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Assessment Data (assessment + data)
Selected AbstractsMeasurement Equivalence of 360°-Assessment Data: Are different raters rating the same constructs?INTERNATIONAL JOURNAL OF SELECTION AND ASSESSMENT, Issue 3 2007Kelly M. Hannum This study uses data collected using a 360°-assessment instrument to investigate the structural equivalence of 360°-assessment ratings, according to rater type, controlling for organizational level. Data from 533 managers and their raters were employed in the study, which used multi-group structural equations modeling. Issues central to the implementation and use of 360°-assessment data are also considered within the context of current research and practice. [source] Physician peer assessments for compliance with methadone maintenance treatment guidelinesTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2007Carol Strike PhD Abstract Introduction: Medical associations and licensing bodies face pressure to implement quality assurance programs, but evidence-based models are lacking. To improve the quality of methadone maintenance treatment (MMT), the College of Physicians and Surgeons of Ontario, Canada, conducts an innovative quality assurance program on the basis of peer assessments. Using data from this program, we assessed physician compliance with MMT guidelines and determined whether physician factors (e.g., training, years of practice), practice type, practice location, and/or caseload is associated with MMT guideline adherence. Methods: Secondary analysis of methadone practice assessment data collected by the College of Physicians and Surgeons of Ontario, Canada. Assessment data from methadone prescribing physicians who completed their first year of methadone practice were analyzed. We calculated the mean percentage compliance per guideline per physician and global compliance across all guidelines per physician. Linear regression was used to assess factors associated with compliance. Results: Data from 149 physician practices and 1,326 patient charts were analyzed. Compliance across all charts was greater than 90% for most areas of care. Compliance was less than 90% for take-home medication procedures; urine toxicology screening; screening for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), tuberculosis, other sexually transmitted infections, and completion of a psychosocial assessment. Mean global compliance across all charts and guidelines per physician was 94.3% (standard deviation = 7.4%) with a range of 70% to 100%. Linear regression analysis revealed that only year of medical school graduation was a significant predictor of physician compliance. Discussion: This is the first report of MMT peer assessments in Canada. Compliance is high. Few countries conduct similar assessment processes; none report physician-level results. We cannot quantify the contribution of peer assessment, training, or self-selection to the compliance rates, but compared to other areas of practice these rates suggest that peer assessment may exert a significant effect on compliance. A similar assessment process may in other areas of clinical practice improve physician compliance. [source] Agrichemicals in surface water and birth defects in the United StatesACTA PAEDIATRICA, Issue 4 2009Paul D Winchester Abstract Objectives: To investigate if live births conceived in months when surface water agrichemicals are highest are at greater risk for birth defects. Methods: Monthly concentrations during 1996,2002 of nitrates, atrazine and other pesticides were calculated using United States Geological Survey's National Water Quality Assessment data. Monthly United States birth defect rates were calculated for live births from 1996 to 2002 using United States Centers for Disease Control and Prevention natality data sets. Birth defect rates by month of last menstrual period (LMP) were then compared to pesticide/nitrate means using logistical regression models. Results: Mean concentrations of agrichemicals were highest in April,July. Total birth defects, and eleven of 22 birth defect subcategories, were more likely to occur in live births with LMPs between April and July. A significant association was found between the season of elevated agrichemicals and birth defects. Conclusion: Elevated concentrations of agrichemicals in surface water in April,July coincided with higher risk of birth defects in live births with LMPs April,July. While a causal link between agrichemicals and birth defects cannot be proven from this study an association might provide clues to common factors shared by both variables. [source] Planetary gear set and automatic transmission simulation for machine design courses,COMPUTER APPLICATIONS IN ENGINEERING EDUCATION, Issue 3 2003Scott T. Dennis Abstract Due to their unique ability to provide a variety of gear ratios in a very compact space, planetary gear systems are seen in many applications from small powered screw drivers to automobile automatic transmissions. The versatile planetary gear device is often studied as part