Assessment Tool Research Articles

Enhancing Intraoperative Tissue Identification: Investigating a Smart Electrosurgical Knife's Functionality During Electrosurgery.

Detecting the cancerous growth margin and achieving a negative margin is one of the challenges that surgeons face during cancer procedures. A smart electrosurgical knife with integrated optical fibers has been designed previously to enable real-time use of diffuse reflectance spectroscopy for intraoperative margin assessment. In this paper, the thermal effect of the electrosurgical knife on tissue sensing is investigated. Porcine tissues and phantoms were used to investigate the performance of the smart electrosurgical knife after electrosurgery. The fat-to-water content ratio (F/W-ratio) served as the discriminative parameter for distinguishing tissues and tissue mimicking phantoms with varying fat content. The F/W-ratio of tissues and phantoms was measured with the smart electrosurgical knife before and after 14 minutes of electrosurgery. Additionally, a layered porcine tissue and phantom were sliced and measured from top to bottom with the smart electrosurgical knife. Mapping the thermal activity of the electrosurgical knife's electrode during animal tissue electrosurgery revealed temperatures exceeding 400 °C. Electrosurgery for 14 minutes had no impact on the device's accurate detection of the F/W-ratio. The smart electrosurgical knife enables real-time tissue detection and predicts the fat content of the next layer from 4 mm ahead. The design of the smart electrosurgical knife outlined in this paper demonstrates its potential utility for tissue detection during electrosurgery. In the future, the smart electrosurgical knife could be a valuable intraoperative margin assessment tool, aiding surgeons in detecting tumor borders and achieving negative margins.

Comparison of Codependency Characteristics of Individuals with and without Dependent Relatives in Terms of Defense Mechanisms, Family Functionality and Attachment Styles

Objective: This study aimed to identify both the shared and distinct aspects of the codependency characteristics of individuals with (clinical group, n=56) and without dependent relatives (non-clinical group, n=59) by comparing them in terms of personal (defense-mechanisms), domestic (family-functionality), and relational (attachment-styles) contexts.
 Method: Codependency Assessment Tool (CODAT), Defense Styles Questionnaire 40 (DSQ-40), Family Assessment Device (FAD), and Relationship Scales Questionnaire (RSQ) were used as data collection tools.
 Results: The clinical group scored statistically significantly higher on CODAT (other focus/self-neglect, low-self-worth, family-of-origin-issues subscales and total), DSQ-40 (immature-defenses subscale), FAD (failure in problem-solving, communication, role-distribution, affective-responsiveness, affective-involvement, general-functioning subscales and total), RSQ (preoccupied-attachment subscale) than the non-clinical group. The non-clinical group scored significantly higher on the mature-defenses subscale than the clinical group. Immature-defenses, failure in problem-solving and preoccupied-attachment predicted codependency in the clinical group whereas in the non-clinical group, immature-defenses and unhealthy-communication were significant predictors of codependency.
 Conclusion: Codependency characteristics differ among individuals with and without dependent family members. As immature defenses predicted codependency in both groups, the use of this defense mechanism may be a fundamental feature of codependency.

A Three-year Retrospective Study Looking at Preventing Hospital Acquired Thrombosis.

