An evaluation of the performance of ten commercial luminometers

An assessment has been carried out of the relative performance of ten instruments for quantification of adenosine triphosphate (ATP) by the firefly luciferase assay. The instruments evaluated were Amersham Amerlite Analyser, Dynatech Tube Luminometer, Dynatech Multiplate Luminometer, Dynatech Camera Luminometer, Hamilton Lumicon, LKB 1250 Luminometer, LKB 1251 Luminometer, Lumac Biocounter M2010A, Turner 20 TD Luminometer and a prototype version of the CLEAR Speed Tech 2000. An 800-fold difference in sensitivity was found between the most sensitive (Lumac, Turner) and the least sensitive (Dynatech Tube) of the conventional instruments. The Dynatech Camera Luminometer which worked on a completely different principle to the other instruments was about 5000 times less sensitive than the best of the photomultiplier tube instruments. The relative sensitivity of the instruments was maintained regardless of whether solutions of ATP in water or trichloroacetic acid extracts of bacteria were analysed. An analysis of 960 ATP bioluminescence assays showed that data obtained from such measurements are normally distributed.     

Developing Item Banks for Measuring Pediatric Generic Health-Related Quality of Life: An Application of the International Classification of Functioning,Disability and Health for Children and Youth and Item Response Theory

The purpose of this study was to develop item banks by linking items from three pediatric health-related quality of life (HRQoL) instruments using a mixed methodology. Secondary data were collected from 469 parents of children aged 8-16 years. The International Classification of Functioning, Disability and Health-Children and Youth (ICF-CY) served as a framework to compare the concepts of items from three HRQoL instruments. The structural validity of the individual domains was examined using confirmatory factor analyses. Samejima''s Graded Response Model was used to calibrate items from different instruments. The known-groups validity of each domain was examined using the status of children with special health care needs (CSHCN). Concepts represented by the items in the three instruments were linked to 24 different second-level categories of the ICF-CY. Eight item banks representing eight unidimensional domains were created based on the linkage of the concepts measured by the items of the three instruments to the ICF-CY. The HRQoL results of CSHCN in seven out of eight domains (except personality) were significantly lower compared with children without special health care needs (p<0.05). This study demonstrates a useful approach to compare the item concepts from the three instruments and to generate item banks for a pediatric population.     

Improved responsiveness and reduced sample size requirements of PROMIS physical function scales with item response theory

Introduction  

The Health Assessment Questionnaire Disability Index (HAQ) and the SF-36 PF-10, among other instruments, yield sensitive and valid Disability (Physical Function) endpoints. Modern techniques, such as Item Response Theory (IRT), now enable development of more precise instruments using improved items. The NIH Patient Reported Outcomes Measurement Information System (PROMIS) is charged with developing improved IRT-based tools. We compared the ability to detect change in physical function using original (Legacy) instruments with Item-Improved and PROMIS IRT-based instruments.     

生态治理政策工具对农户行为的影响差异研究——以宁夏盐池县为例

政策工具被认为是政府为解决某个公共问题采取的具体手段或措施,一项政策可以视作目标和多种政策工具的组合。在生态治理过程中,不同政策工具对农户行为的刺激程度不同,进而导致不同的政策效果。分离不同政策工具的影响,可为工具选择和政策优化提供科学参考。以盐池县为例,利用基于该县1983-2017年内出台的316份生态政策文本构建的政策工具数据集和VAR模型中的脉冲响应和方差分解方法定量研究了强制型、混合型和自愿型三大类政策工具及十种子工具对农户耕作、放牧、造林3种行为的影响。结果表明：（1）政策工具对农户行为的影响具有时效性,一般在政策出台后2-3年内影响最大,随后逐渐减小并消失,影响持续时间为7-10年。（2）总体来看,政策工具对农户行为的冲击力度较小,冲击范围在0-0.30之间,说明农户行为还受到其他诸多因素的影响。（3）10年累计影响从大到小依次为强制型、混合型、自愿型,其中直接提供和规制两种子工具的影响最大。放牧行为受到政策工具的刺激最大,耕作行为次之,造林行为最小。（4）直接提供工具对耕作行为具有最大正向影响,最大冲击为0.30;规制工具在短期内抑制牲畜数量增长,而直接提供和补贴工具促进牲畜数量增长,且由于冲击曲线存在正负波动,说明政府与农户在牲畜养殖上存在长期博弈;只有规制工具对造林行为具有积极影响,说明造林更多是在政府的主导下进行。建议充分利用政策工具的短期效应,凸显政府角色,及时做好政策效果评估工作,调整工具组合,助力生态目标的实现。     

