Comprehensive assessment of the fitness of older people for chemotherapy

Purpose: To present the results of a mixed-method study comparing the level of agreement of a two-phased, nurse-administered Comprehensive Geriatric Assessment (CGA) with current methods that assess the fitness for chemotherapy of older cancer patients. A nurse-led model of multidisciplinary cancer care based on the results is also described. Methods: The two phases comprised initial screening by a nurse with the Vulnerable Elders Survey-13 [VES-13], followed by nurse administration of a detailed CGA. Both phases were linked to a computerised algorithm categorising the patient as ‘fit’, ‘vulnerable’ or ‘frail’. The study determined the level of agreement between VES-13- and CGA-determined categories; and between the CGA and the physicians’ assessments. It also compared the CGA’s predictive abilities in terms of subsequent treatment toxicity; while interviews determined the acceptability of the nurse-led procedure from key stakeholders' perspectives. Results: Data collection was completed in December 2011. The results will be presented at the conference. A consecutive-series n=170 will be enrolled, 33% of whom are ‘fit’; 33% ‘vulnerable’; and 33% ‘too frail’ for treatment. This sample can detect, with 90% power, kappa coefficients of agreement of ≥ 0.70 or higher (“substantial agreement”). Fitness sub-group comparisons of agreement between the medical oncologist and the nurse assessments can detect kappa estimates of Κ ≥ 0.80 with the same power. Conclusion: The results have informed a nurse-led model of cancer care. It meets a clear need to develop, implement and test a nurse-led, robust, evidence-based, clinically-justifiable and economically-feasible CGA process that has relevance in national and international contexts.

Comprehensive assessment of alcohol-related brain damage (ARBD): gap or chasm in the evidence?

Alcohol-related brain damage (ARBD) is primarily caused by chronic alcohol misuse and thiamine deficiency, and results in a broad range of impairments. Despite the increasing incidence of ARBD in the UK in recent decades, it is currently underdiagnosed, managed inappropriately and treated inadequately. Moreover, information about assessments for individuals with ARBD is currently absent from clinical guidelines and policy documents. The aim of this paper was to review the evidence relating to the neurological, neuropsychological, psychosocial, physical and nutritional assessment of individuals with ARBD to identify appropriate assessment tools that could be used to measure and monitor the impact of ARBD over time. A systematic online database search revealed a total of 160 separate references, 133 of which were rejected and two of which could not be accessed. Twenty-five papers were included in the review, including six neuroimaging studies, 17 neuropsychological studies and two studies using psychosocial methods of assessment. A lack of evidence for nutritional and physical assessment of individuals with ARBD was found. The review findings are inconclusive; most instruments currently used in ARBD research have not specifically been validated for use within an ARBD context. Further research is required to identify comprehensive methods of ARBD assessment.

Lock, stock, and barrel: a comprehensive assessment of the determinants of terror

We assess the robustness of previous findings on the determinants of terrorism. Using extreme bound analysis, the three most comprehensive terrorism datasets, and focusing on the three most commonly analyzed aspects of terrorist activity, i.e., location, victim, and perpetrator, we re-assess the effect of 65 proposed correlates. Evaluating around 13.4 million regressions, we find 18 variables to be robustly associated with the number of incidents occurring in a given country-year, 15 variables with attacks against citizens from a particular country in a given year, and six variables with attacks perpetrated by citizens of a particular country in a given year.

Validation of comprehensive assessment of activities of daily living in stroke survivors

This study determined whether the Functional Independence Measure (FIM) and the Frenchay Activities Index (FAI) could be used together as a more comprehensive score to assess the activities of daily living (ADL) in stroke survivors. Subjects were recruited from stroke patients consecutively admitted to the inpatient neurology or rehabilitation department at a university hospital in southern Taiwan. We interviewed 209 first stroke survivors at least 1 year after stroke onset during their clinical visits, at home, or in long-term care institutions. Combinations of FIM and FAI as a comprehensive assessment of ADL were measured. All items of the FIM and the FAI were included in a non-parametric factor analysis to determine their underlying constructs. Two comprehensive functional independence scores were then computed as functions of the FIM and FAI scores. The distributional characteristics of the comprehensive scores were examined. Approximately 90% of the total variation was explained by three factors. One single factor comprised all the items from FIM, while the FAI items loaded on two other factors, suggesting that FIM supplements FAI without overlap in content. We further demonstrated that the presence of ceiling or floor effects when either the FIM or the FAI was used could be removed using combined scores of the two instruments. The FIM and the FAI assessed different domains with good construct validity. A comprehensive assessment of functional independence obtained by combining the FIM and the FAI scores is potentially more appropriate and useful for clinical and research applications in stroke patients.

