Assessment of Intervention Fidelity and Recommendations for Researchers Conducting Studies on the Diagnosis and Treatment of Chronic Cough in the Adult: CHEST Guideline and Expert Panel Report

BACKGROUND: Successful management of chronic cough has varied in the primary research studies in the reported literature. One of the potential reasons relates to a lack of intervention fidelity to the core elements of the diagnostic and/or therapeutic interventions that were meant to be used by the investigators.

METHODS: We conducted a systematic review to summarize the evidence supporting intervention fidelity as an important methodologic consideration in assessing the effectiveness of clinical practice guidelines used for the diagnosis and management of chronic cough. We developed and used a tool to assess for five areas of intervention fidelity. Medline (PubMed), Scopus, and the Cochrane Database of Systematic Reviews were searched from January 1998 to May 2014. Guideline recommendations and suggestions for those conducting research using guidelines or protocols to diagnose and manage chronic cough in the adult were developed and voted upon using CHEST Organization methodology.

RESULTS: A total of 23 studies (17 uncontrolled prospective observational, two randomized controlled, and four retrospective observational) met our inclusion criteria. These articles included 3,636 patients. Data could not be pooled for meta-analysis because of heterogeneity. Findings related to the five areas of intervention fidelity included three areas primarily related to the provider and two primarily related to the patients. In the area of study design, 11 of 23 studies appeared to be underpinned by a single guideline/protocol; for training of providers, two of 23 studies reported training, and zero of 23 reported the use of an intervention manual; and for the area of delivery of treatment, when assessing the treatment of gastroesophageal reflux disease, three of 23 studies appeared consistent with the most recent guideline/protocol referenced by the authors. For receipt of treatment, zero of 23 studies mentioned measuring concordance of patient-interventionist understanding of the treatment recommended, and zero of 23 mentioned measuring enactment of treatment, with three of 23 measuring side effects and two of 23 measuring adherence. The overall average intervention fidelity score for all 23 studies was poor (20.74 out of 48).

CONCLUSIONS: Only low-quality evidence supports that intervention fidelity strategies were used when conducting primary research in diagnosing and managing chronic cough in adults. This supports the contention that some of the variability in the reporting of patients with unexplained or unresolved chronic cough may be due to lack of intervention fidelity. By following the recommendations and suggestions in this article, researchers will likely be better able to incorporate strategies to address intervention fidelity, thereby strengthening the validity and generalizability of their results that provide the basis for the development of trustworthy guidelines.

Development of practical methodology and indicators for on-farm animal welfare assessment

163 p.

An assessment of observed vertical flux divergence in long-term eddy-covariance measurements over two Midwestern forest ecosystems

Vertical divergence of CO2 fluxes is observed over two Midwestern AmeriFlux forest sites. The differences in ensemble averaged hourly CO2 fluxes measured at two heights above canopy are relatively small (0.2–0.5 μmol m−2 s−1), but they are the major contributors to differences (76–256 g C m−2 or 41.8–50.6%) in estimated annual net ecosystem exchange (NEE) in 2001. A friction velocity criterion is used in these estimates but mean flow advection is not accounted for. This study examines the effects of coordinate rotation, averaging time period, sampling frequency and co-spectral correction on CO2 fluxes measured at a single height, and on vertical flux differences measured between two heights. Both the offset in measured vertical velocity and the downflow/upflow caused by supporting tower structures in upwind directions lead to systematic over- or under-estimates of fluxes measured at a single height. An offset of 1 cm s−1 and an upflow/downflow of 1° lead to 1% and 5.6% differences in momentum fluxes and nighttime sensible heat and CO2 fluxes, respectively, but only 0.5% and 2.8% differences in daytime sensible heat and CO2 fluxes. The sign and magnitude of both offset and upflow/downflow angle vary between sonic anemometers at two measurement heights. This introduces a systematic and large bias in vertical flux differences if these effects are not corrected in the coordinate rotation. A 1 h averaging time period is shown to be appropriate for the two sites. In the daytime, the absolute magnitudes of co-spectra decrease with height in the natural frequencies of 0.02–0.1 Hz but increase in the lower frequencies (<0.01 Hz). Thus, air motions in these two frequency ranges counteract each other in determining vertical flux differences, whose magnitude and sign vary with averaging time period. At night, co-spectral densities of CO2 are more positive at the higher levels of both sites in the frequency range of 0.03–0.4 Hz and this vertical increase is also shown at most frequencies lower than 0.03 Hz. Differences in co-spectral corrections at the two heights lead to a positive shift in vertical CO2 flux differences throughout the day at both sites. At night, the vertical CO2 flux differences between two measurement heights are 20–30% and 40–60% of co-spectral corrected CO2 fluxes measured at the lower levels of the two sites, respectively. Vertical differences of CO2 flux are relatively small in the daytime. Vertical differences in estimated mean vertical advection of CO2 between the two measurement heights generally do not improve the closure of the 1D (vertical) CO2 budget in the air layer between the two measurement heights. This may imply the significance of horizontal advection. However, a reliable assessment of mean advection contributions in annual NEE estimate at these two AmeriFlux sites is currently an unsolved problem.

