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British Journal of Health Psychology Sep 2020Objectives The Capabilities, Opportunities, Motivations, Behaviour (COM-B) model is being used extensively to inform intervention design, but there is no standard...
Objectives The Capabilities, Opportunities, Motivations, Behaviour (COM-B) model is being used extensively to inform intervention design, but there is no standard measure with which to test the predictive validity of COM or to assess the impact of interventions on COM. We describe the development, reliability, validity, and acceptability of a generic 6-item self-evaluation COM questionnaire. Design and methods The questionnaire was formulated by behaviour change experts. Acceptability was tested in two independent samples of health care professionals (N = 13 and N = 85, respectively) and a sample of people with low socio-economic status (N = 214). Acceptability (missing data analyses and user feedback), reliability (test-retest reliability and Bland-Altman plots) and validity (floor and ceiling effects, Pearson's correlation coefficient [r], exploratory factor analysis [EFA], and confirmatory factor analysis [CFA] were tested using a national survey of 1,387 health care professionals. Results The questionnaire demonstrated acceptability (missing data for individual items: 5.9-7.7% at baseline and 18.1-32.5% at follow-up), reliability (ICCs .554-.833), and validity (floor effects 0.6-5.5% and ceiling effects 4.1-22.9%; pairwise correlations rs significantly <1.0). The regression models accounted for between 21 and 47% of the variance in behaviour. CFA (three-factor model) demonstrated a good model fit, (χ [6] = 7.34, p = .29, RMSEA = .02, CFI = .99, TLI = .99, BIC = 13,510.420, AIC = 13,428.067). Conclusions The novel six-item questionnaire shows evidence of acceptability, validity, and reliability for self-evaluating capabilities, opportunities, and motivations. Future research should aim to use this tool in different populations to obtain further support for its reliability and validity. Statement of contribution What is already known on the subject? The Capability, Opportunity, Motivation (COM), Behaviour (-B) model is being used extensively to inform intervention design. The lack of an accepted universal measure hinders progress in behaviour change. What does this study add? There is evidence of acceptability, validity, and reliability for self-evaluating COM. Our measure may be sufficiently generic for any behaviour or population, although this requires further testing.
Topics: Factor Analysis, Statistical; Humans; Motivation; Psychometrics; Reproducibility of Results; Surveys and Questionnaires; Weights and Measures
PubMed: 32314500
DOI: 10.1111/bjhp.12417 -
European Biophysics Journal : EBJ May 2021Analytical ultracentrifugation (AUC) is based on the concept of recording and analyzing macroscopic macromolecular redistribution that results from a centrifugal force...
Analytical ultracentrifugation (AUC) is based on the concept of recording and analyzing macroscopic macromolecular redistribution that results from a centrifugal force acting on the mass of suspended macromolecules in solution. Since AUC rests on first principles, it can provide an absolute measurement of macromolecular mass, sedimentation and diffusion coefficients, and many other quantities, provided that the solvent density and viscosity are known, and provided that the instrument is properly calibrated. Unfortunately, a large benchmark study revealed that many instruments exhibit very significant systematic errors. This includes the magnification of the optical detection system used to determine migration distance, the measurement of sedimentation time, and the measurement of the solution temperature governing viscosity. We have previously developed reference materials, tools, and protocols to detect and correct for systematic measurement errors in the AUC by comparison with independently calibrated standards. This 'external calibration' resulted in greatly improved precision and consistency of parameters across laboratories. Here we detail the steps required for calibration of the different data dimensions in the AUC. We demonstrate the calibration of three different instruments with absorbance and interference optical detection, and use measurements of the sedimentation coefficient of NISTmAb monomer as a test of consistency. Whereas the measured uncorrected sedimentation coefficients span a wide range from 6.22 to 6.61 S, proper calibration resulted in a tenfold reduced standard deviation of sedimentation coefficients. The calibrated relative standard deviation and mean error of 0.2% and 0.07%, respectively, is comparable with statistical errors and side-by-side repeatability in a single instrument.
