support Scale. It was then implemented in an observational cohort in Gulu, Uganda, at 1 (n=238) and 3 (n=237) months post-partum (NCT02925429). We performed polychoric and polyserial correlations to remove redundant items and exploratory factor analysis at 1month post-partum to determine the latent factor structure of EBFSS. We further applied confirmatory factor analysis to assess dimensionality of the scale at 3months post-partum. We then conducted tests of predictive, convergent, and discriminant validity against EBF, self-efficacy, general social support, and depression. The modification of the Hughes' scale resulted in 18 items, which were reduced to 16 after examining variances and factor loadings. Three dimensions of support emerged: Instrumental, Emotional, and Informational, with alpha coefficients of 0.79, 0.85, and 0.83, respectively. Predictive, convergent, and discriminant validity of the resultant EBFSS scale was supported. The EBFSS scale is valid and reliable for measuring EBFSS in northern Uganda and may be of use in other low-income settings to assess determinants of EBF.

Diversified recommendation method combining topic model and random walk

As one of the most widely used algorithms in recommendation field, collaborative filtering (CF) predicts the unknown rating of items based on similar neighbors. Although many CF-based recommendation methods have been proposed, there still be room for improvement. Firstly, the data sparsity problem still remains a big challenge for CF algorithms to find similar neighbors. Secondly, there are many redundant similar items in the recommendation list generated by traditional CF algorithms, which cannot meet the user wide interest. Therefore, we propose a diversified recommendation method combining topic model and random walk. A weighted random walk model is presented to find all direct and indirect similar neighbors on the sparse data, improving the accuracy of rating prediction. By taking both users’ behavior data and items’ lags into account, we give a diversity measurement method based on the topic distribution of items discovered by Linked-LDA model. Furthermore, a diversified ranking algorithm is developed to balance the accuracy and diversity of recommendation results. We compare our method with six other recommendation methods on a real-world dataset. Experimental results show that our method outperforms the other methods and achieves the best personalized recommendation effect.

Adaptation of the Neighbourhood Environment Walkability Scale for use in Northern Climates: The NEWS-North ( breakout presentation )

Background The built environment can play an important role in promoting or impeding physical activity. Walkability, the ease and pleasantness of walking in a particular environment, may be particularly important in this regard. Walkability (perceived and objective) has been related to walking behaviour and health outcomes; it is also amenable to policy and planning interventions. Several measures of walkability exist, but most were developed for use in warmer climates and fail to consider winter walkability, which is critical to pedestrian safety and comfort. Aim Our goal was to adapt a well-known American walkability questionnaire, the “Neighborhood Environment Walkability Scale” (NEWS), for use in Northern climates. In such climates, it’s essential to consider winter walking conditions because they limit pedestrian activity and safety. Method Participants in three focus groups reviewed the NEWS and NEWS-A, providing input on items that needed to be added/changed to ensure relevance for Canadian pedestrians. Feedback was used to create an initial draft of the adapted questionnaire (the NEWS-North), which included a section on winter walkability. As part of content validation, walkability experts considered clarity and relevance of the items; they also identified needed changes. The NEWS-North was further validated with data from a convenience sample of 536 people (278 students, 258 residents) who completed an on-line survey, including measures of walking behavior. Results Suggestions from focus groups included: changing spelling and measurement to Canadian standards, deleting some questions and adding others, including a new section to cover winter walkability. The expert panel identified redundant items and some awkward wording. The authors of the NEWS reviewed and approved the NEWS-North, which contains 42 items, organized into seven sections. Confirmatory factor analysis confirmed a seven-factor structure (CFI = 0.9, RMSEA = 0.56). We found good test-retest reliability. Finally, preliminary convergent validity was established through correlations with observed neighbourhood walkability and walking behavior. Conclusion The News-North has shown promising reliability, internal validity, content, and convergent validity. Researchers and municipal and public health decision makers can use the results from the NEWS-North to make their neighbourhoods, towns and cities safer and more conducive to walking.