Development and validation of the physical effort scale (PES)

OBJECTIVES

Previous literature has primarily viewed physical effort as an aversive experience. However, recent research suggests that effort can also be valued positively. These differences in approach and avoidance tendencies toward physical effort may play a key role in the self-regulation of physical activity behaviors. The aim of this study was to develop a scale that measures these tendencies and contributes to a better understanding of physical effort and how it affects behavior.

METHODS

The Physical Effort Scale (PES) was developed in Study 1 based on expert evaluations (n = 9) and cognitive interviews (n = 10). In Study 2 (n = 680, 69% female), content validity and dimensional structure were examined using principal component analysis and confirmatory factor analysis. Item reduction was conducted using item response theory. Preliminary construct validity was explored using regression. Study 3 (n = 297, 71% female) was used to validate dimensional structure, internal consistency, and construct validity, and to assess test-retest reliability.

RESULTS

In Study 1, 44 items were rated for content validity, of which 18 were selected and refined based on cognitive interviews. Analyses from Study 2 allowed reducing the scale to 8 items with a two-dimension structure: tendency to approach (n = 4) and to avoid physical effort (n = 4). The two subscales showed high internal consistency (α = 0.897 for the approach dimension and 0.913 for the avoidance dimension) and explained usual levels of physical activity, providing preliminary evidence of construct validity. Study 3 confirmed the two-dimension structure with high internal consistency (α = 0.907 and 0.916 for the approach and avoidance dimension, respectively) and revealed acceptable test-retest reliability (intraclass correlation >0.66). Patterns of associations with other constructs showed expected relationships, confirming the concurrent, convergent, and discriminant validity of the scale.

CONCLUSIONS

The PES is a valid and reliable measure of individual differences in the valuation of physical effort. This scale can assess the propensity to engage in physically demanding tasks in non-clinical populations. The PES and its manual are available in the Supplementary Material.

Parent Perspectives of Diagnostic and Monitoring Tests Undertaken by Their Child with Inflammatory Bowel Disease

PURPOSE

To assess parent perspectives of the current and potential future tests for their child with inflammatory bowel disease (IBD).

METHODS

New Zealand parents of a child with IBD were invited to complete an anonymous online survey. Experiences relating to their child's blood or faecal tests, medical imaging (abdominal ultrasound [US], abdominal computerised tomography [CT] and magnetic resonance enterography) and colonoscopy were collected. Perceived attitudes to potential future testing of urine, saliva, and breath, were sought.

RESULTS

Twenty-eight parents, 93% female completed the survey, and 86% were aged between 35 and 54 years. Baseline information was provided by parents for 27 of 28 children, 70.3% had Crohn's disease with a mean disease duration of 2.67 years. Blood tests were the most requested and completed tests, while CT was the least ordered and most refused test. Colonoscopy was rated as the least comfortable and generated the most worry. Explanation of test significantly improved parent's levels of understanding when their child had blood, faecal, imaging (US) or colonoscopy tests. Providing an explanation, test invasiveness and the impact of the blood results may have on their child's treatment significantly improved parents' comfort levels. However, explanation of colonoscopy generated a significant parental concerns. Saliva, urine and blood tests were chosen as the most preferred disease monitoring tests.

CONCLUSION

Parents preferred any tests less invasive than colonoscopy for monitoring their child's IBD. Although providing explanation of their child's tests enhanced parents' understanding, it can also affect parents' levels of concern and comfort.

P-values and significance: The null hypothesis that they are not related is correct

False signals and therapeutic optimism have led medicine down many a wrong pathway. Apart from the unnecessary costs of care and redundant research expenditure and efforts this has caused, therapies which were eventually discontinued may have come at a staggering cost of lives lost. Still most statistical information in the medical literature is presented with its p-values and little else. The use of p<0.05 was proposed as an arbitrary threshold for defining a statistically significant difference. Strong signals manifest even with the use of small sample sizes and are highly replicable. However, weak signals, which are increasingly the focus of modern research, may be obscured by the presence of other powerful variables in the dataset are more likely to decay in subsequent studies due to multiple causes. It is time to set higher standards for evidence in medical research. Data that should always be presented in conjunction with the p-value are the Confidence Intervals, which illustrate the uncertainty inherent to the results, and the Fragility Index, which reflects result robustness. Multiple RCTs should be the standard for implementing change. Ideally these studies should consistently demonstrate p-values <0.005, study and control groups with well separated 95% CIs and high fragility indices.

The elusive small bowel adenocarcinoma in the terminal ileum-A case report

INTRODUCTION

Small bowel malignancies are rare and often present with non-specific symptoms. Because of this, diagnosis of small bowel malignancies is often missed.

PRESENTATION OF CASE

71-year-old male presented with a four-week history of right iliac fossa pain and loss of weight. Laboratory tests showed a raised C-reactive protein, but all other pathology results and tumour-associated antigens were normal. Computed tomography (CT) of the abdomen demonstrated an inflammatory mass extending laterally into the pelvic wall. The patient underwent an elective laparotomy and resection of the small bowel tumour. Intra-operative findings included a small bowel tumour adherent to two loops of small bowel. Histology demonstrated a 50 mm poorly differentiated mucinous adenocarcinoma of the terminal ileum.

DISCUSSION

Clinical presentation of small bowel adenocarcinoma is often non-specific, which leads to a delay in diagnosis. As a result, disease is often advanced by the time of diagnosis. Upper and lower endoscopy is useful in detecting tumours in the duodenum and terminal ileum. Video capsule endoscopy allows visualisation of the entire small bowel mucosa. Enteroscopy can also be used to obtain biopsies and perform therapeutic interventions. CT is able to detect abnormalities in 80% of patients, while CT and MR (magnetic resonance) enteroclysis give better visualisation of the mucosa and mural thickness. Surgical exploration may be indicated in patients with a strong clinical suspicion.

