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The Alternative Model for Personality Disorders (AMPD) in Section III of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) conceptualizes personality pathology as a combination of impairment (Criterion A) and traits (Criterion B). One measure used to develop Criterion A was the Social Cognition and Object Relations Scale - Global Rating Method (SCORS-G), which is a multidimensional, object-relational clinician-rated measure of personality functioning. Although there are conceptual links between the AMPD and SCORS-G dimensions, there exists no research examining the relationship. To address this, we examined associations between the SCORS-G dimensions and measures of the AMPD constructs in a large, archival dataset of outpatients and inpatients. More pathological scores on SCORS-G dimensions reflecting self- and interpersonal functioning were associated with greater pathological traits and impairment. Overall, results support further investigation into SCORS-G as a useful measure in AMPD research and assessment.

Introduction Global rating scales (GRSs) such as the Objective Structured Assessment of Technical Skills (OSATS) and Global Operative Assessment of Laparoscopic Surgery (GOALS) are assessment methods for surgical procedures. The aim of this study was to establish construct validity of Procedure-Based Assessment (PBA) and to compare PBA with GRSs for laparoscopic cholecystectomy. Material and methods OSATS and GOALS GRSs were compared with PBA in their ability to discriminate between levels of performance between trainees who can perform the procedure independently and those who cannot. Three groups were formed based on the number of procedures performed by the trainee: novice (1-10), intermediate (11-20) and experienced (>20). Differences between groups were assessed using the Kruskal-Wallis and Mann-Whitney U tests. Results Increasing experience correlated significantly with higher GRSs and PBA scores (all p < .001). Scores of novice and intermediate groups overlapped substantially on the OSATS (p = .1) and GOALS (p = .1), while the PBA discriminated between these groups (p = .03). The median score in the experienced group was higher with less dispersion for PBA (97.2[85.3-100]) compared to OSATS (82.1[60.7-100]) and GOALS (80[60-100]). Conclusion For assessing skill level or the capability of performing a laparoscopic cholecystectomy independently, PBA has a higher discriminative ability compared to the GRSs.

IntroductionAdequate responsiveness and knowledge of the minimal important change (MIC) is essential when using patient-reported outcome measures to assess treatment efficacy.ObjectiveThe objective of this study was to evaluate the responsiveness and MIC of common outcomes in patients with subacromial impingement syndrome undergoing arthroscopic subacromial decompression.MethodsAt baseline and 6 months after surgery, patients completed the Oxford Shoulder Score (OSS), EQ-5D 5-level utility index, EQ visual analogue scale, Fear-Avoidance Belief Questionnaire Physical Activity subscale (FABQ-PA), assessed pain (pain visual analogue scale), and Subjective Shoulder Value. Furthermore, at the 6-month follow-up, patients assessed the overall change with a Global Rating of Change Scale. Responsiveness was examined by analyzing the area under the receiver operating characteristics curve and correlations between the change scores. MIC was assessed using the optimal cutoff point at the receiver operating characteristics curve.ResultsArea under the receiver operating characteristics curve estimates were 0.96 (95% confidence interval [CI] 0.91,1.00) for OSS, 0.82 (95% CI 0.66,0.99) for EQ-5D 5-level utility index, 0.73 (95% CI 0.58,0.87) for EQ visual analogue scale, and 0.74 (95% CI 0.58,0.90) for FABQ-PA. MIC were 6.0 points for OSS, 0.024 points for EQ-5D 5-level utility index, 10.0 points for EQ visual analogue scale, and -5.0 points for FABQ-PA.ConclusionResponsiveness of the OSS, EQ-5D, and FABQ-PA was sufficient to measure improvement after arthroscopic decompression surgery.

Objective: The COVID-19 pandemic caused by the SARS-CoV-2 infection is of global concern. In mid-March 2020 all learning activities in Indonesia were carried out online. The biggest challenge in measuring the competency of graduates during this pandemic time was to test skills online. The aim of this study was to develop adaptation of the online Objective Structured and Clinical Examinations (OSCE) model at the Apothecary programme, Universitas Padjadjaran, Indonesia. Methods: The OSCE online method is designed using two systems, namely active stations and non-active stations with competencies tested based on the OSCE blueprint, and with the application of virtual facilities such as Google meet, Google forms, etc. Results: The results showed that this method can be used for lab skills exams so that candidates and examiners can still take the exam comfortably without being disturbed. The methods can evaluate competence using the Global Rating and Actual Mark Score, and the examiner does not find it difficult to assess the competency being tested.

Limited training opportunities and expanding requirements are challenging surgical education, calling for alternative training methods like simulation or mental training. The aim of this study is to evaluate short- and long-term effects of a structured mental training on surgical performance.Medical students without laparoscopic experience were randomly assigned to 3 groups: (1) control (2) video training, and (3) video plus mental training performing 2 E-BLUS (European Training in Basic Laparoscopic Urological Skills) exercises, "peg transfer" (PT) and "cutting a circle" (CC). Group 3 performed a structured mental training course (identification of procedural key steps, relaxation, mental vocalization, and imaging). Longitudinal assessment including binominal checklists, global rating scales (GRS), procedural times, and Test of Performance Strategies (TOPS) were performed at baseline, day 2, 14, and after 16 months. Statistical analysis included ANOVA and general linear models with repeated measures.The study was conducted in "Olympus Training and Education Center Hamburg West" and "Endo Club Academy" at the University Medical Center Hamburg-Eppendorf.Participants were eligible if they were medical students with no experience in laparoscopy. 24 participants were recruited and finished the study.The mental training group maintained significantly better GRS scores at 16 months for PT (mean score 24.6 [95% CI: 21-28.25]) and CC (mean score 22.5 [18.4-26.6]) (both p0.01) and performed faster in the latter (261 seconds [Std. Dev 116] vs. 427 seconds [SD 132] vs. 368 seconds [SD 78]) compared to the other groups (p = 0.004). Longitudinally, mental training had a significant effect on TOPS scores and procedural times (p0.001 and p = 0.005, respectively).In addition to short time efficacy, our study is the first to ascertain a positive long-term effect of mental training on manual and cognitive skills and might be a useful and cost-effective tool in surgical education.

