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This first Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE-1) from the Society for Academic Emergency Medicine is on the topic: Recurrent, Low-risk Chest Pain in the Emergency Department. The multidisciplinary guideline panel used The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding eight priority questions for adult patients with recurrent, low-risk chest pain and have derived the following evidence based recommendations: (1) for those >3 h chest pain duration we suggest a single, high-sensitivity troponin below a validated threshold to reasonably exclude acute coronary syndrome (ACS) within 30 days; (2) for those with a normal stress test within the previous 12 months, we do not recommend repeat routine stress testing as a means to decrease rates of major adverse cardiac events at 30 days; (3) insufficient evidence to recommend hospitalization (either standard inpatient admission or observation stay) versus discharge as a strategy to mitigate major adverse cardiac events within 30 days; (4) for those with non-obstructive (

BACKGROUND: Stereotactic body radiotherapy (SBRT) is the standard of care for patients with nonoperative, early-stage non-small cell lung cancer (NSCLC) measuring

PURPOSE: For inoperable stage I (T1-T2N0) small cell lung cancer (SCLC), national guidelines recommend chemotherapy with or without conventionally fractionated radiation therapy. The present multi-institutional cohort study investigated the role of stereotactic ablative radiation therapy (SABR) for this population. METHODS AND MATERIALS: The clinical and treatment characteristics, toxicities, outcomes, and patterns of failure were assessed in patients with histologically confirmed stage T1-T2N0M0 SCLC. Kaplan-Meier analysis was used to evaluate the survival outcomes. Univariate and multivariate analyses identified predictors of outcomes. RESULTS: From 24 institutions, 76 lesions were treated in 74 patients (median follow-up 18 months). The median age and tumor size was 72 years and 2.5 cm, respectively. Chemotherapy and prophylactic cranial irradiation were delivered in 56% and 23% of cases, respectively. The median SABR dose and fractionation was 50 Gy and 5 fractions. The 1- and 3-year local control rate was 97.4% and 96.1%, respectively. The median disease-free survival (DFS) duration was 49.7 months. The DFS rate was 58.3% and 53.2% at 1 and 3 years, respectively. The median, 1-year, and 3-year disease-specific survival was 52.3 months, 84.5%, and 64.4%, respectively. The median, 1-year, and 3-year overall survival (OS) was 17.8 months, 69.9%, and 34.0% respectively. Patients receiving chemotherapy experienced an increased median DFS (61.3 vs 9.0 months; P=.02) and OS (31.4 vs 14.3 months; P=.02). The receipt of chemotherapy independently predicted better outcomes for DFS/OS on multivariate analysis (P=.01). Toxicities were uncommon; 5.2% experienced grade ≥2 pneumonitis. Post-treatment failure was most commonly distant (45.8% of recurrence), followed by nodal (25.0%) and elsewhere lung (20.8%). The median time to each was 5 to 7 months. CONCLUSIONS: From the findings of the largest report of SABR for stage T1-T2N0 SCLC to date, SABR (≥50 Gy) with chemotherapy should be considered a standard option.

This article discusses the use of the Many-Facets Rasch Model, via the FACETS computer program (Linacre, 2006a), to scale job/practice analysis survey data as well as to combine multiple rating scales into single composite weights representing the tasks' relative importance. Results from the Many-Facets Rasch Model are compared with those calculated from the Rasch Rating Scale Model (RRSM) (Spray & Huang, 2000) using two examples of actual job analysis data from diverse professions. In addition, this article proposes a solution for establishing the origin of the percentage scale when transferring the task importance weights from a logit unit into percentage weights. Although the resulting test specifications from the two compared methods are not radically different, a case is made that the use of the Many-Facets Rasch Model with a zero point based on the frequency rating scale provides a more justifiable basis for combining multiple rating scales and transforming task survey data. In addition, this study found that the Many-Facets Rasch Rating Model can better accommodate missing data than the RRSM method in situations in which respondents only rate subsets of the multiple scales and not all of the scales for the tasks being surveyed. (Contains 4 tables, 2 figures, and 3 notes.)

Developed a computerized adaptive language proficiency test for a community college in Quebec, Canada and obtained item response theory calibrations on the items from 700 to 800 administrations. Describes projected efforts to detect instances in which "cheating low" (answering incorrectly deliberately) occurs. (SLD)

The development of an online performance assessment instrument, the Assessment of Motor and Process Skills, is reported. Issues addressed include development, implementation, and validation of the scoring rubric in an extended Rasch model, rater training, and implementation of the assessment in a computerized program. (SLD)

Examinations were analyzed using the Rasch model to determine differences in judge severity and grading period stringency for (1) essay examination (subjects were 12 judges and 32 examinees); (2) clinical examination (subjects were 18 judges and 217 examinees); and (3) oral examination (subjects were 46 judges and 270 examinees). (SLD)