Inter-rater agreement and reliability of the COSMIN (COnsensus-based Standards for the selection of health status Measurement Instruments) Checklist

Background: The COSMIN checklist is a tool for evaluating the methodological quality of studies on measurement properties of health-related patient-reported outcomes. The aim of this study is to determine the inter-rater agreement and reliability of each item score of the COSMIN checklist (n = 114). Methods: 75 articles evaluating measurement properties were randomly selected from the bibliographic database compiled by the Patient-Reported Outcome Measurement Group, Oxford, UK. Raters were asked to assess the methodological quality of three articles, using the COSMIN checklist. In a one-way design, percentage agreement and intraclass kappa coefficients or quadratic-weighted kappa coefficients were calculated for each item. Results: 88 raters participated. Of the 75 selected articles, 26 articles were rated by four to six participants, and 49 by two or three participants. Overall, percentage agreement was appropriate (68% was above 80% agreement), and the kappa coefficients for the COSMIN items were low (61% was below 0.40, 6% was above 0.75). Reasons for low inter-rater agreement were need for subjective judgement, and accustom to different standards, terminology and definitions.Conclusions: Results indicated that raters often choose the same response option, but that it is difficult on item level to distinguish between articles. When using the COSMIN checklist in a systematic review, we recommend getting some training and experience, completing it by two independent raters, and reaching consensus on one final rating. Instructions for using the checklist are improved.

Protocol of the COSMIN study: consensus-based standards for the selection of health measurement instruments

Background: Choosing an adequate measurement instrument depends on the proposed use of the instrument, the concept to be measured, the measurement properties (e.g. internal consistency, reproducibility, content and construct validity, responsiveness, and interpretability), the requirements, the burden for subjects, and costs of the available instruments. As far as measurement properties are concerned, there are no sufficiently specific standards for the evaluation of measurement properties of instruments to measure health status, and also no explicit criteria for what constitutes good measurement properties. In this paper we describe the protocol for the COSMIN study, the objective of which is to develop a checklist that contains COnsensus-based Standards for the selection of health Measurement INstruments, including explicit criteria for satisfying these standards. We will focus on evaluative health related patient-reported outcomes (HR-PROs), i.e. patient-reported health measurement instruments used in a longitudinal design as an outcome measure, excluding health care related PROs, such as satisfaction with care or adherence. The COSMIN standards will be made available in the form of an easily applicable checklist.Method: An international Delphi study will be performed to reach consensus on which and how measurement properties should be assessed, and on criteria for good measurement properties. Two sources of input will be used for the Delphi study: (1) a systematic review of properties, standards and criteria of measurement properties found in systematic reviews of measurement instruments, and (2) an additional literature search of methodological articles presenting a comprehensive checklist of standards and criteria. The Delphi study will consist of four (written) Delphi rounds, with approximately 30 expert panel members with different backgrounds in clinical medicine, biostatistics, psychology, and epidemiology. The final checklist will subsequently be field-tested by assessing the inter-rater reproducibility of the checklist.Discussion: Since the study will mainly be anonymous, problems that are commonly encountered in face-to-face group meetings, such as the dominance of certain persons in the communication process, will be avoided. By performing a Delphi study and involving many experts, the likelihood that the checklist will have sufficient credibility to be accepted and implemented will increase.

Performance assessment and league tables. Comparing like with like.

We formulate performance assessment as a problem of causal analysis and outline an approach based on the missing data principle for its solution. It is particularly relevant in the context of so-called league tables for educational, health-care and other public-service institutions. The proposed solution avoids comparisons of institutions that have substantially different clientele (intake).