Issues arising from the implementation of a comprehensive assessment approach in a large, multi-modal Bachelor of Commerce Unit

Recent literature in higher education argues university assessment has been too narrow and hasn’t adequately reflected the quality, breadth and depth of students’ learning. Research shows students often prioritise and learn what they need to know for formal, graded assessment and disregard other academic content seen as less relevant to those requirements. The predominance of essays and examinations has therefore tended to constrain learning. The case for a more comprehensive approach has been clearly articulated. So what happens when staff take up the unique challenge of designing fair and uniform assessment for a large, core, multi-modal, multi-campus unit offered nationally and internationally?
When developing an undergraduate Bachelor of Commerce unit at Deakin University, staff considered the most appropriate ways to assess a range of conceptual understandings and communication skills. This resulted in the mapping and adoption of a comprehensive approach incorporating teacher, peer, and self-assessment aspects, individual and group work, oral and written presentations, and the use of portfolios and journals. Particular practices were adopted to control workloads, ensure fairness in marking, and overcome some problems generally associated with group work. When implementing the approach, practical issues arose that demanded adjustments. This paper details the approach taken, outlines research activities, and discusses the practical implications of issues that arose.

Issues arising from the implementation of a comprehensive assessment approach in a large, multi-modal Bachelor of Commerce unit

Recent literature in higher education argues university assessment has been too narrow and hasn’t adequately reflected the quality, breadth and depth of students’ learning. Research shows students often prioritise and learn what they need to know for formal, graded assessment and disregard other academic content seen as less relevant to those requirements. The predominance of essays and examinations has therefore tended to constrain learning. The case for a more comprehensive approach has been clearly articulated. So what happens when staff take up the unique challenge of designing fair and uniform assessment for a large, core, multi-modal, multi-campus unit offered nationally and internationally?

When developing an undergraduate Bachelor of Commerce unit at Deakin University, staff considered the most appropriate ways to assess a range of conceptual understandings and communication skills. This resulted in the mapping and adoption of a comprehensive approach incorporating teacher, peer, and self-assessment aspects, individual and group work, oral and written presentations, and the use of portfolios and journals. Particular practices were adopted to control workloads, ensure fairness in marking, and overcome some problems generally associated with group work. When implementing the approach, practical issues arose that demanded adjustments. This paper details the approach taken, outlines research activities, and discusses the practical implications of issues that arose.

Comprehensive assessment of gesture production: a new test of upper limb apraxia (TULIA)

BACKGROUND: Only few standardized apraxia scales are available and they do not cover all domains and semantic features of gesture production. Therefore, the objective of the present study was to evaluate the reliability and validity of a newly developed test of upper limb apraxia (TULIA), which is comprehensive and still short to administer. METHODS: The TULIA consists of 48 items including imitation and pantomime domain of non-symbolic (meaningless), intransitive (communicative) and transitive (tool related) gestures corresponding to 6 subtests. A 6-point scoring method (0-5) was used (score range 0-240). Performance was assessed by blinded raters based on videos in 133 stroke patients, 84 with left hemisphere damage (LHD) and 49 with right hemisphere damage (RHD), as well as 50 healthy subjects (HS). RESULTS: The clinimetric findings demonstrated mostly good to excellent internal consistency, inter- and intra-rater (test-retest) reliability, both at the level of the six subtests and at individual item level. Criterion validity was evaluated by confirming hypotheses based on the literature. Construct validity was demonstrated by a high correlation (r = 0.82) with the De Renzi-test. CONCLUSION: These results show that the TULIA is both a reliable and valid test to systematically assess gesture production. The test can be easily applied and is therefore useful for both research purposes and clinical practice.

A comprehensive assessment of environmental ultraviolet radiation induced DNA damage in marine microorganisms

There is evidence that ultraviolet radiation (UVR) is increasing over certain locations on the Earth's surface. Of primary concern is the annual pattern of ozone depletion over Antarctica and the Southern Ocean. Reduction of ozone concentration selectively limits absorption of solar UV-B (290–320 nm), resulting in higher irradiance at the Earth's surface. The effects of ozone depletion on the human population and natural ecosystems, particularly the marine environment, are a matter of considerable concern. Indeed, marine plankton may serve as sensitive indicators of ozone depletion and UV-B fluctuations. Direct biological effects of UVR result from absorption of UV-B by DNA. Once absorbed, energy is dissipated by a variety of pathways, including covalent chemical reactions leading to the formation of photoproducts. The major types of photoproduct formed are cyclobutyl pyrimidine dimer (CPD) and pyrimidine(6-4)pyrimidone dimer [(6-4)PD]. Marine plankton repair these photoproducts using light-dependent photoenzymatic repair or nucleotide excision repair. The studies here show that fluctuations in CPD concentrations in the marine environment at Palmer Station, Antarctica correlate well with ozone concentration and UV-B irradiance at the Earth's surface. A comparison of photoproduct levels in marine plankton and DNA dosimeters show that bacterioplankton display higher resistance to solar UVR than phytoplankton in an ozone depleted environment. DNA damage in marine microorganisms was investigated during two separate latitudinal transects which covered a total range of 140°. We observed the same pattern of change in DNA damage levels in dosimeters and marine plankton as measured using two distinct quantitative techniques. Results from the transects show that differences in photosensitivity exist in marine plankton collected under varying UVR environments. Laboratory studies of Antarctic bacterial isolates confirm that marine bacterioplankton possess differences in survival, DNA damage induction, and repair following exposure to UVR. Results from DNA damage measurements during ozone season, along a latitudinal gradient, and in marine bacterial isolates suggest that changes in environmental UVR correlate with changes in UV-B induced DNA damage in marine microorganisms. Differences in the ability to tolerate UVR stress under different environmental conditions may determine the composition of the microbial communities inhabiting those environments. ^

