Valid Tool Research Articles

Awareness of Osteoporosis among Postmenopausal Women in Najran Region, Saudi Arabia: A Cross-Sectional Study

Introduction: Osteoporosis is characterized by a decrease in bone mass. Fractures due to osteoporosis are associated with chronic pain, limited mobility, increased mortality, and financial burdens. While osteoporosis is common in both genders, postmenopausal women are at increased risk. This study aims to evaluate the awareness of osteoporosis among postmenopausal women in the Najran region, Saudi Arabia, and to identify its associated factors. Methods: This cross-sectional study was conducted from April to June 2024. It evaluated osteoporosis awareness among 313 postmenopausal women in Najran, Saudi Arabia, excluding postmenopausal women who work as healthcare providers on hormone replacement therapy and with mental limitations. An online questionnaire assessed demographic and osteoporosis-related characteristics using the Osteoporosis Knowledge Assessment Tool (OKAT), an Arabic valid and reliable tool, had 20 questions rated on a three-point Likert scale (true, false, and I don’t know). Results: Out of 701 women, only 313 postmenopausal women were included. The median age was 53 years. Seventy-five percent (236) were married,145 (46%) had a university education or higher and 162 (52%) were housewives. Thirty-six percent (114) and 98 (31%) had a personal and family history of osteoporosis, respectively. The median age at puberty was 13 years, and 226 (72%) reported a history of regular menses previously. The mean knowledge score was 8.965±3.406. Among the participants, 43.5% had good knowledge of osteoporosis. Higher education levels were significantly associated with better knowledge (p=0.030), with those with a university education scoring higher than those with lower education levels. Conclusion: Although 43.5% of participants demonstrated good knowledge of osteoporosis, the majority had poor knowledge, highlighting a significant gap in awareness that needs to be addressed through targeted educational interventions

“Food frequency questionnaire for dietary intake of iron in pregnancy- A validation study”

Background and objectiveNutrition in pregnancy plays an important role for wellbeing of mother and fetus, later it further influences the development of child. Iron is one among the most important micronutrients required in pregnancy. There is no validated Food frequency questionnaire (FFQ) to assess iron intake in pregnant women. This initiated the process to develop and validate a FFQ to assess dietary intake of Iron in Pregnant women. MethodologyBased on the food habits in study region and foods rich in iron, in reference to the standard literature, the FFQ was prepared. FFQ was designed in the following categories-cereal grains and products, pulses & legumes, green leafy vegetables, roots-tuber & other vegetables, nuts & seeds, Fruits, non-veg foods and milk & milk products. Content validity carried out by subject experts. To perform construct validity, 25 Primary health centre and 25 Tertiary care hospital pregnant women were interviewed using this FFQ and 24 h diet recall method. The results of both records were analyzed using Wilcoxon signed rank test. Internal reliability (Cronbach's alpha) and construct validity (Pearson correlation) of the questionnaire were determined. ResultsOverall internal reliability of questionnaire is 0.804, indicating good reliability and showing satisfactory construct validity. Median dietary iron intake from FFQ method was 7.67 mg/day and 24 h dietary recall method was 15.70 mg/day. There was a significant difference between both method in assessing dietary iron intake. ConclusionThe FFQ designed in this study is reliable and valid tool to assess dietary iron intake among pregnant women.

Validation and reliability of the Chinese version of the Friendship Scale (FS-C) in family caregivers of people with severe mental illness

Social isolation has been shown to contribute to negative health outcomes. Within a Chinese cultural context where people highly value social relationships, family caregivers of people with severe mental illness are prone to experience social isolation due to demanding caregiving tasks and prevalent social stigma. However, an instrument that could comprehensively measure social isolation in Chinese family caregivers is lacking. The six-item Friendship Scale was designed to measure social isolation but it has not previously been validated for use in the Chinese context. This study aimed to assess the reliability and validity of the Friendship Scale – Chinese version (FS-C) in family caregivers of people with severe mental illness (SMI) (N = 200). Confirmatory factor analysis affirmed FS-C's single-factor structure. FS-C demonstrated good internal consistency (Cronbach's alpha = 0.74) and test-retest reliability (ICC = 0.72). Convergent validity was supported by moderate to strong correlations with social networks (r = 0.342, p < 0.01) and loneliness (r = −0.608, p < 0.01). Divergent validity was confirmed by a weak correlation with perceived social stigma (r = −0.190, p < 0.01). FS-C is a reliable and valid tool for assessing social isolation among Chinese family caregivers of people with SMI.