Controlo interno na prevenção de erros e fraudes

Atualmente, as situações de erros e fraudes, têm ocorrido com muita frequência a nível mundial. Por exemplo em Cabo Verde estas têm vindo a ganhar espaço nos mídias, onde a todo momento aparece casos de erros e fraudes, como por exemplo, os casos da Sociedade Cabo-verdiana de Tabacos, Banco Comercial do Atlântico, Caixa Económica, Câmara Municipal da Ribeira Brava, Associação Sport Club Moreirense, Sociedade de Segurança Industrial, Marítima e Comercial, Ministério das Finanças entre outros. Essas situações desfavoráveis para qualquer empresa, são derivadas de uma gestão menos cuidada dos recursos, e dos valores e princípios éticos cultivados pelas pessoas. O triângulo de fraude criada por Donald Cressey demonstra os motivos que leva um individuo a cometer atos fraudulentos, como sendo a motivação, a pressão e a oportunidade. Neste sentido, o controlo interno surge como uma ferramenta muito importante e fundamental para mitigar os riscos advenientes da ocorrência de erros e fraudes, suscetíveis de acontecer nas empresas. O controlo interno traduz num conjunto de medidas que protegem o património da empresa e garantem o cumprimento dos seus objetivos entretanto, como qualquer outra ferramenta de gestão está possui determinadas limitações que podem ser ultrapassadas com a utilização de alguns procedimentos básicos e, ou alternativos de controlo interno. É imprescindível que um sistema de controlo interno, para além de implementado, adequado e em funcionamento, seja mantido e acompanhado. O estudo dos casos da SILMAC, SA e da SCT, SA, mostram a importância que o controlo interno tem na prevenção e deteção de erros e fraudes, pois denota-se que as fraudes cometidas aconteceram na sequência de fraquezas de controlo interno e no excesso de confiança depositada nos colaboradores. Currently, the situations of errors and fraud have occurred very often in the world. Cape Verde in these situations have gained ground in the media, where every moment appears to errors and fraud cases, such as cases of “Sociedade cabo-verdiana de tabacos, Banco Comercial do Atlântico, Caixa Económica, Câmara Municipal da Ribeira Brava, Associação Sport Club Moreirense, Sociedade de segurança industrial, marítima e comercial, Ministério de finanças” amongst others. These situations which unfavorable for any company, are derived from a less carefully management of resources and ethical principles and values cultivated by people. The fraud triangle created by Donald Cressey, demonstrates reasons that lead an individual to commit fraudulent acts, such as motivation, opportunity and pressure. In this sense, internal control emerges as a very important tool to mitigate the risks arising from situations of errors and fraud, which are likely to happen in companies. The internal control translates into a set of measures that protect the assets of the business and ensure the fulfillment of its objectives however, like any other management tool is has limitations, however these can be overcome with the use of basic procedures, or alternative internal control. It is essential that an internal control system, in addition to implemented, adequate and functioning is maintained and monitored. The case studies of SILMAC and SCT, show the importance of internal control is the prevention and detection of errors and fraud. For note that the fraud occurred following oversights in its internal control and confidence in their employees.

Genome-wide association study of major recurrent depression in the U.K. population.

OBJECTIVE: Studies of major depression in twins and families have shown moderate to high heritability, but extensive molecular studies have failed to identify susceptibility genes convincingly. To detect genetic variants contributing to major depression, the authors performed a genome-wide association study using 1,636 cases of depression ascertained in the U.K. and 1,594 comparison subjects screened negative for psychiatric disorders. METHOD: Cases were collected from 1) a case-control study of recurrent depression (the Depression Case Control [DeCC] study; N=1346), 2) an affected sibling pair linkage study of recurrent depression (probands from the Depression Network [DeNT] study; N=332), and 3) a pharmacogenetic study (the Genome-Based Therapeutic Drugs for Depression [GENDEP] study; N=88). Depression cases and comparison subjects were genotyped at Centre National de Génotypage on the Illumina Human610-Quad BeadChip. After applying stringent quality control criteria for missing genotypes, departure from Hardy-Weinberg equilibrium, and low minor allele frequency, the authors tested for association to depression using logistic regression, correcting for population ancestry. RESULTS: Single nucleotide polymorphisms (SNPs) in BICC1 achieved suggestive evidence for association, which strengthened after imputation of ungenotyped markers, and in analysis of female depression cases. A meta-analysis of U.K. data with previously published results from studies in Munich and Lausanne showed some evidence for association near neuroligin 1 (NLGN1) on chromosome 3, but did not support findings at BICC1. CONCLUSIONS: This study identifies several signals for association worthy of further investigation but, as in previous genome-wide studies, suggests that individual gene contributions to depression are likely to have only minor effects, and very large pooled analyses will be required to identify them.

Informe del consultor para el Proyecto FAO/PER/76/022 cubriendo el trabajo de abril /mayo 1979

El proyecto se inició en mayo de 1978 y se terminó en diciembre de 1981. Sus objetivos principales con establecer las bases científicas para la administración racional de las pesquerías peruanas de aguas continentales y para su óptima utilización.

Brain Tissue Hypoxia is a Strong Predictor of Outcome after Severe Traumatic Brain Injury Independent from Elevated Intracranial Pressure

