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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 -
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 -
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 -
Western Journal of Nursing Research Jan 2019Stroke continues to be a public health problem, and risk perceptions are key to understanding people's thoughts about stroke risk and their preventive health behaviors.... (Review)
Review
Stroke continues to be a public health problem, and risk perceptions are key to understanding people's thoughts about stroke risk and their preventive health behaviors. This review identifies how the perceived risk of stroke has been measured and outcomes in terms of levels, predictors, accuracy, and intervention results. Sixteen studies were included. The perceived risk of stroke has primarily been assessed with single-item measures; no multi-item surveys were found. In general, people tend to perceive a low-moderate risk of stroke; the most common predictors of higher stroke risk perceptions were having risk factors for stroke (hypertension, diabetes) and a higher number of risk factors. However, inaccuracies were common; at least half of respondents underestimated/overestimated their risk. Few studies have examined whether interventions can improve the perceived risk of stroke. Strategies to improve stroke risk perceptions should be explored to determine whether accuracy can promote healthy lifestyles to reduce stroke risk.
Topics: Health Behavior; Humans; Perception; Psychometrics; Risk Assessment; Stroke; Weights and Measures
PubMed: 29243562
DOI: 10.1177/0193945917747856 -
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 -
Journal of Clinical Monitoring and... Feb 2021Any measurement is always afflicted with some degree of uncertainty. A correct understanding of the different types of uncertainty, their naming, and their definition is... (Review)
Review
Any measurement is always afflicted with some degree of uncertainty. A correct understanding of the different types of uncertainty, their naming, and their definition is of crucial importance for an appropriate use of measuring instruments. However, in perioperative and intensive care medicine, the metrological requirements for measuring instruments are poorly defined and often used spuriously. The correct use of metrological terms is also of crucial importance in validation studies. The European Union published a new directive on medical devices, mentioning that in the case of devices with a measuring function, the notified body is involved in all aspects relating to the conformity of the device with the metrological requirements. It is therefore the task of the scientific societies to establish the standards in their area of expertise. Adopting the same understandings and definitions among clinicians and scientists is obviously the first step. In this metrologic review (part 1), we list and explain the most important terms defined by the International Bureau of Weights and Measures regarding quantities and units, properties of measurements, devices for measurement, properties of measuring devices, and measurement standards, with specific examples from perioperative and intensive care medicine.
Topics: Critical Care; Humans; Reference Standards
PubMed: 32185615
DOI: 10.1007/s10877-020-00494-y -
PloS One 2013Many complex systems can be described as multiplex networks in which the same nodes can interact with one another in different layers, thus forming a set of interacting...
Many complex systems can be described as multiplex networks in which the same nodes can interact with one another in different layers, thus forming a set of interacting and co-evolving networks. Examples of such multiplex systems are social networks where people are involved in different types of relationships and interact through various forms of communication media. The ranking of nodes in multiplex networks is one of the most pressing and challenging tasks that research on complex networks is currently facing. When pairs of nodes can be connected through multiple links and in multiple layers, the ranking of nodes should necessarily reflect the importance of nodes in one layer as well as their importance in other interdependent layers. In this paper, we draw on the idea of biased random walks to define the Multiplex PageRank centrality measure in which the effects of the interplay between networks on the centrality of nodes are directly taken into account. In particular, depending on the intensity of the interaction between layers, we define the Additive, Multiplicative, Combined, and Neutral versions of Multiplex PageRank, and show how each version reflects the extent to which the importance of a node in one layer affects the importance the node can gain in another layer. We discuss these measures and apply them to an online multiplex social network. Findings indicate that taking the multiplex nature of the network into account helps uncover the emergence of rankings of nodes that differ from the rankings obtained from one single layer. Results provide support in favor of the salience of multiplex centrality measures, like Multiplex PageRank, for assessing the prominence of nodes embedded in multiple interacting networks, and for shedding a new light on structural properties that would otherwise remain undetected if each of the interacting networks were analyzed in isolation.
Topics: Algorithms; Brain; Humans; Social Networking; Social Support; Weights and Measures
PubMed: 24205186
DOI: 10.1371/journal.pone.0078293 -
Journal of Diabetes Science and... Jan 2012Although altered metabolism has long been known to affect human breath, generating clinically usable metabolic tests from exhaled compounds has proven challenging. If...
BACKGROUND
Although altered metabolism has long been known to affect human breath, generating clinically usable metabolic tests from exhaled compounds has proven challenging. If developed, a breath-based lipid test would greatly simplify management of diabetes and serious pathological conditions (e.g., obesity, familial hyperlipidemia, and coronary artery disease), in which systemic lipid levels are a critical risk factor for onset and development of future cardiovascular events.