Janine Topp,1 Christine Blome,1 Matthias Augustin,1 Nicole Mohr,1 Eike Sebastian Debus,2 Holger Diener,2 Rachel Sommer1 1Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; 2Department of Vascular Medicine, University Medical Center Hamburg‐Eppendorf (UKE), Hamburg, GermanyCorrespondence: Rachel SommerInstitute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, GermanyTel +49 (0) 40 7410 24724Fax +49 (0) 40 7410 40160Email r.sommer@uke.deBackground: The questionnaire for the quality of life with chronic wounds (Wound-QoL) is a valid and reliable instrument to determine the disease-specific health-related QoL of patients with chronic wounds. For the interpretation of HRQoL scores, it is additionally important to know which differences in scores are considered meaningful. The minimal important difference (MID) is defined as a change in HRQoL that a patient would consider meaningful, such that the patient would judge a treatment to be beneficial and worthy of repeating.Objective: To interpret changes in the Wound-QoL scores and draw conclusions regarding the relevance of detected changes; the purpose of this study was to estimate the MID of the Wound-QoL global score and its subscales for patients with chronic wounds.Patients and Methods: Patients completed the Wound-QoL before and four to six weeks after treatment and additionally gave a global rating of wound status change after treatment. The global rating of change served as an anchor question. MIDs were calculated based on an anchor-based and a distribution-based method.Results: In total, 227 patients participated in the study. The mean age of the study population was 66.9 (± 12.7) median was 69.5, and 51.5% of the patients were female. MIDs for the Wound-QoL global score ranged from 0.47 to 0.52, proposing an overall estimation of 0.50.Conclusion: The results can be used to measure and interpret changes in wound-specific QoL over time.Keywords: MID, minimal important difference, health-related quality of life, chronic wounds

This study examined the psychometric properties of custom short forms assessing pain-related self-efficacy and catastrophizing, which are important psychosocial constructs for individuals with pain conditions. Short forms were derived from the University of Washington concerns about pain (UWCAP) and pain-related self-efficacy (UWPRSE) item banks. Participants with low back pain (LBP) in a clinical trial (n = 241) examining nonpharmacologic treatments completed the 8-item UWCAP and 9-item UWPRSE and a numeric pain intensity rating, Oswestry Disability and Fear-Avoidance Beliefs questionnaires at baseline, 1-, 4- and 12-weeks after enrollment. Cronbach’s alpha and intraclass correlation coefficients estimated internal consistency and test–retest reliability, respectively. Floor and ceiling effects for the UWCAP and UWPRSE were examined. Concurrent validity was evaluated with univariate correlation coefficients and predictive validity with multivariate regression models. Participants were divided into categories of treatment responsiveness based on a single-item global rating measure, and UWPRSE and UWCAP change scores and standardized effect sizes were calculated in each category. Both short forms had good internal consistency (α = 0.89–0.90) and test–retest reliability (ICC = 0.77–0.85), without substantial floor or ceiling effects. As expected, the UWCAP was positively correlated, and UWPRSE negatively correlated, with concurrent measures of pain intensity, disability and fear-avoidance beliefs. The UWCAP added to the prediction model for 4-week disability outcomes (β = 0.25, p = 0.008). Responsiveness was supported by the mean change scores and effect sizes across treatment response categories. The UWCAP and UWPRSE short forms demonstrated acceptable psychometric properties, supporting future research on the role of these constructs in the management of persons with LBP. Trial Registration: Clinicaltrials.gov ID: NCT02860834. Registered on August 16, 2016

Objective To investigate trends in quality of screening colonoscopy (using the Global Rating Score) in the 13 years since introduction of the Bowel Cancer Screening Programme in England. Setting An English Bowel Cancer Screening Programme colonoscopy service from 2007 to 2019. Methods A retrospective observational study was undertaken using a prospectively collected database in order to analyse trends in screening endoscopies (including patients following positive faecal occult blood test or with high-risk findings on flexible sigmoidoscopy). The Global Rating Score quality indicators for Bowel Cancer Screening Programme colonoscopy were used as outcome measures, and trends over time were analysed. These included caecal intubation rate, adenoma detection rate, colorectal cancer detection rate, proportion of patients with minimal or mild discomfort scores, proportion of patients who required intravenous sedation, and adverse events. Results There were 5352 colonoscopies included, performed by 3 endoscopists; 73.8% were index procedures (i.e. first Bowel Cancer Screening Programme colonoscopy) and the remainder were follow-up or surveillance colonoscopies. The mean age of patients was 66 (standard deviation 5) years, and 59.8% were male. Mean age increased over time ( R2=0.033; p Conclusion There was a consistent improvement in the Global Rating Score for Bowel Cancer Screening Programme colonoscopies since the start of the programme, even when quality was already high at the start. Patients can expect high-quality colonoscopy when participating in the Bowel Cancer Screening Programme.

The increasingly intelligent and connected vehicles have brought many unprecedented automotive cybersecurity threats, which may cause privacy breaches, personal injuries, and even national security issues. Before providing effective security solutions, a comprehensive risk assessment of the automotive cybersecurity must be carried out. A systematic cybersecurity risk assessment framework for automobiles is proposed in this study. It consists of an assessment process and systematic assessment methods considering the changes of threat environment, evaluation target, and available information in vehicle lifecycle. In the process of risk identification and risk analysis, the impact level and attack feasibility level are assessed based on the STRIDE model and attack tree method. An automotive cybersecurity risk matrix using a global rating algorithm is then constructed to create a quantitative risk metric. Finally, the applicability and feasibility of the proposed risk assessment framework are demonstrated through a use case, and the results prove that the proposed framework is effective. The proposed assessment framework helps to systematically derive automotive cybersecurity requirements.

The Johns Hopkins–Intuitive Gesture and Skill Assessment Working Set (JIGSAWS) dataset is used to develop robotic surgery skill assessment tools, but there has been no detailed analysis of this dataset. The aim of this study is to perform a learning curve analysis of the existing JIGSAWS dataset. Five trials were performed in JIGSAWS by eight participants (four novices, two intermediates and two experts) for three exercises (suturing, knot-tying and needle passing). Global Rating Scores and time, path length and movements were analyzed quantitatively and qualitatively by graphical analysis. There are no significant differences in Global Rating Scale scores over time. Time in the suturing exercise and path length in needle passing had significant differences. Other kinematic parameters were not significantly different. Qualitative analysis shows a learning curve only for suturing. Cumulative sum analysis suggests completion of the learning curve for suturing by trial 4. The existing JIGSAWS dataset does not show a quantitative learning curve for Global Rating Scale scores, or most kinematic parameters which may be due in part to the limited size of the dataset. Qualitative analysis shows a learning curve for suturing. Cumulative sum analysis suggests completion of the suturing learning curve by trial 4. An expanded dataset is needed to facilitate subset analyses.