of an undergraduate mechanical engineering program. Textbook presentations typically illustrate how the different planetary gear components are connected. Understanding of the operation of the planetary gear set can be enhanced using actual hardware or simulations that show how the components move relative to each other. The Department of Engineering Mechanics at the United States Air Force Academy has developed a computer simulation of the planetary gear set and the Chrysler 42LE automatic transmission. Called "PG-Sim," the dynamic simulations complement a static textbook presentation. PG-Sim is used in several of our courses and assessment data clearly indicates students' appreciation of its visual and interactive features. In this paper, we present an overview of PG-Sim and then describe how the simulation courseware facilitates understanding of the planetary gear system. © 2003 Wiley Periodicals, Inc. Comput Appl Eng Educ 11: 144,155, 2003; Published online in Wiley InterScience (www.interscience.wiley.com); DOI 10.1002/cae.10045 [source] Hypothalamic,pituitary,adrenal axis and smoking and drinking onset among adolescents: the longitudinal cohort TRacking Adolescents' Individual Lives Survey (TRAILS)ADDICTION, Issue 11 2009Anja C. Huizink ABSTRACT Aims We examined within a prospective longitudinal study whether cortisol levels were associated with smoking or drinking behaviours, taking parental substance use into account. Design The influence of parental substance use on cortisol levels of their adolescent offspring at age 10,12 years was examined. Next, cortisol levels of adolescents who initiated smoking or drinking at the first data collection (age 10,12) were compared to non-users. Finally, we examined whether cortisol levels could predict new onset and frequency of smoking and drinking 2 years later. Setting and participants First and second assessment data of the TRacking Adolescents' Individual Lives Survey (TRAILS) were used, including 1768 Dutch adolescents aged 10,12 years, who were followed-up across a period of 2 years. Measurements Cortisol was measured in saliva samples at awakening, 30 minutes later, and at 8 p.m. at age 10,12. Self-reported substance use at age 10,12 and 13,14, and parental self-reported substance use were used. Findings Only maternal substance use was related to slightly lower adolescent cortisol levels at 8 p.m. Both maternal and paternal substance use were associated with adolescent smoking and drinking at age 13,14, although fathers' use only predicted the amount used and not the chance of ever use. Finally, higher cortisol levels were related moderately to current smoking and future frequency of smoking, but not to alcohol use. Conclusions In a general population, parental heavy substance use does not seem to affect cortisol levels consistently in their offspring. We found some evidence for higher, instead of lower, hypothalamic,pituitary,adrenal axis activity as a predictor of smoking in early adolescence. [source] Measurement Equivalence of 360°-Assessment Data: Are different raters rating the same constructs?INTERNATIONAL JOURNAL OF SELECTION AND ASSESSMENT, Issue 3 2007Kelly M. Hannum This study uses data collected using a 360°-assessment instrument to investigate the structural equivalence of 360°-assessment ratings, according to rater type, controlling for organizational level. Data from 533 managers and their raters were employed in the study, which used multi-group structural equations modeling. Issues central to the implementation and use of 360°-assessment data are also considered within the context of current research and practice. [source] An approach for post-market monitoring of potential environmental effects of Bt -maize expressing Cry1Ab on natural enemiesJOURNAL OF APPLIED ENTOMOLOGY, Issue 4 2009O. Sanvido Abstract Post-market monitoring (PMM) consistent with Swiss and European Union legislation should ensure the detection and prevention of adverse effects on the environment possibly deriving from commercial cultivation of genetically modified (GM) crops. Insect-resistant GM crops (such as Bt -maize) raise particular questions regarding disturbances of biological control functions provided by beneficial insects such as predators and parasitoids (so-called natural enemies). Consensus among regulators, scientists and the agricultural biotech industry on appropriate PMM plans allowing the detection and possibly prevention of such adverse effects is still lacking. The aims of this study were to identify the necessity for PMM of Bt -maize expressing Cry1Ab on natural enemies and to develop an appropriate PMM plan. The approach chosen consisted in determining what type of monitoring is most appropriate to address potential effects of Bt -maize on natural enemies during commercial cultivation. This included identifying whether there remain substantial scientific uncertainties that would support case-specific monitoring. Existing pre-market risk assessment data indicate that Bt -maize (Cry1Ab) comprises a negligible risk for disturbances in biological