Hospital-acquired venous thromboembolism (HA-VTE) is defined as cases of venous thromboembolism (VTE) that occur in a hospital and within ninety days of a hospital admission. Deep vein thromboses (DVTs) most commonly occur within the deep veins of the pelvis and legs. If the thrombus dislodges and travels to the lungs, it can result in a pulmonary embolus (PE). VTE is associated with significant morbidity and mortality, accounting for almost 10% of all hospital deaths. If risk factors are correctly identified and VTE prophylaxis is prescribed, VTE can be a preventable condition. In 2010, NHS England launched The National Venous Thromboembolism Prevention Programme. This included NICE guidance, and a VTE risk assessment tool, which must be completed for at least 95% of patients on admission. The National Thrombosis Survey, published by Thrombosis UK, studied how this program was implemented locally, and audited HA-VTE prevention strategies nationally. Using the Thrombosis Survey and NICE guidance as an aide, this study collects data about hospital-acquired DVT (HA-DVT) at the Queen Elizabeth Hospital in Gateshead (QEH) and aims to: 1. Identify cases of HA-DVT and understand the clinical circumstances surrounding these cases 2. Assess the quality of VTE preventative measures at QEH 3. Outline potential improvement in reducing the incidence of HA-VTE at this hospital Methods: This retrospective cohort study used electronic records to identify all cases of DVT between April 2019 and April 2022 at QEH. Cases of HA-DVT were defined as: a positive ultrasound doppler report and either the case occurring in the 90 days following an inpatient stay, or beyond two days into an admission. For these cases of HA-DVT, we recorded the: reason for admission; admitting specialty; presence of an underlying active cancer and deaths occurring within 90 days of diagnosis. We assessed the quality of VTE preventative measures, by recording the: completion of VTE risk assessments; prescription of weight-adjusted pharmacological VTE prophylaxis and provision of VTE prophylaxis on discharge. For HA-DVT cases occurring within 90 days of an inpatient stay, the preventative measures were assessed on the original admission. Electronic records were used to record the completion rate of the National VTE risk assessment tool for all inpatients during this time frame. The VTE risk assessment tool was completed for 98.5% of all admissions. One hundred and thirty-five cases of HA-DVT were identified between April 2019 and April 2022. Sixteen patients with HA-DVT did not have VTE prophylaxis prescribed on admission. Eleven of these patients had a clearly documented reason why anticoagulation was avoided. In HA-DVT cases where pharmacological VTE prophylaxis was prescribed, 23% were prescribed an inappropriate dose for their weight. If anticoagulation was required on discharge, this was prescribed appropriately in 94% of cases. About 31% of the patients with HA-DVT had an underlying active malignancy. Thirty-nine patients died within 90 days of the DVT being diagnosed; in only 1 case was VTE thought to be a contributing factor to death. The hospital exceeded the national standard of VTE risk assessment completion on admission (greater than 95%). For almost a quarter of patients with HA-DVT, the dose of thromboprophylaxis prescribed was not appropriate for weight. In five cases of HA-DVT, thromboprophylaxis was omitted with no clear justification. HA-DVT often affects the most clinically vulnerable patients and is associated with a high mortality.

The role of early cerebral edema and hematoma assessment in aneurysmal subarachnoid hemorrhage (a-SAH) in predicting structural brain abnormalities in cognitive impairments-- case controlled study.

Early assessment and management of cerebral edema and hematoma following aneurysmal subarachnoid hemorrhage (a-SAH) can significantly impact clinical cognitive outcomes. However, current clinical practices lack predictive models to identify early structural brain abnormalities affecting cognition. To address this gap, we propose the development of a predictive model termed the a-SAH Early Brain Edema/Hematoma Compression Neural (Structural Brain) Networks Score System (SEBE-HCNNSS). In this study, 202 consecutive patients with spontaneous a-SAH underwent initial computed tomography (CT) or magnetic resonance imaging (MRI) scans within 24 hours of ictus with follow-up 2 months after discharge. Using logistic regression analysis (univariate and multivariate), we evaluated the association of clinically relevant factors and various traditional scale ratings with cognitive impairment (CI). Risk factors with the highest area under the curve (AUC) values were included in the multivariate analysis and least absolute shrinkage and selection operator (LASSO) analysis or Cox regression analysis. A total of 177 patients were enrolled in the study, and 43 patients were classified with a high SEBE-HCNNSS grade (3 to 5). After a mean follow-up of 2 months, 121 individuals (68.36%) with a-SAH and 3 control subjects developed incident CI. The CT inter-observer reliability of the SEBE-HCNNSS scale was high, with a Kappa value of 1. Furthermore, ROC analysis identified the SEBE-HCNNSS scale (OR 3.322, 95% CI 2.312-7.237, P=0.00025) as an independent predictor of edema, CI, and unfavorable prognosis. These results were also replicated in a validation cohort. Overall, the SEBE-HCNNSS scale represents a simple assessment tool with promising predictive value for CI and clinical outcomes post-a-SAH. Our findings indicate its practical utility as a prognostic instrument for risk evaluation after a-SAH, potentially facilitating early intervention and treatment.