Background The residency selection process relies on subjective information in applications, as well as subjective assessment of applications by reviewers. This inherent subjectivity makes residency selection prone to poor reliability between those reviewing files. Objectives We compared the interrater reliability of 2 assessment tools during file review: one rating applicant traits (ie, leadership, communication) and the other using a global rating of application elements (ie, curriculum vitae, reference letters). Methods Ten file reviewers were randomized into 2 groups, and each scored 7 general surgery applications from the 2019–2020 cycle. The first group used an element-based (EB) scoring tool, while the second group used a trait-based (TB) scoring tool. Feedback was collected, discrimination capacities were measured using variation in scores, and interrater reliability (IRR) was calculated using intraclass correlation (ICC) in a 2-way random effects model. Results Both tools identified the same top-ranked and bottom-ranked applicants; however, discrepancies were noted for middle-ranked applicants. The score range for the 5 middle-ranked applicants was greater with the TB tool (6.43 vs 3.80), which also demonstrated fewer tie scores. The IRR for TB scoring was superior to EB scoring (ICC [2, 5] = 0.82 vs 0.55). The TB tool required only 2 raters to achieve an ICC ≥ 0.70. Conclusions Using a TB file review strategy can facilitate file review with improved reliability compared to EB, and a greater spread of candidate scores. TB file review potentially offers programs a feasible way to optimize and reflect their institution's core values in the process.

Background With an increase in the use of endovascular interventions as an alternative to open surgery and the unique technical skills required, current methods for assessing the competence of vascular surgery trainees may not be optimal, suggesting a need for a shift in assessment modalities. We conducted this systematic review to explore current assessment methods used in vascular surgery training to assess competence specific to endovascular procedures. Methods A comprehensive literature search was performed with a structured search strategy using terms focusing on endovascular procedures and assessment. Inclusion and exclusion criteria were used in order to screen for suitable articles. Results We identified 54 articles that satisfied the inclusion criteria. These included a single randomized controlled trial, a single systematic review, a single narrative review and a single literature review, with the vast majority having level 2 evidence. Global rating scales, proficiency assessments and written/oral examinations were described as standard current assessment tools. These modalities lack reproducibility and objectivity, neglecting the needs of assessment of endovascular procedures requiring specialized decision making and finger dexterity. Novel methods such as high fidelity simulation and virtual reality promote reproducible and objective assessment methods in the context of endovascular surgery, and have a promising future. Conclusion While current assessment methods in vascular surgery are widely supported the changing skills required of a vascular surgery trainee warrants a shift in assessment modalities to better align to these requirements. High fidelity simulations show promise, although they require more extensive research to understand their relative merits.

Substance use disorders (SUD) are chronic relapsing medical conditions characterised by compulsive substance seeking and use. They constitute a substantial disease burden globally. Labelling of persons with SUD has created barriers to treatment but there are effective management strategies. The dental profession has embraced reforms designed to address the SUD epidemic by promoting continuing education for practitioners and initiating curriculum changes in dental schools. Screening, Brief Intervention and Referral to Treatment (SBIRT) is an evidence-based model for managing patients with SUD. The use of a formative 1-station Objective Structured Clinical Examination (OSCE) for learning and assessment in SBIRT, operationalised with the MD3 rating scale is presented in this study. In 3 years of implementation, the SBIRT OSCE successfully integrated into the curriculum of the College of Dental Medicine, Columbia University. Mean score of total adherent behaviours was 11.80 (SD =4.23) (range: 2 – 24) and Cronbach’s coefficient alpha for across-items reliability in adherent behaviours was 0.66. Adherent behaviours correlated with the global ratings (r = 0.66). Mean of global rating scores were 2.90 (SD =1.01) for collaboration and 2.97 (SD =1.00) for empathy and the global rating scores correlated with each other (r = 0.85). Histograms of global rating scores resembled normal distribution. The 1-station OSCE is a good model for learning about SBIRT. Psychometric analysis was useful in understanding the underlying construct of the MD3 rating scale and supported its reliability, validity and utility in dental education.

To document two sources of validity evidence for simulation-based assessment in neurological emergencies. A critical aspect of education is development of evaluation techniques that assess learner’s performance in settings that reflect actual clinical practice. Simulation-based evaluation affords the opportunity to standardize evaluations but requires validation. We identified topics from the Neurocritical Care Society’s Emergency Neurological Life Support (ENLS) training, cross-referenced with the American Academy of Neurology’s core clerkship curriculum. We used a modified Delphi method to develop simulations for assessment in neurocritical care. We constructed checklists of action items and communication skills, merging ENLS checklists with relevant clinical guidelines. We also utilized global rating scales, rated one (novice) through five (expert) for each case. Participants included neurology sub-interns, neurology residents, neurosurgery interns, non-neurology critical care fellows, neurocritical care fellows, and neurology attending physicians. Ten evaluative simulation cases were developed. To date, 64 participants have taken part in 274 evaluative simulation scenarios. The participants were very satisfied with the cases (Likert scale 1–7, not at all satisfied—very satisfied, median 7, interquartile range (IQR) 7–7), found them to be very realistic (Likert scale 1–7, not at all realistic—very realistic, median 6, IQR 6–7), and appropriately difficult (Likert scale 1–7, much too easy—much too difficult, median 4, IQR 4–5). Interrater reliability was acceptable for both checklist action items (kappa = 0.64) and global rating scales (Pearson correlation r = .70). We demonstrated two sources of validity in ten simulation cases for assessment in neurological emergencies.

In recent years, there has been growing interest in examining the stimulus pull effects on respondent narratives to the Thematic Apperception Test (Murray, 1943) using standardized coding methods such as the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G; Stein, Hilsenroth, Slavin-Mulford, & Pinsker, 2011; Westen, 1995). The present study expands on prior work by examining sources of variance in SCORS-G dimensions and card pull effect patterns in an adult clinical sample characterized by high psychiatric comorbidity and clinical severity. A sample of 158 adult psychiatric patients in long-term residential treatment provided narratives to 10 TAT cards (five of which have not previously been studied for pull effects). Cards 2 and 7BM pulled for significantly more adaptive narratives (positive pull), whereas Card 13MF pulled for more pathological stories (negative pull). Like prior studies, variance in cognitive dimensions of the SCORS-G was most explained by person effects, whereas the largest source of variance for all other dimensions was best explained by a combination of the card and the person effects on the narrative. Finally, exploratory analyses of card pull effects within different gender groups were conducted. The implications of these findings for performance-based future studies and possible clinical applications of card pull findings are discussed.

Background: Simulation-based basic airway management training may enhance the learner's competence and offer practitioners the opportunity to practice infrequently applied skills in cases with difficult airway management. Here, we aimed to examine the effectiveness of implementing the American College of Surgeons/ Association for Surgical Education (ACS/ASE) simulation-based Basic Airway Management module in the current medical school curriculum in PNU. Methods: This is a quasi-experimental study in which 44 students were enrolled in the training course; the instructors comprised six practicing physicians and technicians from the anesthesia and emergency departments. The students were divided among six groups for a 20-minutes hands-on training. Cognitive assessment and performance rating scale were conducted after the introduction of the module. An independent t-test was applied to analyze the pre- and post-test training scores for the cognitive assessment and performance rating scale. Statistical significance was set at p < 0.05. Results: There was a significant improvement in the post-training cognitive assessment scores, especially for basic maneuvers to establish the airway in a restrained and unrestrained driver, and in a patient with neck hematoma. A significant difference was also observed in pre- and post-training procedural steps, product characteristics, and global rating score. Conclusions: The ACS/ASE surgical skills curriculum for basic airway skills training is a feasible and effective approach for teaching basic airway management skills to medical students in PNU and other local universities.