Interlaboratory comparison of Taq Nuclease Assays for the quantification of the toxic cyanobacteria Microcystis sp

The application of quantitative real-time PCR has been proposed for the quantification of toxic genotypes of cyanobacteria. We have compared the Taq Nuclease Assay (TNA) in quantifying the toxic cyanobacteria Microcystis sp. via the intergenic spacer region of the phycocyanin operon (PC) and mcyB indicative of the production of the toxic heptapeptide microcystin between three research groups employing three instruments (ABI7300, GeneAmp5700, ABI7500). The estimates of mcyB genotypes were compared using (i) DNA of a mcyB containing strain and a non-mcyB containing strain supplied in different mixtures across a low range of variation (0-10% of mcyB) and across a high range of variation (20-100%), and (ii) DNA from field samples containing Microcystis sp. For all three instruments highly significant linear regression curves between the proportion of the mcyB containing strain and the percentage of mcyB genotypes both within the low range and within the high range of mcyB variation were obtained. The regression curves derived from the three instruments differed in slope and within the high range of mcyB variation mcyB proportions were either underestimated (0-50%) or overestimated (0-72%). For field samples cell numbers estimated via both TNAs as well as mcyB proportions showed significant linear relationships between the instruments. For all instruments a linear relationship between the cell numbers estimated as PC genotypes and the cell numbers estimated as mcyB genotypes was observed. The proportions of mcyB varied from 2 to 28% and did not differ between the instruments. It is concluded that the TNA is able to provide quantitative estimates on mcyB genotype numbers that are reproducible between research groups and is useful to follow variation in mcyB genotype proportion occurring within weeks to months.     

Health outcome measures in atopic dermatitis: a systematic review of trends in disease severity and quality-of-life instruments 1985-2010

Background

A number of disease-severity and quality-of-life (QoL) instruments have emerged in atopic dermatitis (AD) in the last decade.

Objectives

To identify trends in outcomes instruments used in AD clinical trials and to provide a useful summary of the dimensions and validation studies for the most commonly used measures.

Method

All randomized control trials (RCTs) from 1985 to 2010 in the treatment of AD were examined.

Results

Among the 791 RCTs reviewed, we identified 20 disease-severity and 14 QoL instruments. Of these outcomes instruments, few have been validated. SCORAD, EASI, IGA and SASSAD were the most commonly used disease-severity instruments and CDLQI, DFI, DLQI and IDQOL were the most frequently used QoL measures.

Limitations

The small number of RCTs using QoL scales makes identifying trends for QoL instruments difficult.

Conclusion

Overall, there is an increase in the use of disease-severity and QoL instruments in AD clinical trials.     

New instruments for preparation of the prosthesis socket and primary stability of the acetabular Press-fit cups]

The aim of the present study was to develop surgical instruments necessary to achieve a precisely reamed surface and stable initial fixation. The instruments used to prepare the socket were a gauge-drill guide, a liner for the spigot hole and two spigotted reamers of different design and indentation intended to achieve a precisely reamed surface while preserving subchondral bone. For each reamer we implanted in a synthetic hip model 10 uncemented cups with 2 mm press-fit and loaded at 2.4 kN in the physiological axis (Mod. 8501, Instron, Canton, MA, USA). The micromotion between implant and bone socket was measured using an inductive micrometric measuring system (MultiNCDT-500, Micro-Epsilon, Ortenburg, Germany) and compared with that seen after using conventional instruments. The use of the new reamer of elliptical design significantly reduced the standard deviations of the measured values (p < 0.01 at the ischium and pubis) and also reduced maximum movement (p < 0.01 at the ischium); at the same time, all the components showed overall limited movement (< 150 microns at the ischium, pubis and ilium) under maximum loading (2.4 kN). Manufacturing tolerances, the quality and wear of the instruments, acetabular bone stock and surgical technique all impact on the degree of press-fit obtainable at surgery. The results of our study show that press-fit and initial stability can be optimized by using adequate instruments to prepare the socket.     

