Assessing caries status according to the CAST instrument and WHO criterion in epidemiological studies

ABSTRACT: Background: The Caries Assessment Spectrum and Treatment (CAST) is a new epidemiological instrument for detection and treatment of dental caries. Worldwide, the WHO criterion constitutes the epidemiological tool most commonly used for caries detection. The objective of the present study is to determine the levels of similarity and difference between the CAST instrument and WHO criterion on the basis of caries prevalence, dmf/DMF counts, examination time and reporting of results. Methods: An epidemiological survey was carried out in Brazil among 6-11-year-old schoolchildren. Time of examinations was recorded. dmft, dmfs, DMFT and DMFS counts and dental caries prevalence were obtained according to the WHO criterion and the CAST instrument, as well the correlation coefficient between the two instruments. Results: Four hundred nineteen children were examined. dmft and dmfs counts were 1.92 and 5.31 (CAST), 1.99 and 5.34 (WHO) with correlation coefficients (r) of 0.95 and 0.93, respectively. DMFT and DMFS counts were 0.20 and 0.33 (CAST), 0.19 and 0.30 (WHO), with r = 0.78 and r=0.72, respectively. Kappa coefficient values for intra-examiner consistency were CAST = 0.91-0.92; WHO = 0.95-0.96 and those for inter-examiner consistency were CAST = 0.90-0.96; WHO = 0.94-1.00. Mean time spent on applying CAST and WHO were 66.3 and 64.7 sec, respectively p = 0.26. The prevalence of dental caries using CAST (codes 2, 5-8) and the WHO criterion for the primary dentition were 63.0% and 65.9%, respectively, and for the permanent dentition they were 12.7% and 12.8%, respectively. Conclusions: The CAST instrument provided similar prevalence of dental caries values and dmf/DMF counts as the WHO criterion in this age group. Time spent on examining children was identical for both caries assessment methods. Presentation of results from use of the CAST instrument, in comparison to WHO criterion, allowed a more detailed reporting of stages of dental caries, which will be useful for oral health planners.

Bia’s smile: an health education instrument on cleft lip and palate

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Two roads to planet detection

One of the most exciting discoveries in astrophysics of the last last decade is of the sheer diversity of planetary systems. These include "hot Jupiters", giant planets so close to their host stars that they orbit once every few days; "Super-Earths", planets with sizes intermediate to those of Earth and Neptune, of which no analogs exist in our own solar system; multi-planet systems with planets smaller than Mars to larger than Jupiter; planets orbiting binary stars; free-floating planets flying through the emptiness of space without any star; even planets orbiting pulsars. Despite these remarkable discoveries, the field is still young, and there are many areas about which precious little is known. In particular, we don't know the planets orbiting Sun-like stars nearest to our own solar system, and we know very little about the compositions of extrasolar planets. This thesis provides developments in those directions, through two instrumentation projects.

The first chapter of this thesis concerns detecting planets in the Solar neighborhood using precision stellar radial velocities, also known as the Doppler technique. We present an analysis determining the most efficient way to detect planets considering factors such as spectral type, wavelengths of observation, spectrograph resolution, observing time, and instrumental sensitivity. We show that G and K dwarfs observed at 400-600 nm are the best targets for surveys complete down to a given planet mass and out to a specified orbital period. Overall we find that M dwarfs observed at 700-800 nm are the best targets for habitable-zone planets, particularly when including the effects of systematic noise floors caused by instrumental imperfections. Somewhat surprisingly, we demonstrate that a modestly sized observatory, with a dedicated observing program, is up to the task of discovering such planets.

We present just such an observatory in the second chapter, called the "MINiature Exoplanet Radial Velocity Array," or MINERVA. We describe the design, which uses a novel multi-aperture approach to increase stability and performance through lower system etendue, as well as keeping costs and time to deployment down. We present calculations of the expected planet yield, and data showing the system performance from our testing and development of the system at Caltech's campus. We also present the motivation, design, and performance of a fiber coupling system for the array, critical for efficiently and reliably bringing light from the telescopes to the spectrograph. We finish by presenting the current status of MINERVA, operational at Mt. Hopkins observatory in Arizona.

The second part of this thesis concerns a very different method of planet detection, direct imaging, which involves discovery and characterization of planets by collecting and analyzing their light. Directly analyzing planetary light is the most promising way to study their atmospheres, formation histories, and compositions. Direct imaging is extremely challenging, as it requires a high performance adaptive optics system to unblur the point-spread function of the parent star through the atmosphere, a coronagraph to suppress stellar diffraction, and image post-processing to remove non-common path "speckle" aberrations that can overwhelm any planetary companions.