Background Objective structured clinical examinations (OSCEs) are an effective method of instruction and evaluation. Their use in nurse practitioner (NP) programs as a means of evaluation warrants further exploration. Purpose The purpose of this project was to test the applicability and feasibility of implementation of OSCEs as a means of formative evaluation in a primary care NP program and to determine student feedback about the experience. Methods This project evaluated the implementation of an educational intervention using 2 previously developed and tested OSCE scenarios with standardized patients. Results Mean scores were computed for the subcategories, as well as for global rating scores on the OSCE. Strong correlations were found across categories within the scenario; no correlations were found between scenarios. Moderate intraclass correlation coefficients were achieved. Student feedback about the experience, including perceived competence and confidence, was overwhelmingly positive. Conclusions This project demonstrates success of a pilot OSCE program.

Background Gender bias is thought to exist in the assessment of clinical teachers, yet its extent in different specialties is not well-documented nor has it been studied at the individual-dyadic level. Objective The authors sought to determine whether gender bias exists in residents' assessments of faculty teaching in 3 clinical departments, and if present, whether this is influenced by gender concordance or discordance between the faculty and resident. Methods Residents' ratings of faculty in internal medicine (800 faculty, 5753 ratings), surgery (377, 2249), and family medicine (672, 3438) at the University of Toronto from 2016–2017 were analyzed using the overall global rating on a 5-point scale. A mixed-effects linear regression analysis accounted for nesting of ratings within each faculty member. Results Overall scores of teaching effectiveness showed a strong skew to favorable ratings for all faculty and a ceiling effect. However, gender effects differed across departments. In internal medicine (38.5% female faculty), no significant gender effects were detected. In surgery (16.2% female) and family medicine (53.0% female), male faculty received significantly higher scores than female faculty. In surgery this was driven by male residents giving male faculty higher ratings (4.46 vs 4.26, P < .001). In family medicine this was driven by male faculty receiving higher ratings regardless of resident gender (4.65 to 4.57, P < .001). Conclusions Although effects were very small and inconsistent, with gender concordance mattering only for one department, it suggests that gender is a meaningful source of variance in teaching assessments.

Background/Objectives: The serious illness conversation (SIC) is an evidence-based framework for conversations with patients about a serious illness diagnosis. The objective of our study was to develop and validate a novel tool, the SIC-evaluation exercise (SIC-Ex), to facilitate assessment of resident-led conversations with oncology patients. Design: We developed the SIC-Ex based on SIC and on the Royal College of Canada Medical Oncology milestones. Seven resident trainees and 10 evaluators were recruited. Each trainee conducted an SIC with a patient, which was videotaped. The evaluators watched the videos and evaluated each trainee by using the novel SIC-Ex and the reference Calgary-Cambridge guide (CCG) at months zero and three. We used Kane's validity framework to assess validity. Results: Intra-class correlation using average SIC-Ex scores showed a moderate level of inter-evaluator agreement (range 0.523–0.822). Most evaluators rated a particular resident similar to the group average, except for one to two evaluator outliers in each domain. Test–retest reliability showed a moderate level of consistency among SIC-Ex scores at months zero and three. Global rating at zero and three months showed fair to good/very good inter-evaluator correlation. Pearson correlation coefficients comparing total SIC-Ex and CCG scores were high for most evaluators. Self-scores by trainees did not correlate well with scores by evaluators. Conclusions: SIC-Ex is the first assessment tool that provides evidence for incorporating the SIG guide framework for evaluation of resident competence. SIC-Ex is conceptually related to, but more specific than, CCG in evaluating serious illness conversation skills.

PurposeThe JIGSAWS dataset is a fixed dataset of robot-assisted surgery kinematic data used to develop predictive models of skill. The purpose of this study is to analyze the relationships of self-defined skill level with global rating scale scores and kinematic data (time, path length and movements) from three exercises (suturing, knot-tying and needle passing) (right and left hands) in the JIGSAWS dataset.MethodsGlobal rating scale scores are reported in the JIGSAWS dataset and kinematic data were calculated using ROVIMAS software. Self-defined skill levels are in the dataset (novice, intermediate, expert). Correlation coefficients (global rating scale-skill level and global rating scale-kinematic parameters) were calculated. Kinematic parameters were compared among skill levels.ResultsGlobal rating scale scores correlated with skill in the knot-tying exercise (r = 0.55,p = 0.0005). In the suturing exercise, time, path length (left) and movements (left) were significantly different (p ConclusionGlobal rating scale scores weakly correlate with skill level and kinematic parameters. The ability of kinematic parameters to differentiate among self-defined skill levels is inconsistent. Additional data are needed to enhance the dataset and facilitate subset analyses and future model development.

PurposeThe purpose of this study is to compare the classification learning ability of our algorithm based on boosted support vector machine (B-SVM), against other classification techniques in predicting the credit ratings of banks. The key feature of this study is the usage of an imbalanced dataset (in the response variable/rating) with a smaller number of observations (number of banks).Design/methodology/approachIn general, datasets in banking sector are small and imbalanced too. In this study, 23 Scheduled Commercial Banks (SCBs) have been chosen (in India), and their corresponding corporate ratings have been collated from the Indian subsidiary of reputed global rating agency. The top management of the rating agency provided 12 input (quantitative) variables that are considered essential for rating a bank within India. In order to overcome the challenge of dataset being imbalanced and having small number of observations, this study uses an algorithm, namely “Modified Boosted Support Vector Machines” (MBSVMs) proposed by Punniyamoorthy Murugesan and Sundar Rengasamy. This study also compares the classification ability of the aforementioned algorithm against other classification techniques such as multi-class SVM, back propagation neural networks, multi-class linear discriminant analysis (LDA) and k-nearest neighbors (k-NN) classification, on the basis of geometric mean (GM).FindingsThe performances of each algorithm have been compared based on one metric—the geometric mean, also known as GMean (GM). This metric typically indicates the class-wise sensitivity by using the values of products. The findings of the study prove that the proposed MBSVM technique outperforms the other techniques.Research limitations/implicationsThis study provides an algorithm to predict ratings of banks where the dataset is small and imbalanced. One of the limitations of this research study is that subjective factors have not been included in our model; the sole focus is on the results generated by the models (driven by quantitative parameters). In future, studies may be conducted which may include subjective parameters (proxied by relevant and quantifiable variables).Practical implicationsVarious stakeholders such as investors, regulators and central banks can predict the credit ratings of banks by themselves, by inputting appropriate data to the model.Originality/valueIn the process of rating banks, the usage of an imbalanced dataset can lessen the performance of the soft-computing techniques. In order to overcome this, the authors have come up with a novel classification approach based on “MBSVMs”, which can be used as a yardstick for such imbalanced datasets. For this purpose, through primary research, 12 features have been identified that are considered essential by the credit rating agencies.

