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.

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.

A comprehensive assessment of self -report experiences of adoptive parents of special needs children in Florida

Adoption of special needs children is now seen as a life long event whereby the adoptive child and family have unique needs. The need for postplacement resources throughout the life cycle of the adoption process is evident. This exploratory-descriptive research employed a random stratified cross-sectional design. The purpose of the study was to describe, identify, examine, and assess the relative influence of identified empirically and conceptually relevant variables of self-report experiences of adoptive parents of special needs children. Primary areas of exploration included: (1) adoptive children and families' characteristics, (2) postplacement service needs, utilization and satisfaction, and (3) adoptive parents' perceptions of their adoption experiences. A proportionate stratified random mail survey was used to obtain 474 families who had adopted special needs children from the 15 geographic districts which make up the state adoption social service agency in Florida. A 144-item survey questionnaire was used to collect basic information on demographic data, service provision, and adoption experiences. Four research questions were analyzed to test the effect the predictor variables had on willingness to adopt another special needs child, successful adoption, satisfying experience, and realism about problems. All four research questions revealed that the full model and the child's antecedent and the adoptive parents' intervening variable blocks were significant in explaining the variance in the dependent variables. The child's intervening variables alone were only significant in explaining the variance for one of the dependent variables. The results of the statistical analysis on the fifth research question and the three hypotheses determined that (1) only one postplacement service, crisis intervention, had a statistically significant impact on the adoptive parents' perceived level of satisfaction with the adoption experience; (2) adoptive parents who rate their adoption as successful are more likely to express a desire to adopt another special needs child; (3) the more adequate information on the child the adoptive parents perceived that they had prior to placement, the more they perceived they were realistic about the problems they would encounter; and (4) six specific postplacement services were found to be significant in predicting successful adoptions--crisis intervention, outpatient drug/alcohol treatment, maintenance subsidy, physical therapy, special medical equipment, and family counseling. Implications for the social work field and future research are discussed. ^

Factors affecting the alignment of *grades and reading scores for third-grade students on the Florida Comprehensive Assessment Test

The purpose of this study was to aid in understanding the relationship between current Reading report card grading practices and standards-based state standardized testing results in Reading and factors associated with the alignment of this relationship. Report card and Florida Comprehensive Assessment Test (FLAT) data for 2004 were collected for 1064 third grade students in nine schools of one feeder pattern in Florida's Miami-Dade County Public Schools. A Third Grade Teacher Questionnaire was administered to 48 Reading teachers. The questionnaire contained items relating to teachers' education, teaching experience, grading practices, and beliefs about the FCAT, instructional Reading activities, methods, and materials. ^ Findings of this study support a strong relationship between report card grades and FCAT Reading achievement levels. However, individual school correlational analysis showed significant differences among schools' alignment measures. Higher teacher alignment between grades and FCAT levels was associated with teachers spending more time on individualized methods of Reading instruction and to teachers feeling there was not enough time to teach and help individual students. Lower teacher alignment of grades and achievement levels was associated with teachers taking homework into account in the final Reading grade. Teacher alignment of grades and achievement levels was not associated with teacher beliefs concerning the FCAT, instructional activities in Reading and Language Arts, the Reading program used, the model of delivery of the Reading program, instruction or type of instructional planning done by the teachers. ^ This study highlights the need for further investigations related to determining additional teacher factors that may affect the alignment relationship between report card grades and standards-based state standardized testing results. ^

A relationship between the Florida Comprehensive Assessment Test 2.0 mathematics scores and racial and ethnic concentration when considering socio-economic status, ESOL student population, and school climate

From the moment children are born, they begin a lifetime journey of learning about themselves and their surroundings. With the establishment of the No Child Left Behind Act of 2001, it mandates that all children receive a high-quality education in a positive school climate. Regardless of the school the child attends or the neighborhood in which the child lives, proper and quality education and resources must be provided and made available in order for the child to be academically successful. The purpose of this ex post facto study was to investigate the relationship between the FCAT 2.0 mathematics scores of public middle school students in Miami-Dade County, Florida and the concentrations of a school's racial and ethnic make-up (Whites, Blacks, and Hispanics), English for Speakers of other Languages (ESOL) population, socio-economic status (SES), and school climate. The research question of this study was: Is there a significant relationship between the FCAT 2.0 Mathematics scores and racial and ethnic concentration of public middle school students in Miami-Dade County when controlling SES, ESOL student population, and school climate for the 2010-2011 school year? The instruments used to collect the data were the FCAT 2.0 and Miami-Dade County Public Schools (M-DCPS) School Climate Survey. The study found that Economically Disadvantaged (SES) students socio-economic status had the strongest correlation with the FCAT 2.0 mathematics scores (r = -.830). The next strongest correlation was with the number of students who agreed that their school climate was positive and helped them learn (r = .741) and the third strongest correlation was a school percentage of White students (r = .668). The study concluded that the FCAT 2.0 mathematics scores of M-DCPS middle school students have a significant relationship with socio-economic status, school climate, and racial concentration.