CONCLUSION

In conclusion, small bowel malignancies are rare and clinicians are reminded to have a high index of suspicion for small bowel malignancies in patients who present with non-specific abdominal symptoms.

Physical activity among children: objective measurements using Fitbit One® and ActiGraph

Background

Self-quantification of health parameters is becoming more popular; thus, the validity of the devices requires assessments. The aim of this study was to evaluate the validity of Fitbit One step counts (Fitbit Inc., San Francisco, CA, USA) against Actigraph wActisleep-BT step counts (ActiGraph, LLC, Pensacola, FL, USA) for measuring habitual physical activity among children.

Design

The study was implemented as a cross-sectional experimental design in which participants carried two waist-worn activity monitors for five consecutive days.

Methods

The participants were chosen with a purposive sampling from three fourth grade classes (9–10 year olds) in two comprehensive schools. Altogether, there were 34 participants in the study. From these, eight participants were excluded from the analysis due to erroneous data. Primary outcome measures for step counts were Fitbit One and Actigraph wActisleep-BT. The supporting outcome measures were based on activity diaries and initial information sheets. Classical Bland–Altman plots were used for reporting the results.

Results

The average per-participant daily difference between the step counts from the two devices was 1937. The range was [116, 5052]. Fitbit One gave higher step counts for all but the least active participant. According to a Bland–Altman plot, the hourly step counts had a relative large mean bias across participants (161 step counts). The differences were partially explained by activity intensity: higher intensity denoted higher differences, and light intensity denoted lower differences.

Conclusions

Fitbit One step counts are comparable to Actigraph step counts in a sample of 9–10-year-old children engaged in habitual physical activity in sedentary and light physical activity intensities. However, in moderate-to-vigorous physical activity, Fitbit One gives higher step counts when compared to Actigraph.

[In-depth interviews and the Kano model to determine user requirements in a burns unit]

OBJECTIVE

To determine the healthcare requirements of patients in a Burns Unit, using qualitative techniques, such us in-depth personal interviews and Kano's methodology.

MATERIAL AND METHODS

Qualitative methodology using in-depth personal interviews (12 patients), Kano's conceptual model, and the SERVQHOS questionnaire (24 patients). All patients had been hospitalised in the last 12 months in the Burns Unit. Using Kano's methodology, service attributes were grouped by affinity diagrams, and classified as follows: must-be, attractive (unexpected, great satisfaction), and one-dimensional (linked to the degree of functionality of the service). The outcomes were compared with those obtained with SERVQHOS questionnaire.

RESULTS

From the analysis of in-depth interviews, 11 requirements were obtained, referring to hotel aspects, information, need for closer staff relationship, and organisational aspects. The attributes classified as must-be were free television and automatic TV disconnection at midnight. Those classified as attractive were: individual room for more privacy, information about dressing change times in order to avoid anxiety, and additional staff for in-patients. The results were complementary to those obtained with the SERVQHOS questionnaire.

CONCLUSIONS

In-depth personal interviews provide extra knowledge about patient requirements, complementing the information obtained with questionnaires. With this methodology, a more active patient participation is achieved and the companion's opinion is also taken into account.

Concise review: microfluidic technology platforms: poised to accelerate development and translation of stem cell-derived therapies

Stem cells are a powerful resource for producing a variety of cell types with utility in clinically associated applications, including preclinical drug screening and development, disease and developmental modeling, and regenerative medicine. Regardless of the type of stem cell, substantial barriers to clinical translation still exist and must be overcome to realize full clinical potential. These barriers span processes including cell isolation, expansion, and differentiation; purification, quality control, and therapeutic efficacy and safety; and the economic viability of bioprocesses for production of functional cell products. Microfluidic systems have been developed for a myriad of biological applications and have the intrinsic capability of controlling and interrogating the cellular microenvironment with unrivalled precision; therefore, they have particular relevance to overcoming such barriers to translation. Development of microfluidic technologies increasingly utilizes stem cells, addresses stem cell-relevant biological phenomena, and aligns capabilities with translational challenges and goals. In this concise review, we describe how microfluidic technologies can contribute to the translation of stem cell research outcomes, and we provide an update on innovative research efforts in this area. This timely convergence of stem cell translational challenges and microfluidic capabilities means that there is now an opportunity for both disciplines to benefit from increased interaction.

Support system for decision making in the identification of risk for body dysmorphic disorder: a fuzzy model

PURPOSE

To develop a fuzzy linguistic model to quantify the level of distress of patients seeking cosmetic surgery. Body dysmorphic disorder (BDD) is a mental condition related to body image relatively common among cosmetic surgery patients; it is difficult to diagnose and is a significant cause of morbidity and mortality. Fuzzy cognitive maps are an efficient tool based on human knowledge and experience that can handle uncertainty in identifying or grading BDD symptoms and the degree of body image dissatisfaction. Individuals who seek cosmetic procedures suffer from some degree of dissatisfaction with appearance.

METHODS

A fuzzy model was developed to measure distress levels in cosmetic surgery patients based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), diagnostic criterion B for BDD. We studied 288 patients of both sexes seeking abdominoplasty, rhinoplasty, or rhytidoplasty in a university hospital.

RESULTS

Patient distress ranged from "none" to "severe" (range=7.5-31.6; cutoff point=18; area under the ROC curve=0.923). There was a significant agreement between the fuzzy model and DSM-IV criterion B (kappa=0.805; p<0.001).

CONCLUSION

The fuzzy model measured distress levels with good accuracy, indicating that it can be used as a screening tool in cosmetic surgery and psychiatric practice.