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For the construction of tests and questionnaires that require multiple raters (e.g., a child behaviour checklist completed by both parents) a novel ordinal scaling technique is currently being further developed, called two-level Mokken scale analysis. The technique uses within-rater and between-rater coefficients to assess the scalability of the test. These coefficients are generalizations of Mokken's scalability coefficients. In this paper we derived standard errors for the two-level coefficients and for their ratios. The coefficients, the estimates, the estimated standard errors and the software implementation are discussed and illustrated using a real-data example, and a small-scale simulation study demonstrates the accuracy of the estimates.

Organizations are confronted with a constant need for efficiency, which affects the working atmosphere, often typified by velocity, time pressure, competition, job insecurity, and information overload, which may lead to stress, burnout, work-life disbalance, and lowered work functioning. This study evaluated an 8-week, 1.5 h-per-week group-based standardized mindfulness program (“Finding peace in a frantic world”), applied on-site in a large multinational company. In a naturalistic longitudinal design self-selected employees (n = 150) completed measurements at wait-list, pre-test, post-test, and 2 and 6 months follow-up. Nearly all participants followed at least five out of eight sessions, were highly satisfied with the training (8.3 out 10), and almost 90% intended to continue with mindfulness practices. Primary outcomes were stress and risk for dropout from work. Using multilevel analyses, mean pre-test scores were compared to the other measurement occasions, and the rate of change in the training period (M = 67 days; SD = 12) was compared to the rate of change in the wait-list period (M = 29 days; SD = 8). Direct and long-term positive effects on risk for dropout from work (p p p

Background With few RCTs having compared active treatments for paediatric PTSD, little is known about whether or which baseline (i.e. pre-randomization) variables predict or moderate outcomes in the evaluated treatments. Objective To identify predictors and moderators of paediatric PTSD outcomes for Eye Movement Desensitization and Reprocessing Therapy (EMDR) and Cognitive Behavioural Writing Therapy (CBWT). Method Data were obtained as part of a multi-centre, randomized controlled trial of up to six sessions (up to 45 minutes each) of either EMDR therapy, CBWT, or wait-list, involving 101 youth (aged 8–18 years) with a PTSD diagnosis (full/subthreshold) tied to a single event. The predictive and moderating effects of the child’s baseline sociodemographic and clinical characteristics, and parent’s psychopathology were evaluated using linear mixed models (LMM) from pre- to post-treatment and from pre- to 3- and 12-month follow-ups. Results At post-treatment and 3-month follow-up, youth with an index trauma of sexual abuse, severe symptoms of PTSD, anxiety, depression, more comorbid disorders, negative posttraumatic beliefs, and with a parent with more severe psychopathology fared worse in both treatments. For children with more severe self-reported PTSD symptoms at baseline, the (exploratory) moderator analysis showed that the EMDR group improved more than the CBWT group, with the opposite being true for children and parents with a less severe clinical profile. Conclusions The most consistent finding from the predictor analyses was that parental symptomatology predicted poorer outcomes, suggesting that parents should be assessed, supported and referred for their own treatment where indicated. The effect of the significant moderator variables was time-limited, and given the large response rate (>90%) and brevity (, HIGHLIGHTS Given the time-limited significance of differential treatment effects on outcome, brevity and large effect size for EMDR and cognitive-behavioural writing therapy for paediatric PTSD, future focus should be on enhancing delivery of these treatments, rather than tailoring them.