Objective To investigate the influence of clinical experience and content expertise on global assessment scores in a Surgical Objective Structured Clinical Exam (OSCE) for senior medical undergraduate students. Design Scripted videos of simulated student performance in an OSCE at two standards (clear pass and borderline) were awarded a global score on each of two rating scales by a range of clinical assessors. Results were analysed by examiner experience and content expertise. Setting The study was designed in a large Medical School in Ireland. Examiners were consultant and training grade doctors from three university teaching hospitals. Participants 147 assessors participated. Of these, 75 (51%) were surgeons and 25 (17%) had sub-speciality surgical expertise directly relevant to the OSCE station. 41 were consultants. Results Responsible academic scoring set the benchmark. By multivariable linear regression analysis, neither clinical experience (consultant status) nor relevant content expertise in surgery was independently predictive of assessor grading for either clear pass or borderline student performance. No educational factor (previous examining experience/training, self-rated confidence in assessment or frame of reference) was significant. Assessor gender (male) was associated with award of a fail grade for borderline performance. Trainees were reliable graders of borderline performance but more lenient than the gold standard for clear pass. We report greater agreement with the gold standard score using the global descriptive scale, with strong agreement for all assessors in the borderline case. Conclusions Neither assessor clinical experience nor content expertise is independently predictive of grade awarded in an OSCE. Where non-experts or trainees assess, we find evidence for use of a descriptive global score to maximise agreement with expert gold standard, particularly for borderline performance. These results inform the fair and reliable participation of a range of examiners across subspecialty stations in the surgical OSCE format.

Objective To characterize how pediatric resident self-evaluation compares to standardized patient evaluations in simulated child death disclosure scenarios. Methods This was a prospective, observational, mixed-methods study in which 18 second-year pediatric residents delivered the news of a death of a child to a trained standardized patient (SP) couple. The SPs evaluated residents via a quantitative global rating (1–3 scale) and via qualitative comments. Following the training, the residents completed self-assessments consisting of a global rating, qualitative comments, and their confidence related to 5 death disclosure skills. Results Agreement between SPs and resident ratings was poor; resident scores were compared to each of their 2 SP evaluators yielding Kappa coefficients of −0.23 (95% confidence interval = −0.60 to −0.07) and −0.30 (95% confidence interval = −0.70 to −0.04). Residents uniformly rated themselves as less capable in their communication skills than SPs did. Residents reported significant increases in their confidence in discussing autopsy and organ donation. Major themes determined from the qualitative comments from SPs included nonverbal communication, verbal communication, attunement to parents, and management of next steps. Residents’ comments mirrored these themes with the exception of the absence of nonverbal communication. Conclusions Pediatric residents underestimated their abilities in a self-assessment of their performance in a SP death disclosure scenario, demonstrating the importance of external feedback, particularly from SPs themselves. Based on SP feedback, future death disclosure trainings should emphasize nonverbal communication skills and specific behaviors that convey effective attunement to families.

Purpose The purpose of this study was to evaluate the psychometric properties of the PROMIS-Physical Function (PF) and Worst Stiffness Numeric Rating Scale (NRS) among patients with tenosynovial giant cell tumors (TGCT). Methods Measurement properties of the customized lower extremity (LE) and upper extremity (UE) PROMIS-PF scales and Worst Stiffness NRS were assessed using data from the Phase 3 ENLIVEN trial (n = 120). Anchor- and distribution-based analyses were utilized to derive a responder threshold for meaningful change over time. The Patient Global Rating of Concept (PGRC)-Physical Functioning and Patient Global Impression of Change (PGIC)-Stiffness served as anchors. Responsiveness and responder threshold analyses were from baseline to week 25. Results Cronbach’s alpha values for internal consistency reliability were 0.93 and 0.91 for the PROMIS-PF LE and UE, respectively. Test-retest reliability intra-class correlation coefficients were > 0.75 for both instruments. Convergent validity for both instruments was supported by moderate to strong correlations (≥0.30) with the Brief Pain Inventory and EQ-5D. Known-groups validity was established between subgroups stratified by pain level (p Conclusion This study is the first to establish the psychometric properties of patient-reported outcome measures in TGCT. The evidence demonstrates that the PROMIS-PF and Worst Stiffness NRS have good reliability, validity, and responsiveness, and provides guidance for the interpretation of meaningful change.

The school building is one of the most important elements of the educational process. It is an important factor in its success and increase the level of scientific performance of the students, whenever the school building is suitable and equipped with all the means of comfort, the positive effect will be on the whole educational process. and in the same context, there are several determinants of help to improve the environmental performance of the building and check adapted to the building with the surrounding environment without damaging the building or the environment with the convenience of individuals, which result in knowledge of the requirements the design and trying each side is interested in developing an ongoing basis. So it will deal to find the performance of global rating systems for sustainable educational buildings and also deal with the rating system of Egypt as the local system and clarifying each system and achievement credit of the system of those parameters and comparing these determinants in order to access to the determinants of improving the performance of the school in the context of specific and comprehensive, and then try to gain access to the methodology in the context of the most important credits affecting the performance of the building which can be applied to the existing school building to increase the sustainability of the school. The research will also include an applied example of an existing school building with proposed modifications and a determination of the sustainability ratio that is accessible to the school

Purpose To develop an Arabic version of the CPQ8–10 and test its validity and reliability for use among Arabic-speaking children. Methods The 25-item professionally translated questionnaire included two global rating questions across four domains, which was assessed through a pilot study on 20 participants who were not included in the main study. Children (n = 175) aged 8–10 years were consecutively recruited: group I (n = 120) included pediatric dental patients, group II (n = 25) included children with orofacial clefts, and group III (n = 30) included orthodontic patients. Construct (convergent and discriminant) validity, internal consistency, and test–retest reliability were assessed using Spearman’s rank correlation coefficients, Cronbach’s alpha coefficient, and intraclass correlation coefficient, respectively. All children were clinically examined; 66 children completed the questionnaire a second time. A cross-sectional study design was employed. Results CPQ8–10 scores and global ratings were positively correlated. CPQ8–10 scores were highest in group II, followed by groups I and III, respectively. CPQ8–10 scores were significantly higher in children affected with caries or malocclusion compared to unaffected children. Cronbach’s alpha was 0.95 and the intraclass correlation coefficient was 0.97. Conclusions The Arabic CPQ8–10 was valid and reliable; therefore, it can be utilized with Arabic-speaking children in this age group.

