AIM To examine which instruments used to assess participation of children with acquired brain injury (ABI) or cerebral palsy (CP) align with attendance and/or involvement constructs of participation; and to systematically review measurement properties of these instruments in children with ABI or CP, to guide instrument selection. METHOD Five databases were searched. Instruments that quantified ‘attendance’ and/or ‘involvement’ aspects of participation according to the family of participation-related constructs were selected. Data on measurement properties were extracted and methodological quality of the studies assessed. RESULTS Thirty-seven instruments were used to assess participation in children with ABI or CP. Of those, 12 measured attendance and/or involvement. The reliability, validity, and responsiveness of eight of these instruments were examined in 14 studies with children with ABI or CP. Sufficient measurement properties were reported for most of the measures, but no instrument had been assessed on all relevant properties. Moreover, most psychometric studies have marked methodological limitations. INTERPRETATION Instruments to assess participation of children with ABI or CP should be selected carefully, as many available measures do not align with attendance and/or involvement. Evidence for measurement properties is limited, mainly caused by low methodological study quality. Future studies should follow recommended methodological guidelines.
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This paper discusses the potential application of procedural content generation to a game about economical crises, intended to teach a large general audience about how banks function within a market-guided economy, and the financial risks and moral dilemmas that are involved. Procedurally generating content for abstract and complex notions such as inflation, market crashes, and market flux is different from generating spatial maps or physical assets in a game, and poses several design challenges. Instead of generating these kinds of phenomena and other macro-economic effects directly, the designers aim to let them emerge from automatically generated game mechanics. The game mechanics we propose include generic business models that can be parameterized to model the behavior of companies in the game, while the player controls the actions of a bank. What makes generating these game mechanics particularly challenging is the interaction between phenomena at different levels of abstraction. Therefore, relevant economic concepts are discussed in terms of design challenges, and how they could be modeled as emergent properties using generative methods.
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This article focuses on the role of the artistic process in connecting to the natural environment. In my research I have explored what participants experience and learn when they engage in different types of arts-based environmental education (AEE) practices that I have facilitated. The premise of AEE is that efforts to learn about our (natural) environment can effectively take their starting point in an artistic activity, usually conducted in groups. I found that, on the whole, two major orientations can be distinguished. One starts from the point of aesthetic sensibility: the tuning in with the senses, or with ‘a new organ of perception’ (Goethe), in order to perceive ‘the more than human’ with fresh new eyes. This tradition can be traced back (but is by no means limited) to the Romantic Movement. Art in this context may help to amplify the receptivity of the senses and strengthen a sense of connectedness to the natural world. The other major orientation in seeking bridges between nature and art builds on a view of artistic process as leading to unexpected outcomes and ‘emergent properties’. The fundamentally singular experience of making a work of art may evoke an aesthetic object that becomes a ‘self-sufficient, spiritually breathing subject’ (Kandinsky). The artwork can be spontaneously generative and multilayered with meanings, some of which may even be ambiguous and paradoxical. But perhaps more importantly: it can catch the participant of an AEE activity by surprise, overwhelm him or her as ‘coming from behind one’s back’. The element of improvisation, of taking in the new and unanticipated and accommodating for it, is the core quality here. These two orientations, when practiced as part of AEE, have implications on how we relate to nature through art. In the closing of this article I address the question of whether it is possible to bridge the dualism between the two orientations.
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Background: Regular inspection of the oral cavity is required for prevention, early diagnosis and risk reduction of oral- and general health-related problems. Assessments to inspect the oral cavity have been designed for non-dental healthcare professionals, like nurses. The purpose of this systematic review was to evaluate the content and the measurement properties of oral health assessments for use by non-dental healthcare professionals in assessing older peoples’ oral health, in order to provide recommendations for practice, policy, and research. Methods: A systematic search in PubMed, EMBASE.com, and Cinahl (via Ebsco) has been performed. Search terms referring to ‘oral health assessments’, ‘non-dental healthcare professionals’ and ‘older people (60+)’ were used. Two reviewers individually performed title/abstract, and full-text screening for eligibility. The included studies have investigated at least one measurement property (validity/reliability) and were evaluated on their methodological quality using “The Consensus-based Standards for the selection of health Measurement Instruments” (COSMIN) checklist. The measurement properties were then scored using quality criteria (positive/negative/indeterminate). Results: Out of 879 hits, 18 studies were included in this review. Five studies showed good methodological quality on at least one measurement property and 14 studies showed poor methodological quality on some of their measurement properties. None of the studies assessed all measurement properties of the COSMIN. In total eight oral health assessments were found: the Revised Oral Assessment Guide (ROAG); the Minimum Data Set (MDS), with oral health component; the Oral Health Assessment Tool (OHAT); The Holistic Reliable Oral Assessment Tool (THROAT); Dental Hygiene Registration (DHR); Mucosal Plaque Score (MPS); The Brief Oral Health Screening Examination (BOHSE) and the Oral Assessment Sheet (OAS). Most frequently assessed items were: lips, mucosa membrane, tongue, gums, teeth, denture, saliva, and oral hygiene. Conclusion: Taken into account the scarce evidence of the proposed assessments, the OHAT and ROAG are most complete in their included oral health items and are of best methodological quality in combination with positive quality criteria on their measurement properties. Non-dental healthcare professionals, policymakers and researchers should be aware of the methodological limitations of the available oral health assessments and realize that the quality of the measurement properties remains uncertain.
