Cross-cultural adaptation and assessment of the reliability and validity of the Core Outcome Measures Index (COMI) for the Brazilian-Portuguese language

The use of patient-orientated questionnaires is of utmost importance in assessing the outcome of spine surgery. Standardisation, using a common set of outcome measures, is essential to aid comparisons across studies/in registries. The Core Outcome Measures Index (COMI) is a short, multidimensional outcome instrument validated for patients with spinal disorders. This study aimed to produce a Brazilian-Portuguese version of the COMI. A cross-cultural adaptation of the COMI into Brazilian-Portuguese was carried out using established guidelines. 104 outpatients with chronic LBP (> 3 months) were recruited from a Public Health Spine Medical Care Centre. They completed a questionnaire booklet containing the newly translated COMI, and other validated symptom-specific questionnaires: Oswestry Disability Index (ODI) and Roland Morris disability scale (RM), and a pain visual analogue scale. All patients completed a second questionnaire within 7-10 days to assess reproducibility. The COMI summary score displayed minimal floor and ceiling effects. On re-test, the responses for each individual domain of the COMI were within 1 category in 98% patients for the domain 'function', 96% for 'symptom-specific well-being', 97% for 'general quality of life', 99% for 'social disability' and 100% for 'work disability'. The intraclass correlation coefficients (ICC2,1) for COMI pain and COMI summary scores were 0.91-0.96, which compared favourably with the corresponding values for the RM (ICC, 0.99) and ODI (ICC, 0.98). The standard error of measurement for the COMI was 0.6, giving a "minimum detectable change" (MDC95%) of approximately 1.7 points i.e., the minimum change to be considered "real change" beyond measurement error. The COMI scores correlated as hypothesised (Rho, 0.4-0.8) with the other symptom-specific questionnaires. The reproducibility of the Brazilian-Portuguese version of the COMI was comparable to that of other language versions. The COMI scores correlated in the expected manner with existing but longer symptom-specific questionnaires suggesting good convergent validity for the COMI. The Brazilian-Portuguese COMI represents a valuable tool for Brazilian study-centres in future multicentre clinical studies and surgical registries.

SOAP processing performance and enhancement

The web services (WS) technology provides a comprehensive solution for representing, discovering, and invoking services in a wide variety of environments, including Service Oriented Architectures (SOA) and grid computing systems. At the core of WS technology lie a number of XML-based standards, such as the Simple Object Access Protocol (SOAP), that have successfully ensured WS extensibility, transparency, and interoperability. Nonetheless, there is an increasing demand to enhance WS performance, which is severely impaired by XML's verbosity. SOAP communications produce considerable network traffic, making them unfit for distributed, loosely coupled, and heterogeneous computing environments such as the open Internet. Also, they introduce higher latency and processing delays than other technologies, like Java RMI and CORBA. WS research has recently focused on SOAP performance enhancement. Many approaches build on the observation that SOAP message exchange usually involves highly similar messages (those created by the same implementation usually have the same structure, and those sent from a server to multiple clients tend to show similarities in structure and content). Similarity evaluation and differential encoding have thus emerged as SOAP performance enhancement techniques. The main idea is to identify the common parts of SOAP messages, to be processed only once, avoiding a large amount of overhead. Other approaches investigate nontraditional processor architectures, including micro-and macrolevel parallel processing solutions, so as to further increase the processing rates of SOAP/XML software toolkits. This survey paper provides a concise, yet comprehensive review of the research efforts aimed at SOAP performance enhancement. A unified view of the problem is provided, covering almost every phase of SOAP processing, ranging over message parsing, serialization, deserialization, compression, multicasting, security evaluation, and data/instruction-level processing.