control functions of natural enemies. As a consequence, a faunistic monitoring of specific groups of natural enemies is not considered an appropriate approach to detect failures in biological control functions. Alternatively, an approach is proposed that consists in indirectly analysing biological control functions by surveying outbreaks of maize herbivores. Unusual herbivore outbreaks could indicate failures in biological control functions of natural enemies. Data could be collected via questionnaires addressed to farmers growing Bt -maize. Significant correlations between unusual occurrences of specific maize herbivores and the cultivation of Bt -maize would subsequently need specific studies to determine possible causalities in more detail. The here proposed approach has the advantage of covering different natural enemy groups. It represents a cost-effective strategy to obtain scientifically sound data as a basis for regulatory decision-making. [source] Adrenal toxicology: a strategy for assessment of functional toxicity to the adrenal cortex and steroidogenesisJOURNAL OF APPLIED TOXICOLOGY, Issue 2 2007Philip W. Harvey Abstract The adrenal is the most common toxicological target organ in the endocrine system in vivo and yet it is neglected in regulatory endocrine disruption screening and testing. There has been a recent marked increase in interest in adrenal toxicity, but there are no standardised approaches for assessment. Consequently, a strategy is proposed to evaluate adrenocortical toxicity. Human adrenal conditions are reviewed and adrenocortical suppression, known to have been iatrogenically induced leading to Addisonian crisis and death, is identified as the toxicological hazard of most concern. The consequences of inhibition of key steroidogenic enzymes and the possible toxicological modulation of other adrenal conditions are also highlighted. The proposed strategy involves an in vivo rodent adrenal competency test based on ACTH challenge to specifically examine adrenocortical suppression. The H295R human adrenocortical carcinoma cell line is also proposed to identify molecular targets, and is useful for measuring steroids, enzymes or gene expression. Hypothalamo-pituitary-adrenal endocrinology relevant to rodent and human toxicology is reviewed (with an emphasis on multi-endocrine axis effects on the adrenal and also how the adrenal affects a variety of other hormones) and the endocrinology of the H295R cell line is also described. Chemicals known to induce adrenocortical toxicity are reviewed and over 60 examples of compounds and their confirmed steroidogenic targets are presented, with much of this work published very recently using H295R cell systems. In proposing a strategy for adrenocortical toxicity assessment, the outlined techniques will provide hazard assessment data but it will be regulatory agencies that must consider the significance of such data in risk extrapolation models. The cases of etomindate and aminoglutethimide induced adrenal suppression are clearly documented examples of iatrogenic adrenal toxicity in humans. Environmentally, sentinel species, such as fish, have also shown evidence of adrenal endocrine disruption attributed to exposure to chemicals. The extent of human sub-clinical adrenal effects from environmental chemical exposures is unknown, and the extent to which environmental chemicals may act as a contributory factor to human adrenal conditions following chronic low-level exposures will remain unknown unless purposefully studied. Copyright © 2007 John Wiley & Sons, Ltd. [source] Evaluation of nursing and medical students' attitudes towards people with disabilitiesJOURNAL OF CLINICAL NURSING, Issue 15-16 2010Hatice Sahin Aims and objectives., The aim of this study is to assess the attitudes of students towards disabled people and provide suggestions to make necessary changes in the curricula. Background., Disabled people suffer from rejection, exclusion and discrimination. The undergraduate education of future health professionals should include processes of critical thinking towards and analysis of the disabled. Design., Cross-sectional design was used. Methods., All the preclinical medical and nursing students in our institution were included in study. Data were collected using the Turkish Attitudes towards Disabled Person Scale (TATDP) and demographical variables. TATDP Scale was scored according to five-point Likert Scale. Results., Students' mean attitude score is 120·57 (SD 15·24). Subscale mean scores are 53·61 (SD 7·25) for compassion (CP), 50·47 (SDS 7·26) for social value (SV) and 16·49 (SD 2·89) for resource distribution (RD). Whilst nursing students had less contact with the disabled, medical students had a closer contact with them. Medical students acquired more prior knowledge about attitudes towards the disabled. Total attitude scores of female students were above the students' mean attitude score when compared to those of male students. Conclusion., Only if early contact is established with patients and the disabled, practical educational