Evaluation of four hematology and a chemistry portable benchtop analyzers using non-human primate blood

Background  Near patient testing (NPT) and point-of-care testing (POCT) using portable benchtop analyzers has become necessary in many areas of the medical community, including biocontainment.
Methods  We evaluated the Beckman AcT diff, Abaxis Vetscan HMII (two instruments), Abbott Cell-Dyn 1800, and Abaxis Vetscan VS2 for within-run precision and correlation to central laboratory instruments using non-human primates blood.
Results  Compared with the central laboratory instruments, the Beckman AcT diff correlated on 80%; the HMII instruments on 31% and 44%, the CD1800 on 31%, and the VS2 on 71% of assays. For assays with published manufacturers precision guidelines, the AcT diff met all nine, the HMII instruments met one and six of six, and the CD 1800 met one of six.
Conclusions  Laboratories using NPT/POCT must test their individual instruments for precision and correlation, identify assays that are reliable, and exclude or develop supplemental procedures for assays that are not.     

How to select outcome measurement instruments for outcomes included in a “Core Outcome Set” – a practical guideline

BackgroundIn cooperation with the Core Outcome Measures in Effectiveness Trials (COMET) initiative, the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) initiative aimed to develop a guideline on how to select outcome measurement instruments for outcomes (i.e., constructs or domains) included in a “Core Outcome Set” (COS). A COS is an agreed minimum set of outcomes that should be measured and reported in all clinical trials of a specific disease or trial population.MethodsInformed by a literature review to identify potentially relevant tasks on outcome measurement instrument selection, a Delphi study was performed among a panel of international experts, representing diverse stakeholders. In three consecutive rounds, panelists were asked to rate the importance of different tasks in the selection of outcome measurement instruments, to justify their choices, and to add other relevant tasks. Consensus was defined as being achieved when 70 % or more of the panelists agreed and when fewer than 15 % of the panelists disagreed.ResultsOf the 481 invited experts, 120 agreed to participate of whom 95 (79 %) completed the first Delphi questionnaire. We reached consensus on four main steps in the selection of outcome measurement instruments for COS: Step 1, conceptual considerations; Step 2, finding existing outcome measurement instruments, by means of a systematic review and/or a literature search; Step 3, quality assessment of outcome measurement instruments, by means of the evaluation of the measurement properties and feasibility aspects of outcome measurement instruments; and Step 4, generic recommendations on the selection of outcome measurement instruments for outcomes included in a COS (consensus ranged from 70 to 99 %).ConclusionsThis study resulted in a consensus-based guideline on the methods for selecting outcome measurement instruments for outcomes included in a COS. This guideline can be used by COS developers in defining how to measure core outcomes.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1555-2) contains supplementary material, which is available to authorized users.     

Assessing Sleep Disturbance in Low Back Pain: The Validity of Portable Instruments

Although portable instruments have been used in the assessment of sleep disturbance for patients with low back pain (LBP), the accuracy of the instruments in detecting sleep/wake episodes for this population is unknown. This study investigated the criterion validity of two portable instruments (Armband and Actiwatch) for assessing sleep disturbance in patients with LBP. 50 patients with LBP performed simultaneous overnight sleep recordings in a university sleep laboratory. All 50 participants were assessed by Polysomnography (PSG) and the Armband and a subgroup of 33 participants wore an Actiwatch. Criterion validity was determined by calculating epoch-by-epoch agreement, sensitivity, specificity and prevalence and bias- adjusted kappa (PABAK) for sleep versus wake between each instrument and PSG. The relationship between PSG and the two instruments was assessed using intraclass correlation coefficients (ICC 2, 1). The study participants showed symptoms of sub-threshold insomnia (mean ISI = 13.2, 95% CI = 6.36) and poor sleep quality (mean PSQI = 9.20, 95% CI = 4.27). Observed agreement with PSG was 85% and 88% for the Armband and Actiwatch. Sensitivity was 0.90 for both instruments and specificity was 0.54 and 0.67 and PABAK of 0.69 and 0.77 for the Armband and Actiwatch respectively. The ICC (95%CI) was 0.76 (0.61 to 0.86) and 0.80 (0.46 to 0.92) for total sleep time, 0.52 (0.29 to 0.70) and 0.55 (0.14 to 0.77) for sleep efficiency, 0.64 (0.45 to 0.78) and 0.52 (0.23 to 0.73) for wake after sleep onset and 0.13 (−0.15 to 0.39) and 0.33 (−0.05 to 0.63) for sleep onset latency, for the Armband and Actiwatch, respectively. The findings showed that both instruments have varied criterion validity across the sleep parameters from excellent validity for measures of total sleep time, good validity for measures of sleep efficiency and wake after onset to poor validity for sleep onset latency.     