METHODS
We, therefore, induced controlled fluctuations of plasma lipids (insulin-induced lipid suppression or intravenous infusion of Intralipid) during 4-h in vivo experiments on 23 healthy volunteers (12 males/11 females, 28.0 ± 0.3 years) to find correlations between exhaled volatile organic compounds and plasma lipids. In each subject, plasma triglycerides (TG) and free fatty acids (FFA) concentrations were both directly measured and calculated via individualized prediction equations based on the multiple linear regression analysis of a cluster of 4 gases. In the lipid infusion protocol, we also generated common prediction equations using a maximum of 10 gases.
RESULTS
This analysis yielded strong correlations between measured and predicted values during both lipid suppression (r = 0.97 for TG; r = 0.90 for FFA) and lipid infusion (r = 0.97 for TG; r = 0.94 for FFA) studies. In our most accurate common prediction model, measured and predicted TG and FFA values also displayed very strong statistical agreement (r = 0.86 and r = 0.81, respectively).
CONCLUSIONS
Our results demonstrate the feasibility of measuring plasma lipids through breath analysis. Optimization of this technology may ultimately lead to the development of portable breath analyzers for plasma lipids, replacing blood-based bioassays.
Topics: Adult; Blood Chemical Analysis; Breath Tests; Chromatography, Gas; Exhalation; Fatty Acids, Nonesterified; Feasibility Studies; Female; Forecasting; Humans; Infusions, Intravenous; Insulin; Lipids; Male; Osmolar Concentration; Triglycerides; Weights and Measures
PubMed: 22401327
DOI: 10.1177/193229681200600112 -
Mutation Research Feb 2012Studies of telomeres and telomere biology often critically rely on the detection of telomeric DNA and measurements of the length of telomere repeats in either single... (Review)
Review
Studies of telomeres and telomere biology often critically rely on the detection of telomeric DNA and measurements of the length of telomere repeats in either single cells or populations of cells. Several methods are available that provide this type of information and it is often not clear what method is most appropriate to address a specific research question. The major variables that need to be considered are the material that is or can be made available and the accuracy of measurements that is required. The goal of this review is to provide a comprehensive summary of the most commonly used methods and discuss the advantages and disadvantages of each. Methods that start with genomic DNA include telomere restriction fragment (TRF) length analysis, PCR amplification of telomere repeats relative to a single copy gene by Q-PCR or MMQPCR and single telomere length analysis (STELA), a PCR-based approach that accurately measures the full spectrum of telomere lengths from individual chromosomes. A different set of methods relies on fluorescent in situ hybridization (FISH) to detect telomere repeats in individual cells or chromosomes. By including essential calibration steps and appropriate controls these methods can be used to measure telomere repeat length or content in chromosomes and cells. Such methods include quantitative FISH (Q-FISH) and flow FISH which are based on digital microscopy and flow cytometry, respectively. Here the basic principles of various telomere length measurement methods are described and their strengths and weaknesses are highlighted. Some recent developments in telomere length analysis are also discussed. The information in this review should facilitate the selection of the most suitable method to address specific research question about telomeres in either model organisms or human subjects.
Topics: Biotechnology; Flow Cytometry; Genetic Techniques; Humans; In Situ Hybridization, Fluorescence; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Telomere; Weights and Measures
PubMed: 21663926
DOI: 10.1016/j.mrfmmm.2011.04.003 -
Trends in Cognitive Sciences Apr 2011Most human cognition occurs outside conscious awareness or conscious control. Some of these implicit processes influence social perception, judgment and action. The past... (Review)
Review
Most human cognition occurs outside conscious awareness or conscious control. Some of these implicit processes influence social perception, judgment and action. The past 15 years of research in implicit social cognition can be characterized as the Age of Measurement because of a proliferation of measurement methods and research evidence demonstrating their practical value for predicting human behavior. Implicit measures assess constructs that are distinct, but related, to self-report assessments, and predict variation in behavior that is not accounted for by those explicit measures. The present state of knowledge provides a foundation for the next age of implicit social cognition: clarification of the mechanisms underlying implicit measurement and how the measured constructs influence behavior.
Topics: Awareness; Cognition; Consciousness; Humans; Models, Psychological; Neuropsychological Tests; Self Report; Social Behavior; Weights and Measures
PubMed: 21376657
DOI: 10.1016/j.tics.2011.01.005