Scientific Literature on the Reliability and Validity of the Manchester Triage System (MTS) Protocol: A Integrative Literature Review

OBJECTIVE To analyze the scientific production about the validity and reliability of the Manchester Triage System (MTS) protocol. METHOD A descriptive study of an integrative literature review. Articles on the validity and reliability of the MTS developed with children and adults published between 1999 and 2013 were included. RESULTS 14 articles were selected from a total of 8438, nine of validity and five of reliability. The reliability of the MTS ranged from moderate to almost perfect, with higher intra-evaluation. Regarding validity, the results seem to point to equivalent and satisfactory sensibility and specificity levels of the MTS. The instrument proved to be a good predictor of the need for hospitalization and of hospital mortality. CONCLUSION The reliability and validity of the MTS obtained in the studies is varied. It is recommended that new studies indicate necessary modifications to the MTS so that it is more safely used by nurses.

Interrater reliability of Nursing Activities Score among Intensive Care Unit health professionals

ABSTRACT Objective To analyze the interrater reliability of NAS among critical care nurses and managers in an ICU. Method This was a methodological study performed in an adult, general ICU in Norway. In a random selection of patients, the NAS was scored on 101 patients by three raters: a critical care nurse, an ICU physician and a nurse manager. Interrater reliability was analyzed by agreement between groups and kappa statistics. Results The mean NAS were 88.4 (SD=16.2) and 88.7 (SD=24.5) respectively for the critical care nurses and nurse managers. A lower mean of 83.7 (SD=21.1) was found for physicians. The 18 medical interventions showed higher agreement between critical care nurses and physicians (85.6%), than between critical care nurses and nurse managers (78.7). In the five nursing activities the Kappa-coefficients were low for all activities in all compared groups. Conclusion The study indicated a satisfactory agreement of nursing workload between critical care nurses and managers.

Reliability of panel-based guidelines for colonoscopy: an international comparison.

BACKGROUND: This study examined the reliability of explicit guidelines developed using the RAND-UCLA appropriateness method. METHODS: The appropriateness of over 400 indications for colonoscopy was rated by two multispecialty expert panels (United States and Switzerland). A nine-point scale was used, which was consolidated into three categories of appropriateness: appropriate, uncertain, inappropriate. The distribution of appropriateness ratings between the two panels and the intrapanel and interpanel agreement for categories of appropriateness were calculated for all possible indications. Similar statistics were calculated for a series of 577 primary care patients referred for colonoscopy in Switzerland. RESULTS: Over 80% of all indications (348) could be directly compared. The proportions of indications classified as appropriate, uncertain, or inappropriate were 28.4%, 24.7%, 46.6% and 33.0%, 23.0%, 44.0% for the U.S. and the Swiss panels, respectively. Interpanel agreement was excellent for all the possible indications (kappa value: 0.75) and lower for actual cases (kappa value: 0.51) because of lower agreement for the most frequently encountered indications. CONCLUSIONS: Good agreement between the two sets of criteria was found, pointing to the reliability of the method. Partial disagreement occurred essentially for a few, albeit frequently encountered, indications for use of colonoscopy in cases of uncomplicated lower abdominal pain or constipation.

Power of Attorney Handbook, January 2006

This booklet is designed to assist those who have been appointed as an attorney-in-fact, those who are considering the need for a power of attorney, or those who have an interest in the subject. This is a general overview.

Relative and absolute reliability of the clinical version of the Narrow Path Walking Test (NPWT) under single and dual task conditions.

Decline in gait stability has been associated with increased fall risk in older adults. Reliable and clinically feasible methods of gait instability assessment are needed. This study evaluated the relative and absolute reliability and concurrent validity of the testing procedure of the clinical version of the Narrow Path Walking Test (NPWT) under single task (ST) and dual task (DT) conditions. Thirty independent community-dwelling older adults (65-87 years) were tested twice. Participants were instructed to walk within the 6-m narrow path without stepping out. Trial time, number of steps, trial velocity, number of step errors, and number of cognitive task errors were determined. Intraclass correlation coefficients (ICCs) were calculated as indices of agreement, and a graphic approach called "mountain plot" was applied to help interpret the direction and magnitude of disagreements between testing procedures. Smallest detectable change and smallest real difference (SRD) were computed to determine clinically relevant improvement at group and individual levels, respectively. Concurrent validity was assessed using Performance Oriented Mobility Assessment Tool (POMA) and the Short Physical Performance Battery (SPPB). Test-retest agreement (ICC1,2) varied from 0.77 to 0.92 in ST and from 0.78 to 0.92 in DT conditions, with no apparent systematic differences between testing procedures demonstrated by the mountain plot graphs. Smallest detectable change and smallest real change were small for motor task performance and larger for cognitive errors. Significant correlations were observed for trial velocity and trial time with POMA and SPPB. The present results indicate that the NPWT testing procedure is highly reliable and reproducible.

Power transformations in correspondence analysis

Power transformations of positive data tables, prior to applying the correspondence analysis algorithm, are shown to open up a family of methods with direct connections to the analysis of log-ratios. Two variations of this idea are illustrated. The first approach is simply to power the original data and perform a correspondence analysis this method is shown to converge to unweighted log-ratio analysis as the power parameter tends to zero. The second approach is to apply the power transformation to thecontingency ratios, that is the values in the table relative to expected values based on the marginals this method converges to weighted log-ratio analysis, or the spectral map. Two applications are described: first, a matrix of population genetic data which is inherently two-dimensional, and second, a larger cross-tabulation with higher dimensionality, from a linguistic analysis of several books.