Performance And Agreement Of Risk Stratification Instruments For Postoperative Delirium In Persons Aged 50 Years Or Older

Several risk stratification instruments for postoperative delirium in older people have been developed because early interventions may prevent delirium. We investigated the performance and agreement of nine commonly used risk stratification instruments in an independent validation cohort of consecutive elective and emergency surgical patients aged ≥50 years with ≥1 risk factor for postoperative delirium. Data was collected prospectively. Delirium was diagnosed according to DSM-IV-TR criteria. The observed incidence of postoperative delirium was calculated per risk score per risk stratification instrument. In addition, the risk stratification instruments were compared in terms of area under the receiver operating characteristic (ROC) curve (AUC), and positive and negative predictive value. Finally, the positive agreement between the risk stratification instruments was calculated. When data required for an exact implementation of the original risk stratification instruments was not available, we used alternative data that was comparable. The study population included 292 patients: 60% men; mean age (SD), 66 (8) years; 90% elective surgery. The incidence of postoperative delirium was 9%. The maximum observed incidence per risk score was 50% (95%CI, 15–85%); for eight risk stratification instruments, the maximum observed incidence per risk score was ≤25%. The AUC (95%CI) for the risk stratification instruments varied between 0.50 (0.36–0.64) and 0.66 (0.48–0.83). No AUC was statistically significant from 0.50 (p≥0.11). Positive predictive values of the risk stratification instruments varied between 0–25%, negative predictive values between 89–95%. Positive agreement varied between 0–66%. No risk stratification instrument showed clearly superior performance. In conclusion, in this independent validation cohort, the performance and agreement of commonly used risk stratification instruments for postoperative delirium was poor. Although some caution is needed because the risk stratification instruments were not implemented exactly as described in the original studies, we think that their usefulness in clinical practice can be questioned.     

Spatial Overlap between Environmental Policy Instruments and Areas of High Conservation Value in Forest

In order to safeguard biodiversity in forest we need to know how forest policy instruments work. Here we use a nationwide network of 9400 plots in productive forest to analyze to what extent large-scale policy instruments, individually and together, target forest of high conservation value in Norway. We studied both instruments working through direct regulation; Strict Protection and Landscape Protection, and instruments working through management planning and voluntary schemes of forest certification; Wilderness Area and Mountain Forest. As forest of high conservation value (HCV-forest) we considered the extent of 12 Biodiversity Habitats and the extent of Old-Age Forest. We found that 22% of productive forest area contained Biodiversity Habitats. More than 70% of this area was not covered by any large-scale instruments. Mountain Forest covered 23%, while Strict Protection and Wilderness both covered 5% of the Biodiversity Habitat area. A total of 9% of productive forest area contained Old-Age Forest, and the relative coverage of the four instruments was similar as for Biodiversity Habitats. For all instruments, except Landscape Protection, the targeted areas contained significantly higher proportions of HCV-forest than areas not targeted by these instruments. Areas targeted by Strict Protection had higher proportions of HCV-forest than areas targeted by other instruments, except for areas targeted by Wilderness Area which showed similar proportions of Biodiversity Habitats. There was a substantial amount of spatial overlap between the policy tools, but no incremental conservation effect of overlapping instruments in terms of contributing to higher percentages of targeted HCV-forest. Our results reveal that although the current policy mix has an above average representation of forest of high conservation value, the targeting efficiency in terms of area overlap is limited. There is a need to improve forest conservation and a potential to cover this need by better targeting high conservation value areas.     