Pathological Changes and Sodium Rhodizonate Test as Tools for Investigating Gunshot Wounds in Veterinary Forensic Pathology.

Gunshot wound morphology and gunshot residues (GSRs) evaluation have been poorly investigated in veterinary forensic pathology. The aims of the present study were to assess the gunshot wound morphology in animals and evaluate the detectability of lead deriving from GSRs using colorimetric techniques. To these aims, cadavers were divided into four different groups. Group A comprised eight animals who died from firearm-related injuries, while groups B and C included dog limbs shot using different shooting ranges; group D comprised dog limbs stabbed with a screwdriver. Morphological analysis was performed on all entry gunshot wounds. Lead residues were investigated using a Bullet Hole Testing Kit (BTK) and Rhodizonate Sodium histochemical staining (NaR-s). Gunshot wounds in group A showed an abrasion ring associated with hemorrhages and tissue necrosis. Groups B and C showed injuries related to the shooting range. NaR-s showed positive results in both animals that died from gunshot wounds and experimentally shot limbs. However, the number of positive cases and the pattern of lead distribution varied with the shooting range. Positive results by BTK were limited to close-contact shots in group B limbs. Our results suggest that both pathological examination and NaR tests represent valid tools for investigating gunshot wounds in veterinary pathology.

A reliable and valid assessment of upper limb movement quality after stroke: the observational Drinking Task Assessment.

To develop and evaluate the reliability and validity of a new observational Drinking Task Assessment (DTA) designed to assess quality of movement in task performance after stroke. Reliability and validity. The DTA measures movement time and movement quality (smoothness, trunk, shoulder, elbow, and grasp movements) on a 4-level ordinal scale. Thirty participants with chronic stroke were assessed independently by 2 therapists. Intra-class correlation (ICC), standard error of measurement (SEM) and minimal real difference (MRD), weighted kappa, percentage of agreement, and Svensson method were used for reliability assessment. Motion capture-based kinematics and established clinical scales were used to evaluate validity. The absolute SEM and MRD for movement time were 0.4 and 1 s (11%), respectively. The ICC (≥ 0.93) and weighted kappa (0.71-1.0) showed good to excellent agreement for intra- and inter-rater reliability. DTA showed strong correlations with Fugl-Meyer Assessment (0.74), Action Research Arm Test (0.93), and kinematic measures of smoothness (0.93), trunk displacement (0.91), elbow extension (0.73), and shoulder movements (0.56), indicating good construct validity. The new DTA proved to be a reliable and valid tool for assessment of movement quality during task performance after stroke.

Computing Precise Control Interface Specifications

Verifying network programs is challenging because of how they divide labor: the control plane computes high level routes through the network and compiles them to device configurations, while the data plane uses these configurations to realize the desired forwarding behavior. In practice, the correctness of the data plane often assumes that the configurations generated by the control plane will satisfy complex specifications. Consequently, validation tools such as program verifiers, runtime monitors, fuzzers, and test-case generators must be aware of these control interface specifications (ci-specs) to avoid raising false alarms. In this paper, we propose the first algorithm for computing precise ci-specs for network data planes. Our specifications are designed to be efficiently monitorable —concretely, checking that a fixed configuration satisfies a ci-spec can be done in polynomial time. Our algorithm, based on modular program instrumentation, quantifier elimination, and a path-based analysis, is more expressive than prior work, and is applicable to practical network programs. We describe an implementation and show that ci-specs computed by our tool are useful for finding real bugs in real-world data plane programs.

Psychometric properties of the Functional Literacy Questionnaire among Portuguese adolescents.