Efficacy of non-pharmacological interventions for primary dysmenorrhoea: a systematic review and Bayesian network meta-analysis

ObjectivesTo assess the relative benefits of various non-pharmacological interventions on treating primary dysmenorrhoea within a network meta-analysis.Study designSystematic review and Bayesian network meta-analysis.Inclusion criteriaRandomised controlled trial involving patient with primary...

Rapid reviews methods series: guidance on rapid qualitative evidence synthesis

This paper forms part of a series of methodological guidance from the Cochrane Rapid Reviews Methods Group and addresses rapid qualitative evidence syntheses (QESs), which use modified systematic, transparent and...

Application of Machine Learning Algorithms to Predict Osteoporotic Fractures in Women.

Predicting the risk of osteoporotic fractures is vital for prevention. Traditional methods such as the Fracture Risk Assessment Tool (FRAX) model use clinical factors. This study examined the predictive power of the FRAX score and machine-learning algorithms trained on FRAX parameters. We analyzed the data of 2,147 female participants from the Ansan cohort study. The FRAX parameters employed in this study included age, sex (female), height and weight, current smoking status, excessive alcohol consumption (>3 units/d of alcohol), and diagnosis of rheumatoid arthritis. Osteoporotic fracture was defined as one or more fractures of the hip, spine, or wrist during a 10-year observation period. Machine-learning algorithms, such as gradient boosting, random forest, decision tree, and logistic regression, were employed to predict osteoporotic fractures with a 70:30 training-to-test set ratio. We evaluated the area under the receiver operating characteristic curve (AUROC) scores to assess and compare the performance of these algorithms with the FRAX score. Of the 2,147 participants, 3.5% experienced osteoporotic fractures. Those with fractures were older, shorter in height, and had a higher prevalence of rheumatoid arthritis, as well as higher FRAX scores. The AUROC for the FRAX was 0.617. The machine-learning algorithms showed AUROC values of 0.662, 0.652, 0.648, and 0.637 for gradient boosting, logistic regression, decision tree, and random forest, respectively. This study highlighted the immense potential of machine-learning algorithms to improve osteoporotic fracture risk prediction in women when complete FRAX parameter information is unavailable.

Development and Validation of Instruments for Assessing the Impact of Artificial Intelligence on Students in Higher Education

<p style="text-align:justify">The role of artificial intelligence (AI) in education remains incompletely understood, demanding further evaluation and the creation of robust assessment tools. Despite previous attempts to measure AI's impact in education, existing studies have limitations. This research aimed to develop and validate an assessment instrument for gauging AI effects in higher education. Employing various analytical methods, including Exploratory Factor Analysis, Confirmatory Factor Analysis, and Rasch Analysis, the initial 70-item instrument covered seven constructs. Administered to 635 students at Nueva Ecija University of Science and Technology – Gabaldon campus, content validity was assessed using the Lawshe method. After eliminating 19 items through EFA and CFA, Rasch analysis confirmed the construct validity and led to the removal of three more items. The final 48-item instrument, categorized into learning experiences, academic performance, career guidance, motivation, self-reliance, social interactions, and AI dependency, emerged as a valid and reliable tool for assessing AI's impact on higher education, especially among college students.</p>