Development and application of portable manual non-contact-type anthropometric instruments for measuring human anatomical longitudinal parameters

Several contact-type anthropometric instruments have been previously established for use in population surveys that contribute to the construction of anthropometric databases. Manual anthropometric measurements need to comply with or fulfill the following conditions: anatomical landmarks (term, location, and detecting method); measuring methods (item and subject's posture); five contact-type instruments (anthropometer, large sliding caliper, sliding caliper, spreading caliper, and tape measure); and well-trained examiners. Here, two manual non-contact-type portable anthropometric instruments were developed for measuring small regions such as the head and for larger regions such as the trunk of the human body, and for obtaining anatomical longitudinal parameters (length, height, breadth, and depth) based on the principle of projection by spot irradiation using laser markers. A new landmark-detecting method, based on the idea of visual landmarks, was proposed instead of the conventional palpation method (direct feeling with fingers), which was not appropriate for a non-contact measuring system. The accuracy of each instrument was tested using industrial tools, and performance was compared with contact-type instruments using a skeletal model (four measurements), a free posture manikin (eight measurements), and the healthy human body (five males and five females; nine measurements). Measurement errors and visual inspection to detect landmarks were discussed. The instruments show applicability to non-contact anthropometry.     

The Legal Regulation of Floats and Gliders—In Quest of a New Regime?

This article analyzes the legal status of unmanned instruments (particularly, floats and gliders) for observation purposes in the ocean environment. These new kinds of instruments are being deployed by the thousands into the oceans, not the least as part of the Argo Project of the International Oceanographic Commission. Their uncontrolled drifting has raised legal questions, especially when such instruments enter waters subject to the jurisdiction of foreign states. The authors argue that the current international legal framework is insufficient to address the pertinent issues, and that a new legal regime is needed.     

Evaluation of non-specific tissue alkaline phosphatase on bone samples from traditional and piezoelectric osteotomy

The aim of this study is to test the response of bone during cutting actions in dental procedures by sampling alkaline phosphatase (ALP) as a biological reference marker. ALP is found abundantly in bone tissue. In the first series of experiments a temporal-minimum quantity of ALP enzyme response was recorded, the observed period was 40 minutes. The ALP samples treated with piezoelectric surgery showed a rapid increase, with peak at 30 min, and then declined rapidly within the next 10 minutes. A second experiment was performed to evaluate 4 cutting instruments: drill bits high speed turbine (T1); drill bits contra-angle (T2) Piezoelectric insertions (T3), and manual instruments (controls). This second experiment was to evaluate the ALP activity at 30 min. The T1 samples produced the highest results (3,66499 +- 0,51394); control groups had a lower response (0,72793 +- 0,22353), while the T2 group produced statistically significant higher results (2,77793 +- 0,40553) than T3 (1,16608 +- 0,32676). The different values obtained for ALP in these two experiments for a short period of time (30 min) cannot be interpreted as a response of bone tissue regeneration subjected to surgical trauma. The MINIMUM trauma caused by the surgical piezoelectric instruments, in respect to conventional surgical instruments is clearly evident from the phosphatase inflammatory activity.     

Measurement properties of questionnaires measuring continuity of care: a systematic review

Background

Continuity of care is widely acknowledged as a core value in family medicine. In this systematic review, we aimed to identify the instruments measuring continuity of care and to assess the quality of their measurement properties.

Methods

We did a systematic review using the PubMed, Embase and PsycINFO databases, with an extensive search strategy including ‘continuity of care’, ‘coordination of care’, ‘integration of care’, ‘patient centered care’, ‘case management’ and its linguistic variations. We searched from 1995 to October 2011 and included articles describing the development and/or evaluation of the measurement properties of instruments measuring one or more dimensions of continuity of care (1) care from the same provider who knows and follows the patient (personal continuity), (2) communication and cooperation between care providers in one care setting (team continuity), and (3) communication and cooperation between care providers in different care settings (cross-boundary continuity). We assessed the methodological quality of the measurement properties of each instrument using the COSMIN checklist.

Results

We included 24 articles describing the development and/or evaluation of 21 instruments. Ten instruments measured all three dimensions of continuity of care. Instruments were developed for different groups of patients or providers. For most instruments, three or four of the six measurement properties were assessed (mostly internal consistency, content validity, structural validity and construct validity). Six instruments scored positive on the quality of at least three of six measurement properties.