Topics: Calibration; Macromolecular Substances; Solvents; Ultracentrifugation; Viscosity
PubMed: 33398460
DOI: 10.1007/s00249-020-01485-2 -
Critical Care (London, England) Nov 2019Excessive respiratory muscle effort during mechanical ventilation may cause patient self-inflicted lung injury and load-induced diaphragm myotrauma, but there are no...
BACKGROUND
Excessive respiratory muscle effort during mechanical ventilation may cause patient self-inflicted lung injury and load-induced diaphragm myotrauma, but there are no non-invasive methods to reliably detect elevated transpulmonary driving pressure and elevated respiratory muscle effort during assisted ventilation. We hypothesized that the swing in airway pressure generated by respiratory muscle effort under assisted ventilation when the airway is briefly occluded (ΔP) could be used as a highly feasible non-invasive technique to screen for these conditions.
METHODS
Respiratory muscle pressure (P), dynamic transpulmonary driving pressure (ΔP, the difference between peak and end-expiratory transpulmonary pressure), and ΔP were measured daily in mechanically ventilated patients in two ICUs in Toronto, Canada. A conversion factor to predict ΔP and P from ΔP was derived and validated using cross-validation. External validity was assessed in an independent cohort (Nanjing, China).
RESULTS
Fifty-two daily recordings were collected in 16 patients. In this sample, P and ΔP were frequently excessively high: P exceeded 10 cm HO on 84% of study days and ΔP exceeded 15 cm HO on 53% of study days. ΔP measurements accurately detected P > 10 cm HO (AUROC 0.92, 95% CI 0.83-0.97) and ΔP > 15 cm HO (AUROC 0.93, 95% CI 0.86-0.99). In the external validation cohort (n = 12), estimating P and ΔP from ΔP measurements detected excessively high P and ΔP with similar accuracy (AUROC ≥ 0.94).
CONCLUSIONS
Measuring ΔP enables accurate non-invasive detection of elevated respiratory muscle pressure and transpulmonary driving pressure. Excessive respiratory effort and transpulmonary driving pressure may be frequent in spontaneously breathing ventilated patients.
Topics: Acute Lung Injury; Aged; Female; Humans; Male; Middle Aged; Monitoring, Physiologic; Noninvasive Ventilation; Pressure; Respiration, Artificial; Respiratory Muscles; Weights and Measures; Work of Breathing
PubMed: 31694692
DOI: 10.1186/s13054-019-2617-0 -
Journal of the American Medical... Nov 2023This article proposes a framework to support the scientific research of standards so that they can be better measured, evaluated, and designed.
OBJECTIVE
This article proposes a framework to support the scientific research of standards so that they can be better measured, evaluated, and designed.
METHODS
Beginning with the notion of common models, the framework describes the general standard problem-the seeming impossibility of creating a singular, persistent, and definitive standard which is not subject to change over time in an open system.
RESULTS
The standard problem arises from uncertainty driven by variations in operating context, standard quality, differences in implementation, and drift over time. As a result, fitting work using conformance services is needed to repair these gaps between a standard and what is required for real-world use. To guide standards design and repair, a framework for measuring performance in context is suggested, based on signal detection theory and technomarkers. Based on the type of common model in operation, different conformance strategies are identified: (1) Universal conformance (all agents access the same standard); (2) Mediated conformance (an interoperability layer supports heterogeneous agents); and (3) Localized conformance (autonomous adaptive agents manage their own needs). Conformance methods include incremental design, modular design, adaptors, and creating interactive and adaptive agents.
DISCUSSION
Machine learning should have a major role in adaptive fitting. Research to guide the choice and design of conformance services may focus on the stability and homogeneity of shared tasks, and whether common models are shared ahead of time or adjusted at task time.
CONCLUSION
This analysis conceptually decouples interoperability and standardization. While standards facilitate interoperability, interoperability is achievable without standardization.