PurposeThe purpose of the paper is to study the problem of socio-economic inequality from the positions of the neo-institutional economic theory, to determine the causal connections of emergence and manifestation of this problem as a barrier on the path of sustainable development and to develop institutional measures for its solution based on state regulation.Design/methodology/approachThe scientific and methodological basis of this research is based on regression analysis, which is used for creating and analyzing the regression curves. For the fullest coverage of countries of the world and provision of high representation of the research results, the objects of the research are countries from each category that were distinguished according to their position in the global rating of countries as to the index of sustainable development, calculated and compiled by Sustainable Development Solutions Network (2019).FindingsIt is substantiated that financial inequality is a result of violation of the principles of social justice—primarily, in the labor market. The institutional approach, which is used for studying the problem of socio-economic inequality, allows presenting this problem as a result of the action of social institutes with own system of rules and norms and offering the institutional measures of regulation, which are to influence the rules and norms in society in the labor market. Due to this, the object of regulation is not the consequence but the reasons—and better and long-term results are achieved.Originality/valueIt is proved that social justice is the key condition of overcoming socio-economic inequality, formation of inclusive society and achievement of balance of the global economic system—thus opening a path to sustainable development. Four “institutional traps” are determined, which establish the practices of violation of the principles of social justice in the system of norms and rules of behavior of the labor market's participants. The authors determine perspectives and directions and offer measures of state regulation of the institutes of socio-economic inequality for its overcoming and provision of sustainable development of national economy and the global economy.

Supplemental Digital Content is available in the text The purpose of this study was to translate and culturally adapt the Neck Disability Index (NDI) into the simplified-Chinese language (NDI-SC) and to evaluate its psychometric properties. The results of this study showed that the NDI-SC is a reliable, valid, and responsive instrument., Study Design. Cross-cultural adaptation and psychometric evaluation. Objective. The aim of this study was to translate the Neck Disability Index (NDI) into the simplified-Chinese language and to evaluate the reliability, validity, and responsiveness of the new questionnaire. Summary of Background Data. Neck pain is a major health problem resulting in major disability. NDI is the most frequently used scale for self-rating of disability due to neck pain. At present, there is no simplified-Chinese version of the NDI. The aims of this study were to culturally adapt and translate the NDI into the simplified-Chinese language (NDI-SC) and to evaluate its psychometric properties in patients with neck pain. Methods. The NDI was translated into simplified-Chinese version based on established guidelines. A total of 70 patients participated in this study. Patients were asked to complete a set of questionnaires comprising of their demographic information, the NDI-SC, and a visual analog scale (VAS) of pain. Fifty-six patients returned after 1 to 2 weeks to complete the same set of questionnaires and the global rating of change (GROC) scale. Then, the NDI-SC was evaluated for content validity, construct validity, internal consistency, test-retest reliability, and responsiveness. Results. The NDI-SC demonstrated excellent internal consistency (Cronbach α = 0.92) and good test-retest reliability (ICC2,1 = 0.85). Content validity was confirmed as no floor or ceiling effects were detected for the NDI-SC total score. Construct validity was established with factor analysis revealing two-factor subscales explaining 66% of the variance. The NDI-SC showed a strong correlation with VAS (Rp = 0.61, P

Background Trainees in Otolaryngology–Head and Neck Surgery must gain proficiency in a variety of challenging temporal bone surgical techniques. Traditional teaching has relied on the use of cadavers; however, this method is resource-intensive and does not allow for repeated practice. Virtual reality surgical training is a growing field that is increasingly being adopted in Otolaryngology. CardinalSim is a virtual reality temporal bone surgical simulator that offers a high-quality, inexpensive adjunct to traditional teaching methods. The objective of this study was to establish the face and content validity of CardinalSim through a national study. Methods Otolaryngologists and resident trainees from across Canada were recruited to evaluate CardinalSim. Ethics approval and informed consent was obtained. A face and content validity questionnaire with questions categorized into 13 domains was distributed to participants following simulator use. Descriptive statistics were used to describe questionnaire results, and either Chi-square or Fishers exact tests were used to compare responses between junior residents, senior residents, and practising surgeons. Results Sixty-two participants from thirteen different Otolaryngology–Head and Neck Surgery programs were included in the study (32 practicing surgeons; 30 resident trainees). Face validity was achieved for 5 out of 7 domains, while content validity was achieved for 5 out of 6 domains. Significant differences between groups (p-value of p = 0.002) and two content validity domains (teaching drilling technique, p = 0.011 and overall teaching utility, p = 0.006). The assessment scores, global rating scores, and overall attitudes towards CardinalSim, were universally positive. Open-ended questions identified limitations of the simulator. Conclusion CardinalSim met acceptable criteria for face and content validity. This temporal bone virtual reality surgical simulation platform may enhance surgical training and be suitable for patient-specific surgical rehearsal for practicing Otolaryngologists.

Objectives Determining the changes in symptomatology suffered by dry eye disease (DED) patients after an intervention is difficult because there is only one validated questionnaire specifically designed to measure these changes and it is somewhat complex. This work uses a simplified questionnaire to evaluate the changes in DED-related symptoms. Methods A new questionnaire based on a global rating of change scale was designed. The Change in Dry Eye Symptoms Questionnaire (CDES-Q) consists of 2 questions: CDES-Q1 asks for the change in symptoms ("better," "same," or "worse") relative to a determined previous time and CDES-Q2 quantifies this change (range: 0 to +100). To evaluate the CDES-Q, a prospective observational study was performed. At baseline (V1; day-0), DED-related symptoms were evaluated using the ocular surface disease index (OSDI). In the post-treatment visit (V2; day-90), OSDI, Symptoms Assessment Questionnaire in Dry Eye (SANDE) II, and CDES-Q were used. Also, clinical evaluations were performed in each visit. Results Thirty-six patients were included. At V2, OSDI, SANDE II, and CDES-Q showed a significant reduction in symptoms (-7.17±12.73, P=0.0021; -11.29±20.95, P=0.0035; -25.28±42.28, P=0.0011, respectively). Patients who answered "better" in CDES-Q1 showed a significantly lower SANDE II than those who answered "same" or "worse," while SANDE II did not discriminate between these groups. Conclusions CDES-Q can be a useful tool for the evaluation of changes in DED-related symptoms. It is simple and better discriminates patients without changes from those who suffered a worsening than SANDE II.