To this end, we present the "Stellar Double Coronagraph," or SDC, a flexible coronagraphic platform for use with the 200" Hale telescope. It has two focal and pupil planes, allowing for a number of different observing modes, including multiple vortex phase masks in series for improved contrast and inner working angle behind the obscured aperture of the telescope. We present the motivation, design, performance, and data reduction pipeline of the instrument. In the following chapter, we present some early science results, including the first image of a companion to the star delta Andromeda, which had been previously hypothesized but never seen.

A further chapter presents a wavefront control code developed for the instrument, using the technique of "speckle nulling," which can remove optical aberrations from the system using the deformable mirror of the adaptive optics system. This code allows for improved contrast and inner working angles, and was written in a modular style so as to be portable to other high contrast imaging platforms. We present its performance on optical, near-infrared, and thermal infrared instruments on the Palomar and Keck telescopes, showing how it can improve contrasts by a factor of a few in less than ten iterations.

One of the large challenges in direct imaging is sensing and correcting the electric field in the focal plane to remove scattered light that can be much brighter than any planets. In the last chapter, we present a new method of focal-plane wavefront sensing, combining a coronagraph with a simple phase-shifting interferometer. We present its design and implementation on the Stellar Double Coronagraph, demonstrating its ability to create regions of high contrast by measuring and correcting for optical aberrations in the focal plane. Finally, we derive how it is possible to use the same hardware to distinguish companions from speckle errors using the principles of optical coherence. We present results observing the brown dwarf HD 49197b, demonstrating the ability to detect it despite it being buried in the speckle noise floor. We believe this is the first detection of a substellar companion using the coherence properties of light.

Three flying saucers

Three Flying Saucers is wall mounted set of three works which parody the iconic kitsch set of three flying ducks which inhabit the walls of many houses from the 1950’s to today. The project proposes a time in the future where contact with alien intelligent life has been established and we have finally obtained proof that Flying Saucers were real and had been visiting our world for many decades. Now these mysterious celestial forms have been adopted as the new kitsch and adorn the homes of the future.

Extended studies on fibre diameter measurement with OFDA instrument

OFDA 2000 is a widely used fibre diameter measurement instrument. The instrument can provide improved statistical accuracy measurements in comparison with traditional technology. In this paper, a new technique has been developed to enable fibre diameters to be measured in an aqueous environment using the OFDA 2000 instrument. This new technique was utilised to assess the effects of pH and temperature on the diameters of Merino wool fibres in aqueous environments. Significant changes in fibre diameter under aqueous conditions were found as a function of pH and temperature. It is also demonstrated in this paper that the fibre diameter measurement results can be affected by fibre colour. In both dry and aqueous conditions, variation in fibre diameter was observed on fibres with different colours. This could be due to an optical effect or more likely due to physical changes in the dyed fibres as a result of the presence of dyes. Apart from their physical bulk, dyes may also affect the water content of fibres and hence have an influence on the swelling of fibres when they are measured under ambient regain and wet conditions.

RSSI-based localization of a wireless sensor node with a flying robot

We consider the problem of navigating a ying robot to a specific sensor node within a wireless sensor network. This target sensor node periodically sends out beacons. The robot is capable of sensing the received signal strength of each received beacon (RSSI measurements). Existing approaches for solving the sensor spotting problem with RSSI measurements do not deal with noisy channel conditions and/or heavily depend on additional hardware capabilities. In this work we reduce RSSI uctuations due to noise by continuously sampling RSSI values and maintaining an exponential moving average (EMA). The EMA values enable us to detect significant decrease of the received signal strength. In this case it is reasoned that the robot is moving away from the sensor. We present two basic variants to decide a new moving direction when the robot moves away from the sensor. Our simulations show that our approaches outperform competing algorithms in terms of success rate and ight time. Infield experiments with real hardware, a ying robocopter successfully and quickly landed near a sensor placed in an outdoor test environment. Traces show robustness to additional environmental factors not accounted for in our simulations.