Topics: Reference Standards
PubMed: 37654094
DOI: 10.1093/jamia/ocad176 -
Families, Systems & Health : the... Sep 2019The aim of this article is to introduce key definitions to patient access and a measurement approach, translated for a clinic-based research study or program evaluation....
The aim of this article is to introduce key definitions to patient access and a measurement approach, translated for a clinic-based research study or program evaluation. The authors hope this piece will provide those seeking to improve access with some basic starting points and replace rhetoric with rigor in evaluation. Issues discussed include defining access for measurement, measuring access, starting with the end point in mind, and using a logic model. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Topics: Health Services Accessibility; Humans; Weights and Measures
PubMed: 31512907
DOI: 10.1037/fsh0000442 -
Clinica Chimica Acta; International... Jun 2022Uncertainty is an inseparable part of all kinds of measurements performed in clinical laboratories. Accreditation standards including the ISO/IEC 17025:2017 and ISO...
Uncertainty is an inseparable part of all kinds of measurements performed in clinical laboratories. Accreditation standards including the ISO/IEC 17025:2017 and ISO 15189:2012 require that laboratories have routines for calculating the measurement uncertainty of reported results. Various guidelines such as CLSI EP29, Nordest 537, and ISO 20914:2019 have proposed methods for this purpose. However, due to the conceived complexity of the proposed calculation methods, these guidelines have not been generally and effectively applied in clinical laboratories. High workload and measurand heterogeneity favor a pragmatic utilitarian approach. The purpose of this paper is to describe such an approach, including its advantages and disadvantages. Measurement uncertainty should include the most influential factors affecting patients' test results. Since patients' samples for the same measurand can be analyzed in one laboratory or several laboratories using different measuring systems, the measurement uncertainty should be calculated using results obtained from analyzing the same internal quality control material if commutable or patients pooled/split samples.
Topics: Clinical Laboratory Services; Humans; Laboratories; Quality Control; Reference Standards; Uncertainty
PubMed: 35513038
DOI: 10.1016/j.cca.2022.04.1003 -
Medicine Aug 2021Early diagnosis as well as treatment is important in management of congenital muscular torticollis (CMT). The purpose of this study was to find an effective physical...
Effect of physical therapy intervention on thickness and ratio of the sternocleidomastoid muscle and head rotation angle in infants with congenital muscular torticollis: A randomized clinical trial (CONSORT).
BACKGROUND
Early diagnosis as well as treatment is important in management of congenital muscular torticollis (CMT). The purpose of this study was to find an effective physical therapy modality to improve the sternocleidomastoid (SCM) muscle thickness, the ratio of the SCM muscle thickness on the affected side to that on the non-affected side (A/N ratio), and head rotation in infant under 3 months of age diagnosed with CMT.
METHODS AND ANALYSIS
A single-blind, randomized clinical trial was conducted. Participants were assigned in one of the 3 study groups through randomization. The treatment was performed 3 times a week for 30 minutes until the head tilt was ≤5 degrees. Group 1 was treated by handling for active or active-assist movement, group 2 was treated with passive stretching, and group 3 was treated with thermotherapy. For general characteristics, a χ2 test and 1-way analysis of variance were used. Intragroup differences were analyzed using a paired t test, and intergroup differences were analyzed using an age-adjusted analysis of covariance.
RESULTS
After the intervention, there was no significant difference between groups in terms of SCM thickness on the affected side and A/N ratio (P > .05). Degree of head rotation on the affected side showed significant differences between groups (P < .05), with Group 2 showing significantly better results than group 1 and group 3 (P < .05, both).
CONCLUSION
Passive stretching treatment was more effective than other treatments of this study for improvement in degree of head rotation in CMT infants under 3 months of age.
TRIAL REGISTRATION
The trial is registered at the Institutional Review Board of Sahmyook University (IRB number, 2-7001793-AB-N-012019103HR) and the Clinical Research Information Service (CRiS; registry number, KCT0004862).