Endogenous bargaining power

We present a novel approach to N-person bargaining, based on the idea thatthe agreement reached in a negotiation is determined by how the directconflict resulting from disagreement would be resolved. Our basic buildingblock is the disagreement function, which maps each set of feasible outcomesinto a disagreement point. Using this function and a weak axiom basedon individual rationality we reach a unique solution: the agreement inthe shadow of conflict, ASC. This agreement may be construed as the limitof a sequence of partial agreements, each of which is reached as a functionof the parties relative power. We examine the connection between ASC andasymmetric Nash solutions. We show the connection between the power ofthe parties embodied in the ASC solution and the bias in the SWF thatwould select ASC as an asymmetric Nash solution.

Power Fund Rollout Address, March 29, 2007

Speech by Governor Culver.

When Preference Is Not Satisfied but the Individual Is: How Power Distance Affects Person-Job Fit

One aspect of person-job fit reflects congruence between personal preferences and job design; as congruence increases so should satisfaction. We hypothesized that power distance would moderate whether fit is related to satisfaction with degree of job formalization. We obtained measures of job-formalization, fit and satisfaction, as well as organizational commitment from employees (n = 772) in a multinational firm with subsidiaries in six countries. Confirming previous findings, individuals from low power-distance cultures were most satisfied with increasing fit. However, the extent to which individuals from high power-distance cultures were satisfied did not necessarily depend on increasing fit, but mostly on whether the degree of formalization received was congruent to cultural norms. Irrespective of culture, satisfaction with formalization predicted a broad measure of organizational commitment. Apart from our novel extension of fit theory, we show how moderation can be tested in the context of polynomial response surface regression and how specific hypotheses can be tested regarding different points on the response surface.

University admission marks in Catalonia: Some highlights from the empirical research

The results of the examinations taken by graduated high school studentswho want to enrol at a Catalan university are here studied. To do so,the authors address several issues related to the equity of the system:reliability of grading, difficulty and discrimination power of the exams.The general emphasis is put upon the concurrent research and empiricalevidence about the properties of the examination items and scores. Aftera discussion about the limitations of the exams' format and appropriatenessof the instruments used in the study, the article concludes with somesuggestions to improve such examinations.

Redes Eléctricas Digitais Power Line Communication :- Desafios e Oportunidades para Cabo Verde

Para distribuir e socializar a informação, nos mais diversos locais e das formas mais rápidas possíveis, proliferam as redes de comunicação de dados, cada vez mais presentes em nosso quotidiano, especialmente através do uso das novas tecnologias. Dentre elas, destaca-se a tecnologia Power Line Communication (PLC) Linha de força de comunicação, em que os dados são transmitidos através da corrente eléctrica. Hoje, um pouco por todo o mundo, estuda-se a alternativa viável, desafios e oportunidades de se utilizar a rede de energia eléctrica como um canal efectivo para transmissão de dados, voz e imagem, tornando-se assim, também uma rede de comunicação de dados. Ainda sem uma oferta comercial a funcionar em Cabo Verde, apesar de já terem sido feito algumas tentativas de testes de equipamentos, a Power Line Communication é já utilizada com sucesso em vários países, ligando em banda larga casas e empresas. Assim, este trabalho pretende fazer o enquadramento da tecnologia em si, bem como analisar os desafios e oportunidades da implementação do PLC no mercado Cabo-verdiano.

Sistemas de Tratamento e Disposição dos Resíduos Sólidos Compact Power & Aterro Sanitário

Na actual monografia intitulada “Sistemas de Tratamento e Disposição dos Resíduos Sólidos” adoptar-se-á as teorias clássicas de solos, para representar os resíduos sólidos urbanos. No que diz ao tratamento e disposição, diversos métodos e técnicas vão ser apresentados. Assim esta pesquisa tem como objectivo principal avaliar o Aterro Sanitário proposto para Santiago, 1999 e a tecnologia do Compact Power (pirólise/gasificação). Os dados dos resíduos sólidos ficaram restringidos aos resíduos urbanos, encontrando-se uma grande heterogeneidade e constantes questionamentos em diversas bibliografias. Analisa-se os elementos base para o dimensionamento do Aterro Sanitário abrangendo um estudo mais aprofundado sobre a estabilização dos taludes. Quanto ao Compact Power, far-se-á a apresentação da planta que incluiu duas linhas, uma para o resíduo misturado e o outro para resíduos separados, uma planta de compostagem e uma planta de conversão térmica avançada (empregando os processos de pirólises, gaseificação e oxidação a alta temperatura). Na compilação deste documento, encontra-se uma análise SWOT, com o intuito de melhor analisar as referidas tecnologias apresentadas.

The discriminatory power of MALDI-TOF mass spectrometry to differentiate between isogenic teicoplanin-susceptible and teicoplanin-resistant strains of methicillin-resistant Staphylococcus aureus.

To explore the discriminatory power of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for detecting subtle differences in isogenic isolates, we tested isogenic strains of Staphylococcus aureus differing in their expression of resistance to methicillin or teicoplanin. More important changes in MALDI-TOF MS spectra were found with strains differing in methicillin than in teicoplanin resistance. In comparison, very minor or no changes were recorded in pulsed-field gel electrophoresis profiles or peptidoglycan muropeptide digest patterns of these strains, respectively. MALDI-TOF MS might be useful to detect subtle strain-specific differences in ionizable components released from bacterial surfaces and not from their peptidoglycan network.