Robust tools to assess self-reported adolescent functional health literacy are lacking. In Portugal, the only available tool is the Newest Vital Sign for Portuguese adolescents (NVS-PTeen), though presenting modest validity and reliability properties. A new instrument-the Functional Literacy Questionnaire (FLiQ)-was developed, inspired by the NVS-PTeen, but following the European Regulation for food labeling and targeting a balanced assessment of numeracy and verbal comprehension skills. This study aimed to evaluate several psychometric properties of the FLiQ when administered to Portuguese adolescents. We conducted a longitudinal observational study with three phases: (1) Delphi panel with health literacy experts; (2) self-administration of FLiQ and NVS-PTeen to adolescents in 7th to 9th grades; and (3) re-administration of FLiQ four weeks after baseline, to the same group of participants. FLiQ's content validity was excellent, with an Average-Content Validity Index of .95. Overall, 372 adolescents (50.3% girls) aged between 12-17 years (median age: 13) participated in the study. Of these, 150 completed the test-retest assessment. Internal consistency was good (Kuder-Richardson Fornula-20 = .70), as well as test-retest reliability (Intraclass Coefficient Correlation = .82). FLiQ total score was weakly correlated with the school year (rho = .174), and moderately with Portuguese (rho = .348) and Mathematics grades (rho = .333). Factor analysis indicated a two-dimension structure, reflecting numeracy and verbal comprehension skills. Item response theory analysis revealed differences in difficulty and discrimination capacity among items, all with adequate fit values. FLiQ is a valid and reliable tool. It can be used to monitor functional health literacy levels in Portuguese adolescents.

Cross-cultural adaptation and psychometric properties of the Arabic version of the Central Sensitization Inventory in people with chronic musculoskeletal pain.

The Central Sensitization Inventory (CSI) is a patient-reported screening instrument that can be used to identify and assess central sensitization (CS)/Central Sensitization Syndrome (CSS)-related symptoms. The aim was to translate the CSI into Arabic (CSI-Ar) and to subsequently validate its psychometric properties. Cross-sectional. The CSI was translated and cross-culturally adapted into Arabic, and validated following international standardized guidelines. This study included patients with chronic musculoskeletal pain (n = 264) and healthy control participants (n = 56). Patients completed the CSI-Ar, Pain Catastrophizing Scale (PCS), Depression, Anxiety, and Stress scale (DASS-21), Tampa Scale of Kinesiophobia (TSK), and 5-level EuroQol-5D (EQ-5D). Patients completed the CSI-Ar twice to assess test-retest reliability. To evaluate discriminative validity, healthy controls participants completed the CSI-Ar. Statistical analyses were conducted to test the internal consistency, reliability, and structural, construct and discriminant validity of CSI-Ar. The CSI-Ar showed acceptable internal consistency (Cronbach's alpha = 0.919) and excellent test-retest reliability (intraclass correlation coefficient = 0.874). The CSI-Ar scale had significant correlations (P < 0.001) with all PCS subscales and total score (Spearman's rho = 0.459-0.563, P < 0.001), all DASS-21 subscales and total score (Spearman's rho = 0.599-0.685, P < 0.001), the TSK (Spearman's rho = 0.395, P < 0.001), and the EQ-5D (Spearman's rho = -0.396, P < 0.001). The Mann-Whitney U-test showed a statistically significant difference between the patient group and the healthy control group (P < 0.001), with the healthy controls displaying a lower average CSI-Ar score (12.27 ± 11.50) when compared to the patient group (27.97 ± 16.08). Factor analysis indicated that the CSI-Ar is a unidimensional tool. The CSI-Ar is a reliable and valid screening tool that can be used to assess CS/CSS-related symptoms in Arabic-speaking people with chronic musculoskeletal pain.

Development and validation of an instrument to evaluate the perspective of using the electronic health record in a hospital setting