The Comprehensive Assessment of Leadership for Learning: A Next Generation Formative Evaluation and Feedback System

Recent developments in federal policy have prompted the creation of state evaluation frameworks for principals and teachers that hold educators accountable for effective practices and student outcomes. These changes have created a demand for formative evaluation instruments that reflect current accountability pressures and can be used by schools to focus school improvement and leadership development efforts. The Comprehensive Assessment of Leadership for Learning (CALL) is a next generation, 360-degree on-line assessment and feedback system that reflect best practices in feedback design. Some unique characteristics of CALL include a focus on: leadership distributed throughout the school rather than as carried out by an individual leader; assessment of leadership tasks rather than perceptions of leadership practice; a focus on larger complex systems of middle and high school; and transparency of assessment design. This paper describes research contributing to the design and validation of the CALL survey instrument.

Was the ECB’s Comprehensive Assessment up to standard? CEPS Policy Brief No. 325, 10 November 2014

The Comprehensive Assessment conducted by the European Central Bank (ECB) represents a considerable step forward in enhancing transparency in euro-area banks’ balance sheets. The most notable progress since the previous European stress test has been the harmonisation of the definition of non-performing loans and other concepts as well as uncovering hidden losses, which resulted in a €34 billion aggregate capital-charge net of taxes. Despite this tightening, most banks were able to meet the 5.5% common equity tier 1 (CET1) threshold applied in the test, which suggests that the large majority of the euro-area banks have improved their financial position sufficiently that they should no longer be constrained in financing the economy. As shown in this CEPS Policy Brief by Willem Pieter de Groen, however, the detailed results provide a more nuanced picture: there remain a large number of the banks in the euro area that are still highly leveraged and in many cases unable to meet the regulatory capital requirements that will be introduced in the coming years under the adverse stress test scenario.

The effect of a reform on a school organizational culture after receiving a failing Florida Comprehensive Assessment Test rating

The purpose of this research was to explore the effects of a reform that took place in an elementary school during 2000/2001 as a result of a failure rating on the Florida Comprehensive Assessment Test on the structure and the personnel of the organization. ^ The exploration took place over a period of 10 months starting in August 2000 until June 2001. It focused on the effect of the failure rating on the: (a) structure and operation of the school; (b) morale, beliefs, behaviors, and daily lives of teachers and the principal; and (c) the effect of the reform effort on the leadership style of the principal, whether she became a transactional or a transformative leader. ^ The researcher assumed the role of a participant observer. Data sources were her personal recollections of major events that took place during the year of the reform, interviews, observations, and school documents. The sample included 15 teachers present during the time of the reform. Ten taught second through fifth grade. The remaining five participants were the music teacher, the counselor, and the writing, reading and technology specialists. Together they represented the instructional team or represented special education areas. ^ The findings indicated that the reform effort had an effect on the structure and the operation of the school. The changes included reorganization of the physical set up, changes in curriculum and instruction, changes in the means of communication among the staff, and the addition of new staff members including an official agent of change. The reform had a greater effect on the daily lives of teachers and their morale than on their beliefs and behaviors. Teachers reported that during the effort their daily lives were stressful and their morale very low due to the enormous expectations that they had to meet. On the other hand, the reform effort had a positive effect on the daily life, morale, beliefs, and behaviors of the principal. It energized her. She spoke positively about the change. She functioned as an effective, positive, resilient transactional leader who did what was necessary in order to enable the teachers to cope with the complex situation. ^

High Stakes and No Takers: The Impact of Florida Comprehensive Assessment Test (FCAT) Writing on Students’ and Teachers’ Perceptions of Writing

This ethnographic case study of ten students and their teachers concludes that the state writing test had a negative impact on students’ and teachers’ perceptions of writing in four categories: strengths and weaknesses in student writing, self-assessment of writing skills, factors impacting test scores, and motivation and attitudes toward writing.

Categorical Differences in Scores of Students with Disabilities on the Florida Comprehensive Assessment Test

Students with disabilities participate in statewide assessments as required by federal law, and the success of schools is contingent on this group making Adequate Yearly Progress. This report on research includes the findings of differences between disability categories scoring proficient on the FCAT from the years 2005 through 2010.