strategies are adopted, and the students are provided with information on attitudes about the disabled, will a social model of disability be introduced into the curriculum. Relevance to clinical practice., This study results were presented to curriculum planning committees of nursing and medical schools, so that they should use them as needs assessment data in developing a disability awareness curriculum. The curriculum will be implemented in cooperation with not only schools but also other social institutions. For instance, clerkship applications will be accomplished by cooperating with nursing homes and organisations of disabled people. [source] Diagnostic sub-types, psychological distress and psychosocial dysfunction in southern Chinese people with temporomandibular disordersJOURNAL OF ORAL REHABILITATION, Issue 3 2008L. T. K. LEE Summary, The study aimed to assess the distribution of temporomandibular disorders (TMD) sub-types, psychological distress and psychosocial dysfunction in southern Chinese people seeking treatment for TMD using Research Diagnostic Criteria for TMD (RDC/TMD) and investigate potential cross-cultural differences in sub-type prevalence and psychosocial impact. Eighty-seven consecutive patients (77 females; 10 males) with a mean age of 39·3 years (s.d. 12·8) newly referred to the specialist TMD clinic at the Prince Philip Dental Hospital, Hong Kong over a 20-month period took part in the study. RDC/TMD history questionnaire and clinical assessment data were used to derive Axis I and II findings. Group I muscle disorders were the most common and found in 57·5% of patients. Group II (disc displacement) disorders were found in 42·5% and 47·1% of the right and left temporomandibular joints (TMJ) respectively. Group III disorders (arthralgia/arthrosis/arthritis) were revealed in 19·5% and 23·0% of right and left TMJ's respectively. In the Axis II assessment, 42·5% of patients had moderate/severe depression scores, 59·7% had moderate/severe somatization scores and based on graded chronic pain scores 15·0% had psychosocial dysfunction (grade III and IV). While acknowledging the small sample size, the distribution of RDC/TMD Axis I and II diagnoses was fairly similar in Chinese TMD patients compared with Western and other Asian patient groups. However, in Chinese patients, myofascial pain with limited jaw opening and TMJ disc displacement with reduction were more common and a significant number experienced psychological distress and psychosocial dysfunction. The findings have implications for the management of TMD in Chinese people. [source] Use of volumetric computerized tomography as a primary outcome measure to evaluate drug efficacy in the prevention of peri-prosthetic osteolysis: A 1-year clinical pilot of etanercept vs. placeboJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 6 2003Edward M. Schwarz Although total hip replacement (THR) is amongst the most successful and beneficial medical procedures to date, long-term outcomes continue to suffer from aseptic loosening secondary to peri-prosthetic osteolysis. Extensive research over the last two decades has elucidated a central mechanism for osteolysis in which wear debris generated from the implant stimulates inflammatory cells to promote osteoclastogenesis and bone resorption. The cytokine tumor necrosis factor alpha (TNF,) has been demonstrated to be central to this process and is considered to be a leading target for intervention. Unfortunately, even though FDA approved TNF antagonists are available (etanercept), currently there are no reliable outcome measures that can be used to evaluate the efficacy of a drug to prevent peri-prosthetic osteolysis. To the end of developing an effective outcome measure, we evaluated the progression of lesion size in 20 patients with established peri-acetabular osteolysis (mean = 29.99 cm3, range = 2.9,92.7 cm3) of an uncemented primary THR over 1-year, using a novel volumetric computer tomography (3D-CT) technique. We also evaluated polyethylene wear, urine N-telopeptides and functional assessments (WOMAC, SF-36 and Harris Hip Score) for comparison. At the time of entry into the study baseline CT scans were obtained and the patients were randomized to etanercept (25 mg s.q., twice/week) and placebo in a double-blinded fashion. CT scans, urine and functional assessments were also obtained at 6 and 12 months. No serious adverse drug related events were reported, but one patient had to have revision surgery before completion of the study due to aseptic loosening. No remarkable differences between the groups were observed. However, the study was not powered to see significant drug effects. 