BackgroundEvaluating healthcare information systems, such as the Electronic Health Records (EHR), is both challenging and essential, especially in resource-limited countries. This study aims to psychometrically develop and validate an instrument (questionnaire) to assess the factors influencing the successful adoption of the EHR system by healthcare professionals in Moroccan university hospitals.MethodsThe questionnaire validation process occurred in two main stages. Initially, data collected from a pilot sample of 164 participants underwent analysis using exploratory factor analysis (EFA) to evaluate the validity and reliability of the retained factor structure. Subsequently, the validity of the overall measurement model was confirmed using confirmatory factor analysis (CFA) in a sample of 368 healthcare professionals.ResultsThe structure of the modified HOT-fit model, comprising seven constructs (System Quality, Information Quality, Information technology Service Quality, User Satisfaction, Organization, Environment, and Clinical Performance), was confirmed through confirmatory factor analysis. Absolute, incremental, and parsimonious fit indices all indicated an appropriate level of acceptability, affirming the robustness of the measurement model. Additionally, the instrument demonstrated adequate reliability and convergent validity, with composite reliability values ranging from 0.75 to 0.89 and average variance extracted (AVE) values ranging from 0.51 to 0.63. Furthermore, the square roots of AVE values exceeded the correlations between different pairs of constructs, and the heterotrait-monotrait ratio of correlations (HTMT) was below 0.85, confirming suitable discriminant validity.ConclusionsThe resulting instrument, due to its rigorous development and validation process, can serve as a reliable and valid tool for assessing the success of information technologies in similar contexts.

Adaptation of the health literacy survey19-Europe-Q12 into Turkish culture: A psychometric study.

Misinformation can lead to adverse outcomes on the health beliefs and behaviors of individuals. Therefore, health literacy skills are needed as a central competency to recognize the trustfulness of health-related knowledge in any resources. To ensure this, a time-efficient, skill-oriented psychometric tools are needed to measure the comprehensive general health literacy level of communities. This research was conducted to evaluate the psychometric properties of the 12-item Health Literacy Survey-Europe (HLS19-Q12) regarding Turkish culture. A methodological design was adopted. The population consisted of adult individuals registered to two family health centers in Ankara. The sample was determined based on 5-10 times the number of scale items rule (ntotal = 192). A questionnaire and Health Literacy Survey-Europe-Q12 were used to collect data. Language, content and construct validities and internal consistency reliability tests were performed through IBM-SPSS 25.0 and AMOS 24.0 programs. The content validity was determined via the Davis technique. The construct validity was examined by exploratory (EFA) (n1 = 120) and confirmatory factor analysis (CFA) (n2 = 72). Internal consistency was evaluated using Cronbach's alpha coefficient. Time invariance was evaluated by test-retest method (nretest = 32) 4 weeks later. The mean age was 30.17 ± 10.37 (min. 18-max. 61). The Kaiser-Meyer Olkin test result was 0.898, and the Bartlett's Test of Sphericity result was 604.889 (p < 0.001). The model-fit indices showed good fit. The difference between the first and the second measurements was statistically insignificant (t = -1.659, p = 0.107). The Cronbach's alpha was 0.88. The HLS19-Q12-TR was a valid and reliable measurement tool in determining the health literacy level of the Turkish adult population. As one of the social determinants of health, easy measurement and generating a general health literacy map of the population is considered a necessity.

Cross-cultural adaptation and psychometric properties of the Chinese version of the Intermittent Self-Catheterization Questionnaire (ISC-Q).

The intermittent self-catheterization questionnaire (ISC-Q) is a valid and reliable tool to assess the quality of life (QOL) in patients with neurogenic lower urinary tract dysfunction (NLUTD) who engage in ISC. The aim of this research is to culturally adapt the ISC-Q and evaluate its psychometric properties within the Chinese patient population. The cross-sectional research was meticulously conducted in two pivotal stages: initially, the focus was on cross-cultural adaptation, followed by an extensive phase of psychometric testing. This comprehensive analysis involved 405 Chinese patients with NLUTD who use ISC. Various analyses, including evaluations of the floor and ceiling effects, item analysis, content validity, exploratory and confirmatory factor analysis (EFA and CFA), assessments of convergent, discriminant, and criterion validity. Additionally, Cronbach's alpha was utilized to determine internal consistency, and test-retest reliability was measured using the intraclass correlation coefficient (ICC). No floor and ceiling effects were observed. The content validity index was 0.967. The EFA identified four factors, accounting for 64.953% of the total variance, and this four-factor structure was confirmed by the CFA. The fit indices in CFA were favorable, with χ2/df = 1.999, root mean square error of approximation = 0.070, comparative fit index = 0.916, Tucker-Lewis index = 0.900, goodness-of-fit index = 0.863, and incremental fit index = 0.917. The average variance extracted for the four factors ranged from 0.466 to 0.565, with composite reliability values ranging from 0.776 to 0.859. The ISC-Q showed a positive correlation with the intermittent self-catheterization acceptance questionnaire (r = 0.557, P < 0.001). The ICC overall Cronbach's alpha coefficient for the questionnaire was 0.821, and the for test-retest reliability was 0.951 (95% CI [0.900-0.976] P < 0.001). The validity and reliability of the Chinese version of the ISC-Q have been verified, making it suitable for measuring the QOL in NLUTD patients who practice ISC.