Earthworm coelomocytes as a soil health assessment tool

Different pollutants can disrupt earthworm coelomocytes integrity and functions, and their responses can be applied as biomarkers of sublethal contaminant exposure. In this context, the aim of this study was to develop an in vitro protocol for coelomocyte extraction, maintenance and analysis with regard to soil health status and chemical toxicity profile assessments. The extrusion technique was first tested comparing previously depurated (purged stomach content) and non-depurated and resampled earthworms. After testing, earthworms were exposed to different 2,4D and chloroacetamide concentrations for methodology validation. The values of viability were not affected by food restriction since no statistical difference was observed between non-depurated (sample A) and depurated (sample B) organisms. Regarding to cell density, a significant (p<0;05) reduction of 22% was observed between non-depurated and depurated organisms, indicating that food restriction may affect cell density. However, the non-depurated resampling did not show a significant reduction, indicating that this assessment may not be affect by resampling of the same organism. For both chemical compounds, no change in cell viability was observed at all assessed concentrations and exposure times. However, for cell density, a mainly time-dependent effect was observed for organisms exposed to chloroacetamide, and concentration-dependent effect for organisms exposed to 2,4D. The proportion of immune system cells was altered, mainly after 24 h, with the increasing of granular amoebocytes proportion. The difference in the proportion of granular amoebocytes in earthworms exposed to 2,4D can be explained by the existence of recognition and elimination mechanisms for this chemical substance. Thus, assessments of pollutant responses with in vitro coelomocytes seem to be a powerful tool for ecotoxicological studies.

MocapMe: DeepLabCut-Enhanced Neural Network for Enhanced Markerless Stability in Sit-to-Stand Motion Capture.

This study examined the efficacy of an optimized DeepLabCut (DLC) model in motion capture, with a particular focus on the sit-to-stand (STS) movement, which is crucial for assessing the functional capacity in elderly and postoperative patients. This research uniquely compared the performance of this optimized DLC model, which was trained using 'filtered' estimates from the widely used OpenPose (OP) model, thereby emphasizing computational effectiveness, motion-tracking precision, and enhanced stability in data capture. Utilizing a combination of smartphone-captured videos and specifically curated datasets, our methodological approach included data preparation, keypoint annotation, and extensive model training, with an emphasis on the flow of the optimized model. The findings demonstrate the superiority of the optimized DLC model in various aspects. It exhibited not only higher computational efficiency, with reduced processing times, but also greater precision and consistency in motion tracking thanks to the stability brought about by the meticulous selection of the OP data. This precision is vital for developing accurate biomechanical models for clinical interventions. Moreover, this study revealed that the optimized DLC maintained higher average confidence levels across datasets, indicating more reliable and accurate detection capabilities compared with standalone OP. The clinical relevance of these findings is profound. The optimized DLC model's efficiency and enhanced point estimation stability make it an invaluable tool in rehabilitation monitoring and patient assessments, potentially streamlining clinical workflows. This study suggests future research directions, including integrating the optimized DLC model with virtual reality environments for enhanced patient engagement and leveraging its improved data quality for predictive analytics in healthcare. Overall, the optimized DLC model emerged as a transformative tool for biomechanical analysis and physical rehabilitation, promising to enhance the quality of patient care and healthcare delivery efficiency.

Cardiovascular risk assessment in Italy: the CUORE Project risk score and risk chart

Aim: Risk charts and risk score, based on the global absolute risk, are key tools for CVD risk assessment. When applied to the population from which they derive, they provide the best estimate of CVD risk. That is why the CUORE Project has among its objectives the assessment of the Italian population’s cardiovascular risk, identifying the model for the prediction of coronary and cerebrovascular events in 10 years. Methods: Data fromdifferent cohorts enrolled in the North, Centre and South of Italy between the 1980s and the 1990s were used. From the 7,056 men and 12,574 women aged 35-69 years, free of cardiovascular disease at base-line and followed up for a mean time of 10 years for total and cause-specific mortality and non fatal cerebrovascular and coronary events, 894 major cardiovascular events (596 coronary and 298 cerebrovascular) were identified and validated. To assess 10-year cardiovascular risk, the risk score and risk chart were developed for men and women separately, considering the first major coronary or cerebrovascular event as the endpoint. Results: The risk score is applied tomen andwomen aged 35-69 years and includes age, systolic blood pressure, total cholesterol, HDL-cholesterol, smoking habit, diabetes and hypertension treatment using continuous values when possible. The risk chart is applied to persons aged 40-69 years and includes the same risk factors as risk score, except for HDL-cholesterol and hypertension treatment, and uses categorical values for all variables. Conclusions: The risk score and risk chart are easy-to-use tools which enable general practitioners and specialists to achieve an objective evaluation of the absolute global cardiovascular risk of middle-aged persons in primary prevention.