Background Both the presence of psychological problems and the absence of an employment contract are related to long-term sickness absence, prolonged work disability and unemployment. Studies researching the effectiveness of return-to-work interventions on these non-permanent workers, including unemployed and temporary agency workers and workers with an expired fixed-term contract, are lagging behind. Therefore, a return-to-work intervention called “Brainwork” was developed. The aim of this study was to assess the effectiveness of the ‘Brainwork Intervention’ in reducing the duration of sick leave compared to usual care over a 12-month follow-up. Methods In a multicenter controlled clinical trial, using a quasi-randomization procedure, we compared the Brainwork Intervention (n = 164) to usual care (n = 156). The primary outcome was the duration of sick leave. Secondary outcomes were the duration of sick leave starting from Social Security Agency transfer; the proportion of workers returned to work; the number of hours of paid employment during the follow-up period; the degree of worker participation; the level of psychological complaints; and the self-efficacy for return to work. Protocol adherence (Brainwork Intervention) was considered sufficient when at least three of the five protocol steps were followed. Cox regressions, linear and ordinal regression, and Mixed Model analyses were performed. Results All 320 participants were analyzed. The Brainwork Intervention resulted in a non-significant reduction of the duration of sick leave compared to usual care (269 days versus 296 days; HR = 1.29; 95% CI 0.94–1.76; p = 0.11). For those working (46%) during the 12-month follow-up, the mean number of hours of paid employment was non-significantly higher in the usual care group (682 h versus 493 h; p = 0.053). No significant differences were found for other secondary outcomes. Protocol adherence was 10%. Conclusions The Brainwork Intervention as performed with a low protocol adherence did not result in a significant reduction of the duration of sick leave compared to usual care. It remains unclear what the results would have been if the Brainwork Intervention had been executed according to protocol. Trial registration The Netherlands Trial Register (NTR); NTR3976 (old registration number NTR4190). Registered September 27th 2013.

In the wake of the COVID-19 pandemic, physical distancing behavior turned out to be key to mitigating the virus spread. Therefore, it is crucial that we understand how we can successfully alter our behavior and promote physical distancing. We present a framework to systematically assess the effectiveness of behavioral interventions to stimulate physical distancing. In addition, we demonstrate the feasibility of this framework in a large-scale natural experiment (N = 639) conducted during an art fair. In an experimental design, we varied interventions to evaluate the effect of face masks, walking directions, and immediate feedback on visitors’ contacts. We represent visitors as nodes, and their contacts as links in a contact network. Subsequently, we used network modelling to test for differences in these contact networks. We find no evidence that face masks influence physical distancing, while unidirectional walking directions and buzzer feedback do positively impact physical distancing. This study offers a feasible way to optimize physical distancing interventions through scientific research. As such, the presented framework provides society with the means to directly evaluate interventions, so that policy can be based on evidence rather than conjecture.

Lessons Learned Background Endoglin is an angiogenic receptor expressed on proliferating tumor vessels and renal cell carcinoma (RCC) stem cells that is implicated as a mechanism of resistance to vascular endothelial growth factor receptor (VEGFR) inhibitors. This study evaluated an antiendoglin monoclonal antibody (carotuximab, TRC105) combined with axitinib in patients with advanced or metastatic clear cell renal cell carcinoma (mccRCC) who had progressed following one or more prior VEGF inhibitors. Methods TRAXAR was a multicenter, international randomized 1:1 (stratified by ECOG, 0 vs. 1), phase II study of carotuximab combined with axitinib versus axitinib alone in mccRCC patients who had progressed following one or more prior VEGF inhibitors. The primary endpoint was progression-free survival (PFS) assessed by independent central review (ICR) per RECIST 1.1 Results A total of 150 patients were randomized. The combination therapy resulted in shorter median PFS by RECIST 1.1 than axitinib monotherapy (6.7 vs. 11.4 months). The combination was tolerated similarly to axitinib monotherapy, and there were no treatment related deaths. Exploratory evaluation of pretreatment circulating biomarkers suggested the combination might benefit patients who have low baseline VEGF levels. Conclusion The combination of carotuximab with axitinib did not demonstrate additional efficacy over single agent axitinib in patients with mccRCC who progressed following one or more prior VEGF inhibitor treatment.

We investigated whether early algebra lessons that explicitly aimed to elicit mathematical discussions (shift-problem lessons) invoke more and qualitatively better mathematical discussions and raise students’ mathematical levels more than conventional lessons in a small group setting. A quasi-experimental study (pre- and post-test, control group) was conducted in 6 seventh-grade classes (N = 160). An analysis of the interaction processes of five student groups showed that more mathematical discussions occurred in the shift-problem condition. The quality of the mathematical discussions in the shift-problem condition was better compared to that in the conventional textbook condition, but there is still more room for improvement. A qualitative illustration of two typical mathematical discussions in the shift-problem condition are provided. Although students’ mathematical levels were raised a fair amount in both conditions, no differences between conditions were found. We concluded that shift-problem lessons are powerful for eliciting mathematical discussions in seventh-grade shift-problem early algebra lessons.