Psychometric Evaluation of the Personal Mastery Scale Among Italian Nurses: Assessing Personal Mastery in the Nursing Profession.

Background and Purpose: Personal mastery is essential in the nursing profession, as it directly impacts the quality of care and the well-being of the nurses themselves. However, there is a lack of psychometrically reliable tools to measure it among nurses. This study evaluates the applicability of the Personal Mastery Scale (PMS) among Italian nurses. Methods: A cross-sectional study surveyed Italian nurses using self-administered questionnaires, including the PMS. A total of 209 healthcare workers, primarily nurses, from various operational units participated in the study. The majority of respondents (84.2%) were nurses. The gender distribution was predominantly female (83.3%). Results: Statistical analyses, including factor analyses, assessed the scale's reliability and validity. The scale demonstrated adequate internal consistency (Cronbach's alpha = .670) and construct validity. Conclusions: The Italian version of the PMS is a reliable and valid tool for assessing personal mastery among nurses. Understanding personal mastery is crucial for promoting resilience and delivering quality care. Further research should explore its relationship with outcomes and intervention effectiveness.

Validation of the Real-World Application of the Hidradenitis Suppurativa Quality of Life (HiSQOL) Score to Adults with Hidradenitis Suppurativa.

Hidradenitis suppurativa (HS) has unique symptoms and physical features among skin diseases. Patient reported outcome measures (PROMs) agnostic to specific skin diseases may not fully characterise the influence of HS on quality of life (QoL). A HS-specific PROM is needed to capture the impact of HS on QoL in the real-world setting. To validate the Hidradenitis Suppurativa Quality of Life Questionnaire (HiSQOL) as a HS-specific PROM by comparing it to the Dermatology Life Quality Index (DLQI) in clinical practice. Data were drawn from the Adelphi HS Disease Specific Programme™, a cross-sectional survey of physicians and patients conducted in France, Germany, Italy, Spain, and the United States between November, 2020 and April, 2021. Practicing physicians each provided demographic and clinical data for 5-7 consecutively evaluated HS patients aged at least 10 years receiving any treatment for HS, and an additional 3 patients undergoing biologic treatment; only patients aged at least 18 years were included in this study. Patients completed the DLQI and HiSQOL. Construct validity was assessed by Pearson's correlation between DLQI and HiSQOL scores. The HiSQOL item discrimination was assessed by comparing differences in item responses between the highest and lowest 25% of HiSQOL scores. Multivariable linear regressions assessed relationships between individual PROM item responses and the total score of the other PROM. In total, 677 patients [mean age of 34.3 (11.3) years; female (57.3%, n=388)] completed both the HiSQOL and DLQI. There was strong correlation between HiSQOL and DLQI total scores (Pearson's correlation 0.87 [95% confidence interval: 0.85-0.89, p<0.001]). The HiSQOL items that had the biggest impact on QoL related to "Embarrassment", "Depression" and "Anxiety", items that also had among the lowest relationship to total DLQI score. The HiSQOL is a valid tool for assessing QoL in HS patients in the real-world setting. Furthermore, the HiSQOL better captures those aspects of HS that have the highest impact on QoL, including depression and anxiety, which are not captured by the DLQI.

Unraveling subcellular functional traits: Adaptive insights into chloroplast ultrastructure in nonmodel species.