3D-CT data from the 19 patients was used to determine the mean increase in lesion size over 48 weeks, which was 3.19 cm3 (p < 0.0013). Analysis of the urine N-telopeptides and functional assessment data failed to identify a significant correlation with wear or osteolysis. In conclusion, volumetric CT was able to measure progression of osteolysis over the course of a year, thus providing a technology that could be used in therapeutic trials. Using the data from this pilot we provide a model power calculation for such a trial. © 2003 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved. [source] Initial evaluation of the first year of the Foundation Assessment ProgrammeMEDICAL EDUCATION, Issue 1 2009Helena Davies Objectives, This study represents an initial evaluation of the first year (F1) of the Foundation Assessment Programme (FAP), in line with Postgraduate Medical Education and Training Board (PMETB) assessment principles. Methods, Descriptive analyses were undertaken for total number of encounters, assessors and trainees, mean number of assessments per trainee, mean number of assessments per assessor, time taken for the assessments, mean score and standard deviation for each method. Reliability was estimated using generalisability coefficients. Pearson correlations were used to explore relationships between instruments. The study sample included 3640 F1 trainees from 10 English deaneries. Results, A total of 2929 trainees submitted at least one of all four methods. A mean of 16.6 case-focused assessments were submitted per F1 trainee. Based on a return per trainee of six of each of the case-focused assessments, and eight assessors for multi-source feedback, 95% confidence intervals (CIs) ranged between 0.4 and 0.48. The estimated time required for this is 9 hours per trainee per year. Scores increased over time for all instruments and correlations between methods were in keeping with their intended focus of assessment, providing evidence of validity. Conclusions, The FAP is feasible and achieves acceptable reliability. There is some evidence to support its validity. Collated assessment data should form part of the evidence considered for selection and career progression decisions although work is needed to further develop the FAP. It is in any case of critical importance for the profession's accountability to the public. [source] Reliability: on the reproducibility of assessment dataMEDICAL EDUCATION, Issue 9 2004Steven M Downing Context, All assessment data, like other scientific experimental data, must be reproducible in order to be meaningfully interpreted. Purpose, The purpose of this paper is to discuss applications of reliability to the most common assessment methods in medical education. Typical methods of estimating reliability are discussed intuitively and non-mathematically. Summary, Reliability refers to the consistency of assessment outcomes. The exact type of consistency of greatest interest depends on the type of assessment, its purpose and the consequential use of the data. Written tests of cognitive achievement look to internal test consistency, using estimation methods derived from the test-retest design. Rater-based assessment data, such as ratings of clinical performance on the wards, require interrater consistency or agreement. Objective structured clinical examinations, simulated patient examinations and other performance-type assessments generally require generalisability theory analysis to account for various sources of measurement error in complex designs and to estimate the consistency of the generalisations to a universe or domain of skills. Conclusions, Reliability is a major source of validity evidence for assessments. Low reliability indicates that large variations in scores can be expected upon retesting. Inconsistent assessment scores are difficult or impossible to interpret meaningfully and thus reduce validity evidence. Reliability coefficients allow the quantification and estimation of the random errors of measurement in assessments, such that overall assessment can be improved. [source] Assessment of child problem behaviors by multiple informants: a longitudinal study from preschool to school entryTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 10 2007David C.R. Kerr Background:, Children's early problem behavior that manifests in multiple contexts is often more serious and stable. The concurrent and predictive validity of ratings of externalizing and internalizing by four informants was examined at preschool and early school age in an at-risk sample. Methods:, Two hundred forty children were assessed by mothers and fathers (Child Behavior Checklist (CBCL)), and teachers and laboratory examiners (Teacher Report Form (TRF)) at ages 3 and 5 years. Results:, All informants' ratings of externalizing converged on a common factor at ages 3 and 5 that showed strong stability over time (, = .80). All informants' age 3 externalizing ratings significantly predicted the problem factor at age 5; mothers', fathers', and teachers' ratings were independently predictive. Ratings of internalizing (except by examiners at age 3) also converged at both ages; the problem factor showed medium stability (, = .39) over time. Only fathers' ratings of age 3 internalizing predicted the age 5 problem factor. Conclusions:, Findings support the value of multi-informant assessment, uphold calls to include fathers in childhood research, and suggest that examiners provide valid, though non-unique