Lymphedema after complete axillary node dissection for melanoma: assessment using a new, objective definition

Objectives: The objectives of this study were to define appropriate criteria for assessing the presence of lymphedema, and to report the prevalence and risk factors for development of upper limb lymphedema after level I-III axillary dissection for melanoma.
Summary Background Data: The lack of a consistent and reliable objective definition for lymphedema remains a significant barrier to appreciating its prevalence after axillary dissection for melanoma (or breast carcinoma).
Methods: Lymphedema was assessed in 107 patients (82 male, 25 female) who had previously undergone complete level I-III axillary dissection. Of the 107 patients, 17 had also received postoperative axillary radiotherapy. Arm volume was measured using a water displacement technique. Change in volume of the arm on the side of the dissection was referenced to the volume of the other (control) arm. Volume measurements were corrected for the effect of handedness using corrections derived from a control group. Classification and regression tree (CART) analysis was used to determine a threshold fractional arm volume increase above which volume changes were considered to indicate lymphedema.
Results: Based on the CART analysis results, lymphedema was defined as an increase in arm volume greater than 16% of the volume of the control arm. Using this definition, lymphedema prevalence for patients in the present study was 10% after complete level I-III axillary dissection for melanoma and 53% after additional axillary radiotherapy. Radiotherapy and wound complications were independent risk factors for the development of lymphedema.
Conclusions: A suggested objective definition for arm lymphedema after axillary dissection is an arm volume increase of greater than 16% of the volume of the control arm.

Assessment of physical activity among primary school aged children: the Children's Leisure Activities Study (CLASS)

Overweight and obesity rates among children in Australia have increased twofold in the last decade. Physical activity is thought to play an important role in the prevention and treatment of childhood obesity. Children's physical activity data in Australia are incomplete and mainly based on parental proxy reports. One of the reasons for the lack of children's physical activity prevalence data in Australia is the difficulties of measurement. The aim of this study was to develop and examine a reliable, valid and feasible method for assessing physical activity among primary school aged children. A total of 112 grade 5 and 6 children and their parents were recruited from four state primary schools in the eastern and western suburbs of Melbourne. The test-retest reliability of a parental proxy physical activity questionnaire and a children's self report physical activity questionnaire was assessed. The criterion validity of the questionnaires was assessed using accelerometry. Findings suggest that the self report and proxy report questionnaires provided reliable measures of the type, frequency and duration of children's physical activity behaviour. Overall, the criterion validity of the questionnaires was poor. Although accelerometry as an objective measure shows promise, it does not provide the important physical activity behavioural and contextual information that is critical for the development of strategies to promote physical activity among children. We recommend that a combination of self report or proxy and objective measurement (using accelerometry or even pedometry) appears to be the current 'best buy' in the assessment of children's physical activity behaviour.

Work readiness in graduate recruitment and selection : a review of current assessment methods

Graduate recruitment and selection differs from other contexts in that graduate applicants generally lack job-related experience. Recent research has highlighted that employers are placing increasing value on graduates being work ready. Work readiness is believed to be indicative of graduate potential in terms of long term job performance and career advancement. A review of the literature has found that current graduate recruitment and selection practices lack the rigour and construct validity to effectively assess work readiness. In addition, the variety of interchangeable terms and definitions articulated by employers and academics on what constitutes work readiness suggests the need to further refine this construct. This paper argues that work readiness is an important selection criterion, and should be examined systematically in the graduate assessment process, as a construct in itself. The ineffectiveness of current assessment methods in being able to measure work readiness supports the need to develop a specific measure of work readiness that will allow more effective decision practices and potentially predict long term job capacity and performance.

A comparative assessment of austempered ductile iron as a substitute in weight reduction applications

Manufacturing engineering has had to undergo drastic changes in the approach to material selection in order to meet new design challenges. In the automotive industry, researchers in their effort to reduce emissions and satisfy environmental regulations, have shifted their focus to new emerging materials such as high-strength aluminium alloys, metal matrix composites, plastics, polymers and of late, Austempered Ductile Iron (ADI). ADI is a good choice for design where the criterion is high performance at reduced weight and cost. The unique, ausferrite microstructure gives the material desirable material properties and an edge over other materials. A comparative study of ADI in terms of materials properties and machining characteristics with other materials is desirable to highlight the potential of the material. This paper focuses on a comparative assessment of material and machining characteristics of ADI for different applications. The properties under consideration are machinability, weight and cost savings and versatility. ADI has a higher strength-to-weight ratio than aluminium making it a ready alternative for material selection. In terms of machinability, there are some problems associated with machining of ADI due to its work hardening nature. This paper attempts to identify the possible potential applications of ADI, by critically reviewing specific applications such as machinability, overall economics and service.