The Indonesian version of volunteer functions inventory: Its validity and reliability

The volunteer function inventory (VFI) is an assessment tool to measure individual volunteer motivation. VFI measures individual motivation to volunteer by examining the functional motives of each volunteer. This research aimed to adapt the VFI to the Indonesian language. VFI consists of 30 items divided into five dimensions. This study utilized a non-experimental quantitative research method. Samples were acquired by accidental random sampling with N = 176. In this study, reliability testing was carried out with items and dimensions of Cronbach's α. Validity tests were examined using construct validity and item analysis. The results of the Indonesian version of VFI showed high reliability and validity. Besides, the item analysis also shows that the quality of each item is excellent. The Indonesian version of VFI will be suitable for various education fields in Indonesia to measure the students' voluntary willingness in community development activities, for example, in measuring the impact of volunteerism in the Merdeka Belajar Kampus Merdeka (MBKM) social activities and other activities within the communities.

Writing anxiety among prospective nonlanguage teachers: A quantitative study of a nonmetropolitan state university

This research focuses on exploring the aftermath and diverse impacts of writing anxiety experienced by prospective nonlanguage teachers. The study primarily delves into the levels and types of writing anxiety that disrupt the academic performance and personal pursuits of future educators. The participants in this study encompassed 165 students pursuing majors unrelated to language, such as Bachelor of Secondary Education Major in Mathematics (BSED Math), Bachelor of Culture and Arts Education (BCAED), and Bachelor of Special Needs Education (BSNED). To ensure accurate data collection, the study employed assessment tools, namely, the Second Language Writing Anxiety Inventory (SLWAI) and the Causes of Writing Anxiety Inventory (CWAI), both exhibiting high-reliability scores of .757 and .936, respectively. Employing one-way ANOVA, the collected data were subjected to statistical analysis. The findings of the study indicated that the participants consistently experienced heightened anxiety levels in writing. The investigation also revealed that among the various types of writing-related anxiety, cognitive anxiety emerged as the most prominent, followed by somatic anxiety and avoidance behavior. Furthermore, the study identified time constraints and the pressure to achieve perfection as the two most prevalent causes of writing anxiety among the participants. The conclusions drawn from these findings are extensively discussed within the study, shedding light on the implications for both educators and students in a nonmetropolitan state university.

Suite test. A virtual reality based neuropsychological assessment tool for memory. A normative study on immediate, short-term and delayed memory tasks

Objective To collect normative data for the Suite test, a virtual reality (VR) tool designed to assess memory processes. Method The normative sample included 676 subjects (49.7% female), aged from 12 to 85 years. The Suite test comprises a 360-degree VR environment designed as a furniture shop, in which participants must group specific sets of furniture items (ordered by different families of customers) by clicking on the furniture to be packed following instructions from a voice-over. Results Core variables provided were grouped into immediate, short-term and long-term delayed recall. Cluster analyses established five age groups (12 years old, 13 to 26, 27 to 44, 45 to 58, and 59 to 85) with gender differentiated norms only deemed necessary for those transitioning from adolescence to adulthood (13 to 26) and from middle age to older adulthood (45 to 58). No statistically significant differences were found for additional gender × age normative groups, or for any group differentiated by educational level. A confirmatory factor analysis raised the existence of two differentiated factors, one associated to encoding processes (immediate memory trials) and the other to retrieval processes (both short term and long-term delayed recall trials grouping into the same factor). Additional results on the test reliability and internal consistency are presented. Conclusions Suite Test can help explore memory deficits across the life span and differentiate between visual and verbal memory strategies. Further research is required to study the test sensitivity and specificity, as well as convergent validity studies with well-established memory assessment tools.

A new dıagnostic tool for assessment of pelvıc dysfunction ın MR defecography.