Measuring nursing competencies in the operating theatre: instrument development and psychometric analysis using Item Response Theory

BACKGROUND: Concern about the process of identifying underlying competencies that contribute to effective nursing performance has been debated with a lack of consensus surrounding an approved measurement instrument for assessing clinical performance. Although a number of methodologies are noted in the development of competency-based assessment measures, these studies are not without criticism. RESEARCH AIM: The primary aim of the study was to develop and validate a Performance Based Scoring Rubric, which included both analytical and holistic scales. The aim included examining the validity and reliability of the rubric, which was designed to measure clinical competencies in the operating theatre. RESEARCH METHOD: The fieldwork observations of 32 nurse educators and preceptors assessing the performance of 95 instrument nurses in the operating theatre were used in the calibration of the rubric. The Rasch model, a particular model among Item Response Models, was used in the calibration of each item in the rubric in an attempt at improving the measurement properties of the scale. This is done by establishing the 'fit' of the data to the conditions demanded by the Rasch model. RESULTS: Acceptable reliability estimates, specifically a high Cronbach's alpha reliability coefficient (0.940), as well as empirical support for construct and criterion validity for the rubric were achieved. Calibration of the Performance Based Scoring Rubric using Rasch model revealed that the fit statistics for most items were acceptable. CONCLUSION: The use of the Rasch model offers a number of features in developing and refining healthcare competency-based assessments, improving confidence in measuring clinical performance. The Rasch model was shown to be useful in developing and validating a competency-based assessment for measuring the competence of the instrument nurse in the operating theatre with implications for use in other areas of nursing practice.

Validity and reliability of a pictorial instrument for assessing perceived motor competence in Portuguese children

BACKGROUND: It is important to assess young children's perceived Fundamental Movement Skill (FMS) competence in order to examine the role of perceived FMS competence in motivation toward physical activity. Children's perceptions of motor competence may vary according to the culture/country of origin; therefore, it is also important to measure perceptions in different cultural contexts. The purpose was to assess the face validity, internal consistency, test-retest reliability and construct validity of the 12 FMS items in the Pictorial Scale for Perceived Movement Skill Competence for Young Children (PMSC) in a Portuguese sample.

METHODS: Two hundred one Portuguese children (girls, n = 112), 5 to 10 years of age (7.6 ± 1.4), participated. All children completed the PMSC once. Ordinal alpha assessed internal consistency. A random subsamples (n = 47) were reassessed one week later to determine test-retest reliability with Bland-Altman method. Children were asked questions after the second administration to determine face validity. Construct validity was assessed on the whole sample with a Bayesian Structural Equation Modelling (BSEM) approach. The hypothesized theoretical model used the 12 items and two hypothesized factors: object control and locomotor skills.

RESULTS: The majority of children correctly identified the skills and could understand most of the pictures. Test-retest reliability analysis was good, with an agreement ration between 0.99 and 1.02. Ordinal alpha values ranged from acceptable (object control 0.73, locomotor 0.68) to good (all FMS 0.81). The hypothesized BSEM model had an adequate fit.

CONCLUSIONS: The PMSC can be used to investigate perceptions of children's FMS competence. This instrument can also be satisfactorily used among Portuguese children.

Adaptation and validation of a survey instrument measuring perceived preparedness of nursing graduates

BACKGROUND: In Australia, a significant percentage of bachelor of nursing students are employed in the aged care sector, or in aged care settings, as assistants in nursing (AINs) or personal care assistants. However the value of aged care in nursing education is often overlooked. AIM: To outline the adaptation and validation of a survey, originally developed for medical graduates, for use with nursing graduates. DISCUSSION: Adaptation of the instrument was undertaken as part of a doctoral study that aimed to explore whether employment as an undergraduate assistant in nursing (AIN) in aged care prepares new graduates for clinical work. CONCLUSION: Outlining each step of the modification process can help nurse researchers who want to adapt existing instruments to meet their research objectives. IMPLICATIONS FOR PRACTICE: Undergraduate AIN employment has the potential to supplement clinical learning without the restrictions inherent in the student role. Furthermore, it has the potential to enhance recruitment and retention in the aged care sector.