assessment data. Examiner contributions may prove useful in many research contexts. [source] Physician peer assessments for compliance with methadone maintenance treatment guidelinesTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2007Carol Strike PhD Abstract Introduction: Medical associations and licensing bodies face pressure to implement quality assurance programs, but evidence-based models are lacking. To improve the quality of methadone maintenance treatment (MMT), the College of Physicians and Surgeons of Ontario, Canada, conducts an innovative quality assurance program on the basis of peer assessments. Using data from this program, we assessed physician compliance with MMT guidelines and determined whether physician factors (e.g., training, years of practice), practice type, practice location, and/or caseload is associated with MMT guideline adherence. Methods: Secondary analysis of methadone practice assessment data collected by the College of Physicians and Surgeons of Ontario, Canada. Assessment data from methadone prescribing physicians who completed their first year of methadone practice were analyzed. We calculated the mean percentage compliance per guideline per physician and global compliance across all guidelines per physician. Linear regression was used to assess factors associated with compliance. Results: Data from 149 physician practices and 1,326 patient charts were analyzed. Compliance across all charts was greater than 90% for most areas of care. Compliance was less than 90% for take-home medication procedures; urine toxicology screening; screening for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), tuberculosis, other sexually transmitted infections, and completion of a psychosocial assessment. Mean global compliance across all charts and guidelines per physician was 94.3% (standard deviation = 7.4%) with a range of 70% to 100%. Linear regression analysis revealed that only year of medical school graduation was a significant predictor of physician compliance. Discussion: This is the first report of MMT peer assessments in Canada. Compliance is high. Few countries conduct similar assessment processes; none report physician-level results. We cannot quantify the contribution of peer assessment, training, or self-selection to the compliance rates, but compared to other areas of practice these rates suggest that peer assessment may exert a significant effect on compliance. A similar assessment process may in other areas of clinical practice improve physician compliance. [source] Physician-patient encounters: The structure of performance in family and general office practiceTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2006Elizabeth F. Wenghofer PhD Abstract Introduction: The College of Physicians and Surgeons of Ontario, the regulatory authority for physicians in Ontario, Canada, conducts peer assessments of physicians' practices as part of a broad quality assurance program. Outcomes are summarized as a single score and there is no differentiation between performance in various aspects of care. In this study we test the hypothesis that physician performance is multidimensional and that dimensions can be defined in terms of physician-patient encounters. Methods: Peer assessment data from 532 randomly selected family practitioners were analyzed using factor analysis to assess the dimensional structure of performance. Content validity was confirmed through consultation sessions with 130 physicians. Multiple-item measures were constructed for each dimension and reliability calculated. Analysis of variance determined the extent to which multiple-item measure scores would vary across peer assessment outcomes. Results: Six performance dimensions were confirmed: acute care, chronic conditions, continuity of care and referrals, well care and health maintenance, psychosocial care, and patient records. Discussion: Physician performance is multidimensional, including types of physician-patient encounters and variation across dimensions, as demonstrated by individual practice. A conceptual framework for multidimensional performance may inform the design of meaningful evaluation and educational recommendations to meet the individual performance of practicing physicians. [source] Preoperative prediction of long-term outcome following laparoscopic fundoplicationANZ JOURNAL OF SURGERY, Issue 7 2002Colm J. O'Boyle Background: Although long-term outcomes following laparoscopic fundoplication for gastro-oesophageal disease have now been reported as very satisfactory, a small, but important, minority of patients are unhappy with the outcome, often due to recurrent reflux symptoms or new-onset dysphagia. In this study, we sought to establish whether various parameters that can be determined before surgery, can predict the long-term outcome of surgery. Methods: Data collected prospectively were evaluated to determine factors that were associated with outcome at 5 years following laparoscopic fundoplication. Inclusion criteria were complete preoperative assessment data and 5-year follow-up