Pelvic floor dysfunction is characterized by incomplete fecal defecation, affecting quality of life in a negative way. Magnetic resonance defecography (MRD) is a useful examination that is ionizing radiation-free and easily reproducible, and which provides anatomical and functional details that are obtainable through multiplanar and dynamic examinations. We aimed to detect pathology using MRD in patients with suspected pelvic floor dysfunction and determine its cause. MRD was performed in 79 individuals. Dynamic images were obtained at rest, straining, and during defecation. Pelvic hiatus mediolateral diameters were compared between groups. Defecation phase provided significantly more accurate results than the straining phase for determining the existence and severity of pathology. Conclusıons: The defecation phase is the most accurate phase for identifying the existence and severity of pathology. As the pelvic hiatus mediolateral diameter is thought to be an important factor in triggering pelvic dysfunction.

Novel UHPC with calcium-oxide-activated materials and fibres: engineering properties and sustainability evaluation

Novel ultra-high-performance concretes (UHPCs) made with calcium-oxide-activated materials (CAM), modified synthetic macro (MSM) fibres, glass fibres and steel fibres were developed. The mechanical and durability properties of UHPC-CAM specimens made with the different fibre types were tested and compared. The microstructure of the samples was examined using scanning electron microscopy (SEM). The environmental impacts of the mix designs were assessed using the Impact 2002+ method, a life cycle assessment tool. The results showed that the UHPC-CAM made with glass or MSM fibres had a high compressive strength (>110 MPa) and improved ductility. These specimens also had low water absorption and high electrical resistance, indicating low corrosion risk. SEM analyses showed that the MSM fibres created a denser geopolymer matrix than the glass fibres. The UHPC-CAM was found to have a lower environmental impact than conventional UHPC in terms of human health, ecosystem quality, carbon dioxide footprint and use of resources. MSM fibres were determined to be the most eco-friendly fibres for UHPC-CAM production.

Remote Ischemic Conditioning With Medical Management or Reperfusion Therapy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

Remote ischemic conditioning (RIC) is a low-cost, accessible, and noninvasive neuroprotective treatment strategy, but its efficacy and safety in acute ischemic stroke are controversial. With the publication of several randomized controlled trials (RCTs) and the recent results of the RESIST trial, it may be possible to identify the patient population that may (or may not) benefit from RIC. This systematic review and meta-analysis aims to evaluate the effectiveness and safety of RIC in patients with ischemic stroke receiving different treatments by pooling data of all randomized controlled studies to date. We searched the PubMed, Embase, Cochrane, Elsevier, and Web of Science databases to obtain articles in all languages from inception until May 25, 2023. The primary outcome was the modified Rankin Scale (mRS) score at the specified endpoint time in the trial. The secondary outcomes were change in NIH Stroke Scale (NIHSS) and recurrence of stroke events. The safety outcomes were cardiovascular events, cerebral hemorrhage, and mortality. The quality of articles was evaluated through the Cochrane risk assessment tool. This study was registered in PROSPERO (CRD42023430073). There were 7,657 patients from 22 RCTs included. Compared with the control group, patients who received RIC did not have improved mRS functional outcomes, regardless of whether they received medical management, reperfusion therapy with intravenous thrombolysis (IVT), or mechanical thrombectomy (MT). In the medical management group, patients who received RIC had decreased incidence of stroke recurrence (risk ratio 0.63, 95% CI 0.43-0.92, p = 0.02) and lower follow-up NIHSS score by 1.72 points compared with the control group (p < 0.00001). There was no increased risk of adverse events including death or cerebral hemorrhage in the IVT or medical management group. In patients with ischemic stroke who are not eligible for reperfusion therapy, RIC did not affect mRS functional outcomes but significantly improved the NIHSS score at the follow-up endpoint and reduced stroke recurrence, without increasing the risk of cerebral hemorrhage or death. In patients who received IVT or MT, the benefit of RIC was not observed.

Developing and validating the construct maps to assess mathematical proficiencies

The study was aimed to develop and validate a measurement test to assess mathematical proficiencies in the numbers and algebra strand. A total of 125 seventh-grade learners with diverse learning abilities from secondary educational institutions under the management of the Khon Kaen Educational Service Area 25, Thailand was chosen as respondents. The researchers employed design-based research consisting of four building blocks to construct a prototype utilizing a construct modeling approach. Firstly, the researchers developed construct maps to identify the learners’ mathematical proficiency (MP) level. This was followed by the creation of the items of measurement test according to the proficiency levels. Next, the researchers allocated scoring measures and formed the conversion of learners’ MP stages. Lastly, the researchers validated the superiority of the measurement test through Wright map consuming the multi-dimensional random coefficient multinomial logit model. The construct maps of the MP level consisted of two dimensions, namely mathematical procedures and structure of learning outcome. Findings discovered that there were 20 items in the assessment tool and its quality passed the determined education and psychological assessment criteria. It can be determined that every item is capable to measure the learners’ multi-dimensional mathematical proficiencies.