Assessment of spatiotemporal varying relationships between rainfall, land cover and surface water area using geographically weighted regression

Traditional regression techniques such as ordinary least squares (OLS) are often unable to accurately model spatially varying data and may ignore or hide local variations in model coefficients. A relatively new technique, geographically weighted regression (GWR) has been shown to greatly improve model performance compared to OLS in terms of higher R 2 and lower corrected Akaike information criterion (AICC). GWR models have the potential to improve reliabilities of the identified relationships by reducing spatial autocorrelations and by accounting for local variations and spatial non-stationarity between dependent and independent variables. In this study, GWR was used to examine the relationship between land cover, rainfall and surface water habitat in 149 sub-catchments in a predominately agricultural region covering 2.6 million ha in southeast Australia. The application of the GWR models revealed that the relationships between land cover, rainfall and surface water habitat display significant spatial non-stationarity. GWR showed improvements over analogous OLS models in terms of higher R 2 and lower AICC. The increased explanatory power of GWR was confirmed by the results of an approximate likelihood ratio test, which showed statistically significant improvements over analogous OLS models. The models suggest that the amount of surface water area in the landscape is related to anthropogenic drainage practices enhancing runoff to facilitate intensive agriculture and increased plantation forestry. However, with some key variables not present in our analysis, the strength of this relationship could not be qualified. GWR techniques have the potential to serve as a useful tool for environmental research and management across a broad range of scales for the investigation of spatially varying relationships.

Developing robust assessment criteria for postgraduate research oriented papers

Assessment criteria designed to fully evaluate prescribed learning outcomes is a significant aid to both student and staff alike. For the student, it allows them to fully understand the requirements for a specific grade and for staff, it simplifies marking (grading) and minimises the likelihood of student appeals against assessment. Whilst criterion referencing is common place in the more traditional analytical type taught papers common in the Engineering degree curriculum it is perhaps less commonly utilised for research based papers. Presented here is a case study where both learning outcomes and achievement criteria have been proposed for a postgraduate research methodology paper which prepares students for their thesis. It has significant cross over to a descriptor for the thesis paper itself and is considered a template which could be equally applied to other subject domains where research methodology is taught.

Role assessment of GIS analysis and its reliability while ranking urban sustainability using scenarios specific to regional climate, community and culture

Urban Sustainability expresses the level of conservation of a city while living a town or consuming its urban resources, but the measurement of urban sustainability depends on what are considered important indicators of conservation besides the permitted levels of consumption in accordance with adopted criteria. This criterion should have common factors that are shared for all the members tested or cities to be evaluated as in this particular case for Abu Dhabi, but also have specific factors that are related to the geographic place, community and culture, that is the measures of urban sustainability specific to a middle east climate, community and culture where GIS Vector and Raster analysis have a role or add a value in urban sustainability measurements or grading are considered herein. Scenarios were tested using various GIS data types to replicate urban history (ten years period), current status and expected future of Abu Dhabi City setting factors to climate, community needs and culture. The useful Vector or Raster GIS data sets that are related to every scenario where selected and analysed in the sense of how and how much it can benefit the urban sustainability ranking in quantity and quality tests, this besides assessing the suitable data nature, type and format, the important topology rules to be considered, the useful attributes to be added, the relationships which should be maintained between data types of a geo- database, and specify its usage in a specific scenario test, then setting weights to each and every data type representing some elements of a phenomenon related to urban suitability factor. The results of assessing the role of GIS analysis provided data collection specifications such as the measures of accuracy reliable to a certain type of GIS functional analysis used in an urban sustainability ranking scenario tests. This paper reflects the prior results of the research that is conducted to test the multidiscipline evaluation of urban sustainability using different indicator metrics, that implement vector GIS Analysis and Raster GIS analysis as basic tools to assist the evaluation and increase of its reliability besides assessing and decomposing it, after which a hypothetical implementation of the chosen evaluation model represented by various scenarios was implemented on the planned urban sustainability factors for a certain period of time to appraise the expected future grade of urban sustainability and come out with advises associated with scenarios for assuring gap filling and relative high urban future sustainability. The results this paper is reflecting are concentrating on the elements of vector and raster GIS analysis that assists the proper urban sustainability grading within the chosen model, the reliability of spatial data collected; analysis selected and resulted spatial information. Starting from selecting some important indicators to comprise the model which include regional culture, climate and community needs an example of what was used is Energy Demand & Consumption (Cooling systems). Thus, this factor is related to the climate and it‟s regional specific as the temperature varies around 30-45 degrees centigrade in city areas, GIS 3D Polygons of building data used to analyse the volume of buildings, attributes „building heights‟, estimate the number of floors from the equation, following energy demand was calculated and consumption for the unit volume, and compared it in scenario with possible sustainable energy supply or using different environmental friendly cooling systems this is followed by calculating the cooling system effects on an area unit selected to be 1 sq. km, combined with the level of greenery area, and open space, as represented by parks polygons, trees polygons, empty areas, pedestrian polygons and road surface area polygons. (initial measures showed that cooling system consumption can be reduced by around 15 -20 % with a well-planned building distributions, proper spaces and with using environmental friendly products and building material, temperature levels were also combined in the scenario extracted from satellite images as interpreted from thermal bands 3 times during the period of assessment. Other examples of the assessment of GIS analysis to urban sustainability took place included Waste Productivity, some effects of greenhouse gases measured by the intensity of road polygons and closeness to dwelling areas, industry areas as defined from land use land cover thematic maps produced from classified satellite images then vectors were created to take part in defining their role within the scenarios. City Noise and light intensity assessment was also investigated, as the region experiences rapid development and noise is magnified due to construction activities, closeness of the airports, and highways. The assessment investigated the measures taken by urban planners to reduce degradation or properly manage it. Finally as a conclusion tables were presented to reflect the scenario results in combination with GIS data types, analysis types, and the level of GIS data reliability to measure the sustainability level of a city related to cultural and regional demands.