Topics: Humans; Infant; Muscles; Physical Therapy Modalities; Single-Blind Method; Sternum; Torticollis; Weights and Measures
PubMed: 34414985
DOI: 10.1097/MD.0000000000026998 -
Nature Human Behaviour Dec 2020Behavioural researchers often seek to experimentally manipulate, measure and analyse latent psychological attributes, such as memory, confidence or attention. The best... (Review)
Review
Behavioural researchers often seek to experimentally manipulate, measure and analyse latent psychological attributes, such as memory, confidence or attention. The best measurement strategy is often difficult to intuit. Classical psychometric theory, mostly focused on individual differences in stable attributes, offers little guidance. Hence, measurement methods in experimental research are often based on tradition and differ between communities. Here we propose a criterion, which we term 'retrodictive validity', that provides a relative numerical estimate of the accuracy of any given measurement approach. It is determined by performing calibration experiments to manipulate a latent attribute and assessing the correlation between intended and measured attribute values. Our approach facilitates optimising measurement strategies and quantifying uncertainty in the measurement. Thus, it allows power analyses to define minimally required sample sizes. Taken together, our approach provides a metrological perspective on measurement practice in experimental research that complements classical psychometrics.
Topics: Calibration; Humans; Psychology; Psychometrics
PubMed: 33199857
DOI: 10.1038/s41562-020-00976-8 -
Critical Care (London, England) Nov 2020Clinical practice guidelines recommend performing a cuff leak test in mechanically ventilated adults who meet extubation criteria to screen those at high risk for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Clinical practice guidelines recommend performing a cuff leak test in mechanically ventilated adults who meet extubation criteria to screen those at high risk for post-extubation stridor. Previous systematic reviews demonstrated excellent specificity of the cuff leak test but disagreed with respect to sensitivity. We conducted a systematic review and meta-analysis to assess the diagnostic accuracy of the cuff leak test for predicting post-extubation airway complications in intubated adult patients in critical care settings.
METHODS
We searched Medline, EMBASE, Scopus, ISI Web of Science, the Cochrane Library for eligible studies from inception to March 16, 2020, without language restrictions. We included studies that examined the diagnostic accuracy of cuff leak test if post-extubation airway obstruction after extubation or reintubation was explicitly reported as the reference standard. Two authors in duplicate and independently assessed the risk of bias using the Quality Assessment for Diagnostic Accuracy Studies-2 tool. We pooled sensitivities and specificities using generalized linear mixed model approach to bivariate random-effects meta-analysis. Our primary outcomes were post-extubation airway obstruction and reintubation.
RESULTS
We included 28 studies involving 4493 extubations. Three studies were at low risk for all QUADAS-2 risk of bias domains. The pooled sensitivity and specificity of cuff leak test for post-extubation airway obstruction were 0.62 (95% CI 0.49-0.73; I = 81.6%) and 0.87 (95% CI 0.82-0.90; I = 97.8%), respectively. The pooled sensitivity and specificity of the cuff leak test for reintubation were 0.66 (95% CI 0.46-0.81; I = 48.9%) and 0.88 (95% CI 0.83-0.92; I = 87.4%), respectively. Subgroup analyses suggested that the type of cuff leak test and length of intubation might be the cause of statistical heterogeneity of sensitivity and specificity, respectively, for post-extubation airway obstruction.
CONCLUSIONS
The cuff leak test has excellent specificity but moderate sensitivity for post-extubation airway obstruction. The high specificity suggests that clinicians should consider intervening in patients with a positive test, but the low sensitivity suggests that patients still need to be closely monitored post-extubation.
Topics: Adult; Airway Extubation; Humans; Predictive Value of Tests; Pressure; Sensitivity and Specificity; Weights and Measures
PubMed: 33160405
DOI: 10.1186/s13054-020-03358-8 -
JAMA Psychiatry Nov 2020
Topics: Cognition; Humans; Weights and Measures
PubMed: 32639514
DOI: 10.1001/jamapsychiatry.2020.1618