Development of higher order thinking skill assessment instruments in social studies learning

&lt;span lang="EN-US"&gt;Higher order thinking skill (HOTS) in social studies learning are still often ignored by teachers despite the need for students to acquire these skills. The purpose of this study is to develop her HOTS assessment in a social studies classroom to help teachers improve their students’ thinking skills. This kind of research is research and development with 4D models. Validation was performed by two social studies learning assessment specialists and three social studies teachers. The HOTS test was administered to 112 students in class VIII (second grade) of Yogyakarta junior high school. Data analysis consisted of validity, reliability, difficulty, selectivity, and distractor index. Explanatory factor analysis (EFA) pathway analysis was used for data analysis of small trials and confirmatory factor analysis (CFA) pathway analysis was used for large trials. The multiple-choice HOTS assessment tool consisted of 30 items, and the effectiveness results of this HOTS questions on material, structure, and language aspects by two social studies learning assessment experts where it was valid and suitable for our application. Effective results for three social studies teachers indicated that the assessment tool was valid and applicable. HOTS in social studies learning helps improve quality and learning outcomes, enabling students to examine information critically, develop creativity, and improve problem-solving skills.&lt;/span&gt;

Risk Analysis Index as a preoperative frailty tool for elective ventriculoperitoneal shunt surgery for idiopathic normal pressure hydrocephalus.

Idiopathic normal pressure hydrocephalus (iNPH) predominantly occurs in older patients, and ventriculoperitoneal shunt (VPS) placement is the definitive surgical treatment. VPS surgery carries significant postoperative complication rates, which may tip the risk/benefit balance of this treatment option for frail, or higher-risk, patients. In this study, the authors investigated the use of frailty scoring for preoperative risk stratification for adverse event prediction in iNPH patients who underwent elective VPS placement. The Nationwide Readmissions Database (NRD) was queried from 2018 to 2019 for iNPH patients aged ≥ 60 years who underwent VPS surgery. Risk Analysis Index (RAI) and modified 5-item Frailty Index (mFI-5) scores were calculated and RAI cross-tabulation was used to analyze trends in frailty scores by the following binary outcome measures: overall complications, nonhome discharge (NHD), extended length of stay (eLOS) (> 75th percentile), and mortality. Area under the receiver operating characteristic curve analysis was performed to assess the discriminatory accuracy of RAI and mFI-5 for primary outcomes. A total of 9319 iNPH patients underwent VPS surgery, and there were 685 readmissions (7.4%), 593 perioperative complications (6.4%), and 94 deaths (1.0%). Increasing RAI score was significantly associated with increasing rates of postoperative complications: RAI scores 11-15, 5.4% (n = 80); 16-20, 5.6% (n = 291); 21-25, 7.6% (n = 166); and ≥ 26, 11.6% (n = 56). The discriminatory accuracy of RAI was statistically superior (DeLong test, p < 0.05) to mFI-5 for the primary endpoints of mortality, NHD, and eLOS. All RAI C-statistics were > 0.60 for mortality within 30 days (C-statistic = 0.69, 95% CI 0.68-0.70). In a nationwide database analysis, increasing frailty, as measured by RAI, was associated with NHD, 30-day mortality, unplanned readmission, eLOS, and postoperative complications. Although the RAI outperformed the mFI-5, it is essential to account for the potentially reversible clinical issues related to the underlying disease process, as these factors may inflate frailty scores, assign undue risk, and diminish their utility. This knowledge may enhance provider understanding of the impact of frailty on postoperative outcomes for patients with iNPH, while highlighting the potential constraints associated with frailty assessment tools.