This essay discusses how the ultrastructural changes in chloroplasts, particularly the mechanisms of thylakoid membrane unstacking, help maintain the photosynthetic performance of photosystem II (PSII) under stress conditions. This phenomenon may facilitate the repair of damaged PSII by providing access to the repair machinery. It is argued that this PSII repair mechanism accelerates PSII recovery, optimizing photosynthetic processes in stressed plants. Although some studies demonstrate the relationship between thylakoid membrane unstacking in stress conditions, these studies were developed with model species under controlled conditions. Thus, this essay serves as a validation tool for these previous studies, because it demonstrates that the relationships between ultrastructural changes in chloroplasts and the functioning of PSII are essential acclimative strategies for nonmodel plants to survive the constant edaphoclimatic changes of natural environments. Understanding these subcellular dynamics can significantly inform biologists about the plastic potential of plants, especially in heterogeneous environments. An integrated approach in future studies is necessary, highlighting the importance of exploring plant functional traits at multiple scales, because subcellular characteristics have great potential to understand plant acclimatization.

Understanding the Experiences of Nurses' Work: Development and Psychometric Evaluation of an End of Shift Survey.

To explore and validate an end of shift survey with a low response burden, practical application and generated evidence of related associations between workload, quality of work and patient care, missed care and job satisfaction. A retrospective cross-sectional survey of the experiences of nursing staff. Data were collected from 265 nurses who responded to a questionnaire at the end of their shift in 2022. Exploratory factor analysis was undertaken using IBM SPSS v.27 and confirmatory factor analysis was undertaken using IBM AMOS v27. Hypotheses testing was undertaken using IBM SPSS v.27 using multiple regression analyses. All of the hypotheses were supported. There was a negative association between workload and quality of work and job satisfaction. Quality of work was negatively associated with workload and missed care and positively associated with job satisfaction. The association between missed care and job satisfaction was negative. The EOSS is a valid and reliable tool with a low response burden. The tool supports previous research which demonstrated there is a negative relationship between level of workload and shift type with satisfaction, quality of work and potentially nurse retention. In the context of a global nursing shortage nursing leaders must ensure that care we provide is of the highest quality. We must take every action to address high workload to reduce the risk that fundamental care is not sacrificed, job satisfaction is improved and nurses remain in the profession. The EOSS gives nurse leaders a reliable, practical, consistent, applied tool that will better enable associations to be observed between resource configuration, workload and critical impacts on nursing and patient care. We have adhered to the relevant EQUATOR guidelines using the STROBE reporting method. No Patient or Public Contribution.

Digital breast tomosynthesis for early detection of malignant breast microcalcification: A hospital-based cross-sectional study

Background: Breast cancer is the leading cause of cancer-related deaths in women. Early detection by screening is crucial for improved survival. Digital breast tomosynthesis (DBT) may offer better visibility than conventional screening. This study aims to assess the diagnostic accuracy of DBT in detecting malignant breast microcalcifications compared to histopathological findings. Methods: This cross-sectional study was done at the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University, Dhaka, from July 2022 to June 2023 and enrolled 35 women suspected of having breast cancer. Each patient underwent DBT and histopathology tests. The diagnostic accuracy of DBT in detecting malignant breast microcalcifications was assessed compared to the gold standard of histopathology. Results: The average age of the participants was 48.6 years. Palpable breast lumps (91.4%) were the most common clinical presentation. Among them, 80% had malignant microcalcifications diagnosed by DBT, primarily with linear (40.0%) and segmental (28.6%) distribution. Histopathology identified 80% of cases as malignant, with ductal carcinoma in situ (34.3%) being the most prevalent type. DBT demonstrated high sensitivity (100%) and specificity (85.7%) in detecting malignant microcalcifications, resulting in an overall accuracy of 97.1%. Conclusions: DBT has high diagnostic accuracy for detecting malignant breast microcalcifications and can be considered a valid tool for the early detection of breast microcalcifications, particularly in the context of diagnosing breast cancer.

How Are Diagnosis-Related Groups and Staffing Allocation Systems Associated with the Complexity of Nursing Care? An Observational Study.