Two-level Mokken scale analysis is a generalization of Mokken scale analysis for multi-rater data. The bias of estimated scalability coefficients for two-level Mokken scale analysis, the bias of their estimated standard errors, and the coverage of the confidence intervals has been investigated, under various testing conditions. It was found that the estimated scalability coefficients were unbiased in all tested conditions. For estimating standard errors, the delta method and the cluster bootstrap were compared. The cluster bootstrap structurally underestimated the standard errors of the scalability coefficients, with low coverage values. Except for unequal numbers of raters across subjects and small sets of items, the delta method standard error estimates had negligible bias and good coverage. Post hoc simulations showed that the cluster bootstrap does not correctly reproduce the sampling distribution of the scalability coefficients, and an adapted procedure was suggested. In addition, the delta method standard errors can be slightly improved if the harmonic mean is used for unequal numbers of raters per subject rather than the arithmetic mean.

This study provides an overview of components of teacher identity that are found in quantitative measurement instruments; and reports on the psychometric quality of these measurement instruments. Our search included studies that assessed components of teacher identity published in English-written, peer-reviewed articles between 2000 and 2018. We analyzed a total of 59 components in 20 studies. After we categorized the components on the basis of a substantive analysis, six main domains of teacher identity became apparent: Self-image, Motivation, Commitment, Self-efficacy, Task perception, and Job satisfaction. Whereas the overall psychometric properties of the measurement instruments used in the different studies were acceptable to good, our systematic overview revealed several conceptual and methodological issues that need to be resolved. The results may contribute to the further operationalization of the complex construct of teacher identity.

Additional file 2. Figure Brainwork Intervention.

Additional file 1. Table Brainwork category classification.

This study aimed to design and validate the Teacher Identity Measurement Scale (TIMS) for assessing primary student teachers’ professional identity. Based on identity theory and a systematic review into quantitative instruments of teacher identity, teacher identity was decomposed in four first-order constructs: motivation, self-image, self-efficacy, and task perception. This resulted in a measurement scale consisting of 46 items. The factorial design was examined by administering the TIMS to first- and second-year primary student teachers. In phase 1, involving 17 students, qualitative scale development methods were used to assess the construct validity. In phase 2, its second-order factor structure was tested and confirmed among a sample of 211 students. In phase 3, this structure was cross-validated among a new sample of 419 students. The instrument may contribute to understanding primary student teacher’s professional development and can be used as a tool to support the process of developing a professional teacher identity.

Background TRC105 is an IgG1 endoglin monoclonal antibody that potentiates VEGF inhibitors in preclinical models. We assessed safety, pharmacokinetics, and antitumor activity of TRC105 in combination with axitinib in patients with metastatic renal cell carcinoma (mRCC). Subjects, Materials, and Methods Heavily pretreated mRCC patients were treated with TRC105 weekly (8 mg/kg and then 10 mg/kg) in combination with axitinib (initially at 5 mg b.i.d. and then escalated per patient tolerance to a maximum of 10 mg b.i.d.) until disease progression or unacceptable toxicity using a standard 3 + 3 phase I design. Results Eighteen patients (median number of prior therapies = 3) were treated. TRC105 dose escalation proceeded to 10 mg/kg weekly without dose-limiting toxicity. Adverse event characteristics of each drug were not increased in frequency or severity when the two drugs were administered concurrently. TRC105 and axitinib demonstrated preliminary evidence of activity, including partial responses (PR) by RECIST in 29% of patients, and median progression-free survival (11.3 months). None of the patients with PR had PR to prior first-line treatment. Lower baseline levels of osteopontin and higher baseline levels of TGF-β receptor 3 correlated with overall response rate. Conclusion TRC105 at 8 and 10 mg/kg weekly was well tolerated in combination with axitinib, with encouraging evidence of activity in patients with mRCC. A multicenter, randomized phase II trial of TRC105 and axitinib has recently completed enrollment (NCT01806064). Implications for Practice TRC105 is a monoclonal antibody to endoglin (CD105), a receptor densely expressed on proliferating endothelial cells and also on renal cancer stem cells that is implicated as a mediator of resistance to inhibitors of the VEGF pathway. In this Phase I trial, TRC105 combined safely with axitinib at the recommended single agent doses of each drug in patients with renal cell carcinoma. The combination demonstrated durable activity in a VEGF inhibitor-refractory population and modulated several angiogenic biomarkers. A randomized Phase II trial testing TRC105 in combination with axitinib in clear cell renal cell carcinoma has completed accrual.