Purpose The Accreditation Council for Graduate Medical Education (ACGME) restricted the duty hours for residents training in 2004. With less time to learn medicine, residents may not develop the clinical reasoning skills needed. Simulation can provide a remedy for this lack of time by allowing residents to practice skills and develop clinical reasoning in a simulated environment. Simulation Wars (SimWars), a clinical reasoning simulation has been shown to improve clinical reasoning skills. The purpose of the study was to investigate the effect of Simulation Wars on In-Training Examination (ITE) Scores and Global Rating Scale (GRS) Scores in Emergency Medicine (EM) residents. Methods The Quasi-Experimental design was used in this retrospective study. The main comparison was between historical controls, the residents who did not participate in the Simulation Wars, and the intervention group comprised of residents who participated in the SimWars. Results A total of 127 residents were participants in this study including 70 from the intervention and 57 from the historical control group. There were no significant differences found in GRS scores between both groups except for Communication and Professionalism (p

Background Musculoskeletal injuries are recognized as the leading health problem and primary source of injury, disability, and financial burden across the military.1-5 Special Operations Forces are at an increased risk of musculoskeletal injury due to increased physical demands, precipitous deployments, and continual training and deployment cycles.6,4 Multiple injury screening tools exist, yet decisions to return to duty are frequently deferred to individual institutional protocol or provider clinical decision making, with no accepted gold standard.2,3,4,5. Purpose The purpose of this case report is to describe the application of a system to return a Special Operations Forces candidate to duty following an ankle injury sustained during a military static line airborne operation while in the Special Forces Qualification Course. Case description The subject was a 34-year-old male with surgical fixation of a left distal fibular fracture with syndesmotic tear after landing from a static line airborne jump during the Special Forces Qualification Course. This case report provides a system to determine return to duty following an ankle fracture and provides a guide to returning a subject to participation, duty, and tactical performance training. Outcomes Outcome measures recorded were vast, as the use of multiple measures are more indicative of overall function than any single measure. Impairment based measures included Global Rating of Change Scale (GROC), Numeric Pain Rating Scale (NPRS), lateral step down and Closed Chain Dorsiflexion (CCDF). Functional outcome measures included: the Functional Movement Screen™ (FMS™), Lower Quarter Y-Balance (LQYB), three hop tests for distance, and physical performance metrics. Discussion The most substantial challenge to this process was the lack of standardized and validated military return to duty testing and guidelines in the literature. Ideally, pre-injury assessment would provide a baseline; however, compared to peers, the subject was well within acceptable ranges for all physical performance metrics at final Return to Duty testing. The subject was returned to duty 10 months after initial injury being physically comparable to his cohorts and being able to complete all military requirements. Levels of evidence 5.

Background The increasing use of review websites by consumers has become a crucial first step in choosing a physician with more than half of Americans consulting review sites before physician selection. We sought to identify whether differences exist in the quality and content of online reviews for men versus women surgeons. Methods Using a deliberate sampling algorithm of the two most populated physician review websites, RateMDs.com and Yelp.com , we purposefully sampled reviews for the top 20 surgeons per tercile from the four most populated urban areas in the United States: New York, Houston, Los Angeles, and Chicago. A grounded theory qualitative assessment was performed of major and minor thematic elements including global rating, communication, technical skills, and comments on ancillary elements. Results Four-hundred and thirty-one online patient reviews of 238 surgeons were identified from RateMDs.com (51%) and Yelp.com (49%) with available information on gender for analysis. Seventy-six percent of reviews were of male surgeons. Reviewers were more likely to mention a global rating and technical skill for men compared with women surgeons. Most reviews were positive with no difference in global rating by gender (83.7% positive for men and 74.3% positive for women, P = 0.08). Women surgeons were more likely to have positive comments on social interactions as compared with men (94.7% versus 88.0%, P = 0.03); whereas men surgeons were more likely to have a positive rating on technical skill compared with women (88.2% versus 76.2%, P = 0.04). Conclusions The content and quality of online surgeon reviews differ by gender. There is no difference in global rating between men and women. Women are rated higher for social interaction domains and men are rated higher on technical skill domains.

Today, there is a need for new theoretical-methodological and practical methods and approaches to activate and efficiently use creative human potential, which is an important factor in stabilizing and sustainable development of the modern economy. It is specified that creative and intellectual human potential is the main driver of formation of the new economy and a determining factor of competitiveness at the global level. In the article, the creative economy is defined as the conception of a post-industrial economy, which is based on the formation of a system of socio-economic relations regarding the production, distribution and consumption of benefits, which use as factors the production creativity, intellectual resources, as well as a talent for generating new ideas, which creates an innovative product or service. Also proved is the probability of Ukraine’s creative economy reaching the highest level of development, provided the efforts of the State, enterprises and society are combined, as evidenced by Ukraine’s high position in the global rankings of creativity and innovation. The creative potential of each of the five continents of the world are analyzed and a rating of creative industries by the level of profitability is built up. Creative industries with the largest share of profitability (television, visual arts, newspapers and magazines) as well as regional leaders for most creative industries – the USA and Asia – are identified. The profitability of creative industries in different regions of the world is estimated and, according to the results obtained, the prevailing share of creative industries is observed in the Asia-Pacific region (33%). The importance of supporting creative businesses during the crisis caused by the COVID-19 pandemic is emphasized. Based on the analysis of the survey of creative business owners, recommendations are made for the government to enable creative industries to compensate for their own losses and to provide favorable conditions for the reactivation of their activities.

The most important condition of modern world globalization for university system is the position of the uni-versity, its role and place, both in its own country and in the world positioning. Getting into the world ranking in the leading places, universities sharply increase their attractiveness not only for applicants, but also for employers, investors and the state, which can provide additional subsidies. The article considers the position of the Plekhanov Russian University of Economics in the QS World University Rankings.

Background: In the past decade, Tri-Service General Hospital has trained many actors-background standardized patients (SPs). However, we also have recruited some nonactor SPs since 2010. Reviewing the literature, the reliability of SPs with or without actor background would be the impact factor on high-stakes OSCE has not been well studied. Aim: The purpose of this retrospective observation is to clarify whether a SP with or without a professional actor background will affect the performances of the examination when participating in the Taiwan high-stakes objective structured clinical examination (OSCE). The result will be the policy for selecting which kind of SPs to participate in the high-stack OSCE in our hospital. Methods: In this retrospective observation, we analyzed 74 actor background SPs (A-SPs), and 70 no actor background SPs (NA-SPs) who have participated in each spring test of 2015–2017 Taiwan high-stakes OSCE. The data of SPs performance have come from two parts: one is from the examinee with the global rating of the SPs performance and the other is from the examiner with eight-item checklist for the SPs performance. The scoring of both examinee and examiner is a five-point Likert scale. Results: The results show that there is no significant difference in SPs performance from the examinee scoring in the subsequent 3 years, stable and satisfactory, and let examinees feel like real patients. The scores from examiners also showed that two groups of SPs performed equally well without significant differences. Their performance is reliable and consistent, simulating to be a real patient in both groups. However, only one interest finding, when compared to the different age subdivision of SPs, showed the aged subgroup of A-SPs and NA-SPs with the significant difference in the item of reliability and consistent (4.67 ± 0.53 vs. 4.41 ± 0.50, P < 0.05), the possible reason is related to the less-experienced associate with mild memory decline in aged NA-SPs.Conclusions: Our observation gives the essential information, that the well-trained and experienced SP are necessary for participating in the high-stakes OSCE examination, even without the background of the actor. What we need is a professional SP who not only has excellent professionalism but also has a good personality literacy to engage in his/her work.