data. Data examined included information on preoperative age, sex, weight, home address, health insurance status, duration of reflux symptoms, previous surgery, operating surgeon, endoscopy and 24-h pH monitoring. In addition, lower oesophageal sphincter resting and residual relaxation pressures were evaluated before and after surgery. The postoperative symptoms of heartburn and dysphagia, as well as overall satisfaction 5 years following surgery was determined using a 0,10 visual analogue scale. The association of the pre- and perioperative factors and outcome at 5 years was determined by univariate and linear regression analysis. Results: Two hundred and sixty-two patients from an overall experience of over 1000 laparoscopic anti-reflux procedures met the entry criteria. There was no association between patient address, age, weight, duration of symptoms, the presence of endoscopically proven oesophagitis, operating surgeon, the necessity for conversion to an open procedure, change in lower oesophageal sphincter residual relaxation pressure and the outcome parameters. Using univariate analysis, a higher heartburn score was associated with previous abdominal surgery, female sex, no private health insurance, and a normal preoperative 24-h pH study. A higher dysphagia score was associated with a normal preoperative pH study, a postoperative increase in lower oesophageal sphincter resting pressure of more than 6 mmHg, and previous abdominal surgery. Overall satisfaction with the outcome at 5 years was higher among male patients, private patients, patients who had a hiatus hernia, and patients who had an abnormal preoperative pH study. Linear regression analysis confirmed that private insurance, male sex, and the absence of previous abdominal surgery, were the strongest predictors of an improved heartburn score, whereas male sex and private health insurance were the strongest predictors of greater satisfaction with the overall outcome. Conclusions: There are parameters that can be assessed before or during laparoscopic Nissen fundoplication that correlate with late outcome parameters. In particular, male patients and those from higher socioeconomic groups appear to have a better long-term outcome. [source] Establishing survey and monitoring protocols for the assessment of conservation status of fish populations in river Special Areas of Conservation in the UKAQUATIC CONSERVATION: MARINE AND FRESHWATER ECOSYSTEMS, Issue 1 2009I.G. Cowx Abstract 1.Under the EC Habitats Directive (92/43/EEC), several rivers in the UK have been designated Special Areas of Conservation (SACs) because they support important populations of fish species. Several factors need to be considered when establishing survey protocols to assess the conservation status of fish species in these rivers. 2.It is important to understand the biology and habitat requirements of fish species and to design appropriate monitoring surveys that adequately assess the status of the fish populations. This information can, in turn, provide the basis for establishing sustainable conservation targets for specific stocks, a process known as condition assessment. 3.Favourable condition of fish species in SAC rivers is assessed using three criteria. The first relates to density of fish in various life stages against pre-set targets, assuming that an appropriate number of sites is surveyed to account for natural spatial and temporal variations in fish populations. The second is evaluation of the demographic structure to demonstrate continued recruitment success. Third, by mapping the distribution of the target species in individual rivers and where favourable condition is only achieved where there has been no reduction in the distribution range river between surveys. 4.The framework described was developed from limited survey data. As more monitoring and assessment data become available, the threshold criteria for favourable condition for each species should be improved, and uncertainty in the procedures reduced. Copyright © 2008 John Wiley & Sons, Ltd. [source] From Surface to Depth: Diagnosis and Assessment in Personality PathologyCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 2 2007Robert F. Bornstein As Sheets and Craighead (2007) note, the current organization of personality disorders (PDs) in the Diagnostic and Statistical Manual of Mental Disorders (DSM) is limited by excessive comorbidity among different forms of personality pathology and by co-occurrence of symptoms from ostensibly unrelated PDs. In this commentary, I offer an alternative solution to the syndrome- and symptom-level problems that characterize our current organization of PDs. This solution involves (a) formally conceptualizing each DSM PD using multiple theoretical frameworks, and (b) using psychological assessment data to obtain information relevant to key elements of these theoretical frameworks. Guidelines for multimodal assessment of PDs are offered, and suggestions for integrating diagnostic information and psychological test data are described. [source] | ||||||||||||||||