Developing a Process to Create and Validate an Instrument Assessing Student Attainment of Competencies at an Intercultural University in Mexico

This study took place at one of the intercultural universities (IUs) of Mexico that serve primarily indigenous students. The IUs are pioneers in higher education despite their numerous challenges (Bertely, 1998; Dietz, 2008; Pineda & Landorf, 2010; Schmelkes, 2009). To overcome educational inequalities among their students (Ahuja, Berumen, Casillas, Crispín, Delgado et al., 2004; Schmelkes, 2009), the IUs have embraced performance-based assessment (PBA; Casillas & Santini, 2006). PBA allows a shared model of power and control related to learning and evaluation (Anderson, 1998). While conducting a review on PBA strategies of the IUs, the researcher did not find a PBA instrument with valid and reliable estimates. The purpose of this study was to develop a process to create a PBA instrument, an analytic general rubric, with acceptable validity and reliability estimates to assess students’ attainment of competencies in one of the IU’s majors, Intercultural Development Management. The Human Capabilities Approach (HCA) was the theoretical framework and a sequential mixed method (Creswell, 2003; Teddlie & Tashakkori, 2009) was the research design. IU participants created a rubric during two focus groups, and seven Spanish-speaking professors in Mexico and the US piloted using students’ research projects. The evidence that demonstrates the attainment of competencies at the IU is a complex set of actual, potential and/or desired performances or achievements, also conceptualized as “functional capabilities” (FCs; Walker, 2008), that can be used to develop a rubric. Results indicate that the rubric’s validity and reliability estimates reached acceptable estimates of 80% agreement, surpassing minimum requirements (Newman, Newman, & Newman, 2011). Implications for practice involve the use of PBA within a formative assessment framework, and dynamic inclusion of constituencies. Recommendations for further research include introducing this study’s instrument-development process to other IUs, conducting parallel mixed design studies exploring the intersection between HCA and assessment, and conducting a case study exploring assessment in intercultural settings. Education articulated through the HCA empowers students (Unterhalter & Brighouse, 2007; Walker, 2008). This study aimed to contribute to the quality of student learning assessment at the IUs by providing a participatory process to develop a PBA instrument.

The inter-rater reliability of the Risk Instrument for Screening in the Community

Predicting risk of adverse healthcare outcomes is important to enable targeted delivery of interventions. The Risk Instrument for Screening in the Community (RISC), designed for use by public health nurses (PHNs), measures the one-year risk of hospitalisation, institutionalisation and death in community-dwelling older adults according to a five-point global risk score: from low (score 1,2), medium (3) and high (4,5). We examined the inter-rater reliability (IRR) of the RISC between student PHNs (n=32) and expert raters using six cases (two low, medium and high-risk), scored before and after RISC training. Correlations increased for each adverse outcome, statistically significantly for institutionalisation (r=0.72 to 0.80,p=0.04) and hospitalisation, (r=0.51 to 0.71,p<0.01) but not death. Training improved accuracy for low-risk but not all high-risk cases. Overall, the RISC showed good IRR, which increased after RISC training. That reliability reduced for some high-risk cases suggests that the training programme requires adjustment to further improve IRR.

Quality in palliative care from the patient perspective : Instrument development, perceptions of care received and the importance of care

The overall aim was to investigate the quality of palliative care from the patient perspective, to adapt and psychometrically evaluate the Quality from Patients’ Perspective instrument specific to palliative care (QPP-PC) and investigate the relationship between the combination of person- and organization-related conditions and patients’ perceptions of care quality. Methods: In the systematic literature review (I), 23 studies from 6 databases and reference lists in 2014 were synthesized by integrative thematic analysis. The quantitative studies (II–IV) had cross-sectional designs including 191 patients (73% RR) from hospice inpatient care, hospice day care, palliative units in nursing homes and home care in 2013–2014. A modified version of QPP was used. Additionally, person- and organization-related conditions were assessed. Psychometric evaluation, descriptive and inferential statistics were used. Main findings: Patients’ preferences for palliative care included living a meaningful life and responsive healthcare personnel, care environment and organization of care (I). The QPP-PC was developed, comprising 12 factors (49 items), 3 single items and 4 dimensions: medical–technical competence, physical–technical conditions, identity–oriented approach, and socio-cultural atmosphere (II). QPP-PC measured patients’ perceived reality (PR) and subjective importance (SI) of care quality. PR differed across settings, but SI did not (III). All settings exhibited areas of strength and for improvement (II, III). Person-related conditions seemed to be related to SI, and person- and organization-related conditions to PR, explaining 18–30 and 22-29% respectively of the variance (IV). Conclusions: The patient perspective of care quality (SI and PR) should be integrated into daily care and improvement initiatives in palliative care. The QPP-PC can measure patients’ perceptions of care quality. Registered nurses and other healthcare personnel need awareness of person- and organization-related conditions to provide high-quality person-centred care.