Introduction: Low brain tissue oxygen pressure (PbtO2) is associated with worse outcome in patients with severe traumatic brain injury (TBI). However, it is unclear whether brain tissue hypoxia is merely a marker of injury severity or a predictor of prognosis, independent from intracranial pressure (ICP) and injury severity. Hypothesis: We hypothesized that brain tissue hypoxia was an independent predictor of outcome in patients wih severe TBI, irrespective of elevated ICP and of the severity of cerebral and systemic injury. Methods: This observational study was conducted at the Neurological ICU, Hospital of the University of Pennsylvania, an academic level I trauma center. Patients admitted with severe TBI who had PbtO2 and ICP monitoring were included in the study. PbtO2, ICP, mean arterial pressure (MAP) and cerebral perfusion pressure (CPP = MAP-ICP) were monitored continuously and recorded prospectively every 30 min. Using linear interpolation, duration and cumulative dose (area under the curve, AUC) of brain tissue hypoxia (PbtO2 < 15 mm Hg), elevated ICP >20 mm Hg and low CPP <60 mm Hg were calculated, and the association with outcome at hospital discharge, dichotomized as good (Glasgow Outcome Score [GOS] 4-5) vs. poor (GOS 1-3), was analyzed. Results: A total of 103 consecutive patients, monitored for an average of 5 days, was studied. Brain tissue hypoxia was observed in 66 (64%) patients despite ICP was < 20 mm Hg and CPP > 60 mm Hg (72 +/- 39% and 49 +/- 41% of brain hypoxic time, respectively). Compared with patients with good outcome, those with poor outcome had a longer duration of brain hypoxia (1.7 +/- 3.7 vs. 8.3 +/- 15.9 hrs, P<0.01), as well as a longer duration (11.5 +/- 16.5 vs. 21.6 +/- 29.6 hrs, P=0.03) and a greater cumulative dose (56 +/- 93 vs. 143 +/- 218 mm Hg*hrs, P<0.01) of elevated ICP. By multivariable logistic regression, admission Glasgow Coma Scale (OR, 0.83, 95% CI: 0.70-0.99, P=0.04), Marshall CT score (OR 2.42, 95% CI: 1.42-4.11, P<0.01), APACHE II (OR 1.20, 95% CI: 1.03-1.43, P=0.03), and the duration of brain tissue hypoxia (OR 1.13; 95% CI: 1.01-1.27; P=0.04) were all significantly associated with poor outcome. No independent association was found between the AUC for elevated ICP and outcome (OR 1.01, 95% CI 0.97-1.02, P=0.11) in our prospective cohort. Conclusions: In patients with severe TBI, brain tissue hypoxia is frequent, despite normal ICP and CPP, and is associated with poor outcome, independent of intracranial hypertension and the severity of cerebral and systemic injury. Our findings indicate that PbtO2 is a strong physiologic prognostic marker after TBI. Further study is warranted to examine whether PbtO2-directed therapy improves outcome in severely head-injured patients .

A software to calculate soil hydraulic conductivity in internal drainage experiments (SHC, Version 2.00)

A software for the calculation of unsaturated soil hydraulic conductivity K(theta) is presented for commonly used methods found in the literature, based on field experiments in which a soil profile is submitted to water infiltration followed by internal drainage. The software is available at: dourado@esalq.usp.br.

Pedotransfer functions related to spatial variability of water retention attributes for lowland soils

The estimation of non available soil variables through the knowledge of other related measured variables can be achieved through pedotransfer functions (PTF) mainly saving time and reducing cost. Great differences among soils, however, can yield non desirable results when applying this method. This study discusses the application of developed PTFs by several authors using a variety of soils of different characteristics, to evaluate soil water contents of two Brazilian lowland soils. Comparisons are made between PTF evaluated data and field measured data, using statistical and geostatistical tools, like mean error, root mean square error, semivariogram, cross-validation, and regression coefficient. The eight tested PTFs to evaluate gravimetric soil water contents (Ug) at the tensions of 33 kPa and 1,500 kPa presented a tendency to overestimate Ug 33 kPa and underestimate Ug1,500 kPa. The PTFs were ranked according to their performance and also with respect to their potential in describing the structure of the spatial variability of the set of measured values. Although none of the PTFs have changed the distribution pattern of the data, all resulted in mean and variance statistically different from those observed for all measured values. The PTFs that presented the best predictive values of Ug33 kPa and Ug1,500 kPa were not the same that had the best performance to reproduce the structure of spatial variability of these variables.

Effective one-dimensional square well for two-dimensional quantum wires

The symmetrical two-dimensional quantum wire with two straight leads joined to an arbitrarily shaped interior cavity is studied with emphasis on the single-mode approximation. It is found that for both transmission and bound-state problems the solution is equivalent to that for an energy-dependent one-dimensional square well. Quantum wires with a circular bend, and with single and double right-angle bends, are examined as examples. We also indicate a possible way to detect bound states in a double bend based on the experimental setup of Wu et al.

Systematic trends in self-consistent calculations of linear quantum wires

Systematic trends in the properties of a linear split-gate heterojunction are studied by solving iteratively the Poisson and Schrödinger equations for different gate potentials and temperatures. A two-dimensional approximation is presented that is much simpler in the numerical implementation and that accurately reproduces all significant trends. In deriving this approximation, we provide a rigorous and quantitative basis for the formulation of models that assumes a two-dimensional character for the electron gas at the junction.

Systematics of properties of the electron gas in deep-etched quantum wires

An efficient method is developed for an iterative solution of the Poisson and Schro¿dinger equations, which allows systematic studies of the properties of the electron gas in linear deep-etched quantum wires. A much simpler two-dimensional (2D) approximation is developed that accurately reproduces the results of the 3D calculations. A 2D Thomas-Fermi approximation is then derived, and shown to give a good account of average properties. Further, we prove that an analytic form due to Shikin et al. is a good approximation to the electron density given by the self-consistent methods.