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OBJECTIVE: Ever since Engel's Biopsychosocial Model (1977) emotions, thoughts, beliefs and behaviors are accepted as important factors of health. The Brief Illness Perception Questionnaire (Brief IPQ) assesses these beliefs. Aim of this study was to cross-culturally adapt the Brief IPQ into the Brief IPQ Dutch Language Version (Brief IPQ-DLV), and to assess its face validity, content validity, reproducibility, and concurrent validity. METHODS: Beaton's guideline was used for cross-culturally adaptation. Face and content validity were assessed in 25 patients, 15 physiotherapists and 24 first-grade students. Reproducibility was established in 27 individuals with chronic obstructive pulmonary disease using Cohen's kappa coefficient (K(w)) and the Smallest Detectable Change (SDC). Concurrent validity was assessed in 163 patients visiting 11 different physical therapists. RESULTS: The Brief IPQ-DLV is well understood by patients, health care professionals and first-grade students. Reliability at 1 week for the dimensions Consequences, Concern and Emotional response K(w)>0.70, for the dimensions Personal control, Treatment control, Identity, K(w)<0.70. A time interval of 3 weeks, reliability coefficients were lower for almost all dimensions. SDC was between 2.45 and 3.37 points for individual measurement purposes and between 0.47 and 0.57 points for group evaluative measurement purposes. Concurrent validity showed significant correlations (P<.05) for four out of eight illness perceptions (IPs) dimensions. CONCLUSION: The face and content properties were found to be acceptable. The reproducibility and concurrent validity needs further investigated
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Objective: To examine the underlying factor structure and psychometric properties of the Assessment of Self-management in Anxiety and Depression (ASAD) questionnaire, which was specifically designed for patients with (chronic) anxiety and depressive disorders. Moreover, this study assesses whether the number of items in the ASAD can be reduced without significantly reducing its precision. Methods: The ASAD questionnaire was completed by 171 participants across two samples: one sample comprised patients with residual anxiety or depressive symptoms, while the other consisted of patients who have been formally diagnosed with a chronic anxiety or depressive disorder. All participants had previously undergone treatment. Both exploratory (EFA) and confirmatory factor analyses (CFA) were conducted. Internal consistency and test–retest reliability were also assessed. Results: Both EFA and CFA indicated three solid factors: Seeking support, Daily life strategies and Taking ownership [Comparative Fit Index = 0.80, Tucker Lewis Index = 0.78, Root Mean Square Error of Approximation = 0.09 (CI 0.08–1.00), Standardized Root Mean Square Residual = 0.09 ($2 = 439.35, df = 168)]. The ASAD was thus reduced from 45 items to 21 items, which resulted in the ASAD-Short Form (SF). All sub-scales had a high level of internal consistency (> a = 0.75) and test–retest reliability (ICC > 0.75). Discussion: The first statistical evaluation of the ASAD indicated a high level of internal consistency and test–retest reliability, and identified three distinctive factors. This could aid patients and professionals’ assessment of types of self-management used by the patient. Given that this study indicated that the 21-item ASAD-SF is appropriate, this version should be further explored and validated among a sample of patients with (chronic or partially remitted) anxiety and depressive disorders. Alongside this, to increase generalizability, more studies are required to examine the English version of the ASAD within other settings and countries.
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Regional sustainability networks in the Netherlands are rooted in regionalculture and have an emphasis on social learning and effective collaboration between multiple actors. The national ‘Duurzaam Door’ (Moving Forward Sustainably) Policy Programme regards these networks as generative governance arrangements where new knowledge, actions and relations can co-evolve together with new insights in governance and learning within sustainability transitions. In order to understand the dynamics of the learning in these networks we have monitored emergent properties of social learning between 2014 and 2016. Our focus is particularly on the interrelated role of trust, commitment, reframing and reflexivity. Our aim is to better understand the role and the dynamics of these emergent properties and to see which actors and roles can foster the effectiveness of social learning in regional transitions towards more sustainable ways of living. We used a retrospective analysis with Reflexive Monitoring in Action (RMA), which we combined with the Most Significant Change approach. We found that reflexivity in particularis a critical property at moments that can make or break the process.