Conclusions

Most included instruments have problems with either the number or quality of its assessed measurement properties or the ability to measure all three dimensions of continuity of care. Based on the results of this review, we recommend the use of one of the four most promising instruments, depending on the target population Diabetes Continuity of Care Questionnaire, Alberta Continuity of Services Scale-Mental Health, Heart Continuity of Care Questionnaire, and Nijmegen Continuity Questionnaire.     

Data analysis strategies for reducing the influence of the bias in cross-cultural research

In cross-cultural research, researchers have to adjust the constructs and associated measurement instruments that have been developed in one culture and then imported for use in another culture. Importing concepts from other cultures is often simply reduced to language adjustment of the content in the items of the measurement instruments that define a certain (psychological) construct. In the context of cross-cultural research, test bias can be defined as a generic term for all nuisance factors that threaten the validity of cross-cultural comparisons. Bias can be an indicator that instrument scores based on the same items measure different traits and characteristics across different cultural groups. To reduce construct, method and item bias,the researcher can consider these strategies: (1) simply comparing average results in certain measuring instruments; (2) comparing only the reliability of certain dimensions of the measurement instruments, applied to the "target" and "source" samples of participants, i.e. from different cultures; (3) comparing the "framed" factor structure (fixed number of factors) of the measurement instruments, applied to the samples from the "target" and "source" cultures, using explorative factor analysis strategy on separate samples; (4) comparing the complete constructs ("unframed" factor analysis, i.e. unlimited number of factors) in relation to their best psychometric properties and the possibility of interpreting (best suited to certain cultures, applying explorative strategy of factor analysis); or (5) checking the similarity of the constructs in the samples from different cultures (using structural equation modeling approach). Each approach has its advantages and disadvantages. The advantages and lacks of each approach are discussed.     

Measuring health state preferences in women with breast hypertrophy

The purpose of this article is to introduce the measurement of utilities, or patient preferences, to the plastic surgery community. Specifically, the study demonstrated the development and validation of a utility measure for estimating the health-related quality of life in women with breast hypertrophy. Two self-administered instruments were developed, a Wheel and a Table. All subjects completed the utility assessments for their "current health" and again for "breast-related symptoms." The reliability of the instruments was assessed in repeat (test-retest) interviews of 47 women within 10 to 18 days. Utilities obtained with the new instruments were also compared with the performance of other validated utility assessment instruments, including a visual analogue scale, a computer-based instrument (U-Titer), and a preference classification system (EuroQol). Of the 47 women in the test-retest reliability study, 21 had experienced breast hypertrophy (13 had not had reduction surgery and 8 had undergone reduction mammaplasty). Mean utility values for breast-related symptoms among women with breast hypertrophy (n = 13) were: Table, 0.85; Wheel, 0.90; and U-Titer, 0.66. Current health utility scores were significantly lower for women with breast hypertrophy (n = 13), as measured by all instruments except the Wheel. The Table had good reliability and distinguished women with breast hypertrophy from those without. Although the Table provided higher utility values for the same health state compared with the computer-based interview (U-Titer), it is much less costly to implement. The Table is recommended as a reasonable alternative for use in multicenter studies of women with breast hypertrophy. The reported utility value for breast hypertrophy of 0.86 is much lower than predicted. It is comparable with the reported burden of living with other health conditions, such as moderate angina (0.90) and a kidney transplant (0.84).     

Measurement of ionized calcium in normal human blood platelets

To measure the concentrations of cytosolic ionized calcium in platelets we used a calcium-sensitive fluorophor (Fura-2) with two different spectrofluorometers (Perkin-Elmer LS-5 and Fluorolog 222). Values obtained by these two instruments for the basal cytosolic ionized calcium concentration of resting platelets and those of agonist-activated platelets did not differ significantly. Both instruments were capable of monitoring the shifts in wavelengths induced by the dye-calcium complex, the ratio between absorbances at the two wavelengths (340/380 nm), and calcium concentrations continuously during agonist-induced platelet activation. We conclude that a relatively inexpensive instrument may be adequate for measuring ionized calcium in cells by this method, although sophisticated kinetic studies may require analytical or research-grade instruments.