Does student engagement in self-assessment calibrate their judgement over time?

One of the implicit aims of higher education is to enable students to become better judges of their own work. This paper examines whether students who voluntarily engage in self-assessment improve in their capacity to make those judgements. The study utilises data from a web-based marking system that provides students with the opportunity to assess themselves on each criterion for each assessment task throughout a programme of study. Student marks were compared with those from tutors to plot changes over time. The findings suggest that overall students’ judgements do converge with those of tutors, but that there is considerable variation across achievement levels, with weaker students showing little improvement. Whilst the study is limited by the exigencies of voluntary participation and thus consequential gaps in the data set, it shows how judgement over time can be demonstrated and points to the potential for more systematic interventions to improve students’ judgements. It also illustrates the use of the web-based marking and feedback software (ReView) that has considerable utility in aiding self-assessment research.

Lecturing and other face-to-face teaching – too much or too little? An assessment based on student feedback and fail rates

Institutes of higher learning are tending to reduce the amount of face-to-face teaching that they offer, and particularly through the traditional pedagogical method of lecturing. There is ongoing debate about the educational value of lectures as a teaching approach, in terms of both whether they facilitate understanding of subject material and whether they augment the student educational experience. In this study, student evaluation of teaching scores plus academic outcome (percentage of students who fail) was assessed for 236 course units offered by a science faculty at an Australian university over the course of one year. These measures were related to the degree to which lectures and other face-to-face teaching were used in these units, controlling for factors such as class size, school and year level. An information-theoretic model selection approach was employed to identify the best models and predictors of student assessments and fail rates. All the top models of student feedback included a measure reflecting amount of face-to-face teaching, with the evaluation of quality of teaching being higher in units with higher proportions of lectures. However, these models explained only 12–20% of the variation in student evaluation scores, suggesting that many other factors come into play. By contrast, units with fewer lectures have lower failure rates. These results suggest that moving away from lectures and face-to-face teaching may not harm, and indeed may improve the number of students who pass the subject, but that this may be incurred at the expense of greater dissatisfaction in students' learning experience.

'Hands-on' assessment: a useful strategy for improving patient safety in emergency departments

BACKGROUND: Patient assessment is an essential nursing intervention that reduces the incidence and impact of errors and preventable adverse events in emergency departments (EDs). This paper reports on a key finding of the ED nurse component of a larger study investigating how registered nurses manage 'discontinuities' or 'gaps' in patient care. METHODS: The larger study was undertaken as a naturalistic inquiry using a qualitative exploratory descriptive approach. Data were collected from a criterion-based purposeful sample of 71 nurses, of which 19 were ED nurses, and analysed using content and thematic analysis strategies. RESULTS: The component of the study reported here revealed that ED nurses used 'hands-on', head-to-toe assessment to manage gaps in patient care. Examination of the data revealed three key dimensions of patient assessment in the ED: (i) assessment is the 'bread and butter' of emergency nursing; (ii) 'hands-on' assessment techniques are irreplaceable and, (iii) patient assessment is undervalued in EDs. CONCLUSIONS: The findings of this study reaffirm the role of 'hands-on' observation and assessment in creating safety in EDs. Further research and inquiry is needed to determine how health care systems can provide the conditions for ensuring that 'hands-on' assessment occurs.