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The Kennedy Axis V is a routine outcome measurement instrument which can assist the assessment of the short-term risk for violence and other adverse patient outcomes. The purpose of this study was to evaluate the interrater reliability and clinical utility of the instrument when used by mental health nurses in daily care of patients with mental illness. This cross-sectional study was conducted in inpatient and outpatient adult psychiatric care units and in one adolescent inpatient unit at a university hospital in the Netherlands. Interrater reliability was measured based on the independent scores of two different nurses for the same patients. The clinical utility of the instrument was evaluated by means of a clinical utility questionnaire. To gain a deeper understanding of rating difficulties at the adolescent unit, additional data were collected in two focus group interviews. The overall results revealed a substantial level of agreement between nurses (intraclass correlation coefficient and Pearson 0.79). Some rating challenges were identified, including difficulties with scoring the instrument and using tailor-made interventions related to the scores. These challenges can be resolved using refined training and implementation strategies. When the Kennedy Axis V is accompanied by a solid implementation strategy in adult mental health care, the instrument can be used for short-term risk assessment and thereby contribute in efforts to reduce violence, suicide, self-harm, severe selfneglect, and enhanced objectivity in clinical decision-making.
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OBJECTIVES: The INTERMED Self-Assessment questionnaire (IMSA) was developed as an alternative to the observer-rated INTERMED (IM) to assess biopsychosocial complexity and health care needs. We studied feasibility, reliability and validity of the IMSA within a large and heterogeneous international sample of adult hospital in- and outpatients, and its predictive value for health care utilization (HCU) and quality of life (QoL).METHODS: 850 participants aged 17 to 90 from 5 countries completed the IMSA and were evaluated with the IM. The following measurement properties were determined: feasibility by percentages of missing values; reliability by Cronbach's alpha; interrater agreement by intraclass correlation coefficients (ICCs); convergent validity of IMSA scores with mental health (SF-36 emotional well-being subscale and HADS), medical health (CIRS) and QoL (EQ-5D) by Spearmans rank correlations; predictive validity of IMSA scores with HCU and QoL by (generalized) linear mixed models.RESULTS: Feasibility, face validity and reliability (Cronbach's alpha 0.80) were satisfactory. ICC between IMSA and IM total scores was .78 (95% CI .75-.81). Correlations of the IMSA with the SF-36, HADS, CIRS and EQ-5D (convergent validity) were -.65, .15, .28 and -.59, respectively. The IMSA significantly predicted QoL and also HCU (emergency room visits, hospitalization, outpatient visits, and diagnostic exams) after 3 and 6 months follow-up. Results were comparable between hospital sites, in- and outpatients, and age groups.CONCLUSION: The IMSA is a generic and time-efficient method to assess biopsychosocial complexity and to provide guidance for multidisciplinary care trajectories in adult patients, with good reliability and validity across different cultures.
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Assessment of the seismic vulnerability of the building stock in the earthquake-prone Marmara region of Turkey is of growing importance since such information is needed for reliable estimation of the losses that possible future earthquakes are likely to induce. The outcome of such loss assessment exercises can be used in planning of urban/regional-scale earthquake protection strategies; this is a priority in Turkey, particularly following the destructive earthquakes of 1999. Considering the size of the building inventory, Istanbul and its surrounding area is a case for which it is not easy to determine the structural properties and characteristics of the building stock. In this paper, geometrical, functional and material properties of the building stock in the northern Marmara Region, particularly around Istanbul, have been investigated and evaluated for use in loss estimation models and other types of statistic- or probability-based studies. In order to do that, the existing reinforced concrete (RC) stock has been classified as 'compliant' or 'non-compliant' buildings, dual (frame-wall) or frame structures and emergent or embedded-beam systems. In addition to the statistical parameters such as mean values, standard deviations, etc., probability density functions and their goodness-of-fit have also been investigated for all types of parameters. Functionalities such as purpose of use and floor area properties have been defined. Concrete properties of existing and recently constructed buildings and also characteristics of 220 and 420 MPa types of steel have been documented. Finally, the financial effects of retrofitting operations and damage repair have been investigated. © 2007 Elsevier Ltd. All rights reserved.
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