In Italy, Diagnosis-Related Groups (DRGs) have been adopted for hospital services reimbursement. In some Italian regions, nurse staffing allocation is purely volume-based, with different minutes/patient/day categories determined by the type of hospital ward. The Information System of Nursing Performance (SIPI) is a valid and reliable tool assessing nursing care complexity as an indicator of the actual nursing care demand. Evidence is lacking about the ability of current resource allocation methods to account for the nursing care demand. To evaluate the association between (1) DRG rates and nursing care complexity and (2) hospital ward categories of nurse staffing and nursing care complexity. All patients discharged from the medical department of an Italian hospital over a data collection period were eligible. To assess the association between nursing care complexity (SIPI) and DRGs, the distribution of the DRG rate (median and first-third quartile) was compared for cases with high or low complexity. To evaluate the association between nursing care complexity (SIPI) and nurse staffing, the frequency of high complexity within nurse staffing categories (120/180/240 min/patient/day) was compared. Because the sample was very large, methods of statistical inference were not applied, and only descriptive measures were reported. 6872 hospitalizations were included. The median DRG rate for high and low complexity admissions were very similar (EUR 3536 and EUR 3285, respectively). The proportion of admissions with high complexity decreased for wards with higher staffing allocation rates. DRG reimbursement and the nurse staffing allocation systems were ineffective in accounting for nursing care complexity. The SIPI could help identify areas requiring more financial and staffing resources for nursing care.

Advancements in railway noise simulation: assessment of tools for virtual validation

In pursuit of more efficient and cost-effective measurement campaigns, the railway industry is embracing the prospect of virtual validation based on simulations. The primary obstacle lies in the need for noise simulation tools capable of accurately replicating complex sources, installation effects, noise propagation, ground reflection and, for some cases, the diffraction in the different train surfaces. This paper presents insights derived from European project Shift2Rail S2R-CFM-CCA-01-2019 Energy and Noise &amp; Vibration WP6, concentrating on the validation and enhancement of two exterior noise simulation tools, tailored for railway applications. The paper covers four reference cases, simulating exterior noise at standstill with diverse noise sources and varying source locations and noise emission (i.e. electrical noise, cooling, etc.). A correlation with previously conducted measurements at typical receiver locations (7.5 meters from the track centerline) is carried out. The measurements were conducted in a "controlled" configuration, isolating as much as possible the analyzed noise source and gathering all the needed information about the ground and train geometry. The evaluation between measurements and simulations is done against a global and a 1/3rd octave band criteria with successful results. Finally, key features essential for achieving more accurate simulations are listed.

Frequency-domain patterns in foot-force line-of-action: an emergent property of standing balance control.

A recent line of work suggests that the net behavior of the foot-ground interaction force provides insight into quiet-standing-balance dynamics and control. Through human subject experiments, Boehm et al. found that the relative variations of the center of pressure and force orientation emerge as a distinct pattern in the frequency domain, termed the "intersection-point height." Subsequent empirical and simulation-based studies showed that different control strategies are reflected in the distribution of intersection-point height across frequency. To facilitate understanding of the strengths and limitations of the intersection-point height in describing the dynamics and control of standing, the present work establishes a spectral-based method that also enables derivation of a closed-form estimate of the intersection-point height from any linear model of quiet stance. This new method explained observations from prior work, including how the measure captures aspects of control and physiological noise. The analysis presented herein highlights the utility of the frequency-dependent foot-force dynamics in probing the balance controller and provides a tool for model development and validation to further our understanding of the neuromotor control of natural upright posture in humans.

Development of a breastfeeding support scale in the workplace and psychometric properties of Turkish version: a validity and reliability

ABSTRACT The purpose of this study was to develop a workplace breastfeeding support scale for working mothers and examine their psychometric properties. This methodological research was conducted between February and April 2022. This study included 325 mothers who continued breastfeeding while working. The tool development stages included item generation, expert review for content validity testing, and psychometric testing. The data were collected through face-to-face interviews between February and April 2022. In data analysis, for explanatory factor analysis, the direct oblimin technique and scree plot test were performed. Structural equation modeling was performed for confirmatory factor analysis. Two sub-dimensions (manager support, environmental support) and a nine-item workplace breastfeeding support scale showed good validity and reliability. The Cronbach’s alpha value of the total scale and sub-dimensions of the scale were greater than 0.70. Confirmatory factor analysis showed that the model fit indices were acceptable (χ2 = 68.658, χ2/df = 2.64, CFI = 0.94, GFI = 0.96, AGFI = 0.92, and RMSEA = 0.07). The total variance explained by the scale was 54.32 percent. This newly developed 9-item and 2-dimensional version is a valid and reliable tool for measuring the working mothers’ perception of workplace breastfeeding support. This tool is recommended to be verified in other low, middle, and high-income countries.