PURPOSE: Individuals with Huntington disease (HD) experience progressive cognitive decline that may appear years before motor manifestations of the disease. These declines have a profound effect on health-related quality of life (HRQOL) over the disease course, and thus it is important that self-report measures of cognitive function are validated for use in longitudinal studies. METHODS: 359 individuals with premanifest or manifest HD completed baseline and at least one follow-up (12- and 24-month) assessment. Neuro-QoL™ Cognitive Function was administered at each time-point. Participants completed a self-reported global rating of cognitive change, as well as performance-based cognitive changes (using the Symbol Digit Modalities Test). Standardized response means (SRMs) and general linear models evaluated whether Neuro-QoL™ Cognitive Function was responsive to change over time with respect to self-reported and performance-based anchors. Test–retest reliability and known-group validity were also examined. RESULTS: Responsiveness was supported by effect sizes that were small in magnitude, but in the expected direction relative to self-reported and performance-based change. General linear models generally supported 12- and 24-month responsiveness relative to self-reported cognitive change and 12-month responsiveness relative to performance-based change. Test–retest reliability was excellent, and the measure exhibited known-group validity. CONCLUSION: Longitudinal analyses generally indicate that the Neuro-QoL™ Cognitive Function measure is sensitive to change over time in individuals with HD. Neuro-QoL Cognitive Function changes reflect self-reported cognitive change at 12 and 24 months and performance-based change at 12 months. This measure may be useful in clinical trials or longitudinal observation studies.

Objectives/hypothesis Create a competency-based assessment tool for pediatric esophagoscopy with foreign body removal. Study design Blinded modified Delphi consensus process. Setting Tertiary care center. Methods A list of 25 potential items was sent via the Research Electronic Data Capture database to 66 expert surgeons who perform pediatric esophagoscopy. In the first round, items were rated as "keep" or "remove" and comments were incorporated. In the second round, experts rated the importance of each item on a seven-point Likert scale. Consensus was determined with a goal of 7 to 25 final items. Results The response rate was 38/64 (59.4%) in the first round and returned questionnaires were 100% complete. Experts wanted to "keep" all items and 172 comments were incorporated. Twenty-four task-specific and 7 previously-validated global rating items were distributed in the second round, and the response rate was 53/64 (82.8%) with questionnaires returned 97.5% complete. Of the task-specific items, 9 reached consensus, 7 were near consensus, and 8 did not achieve consensus. For global rating items that were previously validated, 6 reached consensus and 1 was near consensus. Conclusions It is possible to reach consensus about the important steps involved in rigid esophagoscopy with foreign body removal using a modified Delphi consensus technique. These items can now be considered when evaluating trainees during this procedure. This tool may allow trainees to focus on important steps of the procedure and help training programs standardize how trainees are evaluated. Level of evidence 5. Laryngoscope, 131:1168-1174, 2021.

Aim: To assess the current scientific evidence about the relationship between breastfeeding and the development of infant's socio-emotional competencies. Materials and Methods: A systematic review of literature was conducted through PubMed, LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud), and PsycINFO of population-based cohorts. Records were screened, data extracted, and a quality assessment performed by two authors independently. Results: Thirteen studies were included in the review with six finding a statistically significant association between breastfeeding and the development of socio-emotional competencies such as problem solving, agreeableness, and optimism. In five studies, no statistically significant association was found, and in three, a negative association existed. Regarding quality assessment, four studies had a strong global rating, four had a moderate rating, and five had a weak global rating. Conclusion: Almost half (6/13) of the studies found a positive association between breastfeeding and the development of social-emotional competencies in infants; however, a great heterogeneity was present in the quality of the included studies. There is a need for further and higher quality research into this field of study.

OBJECTIVE: The purpose of this study was to compare the effectiveness of Dowling's and Mulligan's manual therapy techniques on pain and disability in the management of lumbar disc herniation with radiculopathy (LDHR). METHODS: A total of 40 individuals with LDHR were randomly allocated into 2 groups, 20 participants each in PINS and SMWLM groups. Each participant was assessed at baseline, 4 weeks, and 8 weeks postintervention. The primary outcomes measured were pain (visual analog scale) and disability (Roland-Morris Disability Questionnaire). Secondary variables were quality of life (Short-Form 36 Health Survey), sciatica bothersomeness (Sciatica Bothersomeness Index), sciatica frequency (Sciatica Frequency Index), and general perception of recovery (Global Rating of Change Scale). Repeated-measures analysis of variance was used to compute within-group and between-groups interactions. RESULTS: No significant differences were observed in the baseline characteristics of participants in both groups. The results indicate that there were significant time effects for all outcomes in the study (P < .001) within each group. However, there was no significant difference between the 2 groups on any outcome variable (P > .05). CONCLUSION: The findings indicate that there was no difference in pain or disability between the 2 manual therapy techniques in the management of LDHR.

Background The interpretability of change in exercise test scores is an important measurement property. This study aimed to provide a framework for the interpretation of individual change scores of the 10 metre incremental shuttle walk test (ISWT) in cardiac rehabilitation. Methods In a quantitative pre-post design study, 52 patients who were referred to a hospital outpatient department for cardiac rehabilitation participated in this study. Participants completed two ISWTs prior to cardiac rehabilitation. Post cardiac rehabilitation, participants completed a global rating of change score and two ISWTs. Change scores were analysed for smallest detectable change (SDC) and minimum important change (MIC). Results The SDC for an individual was 47 metres. The predicted MIC for participants to report an improvement ranged from 70 to 92 metres. The predicted MIC for participants who did not report a deterioration in the global rating of change (i.e., those who reported unchanged or improved) ranged from 16 to 42 metres. Conclusions The MIC for patients who report any improvement in physical fitness and functional capacity is 70 metres. These results suggest that over an 8-week program, patients would need to improve by at least seven shuttles to perceive an improvement in their physical fitness and functional capacity. Patients with small increases in the 10-metre ISWT distance may still report deterioration in their physical fitness and functional capacity.